Female stress incontinence and uterovaginal prolapse : Collagen turnover and hormone sensitivity in urogenital tissue
Year: 2009
Type: dissertation
Study design: Observational Study
Abstract: Background: Prevalence of both stress urinary incontinence (SUI) and \nuterovaginal prolapse (UP) is high and rising with age. Risk factors \ninclude multiparity, obesity, chronic obstructive lung disease and \nprevious gynecological surgery. The underlying pathology is still unknown \nbut may include defective connective tissue. \n \n \n \nAims: To study collagen turnover markers in urogenital tissue, in order to \ngain insight regarding a possible altered collagen synthesis or \nmetabolism in SUI and UP, if circulating sex steroids have any influence \non collagen turnover and if there are any differences in sex steroids \nbetween women with or without SUI. \n \n \n \nMethods: A total of 126 women were consecutively enrolled and classified \naccording to urogenital status into three groups: SUI without UP, N=71; \nUP without incontinence, N=24; urologically healthy controls without UP, \nN=31. Urogenital tissue biopsies and serum was collected for analysis of \nthe tissue and serum collagen turnover markers carboxy-terminal \npropeptide of type I procollagen (PICP), the carboxy-terminal telopeptide \nof type I collagen (ICTP) and the amino-terminal propeptide of \nprocollagen III (PIIINP) and serum steroids, steroid binding proteins and \nIGF-I. \n \n \n \nResult: Compared to controls tissue (T-)PIIINP and T-ICTP were \nsignificantly lower in SUI and T-PICP and T-PIIINP significantly higher \nin UP. Tissue collagen turnover markers were positively correlated to \nserum estradiol-17beta, especially at physiological serum estrone levels, \nin the controls but not in SUI patients except to a certain degree in \npremenopausal subjects. Instead of being related to serum estradiol- \n17beta, tissue collagen turnover markers in SUI patients were negatively \ncorrelated to serum total and free testosterone. There were no \nsignificant differences between comparable subgroups of SUI patients and \ncontrols in circulating sex steroids. \n \n \n \nConclusions: Our findings indicate a reduced collagen breakdown in SUI and \nan increased collagen turnover in UP, both which may negatively tissue \nelasticity and strength. Urogenital tissue collagen turnover may be \nstimulated by estrogen in urologically healthy women but not in SUI \npatients in general but to a certain degree in premenopausal subjects. \nThe latter finding may indicate menopause related changes as one \nunderlying factor behind SUI. At supraphysiological concentrations \nestrone may act as a partial estradiol-17B antagonist also in vivo. \nUrogenital tissue collagen turnover in SUI patients may be inhibited by \ntestosterone, perhaps by inhibition of matrix metalloprotease activity. \nOur findings emphasize the fact that SUI and UP have two distinctly \ndifferent etiologies and shall be studied using »clean« patient materials
Source: Figshare
Author: Lena Edwall
Language: English
Subfield: Urology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2143088474