Expression of matrix metalloproteinase-1 in round ligament and uterosacral ligament tissue from women with pelvic organ prolapse.

To evaluate the matrix metalloproteinase-1 (MMP-1) expression in different parts of pelvic connective tissue in postmenopausal women with and without pelvic organ prolapse (POP). Ninety-one samples were obtained from only postmenopausal women (42 with POP and 49 non-POP subjects). All women were evaluated by pelvic organ prolapse quantitation. The POP group had stage 2 or more, and the controls had stage 1 or less. Round ligament (RL) and uterosacral ligament (USL) biopsies were obtained from women with POP and controls. Immunohistochemistry for MMP-1 was performed on formalin-fixed and paraffin-embedded sections. The two groups were matched for age, body mass index, parity and postmenopausal status. MedCalc Statistical Software Programme Version 12.0.5 was used for statistical analysis. Expression of MMP-1 were significantly higher in both RL and USL tissue from postmenopausal women with POP, compared with controls. MMP-1 immunoreactivities were identified in both RL and USL biopsies from all women with and without POP. The expression pattern of MMP-1 were similar in these ligaments and were significantly higher in POP group compared with control subjects. These changes indicate a possible relation between MMP-1 expression of RL and USL in women with and without POP.

Intergender differences in histological architecture of the fascia pelvis parietalis: a cadaveric study.

The fascia pelvis parietalis (FPP) or endopelvic fascia is a well-known structure, but few studies described the detailed histological architecture, including the composite fiber directions. We hypothesized a gender-specific fiber architecture corresponding to the functional demand. For the first step to examine this hypothesis, we investigated specimens from 27 adult cadavers (10 males and 17 females) and 11 midterm fetuses (five males and six females) using immunohistochemistry and aldehyde-fuchsin staining. The adult female FPP was a solid, thick monolayered structure that was reinforced by abundant elastic fibers running across the striated muscle fibers, but it contained little or no smooth muscles (SM). In contrast, the male FPP was multilayered with abundant SM. In midterm fetuses, SM originated from the inferior part of the bladder and extended inferiorly along the gender-specific courses. Thus, we found a clear intergender difference in FPP architecture. However, the functional significance remained unknown because the basic architecture was common between nulliparous and multiparous women. Rather than for meeting the likely mechanical demands of pregnancy and vaginal delivery, the intergender difference of the FPP seemed to result from differences in the amount and migration course of bladder-derived SM as well as in hormonal background.

Neuromuscular morphometry of the uterine ligaments and vaginal wall in women with pelvic organ prolapse.

AIMS: The aim of this study was to compare neuromuscular histomorphometry of the uterine ligaments and vaginal wall in women with and without pelvic organ prolapse. METHODS: Biopsies were obtained from the round, uterosacral, and cardinal ligaments of the uterus and apical vaginal wall of women having pelvic organ prolapse repaired (stage ≥ II; prolapse group, 37) and the same location in patients with no prolapse (stage < II; control group, 47). Routine hematoxylin-eosin (H & E) staining and immunohistochemical staining for Protein Gene Product 9.5 (PGP 9.5) and smooth muscle α-actin were performed for all specimens. RESULTS: Smooth muscle percentage of the uterosacral and cardinal ligaments were not significantly different in women with prolapse than in women without. In round ligament, mean smooth muscle percentage was lower than in women with normal support (81.63 ± 8.2 vs. 51.63 ± 16, P=0.000). Mean distance of the smooth muscle fibers from surface epithelium of the vaginal epithelium of the women with prolapse were significantly higher than the control group (1.679 ± 0.34 vs. 2.240 ± 0.33, P = 0.000). PGP 9.5 stained area percentage of uterine ligaments and vaginal wall tissue samples were significantly lower in women with prolapse. CONCLUSIONS: Both total innervation of the anterior vaginal epithelium and uterine ligaments, and muscular percentage of the round ligament and vaginal wall were decreased in women with pelvic organ prolapse.

Age-dependent decreases of sulfur and magnesium in human round ligaments of the uterus and relationships among elements.

To elucidate the compositional change of ligaments with aging, the authors investigated both age-related changes of elements and relationships among elements in the round ligaments of the uterus (round ligaments) by inductively coupled plasma-atomic emission spectrometry. The bilateral round ligaments were resected from 20 cadavers and also from the uteri removed surgically from 11 patients bearing uterine myoma or cancer. Thirty-one subjects ranged in age from 34 to 92 yr. It was found that both S and Mg decreased gradually in the round ligaments with aging, but Ca, P, Zn, Fe, and Al did not change significantly with aging. Regarding the relationships among elements, very significant direct correlations were found among the contents of Ca, P, S, and Mg in the round ligaments, whereas significant inverse correlations were found between the contents of Zn and elements, such as Ca, P, S, and Mg. It should be noted that there was an extremely significant direct correlation between Ca and P contents in the round ligaments.

The round ligament: a target organ for steroid hormones.

Samples of the round ligament from pre- and post-menopausal women were analyzed immunohistochemically for estrogen and progesterone receptors. The steroid hormone receptors were localized in the smooth muscle cell nuclei, with stronger staining for progesterone receptors and somewhat weaker for estrogen receptors. Our findings support the view that the round ligament is a target organ influenced by hormones, which has implications for the changes in the ligament during pregnancy and pre- and postmenopausally.

Striated muscle heteroplasia in the uterine round ligament. A report of 30 cases.

The presence of nonneoplastic mature striated muscle, ie, striated muscle heteroplasia, is described in the proximal stumps of the round ligaments of the uterus. It was an incidental finding in 30 (2.8%) of 1064 surgical specimens studied without clinical or pathologic significance. It is deemed to represent aberrant persistence, differentiation, and maturation of gubernacular rhabdomyoblasts, which normally involute in female fetuses. The reasons for its sporadic occurrence in normal adult women are unknown.