Evaluation of Neuromuscular Morphometry of the Vaginal Wall Using Protein Gene Product 9.5 (Pgp 9.5) and Smooth Muscle α-Actin (Sma) in Patients with Posterior Vaginal Wall Prolapse

Abstract

Abstract Objective: This study aims to compare the neuromuscular structure of the vagina in women with posterior vaginal wall prolapse with women without prolapse, to determine any differences, and to show the role of neuromuscular structure in the physiopathology of prolapse. Materials and Methods: In this prospective study, women aged between 40 and 75 years without any vaginal surgery history and without any abdominal prolapse surgery history were included. The study group included 31 women diagnosed with rectocele on examination, and the control group included 31women who underwent vaginal intervention and hysterectomy for conditions other than rectocele (colposcopy, conization, etc.) without anterior or posterior wall prolapse. Biopsy material was obtained from the epithelium of the posterior wall of the vagina, including the fascia that fits the Ap point. Immunohistochemical staining with Protein Gene Product 9.5 and smooth muscle α-actin was performed in the pathology laboratory. The epithelial thickness measurement and smooth muscle density parameters obtained with these immunohistochemical staining were compared between the two groups. The collected data were analyzed using SPSS 23 package program. P values less than 0.05 were considered statistically significant. Findings: In the control group, muscle thickness and the number of nerves per mm2 of fascia were statistically significantly higher than in the study group (P<0.05). Conclusion: We found that smooth muscle tissue and the number of nerves per mm2 of fascia were lower in posterior vaginal wall prolapse compared to the general population. Based on the correlation coefficients, age was the parameter that most affected the degree of prolapse, followed by the parity, the number of live births, and the number of vaginal deliveries.