ANALYSIS OF COLLAGEN STATUS IN PREMENOPAUSAL NULLIPAROUS WOMEN WITH GENUINE STRESS-INCONTINENCE

Objective To determine if differences exist in the collagen status of premenopausal nulliparous women with genuine stress incontinence compa red with continent controls. Design Thirty-six premenopausal nulliparo us women with urodynamically-proven genuine stress incontinence were c ompared with 25 controls. All the women studied had a periurethral vag inal biopsy taken of approximately 30-50 mg in wet weight. This biopsy was then analysed to determine the collagen content, the type I:III c ollagen ratio and the collagen cross-link content. Setting A tertiary referral urodynamic unit. Results The nulliparous women with genuine s tress incontinence had significantly less collagen in their tissues (P < 0.0001) compared with the continent controls. In addition, there wa s a decreased ratio of type I to type III collagen (P = 0.0008), and t he cross-link content was also significantly reduced in the women with genuine stress incontinence (P < 0.0001). Conclusion Genuine stress i ncontinence is present in a significant number of women before childbi rth. The aetiology of their incontinence appears to be due to a defect in their connective tissue, with both a quantitative and qualitative reduction in their collagen.