Purpose: The purpose of this study was to compare the smooth muscle content and apoptosis of the uterosacral ligament in women with and without uterine prolapse. Study Design: Uterosacral ligaments were sampled in women with (n = 9) or without (n = 9) uterine prolapse undergoing hysterectomy. Smooth muscle of the uterosacral ligament was identified by immunohistochemistry. Digital image analysis was used to determine the fractional area of smooth muscle in the histologic cross sections. Apoptosis was assessed by terminal deoxynucelotidyl-transferase-mediated dUTP nick-end-labeling method. Results: The fractional area of nonvascular smooth muscle in the uterosacral ligament of women with uterine prolapse was significantly decreased compared to women without prolapse (0.32 + 0.12 vs. 0.42 + 0.03, P = .02) and the apoptotic index was significantly higher compared to women without prolapse (0.20 + 0.06 vs. 0.08 + 0.04, P < .01). Conclusion: The fraction of smooth muscle in the uterosacral ligaments is significantly decreased, and the rate of apoptosis is higher in women with uterine prolapse compared to women without prolapse.
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