CONNECTIVE TISSUE AND ETIOLOGY OF GENITOURINARY PROLAPSE

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The intent of this project is to determine the mechanisms of genitourinary prolapse, a common condition as women age. Surgery is currently the only definitive treatment for this condition, and 379,000 major surgical procedures were done in 1987 in the U.S. for conditions of genitourinary prolapse in women. With better understanding of the etiology and development of genitourinary prolapse, preventative care can be directed at high risk groups, and non-surgical treatment options can be developed. Connective tissue, especially collagen and elastin, holds the most promise for explaining the development of genitourinary prolapse, especially why women with the same medical histories and personal habits differ greatly in the degree to which prolapse develops. Because connective tissue is responsible for mechanical strength and many supportive tissues, alterations in collagen cross-linking, proportions of collagen sub-types, and total collagen content may predispose some women to prolapse. Obstetric history, bowel habits, and exercise patterns may then cause genitourinary prolapse in those women prone to fascial weakness. Initial work will establish methods for determining specific parameters and normal amount and proportion of collagen sub-types (I and III) in structures involved in pelvic support. Immunofluroescent studies, chemical extraction methods, and a newly developed ELISA will all be used to achieve this goal. Next, these parameters will be used to compare connective tissue in women with genitourinary prolapse and normal women. Finally, other factors such as cross-linking, stability, and additional components of connective tissue (proteoglycans, elastin, and fibronectin) will be examined for association with herniation of pelvic tissues. By understanding the mechanisms of genitourinary prolapse, high risk groups can be identified and targeted for preventative interventions such as alterations in obstetric care, modification of bowel and exercise habits, and hopefully development of non- surgical treatment options.