Gynecologic Oncology

Nirmala G. Prabawati

Malang , Indonesia

Title: Impaired Muscle Stem Cells (MuSCs) of Levator ani after Chilbirth up to Aging State as Pathogenesis of Pelvic Organ Prolapse


Pelvic organ prolapse (POP) is a common urogynaecological disorder that affects one in four women across all age groups, or over 50% of postmenopausal parous women with a history of vaginal birth. The injury of levator ani muscle as the largest component of pelvic floor during vaginal birth might assosciate with impaired muscle satelite stem cell (MuSCs) deterioration and the occurance of pelvic organ prolapse in elderly state.  MuSCs play a central role to repair and maintain the muscle in which they reside by their self-renewal ability and capacity of differentiating into distinct and specialized cells. As stem cells age, their renewal ability declines and their capacity to maintain organ homeostasis and regeneration is impaired. From a molecular perspective, these changes in stem cells properties can be due to several types of cell intrinsic injury and DNA aberrant alteration as well as changes in the tissue microenviroment might be influenced by muscle tissue injuries during vaginal birth. It has been suggested that aging-induced deterioration of stem cell functions may play a key role in the pathophysiology of the various aging-associated disorders, including pelvic organ prolapse. Aging-related elevation in circulating levels of proinflammatory cytokines, such as interleukin 6 (IL-6) and tumor necrosis factor ? (TNF-?), can also cause differentiation disorders of MuSCs. The decline of MuSC regenerative capacity is due to age-associated extrinsic/environmental changes as well as cell-intrinsic/autonomous changes. As extrinsic factors, inflammatory responses, extracellular components, and changes in interacting cell types definitely affect the function in MuSCs. MuSC function is also impaired by cell-intrinsic damages including oxidative stress, DNA damage, modified signaling pathways, damage to proteins, and altered metabolism. Changes in these microenvironmental factors in response to aging are believed to be responsible for the changes in stem cell function with aging. It has been shown that potentially underlying aging-related tissue degeneration, such as pelvic organ prolapse, could be due to impaired MuSCs by surrounding micro-environmental pathologic factors. Degeneration of pelvic floor muscles in aging process related to deterioration of their stem cell functions since after birth is the key of thie review. 


Nirmala Prabawati is an obstetrician and gynecologist of Brawijaya University Hospital, one of educational hospital In Indonesia. She also a lecturer in Medical Faculty of Brawijaya University, Malang. Her interest is in urogynecology reconstruction and pelvic surgery and she intended to have consultant training in urogynecology. She worked as General Practioner for Freeport Hospital and some rural areas in Tembagapura, Papua Indonesia for 2 years before she enrolled ObsGyn residency in 2009-2013. She held best presentation in oral speech for Obstetrics and Gynecology Asscociation Annual Meeting in 2013, and She won travel award for Internasional Society of Study of Hypertension in Pregnancy in 2014.