Immunohistochemical expression of tenascin and elastin in women with pelvic organ prolapse and/or without stress urinary incontinence

Abstract

Background and aim: Pelvic organ prolapse (POP) and stress urinary incontinence (SUI) constitute entities of pelvic floor disorders and most often occur simultaneously in the same patient, adversely affecting women's quality of life. The pathogenesis of pelvic organ prolapse and stress urinary incontinence is not fully understood. The pelvic viscera are maintained in their place thanks to interconnection of levator ani muscles, cardinal and uterosacral ligaments, and pubocervical and rectovaginal fascia. Ligaments and fascia consist mainly of connective tissue. Alterations in the metabolism of its extracellular matrix could contribute POP and SUI. The aim of this study was to assess the metabolism of extracellular matrix components in relation to the immunohistochemical expression of tenascin and elastin in patients with POP and/or without SUI.Methods: In the present study, we included 90 adult Greek women; 30 women with POP and SUI, 30 women with POP and no SUI, and 30 controls. For the immunohistochemical study, 90 biopsies were obtained after hysterectomy from the vagina (pubocervical fascia) and the attachment areas of uterosacral and cardinal ligaments. The specimens were studied for immunohistochemical evaluation of tenascin and elastin. Results:Tenascin was strongly expressed in all samples obtained from women with prolapse. Patients with total prolapse showed enhanced immunoactivity to the tenascin-specific antigen near connective tissue and around the wall of vessels. Continent patients with only POP and the control group were more likely to have weakly positive or negative tenascin immunoreaction in stromal cells and local expression in muscles/vessels. Regarding the immunohistochemical response of elastin expression, we observed an increased number of patients with reduced elastin and decreased number of patients with positive expression of elastin in patients with prolapse and SUI.Conclusions: These alterations on the metabolism of extracellular matrix components of the connective tissue seem to contribute to the pathogenesis of POP and SUI and may aid in non-surgical treatment of these disorders.