Pelvic organ prolapse (POP) is a multifactorial disorder characterized by the descent of the pelvic organs into the vaginal canal. This disorder is associated with decreased quality of life, and even depression, yet 50% of women over the age of fifty are living with POP. The cost associated with the repair of POP exceeds one billion dollars annually, in the United States alone. This rather exorbitant figure includes the cost of surgery performed for symptom management, but does not include strategies which address the underlying cause of the disorder for which there are none. Because failure rates of native tissue repairs are as high as 30%, vaginal mesh is increasingly used in the surgical repair of POP. The procedure aims to reinforce the fibromuscular layer of the vagina and the paravaginal attachments, thus providing structural integrity to the weakened native tissues. However, the use of mesh is limited by mesh-related complications including exposure, erosion, pain contraction and infection. In an effort to better understand the pathophysiology of POP and to help improve surgical outcomes, numerous studies within the last decade have placed considerable emphasis on understanding vaginal tissue remodeling in women with and without prolpase (1-2). The vagina has received much focus due to its central role in maintaining pelvic support, as it is anchored to the pelvis and attaches to the pelvic floor musculature, to create a bridge of support for the bladder and urethra to sit upon. Since vaginal tone, diameter, and compliance are predominantly maintained by smooth muscle, further emphasis has been placed on smooth muscle remodeling. The results from these studies have shown that women with POP have a higher apoptotic rate of smooth muscle cells (SMCs), a higher degree of disorganization, a smaller fractional area of smooth muscle fibers, and increased nerve degeneration in their vaginal wall (3-4).
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