Low Expression of Lysyl Oxidase-Like 1 (LOXL1) on the Sacrouterine Ligament as a Risk Factor of Stage III-IV Uterine Prolapse

The stage III-IV uterine prolapse commonly presents as discomfort lumps that pop out of the genitals, accompanied by sexual impairment, urinary disorders, rectal emptying disorders, vaginal discharge, back pain, and other diseases that may impact women's quality of life. The etiology of stage III-IV uterine prolapse is still not clear. The sacrouterine ligament is a structure implicated in the pathogenesis of uterine prolapse where Lysyl Oxidase-Like 1 (LOXL1) is an essential part of the sacrouterine ligament. This study aims to prove the low LOXL1 expression in the sacrouterine ligament as a risk factor for stage III-IV uterine prolapse. This observational case-control study involves 44 women who underwent a complete hysterectomy at Sanglah General Hospital, Denpasar. The case group was the patient with stage III-IV uterine prolapse, while the control group was a non-uterine prolapse patient. The Chi-Square test was used to assess the odds ratio of increasing LOXL1 expression to the incidence of stage III-IV uterine prolapse. Low LOXL1 expression has a 5.95-fold higher risk of developing stage III-IV uterine prolapse (OR = 5.95; 95% CI = 1.23-4.33; p = 0.006) than high LOXL1 expression with a cut-off value. The point is 1,772 based on the Receiver Operating Characteristic (ROC) curve. Low LOXL1 expression in the sacrouterine ligament is a risk factor for stage III-IV uterine prolapse.