Changes in Connective Tissue in Patients with Pelvic Organ Prolapse--a Review of the Current Literature

Overview

Journal Int Urogynecol J Pelvic Floor Dysfunct

Specialties Gynecology & Obstetrics
Urology

Date 2008 Oct 16

PMID 18854909

Citations 77

Authors

M H Kerkhof

L Hendriks

H A M Brolmann

Affiliations

Soon will be listed here.

Abstract

Little is known about the pathophysiology of pelvic organ prolapse (POP). In 1996, Jackson presented a hypothesis on pelvic floor connective tissue that tried to explain the development of POP on a molecular level. The objective of this review is to test the hypothesis against recent literature. The method used was a review of literature. The association between POP and connective tissue metabolism is well established. However, the causality of this association is unclear. The characteristics of the pelvic floor connective tissue of POP patients relate to tissue repair. To resolve the question of cause and effect, the role of fibroblasts in producing the extracellular matrix should be clarified. With these data, the use of autologous or allogenic stem cells in the treatment of POP may come in sight. Recent literature supports the hypothesis of Jackson but does not resolve long-standing questions on the aetiology of POP.

Citing Articles

COL3A1 Gene Polymorphism and Its Impact on Female Pelvic Organ Prolapse.

Kurniawati E, Rahmawati N, Widyasari A Med Sci Monit. 2025; 31():e946367.

PMID: 39815606 PMC: 11749065. DOI: 10.12659/MSM.946367.

Promoting cell proliferation and collagen production with ascorbic acid 2-phosphate-releasing poly(l-lactide-co-ε-caprolactone) membranes for treating pelvic organ prolapse.

Kurki A, Paakinaho K, Hannula M, Karjalainen S, Kuismanen K, Hyttinen J Regen Biomater. 2024; 11:rbae060.

PMID: 38903561 PMC: 11187500. DOI: 10.1093/rb/rbae060.

An Improved Understanding of the Pathophysiology of Pelvic Organ Prolapse: A 3D In Vitro Model under Static and Mechanical Loading Conditions.

van Velthoven M, Gudde A, van der Kruit M, van Loon M, Rasing L, Wagener F Adv Healthc Mater. 2024; 13(8):e2302905.

PMID: 38219051 PMC: 11469184. DOI: 10.1002/adhm.202302905.

Early growth response 2, a novel target of pelvic organ prolapse, is highly expressed in anterior vaginal wall tissues with pelvic organ prolapse.

Jin X, Xu H, Hu Q, Yin Y, Qin M, Xia Z Histochem Cell Biol. 2023; 161(2):195-205.

PMID: 37874337 DOI: 10.1007/s00418-023-02240-2.

Diabetic Pneumopathy- A Novel Diabetes-associated Complication: Pathophysiology, the Underlying Mechanism and Combination Medication.

Dwivedi J, Wal P, Dash B, Ovais M, Sachan P, Verma V Endocr Metab Immune Disord Drug Targets. 2023; 24(9):1027-1052.

PMID: 37817659 DOI: 10.2174/0118715303265960230926113201.

References

Cannon T, Lee J, Somogyi G, Pruchnic R, Smith C, Huard J . Improved sphincter contractility after allogenic muscle-derived progenitor cell injection into the denervated rat urethra. Urology. 2003; 62(5):958-63. DOI: 10.1016/s0090-4295(03)00679-4. View

Brincat M, Moniz C, Kabalan S, Versi E, ODowd T, Magos A . Decline in skin collagen content and metacarpal index after the menopause and its prevention with sex hormone replacement. Br J Obstet Gynaecol. 1987; 94(2):126-9. DOI: 10.1111/j.1471-0528.1987.tb02338.x. View

Paul R, Bailey A . Glycation of collagen: the basis of its central role in the late complications of ageing and diabetes. Int J Biochem Cell Biol. 1996; 28(12):1297-310. DOI: 10.1016/s1357-2725(96)00079-9. View

Reay Jones N, Healy J, King L, Saini S, Shousha S, Allen-Mersh T . Pelvic connective tissue resilience decreases with vaginal delivery, menopause and uterine prolapse. Br J Surg. 2003; 90(4):466-72. DOI: 10.1002/bjs.4065. View

Takano C, Girao M, Sartori M, Castro R, Arruda R, Simoes M . Analysis of collagen in parametrium and vaginal apex of women with and without uterine prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2002; 13(6):342-5; discussion 345. DOI: 10.1007/s001920200076. View

Buchanan S, ROBERTSON G, Hocking P . Effects of food restriction or delayed photostimulation on ovarian follicle number, plasma oestradiol concentration and vaginal collagen content in male-line turkeys. Br Poult Sci. 2000; 41(4):502-7. DOI: 10.1080/00071660050195028. View

Bai S, Choe B, Kim J, Park K . Pelvic organ prolapse and connective tissue abnormalities in Korean women. J Reprod Med. 2002; 47(3):231-4. View

Chen B, Wen Y, Wang H, Polan M . Differences in estrogen modulation of tissue inhibitor of matrix metalloproteinase-1 and matrix metalloproteinase-1 expression in cultured fibroblasts from continent and incontinent women. Am J Obstet Gynecol. 2003; 189(1):59-65. DOI: 10.1067/mob.2003.378. View

Buchsbaum G, Duecy E, Kerr L, Huang L, Perevich M, Guzick D . Pelvic organ prolapse in nulliparous women and their parous sisters. Obstet Gynecol. 2006; 108(6):1388-93. DOI: 10.1097/01.AOG.0000245784.31082.ed. View

10.

Drewes P, Yanagisawa H, Starcher B, Hornstra I, Csiszar K, Marinis S . Pelvic organ prolapse in fibulin-5 knockout mice: pregnancy-induced changes in elastic fiber homeostasis in mouse vagina. Am J Pathol. 2007; 170(2):578-89. PMC: 1851882. DOI: 10.2353/ajpath.2007.060662. View

11.

Bai S, Chung D, Yoon J, Shin J, Kim S, Park K . Roles of estrogen receptor, progesterone receptor, p53 and p21 in pathogenesis of pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2005; 16(6):492-6. DOI: 10.1007/s00192-005-1310-9. View

12.

Liapis A, Bakas P, Pafiti A, Arnoyannaki N, Creatsas G . Changes of collagen type III in female patients with genuine stress incontinence and pelvic floor prolapse. Eur J Obstet Gynecol Reprod Biol. 2001; 97(1):76-9. DOI: 10.1016/s0301-2115(00)00478-4. View

13.

Norton P, Baker J, SHARP H, WARENSKI J . Genitourinary prolapse and joint hypermobility in women. Obstet Gynecol. 1995; 85(2):225-8. DOI: 10.1016/0029-7844(94)00386-R. View

14.

Clark A, Slayden O, Hettrich K, Brenner R . Estrogen increases collagen I and III mRNA expression in the pelvic support tissues of the rhesus macaque. Am J Obstet Gynecol. 2005; 192(5):1523-9. DOI: 10.1016/j.ajog.2004.11.042. View

15.

Birk D, Fitch J, Babiarz J, Doane K, Linsenmayer T . Collagen fibrillogenesis in vitro: interaction of types I and V collagen regulates fibril diameter. J Cell Sci. 1990; 95 ( Pt 4):649-57. DOI: 10.1242/jcs.95.4.649. View

16.

Cai W, Koltai S, Kocsis E, Scholz D, Kostin S, Luo X . Remodeling of the adventitia during coronary arteriogenesis. Am J Physiol Heart Circ Physiol. 2002; 284(1):H31-40. DOI: 10.1152/ajpheart.00478.2002. View

17.

Starcher B . Determination of the elastin content of tissues by measuring desmosine and isodesmosine. Anal Biochem. 1977; 79(1-2):11-5. DOI: 10.1016/0003-2697(77)90372-4. View

18.

Lang J, Zhu L, Sun Z, Chen J . Estrogen levels and estrogen receptors in patients with stress urinary incontinence and pelvic organ prolapse. Int J Gynaecol Obstet. 2003; 80(1):35-9. DOI: 10.1016/s0020-7292(02)00232-1. View

19.

Strasser H, Marksteiner R, Margreiter E, Pinggera G, Mitterberger M, Frauscher F . Autologous myoblasts and fibroblasts versus collagen for treatment of stress urinary incontinence in women: a randomised controlled trial. Lancet. 2007; 369(9580):2179-2186. DOI: 10.1016/S0140-6736(07)61014-9. View

20.

Makinen J, Kahari V, Soderstrom K, Vuorio E, Hirvonen T . Collagen synthesis in the vaginal connective tissue of patients with and without uterine prolapse. Eur J Obstet Gynecol Reprod Biol. 1987; 24(4):319-25. DOI: 10.1016/0028-2243(87)90157-2. View