Urogynaecology: Collagen metabolism in the uterosacral ligaments and vaginal skin of women with uterine prolapse

Objective  To compare tissue markers of collagen metabolism in the uterosacral ligaments with those in vaginal tissue in women with uterine prolapse.Design  Prospective observational experimental study.Setting  A tertiary urogynaecology unit.Population  Women referred for hysterectomy for prolapse or benign gynaecological disease.Methods  Matrix metalloproteinase (MMP)‐2 and ‐9 expression, tissue inhibitors of metalloproteinase (TIMP)‐2 expression and hydroxyproline content were measured in the uterosacral ligaments and vaginal tissue from 14 women with prolapse compared with 14 controls.Main outcome measures  Levels of MMP, TIMP and hydroxyproline in the uterosacral ligaments and vaginal tissue of women with prolapse and controls.Results  Fourteen women with prolapse and 14 women without prolapse (controls) were included. A significant increase in pro MMP‐2 expression was seen in vaginal tissue from women with prolapse (P < 0.05) but not activated MMP‐2, MMP‐9 and TIMP‐2. For uterosacral ligaments, the differences were not statistically significant. No significant difference in hydroxyproline content was found between control and prolapse in either tissue. Significant correlations exist in expression of pro‐MMP‐2, activated MMP‐2, MMP‐9 and TIMP‐2 in vaginal tissue with that in uterosacral ligaments.Conclusions  Correlations existed between markers of collagen metabolism in the vaginal and uterosacral tissues. This suggests vaginal tissue reflects the endopelvic fascia. The changes which are more pronounced in vaginal tissue may be as a result of prolapse rather than cause.