Cicatrização do assoalho pélvico e relação com prolapso de órgão pélvico – O que sabemos?
DOI:
https://doi.org/10.11606/issn.1679-9836.v99i4p374-383Palavras-chave:
Gynecology, Urogynecological, Pelvic floor, Wound healing, Pelvic organ prolapseResumo
Pelvic organ prolapse (POP) is a result of the pelvic’s floor supportive tissues weakening, including levator ani muscles, endopelvic fascia, ligaments, and the vaginal wall. The objective of this review is to describe the wound healing physiology in tissues that might be injured in the pelvic floor and to discuss the factors that affect wound healing. Since the most important risk factors for POP, such as pregnancy, vaginal delivery, and increased intra-abdominal pressure, trigger tissue damage, i.e. a wound in the pelvic floor tissues, we hypothesize that a frustrated wound healing process could affect the tissue homeostasis and promote POP. MEDLINE database was searched to review the literature up to 2017. As with skin, the wound healing in the pelvic floor tissues takes place in four phases (hemostasis, inflammation, proliferation and remodeling), however the duration of each phase is longer in the different structures of the pelvic floor compared to skin. Mechanical loading in the pelvic floor negatively affects healing and is associated with increased collagenase activity, whilst estrogen seems to improve the mechanical properties of the stretched tissue and could be beneficial for vaginal wound healing. Neither damaged muscle, nerves, ligaments nor vaginal wall will fully recover their pre-wounding characteristics. We postulate that a frustrated wound healing of the tissues of the pelvic floor generates tissues with altered composition and mechanical properties which could lead to the incidence or progression of POP.
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