Surgical procedure to correct genital prolapse in a patient with reduced CACNA1C gene expression in the round ligament of the uterus
Background. Genital prolapse (GP) is a disease that has a high recurrence rate after surgical correction. It is based on both the underestimation of the factors leading to GP (connective tissue incompetence, the features of microcirculation and labor course, etc.), and the stereotypes and preferences of a surgeon when choosing a method for GP surgical correction. Phenotypically, patients with GP are prominent representatives of a sarcopenia phenotype. Nevertheless, the literature lacks studies investigating the expression level of the α-1 subunit of the voltage-gated calcium channel CaV1.2 in the smooth muscle tissue of patients with GP, which may be another factor for the latter and its recurrences after surgical correction.Smolnova T.Yu., Krasnyi A.M., Chuprynin V.D., Sadekova A.A., Chursin V.V., Tаmbieva F.R.
Case report. The paper describes a 37-year-old female patient with apical GP, pelvic floor protrusion and relaxation with intact pelvic nerve conduction. The patient has connective tissue dysplasia, an Ehler-like phenotype, with the preponderance of a weak stromal and muscular component: grade 2 mitral valve prolapse, incomplete right bundle branch block, childhood myopia, joint hypermobility, arterial hypotension, minor malformations, etc. The investigators performed physical examinations, genital ultrasound evaluation, Echo-CG, special studies (defetography, pelvic nerve conduction test, sphincterometry, and anorectal manometry), and investigation of the CACNA1C gene expression in the smooth muscles of the round ligament of the uterus, by using real-time PCR.
Conclusion. The authors present the combined technique for GP surgical correction, which has been developed for use in patients with hereditary multicompartmental pelvic organ prolapse.
Keywords
genital prolapse
pelvic floor protrusion
defetography
pelvic nerve conduction
connective tissue dysplasia
mesh implant
hysteropexy
sarcopenia
CACNA1C gene expression
round ligament of the uterus
References
- Dietz H.P. The aetiology of prolapse. Int. Urogynecol. J. Pelvic Floor Dysfunct. 2008; 19(10): 1323-9. https://dx.doi.org/10.1007/s00192-008-0695-7.
- Смольнова Т.Ю. Пролапс гениталий и дисплазия соединительной ткани. Клиническая и экспериментальная хирургия. Журнал имени академика Б.В. Петровского. 2015; 2: 53-64. [Smolnova T.Yu. Genital prolapse and connective tissue dysplasia. Clinical and experimental surgery. The journal named after academician B.V. Petrovsky. 2015; 2: 53-64. (in Russian)].
- Hofmann F., Flockerzi V., Kahl S., Wegener J.W. L-type CaV1.2 calcium channels: from in vitro findings to in vivo function. Physiol. Rev. 2014; 94(1): 303-26. https://dx.doi.org/1010.1152/physrev.00016.2013.
- Смольнова Т.Ю., Красный А.М., Чупрынин В.Д. Волгина Н.Е., Никитцева О.В. Влияние уровня экспрессии α-1 субъединицы потенциал-зависимого кальциевого канала CaV1.2 в гладкомышечной ткани у пациенток с пролапсом гениталий. В кн.: Сухих Г.Т., Адамян Л.В., ред. Материалы XIII Международного конгресса по репродуктивной медицине 21–24 января 2019. М.: МЕДИ Экспо; 2019: 126-9. [Smolnova T.Yu., Krasny A.M., Chuprynin V.D. Volgina N.E., Nikitseva O.V. Influence of the expression level of the α-1 subunit of the voltage-gated calcium channel CaV1.2 in smooth muscle tissue in patients with genital prolapse. In the collection: XIII International Congress on Reproductive Medicine January 21–24, 2019. 2019; 126-9. (in Russian)].
- Красный А.М., Озернюк Н.Д. Экспрессия генов, кодирующих субъединицы потенциал-зависимых Са2+-каналов L-типа в пролиферирующих и дифференцирующихся миобластах линии С2С12мыши. Известия Российской академии наук. Серия биологическая. 2011; 3: 349-53. [Krasny A.M., Ozernyuk N.D. Expression of genes encoding the subunits of voltage-dependent Са2+ channels of the L-type in proliferating and differentiating myoblasts of the C2C12 line of the mouse. Proceedings of the Russian Academy of Sciences. Biological series. 2011; 3: 349-53.(in Russian)].
- Чупрынин В.Д., Смольнова Т.Ю., Чурсин В.В., Никитцева О.В. Комбинированный способ лапароскопической гистеропексии и вагинопексии в сочетании с ректопексией, коррекцией высокого ректоцеле, энтероцеле. Патент на изобретение RU 2712006 C1, 23.01.2020. Заявка № 2019103846 от 12.02.2019. [Chuprynin V.D., Smolnova T.Yu., Chursin V.V., Nikitseva O.V. Combined method of laparoscopic hysteropexy and vaginopexy in combination with rectopexy, correction of high rectocele, enterocele. Invention patent RU 2712006 C1, 01/23/2020. Application No. 2019103846 dated 12.02.2019. (in Russian)].
- Sykes L., Clifton N.E., Hall J., Thomas K.L. Regulation of the expression of the psychiatric risk gene cacna1c during associative learning. Mol. Neuropsychiatry. 2018; 4(3): 149-57. https://dx.doi.org/1010.1159/000493917.
- Lee A.S., De Jesus-Cortes H., Kabir Z.D., Knobbe W., Orr M., Burgdorf C. et al. The neuropsychiatric disease-associated gene cacna1c mediates survival of young hippocampal neurons. eNeuro. 2016; 3(2): ENEURO.0006-16.2016. https://dx.doi.org/1010.1523/ENEURO.0006-16.2016.
Received 29.04.2020
Accepted 04.12.2020
About the Authors
Tatiana Yu. Smolnova, MD., senior associate of the Surgery department, V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology,Ministry of Health of Russia. Tel.: +7(926)310-80-90. E-mail: smoltat@list.ru. 4 Akademika Oparina str., Moscow, 117997, Russia.
Aleksey M. Krasnyi, PhD, Head of the Cytology laboratory, V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology,
Ministry of Health of Russia. Tel.: +7(495)438-22-72. E-mail: alexred@list.ru. 4 Akademika Oparina str., Moscow, 117997, Russia.
Vladimir D. Chuprynin, PhD/Med, Head of the Surgery department, V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology,
Ministry of Health of Russia. Tel.: +7(495)438-78-33. E-mail: v_chuprynin@oparina4.ru. 4 Akademika Oparina str., Moscow, 117997, Russia.
Vyacheslav V. Chursin, surgeon at the Department of General Surgery, V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology,
Ministry of Health of Russia. Tel.: +7(495)438-78-33. 4 Akademika Oparina str., Moscow, 117997, Russia.
Fatima R. Tambieva, physician, resident of the Department of General Surgery, V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia. 4 Akademika Oparina str., Moscow, 117997, Russia.
For citation: Smolnova T.Yu., Krasnyi A.M., Chuprynin V.D., Sadekova A.A., Chursin V.V., Tаmbieva F.R. Surgical procedure to correct genital prolapse in a patient with reduced CACNA1C gene expression in the round ligament of the uterus.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2020; 12: 234-241 (in Russian)
https://dx.doi.org/10.18565/aig.2020.12.234-241
Similar Articles
