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Giannotti A, Musco S, Miragliotta V, Lazzarini G, Pirone A, Briganti A, Verardo C, Bernini F, Del Popolo G, Micera S. Swine Pudendal Nerve as a Model for Neuromodulation Studies to Restore Lower Urinary Tract Dysfunction. Int J Mol Sci 2024; 25:855. [PMID: 38255927 PMCID: PMC10815560 DOI: 10.3390/ijms25020855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
Lower urinary tract dysfunction, such as incontinence or urinary retention, is one of the leading consequences of neurological diseases. This significantly impacts the quality of life for those affected, with implications extending not only to humans but also to clinical veterinary care. Having motor and sensory fibers, the pudendal nerve is an optimal candidate for neuromodulation therapies using bidirectional intraneural prostheses, paving the way towards the restoration of a more physiological urination cycle: bladder state can be detected from recorded neural signals, then an electrical current can be injected to the nerve based on the real-time need of the bladder. To develop such prostheses and investigate this novel approach, animal studies are still required since the morphology of the target nerve is fundamental to optimizing the prosthesis design. This study aims to describe the porcine pudendal nerve as a model for neuromodulation studies aiming at restoring lower urinary tract dysfunction. Five male farm pigs were involved in the study. First, a surgical procedure to access the porcine pudendal nerve without muscle resection was developed. Then, an intraneural interface was implanted to confirm the presence of fibers innervating the external urethral sphincter by measuring its electromyographic activity. Finally, the morphophysiology of the porcine pudendal nerve at the level of surgical exposure was described by using histological and immunohistochemical characterization. This analysis confirmed the fasciculate nature of the nerve and the presence of mixed fibers with a spatial and functional organization. These achievements pave the way for further pudendal neuromodulation studies by using a clinically relevant animal model with the potential for translating the findings into clinical applications.
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Affiliation(s)
- Alice Giannotti
- The BioRobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant’Anna, 56127 Pisa, Italy; (A.G.); (C.V.)
| | - Stefania Musco
- Neuro-Urology Department, Careggi University Hospital, 50134 Firenze, Italy; (S.M.); (G.D.P.)
| | - Vincenzo Miragliotta
- Department of Veterinary Sciences, University of Pisa, 56124 Pisa, Italy; (V.M.); (G.L.); (A.P.); (A.B.)
| | - Giulia Lazzarini
- Department of Veterinary Sciences, University of Pisa, 56124 Pisa, Italy; (V.M.); (G.L.); (A.P.); (A.B.)
| | - Andrea Pirone
- Department of Veterinary Sciences, University of Pisa, 56124 Pisa, Italy; (V.M.); (G.L.); (A.P.); (A.B.)
| | - Angela Briganti
- Department of Veterinary Sciences, University of Pisa, 56124 Pisa, Italy; (V.M.); (G.L.); (A.P.); (A.B.)
| | - Claudio Verardo
- The BioRobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant’Anna, 56127 Pisa, Italy; (A.G.); (C.V.)
| | - Fabio Bernini
- BioMedLab, Scuola Superiore Sant’Anna, 56127 Pisa, Italy;
| | - Giulio Del Popolo
- Neuro-Urology Department, Careggi University Hospital, 50134 Firenze, Italy; (S.M.); (G.D.P.)
| | - Silvestro Micera
- The BioRobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant’Anna, 56127 Pisa, Italy; (A.G.); (C.V.)
- Bertarelli Foundation Chair in Translational NeuroEngineering, Center for Neuroprosthetics and Institute of Bioengineering, École Polytechnique Fédérale de Lausanne, 1015 Lausanne, Switzerland
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Fang F, Zhao Z, Xiao J, Wen J, Wu J, Miao Y. Current practice in animal models for pelvic floor dysfunction. Int Urogynecol J 2023; 34:797-808. [PMID: 36287229 DOI: 10.1007/s00192-022-05387-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 08/31/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to explore the current practice of using animal models for female pelvic floor dysfunction (PFD). METHODS By applying PFD and animal models as the keywords, we made a computerized search using PubMed, Ovid-Medline and Ovid-Embase from 2000 to 2022. The publications on the construction and application of animal models for PFD were included, and the results are presented in narrative text. RESULTS Studies on PFD primarily use rodents, large quadrupeds, and nonhuman primates (NHPs). NHPs are closest to humans in anatomy and biomechanics of the pelvic floor, followed by large quadrupeds and rodents. Rodents are more suitable for studying molecular mechanism, histopathology of PFD, and mesh immune rejection. Large quadrupeds are adaptable to the study of pelvic floor biomechanics and the development of new surgical instruments for PFD. NHPs are suitable for studying the occurrence and pathogenesis of pelvic organ prolapse. Among modeling methods, violent destruction of pelvic floor muscles, regulation of hormone levels, and denervation were used to simulate the occurrence of PFD. Gene knockout can be used to study both the pathogenesis of PFD and the efficacy of treatments. Other methods such as abdominal wall defect, vaginal defect, and in vitro organ bath system are more frequently used to observe wound healing after surgery and to verify the efficacy of treatments. CONCLUSIONS The rat is currently the most applicable animal type for numerous modeling methods. Vaginal dilation is the most widely used modeling method for research on the pathogenesis, pathological changes, and treatment of PFD.
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Affiliation(s)
- Fei Fang
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, West China Second University Hospital, Sichuan University, West China Campus, Chengdu, 610041, Sichuan Province, China
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Zhiwei Zhao
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Jingyue Xiao
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Jirui Wen
- Deep Underground Space Medical Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Jiang Wu
- Deep Underground Space Medical Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Yali Miao
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, West China Second University Hospital, Sichuan University, West China Campus, Chengdu, 610041, Sichuan Province, China.
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Gardella B, Scatigno AL, Belli G, Gritti A, Visoná SD, Dominoni M. Aging of Pelvic Floor in Animal Models: A Sistematic Review of Literature on the Role of the Extracellular Matrix in the Development of Pelvic Floor Prolapse. Front Med (Lausanne) 2022; 9:863945. [PMID: 35492348 PMCID: PMC9051040 DOI: 10.3389/fmed.2022.863945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
Pelvic organ prolapse (POP) affects many women and contributes significantly to a decrease in their quality of life causing urinary and/or fecal incontinence, sexual dysfunction and dyspareunia. To better understand POP pathophysiology, prevention and treatment, many researchers resorted to evaluating animal models. Regarding this example and because POP affects principally older women, our aim was to provide an overview of literature on the possible biomechanical changes that occur in the vaginas of animal models and their supportive structures as a consequence of aging. Papers published online from 2000 until May 2021 were considered and particular attention was given to articles reporting the effects of aging on the microscopic structure of the vagina and pelvic ligaments in animal models. Most research has been conducted on rodents because their vagina structure is well characterized and similar to those of humans; furthermore, they are cost effective. The main findings concern protein structures of the connective tissue, known as elastin and collagen. We have noticed a significant discordance regarding the quantitative changes in elastin and collagen related to aging, especially because it is difficult to detect them in animal specimens. However, it seems to be clear that aging affects the qualitative properties of elastin and collagen leading to aberrant forms which may affect the elasticity and the resilience of tissues leading to pelvic floor disease. The analysis of histological changes of pelvic floor tissues related to aging underlines how these topics appear to be not fully understood so far and that more research is necessary.
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Affiliation(s)
- Barbara Gardella
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Annachiara Licia Scatigno
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Giacomo Belli
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Andrea Gritti
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Silvia Damiana Visoná
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Mattia Dominoni
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
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Deprest JA, Cartwright R, Dietz HP, Brito LGO, Koch M, Allen-Brady K, Manonai J, Weintraub AY, Chua JWF, Cuffolo R, Sorrentino F, Cattani L, Decoene J, Page AS, Weeg N, Varella Pereira GM, Mori da Cunha de Carvalho MGMC, Mackova K, Hympanova LH, Moalli P, Shynlova O, Alperin M, Bortolini MAT. International Urogynecological Consultation (IUC): pathophysiology of pelvic organ prolapse (POP). Int Urogynecol J 2022; 33:1699-1710. [PMID: 35267063 DOI: 10.1007/s00192-022-05081-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/27/2021] [Indexed: 10/18/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This manuscript is the International Urogynecology Consultation (IUC) on pelvic organ prolapse (POP) chapter one, committee three, on the Pathophysiology of Pelvic Organ Prolapse assessing genetics, pregnancy, labor and delivery, age and menopause and animal models. MATERIALS AND METHODS An international group of urogynecologists and basic scientists performed comprehensive literature searches using pre-specified terms in selected biomedical databases to summarize the current knowledge on the pathophysiology of the development of POP, exploring specifically factors including (1) genetics, (2) pregnancy, labor and delivery, (3) age and menopause and (4) non-genetic animal models. This manuscript represents the summary of three systematic reviews with meta-analyses and one narrative review, to which a basic scientific comment on the current understanding of pathophysiologic mechanisms was added. RESULTS The original searches revealed over 15,000 manuscripts and abstracts which were screened, resulting in 202 manuscripts that were ultimately used. In the area of genetics the DNA polymorphisms rs2228480 at the ESR1 gene, rs12589592 at the FBLN5 gene, rs1036819 at the PGR gene and rs1800215 at the COL1A1 gene are significantly associated to POP. In the area of pregnancy, labor and delivery, the analysis confirmed a strong etiologic link between vaginal birth and symptoms of POP, with the first vaginal delivery (OR: 2.65; 95% CI: 1.81-3.88) and forceps delivery (OR: 2.51; 95% CI: 1.24-3.83) being the main determinants. Regarding age and menopause, only age was identified as a risk factor (OR : 1.102; 95% CI: 1.02-1.19) but current data do not identify postmenopausal status as being statistically associated with POP. In several animal models, there are measurable effects of pregnancy, delivery and iatrogenic menopause on the structure/function of vaginal support components, though not on the development of POP. CONCLUSIONS Genetics, vaginal birth and age all have a strong etiologic link to the development of POP, to which other factors may add or protect against the risk.
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Affiliation(s)
- Jan A Deprest
- Department Development and Regeneration, Cluster Urogenital Surgery, Biomedical Sciences, and Clinical Department Obstetrics and Gynaecology, University Hospitals Leuven, KU Leuven, Herestraat 49, B-3000, Leuven, Belgium.
| | - Rufus Cartwright
- Department of Epidemiology & Biostatistics, Imperial College London, Norfolk Place, London and Department of Urogynaecology, LNWH NHS Trust, London, UK
| | - Hans Peter Dietz
- Sydney Medical School Nepean, Nepean Hospital, Penrith, NSW, 2750, Australia
| | - Luiz Gustavo Oliveira Brito
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - Marianne Koch
- Department of Obstetrics and Gynaecology, Medical University of Vienna, Vienna, Austria
| | - Kristina Allen-Brady
- Department of Internal Medicine, Genetic Epidemiology, University of Utah, Salt Lake City, UT, USA
| | - Jittima Manonai
- Department of Obstetrics and Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Adi Y Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - John W F Chua
- Department of Gynecology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Romana Cuffolo
- Department of Obstetrics & Gynaecology, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Felice Sorrentino
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, Foggia, Italy
| | - Laura Cattani
- Department Development and Regeneration, Cluster Urogenital Surgery, Biomedical Sciences, and Clinical Department Obstetrics and Gynaecology, University Hospitals Leuven, KU Leuven, Herestraat 49, B-3000, Leuven, Belgium
| | - Judith Decoene
- Department Development and Regeneration, Cluster Urogenital Surgery, Biomedical Sciences, and Clinical Department Obstetrics and Gynaecology, University Hospitals Leuven, KU Leuven, Herestraat 49, B-3000, Leuven, Belgium
| | - Anne-Sophie Page
- Department Development and Regeneration, Cluster Urogenital Surgery, Biomedical Sciences, and Clinical Department Obstetrics and Gynaecology, University Hospitals Leuven, KU Leuven, Herestraat 49, B-3000, Leuven, Belgium
| | - Natalie Weeg
- Sydney Medical School Nepean, Nepean Hospital, Penrith, NSW, 2750, Australia
| | - Glaucia M Varella Pereira
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - Marina Gabriela M C Mori da Cunha de Carvalho
- Department Development and Regeneration, Cluster Urogenital Surgery, Biomedical Sciences, and Clinical Department Obstetrics and Gynaecology, University Hospitals Leuven, KU Leuven, Herestraat 49, B-3000, Leuven, Belgium
| | - Katerina Mackova
- Department Development and Regeneration, Cluster Urogenital Surgery, Biomedical Sciences, and Clinical Department Obstetrics and Gynaecology, University Hospitals Leuven, KU Leuven, Herestraat 49, B-3000, Leuven, Belgium
| | - Lucie Hajkova Hympanova
- Department Development and Regeneration, Cluster Urogenital Surgery, Biomedical Sciences, and Clinical Department Obstetrics and Gynaecology, University Hospitals Leuven, KU Leuven, Herestraat 49, B-3000, Leuven, Belgium
| | - Pamela Moalli
- Division of Urogynecology & Pelvic Reconstructive Surgery, UPMC Magee-Womens Hospital, Pittsburgh, PA, USA
| | - Oksana Shynlova
- Department of Obstetrics, Gynaecology and Physiology, Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada
| | - Marianna Alperin
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego, School of Medicine, San Diego, CA, USA
| | - Maria Augusta T Bortolini
- Department of Gynecology, Sector of Urogynecology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Lee CL, Lee J, Park JM, Na HS, Shin JH, Na YG, Kim KH. Sophisticated regulation of micturition: review of basic neurourology. J Exerc Rehabil 2021; 17:295-307. [PMID: 34805017 PMCID: PMC8566102 DOI: 10.12965/jer.2142594.297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 10/05/2021] [Indexed: 01/23/2023] Open
Abstract
The neurological regulation of the lower urinary tract can be viewed separately from the perspective of sensory neurons and motor neurons. First, in the receptors of the bladder and urethra of sensory nerves, sensations are transmitted through the periaqueductal gray matter of the midbrain to the cerebral cortex, and the cerebrum goes through the process of decision-making. Motor neurons are divided into upper motor neurons (UMNs) and lower motor neurons (LMNs). UMNs coordinate storage and micturition in the brain stem so that synergic voiding can occur. LMNs facilitate muscle contractions in the spinal cord. The muscles involved in urinary storage and micturition are innervated by the somatic branches of sympathetic, parasympathetic, and peripheral nerves. Sympathetic nerves are responsible for contractions of urethral smooth muscles, while parasympathetic nerves originate from S2–S4 and are in charge of contractions of the bladder muscle. Somatic nerves originate from the motor neurons in Onuf’s nucleus, which is a specific part of somatic nerves. In this review, we will investigate the structures of the nervous systems related to the lower urinary tract and the regulatory system of innervation for the urinary storage and micturition and discuss the clinical significance and future prospects of neurourological research.
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Affiliation(s)
- Chung Lyul Lee
- Department of Urology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jaegeun Lee
- Department of Urology, Chungnam National University Sejong Hospital, Chungnam National University School of Medicine, Sejong, Korea
| | - Jong Mok Park
- Department of Urology, Chungnam National University Sejong Hospital, Chungnam National University School of Medicine, Sejong, Korea
| | - Hyun Seok Na
- Department of Urology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Ju Hyun Shin
- Department of Urology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Yong Gil Na
- Department of Urology, Chungnam National University Sejong Hospital, Chungnam National University School of Medicine, Sejong, Korea
| | - Khae Hawn Kim
- Department of Urology, Chungnam National University Sejong Hospital, Chungnam National University School of Medicine, Sejong, Korea
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Pereira da Silva G, Souza Pereira THD, Felipe Lima AK, Russiano Vicente WR, Kuehl TJ, Ruiz JC, Barros Monteiro FO. Female squirrel monkeys as models for research on women's pelvic floor disorders. Lab Anim 2021; 55:499-508. [PMID: 34323623 DOI: 10.1177/00236772211032506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Animal models enable research on biological phenomena with controlled interventions not possible or ethical in patients. Among species used as experimental models, squirrel monkeys (Saimiri genus) are phylogenetically related to humans and are relatively easily managed in captivity. Quadrupedal locomotion of squirrel monkeys resembles most other quadrupedal primates in that they utilize a diagonal sequence/diagonal couplets gait when walking on small branches. However, to assume a bipedal locomotion, the human pelvis has undergone evolutionary changes. Therefore, the pelvic bone morphology is not that similar between the female squirrel monkey and woman, but pelvic floor support structures and impacts of fetal size and malpresentation are similar. Thus, this review explores the pelvic floor support structural characteristics of female squirrel monkeys, especially in relation to childbirth to demonstrate similarities to humans.
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Affiliation(s)
- Gessiane Pereira da Silva
- Postgraduate Program in Animal Health and Production in Amazonia (PPGSPAA), Federal Rural University of the Amazon (UFRA), Brazil
| | - Thyago Habner de Souza Pereira
- Postgraduate Program in Animal Health and Production in Amazonia (PPGSPAA), Federal Rural University of the Amazon (UFRA), Brazil
| | - Ana Kelen Felipe Lima
- Postgraduate Program in Animal Health and Production in Amazonia (PPGSPAA), Federal Rural University of the Amazon (UFRA), Brazil.,Postgraduate Program in Animal and Public Health in the Tropics (PPGSaspt), Federal University of Tocantins (UFT), Brazil
| | - Wilter Ricardo Russiano Vicente
- Postgraduate Program in Animal Health and Production in Amazonia (PPGSPAA), Federal Rural University of the Amazon (UFRA), Brazil
| | - Thomas J Kuehl
- Department of Comparative Medicine, The University of Texas MD Anderson Cancer Center, USA
| | - Julio Cesar Ruiz
- Department of Comparative Medicine, The University of Texas MD Anderson Cancer Center, USA
| | - Frederico Ozanan Barros Monteiro
- Postgraduate Program in Animal Health and Production in Amazonia (PPGSPAA), Federal Rural University of the Amazon (UFRA), Brazil
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Mori da Cunha MGMC, Mackova K, Hympanova LH, Bortolini MAT, Deprest J. Animal models for pelvic organ prolapse: systematic review. Int Urogynecol J 2021; 32:1331-1344. [PMID: 33484287 PMCID: PMC8203535 DOI: 10.1007/s00192-020-04638-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/02/2020] [Indexed: 12/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We aimed to summarize the knowledge on the pathogenesis of pelvic organ prolapse (POP) generated in animal models. METHODS We searched MEDLINE, Embase, Cochrane and the Web of Science to establish what animal models are used in the study of suggested risk factors for the development of POP, including pregnancy, labor, delivery, parity, aging and menopause. Lack of methodologic uniformity precluded meta-analysis; hence, results are presented as a narrative review. RESULTS A total of 7426 studies were identified, of which 51 were included in the analysis. Pregnancy has a measurable and consistent effect across species. In rats, simulated vaginal delivery induces structural changes in the pelvic floor, without complete recovery of the vaginal muscular layer and its microvasculature, though it does not induce POP. In sheep, first vaginal delivery has a measurable effect on vaginal compliance; measured effects of additional deliveries are inconsistent. Squirrel monkeys can develop POP. Denervation of their levator ani muscle facilitates this process in animals that delivered vaginally. The models used do not develop spontaneous menopause, so it is induced by ovariectomy. Effects of menopause depend on the age at ovariectomy and the interval to measurement. In several species menopause is associated with an increase in collagen content in the longer term. In rodents there were no measurable effects of age apart of elastin changes. We found no usable data for other species. CONCLUSION In several species there are measurable effects of pregnancy, delivery and iatrogenic menopause. Squirrel monkeys can develop spontaneous prolapse.
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Affiliation(s)
- Marina Gabriela M C Mori da Cunha
- Centre for Surgical Technologies, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
- Department of Development and Regeneration, Woman and Child, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - Katerina Mackova
- Centre for Surgical Technologies, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
- Department of Development and Regeneration, Woman and Child, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
- Institute for the Care of Mother and Child, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lucie Hajkova Hympanova
- Institute for the Care of Mother and Child, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Maria Augusta T Bortolini
- Department of Gynecology, Sector of Urogynecology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Jan Deprest
- Centre for Surgical Technologies, Group Biomedical Sciences, KU Leuven, Leuven, Belgium.
- Department of Development and Regeneration, Woman and Child, Group Biomedical Sciences, KU Leuven, Leuven, Belgium.
- Pelvic Floor Unit, University Hospitals, KU Leuven, Leuven, Belgium.
- Department of Development and Regeneration, Center of Surgical Technologies UZ Herestraat, Herestraat49, B3000, Leuven, Belgium.
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Padoa A, McLean L, Morin M, Vandyken C. "The Overactive Pelvic Floor (OPF) and Sexual Dysfunction" Part 1: Pathophysiology of OPF and Its Impact on the Sexual Response. Sex Med Rev 2020; 9:64-75. [PMID: 32238325 DOI: 10.1016/j.sxmr.2020.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 11/30/2019] [Accepted: 02/02/2020] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Overactive pelvic floor (OPF) muscles are defined as muscles that do not relax, or may even contract, when relaxation is needed, for example, during micturition or defecation. Conditions associated with OPF are multifactorial and include multiple possible etiologies and symptom complexes. The complex interplay between biological and psychosocial elements can lead to the persistence of OPF symptoms along with psychological and emotional distress. OBJECTIVES (1) To review and contextualize, from a pathophysiologic perspective, the evidence for OPF, (2) to provide an overview of common clinical presentations and comorbidities of OPF, and (3) to discuss the effect of OPF on sexual function in men and women. METHODS Review of the updated literature on the pathophysiology of OPF was carried out. OPF-associated conditions were overviewed, with special emphasis on the impact on sexual function in men and women. RESULTS Individuals with suspected OPF often present with a combination of gastrointestinal, gynecological, musculoskeletal, sexual, and urological comorbidities, mostly accompanied by psychoemotional distress. In both women and men, sexual function is significantly impaired by OPF and genitopelvic pain penetration disorders are often the primary manifestation of this condition. Women with OPF report less sexual desire, arousal, and satisfaction; more difficulty reaching orgasm; lower frequencies of intercourse; more negative attitudes toward sexuality; and more sexual distress than women without sexual pain. The most frequently reported sexual dysfunctions in men with OPF include erectile dysfunction, premature ejaculation, and ejaculatory pain. CONCLUSION The complex pathophysiology of OPF involving multisystemic comorbidities and psychosocial factors emphasize the importance of a biopsychosocial assessment for guiding effective and personalized management. Padoa A, McLean L, Morin M, et al. "The Overactive Pelvic Floor (OPF) and Sexual Dysfunction" Part 1: Pathophysiology of OPF and Its Impact on the Sexual Response. Sex Med 2021;9:64-75.
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Affiliation(s)
- Anna Padoa
- Department of Obstetrics and Gynecology, Yitzhak Shamir (formerly Assaf Harofe) Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Linda McLean
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Melanie Morin
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke and Research Center of the Centre hospitalier de l'Université de Sherbrooke (CHUS), Sherbrooke, QC, Canada
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Chrysanthopoulou EL, Pergialiotis V, Perrea D, Κourkoulis S, Verikokos C, Doumouchtsis SK. Platelet rich plasma as a minimally invasive approach to uterine prolapse. Med Hypotheses 2017; 104:97-100. [PMID: 28673602 DOI: 10.1016/j.mehy.2017.05.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 05/24/2017] [Indexed: 12/19/2022]
Abstract
Pelvic organ prolapse (POP) is a major health problem that affects many women with potentially severe physical and psychological impact as well as impact on their daily activities, and quality of life. Several surgical techniques have been proposed for the treatment of POP. The FDA has published documents that refer to concerns about the use of synthetic meshes for the treatment of prolapse, in view of the severe complications that may occur. These led to hesitancy in use of these meshes and partial increase in use of other biological grafts such as allografts and xenografts. Although there seems to be an increasing tendency to use grafts in pelvic floor reconstructive procedures due to lower risks of erosion than synthetic meshes, there are inconclusive data to support the routine use of biological grafts in pelvic organ prolapse treatment. In light of these observations new strategies are needed for the treatment of prolapse. Platelet rich plasma (PRP) is extremely rich in growth factors and cytokines, which regulate tissue reconstruction and has been previously used in orthopaedics and plastic surgery. To date, however, it has never been used in urogynaecology and there is no evidence to support or oppose its use in women who suffer from POP, due to uterine ligament defects. PRP is a relatively inexpensive biological material and easily produced directly from patients' blood and is, thus, superior to synthetic materials in terms of potential adverse effects such as foreign body reaction. In the present article we summarize the existing evidence, which supports the conduct of animal experimental and clinical studies to elucidate the potential role of PRP in treating POP by restoring the anatomy and function of ligament support.
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Affiliation(s)
- E L Chrysanthopoulou
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, National and Kapodistrian University of Athens, Greece; Department of Obstetrics and Gynaecology, Queen's Hospital, Rom Valley Way, Romford, Essex, United Kingdom.
| | - V Pergialiotis
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, National and Kapodistrian University of Athens, Greece
| | - D Perrea
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, National and Kapodistrian University of Athens, Greece
| | | | - C Verikokos
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, National and Kapodistrian University of Athens, Greece; 2nd Department of Surgery, Vascular Surgery Unit, Laiko General Hospital, Medical School of Athens, Greece
| | - S K Doumouchtsis
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, National and Kapodistrian University of Athens, Greece; Department of Obstetrics and Gynaecology, Epsom and St Helier University Hospitals NHS Trust, United Kingdom; St George's University of London, London, United Kingdom
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Loukas M, Joseph S, Etienne D, Linganna S, Hallner B, Tubbs RS. Topography and landmarks for the nerve supply to the levator ani and its relevance to pelvic floor pathologies. Clin Anat 2015; 29:516-23. [PMID: 26579995 DOI: 10.1002/ca.22668] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 05/30/2015] [Accepted: 10/06/2015] [Indexed: 12/23/2022]
Abstract
The aim of this study was to explore the anatomical variations of the nerve to the levator ani (LA) and to relate these findings to LA dysfunction. One hundred fixed human female cadavers were dissected using transabdominal, gluteal, and perineal approaches, resulting in two hundred dissections of the sacral plexus. The pudendal nerve and the sacral nerve roots were traced from their origin at the sacral foramina to their termination. All nerves contributing to the innervation of the LA were considered to be the nerve to the LA. Based on the spinal nerve components, the nerve to the LA was classified into the following categories: 50% (n = 100) originated from S4 and S5 (type I); 19% (n = 38) originated from S5 (type II); 16% (n = 32) originated from S4 (type III); 11% (n = 22) originated from S3 and S4 (type IV); 4% (n = 8) originated from S3, S4, and S5 (type V). Two patterns of nerve termination were observed. In 42% of specimens, the nerve to the LA penetrated the coccygeus muscle and assumed an external position along the inferior surface of the LA muscle. In the remaining 58% of specimens, the nerve crossed the superior surface of the coccygeus muscle and continued along the superior surface of the iliococcygeus muscle. Damage to the nerve to LA has been associated with various pathologies. In order to minimize injuries during surgical procedures, a thorough understanding of the course and variations of the nerve to the LA is extremely important.
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Affiliation(s)
- Marios Loukas
- Department of Anatomical Sciences, School of Medicine, St George's University, Grenada, West Indies.,Department of Anatomy, Varmia and Mazuria University, Olsztyn, Poland
| | - Shamfa Joseph
- Department of Anatomical Sciences, School of Medicine, St George's University, Grenada, West Indies.,Department of Internal Medicine, Lincoln Medical and Mental Health, Bronx, New York
| | - Denzil Etienne
- Department of Anatomical Sciences, School of Medicine, St George's University, Grenada, West Indies.,Department of Internal Medicine, SUNY Upstate, Syracuse, New York
| | - Sanjay Linganna
- Department of Anatomical Sciences, School of Medicine, St George's University, Grenada, West Indies
| | - Barry Hallner
- Department of Anatomical Sciences, School of Medicine, St George's University, Grenada, West Indies
| | - R Shane Tubbs
- Department of Anatomical Sciences, School of Medicine, St George's University, Grenada, West Indies.,Children Hospital, Pediatric Neurosurgery, Birmingham, Alabama
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de Groat WC, Yoshimura N. Anatomy and physiology of the lower urinary tract. HANDBOOK OF CLINICAL NEUROLOGY 2015; 130:61-108. [PMID: 26003239 DOI: 10.1016/b978-0-444-63247-0.00005-5] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Functions of the lower urinary tract to store and periodically eliminate urine are regulated by a complex neural control system in the brain, spinal cord, and peripheral autonomic ganglia that coordinates the activity of smooth and striated muscles of the bladder and urethral outlet. Neural control of micturition is organized as a hierarchic system in which spinal storage mechanisms are in turn regulated by circuitry in the rostral brainstem that initiates reflex voiding. Input from the forebrain triggers voluntary voiding by modulating the brainstem circuitry. Many neural circuits controlling the lower urinary tract exhibit switch-like patterns of activity that turn on and off in an all-or-none manner. The major component of the micturition switching circuit is a spinobulbospinal parasympathetic reflex pathway that has essential connections in the periaqueductal gray and pontine micturition center. A computer model of this circuit that mimics the switching functions of the bladder and urethra at the onset of micturition is described. Micturition occurs involuntarily during the early postnatal period, after which it is regulated voluntarily. Diseases or injuries of the nervous system in adults cause re-emergence of involuntary micturition, leading to urinary incontinence. The mechanisms underlying these pathologic changes are discussed.
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Affiliation(s)
- William C de Groat
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Naoki Yoshimura
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Abstract
This article summarizes anatomical, neurophysiological, pharmacological, and brain imaging studies in humans and animals that have provided insights into the neural circuitry and neurotransmitter mechanisms controlling the lower urinary tract. The functions of the lower urinary tract to store and periodically eliminate urine are regulated by a complex neural control system in the brain, spinal cord, and peripheral autonomic ganglia that coordinates the activity of smooth and striated muscles of the bladder and urethral outlet. The neural control of micturition is organized as a hierarchical system in which spinal storage mechanisms are in turn regulated by circuitry in the rostral brain stem that initiates reflex voiding. Input from the forebrain triggers voluntary voiding by modulating the brain stem circuitry. Many neural circuits controlling the lower urinary tract exhibit switch-like patterns of activity that turn on and off in an all-or-none manner. The major component of the micturition switching circuit is a spinobulbospinal parasympathetic reflex pathway that has essential connections in the periaqueductal gray and pontine micturition center. A computer model of this circuit that mimics the switching functions of the bladder and urethra at the onset of micturition is described. Micturition occurs involuntarily in infants and young children until the age of 3 to 5 years, after which it is regulated voluntarily. Diseases or injuries of the nervous system in adults can cause the re-emergence of involuntary micturition, leading to urinary incontinence. Neuroplasticity underlying these developmental and pathological changes in voiding function is discussed.
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Affiliation(s)
- William C. de Groat
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, School of Medicine Pittsburgh, Pennsylvania
| | - Derek Griffiths
- Department of Medicine (Geriatrics), University of Pittsburgh, School of Medicine Pittsburgh, Pennsylvania
| | - Naoki Yoshimura
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, School of Medicine Pittsburgh, Pennsylvania
- Department of Urology, University of Pittsburgh, School of Medicine Pittsburgh, Pennsylvania
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Couri BM, Lenis AT, Borazjani A, Paraiso MFR, Damaser MS. Animal models of female pelvic organ prolapse: lessons learned. ACTA ACUST UNITED AC 2014; 7:249-260. [PMID: 22707980 DOI: 10.1586/eog.12.24] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Pelvic organ prolapse is a vaginal protrusion of female pelvic organs. It has high prevalence worldwide and represents a great burden to the economy. The pathophysiology of pelvic organ prolapse is multifactorial and includes genetic predisposition, aberrant connective tissue, obesity, advancing age, vaginal delivery and other risk factors. Owing to the long course prior to patients becoming symptomatic and ethical questions surrounding human studies, animal models are necessary and useful. These models can mimic different human characteristics - histological, anatomical or hormonal, but none present all of the characteristics at the same time. Major animal models include knockout mice, rats, sheep, rabbits and nonhuman primates. In this article we discuss different animal models and their utility for investigating the natural progression of pelvic organ prolapse pathophysiology and novel treatment approaches.
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Affiliation(s)
- Bruna M Couri
- Department of Biomedical Engineering, Cleveland Clinic, 9500 Euclid Avenue ND20 Cleveland, OH 44195, USA
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Alterations in pelvic floor muscles and pelvic organ support by pregnancy and vaginal delivery in squirrel monkeys. Int Urogynecol J 2011; 22:1109-16. [PMID: 21567260 DOI: 10.1007/s00192-011-1443-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Accepted: 04/19/2011] [Indexed: 12/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective of this study was to measure the effects of pregnancy and parturition on pelvic floor muscles and pelvic organ support. METHODS Levator ani, obturator internus, and coccygeus (COC) muscle volumes and contrast uptake were assessed by MRI of seven females prior to pregnancy, 3 days, and 4 months postpartum. Bladder neck and cervix position were measured dynamically with abdominal squeezing. RESULTS The sides of three paired muscles were similar (p > 0.66). COC volumes were greater (p < 0.004) after parturition than before pregnancy or after recovery. COC contrast uptake increased (p < 0.02) immediately after delivery. Bladder neck position both in the relaxed state and abdominal pressure descended (p < 0.04) after delivery and descended further (p < 0.001) after recovery. Cervical position in the relaxed state before delivery was higher (p < 0.001) than postpartum but was unchanged (p = 0.50) with abdominal pressure relative to delivery. CONCLUSION In squirrel monkeys, coccygeus muscles demonstrate the greatest change related to parturition, and parturition-related bladder neck descent seems permanent.
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Gill BC, Moore C, Damaser MS. Postpartum stress urinary incontinence: lessons from animal models. EXPERT REVIEW OF OBSTETRICS & GYNECOLOGY 2010; 5:567-580. [PMID: 21113428 PMCID: PMC2989536 DOI: 10.1586/eog.10.48] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Postpartum stress urinary incontinence (SUI) is associated with chronic SUI in later life, which is 240% more likely to occur in women who deliver vaginally than those who did not. The etiology of SUI is multifactoral and has been associated with defects in both neuromuscular and structural components of continence. Specifically, clinical studies have demonstrated that pudendal nerve damage occurs during vaginal delivery, supporting the concept that neuromuscular damage to the continence mechanism can result in postpartum SUI. Urethral hypermobility and the loss of pelvic floor support, such as that involved in pelvic organ prolapse, have also been associated with SUI. Animal models provide an opportunity to investigate these injuries, individually and in combination, enabling researchers to gain further insight into their relative contributions to the development of SUI and the effectiveness of potential therapies for it. This article discusses the use of animal models of postpartum SUI in addition to the broad insights into treatment efficacy they provide.
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Affiliation(s)
- Bradley C Gill
- Cleveland Clinic Lerner College of Medicine, Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44195, USA
| | - Courtenay Moore
- Glickman Urological and Kidney Institute, Lerner College of Medicine, Cleveland Clinic, 9500 Euclid Ave, Q10, Cleveland, OH 44195, USA
| | - Margot S Damaser
- Department of Biomedical Engineering, Glickman Urological and Kidney Institute, Lerner College of Medicine, Cleveland Clinic, 9500 Euclid Ave, ND20, Cleveland, OH 44195, USA
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Thor KB, de Groat WC. Neural control of the female urethral and anal rhabdosphincters and pelvic floor muscles. Am J Physiol Regul Integr Comp Physiol 2010; 299:R416-38. [PMID: 20484700 PMCID: PMC2928615 DOI: 10.1152/ajpregu.00111.2010] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Accepted: 05/11/2010] [Indexed: 01/20/2023]
Abstract
The urethral rhabdosphincter and pelvic floor muscles are important in maintenance of urinary continence and in preventing descent of pelvic organs [i.e., pelvic organ prolapse (POP)]. Despite its clinical importance and complexity, a comprehensive review of neural control of the rhabdosphincter and pelvic floor muscles is lacking. The present review places historical and recent basic science findings on neural control into the context of functional anatomy of the pelvic muscles and their coordination with visceral function and correlates basic science findings with clinical findings when possible. This review briefly describes the striated muscles of the pelvis and then provides details on the peripheral innervation and, in particular, the contributions of the pudendal and levator ani nerves to the function of the various pelvic muscles. The locations and unique phenotypic characteristics of rhabdosphincter motor neurons located in Onuf's nucleus, and levator ani motor neurons located diffusely in the sacral ventral horn, are provided along with the locations and phenotypes of primary afferent neurons that convey sensory information from these muscles. Spinal and supraspinal pathways mediating excitatory and inhibitory inputs to the motor neurons are described; the relative contributions of the nerves to urethral function and their involvement in POP and incontinence are discussed. Finally, a detailed summary of the neurochemical anatomy of Onuf's nucleus and the pharmacological control of the rhabdosphincter are provided.
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Affiliation(s)
- Karl B Thor
- Urogenix, Inc., Durham, North Carolina, USA.
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17
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Abstract
Normal physiologic function of the pelvic organs depends on the anatomic integrity and proper interaction among the pelvic structures, the pelvic floor support components, and the nervous system. Pelvic floor dysfunction includes urinary and anal incontinence; pelvic organ prolapse; and sexual, voiding, and defecatory dysfunction. Understanding the anatomy and proper interaction among the support components is essential to diagnose and treat pelvic floor dysfunction. The primary aim of this article is to provide an updated review of pelvic support anatomy with clinical correlations. In addition, surgical spaces of interest to the gynecologic surgeon and the course of the pelvic ureter are described. Several concepts reviewed in this article are derived and modified from a previous review of pelvic support anatomy.
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Affiliation(s)
- Marlene M Corton
- Division of Female Pelvic Medicine and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas 75390 9032, USA.
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Birder L, de Groat W, Mills I, Morrison J, Thor K, Drake M. Neural control of the lower urinary tract: peripheral and spinal mechanisms. Neurourol Urodyn 2010; 29:128-39. [PMID: 20025024 PMCID: PMC2910109 DOI: 10.1002/nau.20837] [Citation(s) in RCA: 104] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This review deals with individual components regulating the neural control of the urinary bladder. This article will focus on factors and processes involved in the two modes of operation of the bladder: storage and elimination. Topics included in this review include: (1) The urothelium and its roles in sensor and transducer functions including interactions with other cell types within the bladder wall ("sensory web"), (2) The location and properties of bladder afferents including factors involved in regulating afferent sensitization, (3) The neural control of the pelvic floor muscle and pharmacology of urethral and anal sphincters (focusing on monoamine pathways), (4) Efferent pathways to the urinary bladder, and (5) Abnormalities in bladder function including mechanisms underlying comorbid disorders associated with bladder pain syndrome and incontinence.
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Affiliation(s)
- L Birder
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.
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The Contribution of the Levator Ani Nerve and the Pudendal Nerve to the Innervation of the Levator Ani Muscles; a Study in Human Fetuses. Eur Urol 2008; 54:1136-42. [DOI: 10.1016/j.eururo.2007.11.015] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2007] [Accepted: 11/06/2007] [Indexed: 11/20/2022]
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Pierce LM, Coates KW, Kramer LA, Bradford JC, Thor KB, Kuehl TJ. Effects of bilateral levator ani nerve injury on pelvic support in the female squirrel monkey. Am J Obstet Gynecol 2008; 198:585.e1-8. [PMID: 18313633 DOI: 10.1016/j.ajog.2007.12.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2007] [Revised: 11/09/2007] [Accepted: 12/05/2007] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To determine whether experimental denervation of the levator ani (LA) and its subsequent atrophy contribute to the development of pelvic organ prolapse in the squirrel monkey. STUDY DESIGN Thirty-seven female monkeys were evaluated including 7 that underwent bilateral LA neurectomy (bLAN), 17 nulliparous monkeys without prolapse, 7 parous monkeys without prolapse, and 6 parous monkeys with prolapse. Magnetic resonance imaging was used to calculate LA muscle volumes and obtain measurements of the position of bladder and cervix. Repeat observations in bLAN females occurred at different times in relation to parturition. RESULTS LA volumes were reduced in bLAN monkeys (P = .02). Bladder (P = .03) and cervix (P = .04) positions varied between groups, with nulliparous females having the most cephalad positions and females with prolapse having the most caudal positions. Bladder descent was observed in a subset of 4 bLAN females that experienced vaginal parturition (P = .04) and correlated with external findings of vaginal prolapse. CONCLUSION Bilateral transection of the LA nerve results in atrophy of denervated LA muscles but not a loss of pelvic support in nulliparous monkeys, suggesting that connective tissue components compensate for weakened pelvic floor muscles. LA denervation may accelerate the onset of vaginal prolapse subsequent to parturition.
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Affiliation(s)
- Lisa M Pierce
- Department of Obstetrics and Gynecology, Scott & White Memorial Hospital and Clinic, Texas A&M University Health Science Center College of Medicine, Temple, TX 76508, USA.
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Pierce LM, Baumann S, Rankin MR, Wasserman RM, Biaggi A, Kuehl TJ, Coates KW. Levator ani muscle and connective tissue changes associated with pelvic organ prolapse, parity, and aging in the squirrel monkey: a histologic study. Am J Obstet Gynecol 2007; 197:60.e1-9. [PMID: 17618759 DOI: 10.1016/j.ajog.2007.02.037] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2006] [Revised: 12/29/2006] [Accepted: 02/26/2007] [Indexed: 12/25/2022]
Abstract
OBJECTIVE This study was undertaken to evaluate histologically the levator ani muscle and paravaginal attachments in squirrel monkeys with and without pelvic organ prolapse. STUDY DESIGN Serial sections from 19 females were processed with routine histology stains. Fiber typing was performed with antifast (type II) and antislow (type I) skeletal myosin antibodies, and apoptotic nuclei were examined by dUTP nick-end labeling (TUNEL). RESULTS Gross disruption of the levator ani muscle and its innervation was not observed in animals with or without visible support defects. Myogenic changes occurred more frequently in the pubocaudalis than iliocaudalis muscles, and a significant association was found with aging (P < .05, Fisher exact test) but not with pelvic organ prolapse or parity. Neurogenic changes were observed in 3 of 13 multiparous monkeys. Myocyte diameter increased in animals with pelvic organ prolapse compared with age-, weight-, and parity-matched animals without pelvic organ prolapse (P = .005) and correlated with levator ani muscle wet weight (R = 0.76; P = .0006). In the paravaginal attachments, the numbers of fibroblasts and apoptotic nuclei were not different between animals with and without pelvic organ prolapse, but parity was associated with increased apoptosis (P = .025). CONCLUSION Vaginal prolapse in the squirrel monkey does not result from atrophy or gross disruption of the levator ani muscle or its innervation. As in women, myogenic changes are a common finding in the levator ani muscle and increase with aging, whereas denervation with subsequent reinnervation occurs in some multiparous monkeys.
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Affiliation(s)
- Lisa M Pierce
- Department of Obstetrics and Gynecology, Scott & White Hospital, Temple, TX 76508, USA.
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Deprest J, Zheng F, Konstantinovic M, Spelzini F, Claerhout F, Steensma A, Ozog Y, De Ridder D. The biology behind fascial defects and the use of implants in pelvic organ prolapse repair. Int Urogynecol J 2006; 17 Suppl 1:S16-25. [PMID: 16738743 DOI: 10.1007/s00192-006-0101-2] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Implant materials are increasingly being used in an effort to reduce recurrence after prolapse repair with native tissues. Surgeons should be aware of the biology behind both the disease as well as the host response to various implants. We will discuss insights into the biology behind hernia and abdominal fascial defects. Those lessons from "herniology" will, wherever possible, be applied to pelvic organ prolapse (POP) problems. Then we will deal with available animal models, for both the underlying disease and surgical repair. Then we will go over the features of implants and describe how the host responds to implantation. Methodology of such experiments will be briefly explained for the clinician not involved in experimentation. As we discuss the different materials available on the market, we will summarize some results of recent experiments by our group.
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Affiliation(s)
- Jan Deprest
- Centre for Surgical Technologies, Faculty of Medicine, and Pelvic Floor Centre, Department of Obstetrics, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium.
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Pierce LM, Rankin MR, Foster RT, Dolber PC, Coates KW, Kuehl TJ, Thor KB. Distribution and immunohistochemical characterization of primary afferent neurons innervating the levator ani muscle of the female squirrel monkey. Am J Obstet Gynecol 2006; 195:987-96. [PMID: 16635454 DOI: 10.1016/j.ajog.2006.02.042] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2005] [Revised: 02/09/2006] [Accepted: 02/27/2006] [Indexed: 12/25/2022]
Abstract
OBJECTIVE This study was undertaken to examine the neurofilament and neurochemical composition of subpopulations of primary afferent neurons innervating the levator ani muscle by combining retrograde tracing and triple labeling immunofluorescence in the female squirrel monkey. STUDY DESIGN Cholera toxin B subunit (CTB) was injected unilaterally into the levator ani muscle of 3 monkeys to identify primary sensory neurons in the dorsal root ganglia (DRG) and their central projections in the spinal cord. L7-S2 DRG were processed for dual or triple labeling immunofluorescence 3 days after injection to examine labeling of the 200 kD neurofilament marker RT97 (a marker of myelinated neurons), calcitonin gene-related peptide (CGRP; a marker of peptidergic neurons), isolectin B4 (IB4; a marker of small, unmyelinated neurons), and nerve growth factor receptor (TrkA) in CTB-positive neurons. RESULTS RT97-negative (C-fiber) neurons were more numerous (74% of total CTB-labeled neurons) and smaller in size than RT97-positive (A-fiber) afferent neurons (26% of CTB-labeled neurons). IB4 labeling was almost exclusively found in RT97-negative afferent neurons. Approximately 43% of all CTB-labeled DRG neurons expressed CGRP, and the majority of these were small. The distribution and sizes of CTB-labeled TrkA-positive DRG neurons were similar to those of CTB-labeled CGRP-positive DRG neurons. CONCLUSION The levator ani muscle is innervated by 3 major subpopulations of primary afferent neurons consisting of cells with large, neurofilament-rich soma and A fibers (putative proprioceptive neurons) and those with small, peptidergic or nonpeptidergic, neurofilament-poor soma and C fibers (putative nociceptive, mechanoreceptive, ergoreceptive, and thermoreceptive neurons). Future investigation is needed to elucidate the relationship between primary sensory neuron subpopulations and changes in neuropeptide and neurotrophin expression on experimental levator ani nerve damage, childbirth, and aging.
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Affiliation(s)
- Lisa M Pierce
- Department of Obstetrics and Gynecology, Scott & White Hospital, Temple, TX 76508, USA.
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Abstract
OBJECTIVE We investigated the clinical anatomy of the levator ani nerve and its topographical relationship with the pudendal nerve. METHODS Ten female pelves were dissected and a pudendal nerve blockade was simulated. The course of the levator ani nerve and pudendal nerve was described quantitatively. The anatomical data were verified using (immuno-)histochemically stained sections of human fetal pelves. RESULTS The levator ani nerve approaches the pelvic-floor muscles on their visceral side. Near the ischial spine, the levator ani nerve and the pudendal nerve lie above and below the levator ani muscle, respectively, at a distance of approximately 6 mm from each other. The median distance between the levator ani nerve and the point of entry of the pudendal blockade needle into the levator ani muscle was only 5 mm. CONCLUSION The levator ani nerve and the pudendal nerve are so close at the level of the ischial spine that a transvaginal "pudendal nerve blockade" would, in all probability, block both nerves simultaneously. The clinical anatomy of the levator ani nerve is such that it is prone to damage during complicated vaginal childbirth and surgical interventions.
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Affiliation(s)
- Christian Wallner
- Department of Anatomy & Embryology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Affiliation(s)
- Marlene M Corton
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
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Conway DA, Kamo I, Yoshimura N, Chancellor MB, Cannon TW. Comparison of leak point pressure methods in an animal model of stress urinary incontinence. Int Urogynecol J 2005; 16:359-63. [PMID: 16132162 DOI: 10.1007/s00192-004-1263-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2004] [Accepted: 11/14/2004] [Indexed: 10/25/2022]
Abstract
We compared three different methods of testing leak point pressure (LPP) in rats with or without the pudendal nerves and nerves to the iliococcygeus/pubococcygeus muscles transected: (1) sneeze induced with a whisker in the nostril (sneeze LPP), (2) manually increased abdominal pressure (Crede LPP), and (3) increased intravesical pressure using the vertical tilt table method (vertical tilt table LPP). In sham rats, passive intravesical pressure rises in Crede and vertical tilt table methods induced active urethral closure mechanisms that contributed to high LPPs (41.4 and 35.5 cm H2O, respectively), which were significantly reduced by nerve transection. During sneezing, leakage was observed in nerve-transected rats, but not in sham rats, indicating that sneezing can activate an additional urethral closure mechanism. Measuring LPP during sneezing or passive intravesical pressure rises in the vertical tilt table and Crede method seems to be useful for assessing the continence mechanisms under different stress conditions in rats.
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Affiliation(s)
- Deirdre A Conway
- Department of Urology, Obstetrics & Gynecology, University of Pittsburgh School of Medicine, 700 LS Kaufmann Building, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA
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Mattson JA, Kuehl TJ, Yandell PM, Pierce LM, Coates KW. Evaluation of the aged female baboon as a model of pelvic organ prolapse and pelvic reconstructive surgery. Am J Obstet Gynecol 2005; 192:1395-8. [PMID: 15902119 DOI: 10.1016/j.ajog.2004.12.046] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study examines the baboon as an animal model of pelvic organ prolapse (POP) by describing the pelvic floor anatomy and adapting human clinical assessment tools. STUDY DESIGN The pelvic anatomy of an adult female baboon was observed at necropsy, and comparisons were made to the human and squirrel monkey. The pelvic organ prolapse quantification (POP-Q) system was used to assess vaginal support in 12 living adult baboons, including 6 young, reproductive-age, nulligravid females (4.8 +/- 0.5 years) and 6 older, multiparous females (23.0 +/- 0.5 years). RESULTS The female baboon pelvic anatomy was found to have similar architecture to the human and squirrel monkey female. Six multiparous females with mean parity of 5 (range 2-8) showed no evidence of POP or differences in POP-Q measurements from 6 nulliparous females. CONCLUSION The POP-Q system can be used to assess female baboon vaginal support. In a sample of baboons, pelvic support loss consistent with POP was not identified. As the pelvic anatomy is similar to the human female, the baboon may prove useful for evaluating surgical materials and for modeling pelvic floor reconstructive surgeries.
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Affiliation(s)
- Julia A Mattson
- Department of Obstetrics and Gynecology, Scott and White Clinic, Texas A&M University System Health Science Center College of Medicine, Temple 76508, USA.
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Pierce LM, Reyes M, Thor KB, Dolber PC, Bremer RE, Kuehl TJ, Coates KW. Immunohistochemical evidence for the interaction between levator ani and pudendal motor neurons in the coordination of pelvic floor and visceral activity in the squirrel monkey. Am J Obstet Gynecol 2005; 192:1506-15. [PMID: 15902150 DOI: 10.1016/j.ajog.2004.10.607] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The purpose of this study was to characterize the spinal distribution of afferent and efferent pathways that innervate the levator ani (LA) muscle in the female squirrel monkey. STUDY DESIGN Cholera toxin B (CTB) was injected unilaterally into the LA muscle of 5 monkeys to identify primary sensory neurons in the dorsal root ganglia (DRG) and motor neurons in the spinal cord that contribute fibers to the LA nerve. Fluoro-Gold (FG) was injected into the external anal sphincter of 2 of these animals to label pudendal motor neurons (1 of these animals underwent unilateral LA neurectomy before CTB injection). Spinal cord and DRG were processed for immunofluorescence 3 to 7 days after injections. RESULTS Retrograde transport of CTB from the LA muscle labeled primary afferent neurons in the ipsilateral DRG, their central projections, and motor neurons in the medial portion of the ipsilateral ventral horn of the spinal cord (L7-S2 segments). Injection of FG into the external anal sphincter labeled cells in Onuf's nucleus, primarily in L7. Importantly, CTB-labeled LA motor neurons were virtually absent in Onuf's nucleus, where all pudendal motor neurons are located. CTB-labeled processes were observed within Onuf's nucleus, adjacent to FG-labeled pudendal motor neurons, and appeared to derive from dendrites of LA motor neurons that project into Onuf's nucleus. CONCLUSION The LA muscle has a distinct innervation with very little or no contribution from the pudendal nerve. The intriguing labeling of LA neural elements within a nucleus that innervates the external urethral and anal sphincters (involved in pelvic visceral control) may represent a neuroanatomic substrate for physiologic integration of spinal and supraspinal inputs for the coordination of pelvic floor and visceral activity.
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Weber AM, Buchsbaum GM, Chen B, Clark AL, Damaser MS, Daneshgari F, Davis G, DeLancey J, Kenton K, Weidner AC, Word RA. Basic science and translational research in female pelvic floor disorders: proceedings of an NIH-sponsored meeting. Neurourol Urodyn 2004; 23:288-301. [PMID: 15227643 DOI: 10.1002/nau.20048] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
AIMS To report the findings of a multidisciplinary group of scientists focusing on issues in basic science and translational research related to female pelvic floor disorders, and to produce recommendations for a research agenda for investigators studying female pelvic floor disorders. METHODS A National Institutes of Health (NIH)-sponsored meeting was held on November 14-15, 2002, bringing together scientists in diverse fields including obstetrics, gynecology, urogynecology, urology, gastroenterology, biomechanical engineering, neuroscience, endocrinology, and molecular biology. Recent and ongoing studies were presented and discussed, key gaps in knowledge were identified, and recommendations were made for research that would have the highest impact in making advances in the field of female pelvic floor disorders. RESULTS The meeting included presentations and discussion on the use of animal models to better understand physiology and pathophysiology; neuromuscular injury (such as at childbirth) as a possible pathogenetic factor and mechanisms for recovery of function after injury; the use of biomechanical concepts and imaging to better understand the relationship between structure and function; and molecular and biochemical mechanisms that may underlie the development of female pelvic floor disorders. CONCLUSIONS While the findings of current research will help elucidate the pathophysiologic pathways leading to the development of female pelvic floor disorders, much more research is needed for full understanding that will result in better care for patients through specific rather than empiric therapy, and lead to the potential for prevention on primary and secondary levels.
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Affiliation(s)
- Anne M Weber
- Contraception and Reproductive Health Branch, Center for Population Research, National Institute of Child Health and Human Development, Pittsburgh, Pennsylvania 15238, USA.
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