Periurethral connective tissue status of postmenopausal women with genital prolapse with and without stress incontinence.
OBJECTIVE
Connective tissue consists mainly of collagen and structural glycoproteins and is considered an important factor of the supportive structures of the genitourinary region. Few data have been published as yet with respect to the role of connective tissue in pelvic floor relaxation and genuine stress incontinence (GSI). We compared periurethral connective tissue structures between continent and incontinent postmenopausal women with genital prolapse.


METHODS
Twenty-nine women underwent pelvic floor reconstructive surgery (anterior colporrhaphy: n = 29, sacrospinous fixation: n = 12), with biopsies obtained from the periurethral region. Fifteen patients and 14 women were incontinent and continent, respectively. Tissue samples were investigated for localization and distribution of collagen (types I, III, IV, V, VI) and glycoproteins (fibronectin, laminin, vitronectin) using immunofluorescent microscopic techniques.


RESULTS
Collagen types I, III, IV, V, and VI were found in all tissue samples. Compared with the continent women, the tissue samples of the incontinent women showed a significantly weaker immunohistochemical staining of type I, III, and VI collagen. No difference in staining patterns of collagen type IV and V, fibronectin, and laminin was observed between the two groups. Intact vitronectin was found in the periurethral tissues of all the continent women, whereas this glycoprotein was either absent or fragmented in the incontinent women.


CONCLUSIONS
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.
Goepel
Christian
C
Department of Obstetrics and Gynecology, Martin-Luther-University Halle-Wittenberg, Magdeburger Strasse 24, D-06097 Halle (Saale), Germany.
Hefler
Lukas
L
Methfessel
Hans-Dietrich
HD
Koelbl
Heinz
H
D000368:Aged; D001706:Biopsy; D003094:Collagen / Q000378:metabolism*; D005260:Female; D006023:Glycoproteins / Q000378:metabolism*; D006801:Humans; D007150:Immunohistochemistry; D008875:Middle Aged; D017773:Pelvic Floor / Q000473:pathology; D017698:Postmenopause; D014521:Urethra / Q000473:pathology; D014550:Urinary Incontinence, Stress / Q000473:pathology* / Q000601:surgery; D014596:Uterine Prolapse / Q000473:pathology* / Q000601:surgery
D006023:Glycoproteins; D003094:Collagen