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Resilience and urinary incontinence symptoms in postmenopausal women
EMAS2017 / Maturitas 100 (2017) 93–202
P110 Levonorgestrel intrauterine device and preservation of fertility in endometrial cancer grade I Jordi Rabasa Antonijuan 1,∗ , Rafael Sanchez Borrego 2 , Jaume Pahissa Fabregas 3 1
Diatros, Gynecology, Gava, Spain Diatros, Gynecology, Barcelona, Spain 3 Diatros, Gynecology Oncology, Barcelona, Spain 2
Endometrial cancer is the most frequent gynecologic cancer. Although it mainly occurs in menopausal women, it can hit younger patients as well. Hysterectomy is considered the standard treatment and it could represent a problem for those young women who desire to preserve fertility. A conservative management can be offered to these patients when the tumor is well differentiated and advanced stage is excluded. Several studies are available in literature about fertility-sparing approach. Progestin treatment, seem to be the most validated conservative management. We report the case of a patient 43 years old, nulliparous, diagnosed by directed biopsy by hysteroscopy of endometrial cancer FIGO stage IA grade I. After the conservative treatment (levonorgestrel-releasing IUD ® Mirena ), the patient entered in complete remission. She conceived by IVF treatment and delivered at 31 weeks gestation by caesarean section for obstetrical indication. Laparoscopic total hysterectomy with bilateral salpingectomy was performed five months after delivery.
181
I, III, MMPs -1, -9, ER␣, ER and PR receptors was performed on formaline fixed and paraffin embedded sections. Results: There were no statistically significant differences among the three groups in terms of age, parity, or body mass index. Collagen type III as well as ER␣ and ER receptors were found significantly reduced among samples of Group A. Collagen type I was significantly reduced in Group B when compared to the control Group, while further reduction was observed in Group A. MMPs were significantly increased among patients with pelvic organ prolapse, in comparison with the control Group. The higher levels of MMPs expression were observed in Group A. Conclusions: It seems that lower expression of collagen type III and estrogen receptors in the vaginal wall and around the urethra of postmenopausal women with POP is potentially involved in the pathophysiological pathways of USUI. In addition, alterations in connective tissue such as decrease of collagen type I and increase of the expression of MMP-1, -9 may play an important role on the pathophysiology of both POP and USUI. http://dx.doi.org/10.1016/j.maturitas.2017.03.211 P112 Resilience and urinary incontinence symptoms in postmenopausal women Ana Fernandez-Alonso 1,∗ , Javier Alcaide-Torres 1 , Isabel M. Fernandez-Alonso 1 , Peter Chedraui 2 , Faustino R. Pérez-López 3 1
http://dx.doi.org/10.1016/j.maturitas.2017.03.210 P111 Immunohistochemical analysis of collagen types I, III, matrix metalloproteinases-1, -9, and gonadal steroid receptors alterations on the pathophysiology of female pelvic organ prolapse and urinary incontinence Charalampos Grigoriadis 1,∗ , Aliki Tympa 2 , Anthia Chasiakou 3 , Agathi Kondi-Pafiti 4 , Ilias Liapis 1 , Dimitrios Botsis 1 , Angelos Liapis 1 1
Aretaieion Hospital, University of Athens, 2nd Department of Obstetrics and Gynecology, Athens, Greece 2 Aretaieion Hospital, University of Athens, 1st Department of Anaesthesiology, Athens, Greece 3 Medical School, University of Patras, Rion, Greece 4 Aretaieion Hospital, University of Athens, Pathology Laboratory, Athens, Greece
Introduction: The aim of this study was to investigate the potential effect of alterations in the expression of collagen types I, III, matrix metalloproteinases (MMPs) -1, -9, estrogen (ER␣ and ER) and progesterone (PR) receptors of the pubocervical fascia on the pathophysiology of pelvic organ prolapse (POP) and urodynamic stress urinary incontinence (USUI) after menopause. Materials and methods: This was a prospective clinicopathological study based on immunohistochemical methods. Forty samples were obtained from postmenopausal women with synchronous POP and USUI (Group A), forty specimens were collected from postmenopausal patients with POP only (Group B), while forty postmenopausal women without POP or USUI who underwent gynecological surgery for another benign indication formed control group (Group C). Immunohistochemistry for collagen types
Torrecardenas Hospital, Obstetrics and Gynecology, Almería, Spain 2 Institute of Biomedicine, Facultad de Medicina, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador 3 University of Zaragoza, Faculty of Medicine, Zaragoza, Spain
Background: Bio-, psycho- and social changes take place during the menopausal transition; which affect female health. Resilience is the capacity to overcome stress imposed by life adversity. Objective: To assess and correlate resilience and urinary incontinence (UI) symptoms in postmenopausal women. Methods: In this cross-sectional study, 150 postmenopausal women (45–75 years) were requested to fill out the 10-item Connor-Davidson Resilience Scale (CD-RISC), the 4-item International Consultation on Incontinence Questionnaire (ICIQ-SF) and a questionnaire containing personal data. Results: Mean age of all surveyed women was 58.9 ± 5.7 years, the majority were Caucasian (92.7%), 91.3% had natural menopause, 10% used phytoestrogens, 64% lived in rural areas and 10% smoked. Calculated Cronbach’s alpha coefficients for the CD-RISC and the ICIQ-SF were high (indicating good reliability) (0.89 and 0.91, respectively). For the entire sample, median [Interquartile range] total CD-RISC and ICIQ-SF scores were 35.0 [9.0] and 3.0 [8.0], respectively. An 18.0% of women had severe UI according to item 1 of the ICIQ-SF (scores 3–5). There was an inverse correlation between item 1 ICIQ-SF scores and CD-RISC scores (Rho = −0.24; p = 0.003). Women with severe UI had a higher median total ICIQSF scores (sum of items 1 to 3) and lower total CD-RISC scores as compared to those with nil or mild UI (15.0 [4.0] vs. 0.0 [5.0]; and 31.0 [6.0] vs. 35.0 [9.0], respectively, p < 0.05 for both). Multiple linear regression analysis determined that higher total CD-RISC scores (better resilience) positively correlated with exercising regularly and inversely correlated with economic problems; whereas ICIQ-SF scores positively correlated with age and phytoestrogen use.
182
EMAS2017 / Maturitas 100 (2017) 93–202
Conclusions: In this postmenopausal sample, resilience correlated with economic problems, regular exercise and severity of UI. However, due to the relatively small and convenient sample, our findings do not allow generalizations. http://dx.doi.org/10.1016/j.maturitas.2017.03.212 P113 Vaginal pessary is the best option for some women Tasic 1,∗ ,
Jurisic 1 ,
Lidija Aleksandar Jankovic 2 , Natasa Karadzov 2
Svetlana
1
Gyn-Obstet Clinic Narodni Front, University of Belgrade, Menopausal Department, Belgrade, Serbia 2 Gyn-Obstet Clinic Narodni Front, University of Belgrade, Urogynecology Department, Belgrade, Serbia Introduction: Pelvic organ prolapse (POP) means that uterus, bladder or urethra are protruded toward or through the introitus of the vagina. Due to changes in the position, function of these organs is disturbed. About 50% of women experience some degree of POP during their lifetime. POP can be treated by conservative and surgical treatment. The main conservative treatment is vaginal support device. It is generally safe, non invasive and inexpensive way of POP treating. Material and methods: Over a 3 years period, we tracked 79 patients with POP grade II–IV. In terms of age, we divided them into 2 groups: aged 63–74 and 75–85 years. The first group consisted of 36 patients, mean age of 69.5 years, with POP grade II–IV; the second group consisted of 43 patients, mean age of 80 years, with POP grade III–IV degree. In the first group, 15 patients (41%), immediately decided to undergo operative treatment. These were patients with urinary incontinence and medium levels of POP (II–III). To the remaining patients of the first group, vaginal support device was placed. Because of the discomfort and inadequate relief of symptoms, another 5 women underwent surgical treatment. Other patients were satisfied with vaginal pessary. To all patients of the second group a vaginal pessary was applied. This was older women, with some concomitant diseases, and the possibility of serious operative complications. The satisfaction of these patients was 75%. In 11 patients (25%) problems related to POP were not resolved. Two patients underwent to colpocleisis for unresolved POP problems. None of the patients with vaginal pessary had serious complications. Conclusion: Treatment of POP and urinary incontinence should be adapted to the actual health condition (physical and mental) of the particular patient. Vaginal pessary is a good option for managing POP in older patients, and patients with some chronic concomitant disease with major operative risk. http://dx.doi.org/10.1016/j.maturitas.2017.03.213
P114 The relationship and the seasonal variation between vitamin D and total testosterone Kwangmin Kim ∗ , Muyul Sim, Kyunam Kim, Namseok Ju Ajou University School of Medicine, Family Medicine, Suwon, Republic of Korea Background: There is evidence on a possible association of vitamin D and testosterone level. But there is inconsistent evidence in Korea. And, in Korea, there are insufficient evidences on association of seasonal variation and vitamin D, testosterone. We therefore aim to investigate the association of vitamin D and testosterone in Korean men. Also aim to investigate the vitamin D and testosterone have seasonal variation in Korean men. Methods: This study was cross-sectional study including 1559 men, aged 25–86 years, taken medical examination. We measured serum 25(OH)D level, total testosterone level, other labs and patients’ lifestyle characters. We categorized patients by 4 seasons, analyze seasonal variability in 25(OH)D and total testosterone. Results: The average age of the subjects was 53.3 ± 8.8 years, and the mean serum 25(OH)D, total testosterone levels were 15.9 ± 7.0 ng/ml, 5.1 ± 1.6 ng/ml, respectively. In the ANOVA model, 25(OH)D and testosterone were not have association (p = 0.51). And we analyze seasonal variation in mean of 25(OH)D level by ANOVA, there are relationship with seasonal variation and 25(OH)D (p for trend <0.001). In total testosterone, there are no significant association with seasonal variation and total testosterone level, just has trend (p = 0.06). But after adjustment, total testosterone and 25(OH)D are has significant association with seasonal variability (p = 0.007, p < 0.001). Conclusion: We find the serum 25(OH)D and total testosterone level had not correlation in Korean men. And the serum 25(OH)D and total testosterone level was affected by seasonal variation in Korean men. http://dx.doi.org/10.1016/j.maturitas.2017.03.214 P115 Andropause symptoms severity inventory (ASSI): Preliminary study with a Portuguese sample Pedro Alexandre Costa, Raquel Rosas, Filipa Pimenta ∗ , João Maroco, Isabel Leal, EVISA ISPA – Instituto Universitário, William James Center for Research, Lisbon, Portugal Introduction: The Andropause Symptoms Severity Inventory (ASSI) is a new measure that assesses both intensity and frequency of symptoms of late-onset hypogonadism (LOH), as part of a longitudinal project about LOH (EVISA; Pimenta et al., 2014). The initial pool of 42 symptoms was developed based on a previous validated measure of menopausal symptoms (MSSI-38; Pimenta et al., 2012), and with the input of experts in psychology and endocrinology. The aim of the present study is to present the preliminary analysis of the ASSI with a Portuguese sample. Methods: A community sample of 631 Portuguese men aged between 40 and 91 years (M = 52.14; SD = 8.33) completed the ASSI. Factor exploratory analysis was performed to test the proposed theoretical dimensions. Factorial adequacy was assessed through inter-item correlations and internal reliability (Cronbach’s alpha). Results: Overall inter-item correlations and internal reliability supported the theoretical dimensions proposed; the 42 symptoms
P110 Levonorgestrel intrauterine device and preservation of fertility in endometrial cancer grade I Jordi Rabasa Antonijuan 1,∗ , Rafael Sanchez Borrego 2 , Jaume Pahissa Fabregas 3 1
Diatros, Gynecology, Gava, Spain Diatros, Gynecology, Barcelona, Spain 3 Diatros, Gynecology Oncology, Barcelona, Spain 2
Endometrial cancer is the most frequent gynecologic cancer. Although it mainly occurs in menopausal women, it can hit younger patients as well. Hysterectomy is considered the standard treatment and it could represent a problem for those young women who desire to preserve fertility. A conservative management can be offered to these patients when the tumor is well differentiated and advanced stage is excluded. Several studies are available in literature about fertility-sparing approach. Progestin treatment, seem to be the most validated conservative management. We report the case of a patient 43 years old, nulliparous, diagnosed by directed biopsy by hysteroscopy of endometrial cancer FIGO stage IA grade I. After the conservative treatment (levonorgestrel-releasing IUD ® Mirena ), the patient entered in complete remission. She conceived by IVF treatment and delivered at 31 weeks gestation by caesarean section for obstetrical indication. Laparoscopic total hysterectomy with bilateral salpingectomy was performed five months after delivery.
181
I, III, MMPs -1, -9, ER␣, ER and PR receptors was performed on formaline fixed and paraffin embedded sections. Results: There were no statistically significant differences among the three groups in terms of age, parity, or body mass index. Collagen type III as well as ER␣ and ER receptors were found significantly reduced among samples of Group A. Collagen type I was significantly reduced in Group B when compared to the control Group, while further reduction was observed in Group A. MMPs were significantly increased among patients with pelvic organ prolapse, in comparison with the control Group. The higher levels of MMPs expression were observed in Group A. Conclusions: It seems that lower expression of collagen type III and estrogen receptors in the vaginal wall and around the urethra of postmenopausal women with POP is potentially involved in the pathophysiological pathways of USUI. In addition, alterations in connective tissue such as decrease of collagen type I and increase of the expression of MMP-1, -9 may play an important role on the pathophysiology of both POP and USUI. http://dx.doi.org/10.1016/j.maturitas.2017.03.211 P112 Resilience and urinary incontinence symptoms in postmenopausal women Ana Fernandez-Alonso 1,∗ , Javier Alcaide-Torres 1 , Isabel M. Fernandez-Alonso 1 , Peter Chedraui 2 , Faustino R. Pérez-López 3 1
http://dx.doi.org/10.1016/j.maturitas.2017.03.210 P111 Immunohistochemical analysis of collagen types I, III, matrix metalloproteinases-1, -9, and gonadal steroid receptors alterations on the pathophysiology of female pelvic organ prolapse and urinary incontinence Charalampos Grigoriadis 1,∗ , Aliki Tympa 2 , Anthia Chasiakou 3 , Agathi Kondi-Pafiti 4 , Ilias Liapis 1 , Dimitrios Botsis 1 , Angelos Liapis 1 1
Aretaieion Hospital, University of Athens, 2nd Department of Obstetrics and Gynecology, Athens, Greece 2 Aretaieion Hospital, University of Athens, 1st Department of Anaesthesiology, Athens, Greece 3 Medical School, University of Patras, Rion, Greece 4 Aretaieion Hospital, University of Athens, Pathology Laboratory, Athens, Greece
Introduction: The aim of this study was to investigate the potential effect of alterations in the expression of collagen types I, III, matrix metalloproteinases (MMPs) -1, -9, estrogen (ER␣ and ER) and progesterone (PR) receptors of the pubocervical fascia on the pathophysiology of pelvic organ prolapse (POP) and urodynamic stress urinary incontinence (USUI) after menopause. Materials and methods: This was a prospective clinicopathological study based on immunohistochemical methods. Forty samples were obtained from postmenopausal women with synchronous POP and USUI (Group A), forty specimens were collected from postmenopausal patients with POP only (Group B), while forty postmenopausal women without POP or USUI who underwent gynecological surgery for another benign indication formed control group (Group C). Immunohistochemistry for collagen types
Torrecardenas Hospital, Obstetrics and Gynecology, Almería, Spain 2 Institute of Biomedicine, Facultad de Medicina, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador 3 University of Zaragoza, Faculty of Medicine, Zaragoza, Spain
Background: Bio-, psycho- and social changes take place during the menopausal transition; which affect female health. Resilience is the capacity to overcome stress imposed by life adversity. Objective: To assess and correlate resilience and urinary incontinence (UI) symptoms in postmenopausal women. Methods: In this cross-sectional study, 150 postmenopausal women (45–75 years) were requested to fill out the 10-item Connor-Davidson Resilience Scale (CD-RISC), the 4-item International Consultation on Incontinence Questionnaire (ICIQ-SF) and a questionnaire containing personal data. Results: Mean age of all surveyed women was 58.9 ± 5.7 years, the majority were Caucasian (92.7%), 91.3% had natural menopause, 10% used phytoestrogens, 64% lived in rural areas and 10% smoked. Calculated Cronbach’s alpha coefficients for the CD-RISC and the ICIQ-SF were high (indicating good reliability) (0.89 and 0.91, respectively). For the entire sample, median [Interquartile range] total CD-RISC and ICIQ-SF scores were 35.0 [9.0] and 3.0 [8.0], respectively. An 18.0% of women had severe UI according to item 1 of the ICIQ-SF (scores 3–5). There was an inverse correlation between item 1 ICIQ-SF scores and CD-RISC scores (Rho = −0.24; p = 0.003). Women with severe UI had a higher median total ICIQSF scores (sum of items 1 to 3) and lower total CD-RISC scores as compared to those with nil or mild UI (15.0 [4.0] vs. 0.0 [5.0]; and 31.0 [6.0] vs. 35.0 [9.0], respectively, p < 0.05 for both). Multiple linear regression analysis determined that higher total CD-RISC scores (better resilience) positively correlated with exercising regularly and inversely correlated with economic problems; whereas ICIQ-SF scores positively correlated with age and phytoestrogen use.
182
EMAS2017 / Maturitas 100 (2017) 93–202
Conclusions: In this postmenopausal sample, resilience correlated with economic problems, regular exercise and severity of UI. However, due to the relatively small and convenient sample, our findings do not allow generalizations. http://dx.doi.org/10.1016/j.maturitas.2017.03.212 P113 Vaginal pessary is the best option for some women Tasic 1,∗ ,
Jurisic 1 ,
Lidija Aleksandar Jankovic 2 , Natasa Karadzov 2
Svetlana
1
Gyn-Obstet Clinic Narodni Front, University of Belgrade, Menopausal Department, Belgrade, Serbia 2 Gyn-Obstet Clinic Narodni Front, University of Belgrade, Urogynecology Department, Belgrade, Serbia Introduction: Pelvic organ prolapse (POP) means that uterus, bladder or urethra are protruded toward or through the introitus of the vagina. Due to changes in the position, function of these organs is disturbed. About 50% of women experience some degree of POP during their lifetime. POP can be treated by conservative and surgical treatment. The main conservative treatment is vaginal support device. It is generally safe, non invasive and inexpensive way of POP treating. Material and methods: Over a 3 years period, we tracked 79 patients with POP grade II–IV. In terms of age, we divided them into 2 groups: aged 63–74 and 75–85 years. The first group consisted of 36 patients, mean age of 69.5 years, with POP grade II–IV; the second group consisted of 43 patients, mean age of 80 years, with POP grade III–IV degree. In the first group, 15 patients (41%), immediately decided to undergo operative treatment. These were patients with urinary incontinence and medium levels of POP (II–III). To the remaining patients of the first group, vaginal support device was placed. Because of the discomfort and inadequate relief of symptoms, another 5 women underwent surgical treatment. Other patients were satisfied with vaginal pessary. To all patients of the second group a vaginal pessary was applied. This was older women, with some concomitant diseases, and the possibility of serious operative complications. The satisfaction of these patients was 75%. In 11 patients (25%) problems related to POP were not resolved. Two patients underwent to colpocleisis for unresolved POP problems. None of the patients with vaginal pessary had serious complications. Conclusion: Treatment of POP and urinary incontinence should be adapted to the actual health condition (physical and mental) of the particular patient. Vaginal pessary is a good option for managing POP in older patients, and patients with some chronic concomitant disease with major operative risk. http://dx.doi.org/10.1016/j.maturitas.2017.03.213
P114 The relationship and the seasonal variation between vitamin D and total testosterone Kwangmin Kim ∗ , Muyul Sim, Kyunam Kim, Namseok Ju Ajou University School of Medicine, Family Medicine, Suwon, Republic of Korea Background: There is evidence on a possible association of vitamin D and testosterone level. But there is inconsistent evidence in Korea. And, in Korea, there are insufficient evidences on association of seasonal variation and vitamin D, testosterone. We therefore aim to investigate the association of vitamin D and testosterone in Korean men. Also aim to investigate the vitamin D and testosterone have seasonal variation in Korean men. Methods: This study was cross-sectional study including 1559 men, aged 25–86 years, taken medical examination. We measured serum 25(OH)D level, total testosterone level, other labs and patients’ lifestyle characters. We categorized patients by 4 seasons, analyze seasonal variability in 25(OH)D and total testosterone. Results: The average age of the subjects was 53.3 ± 8.8 years, and the mean serum 25(OH)D, total testosterone levels were 15.9 ± 7.0 ng/ml, 5.1 ± 1.6 ng/ml, respectively. In the ANOVA model, 25(OH)D and testosterone were not have association (p = 0.51). And we analyze seasonal variation in mean of 25(OH)D level by ANOVA, there are relationship with seasonal variation and 25(OH)D (p for trend <0.001). In total testosterone, there are no significant association with seasonal variation and total testosterone level, just has trend (p = 0.06). But after adjustment, total testosterone and 25(OH)D are has significant association with seasonal variability (p = 0.007, p < 0.001). Conclusion: We find the serum 25(OH)D and total testosterone level had not correlation in Korean men. And the serum 25(OH)D and total testosterone level was affected by seasonal variation in Korean men. http://dx.doi.org/10.1016/j.maturitas.2017.03.214 P115 Andropause symptoms severity inventory (ASSI): Preliminary study with a Portuguese sample Pedro Alexandre Costa, Raquel Rosas, Filipa Pimenta ∗ , João Maroco, Isabel Leal, EVISA ISPA – Instituto Universitário, William James Center for Research, Lisbon, Portugal Introduction: The Andropause Symptoms Severity Inventory (ASSI) is a new measure that assesses both intensity and frequency of symptoms of late-onset hypogonadism (LOH), as part of a longitudinal project about LOH (EVISA; Pimenta et al., 2014). The initial pool of 42 symptoms was developed based on a previous validated measure of menopausal symptoms (MSSI-38; Pimenta et al., 2012), and with the input of experts in psychology and endocrinology. The aim of the present study is to present the preliminary analysis of the ASSI with a Portuguese sample. Methods: A community sample of 631 Portuguese men aged between 40 and 91 years (M = 52.14; SD = 8.33) completed the ASSI. Factor exploratory analysis was performed to test the proposed theoretical dimensions. Factorial adequacy was assessed through inter-item correlations and internal reliability (Cronbach’s alpha). Results: Overall inter-item correlations and internal reliability supported the theoretical dimensions proposed; the 42 symptoms