Analysis of collagen status in women with genuine stress incontinence

INTRODUCTION : Genuine stress urinary incontinence is defined as a condition in which involuntary urine loss occurs in an intact urethra, when intra vesical pressure exceeds intra urethral pressure without a detrusor contraction during physical exertion. Genuine stress urinary incontinence results from an anatomical defect of the support of the urethrovesical junction and proximal urethra resulting in displacement of these during stress, but the precise mechanism is poorly understood. Intact functional collagen fibres are needed for mechanical stability of the genitourinary tract, which support the bladder neck, urethra and pelvic organs. In a study by Ulmsten et al and Versi et al showed alterations in collagen synthesis and types are casually related to genuine stress urinary incontinence. Low levels of collagen is found in vesicovaginal fascia, round ligaments, uterosacral ligaments as well as tissues supporting the urethra and bladder neck in women with genuine stress urinary incontinence than continent women. Immunohistochemical analysis of paraurethral tissue for collagen changes suggests that significant role in the maintenance of urinary continence is due to connective tissue that consists mainly of collagen fibres. AIM AND OBJECTIVE : To study the collagen status in peri urethral vaginal tissues. To determine the role of collagen in the maintenance of urinary Incontinence. MATERIALS AND METHODS : All the patients are informed about the procedure. After explaining details of the study, consent form is filled with signature. All details were recorded in a proforma as an outpatient procedure. Analysis was done with the collected details prospectively. All the patients were enquired regarding menstrual history, parity and previous surgical details. All the patients were undergone abdominal examination, per vaginal examination, cystoscopy and urodynamic evaluation. Biopsies for collagen analysis were taken from all cases and all continent controls. The biopsy was taken from the periurethral vagina following application of lignocaine cream. The site of biopsy was 1 cm lateral to the urethra in its lower third. The samples were immediately fixed in formalin for a period of 24 hrs and embedded in paraffin wax. 5 μm sections were mounted and stained with Eosin and Haematoxylin for histological assessment. Immunohistochemical analysis was done in all biopsy specimens. CONCLUSION : The distribution of collagen-I and collagen-III between stress urinary incontinent women and continent control women is found to be statistically significant. These collagen alterations are not influenced by age, parity, mode of delivery, body weight and presence of hypertension and diabetes. Although these data are statistically significant, large study is needed for future usage as diagnostic tool and to discover the pathophysiology of stress urinary incontinence