Vaginal erosion at a long time after synthetic implants insertion during gynecological surgery
V.F. Bezhenar1, P.M. Palastin1, G.Kh. Tolibova2
1 Pavlov First St. Petersburg State Medical University, Saint Petersburg
2 Ott Research Institute of Obstetrics, Gynecology and Reproductology, Saint Petersburg
A frequency of pelvic prolapse, depending on the age group, can be found, according to various authors, from 26 to 80% of cases. A number of synthetic implants used to correct pelvic prolapse increase every year. The number of implant-associated complications increases together with them.
Aim: to study the pathogenesis of the vaginal wall erosion, using histological, immunohistochemical study.
Patients and Methods: the main group consisted of patients aged 45 to 75 years with the vaginal erosion. The control group included patients of the same age with inserted synthetic implants. During a histological examination of the vaginal erosion and a fragment of the vaginal wall from the control group, such parameters as the type and severity of inflammation, vascularization was determined. The immunohistochemical study determined the main markers of inflammation: CD8, CD20, CD128. α and β estrogen receptors were also evaluated as a possible cause of not only the formation of pelvic organ prolapse but also of the pathogenesis of the vaginal wall erosion.
Results: received results indicate the presence of various pathogenetic mechanisms of formation of the vaginal wall erosion. In one case, vaginal erosion is formed against the background of pronounced inflammation, increased vascularization and pronounced hormonal imbalance. In the other, on the contrary, with minimal signs of inflammation, reduced vascularization and hormonal status, similar to that in the control group.
Conclusion: the results of immunohistochemical studies confirmed the results of histological studies. The processes occurring during the formation of erosions of the vaginal wall mucous membrane after the insertion of synthetic implants differ from the processes in the tissues of patients in the control group. These processes indicate the presence of two pathogenetic mechanisms of erosion formation. In some cases, vaginal erosion is formed against the background of pronounced inflammation and hormonal imbalance. In others, with minimal signs of inflammation and hormonal status, as in the control group.
Key words: pelvic prolapse, vaginal wall erosion, immunohistochemistry, inflammatory markers CD8, CD20, CD128, estrogen receptors, vascularization.
For citation: Bezhenar V.F., Palastin P.M., Tolibova G.Kh. Vaginal erosion at a long time after synthetic implants insertion during gynecological surgery // RMJ. Medical Review. 2018. № 10. P. 17–21.
References
1. Jelovsek J.E., Barber M.D. Women seeking treatment for advanced pelvic organ prolapse have decreased body image and quality of life // Am J Obstet Gynecol. 2006. Vol. 194 (5). P. 145–1461.
2. Segedi L.M., Ilić K.P., Curcić A., Visnjevac N. Quality of life in women with pelvic floor dysfunction // Vojnosanit Pregl. 2011. Vol. 68 (11). P. 940–947.
3. De Tayrac R., Deval B., Fernandez H., Marus P. Development of a linguistically validated French version of two short-form, condition-specific quality of life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7) // J Gynecol Obstet Biol Reprod (Paris). 2007. Vol. 36 (8). P. 738–748.
4. Бахаев В.В., Горин В.С. Выпадение половых органов у женщин: этиология и патогенез // Акушерство и гинекология. 2009. № 3. C. 7–10 [Bakhayev V.V., Gorin V.S. Vypadeniye polovykh organov u zhenshchin: etiologiya i patogenez // Akusherstvo i ginekologiya. 2009. № 3. S. 7–10 (in Russian)].
5. Barber M.D., Visco A.G., Wyman J.F. et al. Sexual function in women with urinary incontinence and pelvic organ prolapse // Obstet. Gynecol. 2002. Vol. 99 (2). P. 281–289.
6. Zyczynski H.М., Slack M., Reisenauer C. et al. A new operation for vaginal prolapse repair using mesh and a vaginal support device: 1 year anatomic and functional results of an international multicentre study // Int. Urogynecol. J. 2009. Vol. 181 (4). Suppl. 2. P. 157–158.
7. Mathlouthi N., Ben Ayed B., Dhouib et al. Genital prolapse in young women: a study of risk factors // Tunis Med. 2011. Vol. 89 (7). P. 627–631.
8. Cervigni M., Natale F. The use of synthetics in the treatment of pelvic organ prolapse // Curr Opin Urol. 2001. Vol. 11 (4). P. 429–435.
9. Cundiff G.W., Weidner A.C., Visco A.G. et al. An anatomic and functional assessment of the discrete defect rectocele repair // Am J Obstet Gynecol. 1998. Vol. 179. P. 1451–1456.
10. Попов А.А., Краснопольская И.В., Тюрина С.С. и др. Сакроспинальная фиксация в лечении женщин с пролапсом гениталий в эру mesh-технологий // Российский вестник акушера-гинеколога. 2013. Т. 13. № 2. С. 36–41 [Popov A.A., Krasnopol’skaya I.V., Tyurina S.S. i dr. Sakrospinal’naya fiksatsiya v lechenii zhenshchin s prolapsom genitaliy v eru mesh-tekhnologiy // Rossiyskiy vestnik akushera-ginekologa. 2013. T. 13. № 2. S. 36–41 (in Russian)].
11. Hinoul P., Ombelet W.U., Burger M.P. et al. A prospective study to evaluate the anatomic and functional outcome of a transobturator mesh kit (Prolift anterior) for symptomatic cystocele repair // J Minim Invasive Gynecol. 2008. Vol. 15 (5). P. 615–620.
12. Lucioni A., Rapp D.E., Gong E.M. et al. The surgical technique and early postoperative complications of the Gynecare Prolift pelvic floor repair system // Can. J. Urol. 2008. Vol. 15 (2). P. 4004–4008.
13. Беженарь В.Ф., Богатырева Е.В. Новые возможности хирургической коррекции тазового пролапса с использованием синтетических имплантов: пути профилактики послеоперационных осложнений // Акушерство. Гинекология. Репродукция. 2012. Т. 6, № 2. С. 6–13 [Bezhenar’ V.F., Bogatyreva Ye.V. Novyye vozmozhnosti khirurgicheskoy korrektsii tazovogo prolapsa s ispol’zovaniyem sinteticheskikh implantov: puti profilaktiki posleoperatsionnykh oslozhneniy // Akusherstvo. Ginekologiya. Reproduktsiya. 2012. T. 6, № 2. S. 6–13 (in Russian)].
14. Rogo-Gupta L., Rodriguez L.V., Litwin M.S. et al. Trends in surgical mesh use for pelvic organ prolapse from 2000 to 2010 // Obstet. Gynecol. 2012. Vol. 120 (5). P. 1105–1115.
15. Barber M.D., Walters M.D., Bump R.C. Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7) // Am J Obstet Gynecol. 2005. Vol. 193. P. 103–113.
16. Muffly T., Barber M.D. Insertion and Removal of Vaginal Mesh for Pelvic Organ Prolapse // Clinical Obstetrics and Gynecology. 2010. Vol. 53 (1). P. 99–114.
17. Попов A.A., Мананникова Т.Н., Мачанските О.В. Анализ осложнений операции Prolift: Материалы 2-го Российского конгресса по эндоурологии и новым технологиям. М., 2010. С. 142–143 [Popov A.A., Manannikova T.N., Machanskite O.V. Analiz oslozhneniy operatsiy Prolift: Materialy 2 Rossiyskiy kongress po endourologii i novym tekhnologiyam. М., 2010. S. 142–143 (in Russian)].
18. Беженарь В.Ф. Осложнения при коррекции тазового пролапса с использованием проленовой системы Prolift // Акушерство и гинекология. 2012. № 4–2. С. 116–121 [Bezhenar’ V.F. Oslozhneniya pri korrektsii tazovogo prolapsa s ispol’zovaniyem prolenovoy sistemy Prolift // Akusherstvo i ginekologiya. 2012. № 4–2. S. 116–121 (in Russian)].
19. Ищенко А.И., Шульгина И.В., Ищенко А.А. и др. MESH-ассоциированные осложнения, факторы риска // Архив акушерства и гинекологии им. В.Ф. Снегирева. 2014. № 2. С. 4–7 [Ishchenko A.I., Shul’gina I.V., Ishchenko A.A. i dr. MESH-assotsiirovannyye oslozhneniya, faktory riska // Arkhiv akusherstva i ginekologii im. V.f. Snegirova. 2014. № 2. S. 4–7 (in Russian)].
20. Shah H.N., Badlani G.H. Mesh complications in female pelvic floor reconstructive surgery and their management: A systematic review // Ind. J. Urology. 2012. Vol. 28 (2). P. 129–153. DOI: 10.4103/0970–1591.98453.
21. Nieminen K., Hiltunen R., Takala T. et al. Outcomes after anterior vaginal wall repair with mesh: A randomized, controlled trial with a 3 year follow-up // Am. J. Obstet. Gynecol. 2010. Vol. 203 (3). Р. 235.e1–8. DOI: 10.1016/j.ajog.2010.03.030.
22. Withagen M.I., Milani A.L., den Boon J. et al. Trocar-guided mesh compared with conventional vaginal repair in recurrent prolapse: A randomized controlled trial // Obstet. Gynecol. 2011. Vol. 117 (2 Pt 1). P. 242–250.
23. Ignjatovic I., Stojkovic I., Basic D. et al. Optimal primary minimally invasive treatment for patients with stress urinary incontinence and symptomatic pelvic organ prolapse: Tension free slings with colporrhaphy, or Prolift with the tension free midurethral sling? // Eur. J. Obstet. Gynecol. Reprod. Biol. 2010. Vol. 150 (1). P. 97–101.
24. Руководство по иммуногистохимической диагностике опухолей человека / под ред. С.В. Петрова, Н.Т. Райхлина. 4-е изд., доп. и перераб. Казань: Татмедиа, 2012. 623 с. [Rukovodstvo po immunogistokhimicheskoy diagnostike opukholey cheloveka / pod red. S.V. Petrova, N.T. Raykhlina. 4-ye izd., Dop. i pererab. Kazan’: Tatmedia, 2012. 623 s. (in Russian)].
25. Беженарь В.Ф., Русина Л.К., Цуладзе А.А. и др. Эффективный клинический опыт использования субуретральных слингов в лечении недержания мочи у женщин // Журнал акушерства и женских болезней. 2012. Т. 61. № 5. С. 30–37 [Bezhenar’ V.F., Rusina L.K., Tsuladze A.A. i dr. Effektivnyy klinicheskiy opyt ispol’zovaniya suburetral’nykh slingov v lechenii nederzhaniya mochi u zhenshchin // Zhurnal akusherstva i zhenskikh bolezney. 2012. T. 61. № 5. S. 30–37 (in Russian)].
26. Толибова Г.Х., Траль Т.Г., Клещев М.А. и др. Эндометриальная дисфункция: Алгоритм гистологического и иммуногистохимического исследования // Журнал акушерства и женских болезней. 2015. № 4. С. 69–74 [Tolibova G. Kh., Trail T.G., Kleschev M.A. Endometrial dysfunction: Algorithm of histological and immunohistochemical studies // Journal of Obstetrics and Women’s Diseases. 2015. № 4. P. 69–74 (in Russian
2. Segedi L.M., Ilić K.P., Curcić A., Visnjevac N. Quality of life in women with pelvic floor dysfunction // Vojnosanit Pregl. 2011. Vol. 68 (11). P. 940–947.
3. De Tayrac R., Deval B., Fernandez H., Marus P. Development of a linguistically validated French version of two short-form, condition-specific quality of life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7) // J Gynecol Obstet Biol Reprod (Paris). 2007. Vol. 36 (8). P. 738–748.
4. Бахаев В.В., Горин В.С. Выпадение половых органов у женщин: этиология и патогенез // Акушерство и гинекология. 2009. № 3. C. 7–10 [Bakhayev V.V., Gorin V.S. Vypadeniye polovykh organov u zhenshchin: etiologiya i patogenez // Akusherstvo i ginekologiya. 2009. № 3. S. 7–10 (in Russian)].
5. Barber M.D., Visco A.G., Wyman J.F. et al. Sexual function in women with urinary incontinence and pelvic organ prolapse // Obstet. Gynecol. 2002. Vol. 99 (2). P. 281–289.
6. Zyczynski H.М., Slack M., Reisenauer C. et al. A new operation for vaginal prolapse repair using mesh and a vaginal support device: 1 year anatomic and functional results of an international multicentre study // Int. Urogynecol. J. 2009. Vol. 181 (4). Suppl. 2. P. 157–158.
7. Mathlouthi N., Ben Ayed B., Dhouib et al. Genital prolapse in young women: a study of risk factors // Tunis Med. 2011. Vol. 89 (7). P. 627–631.
8. Cervigni M., Natale F. The use of synthetics in the treatment of pelvic organ prolapse // Curr Opin Urol. 2001. Vol. 11 (4). P. 429–435.
9. Cundiff G.W., Weidner A.C., Visco A.G. et al. An anatomic and functional assessment of the discrete defect rectocele repair // Am J Obstet Gynecol. 1998. Vol. 179. P. 1451–1456.
10. Попов А.А., Краснопольская И.В., Тюрина С.С. и др. Сакроспинальная фиксация в лечении женщин с пролапсом гениталий в эру mesh-технологий // Российский вестник акушера-гинеколога. 2013. Т. 13. № 2. С. 36–41 [Popov A.A., Krasnopol’skaya I.V., Tyurina S.S. i dr. Sakrospinal’naya fiksatsiya v lechenii zhenshchin s prolapsom genitaliy v eru mesh-tekhnologiy // Rossiyskiy vestnik akushera-ginekologa. 2013. T. 13. № 2. S. 36–41 (in Russian)].
11. Hinoul P., Ombelet W.U., Burger M.P. et al. A prospective study to evaluate the anatomic and functional outcome of a transobturator mesh kit (Prolift anterior) for symptomatic cystocele repair // J Minim Invasive Gynecol. 2008. Vol. 15 (5). P. 615–620.
12. Lucioni A., Rapp D.E., Gong E.M. et al. The surgical technique and early postoperative complications of the Gynecare Prolift pelvic floor repair system // Can. J. Urol. 2008. Vol. 15 (2). P. 4004–4008.
13. Беженарь В.Ф., Богатырева Е.В. Новые возможности хирургической коррекции тазового пролапса с использованием синтетических имплантов: пути профилактики послеоперационных осложнений // Акушерство. Гинекология. Репродукция. 2012. Т. 6, № 2. С. 6–13 [Bezhenar’ V.F., Bogatyreva Ye.V. Novyye vozmozhnosti khirurgicheskoy korrektsii tazovogo prolapsa s ispol’zovaniyem sinteticheskikh implantov: puti profilaktiki posleoperatsionnykh oslozhneniy // Akusherstvo. Ginekologiya. Reproduktsiya. 2012. T. 6, № 2. S. 6–13 (in Russian)].
14. Rogo-Gupta L., Rodriguez L.V., Litwin M.S. et al. Trends in surgical mesh use for pelvic organ prolapse from 2000 to 2010 // Obstet. Gynecol. 2012. Vol. 120 (5). P. 1105–1115.
15. Barber M.D., Walters M.D., Bump R.C. Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7) // Am J Obstet Gynecol. 2005. Vol. 193. P. 103–113.
16. Muffly T., Barber M.D. Insertion and Removal of Vaginal Mesh for Pelvic Organ Prolapse // Clinical Obstetrics and Gynecology. 2010. Vol. 53 (1). P. 99–114.
17. Попов A.A., Мананникова Т.Н., Мачанските О.В. Анализ осложнений операции Prolift: Материалы 2-го Российского конгресса по эндоурологии и новым технологиям. М., 2010. С. 142–143 [Popov A.A., Manannikova T.N., Machanskite O.V. Analiz oslozhneniy operatsiy Prolift: Materialy 2 Rossiyskiy kongress po endourologii i novym tekhnologiyam. М., 2010. S. 142–143 (in Russian)].
18. Беженарь В.Ф. Осложнения при коррекции тазового пролапса с использованием проленовой системы Prolift // Акушерство и гинекология. 2012. № 4–2. С. 116–121 [Bezhenar’ V.F. Oslozhneniya pri korrektsii tazovogo prolapsa s ispol’zovaniyem prolenovoy sistemy Prolift // Akusherstvo i ginekologiya. 2012. № 4–2. S. 116–121 (in Russian)].
19. Ищенко А.И., Шульгина И.В., Ищенко А.А. и др. MESH-ассоциированные осложнения, факторы риска // Архив акушерства и гинекологии им. В.Ф. Снегирева. 2014. № 2. С. 4–7 [Ishchenko A.I., Shul’gina I.V., Ishchenko A.A. i dr. MESH-assotsiirovannyye oslozhneniya, faktory riska // Arkhiv akusherstva i ginekologii im. V.f. Snegirova. 2014. № 2. S. 4–7 (in Russian)].
20. Shah H.N., Badlani G.H. Mesh complications in female pelvic floor reconstructive surgery and their management: A systematic review // Ind. J. Urology. 2012. Vol. 28 (2). P. 129–153. DOI: 10.4103/0970–1591.98453.
21. Nieminen K., Hiltunen R., Takala T. et al. Outcomes after anterior vaginal wall repair with mesh: A randomized, controlled trial with a 3 year follow-up // Am. J. Obstet. Gynecol. 2010. Vol. 203 (3). Р. 235.e1–8. DOI: 10.1016/j.ajog.2010.03.030.
22. Withagen M.I., Milani A.L., den Boon J. et al. Trocar-guided mesh compared with conventional vaginal repair in recurrent prolapse: A randomized controlled trial // Obstet. Gynecol. 2011. Vol. 117 (2 Pt 1). P. 242–250.
23. Ignjatovic I., Stojkovic I., Basic D. et al. Optimal primary minimally invasive treatment for patients with stress urinary incontinence and symptomatic pelvic organ prolapse: Tension free slings with colporrhaphy, or Prolift with the tension free midurethral sling? // Eur. J. Obstet. Gynecol. Reprod. Biol. 2010. Vol. 150 (1). P. 97–101.
24. Руководство по иммуногистохимической диагностике опухолей человека / под ред. С.В. Петрова, Н.Т. Райхлина. 4-е изд., доп. и перераб. Казань: Татмедиа, 2012. 623 с. [Rukovodstvo po immunogistokhimicheskoy diagnostike opukholey cheloveka / pod red. S.V. Petrova, N.T. Raykhlina. 4-ye izd., Dop. i pererab. Kazan’: Tatmedia, 2012. 623 s. (in Russian)].
25. Беженарь В.Ф., Русина Л.К., Цуладзе А.А. и др. Эффективный клинический опыт использования субуретральных слингов в лечении недержания мочи у женщин // Журнал акушерства и женских болезней. 2012. Т. 61. № 5. С. 30–37 [Bezhenar’ V.F., Rusina L.K., Tsuladze A.A. i dr. Effektivnyy klinicheskiy opyt ispol’zovaniya suburetral’nykh slingov v lechenii nederzhaniya mochi u zhenshchin // Zhurnal akusherstva i zhenskikh bolezney. 2012. T. 61. № 5. S. 30–37 (in Russian)].
26. Толибова Г.Х., Траль Т.Г., Клещев М.А. и др. Эндометриальная дисфункция: Алгоритм гистологического и иммуногистохимического исследования // Журнал акушерства и женских болезней. 2015. № 4. С. 69–74 [Tolibova G. Kh., Trail T.G., Kleschev M.A. Endometrial dysfunction: Algorithm of histological and immunohistochemical studies // Journal of Obstetrics and Women’s Diseases. 2015. № 4. P. 69–74 (in Russian
This work is licensed under a Creative Commons «Attribution» 4.0 License.
Previous article
Next article
