title: Histologic and metabolic assessment in a cohort of patients with genital prolapse: preoperative stage and recurrence investigations.
abstract: BACKGROUND
  Biological basis of prolapse development and recurrence are still unclear. Aim of this observational and prospective study is to correlate clinical stage of anterior vaginal wall prolapse and anatomical recurrence to histological and metabolic characteristics of vaginal tissue.
  
  
  METHODS
  Patients undergoing surgery were divided into two groups according to anterior stage ≤II (group A) and ≥III (group B). Full-thickness excisional biopsies of the anterior vaginal wall were obtained after hysterectomy. Hystological characteristics and metalloproteinases activity (MMP-2) were analyzed.
  
  
  RESULTS
  Sixty-nine patients (35 group A; 34 group B) completed evaluation. Mean follow-up was 35 months. Collagen amount and organization were significantly higher in group B both in lamina propria and fascia specimens, but MMP-2 activity was significantly lower in this group. Recurrence rate of anterior compartment was 10.1%. Collagen cellularity of fascia was higher in recurrence groups. On the contrary MMP-2 activity showed a close to significant correlation to surgical success (P=0.07).
  
  
  CONCLUSIONS
  Patients with advanced stages of prolapse have increased collagen amount associated to decreased MMP-2 activity. This suggests that connective tissue is more abundant but less metabolically active in patients with severe prolapse. A similar trend can be found in recurrences.
authors.affiliation: Department of Obstetrics and Gynaecology, ASST Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy - stefano.manodoro@gmail.com.
authors.forename: Stefano
authors.initials: S
authors.lastname: Manodoro
authors.affiliation: ASST Valtellina and Alto Lario, Hospital of Sondrio, Sondrio, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Spelzini
authors.affiliation: Department of Obstetrics and Gynaecology, ASST Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
authors.forename: Maria C
authors.initials: MC
authors.lastname: Cesana
authors.affiliation: Department of Obstetrics and Gynaecology, ASST Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Frigerio
authors.affiliation: Department of Surgery and Translational Medicine, University of Milano-Bicocca, Monza, Italy.|Experimental Neurology Unit, University of Milano-Bicocca, Monza, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Maggioni
authors.affiliation: Department of Surgery and Translational Medicine, University of Milano-Bicocca, Monza, Italy.|Experimental Neurology Unit, University of Milano-Bicocca, Monza, Italy.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Ceresa
authors.affiliation: Department of Obstetrics and Gynaecology, ASST Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Penati
authors.affiliation: Department of Obstetrics and Gynaecology, ASST Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Sicuri
authors.affiliation: Department of Obstetrics and Gynaecology, ASST Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
authors.forename: Robert
authors.initials: R
authors.lastname: Fruscio
authors.affiliation: Department of Surgery and Translational Medicine, University of Milano-Bicocca, Monza, Italy.|Experimental Neurology Unit, University of Milano-Bicocca, Monza, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Nicolini
authors.affiliation: Department of Obstetrics and Gynaecology, ASST Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Milani
mesh_terms: D000368:Aged; D003094:Collagen / Q000378:metabolism*; D003238:Connective Tissue / Q000378:metabolism; D005205:Fascia / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy; D020778:Matrix Metalloproteinase 2 / Q000378:metabolism*; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D014596:Uterine Prolapse / Q000473:pathology / Q000601:surgery*; D014621:Vagina / Q000473:pathology*
chemical_list: D003094:Collagen; D020778:Matrix Metalloproteinase 2