Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA.
Department of Obstetrics and Gynecology, Baylor College of Medicine, 6651 Main Street, Houston, TX, 77030, USA.
Int Urogynecol J. 2023 Sep;34(9):2081-2088. doi: 10.1007/s00192-023-05505-5. Epub 2023 Mar 27.
We sought to 1) test the hypothesis that young women (≤45 years) with pelvic organ prolapse have a higher prevalence of major levator ani muscle (LAM) defects than old women (≥70 years) with prolapse and 2) compare level II/III measurements between young and old women with prolapse and age-matched controls to evaluate age-related mechanistic differences in the disease process.
A secondary analysis examined four groups of parous women: young prolapse (YPOP, n = 17); old prolapse (OPOP, n = 17); young controls (YC, n = 15); old controls, (OC, n = 13). Prolapse was defined as any compartment at or beyond the hymen with vaginal bulge symptoms. Genital hiatus (GH) was measured on clinical exam. Major LAM defects and level II/III measurements (UGH: urogenital hiatus, LA: levator area, and apex location) were assessed on MRI at rest and strain, and the difference (Δ) between measurements calculated. Principal component analysis was used to evaluate levator plate (LP) shape.
Major LAM defects occurred in 42% of YPOP and 47% of OPOP (p > .99). GH was 1.5 cm larger in OPOP versus YPOP (p < .001) and 2 cm larger in OPOP versus OC (p < .001). Regardless of prolapse status, LA and UGH on MRI increased with age. YPOP had larger ΔLA (p = .04), ΔUGH (p = .03), and Δapex than OPOP (p = .01). Resting LP shape was more dorsally oriented in OPOP versus YPOP (p = .02) and OC versus YC (p = .004).
Prolapse in young women cannot be solely explained by a higher LAM defect prevalence. GH size and other measures of level II/III pelvic support worsen with age regardless of prolapse status.
我们旨在：1）检验以下假设，即患有盆腔器官脱垂的年轻女性（≤45 岁）比患有脱垂的老年女性（≥70 岁）更易发生主要肛提肌（LAM）缺陷；2）比较年轻和老年脱垂患者与年龄匹配的对照组之间的 II/III 级测量值，以评估疾病过程中与年龄相关的机械学差异。
一项二次分析检查了四组经产妇：年轻脱垂组（YPOP，n=17）；老年脱垂组（OPOP，n=17）；年轻对照组（YC，n=15）；老年对照组（OC，n=13）。脱垂定义为任何在处女膜或其以下的阴道膨出伴有阴道膨出症状的部位。在体格检查时测量阴道横径（GH）。在休息和收缩时，通过 MRI 评估主要 LAM 缺陷和 II/III 级测量值（UGH：尿生殖膈裂孔，LA：肛提肌区域，和顶点位置），并计算测量值之间的差值（Δ）。主成分分析用于评估肛提肌板（LP）的形状。
YPOP 中有 42%和 OPOP 中有 47%发生了主要 LAM 缺陷（p>.99）。OPOP 与 YPOP 相比 GH 大 1.5cm（p<.001），OPOP 与 OC 相比 GH 大 2cm（p<.001）。无论脱垂状态如何，MRI 上的 LA 和 UGH 均随年龄增长而增加。YPOP 的 ΔLA（p=.04）、ΔUGH（p=.03）和 Δ顶点（p=.01）均大于 OPOP。OPOP 的 LP 休息时的形状更倾向于背侧（p=.02），OC 的 LP 形状更倾向于背侧（p=.004）。
年轻女性的脱垂不能仅用更高的 LAM 缺陷患病率来解释。无论脱垂状态如何，GH 大小和其他 II/III 级盆腔支撑测量值都会随着年龄的增长而恶化。
