Young women with genital prolapse have a low collagen concentration.
BACKGROUND
Genital prolapse is a common and handicapping form of pelvic floor dysfunction. To explain its genesis as a result of endopelvic connective tissue weakness, the collagen state was analyzed in women with and without genital prolapse.


METHODS
Punch biopsies from the paraurethral ligaments were obtained during the operation from 22 women undergoing surgery for genital prolapse. As controls, similar biopsies were taken from 13 women who underwent gynecologic surgery for other benign reasons. Collagen concentration as hydroxyproline and its extractability by pepsin digestion were studied in relation to age by multiple regression, two-way anova, Levene's test, and Student's t-test. Histological examination was also performed.


RESULTS
Women, younger than 53 years, with genital prolapse had a 30% lower collagen concentration than age-matched controls, which reached significance, P = 0.01. The extractability by pepsin digestion, an indicator of cross-links in the collagen molecule, did not significantly differ between groups. It did, however, decrease significantly with age in both prolapse patient and control groups. Morphology supported these findings with a less-dense extracellular matrix composition subepithelially in genital prolapse compared to a healthy control.


CONCLUSIONS
For the first time, we show that young women with genital prolapse have a decreased collagen concentration, suggesting a different organization of the endopelvic connective tissue extracellular matrix. Furthermore, these alterations differ from those earlier found in younger women with stress urinary incontinence.
Söderberg
Marie Westergren
MW
Division of Obstetrics, Danderyd Hospital, Sweden. marie.w-soderberg@telia.com
Falconer
Christian
C
Byström
Birgitta
B
Malmström
Anders
A
Ekman
Gunvor
G
D000367:Age Factors; D001706:Biopsy; D016022:Case-Control Studies; D002584:Cervix Uteri / Q000473:pathology* / Q000601:surgery; D003094:Collagen / Q000032:analysis*; D005260:Female; D006801:Humans; D006909:Hydroxyproline / Q000032:analysis; D008875:Middle Aged; D010298:Parity; D017773:Pelvic Floor / Q000473:pathology* / Q000601:surgery*; D017698:Postmenopause; D012307:Risk Factors; D014550:Urinary Incontinence, Stress / Q000473:pathology; D013519:Urogenital Surgical Procedures; D014596:Uterine Prolapse / Q000473:pathology* / Q000601:surgery
D003094:Collagen; D006909:Hydroxyproline