Noninvasive assessment of oxidative stress in pelvic organ prolapse: a feasibility study

Pelvic organ prolapse (POP) is increasingly relevant in aging populations. Oxidative stress (OS) may weaken pelvic support structures, but previous studies relied on invasive tissue sampling, limiting longitudinal use. This study evaluated whether OS markers can be detected non-invasively in vaginal fluid and whether they correlate with POP severity. We prospectively enrolled 160 women with POP between February 2021 and June 2023. Vaginal fluid samples were collected, and three OS markers: 8-hydroxy-2'-deoxyguanosine (8-OHdG), 4-hydroxynonenal (HNE), and advanced glycation end products (AGE) were quantified using commercial ELISA kits. POP severity was assessed by POP-Q and ultrasound parameters. 8-OHdG was consistently detectable and significantly elevated in advanced POP compared to early stages (p = 0.001), showing a modest positive correlation with prolapse severity (ρ = 0.24, p < 0.001). Regression analysis confirmed 8-OHdG as an independent predictor of prolapse severity (R² = 0.964). AGE levels did not differ significantly between groups, and HNE values were below detection thresholds in most samples. No associations were found between OS markers and age, BMI, or menopause duration. Non-invasive assessment of oxidative stress in vaginal fluid is feasible. Elevated 8-OHdG correlates with POP severity, supporting its potential as a biomarker for disease monitoring and future translational research.