Search Results (64)

Background: Ultraviolet-C (UV-C) radiation is a high-energy physical mutagen capable of inducing DNA damage and oxidative stress, thereby generating genomic variability in photosynthetic organisms. However, its genome-wide effects in unicellular eukaryotic microalgae remain poorly characterized. This study developed a UV-C mutagenesis protocol in Chlamydomonas reinhardtii and evaluated its genomic and physiological impacts. Methods: Axenic cultures of Chlamydomonas reinhardtii (137c+) were exposed to UV-C (100–280 nm) for 12, 48, and 96 min. Viable colonies were analyzed by Random Amplification of Polymorphic DNA PCR (RAPD-PCR) to assess genetic variability, while chlorophyll content and the expression of stress-responsive genes were measured via spectrophotometry and Reverse Transcription quantitative Polymerase Chain Reaction (RT-qPCR), respectively. Results: UV-C treatment induced extensive genomic polymorphism with heterogeneous clustering patterns independent of exposure time, consistent with stochastic mutagenesis. Several mutants exhibited reduced chlorophyll content, indicating impaired photosynthetic efficiency. In contrast, one genotype (pop18) maintained wild-type chlorophyll levels despite marked genetic divergence, coupled with upregulation of antioxidant, DNA repair, and stress-response genes. Conclusions: Overall, UV-C irradiation represents an effective approach to generate non-directional genomic variability in Chlamydomonas reinhardtii, with evidence that random mutagenesis can drive functional reorganization of stress-response pathways, supporting its application in microalgal strain improvement. Full article

Apical prolapse, a common form of Pelvic Organ Prolapse (POP), is often linked to weakened support structures such as the uterosacral (USL) and cardinal ligaments (CL), influenced by factors like vaginal childbirth, aging, and obesity. Although surgical mesh use is expected to increase, the Food and Drug Administration (FDA) banned polypropylene mesh for transvaginal anterior compartment prolapse in 2019 due to safety concerns, highlighting the need for alternatives such as biodegradable implants. This study developed four biodegradable mesh implants (square and sinusoidal geometries) mimicking the USL and CL. These were applied within a computational pelvic model to assess biomechanical behavior during the Valsalva maneuver and to explore different fixation methods (continuous, interrupted and simple stitch sutures). Baseline analysis of the healthy model established vaginal displacement under normal conditions. Without implant support, complete CL rupture increased displacement by 34%, and complete USL rupture raised displacement by 69%. Polycaprolactone implants consistently reduced anterior vaginal wall displacement in all impairment scenarios. Square implants mimicking the USL reduced displacement by up to 10% in cases of complete USL rupture with intact CL. Similarly, square implants mimicking the CL reduced displacement by up to 15% with complete CL rupture and healthy USL. Simulations with both ligaments impaired showed that USL contribute to support, while CL play a key role in stabilization. These findings demonstrate the potential of biodegradable implants to enhance POP repair. However, further studies are needed to evaluate long-term degradation and clinical applicability. Full article

The environmental degradation of plastics results not only in their mechanical fragmentation into microplastics (MPs), but also in polymer main-chain scission processes, causing continuous leaching and/or volatilization of low-molecular-weight species, often characterized by a hazardous profile. In this study, we investigated the hydrophilic photooxidation products (HyPOPs) generated upon UV irradiation of polystyrene (PS) and their transformation catalyzed by the enzyme laccase from the fungus Trametes versicolor. Through a series of enzymatic tests, the enzyme was found to promote coupling and conjugation reactions of HyPOPs into poorly soluble compounds mimicking natural humic acids. The enzymatic activity of laccase was studied under different experimental conditions to simulate those found in environmental matrices. Due to their oligomeric nature, these humic acid-like products of metabolic transformation by the fungal laccase are here nicknamed “mycoplastics” (i.e., polymers from fungi). This enzymatic biodegradation and biotransformation of xenobiotic HyPOPs highlights the role of specific enzymes as biological tools for environmental self-repair of polluted ecosystems. Moreover, it opens new perspectives for remediation strategies targeting elusive micro- and nanoplastics and their continuously generated hazardous molecular degradation by-products. Humic acid-like products resulting from laccase conversion of HyPOPs could contribute to the rehabilitation of contaminated sites by promoting the removal of toxic contaminants from soil and water. Full article

Background/Objectives: Perineoplasty can be performed as an adjunct to native tissue pelvic organ prolapse (POP) surgery; the optimal indication for perineoplasty is unknown due to limited evidence regarding its benefits and the absence of clear clinical guidelines. This study aims to describe patient-related factors associated with surgeons’ decisions to add perineoplasty to POP surgery and to quantify the frequency of intraoperative changes from preoperative surgical plans. Methods: In this multicenter observational cohort study, women ≥ 18 years scheduled for primary native tissue POP surgery between April 2023 and November 2024 were included. Baseline characteristics, pelvic floor anatomy (POP-Q), genital hiatus (GH), perineal body (PB) measurements, and surgeon-reported considerations regarding perineoplasty were collected. Surgical plans (“with”, “without”, or “undecided”) were documented and compared with the actual performed procedure. Logistic and linear regression analyses were used to identify factors associated with perineoplasty. Results: Among the 305 enrolled women, 285 underwent surgery, of whom 135 (47%) received perineoplasty. Patients who underwent perineoplasty had a larger GH size (5.2 cm) compared to patients without perineoplasty (4.5 cm). Obesity was associated with an increased rate of perineoplasty compared to normal weight (OR 2.3 95%CI 1.2–4.6). There was a strong exponential association between childbirth and perineoplasty, with a fivefold increase for two children (95%CI 1.3–17.1) and thirtyfold increase for four or more children (95%CI 6.3–142) compared to one child. Nearly all procedures (92%) followed the preoperative plan; surgeons were more likely to omit than add perineoplasty intraoperatively. Surgeons frequently reported GH/PB size and age as key considerations to perform perineoplasty and lack of evidence and fear of dyspareunia as reasons to not perform perineoplasty. Conclusions: Surgeons more often perform perineoplasty in patients with factors that have been associated with a higher risk of recurrent prolapse. Prospective comparative studies are required to determine whether perineoplasty reduces recurrent POP after primary surgical repair. Full article

Background/Objectives: The growing population of women aged ≥ 80 years poses a new challenge for urogynecology. Advanced age, comorbidities, and polypharmacy raise concerns regarding the safety of procedures in the management of pelvic floor disorders (PFDs) such as pelvic organ prolapse (POP), stress urinary incontinence (SUI), and overactive bladder (OAB). Individualized, frailty-based assessment is essential in this group. The aim of the study was to evaluate the safety profile of urogynecological surgical procedures among women aged ≥ 80 years at a single tertiary center. Methods: In a retrospective observational single-center study, we analyzed the medical documentation of 774 hospitalizations of women aged ≥ 80 years admitted between 2014 and 2023. The analysis included indications, comorbidities, treatment types, anesthesia, and complications. Comorbidity and surgical risk were evaluated using the Charlson Comorbidity Index (CCI) and Clavien–Dindo classification. Results: A total of 720 admissions with complete medical records were analyzed, of which 65% were for urogynecological conditions. In this group, the mean age was 83.0 years and mean BMI was 27.2 kg/m². Most patients (92.9%) had comorbidities, mainly hypertension (84.2%) and diabetes (21.1%). POP was the leading indication (52%), followed by SUI (35%) and OAB (27%). Surgical management was performed in 95% of POP cases, predominantly via vaginal native tissue repair (80%), especially LeFort colpocleisis (20%). The transobturator sling (TOT) was the most frequent SUI surgery. Intraoperative complications occurred in 1.5% of cases and postoperative ones were mainly minor (Clavien–Dindo I–II). No procedure-related deaths were recorded. Conclusions: In this cohort, surgical treatment of urogynecological problems in women ≥80 years was associated with a low rate of major complications, suggesting that it can be safely offered to elderly patients. Careful preoperative assessment based on frailty and comorbidity rather than chronological age remains essential. Full article

Background/Objectives: Durable apical support after hysterectomy is crucial to prevent subsequent vaginal vault prolapse. Abdominal sacrocolpopexy remains the gold standard but carries risks of visceral injury and wound morbidity. The vaginal natural orifice transluminal endoscopic surgery (vNOTES) approach provides a scarless, minimally invasive alternative, but data on vNOTES-assisted sacrocolpopexy (vNOTES-SC) performed concurrently with hysterectomy remain limited. Methods: A retrospective cohort of 30 women with stage II uterine prolapse underwent concomitant hysterectomy and vNOTES-assisted sacrocolpopexy between January 2023 and January 2024. Anatomical outcomes were evaluated using the Pelvic Organ Prolapse Quantification (POP-Q) system preoperatively and at 12 months postoperatively. The primary endpoint was anatomical success (C ≤ −1 cm); the secondary endpoint used the IUGA criterion (C < −TVL/2). Complications were graded using the Clavien–Dindo classification. Statistical analyses included Wilcoxon signed-rank tests, effect-size estimation, ROC analysis, logistic regression, and Spearman correlation. Results: Mean operative time was 100.2 ± 11.7 min, mean blood loss 155.3 ± 74.8 mL, and mean hospital stay 1.5 ± 0.7 days. Significant improvements were seen in Aa, Ba, C, and Bp points (p < 0.001). Anatomical success (C ≤ −1 cm) was achieved in 73.3% and clinical success in 93.3% of patients. Two patients exhibited anatomical recurrence (6.7%), whereas one patient reported symptomatic recurrence (3.3%). Using the IUGA definition, anatomical success increased to 83.3%. The difference between strict success (C ≤ −1 cm) and IUGA success (C < −TVL/2) reflects definitional sensitivity, particularly in post-hysterectomy vaginal length. All complications were minor (Grade I–II). ROC analysis showed age as a weak predictor (AUC = 0.67). Effect sizes were large for apical and anterior compartments (Cohen’s d = 1.84 for C-point). Conclusions: Concomitant hysterectomy with vNOTES-assisted sacrocolpopexy is a feasible, safe, and effective scarless approach for apical support restoration. The procedure provides significant anatomical correction and rapid recovery with low morbidity. Patients had symptomatic stage II prolapse with risk factors for early failure after native-tissue repair, supporting the selection of sacrocolpopexy for durable apical support. Larger prospective trials are needed to confirm long-term efficacy and functional outcomes. Full article

This article examines how K-Pop Demon Hunters (2025) portrays women’s agency and sorority while curating Korean cultural specificity within the context of global streaming. Adopting a Gender Media Studies approach, the study conducts a scene-indexed close reading of nine key sequences, applying a coding scheme (co-presence, agency, solidarity, body framing, choreography–camera, colour) and a cultural-codes matrix that classifies elements as retained, hybridised, or globalised. Findings show a consistent pattern: when two or more women protagonists appear together, agency and sorority co-occur; this is visible in the narrative arcs and through full-body staging, ensemble composition, and a persistent we/together rhetoric. Korean local specificity is divided by purpose: English-led song hooks extend transnational reach; retained social anchors (space, ritual, foodways, and folklore) preserve locality; and hybridised cues (stylised folklore; idol/traditional blends) manage cultural density without erasure. Authorship and industry context align with this encoding, combining a women centred creative core and Korean cast with on-screen emphasis on women’s friendship, repair, and shared agency. Two tensions remain: traditional attire in spectacle numbers, and the narrow body diversity in the idol-slim body ideal, inviting comparative and interpretative scrutiny. Overall, the case demonstrates how an animated musical can emphasise women’s empowerment and cultural specificity without reducing either to mere marketing tools. Full article

Background/Objectives: Pelvic organ prolapse (POP) is a common condition affecting women. When conservative treatment fails, surgical correction is indicated. Anterior colporrhaphy (AC) is a standard procedure for anterior vaginal wall prolapse repair. Postoperatively, an indwelling urinary catheter (IUC) is typically inserted to prevent urinary retention; however, prolonged catheterization is a known risk factor for urinary tract infection (UTI). This study aimed to evaluate whether postoperative catheterization can be safely shortened from 4 days to 24 h after vaginal POP surgery, and to compare the incidence of urinary retention and UTI between the two groups. Methods: A prospective randomized controlled trial was conducted, including 119 patients scheduled for AC for POP repair. All patients received an IUC after surgery and were randomized to catheter removal after either 24 h (group 1) or 4 days (group 2). Urinary retention was defined as a postvoid residual volume > 200 mL after IUC removal. UTI was diagnosed based on typical symptoms and a positive urine culture (≥10⁵ CFU/mL). Results: Data from 80 patients were analyzed. There were no statistically significant differences in catheter reinsertion rates (15% in group 1 vs. 7.5% in group 2, p = 0.288). The incidence of urinary retention was not influenced by the use of Kelly sutures, concomitant procedures, or patient age. No UTIs were confirmed in either group. Median hospital stay was significantly shorter in group 1 (3 [2–4] days vs. 4 [4–4] days, p < 0.001). Conclusions: Short-term catheterization following anterior colporrhaphy is not associated with increased risk of urinary retention or infection. Reducing catheterization duration results in a shorter hospital stay, which may lower healthcare costs and improve patient throughput. Full article

Urogenital prolapse (UP), a manifestation of pelvic organ prolapse (POP), is prevalent and burdensome, impairing urinary, bowel, sexual and psychosocial health. This review synthesizes evidence on epidemiology, mechanisms, clinical evaluation and treatment, with an emphasis on mesh use. POP results from failure of muscular and fascial support, most consistently associated with childbirth and aging; imaging links levator ani avulsion and hiatal overstretching to onset and recurrence. Diagnosis is chiefly clinical, using standardized pelvic examination, with selective adjuncts such as urodynamics, cystoscopy, pelvic floor ultrasound and defecography. Conservative care includes education, lifestyle measures, pelvic floor muscle training and pessaries. Surgery is considered for bothersome prolapse and individualized by compartment, symptoms, sexual goals, comorbidities and preference. Options span native-tissue vaginal repairs with apical suspension, obliterative procedures for non-sexually active patients and sacrocolpopexy. Sacrocolpopexy remains the durability benchmark for apical support but carries mesh-related risks that accumulate over time. Regulatory scrutiny followed rising complications, culminating in withdrawal of transvaginal mesh kits for anterior prolapse, while mesh for sacrocolpopexy persists. Quality-of-life outcomes are central to assessment. Pain after mesh may reflect placement or evolution (erosion, proximity) or persist despite normal findings, implicating neuroplastic mechanisms. Individualized, shared decision-making is essential to balance durability, safety and function. Full article

Background/Objectives: Pelvic organ prolapse (POP) surgery can lead to postoperative stress urinary incontinence (SUI) in previously continent women, termed de novo SUI. This study assessed the incidence and risk factors of de novo SUI after apical POP repair, hypothesizing that reduced bladder neck elasticity—particularly within the zone of critical elasticity (ZCE) described by the Integral Theory—contributes to its development. Methods: A retrospective single-center analysis was performed in 206 postmenopausal women (≥60 years) who underwent apical POP surgery without concomitant anti-incontinence procedures. Patients were classified by surgical approach as laparoscopic sacrocolpopexy (SCP) or vaginal native tissue repair. Results: The overall incidence of de novo SUI was 8.7%. Laparoscopic SCP for vaginal vault prolapse was significantly associated with a higher risk of postoperative SUI (OR 10.37, 95% CI 2.70–39.79, p = 0.001), whereas other procedures showed no significant association. Neither prior hysterectomy nor cystocele stage was an independent predictor of de novo SUI. Conclusions: These results suggest that surgical alteration of the ZCE—particularly excessive tension or reduced elasticity near the bladder neck—may impair urethral closure. Therefore, preserving ZCE integrity and carefully adjusting mesh tension during apical POP repair may reduce the risk of de novo SUI. Full article

Background/Objectives: Pelvic organ prolapse (POP) is a common condition that increases with age and affects up to 40% of women. Colpocleisis is a possible native-tissue repair used in elderly persons not interested in vaginally penetrative sex to correct advanced POP. This study aims to evaluate the recurrence and reoperation rate of a technique using purse-string sutures in a standardised way. Methods: This retrospective quality control study evaluated all women who underwent obliterative procedures for POP at the Department of Obstetrics and Gynaecology at the University Hospital of Bern from 2014 to 2023. Total Colpocleisis (TC) and Le-Fort Colpocleisis (LFC) were performed by a standardised technical procedure using purse-string sutures. The primary outcome was the recurrence rate measured by the POP-Q stage (stage 2 or higher). Reoperation rate, perioperative complications, bladder outlet disorders and incontinence symptoms were assessed as secondary outcomes. Results: We analysed eighty-eight patients who underwent obliterative surgery with TC or LFC in this study. The recurrence rate for all patients was 16%, and the reoperation rate was 9.2%. In patients without previous surgeries (52%), the recurrence rate was 7%. Thirteen patients (14.8%) had perioperative complications, mainly urinary tract infections (seven patients, 8%). Objective POP improved significantly (p < 0.001), as did the bladder voiding dysfunction in the rate of high postvoid residual volume (p < 0.05), stress urinary incontinence, overactive bladder and mixed urinary incontinence (p < 0.001). In three patients, de novo stress urinary incontinence developed postoperatively. Conclusions: Colpocleisis by the purse-string technique is an effective surgical treatment for advanced POP surgery. Recurrence and reoperation rates are similar to the previously mentioned techniques and are easy to learn due to the standardised procedure. Full article

Pelvic organ prolapse (POP) affects millions of women around the world, with age-standardized prevalence rates of 2769 per 100,000 women in 2021. Although it greatly affects quality of life (QoL), only 18–50% of women experiencing this issue seek medical attention, largely due to a lack of knowledge, misunderstandings about the condition, and obstacles to accessing healthcare. This narrative review explores the progression of POP management towards a focus on patient-centered care, highlighting the importance of personalized treatment strategies that prioritize patient-reported outcomes (PROs) over solely anatomical factors. The approach to treatment has transitioned from being centered on anatomy to focusing on the patient, emphasizing the relief of symptoms and enhancement in QoL. Existing research indicates that monitoring without intervention is advisable for asymptomatic patients, as long-term studies have revealed that up to 40% of women experience stable or improved prolapse over a period up to 60 months. Pessary treatment has a fitting success rate above 90% and a treatment persistence rate of 60%, providing an effective non-surgical option for management. The approach to selecting surgical treatments has progressed to prioritize sufficient apical support as a key factor for achieving lasting results. For primary POP, native tissue repair (NTR) is now recommended as the first-line surgical option. Mesh-augmented repairs are used only in certain high-risk situations, whereas sacrocolpopexy offers the best anatomical stability for particular cases, such as those involving post-hysterectomy prolapse and recurrences. Contemporary POP management involves personalized, patient-focused decision-making that emphasizes addressing symptom severity and functional objectives rather than solely aiming for anatomical precision. The evidence suggests that NTR should be the primary surgical approach, while other procedures should be reserved for specially chosen patients. Success should primarily be evaluated based on PROs instead of anatomical factors, ensuring that treatments align with each patient’s preferences and expectations while reducing complications. Full article

Background/Objectives: The use of vaginal mesh for pelvic organ prolapse (POP) repair remains controversial following global restrictions due to safety concerns. This study evaluated intra- and perioperative morbidity following a standardized single-incision, six-point fixation approach using an ultralight vaginal mesh in primary surgery for anterior/central POP. Methods: We conducted a retrospective multicenter study including 426 women who underwent primary POP repair with the InGYNious mesh system between May 2016 and February 2024. All surgeries followed a uniform technique across seven Italian centers. Data were collected on perioperative complications, urinary function, postoperative pain, and catheter duration. Results: The overall morbidity rate was 7.3% (31/426), primarily due to hematomas (4.5%), bladder injuries (1.4%), and ureteral injuries (0.7%). Median surgery duration was 40 min with minimal blood loss. Early postoperative pain was associated with higher POP-Q scores, longer surgical duration, and lower BMI. No cases of de novo urinary incontinence or urinary tract infection were reported in the perioperative period. Conclusions: This large multicenter case series suggests that, in experienced hands, this standardized vaginal mesh approach is associated with a low perioperative complication rate. However, the absence of a control group and the short follow-up are major limitations. Long-term outcome data, particularly regarding mesh-related complications, are essential before drawing firm conclusions on the broader safety or role of vaginal mesh in POP repair. Full article

Background: Pelvic organ prolapse (POP) significantly impairs patients’ quality of life, especially in urinary, bowel, and sexual domains. While laparoscopic sacrocolpopexy (LS) is the current gold standard for apical prolapse repair, it is associated with certain complications. Laparoscopic pectopexy (LP), a newer technique utilizing the iliopectineal ligament for apical suspension, may offer improved outcomes with fewer adverse effects. This scoping review aimed to evaluate patient-reported outcomes (PROs) and quality of life (QoL) following LP and compare its effectiveness to other established surgical approaches. Methods: A scoping review was conducted in accordance with PRISMA-ScR guidelines. Searches of PubMed, Scopus, and Web of Science databases were performed through June 2025. Eligible studies included randomized controlled trials, prospective and retrospective cohorts, and case series that reported PROs following LP. Data on validated QoL tools (e.g., P-QOL, PFDI-20, PFIQ-7, FSFI, PISQ-12), surgical technique, and follow-up duration were extracted. Due to heterogeneity in the study design and outcomes, findings were synthesized qualitatively. Results: Thirteen studies including a total of 742 patients met the inclusion criteria. Across all included studies, LP was associated with significant improvements in QoL metrics, including urinary and sexual function, and overall patient satisfaction. Tools such as PFDI-20, FSFI, PISQ-12, and PGI-I consistently showed postoperative improvement (p < 0.05). Comparative studies demonstrated that the outcomes for LP were similar or superior to those of sacrocolpopexy, sacrospinous fixation, or sacrohysteropexy, particularly regarding sexual function. Conclusions: LP is an effective surgical alternative for apical POP repair, offering significant improvements in patient-reported quality of life and functional outcomes. Its favorable safety profile and comparable efficacy to traditional methods make it a compelling option, particularly for patients with contraindications to sacral dissection. Findings are limited by small and heterogeneous studies, short follow-up, and potential publication and language biases. Further prospective studies with long-term follow-up periods are necessary to confirm these findings and refine patient selection criteria. Full article

Background/Objectives: De novo stress urinary incontinence (SUI) can develop postoperatively in patients without prior symptoms, and can persist beyond 6 months, posing clinical challenges. This study aimed to identify predictors of persistent de novo SUI after transvaginal mesh (TVM) surgery and to evaluate management strategies. Methods: A retrospective review of 817 women with anterior and apical pelvic organ prolapse (POP) (stage II–IV) who underwent TVM surgery from 2013 to 2021 was conducted. Fifty patients developed de novo SUI postoperatively. Assessments included urodynamic studies, validated symptom questionnaires, and POP quantification (POP-Q) staging. Logistic regression analysis was used to identify predictors of persistent symptoms. Results: Spontaneous resolution occurred in 30% (15/50) of participants within six months, while 70% (35/50) had persistent SUI. Concomitant posterior mesh repair was more frequent in the persistent group compared to the self-limiting group (29% vs. 7%), and was significantly associated with symptom persistence (OR 5.6, 95% CI, 0.65–48.4; p = 0.03, chi-square test). During conservative management with observation alone, 30% (15/50) experienced spontaneous resolution within 6 months, while 70% (35/50) had persistent symptoms. Among those with persistent symptoms, 56% required no further treatment, 10% improved with vaginal laser therapy, and 4% underwent sling surgery. Conclusions: Conservative management remains critical in the early postoperative period, given the high rate of spontaneous symptom resolution. For persistent cases, minimally invasive options such as vaginal laser therapy may be beneficial. Notably, only 4% required anti-incontinence surgery. Full article