VİTAMİN D VE UTERİN PROLAPSUS ARASINDAKİ İLİŞKİ The Association Between Vitamin D and Uterine Prolapse

OZET Amac: Pelvik organ prolapsusu pelvik organlarin vajinal duvarlara veya otesine herniasyonu olarak tanimlanir. Vitamin D eksikliginin pelvik taban kas gucsuzlugune sebep oldugu dusunulmektedir. Calismamizin amaci uterin prolapsusu olan hastalarda vitamin D eksikligini ve incelemektir. Gerec ve Yontemler: Izmir Tepecik Egitim ve Arastirma Hastanesi Kadin Hastaliklari ve Dogum Klinigi’nde Şubat 2015-2016 arasinda peri- ve postmenapozal yasta vajinal degerlendirmede evre 3-4 uterin prolapsusu saptanan ve opere olan hastalar; kontrol grubu olarak da ayni yas grubunda herhangi bir jinekolojik durum nedeniyle opere olan hastalar retrospektif olarak incelendi. Vitamin D metabolizmasini etkileyecek hastalik veya fekal inkontinans sebebi olabilecek evre 3 kronik bobrek yetmezligi, kronik karaciger hastaligi, gastric bypass, kolovajinal fistul ve pelvik radyasyon oykusu olan kisiler calismadan cikarildi.olan kisiler calismadan cikarildi. Dahil edilen kisilerin yas, gravida parite, dogum sekli ve 25 (OH) vitamin D, ICS prolapsus evreleri kaydedildi. Bulgular: Calisma kriterlerine uygun 40 hasta ve 40 kisi kontrol olarak kaydedildi. Hasta grubunun 25-OH D vitamini duzeyleri (9,5±14,0 ng/ml) kontrol grubundan (15,3 ± 20,3 ng/ml) dusuk olarak saptandi (p=0,140). Hasta grubunun 95,0%’i ve kontrol grubunun 77,5%’inde 25-OH D vitamini eksikligi (<20 ng/mL) saptandi (p=0,024). 25-OH D vitamini eksikligi uterin prolapsus icin bagimiz risk faktoru olarak saptandi (OR=5.8, 95% CI=1.0 – 33,3). Sonuc: Vitamin D eksikligi uterin prolapsus gelisimi icin risk faktoru olabilir. Anahtar Kelimeler: Pelvik organ prolapsusu; Vitamin D; Risk faktoru ABSTRACT Aim: Pelvic organ prolapse, the hernniation of the pelvic organs or beyond the vaginal walls. Vitamin D deficiency appears to be cause for pelvic muscle weakness. The aim of this study is to investigate the lack of vitamin D in patients with uterine prolapse. Methods: The records of patients were evaluated retrospectively in peri- and postmenopausal age group who were diagnosed with ICS stage 3-4 uterine prolapse based on vaginal examination and operated between February 2015-2016 in Izmir Tepecik Education and Research Hospital Gyneology and Obstetrics clinic. The files of 40 patients with ICS stage 0 in the peri- and postmenopausal period, whose 25 (OH) vitamin D were measured at the same time with the patient group and who underwent surgery due to any gynecologic indication, were evaluated as control group. Women were excluded if they had any medical conditions known to impair absorption or metabolism of vitamin D, or to be a major cause of fecal incontinence including Stage ≥3 chronic kidney disease, chronic liver disease, gastric bypass, colovaginal fistula, and pelvic irradiation. Results: 40 patients’ and 40 control cases’ data who met the study criteria were recorded. The patient group had a lower level of 25 (OH) vitamin D (9,5 ± 14,0 ng/ml) than the control group (15,3 ± 20,3 ng/ml). Furthermore, 25 (OH) vitamin D deficiency (25 [OH] vitamin D level <20 ng/mL) was found in 95,0% of the patient group and 77,5% of the control group (p=0,024). A 25 (OH) vitamin D level of <20 ng/mL was found to be the independent risk factor for uterine prolapse (OR=5,8, 95% CI=1,0 – 33,3). Conclusion: Vitamin D deficiency may be a risk factor in the development of uterine prolapse. Key words: Pelvic organ prolapse; Vitamin D; Risk factor