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Editorial Comment on: Genetic Influence on Stress Urinary Incontinence and Pelvic Organ Prolapse
european urology 54 (2008) 918–923
Editorial Comment on: Genetic Influence on Stress Urinary Incontinence and Pelvic Organ Prolapse Gary E. Lemack University of Texas Southwestern Medical Center, Dallas, TX, USA [email protected] Studies of environmental risk factors for the development of pelvic floor disorders in women have documented well-defined demographic and physical parameters, which clearly influence the likelihood of experiencing stress urinary incontinence (SUI) and pelvic organ prolapse (POP). Less is clearly known about the influence of genetic factors in the pathogenesis and progression of conditions affecting the pelvic floor, although recent data suggest such a role in early-onset POP [1]. This current paper analyzes the role of both genetic and environmental factors by using two large databases, the Swedish Twin Registry, which has documented all monozygotic and dizygotic twins born in Sweden (in this case assessing twins born between 1926 and 1958), and the Swedish Inpatient Registry, which contains data on individual hospital discharges [2]. The registry was queried for patients undergoing surgery for either SUI or POP. Although obviously only a surrogate for the number of women experiencing these conditions (a clear underestimate of the true prevalence of the condition), and a relatively nonspecific indicator of the condition present (the type and severity of prolapse was not addressed), the registry does provide valuable information on the patients most likely to be seriously affected by these conditions. By comparing the concordance rates and tetrachoric correlations between monozygotic and
923
dizygotic twins, the authors assessed the likelihood that the conditions were genetically influenced. Overall, the authors provide what may be the first substantive evidence that both non-shared environmental factors and genetic factors contribute to the development of SUI and POP in women. Additionally, the authors suggest that shared environmental factors (presumably from the twins’ childhood such as dysfunctional voiding) may contribute as well, though perhaps to a lesser extent. That genetic factors may influence the likelihood of developing pelvic floor disorders in women should not be surprising. It is clearly much too early to speculate how this type of finding might ultimately influence our counseling of women deemed to be at elevated risk. Importantly, as the authors point out, it still seems likely that even with a genetic predisposition, potentially modifiable environmental factors have a substantial, if not more important role, in the development of pelvic floor conditions such as SUI and POP, and should not be overlooked in the context of this new finding.
References [1] Nikolova G, Lee H, Berkovitz S, et al. Sequence variant in the laminin gamma1 (LAMC1) gene associated with familial pelvic organ prolapse. Hum Genet 2007;120: 847–56. [2] Altman D, Forsman M, Falconer C, Lichtenstein P. Genetic influence on stress urinary incontinence and pelvic organ prolapse. Eur Urol 2008;54:918–23.
DOI: 10.1016/j.eururo.2007.12.005 DOI of original article: 10.1016/j.eururo.2007.12.004
Editorial Comment on: Genetic Influence on Stress Urinary Incontinence and Pelvic Organ Prolapse Gary E. Lemack University of Texas Southwestern Medical Center, Dallas, TX, USA [email protected] Studies of environmental risk factors for the development of pelvic floor disorders in women have documented well-defined demographic and physical parameters, which clearly influence the likelihood of experiencing stress urinary incontinence (SUI) and pelvic organ prolapse (POP). Less is clearly known about the influence of genetic factors in the pathogenesis and progression of conditions affecting the pelvic floor, although recent data suggest such a role in early-onset POP [1]. This current paper analyzes the role of both genetic and environmental factors by using two large databases, the Swedish Twin Registry, which has documented all monozygotic and dizygotic twins born in Sweden (in this case assessing twins born between 1926 and 1958), and the Swedish Inpatient Registry, which contains data on individual hospital discharges [2]. The registry was queried for patients undergoing surgery for either SUI or POP. Although obviously only a surrogate for the number of women experiencing these conditions (a clear underestimate of the true prevalence of the condition), and a relatively nonspecific indicator of the condition present (the type and severity of prolapse was not addressed), the registry does provide valuable information on the patients most likely to be seriously affected by these conditions. By comparing the concordance rates and tetrachoric correlations between monozygotic and
923
dizygotic twins, the authors assessed the likelihood that the conditions were genetically influenced. Overall, the authors provide what may be the first substantive evidence that both non-shared environmental factors and genetic factors contribute to the development of SUI and POP in women. Additionally, the authors suggest that shared environmental factors (presumably from the twins’ childhood such as dysfunctional voiding) may contribute as well, though perhaps to a lesser extent. That genetic factors may influence the likelihood of developing pelvic floor disorders in women should not be surprising. It is clearly much too early to speculate how this type of finding might ultimately influence our counseling of women deemed to be at elevated risk. Importantly, as the authors point out, it still seems likely that even with a genetic predisposition, potentially modifiable environmental factors have a substantial, if not more important role, in the development of pelvic floor conditions such as SUI and POP, and should not be overlooked in the context of this new finding.
References [1] Nikolova G, Lee H, Berkovitz S, et al. Sequence variant in the laminin gamma1 (LAMC1) gene associated with familial pelvic organ prolapse. Hum Genet 2007;120: 847–56. [2] Altman D, Forsman M, Falconer C, Lichtenstein P. Genetic influence on stress urinary incontinence and pelvic organ prolapse. Eur Urol 2008;54:918–23.
DOI: 10.1016/j.eururo.2007.12.005 DOI of original article: 10.1016/j.eururo.2007.12.004