La capacité d'auto-soin et le sentiment d'auto-efficacité des patients effectuant des auto-sondages intermittents à domicile

La complexité des mécanismes de contrôle neurologique du système vésicosphinctérien fait que toute pathologie concernant le cerveau, la moelle épinière ou les nerfs périphériques peut avoir des répercussions sur la continence urinaire et indirectement sur la fonction rénale. Actuellement, l'auto-sondage intermittent (ASI) est le traitement recommandé pour les personnes qui présentent des dysfonctionnements de l'appareil urétro-vésical entrainant une vidange incomplète de la vessie ou une incontinence urinaire. Toutefois, cette procédure implique un engagement, des connaissances et une participation des personnes concernées pouvant s'avérer lourds au quotidien. De ce fait, les infirmières ont un rôle primordial à jouer dans l'éducation thérapeutique et le suivi de ces personnes. Le but de cette étude descriptive corrélationnelle est d'évaluer d'une part, les relations entre le sentiment d'auto-efficacité et la capacité d'auto-soin, et d'autre part, les relations entre ces deux variables et les variables sociodémographiques et de santé des personnes pratiquant l'ASI. La théorie des auto-soins d'Orem a été retenue comme cadre de référence. Le recrutement des participants a eu lieu en Suisse romande, auprès de deux institutions de soins et d'une association de patients. L'échantillon de convenance est composé de 77 personnes pratiquant ou ayant arrêté l'ASI. Les données de l'étude ont été recueillies à l'aide d'un questionnaire de données sociodémographiques et de santé, et de deux instruments de mesure validés en français. Les trois instruments étaient auto-administrés. Les résultats montrent qu'il existe une relation entre le sentiment d'autoefficacité et la capacité d'auto-soin des personnes qui pratiquent l'ASI à domicile, r = 0,299, p = 0,0084, IC 95% [0,080, 0,490]. Le sentiment d'auto-efficacité est quant à lui associé au niveau de formation, à la durée des troubles urinaires et à l'utilisation de protection pour l'incontinence. En ce qui concerne la capacité d'auto-soin, elle est associée à l'âge des personnes qui pratiquent l'ASI. En conclusion, les résultats de cette étude nous aident à mieux comprendre quelques enjeux pouvant influencer l'utilisation des ASI à domicile. Leur intégration dans la pratique clinique devrait permettre le développement de nouvelles interventions en éducation thérapeutique et ouvrir des perspectives pour de futures recherches dans ce domaine. Cette étude représente une des premières réalisées en Suisse sur l'utilisation de l'ASI avec des patients atteints de lésion médullaire et de sclérose en plaques. Dans ce contexte, il s'avère indispensable de poursuivre nos explorations.

Puhdistetun jäteveden patogeenit ja desinfiointitarve

Turun seudulla kuuden kunnan jätevesien käsittely keskitetään Kakolanmäen kallion sisälle rakennettuun jätevedenpuhdistamoon, joka otetaan käyttöön vuoden 2008 lopulla. Kakolanmäen jätevedenpuhdistamolla on varauduttu tulevaisuudessa kiristyviin lupaehtoihin sekä mahdollisiin puhdistetun jäteveden hygieenistä laatua koskeviin lisämääräyksiin jättämällä tilavaraus puhdistetun jäteveden desinfioimiselle ultraviolettivalolla. Diplomityössä on selvitetty vuoden kestäneessä tutkimusjaksossa 1.9.2006- 31.8.2007 Turun kaupungin keskuspuhdistamolta mereen johdetun puhdistetun jäteveden ja esiselkeytetyn ohitusveden hygieenisen laadun vaihtelua. Jäteveden desinfiointitarvetta on arvioitu tarkastelemalla jätevedenpuhdistamon hygieenistä puhdistustulosta ja jätevesien vaikutusta purkuvesistön hygieeniseen tilaan. Tutkimuksen perusteella virtaama ei vaikuttanut merkittävästi jäteveden ulosteperäisten bakteerien määriin. Sen sijaan jäteveden bakteeripitoisuudet laskivat alhaisissa lämpötiloissa. Lämpötilan vaikutus näkyi selkeämmin esiselkeytetyssä kuin puhdistetussa jätevedessä eli bakteerien poistumiseen aktiivilietevaiheen aikana vaikuttavat muut tekijät. Mitä tehokkaammin aktiivilietevaihe toimi, sitä tehokkaammin myös bakteereja poistui. Taudinaiheuttajabakteerit selvisivät puhdistusprosessista paremmin viileän kauden aikana. Puhdistetun jäteveden hygieeninen laatu ei täyttänyt uimaveden tai kasteluveden laatuvaatimuksia, joten desinfiointitarve olisi perustelua. Jätevesien vaikutus Turun edustan merialueen hygieeniseen tilaan näkyi ajoittain korkeina bakteeripitoisuuksina purkupaikan lähistöllä. Vielä ei ole suoraa näyttöä siitä aiheuttavatko jätevedet purkupaikan lähistön uimarannoilla terveydellisiä riskejä. Jäteveden UV-desinfiointi kannattava toteuttaa vain jos hygieeninen puhdistusvelvoite määrätään. UV-desinfioinnin mitoituksessa Kakolanmäen jätevedenpuhdistamolla tulee ottaa huomioon suurin sallittu hydraulinen painehäviö. Mitoitus voidaan tehdä puhdistamon käyttöönoton jälkeen kun tarvitut prosessimittaustiedot ovat saatavilla.

Distribuição de coprostanol (5beta(H)-colestan-3beta-ol) em sedimentos superficiais da Baía de Guanabara: indicador da poluição recente por esgotos domésticos

A critical evaluation is presented on the use of faecal sterols for the identification of sewage contamination in Guanabara Bay. Sediments were collected from 8 stations in the bay selected as representative of different contamination levels. GC/MS determination of faecal sterols gave: coprostanol, 335 - 40000 ng g-1; coprostanone, 112-4136 ng g-1; cholesterol, 1407-7800 ng g-1; cholestanol, 2011 - 10900 ng g-1 and cholestanone, 655-7954 ng g-1. The observed concentration is in accordance with the presence of known pollution sources, however, concentration ratios of different sterols species produced unclear results evidently influenced by primary production and microbial processes.

Identifying and Characterizing New Ingredients in vitro for Prebiotic and Synbiotic use

The endogenous microbiota, constituting the microbes that live inside and on humans, is estimated to outnumber human cells by a factor of ten. This commensal microbial population has an important role in many physiological functions, with the densest microbiota population found in the colon. The colonic microbiota is a highly complex and diverse bacterial ecosystem, and a delicate balance exists between the gut microbiota and its host. An imbalance in the microbial ecosystem may lead to severe symptoms in and also beyond the gastrointestinal tract. Due to the important role of the gut microbiota in human health, means of its modification have been introduced in the dietary concepts of pro-, pre- and synbiotics. Prebiotics, which are usually carbohydrates, strive to selectively influence beneficial microbes resident in the colon with the aim of modifying the composition and functionality of the commensal microbial population towards a purportedly healthier one. The study of prebiotic effects on colonic micro-organisms is typically done by using human faecal material, though this provides relatively little information on bacterial populations and metabolic events in different parts of the colon. For this reason, several in vitro models have been developed to investigate the gut microbiota. The aim of this doctoral thesis was to screen through some of the promising prebiotic candidates, characterize their effects on the microbiota through the use of two in vitro methods (pure microbial cultures and a colon simulator model) and to evaluate their potential as emerging prebiotics or synbiotics when combined with the probiotic Bifidobacterium lactis . As a result of the screening work and subsequent colon simulation studies, several compounds with promising features were identified. Xylo-oligosaccharides (XOS), which have previously already shown promise as prebiotic compounds, were well fermented by several probiotic Bifidobacterium lactis strains in pure culture studies and in the following simulation studies utilizing the complex microbiota by endogenous B. lactis Another promising compound was panose, a trisaccharide belonging to isomalto-oligosaccharides (IMO) that also was also able to modify the microbiota in vitro by increasing the number of beneficial microbes investigated. Panose has not been widely studied previously and therefore, this thesis work provided the first data on panose fermentation in mixed colonic microbiota. Galacto-oligosaccharide (GOS) is an established prebiotic, and it was studied here in conjunction with another potential polygosaccharide polydextrose (PDX) and probiotic B. lactis Bi-07. In this final study, the synbiotics including GOS were more effective than the constituting pro- or prebiotics alone in modulating the microbiota composition, thus indicating a synergy resulting from the combination. The results obtained in this in vitro work can be, and have already been, utilized in product development aimed at the nutritional modification of the human colonic microbiota. Some of the compounds have entered the human clinical intervention phase to nvestigate in more detail the prebiotic and synbiotic properties seen in these in vitro studies.

Epidemiological profile and postoperative complications of women undergoing gynecological surgery in a reference center in the northern brazilian legal amazon

Objective: To evaluate the epidemiological profile and the operative complications of patients undergoing gynecological operations for benign diseases in a tertiary public hospital in the state of Roraima, Brazil. Methods: We conducted a retrospective survey through the analysis of 518 records of patients submitted to gynecological operations between January and June 2012. We included the three major operations during this period (n = 175): hysterectomy, colpoperineoplasty and suburethral sling placement. We excluded 236 cases of tubal ligation and 25 cases where it was not possible to access to medical records. Results: The mean age was 47.6 years; the education level of most patients was completed junior high (36.6%); 77% were from the State capital, 47.4% were in stable relationships and 26.3% were housewives. The majority of patients had given birth three or more times (86.6%), with previous vaginal delivery in 50.2%, and cesarean delivery, 21%. The main diagnostic indications for surgical treatment were uterine myoma (46.3%), urinary incontinence (27.4%) and genital dystopias (17.7%). We found three cases (1.7%) of high-grade intraepithelial lesions on Pap smear. The most common procedure was total hysterectomy (19.8%), 15.5% vaginally. The most common complication was wound infection (2.2%). Conclusion: Women undergoing gynecological operations due to benign disease had a mean age of 47 years, most had levels of basic education, came from the capital, were in stable relationships, predominantly housewives, multiparous and showed low operative complication rates.

Tradução e validação para a língua portuguesa de um questionário para avaliação da gravidade da incontinência urinária

OBJETIVO: traduzir para a língua portuguesa, adaptar culturalmente e validar o questionário Incontinence Severity Index (ISI). MÉTODOS: dois tradutores brasileiros realizaram a tradução do ISI para a língua portuguesa e uma versão foi gerada por consenso entre eles. Esta versão foi retraduzida para o inglês por outros dois tradutores que tinham esta língua como língua-mãe. As diferenças entre as versões foram harmonizadas e pré-testadas em um estudo piloto. Após uma semana da realização do questionário ISI, este foi reaplicado para a realização do reteste. A versão final do ISI foi aplicada juntamente com o pad test de uma hora em mulheres com incontinência urinária de esforço (IUE). Para validação do ISI, foram testadas a confiabilidade (consistência interna e teste-reteste) e a validade de constructo. RESULTADOS: a confiabilidade do instrumento foi avaliada por meio do coeficiente α de Cronbach, tendo como resultado geral 0,93, demonstrando excelente confiabilidade e consistência do instrumento. O coeficiente de correlação intraclasse e o erro padrão da medida foram de 0,96 e 0,43, respectivamente. Por meio da correlação de Pearson foi verificada uma correlação forte e positiva (r=0,72, p<0,0001) entre os resultados do questionário ISI e o pad test de uma hora. CONCLUSÃO: a versão em português do ISI, traduzida e adaptada culturalmente para o português do Brasil, apresentou confiabilidade e validade de constructo satisfatórias e foi considerada válida para avaliação da gravidade da IUE.

Predictive factors for voiding dysfunction after transobturator slings

PURPOSE: To identify the predictive factors for voiding dysfunction after transobturator slings. METHODS: We retrospectively reviewed the records of all patients who underwent a transobturator sling between March 2003 and December 2008. A total of 514 women had available data with at least a six-week follow-up. Patients' demographics, preoperative symptoms, urodynamic testing including multichannel voiding studies and surgical variables were tabulated. Voiding dysfunction was defined by a catheterized or ultrasonographic postvoid residual greater than 100 cc (≥six weeks after the procedure) associated with any complaints of abnormal voiding. Univariate logistic regression analysis was performed with respect to postoperative voiding dysfunction. RESULTS: The patient population had a mean age of 58.5±12.9 years. Thirty-three out of 514 patients (6.4%) had postoperative voiding dysfunction according to our definition, and 4 (0.78%) required sling transection. No differences were observed between normal and dysfunctional voiders in age, associated prolapse surgery, preoperative postvoid residual, preoperative urinary flow rate, prior pelvic surgery, and menopausal status. Valsalva efforts during the preoperative pressure flow study was the only predictive factor for postoperative voiding dysfunction, 72.4% dysfunctional versus 27.6% normal (p<0.001). CONCLUSION: Preoperative Valsalva maneuver during the micturition could identify those at risk for voiding dysfunction after transobturator sling, and it should be noted during preoperative counseling.

Survey on control and management practices of equine helminthes infection

Twenty-nine stud farms were selected in the Medium Paraíba region of the Rio de Janeiro state, Brazil. After an interview with the person responsible for the animals, faecal samples were collected from mares and analyzed via the EPG technique, faecal cultures, Sedimentation-centrifugo-flotation, and modified Ueno and Baermann techniques. The prevalence of helminths in the mares and in the stud farms was calculated. The stocking rates of pasture, change of horse bedding, absence of pasture rotation, absence of technology in the property, and less frequent treatment of the animals were associated with a greater prevalence of helminths, showing that these variables must be considered in equine control programs. The intensity of the parasitism was also associated with the stocking rate of pasture, absence of dunghill, presence of the animals only in paddocks, lack of technology in the property, less frequent treatment of the animals, and absence of the use of rotation regarding the anthelmintic class.

Comparison of two methods for glucocorticoid evaluation in maned wolves

Analysis of faecal glucocorticoid metabolites provides a powerful noninvasive tool for monitoring adrenocortical activity in wild animals. However, differences regarding the metabolism and excretion of these substances make a validation for each species and sex investigated obligatory. Although maned wolves (Chrysocyon brachyurus) are the biggest canids in South America, their behaviour and physiology are poorly known and they are at risk in the wild. Two methods for measuring glucocorticoid metabolites in maned wolves were validated: a radio- and an enzyme immunoassay. An ACTH challenge was used to demonstrate that changes in adrenal function are reflected in faecal glucocorticoid metabolites. Our results suggest that both methods enable a reliable assessment of stress hormones in maned wolves avoiding short-term rises in glucocorticoid concentrations due to handling and restraint. These methods can be used as a valuable tool in studies of stress and conservation in this wild species.

Evaluation of resistance in a selected field strain of Haemonchus contortus to ivermectin and moxidectin using the Larval Migration on Agar Test

Haemonchus contortus is one of the most common and economically significant causes of disease in small ruminants worldwide, and the control programs of parasitic nematodes - including H. contortus - rely mostly on the use of anthelmintic drugs. The consequence of the use of this, as the sole sanitary strategy to avoid parasite infections, was the reduction of the efficacy of all chemotherapeutic products with a heavy selection for resistance. The widespread of anthelmintic resistance and the difficulty of its early diagnosis has been a major concern for the sustainable parasite management on farms. The objective of this research was to determine and compare the ivermectin (IVM) and moxidectin (MOX) effect in a selected field strain of H. contortus with a known resistance status, using the in vitro larval migration on agar test (LMAT). Third stage larvae of the selected isolate were obtained from faecal cultures of experimentally infected sheep and incubated in eleven increasing diluted concentrations of IVM and MOX (6, 12, 24, 48, 96, 192, 384, 768, 1536, 3072 and 6144µg/mL). The dose-response sigmoidal curves were obtained using the R² value of >0.90 and the lethal concentration (LC50) dose for the tested anthelmintic drugs using a four-parameter logistic model. The LC50 value for MOX was significantly lower than IVM (1.253µg/mL and 91.06µg/mL), identifying the H. contortus isolate as considerably less susceptible to IVM compared to MOX. Furthermore, the LMAT showed a high consistency (p<0.0001) and provided to be a useful diagnostic tool for monitoring the resistance status of IVM and MOX in H. contortus field isolate, as well as it may be used for official routine drug monitoring programs under the Ministry of Agriculture (MAPA) guidance.

Occurrence and characterization of Campylobacter spp.isolates in dogs, cats and children

To improve the understanding of implications of Campylobacterspp. infections in pets and children of different environments were analysed 160 faecal samples from children and 120 from pets (103 dogs and 17 cats). Campylobacter spp. were detected in 6.87% of the children and in 18.3% of the dogs and cats. From 33 stool samples positive for Campylobacter spp., 57.6% were identified as C. jejuni, and 33.4% were identified as C. coli. More than 50% of the isolates in pets were resistant to ceftiofur, sulphazotrim, norfloxacin and tetracycline. In humans, most of the isolates were resistant to amoxicillin, cefazolin, ceftiofur, erythromycin and norfloxacin. From 19 isolates of C. jejuni, 11 isolates from children and 5 from dogs contained two to four of the virulence genes flaA, pldA, cadF or ciaB.We found an association between the presence of virulence genes and diarrhoea. Furthermore, an association was observed between the presence of Campylobacter spp. and diarrhoea in dewormed pets with blood picture suggestive of bacterial infection, and the therapeutic use of antibiotics was associated with more positive detection of Campylobacterspp. in the faeces of pets. Our data indicate that virulent strains of Campylobacter spp. can be risk factor to diarrhoea in animals, and that high resistance to antimicrobial agents is common in pets.

Gastrointestinal parasites of swine raised in different management systems in the State of Rio de Janeiro, Brazil

Abstract: From 2012 to 2013 were surveyed gastrointestinal parasites from pig farms located in different municpaliyies in the state of Rio de Janeiro. Fecal samples from 790 pigs were collected from the rectum on 88 family farms and 702 farms with industrial production. The samples were subjected to Faust et al., Sheather, Ritchie, Lutz and direct examination faecal techniques. The estimated parasite prevalence was 93.1% in family farms and 59.1% in industrial farms. Balantidium coli, coccidia and Entamoeba sp. were the parasites with the highest frequencies, and the male and female reproductive categories and fatteners pigs the most infected (p<0.05). Trophozoites of B. coli were most evident in stool samples from semi-solid followed by solid and diarrheal consistencies. Strongyles eggs and Trichuris suis have been detected exclusively in family farms. Ascaris suum eggs and Strongyloides ransomi showed low frequency. The high degree of parasitism, especially protozoa, indicates the need to reassess the management of pigs in both types of production.

Of milquetoasts and daredevils : personalities in female eiders

Traditionally biologists have often considered individual differences in behaviour or physiology as a nuisance when investigating a population of individuals. These differences have mostly been dismissed as measurement errors or as non-adaptive variation around an adaptive population mean. Recent research, however, challenges this view. While long acknowledged in human personality studies, the importance of individual variation has recently entered into ecological and evolutionary studies in the form of animal personality. The concept of animal personality focuses on consistent differences within and between individuals in behavioural and physiological traits across time and contexts and its ecological and evolutionary consequences. Nevertheless, a satisfactory explanation for the existence of personality is still lacking. Although there is a growing number of explanatory theoretical models, there is still a lack of empirical studies on wild populations showing how traditional life-history tradeoffs can explain the maintenance of variation in personality traits. In this thesis, I first investigate the validity of variation in allostatic load or baseline corticosterone (CORT) concentrations as a measure for differences in individual quality. The association between CORT and quality has recently been summarised under the “CORT-fitness hypothesis”, which states that a general negative relationship between baseline CORT and fitness exists. I then continue to apply the concept of animal personality to depict how the life-history trade-off between survival and fecundity is mediated in incubating female eiders (Somateria mollissima), thereby maintaining variation in behaviour and physiology. To this end, I investigated breeding female eiders from a wild population that breeds in the archipelago around Tvärminne Zoological Station, SW Finland. The field data used was collected from 2008 to 2012. The overall aim of the thesis was to show how differences in personality and stress responsiveness are linked to a life-history context. In the four chapters I examine how the life-history trade-off between survival and fecundity could be resolved depending on consistent individual differences in escape behaviour, stress physiology, individual quality and nest-site selection. First, I corroborated the validity of the “CORT-fitness hypothesis”, by showing that reproductive success is generally negatively correlated with serum and faecal baseline CORT levels. The association between individual quality and baseline CORT is, however, context dependent. Poor body condition was associated with elevated serum baseline CORT only in older breeders, while a larger reproductive investment (clutch mass) was associated with elevated serum baseline CORT among females breeding late in the season. Interestingly, good body condition was associated with elevated faecal baseline CORT levels in late breeders. High faecal baseline CORT levels were positively related to high baseline body temperature, and breeders in poor condition showed an elevated baseline body temperature, but only on open islands. The relationship between stress physiology and individual quality is modulated by breeding experience and breeding phenology. Consequently, the context dependency highlights that this relationship has to be interpreted cautiously. Additionally, I verified if stress responsiveness is related to risk-taking behaviour. Females who took fewer risks (longer flight initiation distance) showed a stronger stress response (measured as an increase in CORT concentration after capture and handling of the bird). However, this association was modulated by breeding experience and body condition, with young breeders and those in poor body condition showing the strongest relationship between risktaking and stress responsiveness. Shy females (longer flight initiation distance) also incubated their clutch for a shorter time. Additionally, I demonstrated that stress responsiveness and predation risk interact with maternal investment and reproductive success. Under high risk of predation, females that incubated a larger clutch showed a stronger stress response. Surprisingly, these females also exhibited higher reproductive success than females with a weaker stress response. Again, these context dependent results suggest that the relationship between stress responsiveness and risk-taking behaviour should not be studied in isolation from individual quality and that stress responsiveness may show adaptive plasticity when individuals are exposed to different predation regimes. Finally, female risk-taking behaviour and stress coping styles were also related to nest-site choice. Less stress responsive females more frequently occupied nests with greater coverage that were farther away from the shoreline. Females nesting in nests with medium cover and farther from the shoreline had higher reproductive success. These results suggest that different personality types are distributed non-randomly in space. In this thesis I was able to demonstrate that personalities and stress coping strategies are persistent individual characteristics, which express measurable effects on fitness. This suggests that those traits are exposed to natural selection and thereby can evolve. Furthermore, individual variation in personality and stress coping strategy is linked to the alternative ways in which animals resolve essential life-history trade-offs.

Seasonal variation in migratory body condition, corticosterone secretion, oxidative stress and biotransformation activity in barn swallows (Hirundo rustica L.)

I studied the associations between migration-related physiological regulation (corticosterone) and body condition of barn swallows (Hirundo rustica L.). An additional purpose was to determine whether oxidative stress and biotransformation activity vary seasonally. Since physiological regulation, biotransformation activity and the stress involved may be important factors for body condition during migration; they may have direct effects on migration success. This in turn may influence other important life history stages, such as breeding and moult. In the thesis I used barn swallow data of the Finnish Ringing Centre (1997–2009), consisting of all juveniles ringed in the nests and recaptured from night roosts later the same autumn. Before the autumn migration in Finland I also captured, ringed and sampled barn swallows from night roosts in 2003, 2006, 2007 and 2011. Samples preceding spring migration in South Africa were collected in 2007. Juvenile barn swallows started to migrate southward in mid-August (first broods). Second broods started their migration at a younger age and almost a month later than first broods (mid-September). Barn swallows increased body mass and accumulated fat for the autumn migration. In the course of the autumn they seemed to be able to prevent the loss of energy already accumulated, since the proportional overnight mass loss, fat loss and faecal production decreased. Surprisingly, corticosterone, the major energy-regulating hormone in birds, seemed not to be involved in the fuelling process. Previous studies with warblers, sparrows and shorebirds had shown that during migration, the baseline levels of corticosterone were elevated in order to facilitate fuelling. It is possible that for Finnish barn swallows the most important fuelling place is in southern Europe, since northern and eastern populations migrate via the Balkan Peninsula. However, the adrenocortical stress response of Finnish barn swallows in good body condition was lower than that of those in poor body condition. Birds clearly suppressed the response, probably to prevent the catabolic effects of excessive corticosterone levels; birds cannot afford to lose muscle mass before migration. South African barn swallows had high levels of baseline corticosterone, but this may have been associated with the high oxidative damage and biotransformation activity of those birds. Barn swallows in spring and summer had low biotransformation activity and intermediate oxidative stress, which was probably related to breeding. Autumn birds had low biotransformation activity and oxidative stress but high redox enzyme activities in some migration-related enzymes.

Female pelvic floor disorders – outcome after mesh-augmented procedures and studies on vaginal connective tissue

Pelvic floor disorders, such as urinary incontinence (UI) and pelvic organ prolapse (POP), are common disorders in women. Because of the prolonged life expectancy the prevalence of UI and POP and the probability of ending up in surgery are increasing. However, the pathophysiology behind these disorders is still unsolved. The aim of this thesis is to study possible alterations in the connective tissue in the vaginal wall in patients with and without POP. The long-term outcome and complications of mid-urethral slings (MUS) and mesh-augmented POP surgery were studied in heterogenic patient populations. More elastin and a slight increase in immunostaining of type III and V collagens in tissue samples were obtained from patients with POP compared to controls in whom type I collagen was more prominent. The studies assessing the mesh-augmented procedures revealed good efficacy and high patient satisfaction after a long-term follow-up. Patients operated on because of mixed incontinence and with BMI >30 kg/m² reported significantly more urinary symptoms and a lower quality of life than the patients operated on because of stress urinary incontinence and the ones with BMI ≤30 kg/m². The objective outcome was equal between the groups. Mesh exposure through vaginal mucosa occurred in 23 % of the patients after POP surgery, most of these being asymptomatic. There are alterations in connective tissues in patients with POP. Mid-urethral sling procedures produced good long-term cure rates and patient satisfaction. As to the prolapse surgery, in spite of relatively high exposure rate, mesh-augmented procedure proved to be safe and effective method for the correction of POP.