Ceresa, Cecilia

Maggioni, Daniele

Manodoro, Stefano

Marmiroli, Paola

Nicolini, Gabriella

Spelzini, Federico

Firenze University Press: E-Journals

IJAE Vol. 115, n. 1/2 (Supplement), 2010
125
Different stages of pelvic prolapse: morphologic and 
biochemical analysis of anterior vaginal wall
Gabriella Nicolini1, Daniele Maggioni1, Federico Spelzini2, Stefano Manodoro2, Cecilia Ceresa1, Paola 
Marmiroli1
1 Dipartimento di Neuroscienze e Tecnologie Biomediche, Università degli Studi di Milano-Bicocca, Italy
2 Clinica Ostetrica e Ginecologica, Az. Osp. San Gerardo Monza, Università degli Studi di Milano-Bicocca, Italy
Collagen is ubiquitous in the human body and it is the main component of con-
nective tissue. Collagen is also the principal component of endopelvic fascia and it is 
involved in the physiopathology of female organ prolapse (POP). The role of collagen 
in the physiopathology of POP has been studied with conflicting results, being difficult 
to distinguish the cause from the effect and to standardize the samples. The turnover of 
connective tissue in the vaginal wall is an important process both in healthy women and 
in women with prolapse. MMP-1, MMP-8 and MMP-13 specifically cleave native triple 
collagen (I, II, III) helix, yelding two fragments. These fragments are subject to gelatinase 
(MMP-2 and MMP-9) degradation. MMP-2 and MMP-9 activity, may be regulated at dif-
ferent levels (trascriptional and activation level) influencing the amount of collagen. 
Aim of this study is to find a correlation between staging of anterior vaginal wall 
prolapse and morphologic and biochemical (MMP-2 and MMP-9 amount) features of 
anterior vaginal wall.
Anterior vaginal wall full thickness biopsies (eightyfive patients) including endopel-
vic fascia have been collected during surgical procedures. Recurrence or vault prolapse 
have been ruled out. POP samples have been classified according to POP-Quantification 
and they have been divided in three groups: group A (controls), group B (I and II stage 
prolapse) and group C (III and IV stage prolapse). Each sample has been processed for 
both microscopic and zymography analysis. 
Formalin fixed samples have been embedded, cut and stained with Trichromic Masson 
Goldner (TMG) stains. Microscopic analysis have been performed to evaluate collagen 
amount, collagen organization, and to assess muscular component. All parameters have 
been scored semi-quantitatively by two blind observers on vaginal mucosa and under-
lying fascia. MMP-2 and MMP-9 activity have been evaluated by gelatine zymography. 
Statistical evaluation have been made by One-Way ANOVA analysis of variance.
An increase in collagen content and a better connective organization in women with 
prolapse greater than III stage (group C p<0.05) is demonstrated. Moreover a significant 
decrease in MMP-2 activity is evident in high stage prolapse if compared with controls 
(group C p<0.05). The data obtained suggest that high stage POP is correlated with a 
reduction of MMP-2 collagenic activity that determines an increase in collagen amount. 
Such observation correlates with the common finding of a subjectively thickened vagi-
nal wall of patients affected by a III – IV stage (Group C)
Key words
Pelvic prolapse, collagen, morphology, metalloproteinase, anterior vaginal wall


Different stages of pelvic prolapse: morphologic and biochemical analysis of anterior vaginal wall

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Different stages of pelvic prolapse: morphologic and biochemical analysis of anterior vaginal wall

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