title: Changes in elastin density in different locations of the vaginal wall in women with pelvic organ prolapse.
abstract: OBJECTIVE
  The purpose of this study was to analyze the histomorphometric properties of the vaginal wall in women with pelvic organ prolapse (POP).
  
  
  METHODS
  In 15 women undergoing surgery for POP, full-thickness biopsies were collected at two different sites of location from the anterior and/or posterior vaginal wall. Properties of the precervical area (POP-Q point C/D) were compared with the most distal portion of the vaginal wall (POP-Q point Ba/Bp) using histological staining and immunohistochemistry. The densities of total collagen fibers, elastic fibers, smooth muscle cells, and blood vessels were determined by combining high-resolution virtual imaging and computer-assisted digital image analysis.
  
  
  RESULTS
  The mean elastin density was significantly decreased in the lamina propria and muscularis layer of the vaginal wall from the most distal portion of the prolapsed vaginal wall compared with the precervical area. This difference was statistically significant in the lamina propria for both anterior (8.4 ± 1.2 and 12.1 ± 2.0, p = 0.048) and posterior (6.8 ± 0.5 and 10.1 ± 1.4, p = 0.040) locations, and in the muscularis for the anterior (5.2 ± 0.4 and 8.4 ± 1.2, p = 0.009) vaginal wall. There were no statistically significant differences in the mean densities of collagen fibers, smooth muscle cells or blood vessels between the two locations.
  
  
  CONCLUSIONS
  In this study, we observed changes in elastin density in two different locations of the vaginal wall from women with POP. The histomorphometric properties of the vaginal wall can be variable from one place to another in the same patient. This result supports the existence of most vulnerable locations within the vaginal wall and the potential benefit of site-specific prolapse surgery.
authors.affiliation: Department of Obstetrics and Gynecology, University of Liège, CHR La Citadelle, Boulevard du 12e de ligne, no. 1, 4000, Liège, Belgium, ldelandsheere@gmail.com.
authors.forename: Laurent
authors.initials: L
authors.lastname: de Landsheere
authors.forename: Silvia
authors.initials: S
authors.lastname: Blacher
authors.forename: Carine
authors.initials: C
authors.lastname: Munaut
authors.forename: Betty
authors.initials: B
authors.lastname: Nusgens
authors.forename: Chrystèle
authors.initials: C
authors.lastname: Rubod
authors.forename: Agnès
authors.initials: A
authors.lastname: Noel
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Foidart
authors.forename: Michel
authors.initials: M
authors.lastname: Cosson
authors.forename: Michelle
authors.initials: M
authors.lastname: Nisolle
mesh_terms: D000368:Aged; D001706:Biopsy; D003094:Collagen / Q000502:physiology; D004548:Elasticity / Q000502:physiology*; D054459:Elasticity Imaging Techniques; D004549:Elastin / Q000502:physiology*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008875:Middle Aged; D009130:Muscle, Smooth / Q000502:physiology; D056887:Pelvic Organ Prolapse / Q000473:pathology / Q000503:physiopathology*; D014621:Vagina / Q000473:pathology / Q000503:physiopathology*
chemical_list: D003094:Collagen; D004549:Elastin