Effect of gonadal steroid receptors alterations on the pathophysiology of pelvic organ prolapse and urinary incontinence

BACKGROUND: The aim of this study was to investigate the contribution of the gonadal steroid receptors expression to the pathophysiological pathways of pelvic organ prolapse (POP) and urodynamic stress urinary incontinence (USUI) after menopause. METHODS: This was a prospective closely-matched controlled clinicopathological study. immunohistochemistry for estrogen receptor isoform alpha (ER-alpha) and beta (ER-beta), as well as for progesterone receptor (PR), was performed on formaline-fixed and paraffin-embedded sections of specimens coming from the pubocervical fascia of postmenopausal women who were allocated into three groups: patients with synchronous POP and USUI (Group A), patients diagnosed with only POP (Group B), and patients without POP or USUI who underwent gynecological surgery for another benign indication (control group, Group C). RESULTS: There was no statistically significant difference among the three groups for age, parity, body mass index, or smoking. The expression of ER-alpha receptors was found significantly reduced among samples of Group B when compared with control group. Statistically significant reduction not only for ER-alpha, but for ER-beta, as well, was noticed among samples of Group A, compared to the other two groups. No remarkable differences concerning the density of PR receptors were observed among the three groups. CONCLUSIONS: Alterations of ER-alpha in the pubocervical fascia and around the urethra in postmenopausal women may play an important role in the pathophysiology of POP. in addition, the risk for developing USUI among POP patients seems to be strongly associated with the reduction of both estrogen receptors (ER-alpha and ER-beta) exprseison.