elastin and Cystocele

We describe current knowledge about collagen/elastin and extracellular matrix metabolism in the genitourinary tract with special emphasis on stress urinary incontinence. We also explored the influence of genetics and reproductive hormones on extracellular matrix metabolism.. We performed a MEDLINE® search from 1995 to February 2011 using the key words stress urinary incontinence, pelvic organ prolapse, extracellular matrix, collagen, elastin, matrix metalloproteinase, collagenase, tissue inhibitors of matrix metalloproteinase, elastin metabolism, elastase, connective tissue, supportive tissue, mechanical stress, biomechanical properties, selective estrogen receptor modulators, transforming growth factor-β and wound healing.. The literature searched produced data on 4 areas of significance for extracellular matrix metabolism in patients with stress urinary incontinence and prolapse, including collagen, elastin and transforming growth factor-β. Data on collagen metabolism continue to support the hypothesis of increased turnover involving matrix metalloproteinases and serine proteases in pelvic tissues of affected individuals. Elastin metabolism studies suggest increased degradation but also abnormal elastin fiber synthesis. Epidemiological data indicate a genetic predisposition to abnormal extracellular matrix in affected individuals while human tissue and animal models reveal differential expression of candidate genes involved in structural proteins. Transforming growth factor-β pathways have been documented to be involved in stress urinary incontinence in human tissues and animal models. Finally, these extracellular matrix metabolisms are modulated by reproductive hormones and selective estrogen receptor modulators.. Pelvic tissue from women with stress urinary incontinence and pelvic organ prolapse show a genetic predisposition to abnormal extracellular matrix remodeling, which is modulated by reproductive hormones, trauma, mechanical stress load and aging. This progressive remodeling contributes to stress urinary incontinence/pelvic organ prolapse by altering normal tissue architecture and mechanical properties.

Topics: Animals; Collagen; Connective Tissue; Cystocele; Elastin; Estrogens; Extracellular Matrix; Humans; Matrix Metalloproteinase 2; Stress, Mechanical; Transforming Growth Factor beta; Urinary Incontinence, Stress

Topics: Animals; Collagen; Connective Tissue; Cystocele; Elastin; Extracellular Matrix; Humans; Transforming Growth Factor beta; Urinary Incontinence, Stress

To compare elastin expression and elastic fibre width in the anterior vaginal wall of postmenopausal women with and with no bladder prolapse.. Full-thickness specimens were obtained from the upper lateral anterior vaginal wall of women having a large cystocele repaired (stage III or IV; prolapse group, 33) and the same location in patients with no prolapse having radical cystectomy (control group, 10). The percentage of elastin-positive tissue and elastic fibre width were measured by immunohistochemistry on 6 microm thick tissue sections from 10 random field readings per sample using image analysis software. The examiner was unaware of sample identity and the patients' clinical history.. The age was comparable between the control and prolapse groups (median 70.5 years), and the parity, vaginal deliveries, hormone replacement use, cigarette smokers and body mass index were no different between the groups. Immunohistochemical staining and morphometric analysis indicated that elastin expression in the prolapse group was 10.6%, vs 14.4% in the control group (P = 0.049). The median width of elastic fibres was 0.9 microm in the prolapse and 1.8 microm in the control groups (P < 0.001). Elastin expression and elastic fibre width appeared to be stable with increasing age in the prolapse group.. In this case-control study investigating elastin changes in postmenopausal women with prolapse, the elastin expression and fibre width were significantly lower in the vaginal wall of patients with a large cystocele than in controls of a similar age.

Topics: Aged; Case-Control Studies; Cystectomy; Cystocele; Elastic Tissue; Elastin; Female; Humans; Immunohistochemistry; Middle Aged; Postmenopause; Regression Analysis; Vagina