The Expression Of Neuropeptide In Vaginal Tissue Of Stress Urinary Incontinence Women

【Objective】To observe the relativity of expression of Vasoactive intestinal peptide (VIP) and Pituitary adenylate cyclase activating poly peptide (PACAP) in the tissue of anterior vaginal wall, to provide further evidence for denervation of pelvic floor and to explore whether the alteration in the expression of VIP and PACAP could contribute to stress urinary incontinence (SUI) and pelvic organ prolapse (POP).【Methods】Transvaginal biopsies were obtained from the vaginal tissues in the six different groups. Sixty-one women participated in the study. They were divided into 6 groups as follows: 8 premenopausal patients with SUI (group 1), 12 premenopausal patients with POP (group 2), 10 premenopausal patients with neither UI nor POP (group 3), 9 postmenopausal patients with SUI (group 4), 12 postmenopausal patients with POP (group 5), 10 postmenopausal patients with neither UI nor POP (group 6). The histological structures in vaginal tissues were examined with routine HE staining. The expression of VIP and PACAP in the tissue specimens was determined by immuno- histochemical technique and radioimmunoassay.【Results】VIP and PACAP were significantly reduced (p<0.05) in both premenopausal and postmenopausal patients with SUI (including group 1 and 4), compared to the control group (including group 3 and 6). High relativity was found in the expression of VIP and PACAP, the correlation coefficients were 0.833 (premenopausal) and 0.933 (postmenopausal) respectively.VIP and PACAP were significantly reduced (p<0.05) in both premenopausal and postmenopausal patients with POP (including group 2 and 5), compared to control patients (including group 3 and 6). High relativity was also found in the expression of VIP and PACAP, the correlation coefficients were 0.818 (premenopausal) and 0.958 (postmenopausal) respectively.In SUI group, the expression of VIP in anterior vaginal wall was negatively correlated with age (r=-0.566, p<0.05) and menopause status(r=-0.488, p<0.05); the expression of PACAP in anterior vaginal wall was negatively correlated with age (r=-0.743, p<0.05) and menopause status (r=-0.636, p<0.05).In POP group, the expression of VIP in anterior vaginal wall was negatively correlated with age (r=-0.569, p<0.05), menopause status (r=-0.466, p<0.05), parity (r=-0.512, p<0.05) and the stage of prolapse (r=-0.786, p<0.05); the expression of PACAP in anterior vaginal wall was negatively correlated with age(r=-0.484, p<0.05), menopause status (r=-0.432, p<0.05), parity (r=-0.590, p<0.05) and the stage of prolapse (r=-0.676, p<0.05).【Conclusion】In this study, a significantly decreased expression of VIP and PACAP was found in the vaginal tissue in both premenopausal and postmenopausal women with SUI. The distribution of VIP and PACAP was closely relative to blood vessels. We also found a strong correlation between the expression of VIP and PACAP in vaginal tissue; the expression of VIP was negatively correlated with age and menopause status; the expression of PACAP was negatively correlated with age and menopause status. These results suggested that VIP and PACAP might be involved in the pathogenesis of SUI by complementing each other. A low level of VIP and PACAP in the SUI group could be responsible for the changes of the microcirculation of pelvic floor. The alteration of tissue trophism and structural abnormalities of connective tissues were contribution to the progress of SUI.In this study, a significantly decreased expression of VIP and PACAP was found in the vaginal tissue in both premenopausal and postmenopausal women with POP. The distribution of VIP and PACAP was closely relative to blood vessels. We also found a strong correlation between the expression of VIP and PACAP in vaginal tissue; the expression of VIP was negatively correlated with age, menopause status, parity and the stage of prolapse; the expression of PACAP was negatively correlated with age, menopause status, parity and the stage of prolapse. All of these results informed that VIP and PACAP might be involved in the pathogenesis of POP by complementing each other. A low level of VIP and PACAP in the POP group could be responsible for the changes of the microcirculation of pelvic floor. The alteration of tissue trophism and structural abnormalities of connective tissues were contribution to the progress of POP. But whether SUI occurred or not was affected by other factors.