TY - JOUR
T1 - International Urogynecological Consultation (IUC)
T2 - pathophysiology of pelvic organ prolapse (POP)
AU - Deprest, Jan A.
AU - Cartwright, Rufus
AU - Dietz, Hans Peter
AU - Brito, Luiz Gustavo Oliveira
AU - Koch, Marianne
AU - Allen-Brady, Kristina
AU - Manonai, Jittima
AU - Weintraub, Adi Y.
AU - Chua, John W.F.
AU - Cuffolo, Romana
AU - Sorrentino, Felice
AU - Cattani, Laura
AU - Decoene, Judith
AU - Page, Anne Sophie
AU - Weeg, Natalie
AU - Varella Pereira, Glaucia M.
AU - Mori da Cunha de Carvalho, Marina Gabriela M.C.
AU - Mackova, Katerina
AU - Hympanova, Lucie Hajkova
AU - Moalli, Pamela
AU - Shynlova, Oksana
AU - Alperin, Marianna
AU - Bortolini, Maria Augusta T.
N1 - Publisher Copyright:
© 2022, The International Urogynecological Association.
PY - 2022/7/1
Y1 - 2022/7/1
N2 - Introduction and hypothesis: This manuscript is the International Urogynecology Consultation (IUC) on pelvic organ prolapse (POP) chapter one, committee three, on the Pathophysiology of Pelvic Organ Prolapse assessing genetics, pregnancy, labor and delivery, age and menopause and animal models. Materials and methods: An international group of urogynecologists and basic scientists performed comprehensive literature searches using pre-specified terms in selected biomedical databases to summarize the current knowledge on the pathophysiology of the development of POP, exploring specifically factors including (1) genetics, (2) pregnancy, labor and delivery, (3) age and menopause and (4) non-genetic animal models. This manuscript represents the summary of three systematic reviews with meta-analyses and one narrative review, to which a basic scientific comment on the current understanding of pathophysiologic mechanisms was added. Results: The original searches revealed over 15,000 manuscripts and abstracts which were screened, resulting in 202 manuscripts that were ultimately used. In the area of genetics the DNA polymorphisms rs2228480 at the ESR1 gene, rs12589592 at the FBLN5 gene, rs1036819 at the PGR gene and rs1800215 at the COL1A1 gene are significantly associated to POP. In the area of pregnancy, labor and delivery, the analysis confirmed a strong etiologic link between vaginal birth and symptoms of POP, with the first vaginal delivery (OR: 2.65; 95% CI: 1.81–3.88) and forceps delivery (OR: 2.51; 95% CI: 1.24–3.83) being the main determinants. Regarding age and menopause, only age was identified as a risk factor (OR : 1.102; 95% CI: 1.02–1.19) but current data do not identify postmenopausal status as being statistically associated with POP. In several animal models, there are measurable effects of pregnancy, delivery and iatrogenic menopause on the structure/function of vaginal support components, though not on the development of POP. Conclusions: Genetics, vaginal birth and age all have a strong etiologic link to the development of POP, to which other factors may add or protect against the risk.
AB - Introduction and hypothesis: This manuscript is the International Urogynecology Consultation (IUC) on pelvic organ prolapse (POP) chapter one, committee three, on the Pathophysiology of Pelvic Organ Prolapse assessing genetics, pregnancy, labor and delivery, age and menopause and animal models. Materials and methods: An international group of urogynecologists and basic scientists performed comprehensive literature searches using pre-specified terms in selected biomedical databases to summarize the current knowledge on the pathophysiology of the development of POP, exploring specifically factors including (1) genetics, (2) pregnancy, labor and delivery, (3) age and menopause and (4) non-genetic animal models. This manuscript represents the summary of three systematic reviews with meta-analyses and one narrative review, to which a basic scientific comment on the current understanding of pathophysiologic mechanisms was added. Results: The original searches revealed over 15,000 manuscripts and abstracts which were screened, resulting in 202 manuscripts that were ultimately used. In the area of genetics the DNA polymorphisms rs2228480 at the ESR1 gene, rs12589592 at the FBLN5 gene, rs1036819 at the PGR gene and rs1800215 at the COL1A1 gene are significantly associated to POP. In the area of pregnancy, labor and delivery, the analysis confirmed a strong etiologic link between vaginal birth and symptoms of POP, with the first vaginal delivery (OR: 2.65; 95% CI: 1.81–3.88) and forceps delivery (OR: 2.51; 95% CI: 1.24–3.83) being the main determinants. Regarding age and menopause, only age was identified as a risk factor (OR : 1.102; 95% CI: 1.02–1.19) but current data do not identify postmenopausal status as being statistically associated with POP. In several animal models, there are measurable effects of pregnancy, delivery and iatrogenic menopause on the structure/function of vaginal support components, though not on the development of POP. Conclusions: Genetics, vaginal birth and age all have a strong etiologic link to the development of POP, to which other factors may add or protect against the risk.
KW - Age
KW - Delivery
KW - Genetics
KW - Hormones
KW - Labor
KW - Menopause
KW - Pathogenesis
KW - Pelvic organ prolapse
KW - Pregnancy
KW - Risk factor
UR - https://www.scopus.com/pages/publications/85125997851
U2 - 10.1007/s00192-022-05081-0
DO - 10.1007/s00192-022-05081-0
M3 - Article
C2 - 35267063
AN - SCOPUS:85125997851
SN - 0937-3462
VL - 33
SP - 1699
EP - 1710
JO - International Urogynecology Journal
JF - International Urogynecology Journal
IS - 7
ER -