Neuromuscular morphometry of the uterine ligaments and vaginal wall in women with pelvic organ prolapse

Abstract

The aim of this study was to compare neuromuscular histomorphometry of the uterine ligaments and vaginal wall in women with and without pelvic organ prolapse. Biopsies were obtained from the round, uterosacral, and cardinal ligaments of the uterus and apical vaginal wall of women having pelvic organ prolapse repaired (stage ≥ II; prolapse group, 37) and the same location in patients with no prolapse (stage < II; control group, 47). Routine hematoxylin-eosin (H & E) staining and immunohistochemical staining for Protein Gene Product 9.5 (PGP 9.5) and smooth muscle α-actin were performed for all specimens. Smooth muscle percentage of the uterosacral and cardinal ligaments were not significantly different in women with prolapse than in women without. In round ligament, mean smooth muscle percentage was lower than in women with normal support (81.63 ± 8.2 vs. 51.63 ± 16, P=0.000). Mean distance of the smooth muscle fibers from surface epithelium of the vaginal epithelium of the women with prolapse were significantly higher than the control group (1.679 ± 0.34 vs. 2.240 ± 0.33, P = 0.000). PGP 9.5 stained area percentage of uterine ligaments and vaginal wall tissue samples were significantly lower in women with prolapse. Both total innervation of the anterior vaginal epithelium and uterine ligaments, and muscular percentage of the round ligament and vaginal wall were decreased in women with pelvic organ prolapse.