The role of tenascin-X in the uterosacral ligaments of postmenopausal women with pelvic organ prolapse: an immunohistochemical study

Int Urogynecol J. 2020 Jan;31(1):101-106. doi: 10.1007/s00192-018-3820-2. Epub 2018 Dec 10.


Introduction and hypothesis: Abnormalities of connective tissue structure or its repair mechanism may predispose women to pelvic organ prolapse (POP). We hypothesized that the expression of tenascin-X in the uterosacral ligament of postmenopausal women with symptomatic POP is increased compared with postmenopausal women without POP. Furthermore, we identified clinical risk factors associated with POP in our study population.

Methods: We conducted a retrospective case-control study in which 33 postmenopausal women with symptomatic POP ≥ pelvic organ prolapse quantification system (POP-Q) stage II were matched with 33 postmenopausal women without POP. Studied tissue specimens were taken from hysterectomy specimens, and tenascin-X expression was investigated by immunohistochemistry. The immunohistochemical profile of the uterosacral connective tissue of cases and controls was compared.

Results: Tenascin-X was expressed in 94% of POP cases and in 91% of controls. Our study failed to show any statistically significant differences in tenascin-X expression between women with and without POP (p = 0.64). However, tenascin-X was significantly more expressed in cases with severe prolapse (POP-Q stage IV) compared with moderate prolapse stages (POP-Q stage II and III) (p = 0.001). Advanced patient age as well as early menopausal age remained independent risk factors associated with POP in multiple logistic regression analysis (p = 0.001).

Conclusion: No difference could be demonstrated between tenascin-X expression in patients with or without POP. Tenascin-X does not seem to play a major role in the pathogenesis of POP in postmenopausal women.

Keywords: Immunohistochemistry; Pelvic organ prolapse; Postmenopausal women; Tenascin-X expression; Uterosacral ligament.

Publication types

  • Evaluation Study

MeSH terms

  • Case-Control Studies
  • Female
  • Humans
  • Immunohistochemistry
  • Ligaments / metabolism*
  • Logistic Models
  • Middle Aged
  • Pelvic Organ Prolapse / metabolism*
  • Postmenopause / metabolism*
  • Retrospective Studies
  • Risk Factors
  • Sacrum / metabolism
  • Tenascin / metabolism*
  • Uterus / metabolism


  • Tenascin
  • tenascin X