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Changes in collagen tissue matrix in association with pelvic organ prolapse staging
IUGA Academy. Lozo S. Jun 30, 2018; 213067
Topic: Pelvic Organ Prolapse
Svjetlana Lozo
Svjetlana Lozo

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372

Changes in collagen tissue matrix in association with pelvic organ prolapse staging

Lozo, S1

1: University of Chicago/Northshore health system

Introduction: Pelvic organ prolapse (POP) is a debilitating condition that affects millions of women. In this condition, there are either acquired or inherent abnormalities of the supporting endopelvic connective tissue, leading to decreases in tissue strength. Biomechanical studies indicate that degradation of collagen in the pelvic floor connective tissues of patients contributes to their POP. Changes of tissue composition in the collagen matrix leads to reduced tissue elasticity and toughness. We hypothesize that overall POP-Q stage and specifically C point stage correlate with degradation of collagen tissue components illustrated by tissue stiffness.

Objective: The objective of the study is to examine if there is correlation between the stage of pelvic organ prolapse according to C point and changes in collagen component in the pelvic floor connective tissue measured by tissue stiffness.

Methods: Following informed consent, full thickness biopsies of the posterior vaginal fornix were obtained in two groups. First group had surgery for pelvic organ prolapse and second group for benign conditions (control group). All specimens were examined histologically. Samples were cooled to -20C. Slices ofthe tissue were stained by Gomori trichrome to identify collagen from other constituents in the tissue. Once collagen rich region was identified,atomic force microscopic (AFM) studies were used to determine elasticity and toughness ofcollagen fibers on the nanoscopic and microscopic scales. Data was collected and analyzed using Microsoft Excel. Histologic and AFM findings were correlated with overall POP Q stage as well as POP Q stage based on C point.

Results: Median age of patients in POP group was 62, while median age of controls was 44 (Table 1). Majority of patients in our cohort are Caucasian (13/17) while two of our three controls were African American. At the time of the surgery, 16 patients had documented pelvic organ prolapse quantification (POP-Q) and 4 patients had surgery for beginning gynecologic conditions. In the POP group, one patient had Stage 4 prolapse, one Stage 2 prolapse and remaining 14 had Stage 3 prolapse. Taken in account that biopsy was taken for vaginal cuff, decision was made to compare Staging according to the C point (6 pts with Stage 0 prolapse, 8 Stage 2 prolapse and 6 Stage 3 prolapse). There is statistical difference in means between patients in Stage 0 and Stage 2 ( p=0.0018) and Stage 0 and Stage 3 (p=0.0003). There is no statistical difference between patients in Stage 2 and Stage 3 group (p=.69)

Conclusion: Patients who experience POP appear to have higher levels of tissue stiffness in comparison to the controls. Further analysis with larger and more diverse patient sample is needed to further explore the correlation between POP and tissue stiffness.

References:

  1. Ruiz-Zapata, Alejandra M., et al. 'Vaginal fibroblastic cells from women with pelvic organ prolapse produce matrices with increased stiffness and collagen content.'Scientific reports6 (2016): 22971.
  2. Moalli, Pamela A., et al. 'Remodeling of vaginal connective tissue in patients with prolapse.'Obstetrics & Gynecology5, Part 1 (2005): 953-963.


Table 1. Demographics of patients in the study

Sample Number

Age

Race

Diabetes

Parity

Menopausal

POP Stage

Stage Vault (C point)

Tissue stiffness (kPa)

1

77

Caucasian

Y

4

Y

4

2

1249.63

2

66

Caucasian

N

2

Y

3

3

1073.03

3

80

Caucasian

N

2

Y

3

2

579.33

4

62

Caucasian

N

3

Y

2

0

336.93

5

64

Caucasian

N

3

Y

3

2

628.57

6

56

Caucasian

N

3

Y

3

2

1369.35

7

71

Caucasian

Y

4

Y

3

2

966.17

8

40

Caucasian

N

5

N

3

0

683.93

9

77

Caucasian

N

5

Y

3

3

767.28

10

55

Caucasian

N

2

Y

3

2

914.64

11

41

African American

N

0

N

0

0

187.75

12

61

Hispanic

N

6

Y

3

3

643.41

13

44

Hispanic

N

2

N

3

2

793.15

14

52

Caucasian

N

3

Y

3

3

924.1983255

15

66

Hispanic

N

6

Y

3

3

1132.5

16

45

Caucasian

N

2

N

0

0

235.93

17

44

Hispanic

N

2

N

3

2

823.59

18

73

Caucasian

N

3

Y

3

3

1047.810369

19

50

African American

Y

0

N

0

0

400.9

20

40

Caucasian

N

1

N

0

0

213.36

Disclosure:

Work supported by industry: no.

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