OBJECTIVES: To compare elastin expression and elastic fibre width in the anterior vaginal wall of postmenopausal women with and with no bladder prolapse. PATIENTS AND METHODS: Full-thickness specimens were obtained from the upper lateral anterior vaginal wall of women having a large cystocele repaired (stage III or IV; prolapse group, 33) and the same location in patients with no prolapse having radical cystectomy (control group, 10). The percentage of elastin-positive tissue and elastic fibre width were measured by immunohistochemistry on 6 μm thick tissue sections from 10 random field readings per sample using image analysis software. The examiner was unaware of sample identity and the patients' clinical history. RESULTS: The age was comparable between the control and prolapse groups (median 70.5 years), and the parity, vaginal deliveries, hormone replacement use, cigarette smokers and body mass index were no different between the groups. Immunohistochemical staining and morphometric analysis indicated that elastin expression in the prolapse group was 10.6%, vs 14.4% in the control group (P = 0.049). The median width of elastic fibres was 0.9 μm in the prolapse and 1.8 μm in the control groups (P < 0.001). Elastin expression and elastic fibre width appeared to be stable with increasing age in the prolapse group. CONCLUSIONS: In this case-control study investigating elastin changes in postmenopausal women with prolapse, the elastin expression and fibre width were significantly lower in the vaginal wall of patients with a large cystocele than in controls of a similar age.
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