Advertisement

International Urogynecology Journal

, Volume 16, Issue 6, pp 475–479 | Cite as

Uterosacral ligament in postmenopausal women with or without pelvic organ prolapse

  • Boris Gabriel
  • Dominik Denschlag
  • Heike Göbel
  • Cordula Fittkow
  • Martin Werner
  • Gerald Gitsch
  • Dirk Watermann
Original Article

Abstract

The uterosacral ligaments are thought to contribute to pelvic support. The objective of this study was to compare the structural components of these ligaments in women with and without pelvic organ prolapse (POP). We characterized uterosacral ligaments of 25 postmenopausal women with POP and 16 controls histomorphologically and immunohistochemically by quantifying their content of collagen I, III, and smooth muscle using a computerized image analysis. In 84% the uterosacral ligaments were composed of more than 20% of smooth muscle cells. There was no difference in collagen I expression and smooth muscle cell amount between women with POP and those without. In contrast, the collagen III expression was significantly related to the presence of POP (p<0.001) rather than age or parity. Our findings suggest that the higher collagen III expression might be a typical characteristic of POP patients’ connective tissue. The considerable amount of smooth muscle cells in uterosacral ligaments may provide pelvic support.

Keywords

Collagen Pelvic organ prolapse Pelvic support Uterosacral ligament 

Notes

Acknowledgments

The authors thank Professor J. Schulte Mönting of the University of Freiburg for his assistance with the statistical analysis.

References

  1. 1.
    Bump RC, Norton PA (1998) Epidemiology and natural history of pelvic floor dysfunction. Obstet Gynecol Clin North Am 25:723–746Google Scholar
  2. 2.
    Luber KM, Boero S, Choe JY (2001) The demographics of pelvic floor disorders: current observations and future projections. Am J Obstet Gynecol 184:1496–1503Google Scholar
  3. 3.
    Barber MD, Kuchibhatla MN, Pieper CF, Bump RC (2001) Psychometric evaluation of 2 comprehensive condition-specific quality of life instruments for women with pelvic floor disorders. Am J Obstet Gynecol 185:1388–1395Google Scholar
  4. 4.
    Samuelsson EC, Arne Victor FT, Tibblin G, Svardsudd KF (1997) Signs of genital prolapse in a Swedish population of women 20 to 59 years of age and possible related factors. Am J Obstet Gynecol 89:501–506Google Scholar
  5. 5.
    Brown JS, Waetjen LE, Subak LL, Thom DH, Van Den Eeden S, Vittinghoff E (2002) Pelvic organ prolapse surgery in the United States 1997. Am J Obstet Gynecol 186:712–716Google Scholar
  6. 6.
    Mant J, Painter R, Vessey M (1997) Epidemiology of genital prolapse: observations from the Oxford Family Planning Association Study. Br J Obstet Gynaecol 104:579–585Google Scholar
  7. 7.
    Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL (1997) Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 89:501–506Google Scholar
  8. 8.
    DeLancey JOL (1992) Anatomic aspects of vaginal eversion after hysterectomy. Am J Obstet Gynecol 166:1717–1724Google Scholar
  9. 9.
    Amundsen CL, Flynn BJ, Webster GD (2003) Anatomical correction of vaginal vault prolapse by uterosacral ligament fixation in women who also require a pubovaginal sling. J Urol 169:1770–1774Google Scholar
  10. 10.
    Buller JL, Thompson JR, Cundiff GW, Krueger Sullivan L, Schon Ybarra MA, Bent AE (2001) Uterosacral ligament: description of anatomic relationships to optimize surgical safety. Obstet Gynecol 97:873–879Google Scholar
  11. 11.
    Ulmsten U, Falconer C (1999) Connective tissue in female urinary incontinence. Curr Opin Obstet Gynecol 11:509–515Google Scholar
  12. 12.
    Farnsworth BN (2002) Posterior intravaginal slingplasty (infracoccygeal sacropexy) for severe posthysterectomy vaginal vault prolapse—a preliminary report on efficacy and safety. Int Urogynecol J Pelvic Floor Dysfunct 13:4–8Google Scholar
  13. 13.
    Petros PE (2001) Vault prolapse II: restoration of dynamic vaginal support by infracoccygeal sacropexy, an axial day-case vaginal procedure. Int Urogynecol J Pelvic Floor Dysfunct 12:296–303Google Scholar
  14. 14.
    Petros PE, Ulmsten UI (1990) An integral theory of female urinary incontinence: experimental and clinical considerations. Acta Obstet Gynecol Scand Suppl 153:7–31Google Scholar
  15. 15.
    Bump RC, Mattiasson A, Bo K, Brubaker LP, DeLancey JO, Klarskov P et al (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175:10–17Google Scholar
  16. 16.
    Lehr HA, van der Loos CM, Teeling P, Gown AM (1999) Complete chromogen separation and analysis in double immunohistochemical stains using Photoshop-based image analysis. J Histochem Cytochem 47:119–125Google Scholar
  17. 17.
    Jackson SR, Avery NC, Tarlton JF, Eckford SD, Abrams P, Bailey AJ (1996) Changes in metabolism of collagen in genitourinary prolapse. Lancet 347:1658–1661Google Scholar
  18. 18.
    Liapis A, Bakas P, Pafiti A, Frangos-Plemenos M, Arnoyannaki N, Creatsas G (2001) Changes of collagen type III in female patients with genuine stress incontinence and pelvic floor prolapse. Eur J Obstet Gynecol Reprod Biol 97:76–79Google Scholar
  19. 19.
    Yamamoto K, Yamamoto M, Akazawa K, Tajima S, Wakimoto H, Aoyagi M (1997) Decrease in elastin gene expression and protein synthesis in fibroblasts derived from cardinal ligaments of patients with prolapsus uteri. Cell Biol Int 21:605–611Google Scholar
  20. 20.
    Makinen J, Kahari VM, Soderstrom KO, Vuorio E, Hirvonen T (1987) Collagen synthesis in the vaginal connective tissue of patients with and without uterine prolapse. Eur J Obstet Gynecol Reprod Biol 24:19–25Google Scholar
  21. 21.
    Yamamoto M, Aoyagi M, Akazawa K, Tajima S, Yamamoto K (1998) Decrease in p53 protein in cultured cardinal ligament fibroblasts from patients with prolapsus uteri. Cell Biol Int 22:31–40Google Scholar
  22. 22.
    Yamamoto M, Akazawa K, Aoyagi M, Yamamoto K (2000) Changes in biological characteristics during the cellular aging of ligament fibroblasts derived from patients with prolapsus uteri. Mech Ageing Dev 115:175–187Google Scholar
  23. 23.
    Liu S, Yang R, Al-Shaikh R, Lane J (1995) Collagen in tendons, ligaments and bone healing. Clin Orthop 318:265–278Google Scholar
  24. 24.
    Savvas M, Bishop J, Laurent G, Watson N, Studd J (1993) Type III collagen content in the skin of postmenopausal women receiving oestradiol and testosterone implants. Br J Obstet Gynaecol 100:154–156Google Scholar
  25. 25.
    Ewies AA, Al-Azzawi F, Thompson J (2003) Changes in extracellular matrix proteins in the cardinal ligaments of postmenopausal women with or without prolapse: a computerized immunohistomorphometric analysis. Hum Reprod 18:2189–2195Google Scholar

Copyright information

© International Urogynecology Journal 2005

Authors and Affiliations

  • Boris Gabriel
    • 1
  • Dominik Denschlag
    • 1
  • Heike Göbel
    • 2
  • Cordula Fittkow
    • 1
  • Martin Werner
    • 2
  • Gerald Gitsch
    • 1
  • Dirk Watermann
    • 1
  1. 1.Department of Obstetrics and GynecologyFreiburg University Medical CenterFreiburgGermany
  2. 2.Department of PathologyFreiburg University Medical CenterFreiburgGermany

Personalised recommendations