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Changes in elastin density in different locations of the vaginal wall in women with pelvic organ prolapse

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Abstract

Introduction and hypothesis

The purpose of this study was to analyze the histomorphometric properties of the vaginal wall in women with pelvic organ prolapse (POP).

Methods

In 15 women undergoing surgery for POP, full-thickness biopsies were collected at two different sites of location from the anterior and/or posterior vaginal wall. Properties of the precervical area (POP-Q point C/D) were compared with the most distal portion of the vaginal wall (POP-Q point Ba/Bp) using histological staining and immunohistochemistry. The densities of total collagen fibers, elastic fibers, smooth muscle cells, and blood vessels were determined by combining high-resolution virtual imaging and computer-assisted digital image analysis.

Results

The mean elastin density was significantly decreased in the lamina propria and muscularis layer of the vaginal wall from the most distal portion of the prolapsed vaginal wall compared with the precervical area. This difference was statistically significant in the lamina propria for both anterior (8.4 ± 1.2 and 12.1 ± 2.0, p = 0.048) and posterior (6.8 ± 0.5 and 10.1 ± 1.4, p = 0.040) locations, and in the muscularis for the anterior (5.2 ± 0.4 and 8.4 ± 1.2, p = 0.009) vaginal wall. There were no statistically significant differences in the mean densities of collagen fibers, smooth muscle cells or blood vessels between the two locations.

Conclusions

In this study, we observed changes in elastin density in two different locations of the vaginal wall from women with POP. The histomorphometric properties of the vaginal wall can be variable from one place to another in the same patient. This result supports the existence of most vulnerable locations within the vaginal wall and the potential benefit of site-specific prolapse surgery.

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Abbreviations

POP:

Pelvic organ prolapse

ECM:

Extracellular matrix

αSMA:

Alpha smooth actin

RGB:

Red green blue

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Acknowledgements

The authors would like to thank Dr. P. Sobarzo Martinez (University of Conception, Chile) for his logistical and technical assistance with the study protocol and L. Poma, I. Dasoul, E. Feyereisen, and P. Gavitelli (Laboratory of Tumor and Development Biology, LBTD, Liège, Belgium) for their excellent technical assistance with the immunohistochemistry studies. We are also indebted to all the staff of the Departments of Obstetrics and Gynecology in Lille and Liège.

Conflicts of interest

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University of Liège, CHR La Citadelle, Boulevard du 12e de ligne, no. 1, 4000, Liège, Belgium

    Laurent de Landsheere, Jean-Michel Foidart & Michelle Nisolle

  2. Laboratory of Tumor and Development Biology, CHU, GIGA-Cancer, University of Liège, Avenue de l′Hôpital, 3—Pathology Tower (B23), Sart-Tilman, Belgium

    Laurent de Landsheere, Silvia Blacher, Carine Munaut, Agnès Noel, Jean-Michel Foidart & Michelle Nisolle

  3. Laboratory of Connective Tissues Biology, GIGA-Cancer, University of Liège, Avenue de l′Hôpital, 3—Pathology Tower (B23), Sart-Tilman, Belgium

    Betty Nusgens

  4. Department of Gynecologic Surgery, Hôpital Jeanne de Flandre, Centre Hospitalier Régional Universitaire de Lille, Avenue Oscar Lambret, no. 2, 59037, Lille Cedex, France

    Chrystèle Rubod & Michel Cosson

Authors
  1. Laurent de Landsheere
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  2. Silvia Blacher
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  3. Carine Munaut
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  4. Betty Nusgens
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  8. Michel Cosson
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  9. Michelle Nisolle
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Correspondence to Laurent de Landsheere.

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de Landsheere, L., Blacher, S., Munaut, C. et al. Changes in elastin density in different locations of the vaginal wall in women with pelvic organ prolapse. Int Urogynecol J 25, 1673–1681 (2014). https://doi.org/10.1007/s00192-014-2431-9

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  • DOI: https://doi.org/10.1007/s00192-014-2431-9

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