Does the vaginal wall become thinner as prolapse grade increases?

INTRODUCTION AND HYPOTHESIS: The pathophysiology of prolapse is not well understood. However, two main theories predominate: either the fibromuscular layer of the vagina develops a defect/tears away from its supports, or its tissues are stretched and attenuated. The aim of this study was to assess how vaginal wall thickness (VWT) is related to vaginal prolapse. METHODS: The study group comprised 243 women with symptomatic prolapse recruited from the Outpatient Department of a tertiary referral centre for urogynaecology. A history was taken and women were examined to determine their POP-Q score. Using a previously validated technique, ultrasonography was used to measure the mean VWT at three anatomical sites on the anterior and posterior walls. Scores were then compared using t tests, the Kruskal-Wallis test and the Friedman test. RESULTS: The mean age of the patients was 59.7 years (SD 12.0 years range 38 - 84 years). For each measurement VWT reduced as prolapse grade increased until the prolapse extended beyond the hymen. Women with grade 3 prolapse had a significantly higher mean VWT than women with grade 1 or 2 contained prolapse. Menopause status did not have a significant effect on the VWT. CONCLUSIONS: VWT is lower in women with vaginal prolapse until the prolapse extends beyond the hymen and then VWT is thicker and comparable with women without prolapse. This may be explained by changes in the vaginal tissue including reduction of collagen, elastin and smooth muscle, as well as fibrosis in exposed tissues, rather than by defects in the vagina.

Lack of association of joint hypermobility with urinary incontinence subtypes and pelvic organ prolapse.

OBJECTIVE: To test the hypothesis that joint hypermobility (JHM) is associated with specific urinary incontinence (UI) subtypes and uterovaginal prolapse. PATIENTS AND METHODS: In all, 270 women scheduled to undergo urodynamic investigations were invited to self-complete a validated five-item JHM questionnaire. Women underwent history taking, symptoms assessing via the King's Health Questionnaire and clinical examination using the Pelvic Organ Prolapse Quantification system. Associations between JHM and pelvic floor disorders in univariate and multivariate ordinal regression were reported using odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: The prevalence of JHM was 31.1%. JHM had a negative association with age (OR 0.98/year, P = 0.04). There was no association between JHM and either urodynamic (P = 0.41), or symptomatic stress UI (P = 0.48). Nor was there association with detrusor overactivity or symptomatic urgency UI. Multivariate ordinal regression of JHM with maximum prolapse stage, adjusting for age, showed a significant relationship (OR 1.26/stage, 95% CI 1.06-1.46, P < 0.05). CONCLUSION: Although JHM is highly prevalent amongst women with lower urinary tract symptoms (LUTS), there is no strong association of JHM with any UI subtype. There is a trend towards higher prolapse staging in women with JHM, which becomes significant only after adjustment for the confounding negative association between age and JHM.