Elastin Density: Link Between Histological and Biomechanical Properties of Vaginal Tissue in Women with Pelvic Organ Prolapse?

Overview

Journal Int Urogynecol J

Publisher Springer

Specialties Gynecology & Obstetrics
Urology

Date 2015 Dec 15

PMID 26658755

Citations 7

Authors

Laurent De Landsheere

Mathias Brieu

Silvia Blacher

Carine Munaut

Betty Nusgens

Chrystele Rubod

Agnes Noel

Jean-Michel Foidart

Michelle Nisolle

Michel Cosson

Affiliations

Soon will be listed here.

Abstract

Introduction And Hypothesis: The aim of the study was to correlate histological and biomechanical characteristics of the vaginal wall in women with pelvic organ prolapse (POP).

Methods: Tissue samples were collected from the anterior [point Ba; POP Questionnaire (POP-Q)] and/or posterior (point Bp; POP-Q) vaginal wall of 15 women who underwent vaginal surgery for POP. Both histological and biomechanical assessments were performed from the same tissue samples in 14 of 15 patients. For histological assessment, the density of collagen and elastin fibers was determined by combining high-resolution virtual imaging and computer-assisted digital image analysis. For biomechanical testing, uniaxial tension tests were performed to evaluate vaginal tissue stiffness at low (C0) and high (C1) deformation rates.

Results: Biomechanical testing highlights the hyperelastic behavior of the vaginal wall. At low strains (C0), vaginal tissue appeared stiffer when elastin density was low. We found a statistically significant inverse relationship between C0 and the elastin/collagen ratio (p = 0.048) in the lamina propria. However, at large strain levels (C1), no clear relationship was observed between elastin density or elastin/collagen ratio and stiffness, likely reflecting the large dispersion of the mechanical behavior of the tissue samples.

Conclusion: Histological and biomechanical properties of the vaginal wall vary from patient to patient. This study suggests that elastin density deserves consideration as a relevant factor of vaginal stiffness in women with POP.

Citing Articles

Vaginal Fibroblast Behavior as a Function of Stiffness Changes in a Polyisocyanide Hydrogel for Prolapse Repair.

Gudde A, van Velthoven M, Turkel B, Kouwer P, Roovers J, Guler Z ACS Appl Bio Mater. 2023; 6(9):3759-3767.

PMID: 37589427 PMC: 10521013. DOI: 10.1021/acsabm.3c00433.

Non-invasive biomechanical assessment of the prolapsed vaginal wall: an explorative pilot study on cutometry and indentometry.

Latul Y, Kastelein A, de Graaf B, Guler Z, Roovers J Sci Rep. 2023; 13(1):2751.

PMID: 36797400 PMC: 9935514. DOI: 10.1038/s41598-023-29403-4.

Role of fibulin-5 insufficiency and prolapse progression on murine vaginal biomechanical function.

Clark-Patterson G, Roy S, Desrosiers L, Knoepp L, Sen A, Miller K Sci Rep. 2021; 11(1):20956.

PMID: 34697337 PMC: 8546087. DOI: 10.1038/s41598-021-00351-1.

Quantitative Morphometry of Elastic Fibers in Pelvic Organ Prolapse.

Dahal S, Kuang M, Rietsch A, Butler R, Ramamurthi A, Damaser M Ann Biomed Eng. 2021; 49(8):1909-1922.

PMID: 33768411 PMC: 8376789. DOI: 10.1007/s10439-021-02760-9.

Pelvic Organ Prolapse: A Review of In Vitro Testing of Pelvic Support Mechanisms.

Conway C, White S, Russell R, Sentilles C, Clark-Patterson G, Miller K Ochsner J. 2021; 20(4):410-418.

PMID: 33408579 PMC: 7755550. DOI: 10.31486/toj.19.0089.

References

Kerkhof M, Hendriks L, Brolmann H . Changes in connective tissue in patients with pelvic organ prolapse--a review of the current literature. Int Urogynecol J Pelvic Floor Dysfunct. 2008; 20(4):461-74. DOI: 10.1007/s00192-008-0737-1. View

Wu J, Matthews C, Conover M, Pate V, Funk M . Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery. Obstet Gynecol. 2014; 123(6):1201-1206. PMC: 4174312. DOI: 10.1097/AOG.0000000000000286. View

De Landsheere L, Blacher S, Munaut C, Nusgens B, Rubod C, Noel A . Changes in elastin density in different locations of the vaginal wall in women with pelvic organ prolapse. Int Urogynecol J. 2014; 25(12):1673-81. DOI: 10.1007/s00192-014-2431-9. 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

Campeau L, Gorbachinsky I, Badlani G, Andersson K . Pelvic floor disorders: linking genetic risk factors to biochemical changes. BJU Int. 2011; 108(8):1240-7. DOI: 10.1111/j.1464-410X.2011.10385.x. View

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

Rubod C, Boukerrou M, Brieu M, Jean-Charles C, Dubois P, Cosson M . Biomechanical properties of vaginal tissue: preliminary results. Int Urogynecol J Pelvic Floor Dysfunct. 2008; 19(6):811-6. DOI: 10.1007/s00192-007-0533-3. View

Bump R, Mattiasson A, Bo K, Brubaker L, DeLancey J, Klarskov P . The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996; 175(1):10-7. DOI: 10.1016/s0002-9378(96)70243-0. View

Ulrich D, Edwards S, Su K, White J, Ramshaw J, Jenkin G . Influence of reproductive status on tissue composition and biomechanical properties of ovine vagina. PLoS One. 2014; 9(4):e93172. PMC: 3977844. DOI: 10.1371/journal.pone.0093172. View

10.

Alarab M, Bortolini M, Drutz H, Lye S, Shynlova O . LOX family enzymes expression in vaginal tissue of premenopausal women with severe pelvic organ prolapse. Int Urogynecol J. 2010; 21(11):1397-404. DOI: 10.1007/s00192-010-1199-9. View

11.

Chantraine F, Blacher S, Berndt S, Palacios-Jaraquemada J, Sarioglu N, Nisolle M . Abnormal vascular architecture at the placental-maternal interface in placenta increta. Am J Obstet Gynecol. 2012; 207(3):188.e1-9. DOI: 10.1016/j.ajog.2012.06.083. View

12.

Allen-Brady K, Cannon-Albright L, Farnham J, Norton P . Evidence for pelvic organ prolapse predisposition genes on chromosomes 10 and 17. Am J Obstet Gynecol. 2015; 212(6):771.e1-7. PMC: 4457667. DOI: 10.1016/j.ajog.2014.12.037. View

13.

De Landsheere L, Munaut C, Nusgens B, Maillard C, Rubod C, Nisolle M . Histology of the vaginal wall in women with pelvic organ prolapse: a literature review. Int Urogynecol J. 2013; 24(12):2011-20. DOI: 10.1007/s00192-013-2111-1. View

14.

Lin S, Tee Y, Ng S, Chang H, Lin P, Chen G . Changes in the extracellular matrix in the anterior vagina of women with or without prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2006; 18(1):43-8. DOI: 10.1007/s00192-006-0090-1. View

15.

Olsen A, Smith V, Bergstrom J, Colling J, Clark A . Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997; 89(4):501-6. DOI: 10.1016/S0029-7844(97)00058-6. View

16.

Chantereau P, Brieu M, Kammal M, Farthmann J, Gabriel B, Cosson M . Mechanical properties of pelvic soft tissue of young women and impact of aging. Int Urogynecol J. 2014; 25(11):1547-53. DOI: 10.1007/s00192-014-2439-1. View

17.

Jean-Charles C, Rubod C, Brieu M, Boukerrou M, Fasel J, Cosson M . Biomechanical properties of prolapsed or non-prolapsed vaginal tissue: impact on genital prolapse surgery. Int Urogynecol J. 2010; 21(12):1535-8. DOI: 10.1007/s00192-010-1208-z. View

18.

Goepel C, Hefler L, Methfessel H, Koelbl H . Periurethral connective tissue status of postmenopausal women with genital prolapse with and without stress incontinence. Acta Obstet Gynecol Scand. 2003; 82(7):659-64. DOI: 10.1034/j.1600-0412.2003.00019.x. View

19.

Jelovsek J, Maher C, Barber M . Pelvic organ prolapse. Lancet. 2007; 369(9566):1027-38. DOI: 10.1016/S0140-6736(07)60462-0. View

20.

Moalli P, Shand S, Zyczynski H, Gordy S, Meyn L . Remodeling of vaginal connective tissue in patients with prolapse. Obstet Gynecol. 2005; 106(5 Pt 1):953-63. DOI: 10.1097/01.AOG.0000182584.15087.dd. View