Prolapsus uteri olgularında uterus koruyucu cerrahi öncesi dikkate alınması gereken uterin patolojiler

Amaç: Pelvik organ prolapsusu dışında başka uterin patoloji taşımayan kadınlarda, uterus koruyucu rekonstrüktif cerrahi prosedür seçiminin anormal uterus patolojileri bakımından öngörülemeyen risklerinin araştırılması amaçlandı.Yöntemler: Pelvik organ prolapsusu nedeniyle vaginal histerektomi yapılan 121 kadının (105 postmenopoz ve 16 premenopoz) verileri tarandı ve cerrahi sonrası patoloji sonuçları değerlendirildi. Bulgular: Senil kistik atrofi postmenopoz (%63,5) hastalarda en sık görülen endometrial patoloji sonucu iken proliferatif ve sekretuar endometrium premenopozal (%81,3) kadınlarda en sık görülen patoloji bulgusu idi. Bu iki patoloji bulgusu bakımından postmenopoz ve premenopoz kadınlar arasındaki farklılık istatiksel anlamlı idi (p0,05), myoma uteri perimenopoz hastalarda anlamlı daha yüksekti (p=0,01).Sonuç: Asemptomatik, pelvik organ prolapsuslu kadınlarda, özellikle postmenopoz dönemde uterus koruyucu rekonstrüktif cerrahi prosedür öncesi, uterus endometrial patolojiler bakımından değerlendirilmelidir.

Uterine pathologies to be considered before uterus-preserving surgery in cases of uterine prolapse

Objective: Investigation of unpredictable risks due to abnormal uterine pathology after the choice of uterus-preserving reconstructive surgical procedure for women who have uterine prolapse and no other complaints was aimed.Methods: The data of 121 women (105 postmenopausal and 16 premenopausal) who underwent vaginal hysterectomy due to pelvic organ prolapse was examined and the post-hysterectomy histopathology results were evaluated. Results: Senile cystic atrophy was the most common endometrial pathology result among postmenopausal women (63.5%). However, proliferative and secretory endometrium was the most common endometrial pathology finding among premenopausal women (81.3%). There were statistically significant differences between postmenopausal and perimenopausal women in terms of these pathology results (p0.05), myoma uteri was significantly more common in patients with perimenopause (p=0.01).Conclusion: The uterus must be evaluated in terms of endometrial pathologies in asymptomatic women with pelvic organ prolapse before uterus-preserving reconstructive surgical procedure, especially in postmenopausal period.

PDF

___

Baden WF, Walker TA. Genesis of the vaginal profile: a correlated classification of vaginal relaxation. Clin Obstet Gynecol 1972;15:1048-1054.
Handa VL, Garrett E, Hendrix S, et al. Progression and remission of pelvic organ prolapse: a longitudinal study of menopausal women. Am J Obstet Gynecol. 2004;190:27-32.
Okonkwo JE, Obiechina NJ, Obionu CN. Incidence of pelvic organ prolapse in Nigerian women. J Natl Med Assoc 2003;95:132-136.
Olsen AL, Smith VJ, Bergstrom JO, et al. Epidemiology of surgically managed pelvic organ prolapse and uri- nary incontinence. Obstet Gynecol 1997;89:501-506.
Woodman PJ, Swift SE, O'Boyle AL, et al. Prevalence of severe pelvic organ prolapse in relation to job de- scription and socioeconomic status: a multicenter cross-sectional study. Int Urogynecol J Pelvic Floor Dysfunct 2006;17:340-345.
MacLennan AH, Taylor AW, DH Wilson, Wilson D. The prevalence of pelvic floor disorders and their rela- tionship to gender, age, parity and mode of delivery. BJOG 2000;107:1460-1470.
Jackson SR, Avery NC, Tarlton JF, et al. Changes in metabolism of collagen in genitourinary prolapse. Lancet 1996;347:1658-1661.
Chiaffarino F, Chatenoud L, Dindelli M, et al. Reproduc- tive factors, family history, occupation and risk of uro- genital prolapse. Eur J Obstet Gynecol Reprod Biol 1999;82:63-67.
Jelovsek JE, Maher C, Barber MD. Pelvic organ pro- lapse. Lancet 2007;369:1027-1038.
Olsen AL, Smith VJ, Bergstrom JO, et al. Epidemiol- ogy of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 1997;89:501- 506.
Fialkow MF, Newton KM, Lentz GM, Weiss NS. Life- time risk of surgical management for pelvic organ pro- lapse or urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 2008;19:437-440.
Costantini E, Lazzeri M. What part does mesh play in urogenital prolapse management today? Curr Opin Urol 2015;25:300-304.
Maher C, Baessler K, Glazener CM, et al. Surgical management of pelvic organ prolapse in women: a short version Cochrane review. Neurourol Urodyn 2008;27:3-12.
Bump RC, Mattiasson A, Bİ K, et al. The standard- ization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. American Journal of Ob- stetrics and Gynecology 1996;175:10-17.
Lousquy R, Costa P, Delmas V, Haab F. [Update on the epidemiology of genital prolapse]. Prog Urol 2009;19:907-915.
Chow D, Rodríguez LV. Epidemiology and prevalence of pelvic organ prolapse. Curr Opin Urol 2013;23:293- 298.
Chung da J, Bai SW. Roles of sex steroid receptors and cell cycle regulation in pathogenesis of pelvic or- gan prolapse. Curr Opin Obstet Gynecol 2006;18:551- 554.
Chen HY, Wan L, Chung YW, et al. Estrogen recep- tor beta gene haplotype is associated with pelvic organ prolapse. Eur J Obstet Gynecol Reprod Biol 2008;138:105-109.
Chen HY, Chung YW, Lin WY, et al. Progesterone re- ceptor polymorphism is associated with pelvic organ prolapse risk. Acta Obstet Gynecol Scand 2009;88: 835-838.
Mingels MJ, Geels YP, Pijnenborg JM, et al. Histo- pathologic assessment of the entire endometrium in asymptomatic women. Hum Pathol 2013;44:2293- 2301.
Dreisler E, Poulsen LG, Antonsen SL, et al. EMAS clinical guide: Asessment of the endometrium in peri and postmenopausal women. Maturitas 2013;75:181- 190.
Maruo T, Ohara N, Wang J, Matsuo H. Sex steroidal regulation of uterine leiomyoma growth and apopto- sis. Hum Reprod 2004;10:207-220.
Ferenczy A. Pathophysiology of adenomyosis. Hum Reprod Update 1998;4:312-322.
Frick AC, Walters MD, Larkin KS, Barber MD. Risk of unanticipated abnormal gynecologic pathology at the time of hysterectomy for uterovaginal prolapse. Am J Obstet Gynecol. 2010;202:507.
Jones R NHJ, Healy JC, King LJ, et al. Pelvic con- nective tissue resilience decreases with vaginal de- livery, menopause and uterine prolapse. Br J Surg 2003;90:466-472.
Sivridis E, Giatromanolaki A. Proliferative activity in postmenopausal endometrium: the lurking potential for giving rise to an endometrial adenocarcinoma. J Clin Pathol 2004;57:840-844.
Modugno F, Ness RB, Chen C, Weiss NS. Inflamma- tion and endometrial cancer: a hypothesis. Cancer Epidemiol Biomarkers Prev 2005;14:2840-2847.
Wallace AE, Gibson DA, Saunders PT, Jabbour HN. Inflammatory events in endometrial adenocarcinoma. J Endocrinol 2010;206:141-157.
Bohoussou E, Adjoussou SA, Letouzey V, et al. [Should we perform intra-operative endometrial bi- opsy during pelvic reconstructive surgery with uterine preservation?]. J Gynecol Obstet Biol Reprod (Paris) 2014;43:40-45.
Sherman ME. Theories of endometrial carcino- genesis: a multidisciplinary approach. Mod Pathol 2000;13:295-308.