Status Plus

abstract

127 - THE IMPACT OF AGEING AND GENETIC PREDISPOSITION ON PELVIC FLOOR DISORDERS. ANATOMIC AND HISTOLOGIC CONSIDERATIONS

127

THE IMPACT OF AGEING AND GENETICPREDISPOSITION ON PELVIC FLOOR DISORDERS. ANATOMIC AND HISTOLOGICCONSIDERATIONS

H. van GEELEN;
CWZ,Nijmegen, Netherlands.

Introduction: Pregancy andchildbirth have long been known to be associated with increasedincidence of Pelvic Floor Disorders ( PFD’s). Prevalencies of UIand POP increase with age and increasing parity. After the age of 50the effects of the mode of delivery fade away.( 1) .Prospectivelongitudinal studies performed during pregnancy and after childbirthusing validated measuring techniques indicate that inherent weaknessof the pelvic supportive tissues contribute to the increase of PFD’sin later life ( 2 ,3)
Objective: The present study wascarried out to show: 1.The effect of ageing on the anatomy andhistology of the pelvic floor tissues. 2. Constitutional differencesin the composition and quality of the pelvic supportive structuresbetween women within the same age group.
Methods: 6 femalecorpses, deceased by non-gynecologic cause, were referred to thepathologist lab. for autopsy: two were in their fertile age, twoperimenopausal and two postmenopausal. One of the postmenopausalcorpses had evidence of pelvic organ prolapse. At autopsy bladder ,urethra and anterior vaginal wall were carefully dissected and serialtransverse sections at the level of the midurethra including theanterior vaginal wall were made. The sections were stained: Azam ,von Giessen and haematoxylin-eosin staining. The pictures of theslides were magnified 2.5 and 5x
Results: When comparedwith the premenopausal sections (graphic 1 ) the transverse sectionsof the perimenopausal corpses show marked differences in compositionand quantity of muscle fibres and connective tissue: decrease ofsmooth and striated urethral muscle bundles and reduction ofcollagenous tissue . Within each age group the images of thetransverse sections are rather similar. The transverse sections ofthe postmenopausal corpses are marked by a predominance of connectivetissue (graphic 2 ). Smooth and striated muscle bundles within theurethral wall are relatively scarce. The compact structure of thepubo-vesico-cervical fascia is clearly distinguishable in one section. The transverse section of the corpse with genital prolaps alsoshows a predominance of connective tissue , but the structure is moreloose and the volume of the urethral wall is smaller when comparedwith transverse section of the other postmenopausal subject. Smoothand striated muscle bundles are scarce but can still bedistinguished. The pubo-vesico-cervical fascia can not be identified. A total of 7 slides will be shown.
Conclusions: Ageing isassociated with marked and characteristic changes which weaken thesupportive properties of the pelvic floor. There are differencesbetween the transverse sections of the women within the same agegroups which support the results of prospective clinical studiesindicating a genetic predisposition Ageing and a geneticpredisposition are the most determinant factors in the pathofysiologyof pelvic floor disorders. Obstetric and non-obstetric factorscontribute for symptoms of PFD's to become clinicallymanifest.
References: 1. N Engl J Med. 2003. 348: 900-9072. Br J Obstet Gynecol 1998;105: 1300-1307 3. Am J Obstet Gynecol.1982;144 : 636-649