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Koenig JB, Burnett LA. Understanding the Role of Obesity and Metabolism in Pelvic Floor Disorders. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:389-393. [PMID: 38564623 DOI: 10.1097/spv.0000000000001478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Affiliation(s)
- Jenny B Koenig
- From the Department of Obstetrics, Gynecology, and Reproductive Sciences
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Hernandez-Reynoso AG, Rahman FS, Hedden B, Castelán F, Martínez-Gómez M, Zimmern P, Romero-Ortega MI. Secondary urethral sphincter function of the rabbit pelvic and perineal muscles. Front Neurosci 2023; 17:1111884. [PMID: 36875671 PMCID: PMC9978527 DOI: 10.3389/fnins.2023.1111884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/01/2023] [Indexed: 02/18/2023] Open
Abstract
Perineal and pelvic floor muscles play an important role in continence by providing mechanical support to pelvic organs. It is also known that the pubococcygeus muscle (PcM) contracts in the storage phase and is inactive during voiding, while the bulbospongiosus muscle (BsM) is active during the voiding phase. Recent evidence suggested an additional role of these muscles in supporting urethral closure in rabbits. However, the individual role of perineal and pelvic muscles as urethral sphincters is not well-defined. Here we evaluated the individual, sequential and synergistic roles of the PcM and BsM in assisting urethral closure and defined the optimal electrical stimulation parameters that can effectively contract these muscles and increase the urethral pressure (P ura ) in young nulliparous animals (n = 11). Unilateral stimulation of either the BsM or PcM at 40 Hz induced modest increases in average P ura (0.23 ± 0.10 and 0.07 ± 0.04 mmHg, respectively). Investigation on the changes in P ura evoked by stimulation frequencies between 5 and 60 Hz show that sequential contralateral PcM-BsM activation at 40 Hz induced a 2-fold average P ura increase (0.23 ± 0.07 mmHg) compared to that evoked by PcM stimulation. Simultaneous activation of PcM and BsM at 40 Hz also showed an increased average P ura (0.26 ± 0.04 mmHg), with a 2-fold increase in average P ura observed during the unilateral sequential PcM-BsM stimulation at 40 Hz (0.69 ± 0.2 mmHg). Finally, stimulation at 40 Hz of the bulbospongiosus nerve (BsN) induced an approximate 4-fold increase in average P ura (0.87 ± 0.44 mmHg; p < 0.04) compared to that elicited by BsM stimulation, confirming that direct nerve stimulation is more effective. Together, this study shows that in the female rabbit, both perineal and pelvic muscles support of the urethral function during continence, and that unilateral stimulation of the BsN at 40-60 Hz is sufficient to achieve maximal secondary sphincter activity. The results also support the potential clinical value of neuromodulation of pelvic and perineal nerves as bioelectronic therapy for stress urinary incontinence.
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Affiliation(s)
- Ana G Hernandez-Reynoso
- Department of Bioengineering, The University of Texas at Dallas, Richardson, TX, United States
| | - Farial S Rahman
- Department of Biomedical Engineering and Biomedical Sciences, University of Houston, Houston, TX, United States
| | - Brian Hedden
- Department of Bioengineering, The University of Texas at Dallas, Richardson, TX, United States
| | - Francisco Castelán
- Departamento de Biología Celular y Fisiología, Unidad Foránea Tlaxcala, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Tlaxcala, Tlaxcala, Mexico.,Centro Tlaxcala de Biología de la Conducta, Universidad Autónoma de Tlaxcala, Tlaxcala City, Mexico
| | - Margarita Martínez-Gómez
- Departamento de Biología Celular y Fisiología, Unidad Foránea Tlaxcala, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Tlaxcala, Tlaxcala, Mexico.,Centro Tlaxcala de Biología de la Conducta, Universidad Autónoma de Tlaxcala, Tlaxcala City, Mexico
| | - Philippe Zimmern
- Department of Urology, The University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Mario I Romero-Ortega
- Department of Biomedical Engineering and Biomedical Sciences, University of Houston, Houston, TX, United States
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White SE, Kiley JX, Visniauskas B, Lindsey SH, Miller KS. Biaxial Murine Vaginal Remodeling With Reproductive Aging. J Biomech Eng 2022; 144:061010. [PMID: 35425969 PMCID: PMC10782864 DOI: 10.1115/1.4054362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/27/2022] [Indexed: 01/13/2024]
Abstract
Higher reproductive age is associated with an increased risk of gestational diabetes, pre-eclampsia, and severe vaginal tearing during delivery. Further, menopause is associated with vaginal stiffening. However, the mechanical properties of the vagina during reproductive aging before the onset of menopause are unknown. Therefore, the first objective of this study was to quantify the biaxial mechanical properties of the nulliparous murine vagina with reproductive aging. Menopause is further associated with a decrease in elastic fiber content, which may contribute to vaginal stiffening. Hence, our second objective was to determine the effect of elastic fiber disruption on the biaxial vaginal mechanical properties. To accomplish this, vaginal samples from CD-1 mice aged 2-14 months underwent extension-inflation testing protocols (n = 64 total; n = 16/age group). Then, half of the samples were randomly allocated to undergo elastic fiber fragmentation via elastase digestion (n = 32 total; 8/age group) to evaluate the role of elastic fibers. The material stiffness increased with reproductive age in both the circumferential and axial directions within the control and elastase-treated vaginas. The vagina demonstrated anisotropic mechanical behavior, and anisotropy increased with age. In summary, vaginal remodeling with reproductive age included increased direction-dependent material stiffness, which further increased following elastic fiber disruption. Further work is needed to quantify vaginal remodeling during pregnancy and postpartum with reproductive aging to better understand how age-related vaginal remodeling may contribute to an increased risk of vaginal tearing.
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Affiliation(s)
- Shelby E. White
- Department of Biomedical Engineering, Tulane University, 6823 St Charles Ave, New Orleans, LA 70118
| | - Jasmine X. Kiley
- Department of Biology, Tulane University, 6823 St Charles Ave, New Orleans, LA 70118
| | - Bruna Visniauskas
- Department of Pharmacology, Tulane University, 1430 Tulane Ave, New Orleans, LA 70118
| | - Sarah H. Lindsey
- Department of Pharmacology, Tulane University, 1430 Tulane Ave, New Orleans, LA 70118
| | - Kristin S. Miller
- Department of Biomedical Engineering, Tulane University, 6823 St Charles Ave, New Orleans, LA 70118
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Çetindağ EN, Dökmeci F, Çetinkaya ŞE, Seval MM. Changes of pelvic organ prolapse and pelvic floor dysfunction throughout pregnancy in singleton primigravidas: A prospective cohort study. Eur J Obstet Gynecol Reprod Biol 2021; 264:141-149. [PMID: 34303074 DOI: 10.1016/j.ejogrb.2021.07.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 07/08/2021] [Accepted: 07/10/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To document the deterioration in pelvic organ support occurring throughout all trimesters during the first pregnancy of women with no known risk factors. Secondarily to make a comprehensive review in order to verify the current findings and methodologies of similar studies in the literature. STUDY DESIGN In this prospective study, forty-one primigravid women with a singleton pregnancy were recruited during their first trimester. During follow-up pelvic organ support changes were documented by using Pelvic Organ Prolapse Quantification (POP-Q) system. Additionally, pelvic floor muscle strength examination, by modified Oxford scoring (MOS), and symptom assessment by Pelvic Floor Distress Inventory-Short Form (PFDI-20) were performed at three time points: first (T1), second (T2), and third trimester (T3) (n = 33). The Wilcoxon test was performed to test the significance of pairwise differences. Spearman correlation coefficient was estimated to determine the linear association of the findings. RESULTS Both distal and proximal anterior and posterior vaginal walls (Points Aa, Ba, Ap and Bp) with cervix (C) descended towards the hymen, throughout first pregnancy with a significant caudal shift on progressing from T2 to T3 (p ≤ 0.017). Posterior fornix (Point D) made a non-significant cranial shift (p = 0.527). The genital hiatus, perineal body and total vaginal length increased significantly (p ≤ 0.001). No significant difference in MOS was observed throughout pregnancy. The scores of PFDI-20 with all its domains worsened significantly during pregnancy, especially in T3 (p ≤ 0.011). Moderate correlations were observed between posterior vaginal descent and anorectal symptoms (rho 0.427, p < 0.05), and between the changes in genital hiatus and prolapse symptoms (rho 0.406, p < 0.05). CONCLUSION A significant descent both in all compartments of vaginal wall and perineum with an increase in total vaginal length, was observed together with an associated pelvic floor dysfunction throughout the first pregnancy of women.
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Affiliation(s)
- Elif Nazlı Çetindağ
- Ankara University School of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Fulya Dökmeci
- Ankara University School of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey.
| | - Şerife Esra Çetinkaya
- Ankara University School of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Mehmet Murat Seval
- Ankara University School of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey
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Ren K, Wang L, Wang L, Du Q, Cao J, Jin Q, An G, Li N, Dang L, Tian Y, Wang Y, Sun J. Investigating Transcriptional Dynamics Changes and Time-Dependent Marker Gene Expression in the Early Period After Skeletal Muscle Injury in Rats. Front Genet 2021; 12:650874. [PMID: 34220936 PMCID: PMC8248501 DOI: 10.3389/fgene.2021.650874] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/07/2021] [Indexed: 12/21/2022] Open
Abstract
Following skeletal muscle injury (SMI), from post-injury reaction to repair consists of a complex series of dynamic changes. However, there is a paucity of research on detailed transcriptional dynamics and time-dependent marker gene expression in the early stages after SMI. In this study, skeletal muscle tissue in rats was taken at 4 to 48 h after injury for next-generation sequencing. We examined the transcriptional kinetics characteristics during above time periods after injury. STEM and maSigPro were used to screen time-correlated genes. Integrating 188 time-correlated genes with 161 genes in each time-related gene module by WGCNA, we finally identified 18 network-node regulatory genes after SMI. Histological staining analyses confirmed the mechanisms underlying changes in the tissue damage to repair process. Our research linked a variety of dynamic biological processes with specific time periods and provided insight into the characteristics of transcriptional dynamics, as well as screened time-related biological indicators with biological significance in the early stages after SMI.
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Affiliation(s)
- Kang Ren
- School of Forensic Medicine, Shanxi Medical University, Jinzhong, China.,Department of Basic Medicine, Changzhi Medical College, Changzhi, China
| | - Liangliang Wang
- School of Forensic Medicine, Shanxi Medical University, Jinzhong, China
| | - Liang Wang
- School of Forensic Medicine, Shanxi Medical University, Jinzhong, China
| | - Qiuxiang Du
- School of Forensic Medicine, Shanxi Medical University, Jinzhong, China
| | - Jie Cao
- School of Forensic Medicine, Shanxi Medical University, Jinzhong, China
| | - Qianqian Jin
- School of Forensic Medicine, Shanxi Medical University, Jinzhong, China
| | - Guoshuai An
- School of Forensic Medicine, Shanxi Medical University, Jinzhong, China
| | - Na Li
- School of Forensic Medicine, Shanxi Medical University, Jinzhong, China
| | - Lihong Dang
- School of Forensic Medicine, Shanxi Medical University, Jinzhong, China
| | - Yingjie Tian
- School of Forensic Medicine, Shanxi Medical University, Jinzhong, China
| | - Yingyuan Wang
- School of Forensic Medicine, Shanxi Medical University, Jinzhong, China
| | - Junhong Sun
- School of Forensic Medicine, Shanxi Medical University, Jinzhong, China
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Hernandez-Reynoso AG, Corona-Quintanilla DL, López-García K, Horbovetz AA, Castelán F, Zimmern P, Martínez-Gómez M, Romero-Ortega MI. Targeted neuromodulation of pelvic floor nerves in aging and multiparous rabbits improves continence. Sci Rep 2021; 11:10615. [PMID: 34011938 PMCID: PMC8136474 DOI: 10.1038/s41598-021-90088-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 04/30/2021] [Indexed: 02/03/2023] Open
Abstract
Pelvic floor muscle stretch injury during pregnancy and birth is associated with the incidence of stress urinary incontinence (SUI), a condition that affects 30-60% of the female population and is characterized by involuntary urine leakage during physical activity, further exacerbated by aging. Aging and multiparous rabbits suffer pelvic nerve and muscle damage, resulting in alterations in pelvic floor muscular contraction and low urethral pressure, resembling SUI. However, the extent of nerve injury is not fully understood. Here, we used electron microscopy analysis of pelvic and perineal nerves in multiparous rabbits to describe the extent of stretch nerve injury based on axon count, axon size, myelin-to-axon ratio, and elliptical ratio. Compared to young nulliparous controls, mid-age multiparous animals showed an increase in the density of unmyelinated axons and in myelin thickness in both nerves, albeit more significant in the bulbospongiosus nerve. This revealed a partial but sustained damage to these nerves, and the presence of some regenerated axons. Additionally, we tested whether electrical stimulation of the bulbospongiosus nerve would induce muscle contraction and urethral closure. Using a miniature wireless stimulator implanted on this perineal nerve in young nulliparous and middle age multiparous female rabbits, we confirmed that these partially damaged nerves can be acutely depolarized, either at low (2-5 Hz) or medium (10-20 Hz) frequencies, to induce a proportional increase in urethral pressure. Evaluation of micturition volume in the mid-age multiparous animals after perineal nerve stimulation, effectively reversed a baseline deficit, increasing it 2-fold (p = 0.02). These results support the notion that selective neuromodulation of pelvic floor muscles might serve as a potential treatment for SUI.
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Affiliation(s)
- Ana G Hernandez-Reynoso
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX, 75080, USA
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, 75390, USA
- Department of Biomedical Engineering and Biomedical Sciences, University of Houston, Houston, TX, 77204, USA
| | - Dora L Corona-Quintanilla
- Centro Tlaxcala de Biología de la Conducta, Universidad Autónoma de Tlaxcala, Tlaxcala, Tlaxcala, Mexico
| | - Kenia López-García
- Departamento de Biología Celular y Fisiología, Unidad Foránea Tlaxcala, Instituto de Investigaciones Biomédicas, Universidad Autónoma de México, Tlaxcala, Tlaxcala, Mexico
| | - Ana A Horbovetz
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX, 75080, USA
| | - Francisco Castelán
- Centro Tlaxcala de Biología de la Conducta, Universidad Autónoma de Tlaxcala, Tlaxcala, Tlaxcala, Mexico
- Departamento de Biología Celular y Fisiología, Unidad Foránea Tlaxcala, Instituto de Investigaciones Biomédicas, Universidad Autónoma de México, Tlaxcala, Tlaxcala, Mexico
| | - Philippe Zimmern
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, 75390, USA
| | - Margarita Martínez-Gómez
- Centro Tlaxcala de Biología de la Conducta, Universidad Autónoma de Tlaxcala, Tlaxcala, Tlaxcala, Mexico
- Departamento de Biología Celular y Fisiología, Unidad Foránea Tlaxcala, Instituto de Investigaciones Biomédicas, Universidad Autónoma de México, Tlaxcala, Tlaxcala, Mexico
| | - Mario I Romero-Ortega
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, 75390, USA.
- Department of Biomedical Engineering and Biomedical Sciences, University of Houston, Houston, TX, 77204, USA.
- Department of Health Care Sciences, University of Texas Southwestern Medical Center, Dallas, 75390, USA.
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Age-associated changes in the mechanical properties of human cadaveric pelvic floor muscles. J Biomech 2019; 98:109436. [PMID: 31708240 DOI: 10.1016/j.jbiomech.2019.109436] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 10/14/2019] [Accepted: 10/16/2019] [Indexed: 12/12/2022]
Abstract
Proper function of the female pelvic floor requires intact pelvic floor muscles (PFMs). The prevalence of pelvic floor disorders (PFDs) increases substantially with age, in part due to clinically identified deterioration of PFM function with age. However, the etiology of this decline remains largely unknown. We previously demonstrated that PFMs undergo age-related fibrotic changes. This study sought to determine whether aging also impacts PFMs' passive mechanical properties that are largely determined by the intramuscular extracellular matrix. Biopsies from younger (≤52y) and older (>52y) female cadaveric donors were procured from PFMs, specifically coccygeus (C) and two portions of the levator ani - iliococcygeus (IC) and pubovisceralis (PV), and the appendicular muscles - obturator internus (OI) and vastus lateralis (VL). Muscle bundles were subjected to a passive loading protocol, and stress-sarcomere length (Ls) relationships calculated. Muscle stiffness was compared between groups using 2-way ANOVA and Sidak pairwise comparisons, α < 0.05. The mean age was 43.4 ± 11.6y and 74.9 ± 11.9y in younger (N = 5) and older (N = 10) donors, respectively. In all PFMs, the quadratic coefficient of parabolic regression of the stress-Ls curve, a measure of stiffness, was lower in the younger versus older group: C: 33.7 ± 13.9 vs 87.2 ± 10.7, P = 0.02; IC: 38.3 ± 12.7 vs 84.5 ± 13.9, P = 0.04; PV: 24.7 ± 8.8 vs 74.6 ± 9.6, P = 0.04. In contrast, non-PFM stiffness was not affected by aging: OI: 14.5 ± 4.7 vs 32.9 ± 6.2, P = 0.8 and VL: 13.6 ± 5.7 vs 30.1 ± 5.3, P = 0.9. Age-associated increase in PFM stiffness is predicted to negatively impact PFM function by diminishing muscle load-bearing, excursional, contractile, and regenerative capacity, thus predisposing older women to PFDs.
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