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Archivio Italiano Di Urologia,... Sep 2022To compare urodynamic changes before and after hysterectomy (laparoscopic vs. vaginal approach) for benign gynecological diseases.
OBJECTIVE
To compare urodynamic changes before and after hysterectomy (laparoscopic vs. vaginal approach) for benign gynecological diseases.
PATIENTS AND METHODS
A total of 90 women with a mean age of 56.36-years were enrolled in this study between August 2019 and April 2021. They were divided into two equal groups (45 patients each). Group, I had a vaginal hysterectomy, and Group II had a laparoscopic hysterectomy. All patients were assessed clinically using ICIQ-FLUTS questionnaire and a uro-dynamic study before and six months after surgery.
RESULTS
Both vaginal and laparoscopic hysterectomy did not significantly change the maximum flow rate, voiding time, and average flow rate. The increase in residual urine volume in group I was not significant (p = 0.129), as was in Group II (p = 0.217). All the modifications, however, were within permis-sible limits. According to the cystometry result, volume at initial sensation rose in both groups after surgery, with no statistically significant difference (p = 0.364). After both forms of hysterecto-my, maximum bladder capacity did not vary considerably. Preoperatively, all study participants exhibited no overactivity of the detrusor muscle; nevertheless, following surgery, overac-tivity was noted in 9 patients after vaginal hysterectomy com-pared to three patients after laparoscopic hysterectomy, and all the alterations were within a clinically acceptable range. In addition, the ICIQ-FLUTS score was not significantly different between the study groups.
CONCLUSIONS
According to the urodynamic study, hysterectomy for benign uterine conditions, whether vaginal or laparoscopic did not adversely affect urinary bladder function.
Topics: Female; Humans; Hysterectomy; Hysterectomy, Vaginal; Laparoscopy; Middle Aged; Urodynamics; Vagina
PubMed: 36165477
DOI: 10.4081/aiua.2022.3.315 -
Frontiers in Immunology 2022Vaginal microbiome and the local innate immune defense, including the complement system, contribute to anti- and proinflammatory homeostasis during pregnancy and...
BACKGROUND
Vaginal microbiome and the local innate immune defense, including the complement system, contribute to anti- and proinflammatory homeostasis during pregnancy and parturition. The relationship between commensal vaginal bacteria and complement activation during pregnancy and delivery is not known.
OBJECTIVE
To study the association of the cervicovaginal microbiota composition to activation and regulation of the complement system during pregnancy and labor.
STUDY DESIGN
We recruited women during late pregnancy (weeks 41 + 5 to 42 + 0, n=48) and women in active labor (weeks 38 + 4 to 42 + 2, n=25). Mucosal swabs were taken from the external cervix and lateral fornix of the vagina. From the same sampling site, microbiota was analyzed with 16S RNA gene amplicon sequencing. A Western blot technique was used to detect complement C3, C4 and factor B activation and presence of complement inhibitors. For semiquantitative analysis, the bands of the electrophoresed proteins in gels were digitized on a flatbed photo scanner and staining intensities were analyzed using ImageJ/Fiji win-64 software. Patient data was collected from medical records and questionnaires.
RESULTS
The vaginal microbiota was -dominant in most of the samples (n=60), and being the dominant species. and were found to be more abundant during pregnancy than active labor. abundance correlated with C4 activation during pregnancy but not in labor. was associated with C4 activation both during pregnancy and labor. The amount of correlated with factor B activation during pregnancy but not during labor. was more abundant during pregnancy than labor and correlated with C4 activation during labor and with factor B activation during pregnancy. Activation of the alternative pathway factor B was significantly stronger during pregnancy compared to labor. During labor complement activation may be inhibited by the abundant presence of factor H and FHL1.
CONCLUSIONS
These results indicate that bacterial composition of the vaginal microbiota could have a role in the local activation and regulation of complement-mediated inflammation during pregnancy. At the time of parturition complement activation appears to be more strictly regulated than during pregnancy.
Topics: Bacteria; Complement Activation; Complement Factor B; Female; Gardnerella vaginalis; Humans; Intracellular Signaling Peptides and Proteins; LIM Domain Proteins; Microbiota; Muscle Proteins; Parturition; Pregnancy; Vagina
PubMed: 35958597
DOI: 10.3389/fimmu.2022.925630 -
Microbial Cell Factories Mar 2023Exopolysaccharides (EPS) secreted by beneficial lactobacilli exert a plethora of positive activities, but little is known about their effects on biofilms of...
BACKGROUND
Exopolysaccharides (EPS) secreted by beneficial lactobacilli exert a plethora of positive activities, but little is known about their effects on biofilms of opportunistic vaginal pathogens and especially on biofilms of lactobacilli themselves. Here, the EPS produced by six vaginal lactobacilli, belonging to Lactobacillus crispatus (BC1, BC4, BC5) and Lactobacillus gasseri (BC9, BC12, BC14) species were isolated from cultural supernatants and lyophilized.
RESULTS
Lactobacillus EPS were chemically characterized in terms of monosaccharide composition by liquid chromatography (LC) analysis coupled to UV and mass spectrometry (MS) detection. Moreover, the ability of EPS (0.1, 0.5, 1 mg/mL) to stimulate the biofilm formation of lactobacilli and to inhibit the formation of pathogens' biofilms was evaluated by crystal violet (CV) staining and 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assay. Isolated EPS (yields 133-426 mg/L) were heteropolysaccharides mainly composed of D-mannose (40-52%) and D-glucose (11-30%). For the first time we demonstrated that Lactobacillus EPS were able to stimulate in a dose-dependent manner (p < 0.05) the formation of biofilms of ten strains belonging to L. crispatus, L. gasseri and Limosilactobacillus vaginalis species, in terms of cell viability (84-282% increase at 1 mg/mL) and especially biofilm biomass (40-195% increase at 1 mg/mL), quantified with MTT assay and CV staining, respectively. EPS released from L. crispatus and L. gasseri were found to better stimulate the biofilms of the same producer species rather than that of other species, including producing strains themselves and other strains. Conversely, the biofilm formation of bacterial (Escherichia coli, Staphylococcus spp., Enterococcus spp. and Streptococcus agalactiae) and fungal (Candida spp.) pathogens was inhibited. The anti-biofilm activity was dose-dependent and was more marked for L. gasseri-derived EPS (inhibition up to 86%, 70%, and 58% at 1 mg/mL, 0.5 mg/mL, and 0.1 mg/mL, respectively), whilst L. crispatus-derived EPS resulted overall less efficient (inhibition up to 58% at 1 mg/mL and 40% at 0.5 mg/mL) (p < 0.05).
CONCLUSIONS
Lactobacilli-derived EPS favour the biofilm formation of lactobacilli preventing, at the same time, that of opportunistic pathogens. These results support the possible employment of EPS as postbiotics in medicine as a therapeutic/preventive strategy to counteract vaginal infections.
Topics: Lactobacillus; Vagina; Biofilms; Lactobacillus gasseri; Candida; Gentian Violet
PubMed: 36890519
DOI: 10.1186/s12934-023-02053-x -
BioMed Research International 2023Endometriosis is a clinical condition associated with genetic, endocrine, and immunological factors, present in 6 to 10% of women of reproductive age. Currently, the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Endometriosis is a clinical condition associated with genetic, endocrine, and immunological factors, present in 6 to 10% of women of reproductive age. Currently, the human microbiota has been studied and associated with the evolution of diseases due to its influence on pathogenesis, indicating that changes in the colonization of microorganisms in the genitourinary and gastrointestinal systems can promote physiological changes that can trigger inflammatory and immunological processes and hormonal dysregulation, which can be linked to endometriosis. Thus, this systematic review and meta-analysis evaluated microbiota changes in women with endometriosis.
METHODS
The following electronic databases were searched up to April 2022: Medline, Embase, Web of Science, Cochrane Library, and gray literature (Google Scholar), using the keywords "dysbiosis", "microbiome" and "endometriosis", combined with their synonyms. The observational studies conducted with women diagnosed with endometriosis and women without endometriosis as controls were included. For the analyses, a standard mean difference with a 95% confidence interval was used using RevMan software (version 5.4), and for methodological quality assessment, the Newcastle-Ottawa scale was used.
RESULTS
A total of 16 studies were found in the literature assessing the composition of the microbiota in women with endometriosis, and no significant difference were found for changes in alpha diversity analysis in gut microbiota (SMD = -0.28; 95% CI = -0.70 to 0.14; = 0.19; = 52%; four studies, 357 participants) or vaginal microbiota (SMD = -0.68; 95% CI = -1.72 to 0.35; = 0.19; = 66%; two studies, 49 participants).
CONCLUSION
In intestinal and vaginal samples from women with endometriosis, alpha-diversity did not present a significant difference when compared to the control population. However, each study individually showed a possible relationship between the female microbiota and endometriosis. This trial is registered with CRD42021260972.
Topics: Female; Humans; Endometriosis; Microbiota; Vagina; Gastrointestinal Microbiome; Reproduction
PubMed: 38601772
DOI: 10.1155/2023/2675966 -
Nutrients Jan 2023Bacterial vaginosis (BV) is the most common disease in women of childbearing age and is caused by the growth of abnormal microbiota in the vagina. Probiotic consumption... (Randomized Controlled Trial)
Randomized Controlled Trial
Bacterial vaginosis (BV) is the most common disease in women of childbearing age and is caused by the growth of abnormal microbiota in the vagina. Probiotic consumption can be an effective alternative treatment to preserve or improve vaginal health. In the present study, MED-01, a complex of five strains of probiotic candidates isolated from the vagina of Korean women, was used. This study was designed as a 12-week, randomized, multicenter, double-blind, placebo-controlled clinical trial to evaluate the efficacy and safety of MED-01 on vaginal health. A total of 101 reproductive-aged women with a Nugent score of 4-6 took MED-01 (5.0 × 10 CFU) or a placebo once a day, and 76 participants completed the procedure. MED-01 significantly reduced the Nugent score compared with the placebo. Quantitative PCR analysis confirmed that was significantly increased in the vagina, whereas harmful bacteria such as spp., and were suppressed after 12 weeks of MED-01 ingestion. No adverse events to the test food supplements were observed in the participants. These results confirmed that MED-01 can be used as a probiotic for treating BV, as it improves the vaginal microbiota.
Topics: Female; Humans; Adult; Vagina; Vaginosis, Bacterial; Probiotics; Gardnerella vaginalis; Dietary Supplements
PubMed: 36678202
DOI: 10.3390/nu15020331 -
African Health Sciences Mar 2023It is important to train gynecologists and urologists on the principles of urogynecological surgery.
BACKGROUND
It is important to train gynecologists and urologists on the principles of urogynecological surgery.
OBJECTIVES
To report our recent experience in developing a curriculum, application, and the learning outcome of a urogynecology workshop using cadaver training.
METHODS
A full day structured urogynecology cadaver-based educational hands-on course was developed. The theoretical component consisted of lectures on female urinary incontinence and genital prolapse. Hands-on training was on three cadaver stations: First to instruct and guide through the surgical steps of transobturator vaginal tape; second to perform sacrospinous fixation; and third to insert of vaginal mesh. Knowledge gained was evaluated using multiple choice questions. The course was evaluated using a structured seven-point Likert type questionnaire.
RESULTS
There was an a statistically significant improvement in the post-test MCQ marks compared with the pre-test marks (P <0.01) and in the pass percentage (7% compared with 100%, P< 0.001). The overall rating of the workshop was 6.7 out of 7.
CONCLUSIONS
Our course was highly valued by the participants who came from all over the Middle East. The course was enjoyable and achieved its objectives while the participants gained new knowledge and surgical skills.
Topics: Humans; Female; Urinary Incontinence; Curriculum; Vagina; Surveys and Questionnaires; Cadaver
PubMed: 37545959
DOI: 10.4314/ahs.v23i1.64 -
Frontiers in Endocrinology 2023The female reproductive tract harbours unique microbial communities (known as microbiota) which have been associated with reproductive functions in health and disease....
INTRODUCTION
The female reproductive tract harbours unique microbial communities (known as microbiota) which have been associated with reproductive functions in health and disease. While endometrial microbiome studies have shown that the uterus possesses higher bacterial diversity and richness compared to the vagina, the knowledge regarding the composition of the Fallopian tubes (FT) is lacking, especially in fertile women without any underlying conditions.
METHODS
To address this gap, our study included 19 patients who underwent abdominal hysterectomy for benign uterine pathology, and 5 women who underwent tubal ligation as a permanent contraceptive method at Hospital Clínico Universitario Virgen de la Arrixaca (HCUVA). We analyzed the microbiome of samples collected from the FT and endometrium using 16S rRNA gene sequencing.
RESULTS
Our findings revealed distinct microbiome profiles in the endometrial and FT samples, indicating that the upper reproductive tract harbors an endogenous microbiome. However, these two sites also shared some similarities, with 69% of the detected taxa Being common to both. Interestingly, we identified seventeen bacterial taxa exclusively present in the FT samples, including the genera , and , among others. On the other hand, 10 bacterial taxa were only found in the endometrium, including the genera and (FDR <0.05). Furthermore, our study highlighted the influence of the endometrial collection method on the findings. Samples obtained transcervically showed a dominance of the genus Lactobacillus, which may indicate potential vaginal contamination. In contrast, uterine samples obtained through hysterescopy revealed higher abundance of the genera , and .
DISCUSSION
Although the upper reproductive tract appears to have a low microbial biomass, our results suggest that the endometrial and FT microbiome is unique to each individual. In fact, samples obtained from the same individual showed more microbial similarity between the endometrium and FT compared to samples from different women. Understanding the composition of the female upper reproductive microbiome provides valuable insights into the natural microenvironment where processes such as oocyte fertilization, embryo development and implantation occur. This knowledge can improve fertilization and embryo culture conditions for the treatment of infertility.
Topics: Female; Humans; RNA, Ribosomal, 16S; Uterus; Endometrium; Vagina; Infertility; Bacteria
PubMed: 37415669
DOI: 10.3389/fendo.2023.1096050 -
Reproductive Sciences (Thousand Oaks,... Jun 2021While developments in gynecologic health research continue advancing, relatively few groups specifically focus on vaginal tissue research for areas like wound healing,... (Comparative Study)
Comparative Study Review
While developments in gynecologic health research continue advancing, relatively few groups specifically focus on vaginal tissue research for areas like wound healing, device development, and/or drug toxicity. Currently, there is no standardized animal or tissue model that mimics the full complexity of the human vagina. Certain practical factors such as appropriate size and anatomy, costs, and tissue environment vary across species and moreover fail to emulate all aspects of the human vagina. Thus, investigators are tasked with compromising specific properties of the vaginal environment as it relates to human physiology to suit their particular scientific question. Our review aims to facilitate the appropriate selection of a model aptly addressing a particular study by discussing pertinent vaginal characteristics of conventional animal and tissue models. In this review, we first cover common laboratory animals studied in vaginal research-mouse, rat, rabbit, minipig, and sheep-as well as human, with respect to the estrus cycle and related hormones, basic reproductive anatomy, the composition of vaginal layers, developmental epithelial origin, and microflora. In light of these relevant comparative metrics, we discuss potential selection criteria for choosing an appropriate animal vaginal model. Finally, we allude to the exciting prospects of increasing biomimicry for in vitro applications to provide a framework for investigators to model, interpret, and predict human vaginal health.
Topics: Animals; Biomedical Research; Computer Simulation; Disease Models, Animal; Female; Humans; Mice; Microbiota; Models, Animal; Rabbits; Rats; Sheep; Species Specificity; Swine; Swine, Miniature; Vagina; Vaginal Diseases
PubMed: 33825165
DOI: 10.1007/s43032-021-00529-y -
International Braz J Urol : Official... 2022The transverse vaginal septum (TVS) with congenital urethra-vaginal fistula (CUVF) is a rare anomaly of the mullerian duct (1, 2). Incomplete channelling of the vaginal...
INTRODUCTION:
The transverse vaginal septum (TVS) with congenital urethra-vaginal fistula (CUVF) is a rare anomaly of the mullerian duct (1, 2). Incomplete channelling of the vaginal plate, or an abnormality in the fusion of the vaginal component of mullerian duct with the urogenital sinus results in TVS (1, 3, 4). High CUVF occurs due to the persistent communication between the urogenital sinus and utero-vaginal primordium at the tubercle sinus, whereas low CUVF is due to excessive apoptosis of the vaginal plate during channelling (5). The principles of management of CUVF with TVS include: 1) TVS resection, 2) Create a neovagina. We present a case of CUVF with TVS managed by robotic assistance.
MATERIAL AND METHODS:
A 24-year-old female, married for 3 years, presented with cyclical hematuria since menarche, dyspareunia and primary infertility. Examination revealed blind ending vagina 4cm from the introitus. Magnetic resonance imaging revealed a fistulous communication between urethra and vagina, and TVS. Cystourethroscopy confirmed a proximal urethra-vaginal fistula. Urethroscopy guided puncture of the TVS was performed, tract dilated and a catheter was placed across it. Robotic assisted transvaginal approach was planned. Air docking of robot was performed. Traction on the catheter was given to identify the incised edges of the septum. Vaginal flaps were raised laterally, fistulous tract was excised. Proximal vagina mucosa was identified and vaginoplasty was performed.
RESULT:
Patient’s postoperative recovery was uneventful. Urethral catheter was removed after 5 days. She had normal voiding and menstruation. Vaginoscopy performed at 1st month follow-up, revealed an adequate vaginal lumen. Vaginal moulds were advised for 6 weeks during the night, following which she resumed her sexual activity. She conceived 6 months post-surgery, and delivered a child by caesarean section.
CONCLUSION:
We successfully managed this case by resection of septum, neovagina creation and thereby achieving normal menstruation and conception. The advantages of robotic approach were magnification, precision and manoeuvrability in a limited space, avoiding a vaginal release incision.
Topics: Female; Humans; Male; Robotic Surgical Procedures; Urethra; Vagina; Vaginal Diseases; Vaginal Fistula
PubMed: 34735094
DOI: 10.1590/S1677-5538.IBJU.2021.0421 -
International Urogynecology Journal Apr 2021We present a surgical video that describes the technical considerations for performing a modified LeFort partial colpocleisis.
INTRODUCTION AND HYPOTHESIS
We present a surgical video that describes the technical considerations for performing a modified LeFort partial colpocleisis.
METHODS
Hydro-dissection with diluted pituitrin was performed before the creation of anterior and posterior mid-line incisions through which lateral flaps were created bilaterally to expose the bladder and rectum fascia. Several purse-string sutures were placed to push the bladder and rectum back to their normal positions and reinforce the fascia under the vaginal wall. After removing the excess part of the vaginal wall, the lateral margins were re-approximated to create lateral channels that were wide enough to fit one finger. Perineoplasty was then performed to reduce the length of the genital hiatus.
RESULTS
The procedure was performed in a 76-year-old woman with stage III vaginal vault prolapse (POP-Q C + 2), stage IV anterior prolapse (POP-Q Ba+5), stage II posterior prolapse (POP-Q Bp-1), and mild occult stress urinary incontinence. The patient recovered well postoperatively, without recurrent prolapse and/or stress incontinence during 6 months of follow-up.
CONCLUSIONS
Our modified technique used traditional suture methods to strengthen the bladder and rectum fascia, keeping most of the vaginal wall to create a solid longitudinal septum in the center of the vagina that supported the vaginal vault.
Topics: Aged; Colpotomy; Female; Humans; Pelvic Organ Prolapse; Pregnancy; Treatment Outcome; Urinary Bladder; Urinary Incontinence, Stress; Vagina
PubMed: 33001217
DOI: 10.1007/s00192-020-04545-5