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Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Scopus, Emerging Sources Citation Index
Stefano MANODORO 1, Federico SPELZINI 2, Maria C. CESANA 1, Matteo FRIGERIO 1, Daniele MAGGIONI 3, 4, Cecilia CERESA 3, 4, Cristina PENATI 1, Martina SICURI 1, Robert FRUSCIO 1, Gabriella NICOLINI 3, 4, Rodolfo MILANI 1
1 Department of Obstetrics and Gynaecology, ASST Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy; 2 ASST Valtellina e Alto Lario, Hospital of Sondrio, Sondrio, Italy; 3 Department of Surgery and Translational Medicine, University of Milano-Bicocca, Monza, Italy; 4 Experimental Neurology Unit, University of Milano-Bicocca, Monza, Italy
BACKGROUNDː 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.
METHODSː 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 analysed.
RESULTSː 69 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).
CONCLUSIONSː 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.