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Observational Study
. 2017 Mar;28(3):397-402.
doi: 10.1007/s00192-016-3150-1. Epub 2016 Sep 27.

Does the vaginal wall become thinner as prolapse grade increases?

Rhiannon Bray  1 , Alex Derpapas  2 , Ruwan Fernando  2 , Vik Khullar  2 , Demetri C Panayi  3
Affiliations
Observational Study

Does the vaginal wall become thinner as prolapse grade increases?

Rhiannon Bray et al. Int Urogynecol J. 2017 Mar.

Abstract

Introduction and hypothesis: The pathophysiology of prolapse is not well understood. However, two main theories predominate: either the fibromuscular layer of the vagina develops a defect/tears away from its supports, or its tissues are stretched and attenuated. The aim of this study was to assess how vaginal wall thickness (VWT) is related to vaginal prolapse.

Methods: The study group comprised 243 women with symptomatic prolapse recruited from the Outpatient Department of a tertiary referral centre for urogynaecology. A history was taken and women were examined to determine their POP-Q score. Using a previously validated technique, ultrasonography was used to measure the mean VWT at three anatomical sites on the anterior and posterior walls. Scores were then compared using t tests, the Kruskal-Wallis test and the Friedman test.

Results: The mean age of the patients was 59.7 years (SD 12.0 years range 38 - 84 years). For each measurement VWT reduced as prolapse grade increased until the prolapse extended beyond the hymen. Women with grade 3 prolapse had a significantly higher mean VWT than women with grade 1 or 2 contained prolapse. Menopause status did not have a significant effect on the VWT.

Conclusions: VWT is lower in women with vaginal prolapse until the prolapse extends beyond the hymen and then VWT is thicker and comparable with women without prolapse. This may be explained by changes in the vaginal tissue including reduction of collagen, elastin and smooth muscle, as well as fibrosis in exposed tissues, rather than by defects in the vagina.

Keywords: Prolapse; Ultrasonography; Vaginal wall thickness.

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Conflict of interest statement

Rhiannon Bray: None. Alex Derpapas: Travel expenses, Astellas, Pfizer. Ruwan Fernando: Speaker, consultant and paid investigator for Pfizer. Speaker and consultant for Astellas Pharma and Allergan. Vik Khullar: Speaker, consultant and paid investigator for Pfizer. Speaker and consultant for Astellas Pharma and Allergan. Demetri C. Panayi: Speaker and consultant for Astellas Pharma.

Figures

Fig. 1
Fig. 1
Study flow chart showing exclusion criteria, intervention and analysis
Fig. 2
Fig. 2
Ultrasound image showing measurement of vaginal wall thickness at the level of the bladder neck i and the anorectal junction ii
Fig. 3
Fig. 3
Vaginal wall thickness (VWT) in relation to prolapse grade. a Anterior compartment with prolapse graded according to POP-Q score at point Aa (p < 0.001): fornix (VWTAF), bladder neck (VWTBN), and bladder (VWTB). b Posterior compartment with prolapse graded according to POP-Q score at point Ap (p < 0.001): anorectal junction (VWTARJ), rectum (VWTB), and fornix (VWTPF). The data are presented as means with error bars indicating 95 % confidence intervals
See this image and copyright information in PMC

References

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