Periurethral connective tissue status of postmenopausal women with genital prolapse with and without stress incontinence

Goepel, Christian; Hefler, Lukas; Methfessel, H. D.; Koelbl, Heinz

doi:10.1034/j.1600-0412.2003.00019.x

Cited by 69 publications

(43 citation statements)

References 50 publications

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“…Periurethral connective tissue Fig. 5 Percentage of smooth muscle, striated muscle, and connective tissue of the urogenital diaphragmx undergoes alteration in postmenopausal women with genital prolapse with and without stress incontinence [12]. Cadaver studies show that, in older women, all layers of striated urethral muscle become thinner; 2% of striated muscle in the anterior urethral wall is lost per year between the age of 20 and 80 [13,14] and may be completely absent posteriorly [15].…”

Section: Discussionmentioning

confidence: 99%

Histomorphological analysis of the urogenital diaphragm in elderly women: a cadaver study

et al. 2008

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The objective of this study was to describe the histomorphological structure of the urogenital diaphragm in elderly women using a modern morphometric procedure. Biopsies were taken from the posterior margin of the urogenital diaphragm of 22 female cadavers (mean age, 87 years) using a 60-mm punch. Hematoxylin/eosin and Goldner sections were analyzed with the Cavalieri estimator. The mean thickness of the urogenital diaphragm was 5.5 mm. The main component was connective tissue. All biopsies contained smooth muscle. Eighteen biopsies contained more smooth muscle than striated muscle. In six of 22 biopsies, no striated muscle was found. The ratio of striated to smooth muscle to connective tissue was 1:2.3:13.3. Muscle fibers were dispersed in all parts of the urogenital diaphragm. The urogenital diaphragm of elderly women mainly consists of connective tissue. Smooth muscle was also found but to a lesser extent. The frequently used English term "perineal membrane" for the urogenital diaphragm is justified and well describes our findings in elderly women.

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Section: Discussionmentioning

confidence: 99%

Histomorphological analysis of the urogenital diaphragm in elderly women: a cadaver study

et al. 2008

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“…the supernatants corresponding to individual samples were then combined, and collagens were precipitated by addition of 4.0 M naCl to a final concentration of 2.0 M. Each precipitate was dissolved in 0.5 m acetic acid, and the solution was dialyzed against 0.02 m na 2 hpO 4 . precipitated collagens were redissolved in 0.5 m acetic acid, dialyzed exhaustively against 0.05 M acetic acid and finally lyophilized.…”

Section: Methodsmentioning

confidence: 99%

“…thus, there have been many studies throughout the literature in which collagen is analyzed in vaginal and uterine-supporting ligament biopsies procured at the time of a repair of prolapse in patients with prolapse or at the time of a hysterectomy in patients without prolapse. the comparison of these samples has provided conflicting results (4)(5)(6)(7)(8)(9)(10)(11)(12)(13). trauma or pathology may lead to altered responses to mechanical stresses placed on connective tissue, producing changes in the Ecm.…”

Section: Introductionmentioning

confidence: 99%

Decreased type III collagen expression in human uterine cervix of prolapse uteri

Iwahashi

Muragaki

2011

Experimental and Therapeutic Medicine

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Abstract. the precise mechanism of prolapse uteri is not fully understood. there is evidence to suggest that abnormalities of collagen, the main component of extracellular matrix, or its repair mechanism, may predispose women to prolapse. to investigate the characteristic structure of human uterine cervix of patients with prolapse uteri, various types of collagen expression in the uterine cervix tissues of the prolapse uteri were compared to those of normal uterine cervix. after informed consent, 36 specimens of uterine cervical tissues were obtained at the time of surgery from 16 postmenopausal women with prolapse uteri (stage iii-iV by the pelvic Organ Prolapse Quantification examination) and 20 postmenopausal women without prolapse uteri (control group). Collagens were extracted from the uterine cervix tissues by salt precipitation methods. the relative levels of various collagens were evaluated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. the uterine cervix was longer in the patients with prolapse uteri than those of postmenopausal controls without prolapse uteri. the ratios of type iii to type i collagen in the uterine cervical tissues were significantly decreased in the prolapse uteri, as compared to those of the postmenopausal uterine cervix without prolapse. these results suggest that decreased type iii collagen expression may play an important role in determing the physiology and structure of the uterine cervix tissues of prolapse uteri. IntroductionThe extracellular matrix (ECM) is considered to play an important role in the stability of tissues and in regulating the growth and differentiation of cells (1,2). Synthesis, accumulation and catabolism of the Ecm occur during wound healing and during the initiation and progression of numerous diseases (3). moreover, it is generally acknowledged that the Ecm does not function as a mere passive scaffold for connective tissue within organ architecture. it also plays an 'informational' role through a network of interactions between cells and signal molecules which is of primary importance in the control of cellular proliferation and motility during histogenesis for the maintenance of tissue homeostasis and in cancer development.prolapse of the pelvic organs is a common disease affecting the lives of millions of women. Women with prolapse suffer from chronic pelvic pain and pressure, urinary and fecal incontinence, sexual dysfunction and social isolation. despite the high prevalence of this disease and the devastating impact on the lives of women, very little is known about its pathophysiology.recently, it has been suggested that a structural defect in the vagina and its supportive tissues, such as a decrease in collagen content or a change in collagen subtypes, is one of the mechanisms that predisposes a woman to prolapse. thus, there have been many studies throughout the literature in which collagen is analyzed in vaginal and uterine-supporting ligament biopsies procured at the time of a repair of prolapse in patients with prolapse or at the t...

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“…From the study by Goepel et al who investigated several collagen types in the periurethral vagina wall in continent and incontinent postmenopausal women with POP, it seems that tissues from POP patients with GSI showed weaker immunostaining for types I, III, and IV collagens [17]. In agreement with these results, by investigating the same molecules and analyzing the immunostaining by automatic digital image analysis, Lin et al observed a significant reduction in only collagen III in the apex of the anterior vaginal wall in patients with POP [18].…”

Section: Collagenmentioning

confidence: 99%

“…Several studies have analyzed changes in the vaginal connective tissue of patients with and without POP by histology [12][13][14][15][16][17][18][19] using various methods and stainings to assess changes in collagen content in the vaginal wall. The results of these studies are described in Table 1.…”

Section: Collagenmentioning

confidence: 99%

Histology of the vaginal wall in women with pelvic organ prolapse: a literature review

et al. 2013

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Introduction and hypothesis The pathophysiology of pelvic organ prolapse (POP) is incompletely understood. The purpose of this study is to describe the current knowledge about histology of the vaginal wall and its possible involvement in the pathogenesis of pelvic organ prolapse. Methods Eligible studies were selected through a MEDLINE search covering January 1986 to December 2012. The research was limited to English-language publications. Results Investigations of changes in the vaginal tissue that occur in women with genital prolapse are currently still limited and produced contrary results. The heterogeneity of the patients and the control groups in terms of age, parity and hormonal status, of the localization of biopsies and the histological methods as well as the lack of validation of the quantification procedures do not allow clear and definitive conclusions to be drawn. Conclusions This review shows that current knowledge of the histological changes observed in women with POP are inconclusive and relatively limited. More studies are needed in this specific field to better understand the mechanisms that lead to POP.

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Periurethral connective tissue status of postmenopausal women with genital prolapse with and without stress incontinence

Abstract: Our results indicate an altered metabolism of connective tissue in the periurethral region with a significant decrease of collagen and vitronectin expression in postmenopausal women with pelvic floor relaxation with and without GSI.

Cited by 69 publications

References 50 publications

Histomorphological analysis of the urogenital diaphragm in elderly women: a cadaver study

Histomorphological analysis of the urogenital diaphragm in elderly women: a cadaver study

Decreased type III collagen expression in human uterine cervix of prolapse uteri

Histology of the vaginal wall in women with pelvic organ prolapse: a literature review

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