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Elastin density: Link between histological and biomechanical properties of vaginal tissue in women with pelvic organ prolapse?

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Abstract

Introduction and hypothesis

The aim of the study was to correlate histological and biomechanical characteristics of the vaginal wall in women with pelvic organ prolapse (POP).

Methods

Tissue samples were collected from the anterior [point Ba; POP Questionnaire (POP-Q)] and/or posterior (point Bp; POP-Q) vaginal wall of 15 women who underwent vaginal surgery for POP. Both histological and biomechanical assessments were performed from the same tissue samples in 14 of 15 patients. For histological assessment, the density of collagen and elastin fibers was determined by combining high-resolution virtual imaging and computer-assisted digital image analysis. For biomechanical testing, uniaxial tension tests were performed to evaluate vaginal tissue stiffness at low (C0) and high (C1) deformation rates.

Results

Biomechanical testing highlights the hyperelastic behavior of the vaginal wall. At low strains (C0), vaginal tissue appeared stiffer when elastin density was low. We found a statistically significant inverse relationship between C0 and the elastin/collagen ratio (p = 0.048) in the lamina propria. However, at large strain levels (C1), no clear relationship was observed between elastin density or elastin/collagen ratio and stiffness, likely reflecting the large dispersion of the mechanical behavior of the tissue samples.

Conclusion

Histological and biomechanical properties of the vaginal wall vary from patient to patient. This study suggests that elastin density deserves consideration as a relevant factor of vaginal stiffness in women with POP.

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Abbreviations

POP:

Pelvic organ prolapse

ECM:

Extracellular matrix

αSMA:

Alpha smooth-muscle actin

RGB:

Red–green–blue

SHM:

Scanning haptic microscope

LOX:

Lysyl oxydases

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Acknowledgments

The authors thank Dr P. Sobarzo Martinez (University of Conception, Chile), L. Poma, I. Dasoul, E. Feyereisen, and P. Gavitelli (Laboratory of Tumor and Development Biology, LBTD, Liège, Belgium) for their excellent technical assistance with immunohistochemistry studies.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University of Liège, CHR La Citadelle, Boulevard du 12e de ligne, n°1, 4000, Liège, Belgium

    Laurent de Landsheere, Jean-Michel Foidart & Michelle Nisolle

  2. Laboratory of Tumor and Development Biology, GIGA-Cancer, University of Liège, CHU Sart-Tilman, Avenue de l’Hôpital, 4000, Liège, Belgium

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

  3. LML, CNRS UMR 8107, Ecole centrale de Lille, University Nord de France, Lille, France

    Mathias Brieu

  4. Laboratory of Connective Tissues Biology, GIGA-Cancer, University of Liège, CHU Sart-Tilman, Avenue de l’Hôpital, 4000, Liège, Belgium

    Betty Nusgens

  5. Department of Gynecologic Surgery, Hôpital Jeanne de Flandre, Centre Hospitalier Régional Universitaire de Lille, Avenue Oscar Lambret, n°2, 59037, Lille Cedex, France

    Chrystèle Rubod & Michel Cosson

Authors
  1. Laurent de Landsheere
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  2. Mathias Brieu
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  3. Silvia Blacher
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  4. Carine Munaut
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  9. Michelle Nisolle
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  10. Michel Cosson
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Corresponding author

Correspondence to Laurent de Landsheere.

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Conflicts of interests

The authors have no conflicts of interests except Michel Cosson, who is consultant for Ethicon, AMS, Boston, Allergan, and Olympus. He is owner of patents in the field of urogynecology in development, and has one Research project funded by Ethicon.

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de Landsheere, L., Brieu, M., Blacher, S. et al. Elastin density: Link between histological and biomechanical properties of vaginal tissue in women with pelvic organ prolapse?. Int Urogynecol J 27, 629–635 (2016). https://doi.org/10.1007/s00192-015-2901-8

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  • DOI: https://doi.org/10.1007/s00192-015-2901-8

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