Objective Pelvic organ prolapse (POP) refers to the decline of pelvic organ position and dysfunction caused by weak pelvic floor support. The aim of the present study was to screen the hub genes and immune cell infiltration related to POP disease. Methods Microarray data of 34 POP tissues in the GSE12852 gene expression dataset were used as research objects. Weighted gene co-expression network analysis (WGCNA) was performed to elucidate the hub module and hub genes related to POP occurrence. Gene function annotation was performed using the DAVID tool. Differential analysis based on the GSE12852 dataset was carried out to explore the expression of the selected hub genes in POP and non-POP tissues, and RT-qPCR was used to validate the results. The differential immune cell infiltration between POP and non-POP tissues was investigated using the CIBERSORT algorithm. Results WGCNA revealed the module that possessed the highest correlation with POP occurrence. Functional annotation indicated that the genes in this module were mainly involved in immunity. ZNF331, THBS1, IFRD1, FLJ20533, CXCR4, GEM, SOD2, and SAT were identified as the hub genes. Differential analysis and RT-qPCR demonstrated that the selected hub genes were overexpressed in POP tissues as compared with non-POP tissues. The CIBERSORT algorithm was employed to evaluate the infiltration of 22 immune cell types in POP tissues and non-POP tissues. We found greater infiltration of activated mast cells and neutrophils in POP tissues than non-POP tissues, while the infiltration of resting mast cells was lower in POP tissues. Moreover, we investigated the relationship between the type of immune cell infiltration and hub genes by Pearson correlation analysis. The results indicate that activated mast cells and neutrophils had a positive correlation with the hub genes, while resting mast cells had a negative correlation with the hub genes. Conclusions Our research identified eight hub genes and the infiltration of three types of immune cells related to POP occurrence. These hub genes may participate in the pathogenesis of POP through the immune system, giving them a certain diagnostic and therapeutic value.

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BackgroundWe evaluated the utility of three-dimensional transperineal ultrasonography in detecting occult stress urinary incontinence in women undergoing anterior pelvic floor reconstruction surgery for severe cystocele.Material/MethodsWe enrolled 207 women with stage III–IV cystocele without urinary stress incontinence. One week before the operation, the patients underwent pelvic floor ultrasonography. We measured the vertical distance between the bladder neck and posterior margin of the pubic symphysis, the posterior vesicourethral angle, the urethral rotation angle, the formation of funnel shape, the hiatus area, and the length of the urethra and the funnel shape. Postoperatively, the patients were evaluated for symptoms of stress urinary incontinence and with the 20-minute pad test.ResultsThe posterior vesicourethral angle with Valsalva maneuver, the difference in the posterior vesicourethral angle between the resting state and with the Valsalva state, and the angle of the proximal urethra were larger in the incontinence-positive group than in the incontinence-negative group (P<0.05). Funnel shape urethra was longer in the incontinence-positive group than in the incontinence-negative group (P<0.05). The cutoff value was 137.5° for the posterior vesicourethral angle with Valsalva maneuver, 39.5° for the difference in the posterior vesicourethral angle, 44.5° for the angle of the proximal urethra, and 0.35 cm for the length of the funnel shape. Multivariate analysis revealed that the difference between the posterior vesicourethral angle in the resting state and with Valsalva, the angle of the proximal urethra, and the length of funnel shape were strongly correlated with occult stress urinary incontinence.ConclusionsUltrasonography is an effective method for identifying occult stress urinary incontinence.

Background The purpose of this study was to investigate the relevant factors of pain after transvaginal mesh (TVM) surgery for the treatment of pelvic organ prolapse and to analyse the management and relief of the pain. Methods A multicentre retrospective study of a clinical database of patients who underwent TVM surgery was conducted, and pain related aspects were analysed. Results A total of 1855 patients were included in the study. We divided the patients into two groups: pain-free (1805 patients) and pain (50 patients) group. The incidence of pain after TVM surgery was 2.70%, with a median occurrence time of 7.5 months. Pain mainly involved the vagina, perineum, buttocks, groin, inner thighs, and lower abdomen. Excessive intraoperative blood loss (OR = 1.284, 95% CI 0.868–2.401) and postoperative anatomic failure (OR = 1.577, 95% CI 0.952–3.104) were analysed as risk factors with statistical significance. Mesh exposure rate in the pain group was 38%, showing a significant difference between the groups (P < 0.01). Forty patients underwent non-surgical treatment, with a relief rate of 40.0%, 33 patients received surgical treatment, 15 underwent partial mesh removal, and 18 underwent complete mesh removal, with a relief rate of 84.8%. The total relief rate was 88% within all 50 patients suffering from pain. Conclusions Excessive intraoperative bleeding and unsatisfactory postoperative anatomic outcomes can increase the risk of postoperative pain; mesh exposure is also associated with the pain. Most patients can get pain relief with proper management, more than half of whom may need mesh removal with differing approach.

Objective. The objective is to determine the possible improvement in outlet obstructive constipation symptoms after vaginal stent treatment for rectocele. Methods. Female patients with rectocele (n = 156) accompanied with outlet obstructive constipation were selected in this study. Longo’s obstructed defecation syndrome (ODS) questionnaire, rectoanal pressures, and rectal balloon expulsion (BET) were evaluated at baseline, 1 month follow-up, and 6 months follow-up. Moreover, the side effects and the potential reasons for giving up treatment were also detected. Results. Vaginal stent significantly decreased the straining intensity, shortened the straining extensity time, decreased the use of laxatives, and alleviated the symptoms of incomplete evacuation ( P < .05). The vaginal stent also increased the rectal pressure and shortened the balloon expulsion time ( P < .05). Conclusions. As an effective, feasible, and safe procedure, the vaginal stent can be recommended as a treatment of choice for rectocele combined with outlet obstructive constipation.