Evaluation of neuromuscular morphometry of vagen wall by using protein gene product 9.5 (PGP 9.5) and smooth muscle α-actin (SMA) in cases with posterior vaginal wall prolapsus

Objective: The aim of this study is to compare the neuromuscular structure of the vagina in women with posterior vaginal wall prolapse and the vaginal neuromuscular structure of women without prolapse and to determine the difference between them. Demonstrating the role of the neuromuscular structure in the physiopathology of prolapse. Materials and Methods: In the prospectively planned study, women between the ages of 40-75 years, who had not undergone any vaginal surgery and who did not have any prolapse surgery by the abdominal route were included. 31 women diagnosed with rectocele during examination were included in the study group. 31 patients without anterior or posterior wall prolapse who underwent vaginal intervention and hysterectomy for reasons other than rectocele (colposcopy, conization, etc.) were included in the control group. Patients who applied to Hitit University Erol Olçok Education and Research Hospital Gynecology and Obstetrics Clinic between December 2019 and June 2020 and received a voluntary consent form were included in both groups. Biopsy material was taken from the posterior vaginal epithelium, including the fascia corresponding to the Ap point. Immunohistochemical staining was performed with Protein Gene Product 9.5 and smooth muscle α-actinin in the pathology laboratory. The epithelium thickness measurement and smooth muscle density parameters obtained by these immunohistochemical staining were compared between the two groups. Collected data were analyzed using SPSS 23 package program. P values less than 0.05 were considered statistically significant. Results: In the control group, the muscle thickness and the number of nerves per mm2 in the fascia were statistically significantly higher than the study group (P <0.05). Conclusion: We found that smooth muscle tissue in posterior vaginal wall prolapse and the number of nerves per mm2 in the fascia decreased compared to the normal population. According to the correlation coefficients, the parameter affecting the degree of prolapse most was age, followed by parity, the number of live births and the number of vaginal births. Keywords: Posterior vaginal wall prolapse, Protein Gene Product 9.5, α Smooth Muscle Actin