1
|
Maher S, Gerber D, Balog B, Wang L, Kuang M, Hanzlicek B, Malakalapalli T, Van Etten C, Khouri R, Damaser MS. Contribution of pudendal nerve injury to stress urinary incontinence in a male rat model. Sci Rep 2024; 14:7444. [PMID: 38548832 PMCID: PMC10978927 DOI: 10.1038/s41598-024-57493-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/19/2024] [Indexed: 04/01/2024] Open
Abstract
Urinary incontinence is a common complication following radical prostatectomy, as the surgery disturbs critical anatomical structures. This study explored how pudendal nerve (PN) injury affects urinary continence in male rats. In an acute study, leak point pressure (LPP) and external urethral sphincter electromyography (EMG) were performed on six male rats with an intact urethra, the urethra exposed (UE), the PN exposed (NE), and after PN transection (PNT). In a chronic study, LPP and EMG were tested in 67 rats 4 days, 3 weeks, or 6 weeks after sham PN injury, PN crush (PNC), or PNT. Urethras were assessed histologically. Acute PNT caused a significant decrease in LPP and EMG amplitude and firing rate compared to other groups. PNC resulted in a significant reduction in LPP and EMG firing rate 4 days, 3 weeks, and 6 weeks later. EMG amplitude was also significantly reduced 4 days and 6 weeks after PNC. Neuromuscular junctions were less organized and less innervated after PNC or PNT at all timepoints compared to sham injured animals. Collagen infiltration was significantly increased after PNC and PNT compared to sham at all timepoints. This rat model could facilitate preclinical testing of neuroregenerative therapies for post-prostatectomy incontinence.
Collapse
Affiliation(s)
- Shaimaa Maher
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue ND20, Cleveland, OH, 44195, USA
| | - Daniel Gerber
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Brian Balog
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue ND20, Cleveland, OH, 44195, USA
| | - Lan Wang
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue ND20, Cleveland, OH, 44195, USA
| | - Mei Kuang
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue ND20, Cleveland, OH, 44195, USA
| | - Brett Hanzlicek
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue ND20, Cleveland, OH, 44195, USA
- Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Tejasvini Malakalapalli
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue ND20, Cleveland, OH, 44195, USA
| | - Cassandra Van Etten
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue ND20, Cleveland, OH, 44195, USA
| | - Roger Khouri
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Margot S Damaser
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue ND20, Cleveland, OH, 44195, USA.
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
- Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA.
| |
Collapse
|
2
|
Time course for urethral neuromuscular reestablishment and its facilitated recovery by transcutaneous neuromodulation after simulated birth trauma in rats. Sci Rep 2021; 11:21591. [PMID: 34732833 PMCID: PMC8566552 DOI: 10.1038/s41598-021-01200-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/25/2021] [Indexed: 11/08/2022] Open
Abstract
The aims of the study were to determine the time-course of urinary incontinence recovery after vaginal distension (VD), elucidate the mechanisms of injury from VD leading to external urethral sphincter (EUS) dysfunction, and assess if transcutaneous electrical stimulation (TENS) of the dorsal nerve of the clitoris facilitates recovery of urinary continence after VD. Rats underwent 4-h VD, 4-h sham VD (SH-VD), VD plus 1-h DNC TENS, and VD plus 1-h sham TENS (SH-TENS). TENS or SH-TENS were applied immediately and at days 2 and 4 post-VD. Micturition behavior, urethral histochemistry and histology, EUS and nerve electrophysiology, and cystometrograms were evaluated. VD induced urine leakage and significantly disrupted EUS fibers and nerve-conduction (VD vs SH-VD group;p < 0.01). Urine leakage disappeared 13 days post-VD (p < 0.001). Structural and functional recovery of EUS neuromuscular circuitry started by day 6 post-VD, but did not fully recover by day 11 post-VD (p > 0.05). TENS significantly decreased the frequency of urine leakage post-VD (days 5–7;p < 0.01). We conclude that rat urinary continence after VD requires 2 weeks to recover, although urethra structure is not fully recovered. TENS facilitated urinary continence recovery after VD. Additional studies are necessary to assess if TENS could be used in postpartum women.
Collapse
|
3
|
Transurethral versus suprapubic catheterization to test urethral function in rats. Sci Rep 2021; 11:14369. [PMID: 34257341 PMCID: PMC8277785 DOI: 10.1038/s41598-021-93772-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 06/15/2021] [Indexed: 11/21/2022] Open
Abstract
Transurethral and suprapubic catheterization have both been used to test urethral function in rats; however, it is unknown whether these methods affect urethral function or if the order of catheterization affects the results. The aim of this cross-over designed experiment was to compare the effects of catheterization methods and order on leak point pressure (LPP) testing. LPP and simultaneous external urethral sphincter electromyography (EUS EMG) were recorded in anesthetized female virgin Sprague-Dawley rats in a cross-over design to test the effects of transurethral and suprapubic catheterization. There was no significant difference in peak bladder pressure during LPP testing whether measured with a transurethral or suprapubic catheter. There was no significant difference in peak bladder pressure between the first and second catheter insertions. However, peak EMG firing rate, as well as peak EMG amplitude and EMG amplitude difference between peak and baseline were significantly higher after the first catheter insertion compared to the second insertion, regardless of the catheter method. Our results suggest that route of catheterization does not alter urethral function, e.g. create a functional partial outlet obstruction. Either catheterization method could be used for LPP and/or EUS EMG testing in rats.
Collapse
|
4
|
Feitosa SM, Bortolini MAT, Salerno GRF, Bilhar APM, Ihara SSM, Simões MJ, Castro RA. Electrotherapy for urethral modulation: Are extracellular matrix molecules and growth factors potential targets? Neurourol Urodyn 2021; 40:968-977. [PMID: 33769595 DOI: 10.1002/nau.24664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 02/01/2021] [Accepted: 03/15/2021] [Indexed: 11/10/2022]
Abstract
AIMS To evaluate the expression of genes and proteins involved in the urethral components: vessels, nerves, and extracellular matrix, in female rats after trauma by vaginal distension (VD) and after electrical stimulation therapy (electrotherapy). METHODS We analyzed the urethras of three groups of 18 female rats 30 days posttrauma by VD: control (no interventions); trauma (animals that had VD); and electrotherapy group (those that had VD and were treated with electrical stimulation). We compared the expression of vascular endothelial growth factor (VEGF), nerve growth factor (NGF), collagen types I and III (COL1a1 and COL3a1), and lysyl-oxidase like 1 (LOXL1) among the groups. Real-time reverse transcription-polymerase chain reaction, Western blot, and immunohistochemistry were used for molecule quantification. We used the Kruskal-Wallis test and analysis of variance for statistical analyses with p < 0.05 for significance. RESULTS The COL1a1 gene expression was higher in the electrotherapy group than the trauma group (p = 0.036). COL3a1, VEGF, NGF, LOXL1 messenger RNA (mRNA) expression did not differ among the groups (p ≥ 0.05). COL1a1, COL3a1, VEGF, NGF, LOXL1 protein levels did not significantly differ among the groups (p ≥ 0.05) in Western blot analysis or immunohistochemistry assays. CONCLUSIONS Electrotherapy caused a long-term increase in the COL1a1 mRNA level but did not change COL1a1 protein expression or VEGF, NGF, COL3a1, and LOXL1 genes and proteins in the urethras of rats after trauma by VD.
Collapse
Affiliation(s)
- Suellen M Feitosa
- Department of Gynecology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Maria A T Bortolini
- Department of Gynecology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Gisela R F Salerno
- Department of Gynecology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Andreisa P M Bilhar
- Department of Gynecology, Universidade Federal de São Paulo, São Paulo, Brazil.,Department of Gynecology, Universidade Federal do Ceará, Ceará, Brazil
| | - Silvia S M Ihara
- Department of Gynecology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Manuel J Simões
- Department of Histology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Rodrigo A Castro
- Department of Gynecology, Universidade Federal de São Paulo, São Paulo, Brazil
| |
Collapse
|
5
|
Harten IA, Evanko SP, Choe CH, Lee EW, Patel BN, Bogdani M, Wight TN, Lee UJ. The extracellular matrix molecules versican and hyaluronan in urethral and vaginal tissues in stress urinary incontinence. Neurourol Urodyn 2021; 40:771-782. [PMID: 33645869 DOI: 10.1002/nau.24635] [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: 10/30/2020] [Revised: 01/08/2021] [Accepted: 02/06/2021] [Indexed: 11/07/2022]
Abstract
PURPOSE Abnormal extracellular matrix (ECM) changes are correlated with stress urinary incontinence (SUI). The ECM components versican (Vcan) and hyaluronan (HA) play key roles in regulating tissue inflammation and maintaining connective tissue homeostasis. We analyzed the localization and expression of these ECM components in urethral and vaginal tissues from a rat model of urinary incontinence and from human clinical specimens. METHODS Nulliparous rats underwent vaginal distension (VD), a rodent model of SUI, or a sham procedure. Tissues were harvested from six rats per group at days 1, 4, and 21 for immunohistochemistry and RNA expression analysis of ECM components. Periurethral vaginal samples from female patients with SUI were also examined. RESULTS High-intensity staining for Vcan was observed 1 day after procedure in both control and VD animals. This level of abundance persisted at day 4 in VD compared to control, with concurrent reduced messenger RNA (mRNA) expression of the Vcan-degrading enzymes ADAMTS5 and ADAMTS9 and reduced staining for the Vcan cleavage epitope DPEAAE. Abundance of HA was not different between VD and control, however mRNA expression of the HA synthase Has2 was significantly reduced in VD tissues at day 4. Abundant Vcan staining was observed in 60% of SUI patient samples, which was strongest in regions of disrupted elastin. CONCLUSION Reduction of Vcan-degrading enzymes and HA synthases at day 4 postsurgery indicates a potential delay in ECM turnover associated with SUI. Abundant Vcan is associated with inflammation and elastin fiber network disruption, warranting further investigation to determine its role in SUI pathogenesis.
Collapse
Affiliation(s)
- Ingrid A Harten
- Matrix Biology Program, Benaroya Research Institute at Virginia Mason, Seattle, Washington, USA
| | - Stephen P Evanko
- Matrix Biology Program, Benaroya Research Institute at Virginia Mason, Seattle, Washington, USA
| | - Chong H Choe
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, Washington, USA.,Urology, Kaiser Permanente Hayward Sleepy Hollow, Hayward, California, USA
| | - Eugene W Lee
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, Washington, USA.,Naval Medical Center San Diego Urology, San Diego, California, USA
| | - Bhavin N Patel
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, Washington, USA.,Urology, Kaiser Permanente Fresno Medical Center, Fresno, California, USA
| | - Marika Bogdani
- Matrix Biology Program, Benaroya Research Institute at Virginia Mason, Seattle, Washington, USA
| | - Thomas N Wight
- Matrix Biology Program, Benaroya Research Institute at Virginia Mason, Seattle, Washington, USA
| | - Una J Lee
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, Washington, USA
| |
Collapse
|
6
|
The effects of simulated childbirth trauma on the gene expression of neurotransmitter receptors in the bladder of female rats. J Formos Med Assoc 2021; 120:1305-1313. [PMID: 33472764 DOI: 10.1016/j.jfma.2020.12.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 12/28/2020] [Accepted: 12/30/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND/PURPOSE To investigate the effects of simulated childbirth on the gene expression of parasympathetic muscarinic, purinergic (P2X), and neurokinin receptors of lower urinary tract in rats. METHODS In all, twenty-four primiparous pregnant Sprague-Dawley female rats were equally divided into three groups: (1). Control group; 8 rats, (2) intra-vaginal balloon dilation for 2 h group; 8 rats, (3) and for 4 h group; 8 rats. After balloon dilatation for 4 months, all rats were sacrificed. We analyzed the gene expression of parasympathetic muscarinic, purinergic (P2X), and neurokinin receptors by real-time quantitative PCR (q-PCR). We quantified pro-inflammatory cytokines of TNF-α and IL-6 by Enzyme-linked immunosorbent assays (ELISA). The urodynamic parameters and micturition frequency by cystometry (CMG) were recorded. RESULTS Our results showed that the balloon dilation significantly increased micturition frequency and modified peak micturition pressure compare to those in the control groups. Balloon dilation significantly decreased voiding interval and bladder volume compared to those in the control groups. Gene expressions of M3 muscarinic, P2X3 purinergic receptors, and significantly increased following balloon dilation for 2 hours and 4 hours than those in the control group. In addition, we found that NK1R and NK3R receptors were significantly decreased after balloon dilation compare to control group. The marked increase of TNF-α and IL-6 were also seen in the 2 balloon groups. CONCLUSION The results of our study suggested that birth trauma may impair the function of urinary tract, this being partly related to the changes in the gene expression of the neurotransmitter receptors of the lower urinary tract.
Collapse
|
7
|
Lo TS, Lin YH, Uy-Patrimonio MC, Chu HC, Hsieh WC, Chua S. Dissecting of the paravesical space associated with lower urinary tract dysfunction - a rat model. Sci Rep 2020; 10:1718. [PMID: 32015355 PMCID: PMC6997187 DOI: 10.1038/s41598-020-58604-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 11/15/2019] [Indexed: 11/09/2022] Open
Abstract
To determine the association of opening the paravesical space in relation to its occurrence of de novo SUI in an animal model. Thirty five female Sprague Dawley rats were divided into 5 groups of 7 rats each: Control group, Sham groups(F, H), and Study groups(MF, MH). Groups labeled with "F" had the paravesical space opened, "H" had tissue dissection with no opening of the space, and "M" had mesh implanted inside the vaginal wall. Urodynamic studies, immunohistochemical analysis, and western blot were done at day 40. The mean weight and age of 35 rats were 302.1 ± 25.1 grams and 12.8 ± 1.2 weeks old. No significant differences were noted among the control, Sham F, Sham H, Study MF, and Study MH on the voiding pressure and voided volume. The Sham F and Study MF (opened paravesical space) groups had significantly lower values on leak point pressures (LPP) (p = 0.026; p < 0.001) and shorter voiding intervals (p = 0.032; p = 0.005) when compared to other groups. Immunohistochemical analysis showed IL-1 and TNF-α to be intensely increased for the Study MF group (p = 0.003; p = <0.001). MMP-2 and CD 31 markers were also significantly higher in the Study MH and MF group. NGF expression was significantly increased in the Study MF and Sham F groups. Thus, opening of the paravesical space causes an increased inflammatory reaction, which leads to tissue destruction and lower urinary tract dysfunction, exemplified in the study with low leak point pressure and shortened voiding intervals.
Collapse
Affiliation(s)
- Tsia-Shu Lo
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung, Medical Center, Keelung, Taiwan, Republic of China. .,Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, Republic of China. .,Chang Gung University, School of Medicine, Taoyuan, Taiwan, Republic of China.
| | - Yi-Hao Lin
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, Republic of China.,Chang Gung University, School of Medicine, Taoyuan, Taiwan, Republic of China
| | - Ma Clarissa Uy-Patrimonio
- Department of Obstetrics and Gynecology, Dr. Pablo O. Torre Memorial Hospital, Bacolod City, Philippines.,Fellow of the Division of Urogynaecology, Department of Obstetrics & Gynaecology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan, Republic of China
| | - Hsiao-Chien Chu
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung, Medical Center, Keelung, Taiwan, Republic of China.,Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, Republic of China
| | - Wu-Chiao Hsieh
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, Republic of China
| | - Sandy Chua
- Fellow of the Division of Urogynaecology, Department of Obstetrics & Gynaecology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan, Republic of China.,Department of Obstetrics and Gynecology, Cebu Institue of Medicine- Cebu Velez General Hospital, Cebu City, Philippines
| |
Collapse
|
8
|
Zhou F, Reed-Maldonado AB, Tan Y, Yuan H, Peng D, Banie L, Wang G, Hou J, Lin G, Lue TF. Development of Male External Urethral Sphincter and Tissue-Resident Stem/Progenitor Cells in Rats. Stem Cells Dev 2020; 29:133-143. [PMID: 31822215 PMCID: PMC6987740 DOI: 10.1089/scd.2019.0241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 12/09/2019] [Indexed: 12/14/2022] Open
Abstract
Stress urinary incontinence (SUI) after prostate surgery is primarily caused by urethral sphincter damage. There are few effective therapeutic approaches for male SUI due to both insufficient study of the structure of the external urethral sphincter (EUS) and incomplete understanding of the resident EUS stem/progenitor cells. The goals of this study were to localize and to determine the distribution of tissue-resident stem/progenitor cells in the male EUS throughout EUS development and to understand the anatomic temporal patterns of the EUS. Newborn Sprague Dawley rats were intraperitoneally injected with the thymidine analogue, 5-ethynyl-2-deoxyuridine (EdU), and the EUS was harvested at five time points (1, 2, 3, 4, and 8 weeks postinjection). The tissue was then processed for EdU staining and immunofluorescence staining for stem cell markers Ki67 and proliferating cell nuclear antigen. We counted the EdU+ label-retaining cells (LRCs) at each time point and colocalized with each stem cell marker, also we isolated and cultured the cells in vitro. The results revealed that the number of EdU+ LRCs in each EUS cross-section decreased over time and that the LRCs were located immediately under the basal membrane of laminin, densely adherent to the muscle fibers. In addition, the thickness of the striated muscle layer developed much faster than the smooth muscle layer during EUS development. By 4 weeks, the structure of the EUS layers was well differentiated. The EUS resident stem/progenitor cells were isolated with MACS® MicroBeads system, and myogenesis was confirmed. In this study, we defined both the time-course development of the EUS and the distribution of resident stem/progenitor cells. This information is crucial for forthcoming studies regarding male micturition and for development of novel therapeutic approaches for postoperative male SUI.
Collapse
Affiliation(s)
- Feng Zhou
- Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, California
- Department of Urology, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, China
| | - Amanda B. Reed-Maldonado
- Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, California
- Department of Urology, Tripler Army Medical Center, Honolulu, Hawaii
| | - Yan Tan
- Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, California
| | - Huixing Yuan
- Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, California
| | - Dongyi Peng
- Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, California
| | - Lia Banie
- Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, California
| | - Guifang Wang
- Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, California
| | - Jianquan Hou
- Department of Urology, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, China
| | - Guiting Lin
- Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, California
| | - Tom F. Lue
- Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, California
| |
Collapse
|
9
|
Duran P, Ward S, Christman KL, Alperin M. Mechanical impact of parturition-related strains on rat pelvic striated sphincters. Neurourol Urodyn 2019; 38:912-919. [PMID: 30779377 PMCID: PMC6431564 DOI: 10.1002/nau.23946] [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: 11/27/2018] [Revised: 01/11/2019] [Accepted: 01/18/2019] [Indexed: 11/08/2022]
Abstract
AIMS To define the operational resting sarcomere length (Ls ) of the female rat external urethral sphincter (EUS) and external anal sphincter (EAS) and to determine the mechanism of parturition-related injury of EUS and EAS using a simulated birth injury (SBI) vaginal distention model. METHODS EUS and EAS of 3-month-old Sprague-Dawley control and injured rats were fixed in situ, harvested, and microdissected for Ls measurements and assessment of ultrastructure. EUS and EAS function was determined at baseline, and immediately and 4 weeks after SBI, using leak point pressure (LPP) and anorectal manometry (ARM), respectively. Operational L s was compared to species-specific optimal L s using one sample Student's t test. Data (mean ± SD) were compared between groups and time points using repeated measures one-way analysis of variance, followed by Tukey's post hoc pairwise comparisons, with significance set to 0.05. RESULTS The operational resting Ls of both sphincters (EUS: 2.09 ± 0.07 µm, EAS: 2.02 ± 0.03 µm) was significantly shorter than optimal rat Ls of 2.4 µm. Strains imposed on EUS and EAS during SBI resulted in significant sarcomere elongation and disruption, compared with the controls (EUS: 3.09 ± 0.11 µm, EAS: 3.37 ± 0.09 µm). Paralleling structural changes, LPP and ARM measures were significantly lower immediately (LPP: 21.5 ± 1.0 cmH2 O, ARM: 5.1 ± 2.31 cmH2 O) and 4 weeks (LPP: 27.7 ± 1.3cmH2 O, ARM: 2.5 ± 1.0 cmH2 O) after SBI relative to the baseline (LPP: 43.4 ± 8.5 cmH2 O, ARM: 8.2 ± 2.0 cmH2 O); P < 0.05. CONCLUSIONS Analogous to humans, the short resting Ls of rat EUS and EAS favors their sphincteric function. The insult experienced by these muscles during parturition leads to sarcomere hyperelongation, myofibrillar disruption, and dysfunction of the sphincters long-term.
Collapse
Affiliation(s)
- Pamela Duran
- Department of Bioengineering, Sanford Consortium for Regenerative Medicine, University of California San Diego, La Jolla, CA
| | - Samuel Ward
- Department of Orthopaedic Surgery, University of California San Diego, La Jolla, CA
- Department of Radiology, University of California San Diego, La Jolla, CA
| | - Karen L. Christman
- Department of Bioengineering, Sanford Consortium for Regenerative Medicine, University of California San Diego, La Jolla, CA
| | - Marianna Alperin
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Female Pelvic Medicine and Reconstructive Surgery, University of California San Diego, La Jolla, CA
| |
Collapse
|
10
|
Qiu F, Wang K, Li T, Song D, Wang Z, Zhang H, Liu J, Ren M, Qi X. Differential Diagnosis Of Multiple-System Atrophy With Parkinson's Disease By External Anal- And Urethral-Sphincter Electromyography. Neuropsychiatr Dis Treat 2019; 15:3061-3067. [PMID: 31806975 PMCID: PMC6842278 DOI: 10.2147/ndt.s218073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 10/02/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The differential diagnosis of Parkinson's disease (PD) with multiple-system atrophy (MSA) is difficult because of their similarity in symptoms and signs. The objective of this study was to investigate the value of external anal-sphincter electromyography (EAS-EMG) and urethral-sphincter electromyography (US-EMG) in differentiating MSA from PD. METHODS A total of 201 patients, - 101 MSA and 100 PD - were recruited in this study. Average duration and amplitude of motor unit potentials (MUPs), percentage of polyphasic MUPs, amplitude during strong contractions, and recruitment patterns during maximal voluntary contractions were recorded and analyzed to assess diagnostic efficiency of EAS-EMG and US-EMG for MSA. RESULTS Significant differences in average MUP duration and recruitment patterns during maximal voluntary contractions were found between patients with MSA and patients with PD using both EAS-EMG (P<0.001, P<0.001) and US-EMG (P<0.001, P<0.001). The percentage of polyphasic MUPs and amplitude during strong contractions showed significant differences in MSA and PD using only EAS-EMG (P<0.001, P=0.005). Cutoff points for average MUP duration in EAS-EMG and US-EMG for differential diagnosis of MSA with PD were 10.9 and 11.1 milliseconds, respectively. With average MUP duration of EAS-EMG and US-EMG being applied jointly, sensitivity and specificity in distinguishing MSA from PD were 83.2% and 71.8%, respectively. CONCLUSION EAS-EMG and US-EMG were sensitive and specific methods for the diagnosis and differential diagnosis of MSA, and the combination of both would improve the diagnostic rate of MSA compared to only one method being used.
Collapse
Affiliation(s)
- Feng Qiu
- Department of Neurology, Sixth Medical Center of Chinese PLA General Hospital, Beijing, 100048, People's Republic of China
| | - Kunyu Wang
- Department of Neurology, Sixth Medical Center of Chinese PLA General Hospital, Beijing, 100048, People's Republic of China
| | - Tingting Li
- Department of Gastroenterology, Second Medical Center of Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Dandan Song
- Department of Medicine, Beijing Northern Hospital of China North Industries Group Corporation, Beijing 100089, People's Republic of China
| | - Zhiwei Wang
- Department of Neurology, Sixth Medical Center of Chinese PLA General Hospital, Beijing, 100048, People's Republic of China
| | - Hailing Zhang
- Department of Neurology, Changhai Hospital, Shanghai 200433, People's Republic of China
| | - Jianguo Liu
- Department of Neurology, Sixth Medical Center of Chinese PLA General Hospital, Beijing, 100048, People's Republic of China
| | - Ming Ren
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University, Beijing 100191, People's Republic of China
| | - Xiaokun Qi
- Department of Neurology, Sixth Medical Center of Chinese PLA General Hospital, Beijing, 100048, People's Republic of China
| |
Collapse
|
11
|
El Hassan R, Galante A, Kavran M, Ganocy S, Khalifa AO, Hijaz A. The vaginal distention model in mice is not a reliable model of simulated birth trauma-induced stress urinary incontinence. Neurourol Urodyn 2018; 38:599-606. [PMID: 30549310 DOI: 10.1002/nau.23886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 10/15/2018] [Indexed: 11/10/2022]
Abstract
AIMS Vaginal distention (VD) is a validated model of birth-related trauma in rats. Recently a mouse VD model was reported. Our study was originally conducted to evaluate the impact of age on VD in mice. This manuscript describes the study and reports on the lack of reproducibility of VD models in mice. METHODS We utilized female C57BL/6 mice. A total of 190, 12-weeks old mice, were randomized into VD and sham groups. We inflated a modified Foley's balloon with 0.3 mL for 1 h inside the mice vagina. Afterwards, we measured the leak point pressure (LPP) at defined timepoints (0, 4, 10, 20, or 40 days). We randomized another 190, 40-week old, C57BL/6 mice into either VD or sham groups. We used an extra 20 mice as age - matched controls. RESULTS In both 12 and 40 weeks-old mice, LPP was significantly decreased versus the negative controls at day 0. Additionally, in both 12 and 40 weeks-old mice, the decrease in LPP was significantly higher in the VD group compared to the sham group at day 0. However, the LPP results were comparable between VD and sham at any other time point thereafter. Furthermore, there was no significant change in LPP values between instrumented (VD and sham) mice and control mice at any time after day 0. CONCLUSIONS The VD models previously described is not a reproducible model for the study of VD with large number of mice. Our results, unfortunately, do not support its use to study VD injury in mice.
Collapse
Affiliation(s)
- Ramzi El Hassan
- Department of Urology, University of Rochester Medical Center, Rochester, New York
| | - Alex Galante
- Department of Urology, University of Florida, Gainesville, Florida
| | - Michael Kavran
- Department of Radiology, Case Western Reserve University, Cleveland, Ohio
| | - Stephen Ganocy
- Department of Psychiatry, University Hospitals Cleveland Medical Center, Case Western Reserve University,, Cleveland, Ohio
| | - Ahmad O Khalifa
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio.,Department of Urology, Menoufia University, Shebin Al Kom, Egypt
| | - Adonis Hijaz
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| |
Collapse
|
12
|
Castelán F, López‐García K, Moreno‐Pérez S, Zempoalteca R, Corona‐Quintanilla DL, Romero‐Ortega MI, Jiménez‐Estrada I, Martínez‐Gómez M. Multiparity affects conduction properties of pelvic floor nerves in rabbits. Brain Behav 2018; 8:e01105. [PMID: 30240150 PMCID: PMC6192397 DOI: 10.1002/brb3.1105] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 07/27/2018] [Accepted: 07/31/2018] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Women often develop pelvic floor dysfunction due to damage to the pelvic musculature during childbirth; however, the effect on pelvic floor nerves function is less understood. This study used adult rabbits to evaluate the electrophysiological and histological characteristics of the bulbospongiosus (Bsn) and pubococcygeus nerves (Pcn) in multiparity. METHODS Compound nerve action potentials (CNAP) were compared between age-matched nulliparous and multiparous animals and associated to the histological characteristics of myelinated axons from the Bsn and Pcn nerves. The extensor digitorum longus nerve (EDLn) was used as negative control. Data were analyzed with unpaired two-tailed Student's t test or Mann-Whitney U test to determine significant differences between groups. RESULTS The onset and peak latencies, duration, and conduction velocity of the motor fibers in these pelvic nerves were not significantly different between nulliparous and multiparous animals. However, the peak-to-peak amplitude and area of the CNAP in both Bsn and Pcn were reduced in multiparous rabbits. Histology showed a higher percentage of axons with myelin disorganization caused by multiparity in these pelvic nerves. Together, the data indicate a reduction in the number of functional pelvic axons due to multiparity. As expected, no effect of parity was observed in the EDLn controls. CONCLUSIONS Present findings demonstrated that multiparity affects myelination and consequently conduction properties in the small pelvic floor nerves.
Collapse
Affiliation(s)
- Francisco Castelán
- Departamento de Biología Celular y Fisiología, Unidad Foránea Tlaxcala, Instituto de Investigaciones BiomédicasUniversidad Nacional Autónoma de MéxicoTlaxcalaMéxico
- Centro Tlaxcala de Biología de la ConductaUniversidad Autónoma de TlaxcalaTlaxcalaMéxico
| | - Kenia López‐García
- Departamento de Biología Celular y Fisiología, Unidad Foránea Tlaxcala, Instituto de Investigaciones BiomédicasUniversidad Nacional Autónoma de MéxicoTlaxcalaMéxico
| | - Suelem Moreno‐Pérez
- Centro Tlaxcala de Biología de la ConductaUniversidad Autónoma de TlaxcalaTlaxcalaMéxico
| | - René Zempoalteca
- Maestría en Ciencias BiológicasUniversidad Autónoma de TlaxcalaTlaxcalaMéxico
| | | | | | - Ismael Jiménez‐Estrada
- Departamento de Fisiología, Biofísica y NeurocienciasCentro de Investigación y de Estudios Avanzados del Instituto Politécnico NacionalCiudad de MéxicoMéxico
| | - Margarita Martínez‐Gómez
- Departamento de Biología Celular y Fisiología, Unidad Foránea Tlaxcala, Instituto de Investigaciones BiomédicasUniversidad Nacional Autónoma de MéxicoTlaxcalaMéxico
- Centro Tlaxcala de Biología de la ConductaUniversidad Autónoma de TlaxcalaTlaxcalaMéxico
| |
Collapse
|
13
|
Catanzarite T, Bremner S, Barlow CL, Bou-Malham L, O'Connor S, Alperin M. Pelvic muscles' mechanical response to strains in the absence and presence of pregnancy-induced adaptations in a rat model. Am J Obstet Gynecol 2018; 218:512.e1-512.e9. [PMID: 29432755 DOI: 10.1016/j.ajog.2018.02.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 01/09/2018] [Accepted: 02/05/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Maternal birth trauma to the pelvic floor muscles is thought to be consequent to mechanical demands placed on these muscles during fetal delivery that exceed muscle physiological limits. The above is consistent with studies of striated limb muscles that identify hyperelongation of sarcomeres, the functional muscle units, as the primary cause of mechanical muscle injury and resultant muscle dysfunction. However, pelvic floor muscles' mechanical response to strains have not been examined at a tissue level. Furthermore, we have previously demonstrated that during pregnancy, rat pelvic floor muscles acquire structural and functional adaptations in preparation for delivery, which likely protect against mechanical muscle injury by attenuating the strain effect. OBJECTIVE We sought to determine the mechanical impact of parturition-related strains on pelvic floor muscles' microstructure, and test the hypothesis that pregnancy-induced adaptations modulate muscle response to strains associated with vaginal delivery. STUDY DESIGN Three-month-old Sprague-Dawley late-pregnant (N = 20) and nonpregnant (N = 22) rats underwent vaginal distention, replicating fetal crowning, with variable distention volumes. Age-matched uninjured pregnant and nonpregnant rats served as respective controls. After sacrifice, pelvic floor muscles, which include coccygeus, iliocaudalis, and pubocaudalis, were fixed in situ and harvested for fiber and sarcomere length measurements. To ascertain the extent of physiological strains during spontaneous vaginal delivery, analogous measurements were obtained in intrapartum rats (N = 4) sacrificed during fetal delivery. Data were compared with repeated measures and 2-way analysis of variance, followed by pairwise comparisons, with significance set at P < .05. RESULTS Gross anatomic changes were observed in the pelvic floor muscles following vaginal distention, particularly in the entheseal region of pubocaudalis, which appeared translucent. The above appearance resulted from dramatic stretch of the myofibers, as indicated by significantly longer fiber length compared to controls. Stretch ratios, calculated as fiber length after vaginal distention divided by baseline fiber length, increased gradually with increasing distention volume. Paralleling these macroscopic changes, vaginal distention resulted in acute and progressive increase in sarcomere length with rising distention volume. The magnitude of strain effect varied by muscle, with the greatest sarcomere elongation observed in coccygeus, followed by pubocaudalis, and a smaller increase in iliocaudalis, observed only at higher distention volumes. The average fetal rat volume approximated 3 mL. Pelvic floor muscle sarcomere lengths in pregnant animals undergoing vaginal distention with 3 mL were similar to intrapartum sarcomere lengths in all muscles (P > .4), supporting the validity of our experimental approach. Vaginal distention resulted in dramatically longer sarcomere lengths in nonpregnant compared to pregnant animals, especially in coccygeus and pubocaudalis (P < .0001), indicating significant attenuation of sarcomere elongation in the presence of pregnancy-induced adaptations in pelvic floor muscles. CONCLUSION Delivery-related strains lead to acute sarcomere elongation, a well-established cause of mechanical injury in skeletal muscles. Sarcomere hyperelongation resultant from mechanical strains is attenuated by pregnancy-induced adaptations acquired by the pelvic floor muscles prior to parturition.
Collapse
Affiliation(s)
- Tatiana Catanzarite
- Division of Urogynecology and Pelvic Reconstructive Surgery, University of California-San Diego, San Diego, CA; Department of Reproductive Medicine, University of California-San Diego, San Diego, CA
| | - Shannon Bremner
- Department of Orthopedic Surgery, University of California-San Diego, San Diego, CA
| | - Caitlin L Barlow
- Department of Reproductive Medicine, University of California-San Diego, San Diego, CA
| | - Laura Bou-Malham
- Department of Reproductive Medicine, University of California-San Diego, San Diego, CA
| | - Shawn O'Connor
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA
| | - Marianna Alperin
- Division of Urogynecology and Pelvic Reconstructive Surgery, University of California-San Diego, San Diego, CA; Department of Reproductive Medicine, University of California-San Diego, San Diego, CA.
| |
Collapse
|
14
|
Bortolini MAT, Feitosa SM, Bilhar APM, Salerno GGR, Zanoteli E, Simões MJ, Castro RA. Molecular and histomorphological evaluation of female rats’ urethral tissues after an innovative trauma model of prolonged vaginal distention: immediate, short-term and long-term effects. Int Urogynecol J 2018; 30:465-476. [DOI: 10.1007/s00192-018-3634-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 03/08/2018] [Indexed: 02/06/2023]
|
15
|
Inoue KI, Kishimoto S, Kaga K, Fuse M, Furuta A, Yamanishi T. Autologous and heterotopic transplantation of adipose stromal vascular fraction ameliorates stress urinary incontinence in rats with simulated childbirth trauma. Regen Ther 2017; 8:9-14. [PMID: 30271860 PMCID: PMC6147152 DOI: 10.1016/j.reth.2017.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 11/10/2017] [Accepted: 11/29/2017] [Indexed: 01/30/2023] Open
Abstract
Introduction Autologous transplantation of adipose stromal vascular fraction (SVF) is a cost-effective and technically accessible option for cell therapy. Clinical study of SVF transplantation for male stress urinary incontinence (SUI) is underway, but the effectiveness remains unknown for female SUI, majority of which is caused by childbirth trauma. Methods Vaginal Distension (VD) rats were generated as in vivo model for female SUI. To quantitate the severity of SUI, leak point pressure (LPP) was measured by placing a bladder catheter. There was a characteristic waveform of LPP with two-peaks, and we counted the second peak as an LPP value. Adipose SVF was separated from inguinal fat and delivered into external urethral sphincter (EUS) through transperineal injection. LPP was measured 7 or 14 days after SVF transplantation. Tissue damage and collagen synthesis around the EUS were visualized by Masson's trichrome and eosin staining. Antibody against α-smooth muscle actin (α-SMA) was used to stain smooth muscle or activated stromal cells. Donor SVF cells were distinguished from recipient EUS tissue by tracking with GFP transgene. Results VD procedure decreased the frequency at which the normal LPP waveform appeared and lowered the LPP value. SVF injection normalized the waveform as well as the level of LPP. VD disrupted histological structure of EUS and SVF failed to differentiate into striatal muscles. Instead, SVF increased α-SMA positive cells and collagen synthesis but the phenomena depended on VD stimulus. GFP tracking indicated that the transplanted SVF cells persisted for four weeks and synthesized α-SMA protein simultaneously. Conclusions Autologous transplantation of adipose SVF displayed bulking effects through collagen synthesis. However, such heterotopic activation was dependent on tissue damage. VD rat is a reproducible in vivo model for female SUI. LPP waveform is a good indicator of normal EUS function. Transplantation of adipose SVF normalizes LPP decline caused by VD. Heterotopic SVF synthesizes collagen, depending on tissue damage. Heterotopic SVF does not display voiding obstruction.
Collapse
Affiliation(s)
- Ken-Ichi Inoue
- Center for Research Support, Dokkyo Medical University, Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Satoko Kishimoto
- Center for Research Support, Dokkyo Medical University, Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Kanya Kaga
- Department of Urology, Continence Center, Dokkyo Medical University, Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Miki Fuse
- Department of Urology, Continence Center, Dokkyo Medical University, Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Akira Furuta
- Department of Urology, Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-Ku, Tokyo, 105-0003, Japan
| | - Tomonori Yamanishi
- Department of Urology, Continence Center, Dokkyo Medical University, Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| |
Collapse
|
16
|
Yan H, Zhong L, Jiang Y, Yang J, Deng J, Wei S, Opara E, Atala A, Mao X, Damaser MS, Zhang Y. Controlled release of insulin-like growth factor 1 enhances urethral sphincter function and histological structure in the treatment of female stress urinary incontinence in a rat model. BJU Int 2017; 121:301-312. [PMID: 28805303 DOI: 10.1111/bju.13985] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To determine the effects of controlled release of insulin-like growth factor 1 (IGF-1) from alginate-poly-L-ornithine-gelatine (A-PLO-G) microbeads on external urethral sphincter (EUS) tissue regeneration in a rat model of stress urinary incontinence (SUI), as SUI diminishes the quality of life of millions, particularly women who have delivered vaginally, which can injure the urethral sphincter. Despite several well-established treatments for SUI, growth factor therapy might provide an alternative to promote urethral sphincter repair. MATERIALS AND METHODS In all, 44 female Sprague-Dawley rats were randomised into four groups: vaginal distension (VD) followed by periurethral injection of IGF-1-A-PLO-G microbeads (VD + IGF-1 microbeads; 1 × 104 microbeads/1 mL normal saline); VD + empty microbeads; VD + saline; or sham-VD + saline (sham). RESULTS Urethral function (leak-point pressure, LPP) was significantly lesser 1 week after VD + saline [mean (sem) 23.9 (1.3) cmH2 O] or VD + empty microbeads [mean (sem) 21.7 (0.8) cmH2 O) compared to the sham group [mean (sem) 44.4 (3.4) cmH2 O; P < 0.05), indicating that the microbeads themselves do not create a bulking or obstructive effect in the urethra. The LPP was significantly higher 1 week after VD + IGF-1 microbeads [mean (sem) 28.4 (1.2) cmH2 O] compared to VD + empty microbeads (P < 0.05), and was not significantly different from the LPP in sham rats, demonstrating an initiation of a reparative effect even at 1 week after VD. Histological analysis showed well-organised skeletal muscle fibres and vascular development in the EUS at 1 week after VD + IGF-1 microbeads, compared to substantial muscle fibre attenuation and disorganisation, and less vascular formation at 1 week after VD + saline or VD + empty microbeads. CONCLUSION Periurethral administration of IGF-1-A-PLO-G microbeads facilitates recovery from SUI by promoting skeletal myogenesis and revascularisation. This therapy is promising, but detailed and longer term studies in animal models and humans are needed.
Collapse
Affiliation(s)
- Hao Yan
- Biomedical Engineering Department of the Lerner Research Institute, Cleveland, OH, USA.,Department of Urology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Liren Zhong
- Institute for Regenerative Medicine, Wake Forest University, Winston-Salem, NC, USA.,Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yaodong Jiang
- Institute for Regenerative Medicine, Wake Forest University, Winston-Salem, NC, USA.,Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jian Yang
- Institute for Regenerative Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Junhong Deng
- Department of Andrology, The First People's Hospital of Guangzhou, Guangzhou, Guangdong, China
| | - Shicheng Wei
- Laboratory of Biomaterials and Regenerative Medicine, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
| | - Emmanuel Opara
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Anthony Atala
- Institute for Regenerative Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Xiangming Mao
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Margot S Damaser
- Biomedical Engineering Department of the Lerner Research Institute, Cleveland, OH, USA.,The Advanced Platform Technology Center of the Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA.,Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Yuanyuan Zhang
- Institute for Regenerative Medicine, Wake Forest University, Winston-Salem, NC, USA
| |
Collapse
|
17
|
Callewaert G, Da Cunha MMCM, Sindhwani N, Sampaolesi M, Albersen M, Deprest J. Cell-based secondary prevention of childbirth-induced pelvic floor trauma. Nat Rev Urol 2017; 14:373-385. [PMID: 28374792 DOI: 10.1038/nrurol.2017.42] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
With advancing population age, pelvic-floor dysfunction (PFD) will affect an increasing number of women. Many of these women wish to maintain active lifestyles, indicating an urgent need for effective strategies to treat or, preferably, prevent the occurrence of PFD. Childbirth and pregnancy have both long been recognized as crucial contributing factors in the pathophysiology of PFD. Vaginal delivery of a child is a serious traumatic event, causing anatomical and functional changes in the pelvic floor. Similar changes to those experienced during childbirth can be found in symptomatic women, often many years after delivery. Thus, women with such PFD symptoms might have incompletely recovered from the trauma caused by vaginal delivery. This hypothesis creates the possibility that preventive measures can be initiated around the time of delivery. Secondary prevention has been shown to be beneficial in patients with many other chronic conditions. The current general consensus is that clinicians should aim to minimize the extent of damage during delivery, and aim to optimize healing processes after delivery, therefore preventing later dysfunction. A substantial amount of research investigating the potential of stem-cell injections as a therapeutic strategy for achieving this purpose is currently ongoing. Data from small animal models have demonstrated positive effects of mesenchymal stem-cell injections on the healing process following simulated vaginal birth injury.
Collapse
Affiliation(s)
- Geertje Callewaert
- Department of Development and Regeneration, Cluster Organ Systems, Faculty of Medicine, University of Leuven, Herestraat 49, Leuven 3000, Belgium.,Department of Obstetrics and Gynaecology, Division Woman and Child, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium
| | | | - Nikhil Sindhwani
- Department of Development and Regeneration, Cluster Organ Systems, Faculty of Medicine, University of Leuven, Herestraat 49, Leuven 3000, Belgium
| | - Maurilio Sampaolesi
- Department of Obstetrics and Gynaecology, Division Woman and Child, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium
| | - Maarten Albersen
- Department of Development and Regeneration, Cluster Organ Systems, Faculty of Medicine, University of Leuven, Herestraat 49, Leuven 3000, Belgium.,Department of Urology, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium
| | - Jan Deprest
- Department of Development and Regeneration, Cluster Organ Systems, Faculty of Medicine, University of Leuven, Herestraat 49, Leuven 3000, Belgium.,Department of Obstetrics and Gynaecology, Division Woman and Child, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium
| |
Collapse
|
18
|
da Cunha MGMCM, Callewaert G, Giacomazzi G, Russo FM, Hympanova L, Velde GV, Albersen M, Sampaolesi M, Deprest J. Optimal delivery route of mesoangioblasts for stem cell therapy in rat model for simulated vaginal birth injury. Eur J Obstet Gynecol Reprod Biol 2017. [DOI: 10.1016/j.ejogrb.2017.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
19
|
Akbari P, Fathollahi A, Mo R, Kavran M, Episalla N, Hui CC, Farhat WA, Hijaz AK. A genetic female mouse model with congenital genitourinary anomalies and adult stages of urinary incontinence. Neurourol Urodyn 2017; 36:1981-1987. [PMID: 28244147 DOI: 10.1002/nau.23230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 12/28/2016] [Accepted: 01/10/2017] [Indexed: 11/10/2022]
Abstract
AIMS To characterize the urinary incontinence observed in adult Gli2+/- ; Gli3Δ699/+ female mice and identify the defects underlying the condition. METHODS Gli2+/- and Gli3Δ699/+ mice were crossed to generate: wild-type, mutant Gli2 (Gli2+/- ), mutant Gli3 (Gli3Δ699/+ ), and double mutant (Gli2+/- ; Gli3Δ699/+ ) female mice, verified via Polymerase Chain Reactions. Bladder functional studies including cystometrogram (CMG), leak point pressure (LPP), and voiding testing were performed on adult female mice. Female bladders and urethras were also analyzed via ink injection and histological assays. RESULTS CMG tracing showed no signal corresponding to the filling of the Gli2+/- ; Gli3Δ699/+ bladders. LPP were significantly reduced in Gli2+/- ; Gli3Δ699/+ mice compared to wild-type mice. CMG studies revealed a decrease in peak micturition pressure values in Gli2+/- ; Gli3Δ699/+ mice compared with all other groups. No significant differences between mutant and wild-type mice were detected in urinary output. Histological analyses revealed Gli2+/- ; Gli3Δ699/+ mice exhibited a widened urethra and a decrease in smooth muscle layer thickness in the bladder outlet and urethra, with increased mucosal folding. CONCLUSIONS Gli2+/- ; Gli3Δ699/+ adult female mice display persistent urinary incontinence due to the malformation of the bladder outlet and urethra. This presents a consistent and reliable genetic mouse model for female urinary incontinence and alludes to the key role of genetic factors involved in the condition.
Collapse
Affiliation(s)
- Pedram Akbari
- Program in Developmental & Stem Cell Biology, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Rong Mo
- Program in Developmental & Stem Cell Biology, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michael Kavran
- Department of Radiology, Case Western Reserve University, Cleveland, Ohio
| | - Nicole Episalla
- Georgetown University School of Medicine, Washington, DC, Washington
| | - Chi-Chung Hui
- Program in Developmental & Stem Cell Biology, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Walid A Farhat
- Program in Developmental & Stem Cell Biology, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Urology, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Adonis K Hijaz
- University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, Ohio
| |
Collapse
|
20
|
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.
Collapse
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
| |
Collapse
|
21
|
Marson L, Giamberardino MA, Costantini R, Czakanski P, Wesselmann U. Animal Models for the Study of Female Sexual Dysfunction. Sex Med Rev 2015; 1:108-122. [PMID: 27784584 DOI: 10.1002/smrj.14] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Significant progress has been made in elucidating the physiological and pharmacological mechanisms of female sexual function through preclinical animal research. The continued development of animal models is vital for the understanding and treatment of the many diverse disorders that occur in women. AIM To provide an updated review of the experimental models evaluating female sexual function that may be useful for clinical translation. METHODS Review of English written, peer-reviewed literature, primarily from 2000 to 2012, that described studies on female sexual behavior related to motivation, arousal, physiological monitoring of genital function and urogenital pain. MAIN OUTCOMES MEASURES Analysis of supporting evidence for the suitability of the animal model to provide measurable indices related to desire, arousal, reward, orgasm, and pelvic pain. RESULTS The development of female animal models has provided important insights in the peripheral and central processes regulating sexual function. Behavioral models of sexual desire, motivation, and reward are well developed. Central arousal and orgasmic responses are less well understood, compared with the physiological changes associated with genital arousal. Models of nociception are useful for replicating symptoms and identifying the neurobiological pathways involved. While in some cases translation to women correlates with the findings in animals, the requirement of circulating hormones for sexual receptivity in rodents and the multifactorial nature of women's sexual function requires better designed studies and careful analysis. The current models have studied sexual dysfunction or pelvic pain in isolation; combining these aspects would help to elucidate interactions of the pathophysiology of pain and sexual dysfunction. CONCLUSIONS Basic research in animals has been vital for understanding the anatomy, neurobiology, and physiological mechanisms underlying sexual function and urogenital pain. These models are important for understanding the etiology of female sexual function and for future development of pharmacological treatments for sexual dysfunctions with or without pain. Marson L, Giamberardino MA, Costantini R, Czakanski P, and Wesselmann U. Animal models for the study of female sexual dysfunction. Sex Med Rev 2013;1:108-122.
Collapse
Affiliation(s)
- Lesley Marson
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | | | | | - Peter Czakanski
- University of Alabama at Birmingham-Departments of Anesthesiology and Obstetrics & Gynecology, Birmingham, AL, USA
| | - Ursula Wesselmann
- University of Alabama at Birmingham-Departments of Anesthesiology and Neurology, Birmingham, AL, USA
| |
Collapse
|
22
|
Hakim L, De Ridder D, Van der Aa F. Slings for urinary incontinence and the application of cell-based therapy. Adv Drug Deliv Rev 2015; 82-83:22-30. [PMID: 25463774 DOI: 10.1016/j.addr.2014.11.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 10/15/2014] [Accepted: 11/08/2014] [Indexed: 02/08/2023]
Abstract
The most commonly used technique for the treatment of stress urinary incontinence (SUI) in women is the suburethral polypropylene sling, using either a retropubic or transobturator tape approach This treatment results in a cure rate of over 80%, based on both subjective and objective evaluations. Biological slings have been largely abandoned due to lack of efficacy. Despite the high success rates, 10-20% of women remain incontinent. Cell-based therapy might offer solutions for the future both for the primary setting as for the treatment of failures. Preclinical studies suggest that stem cells (SC) can enhance the recovery of damaged tissue either by direct integration and replacement of damaged tissue (differentiation) or by secreting factors that influence host response mechanisms (paracrine effect). The clinical data to date do not allow strong efficacy conclusions, except that SC therapy seems to be safe in the short term. Most published studies use autologous cells. Allogeneic cell sources need to be investigated as well to allow ready-to-use solutions in the future. Most importantly, we need better insight into the mechanisms of action. We need more basic stem cell research, better acute and chronic animal models, better investigational tools and more efforts using tissue engineering approach.
Collapse
|
23
|
Cruz Y, Pastelín C, Balog BM, Zaszczurynski PJ, Damaser MS. Somatomotor and sensory urethral control of micturition in female rats. Am J Physiol Renal Physiol 2014; 307:F1207-14. [PMID: 25339694 DOI: 10.1152/ajprenal.00255.2014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
In rats, axons of external urethral sphincter (EUS) motoneurons travel through the anastomotic branch of the pudendal nerve (ABPD) and anastomotic branch of the lumbosacral trunk (ABLT) and converge in the motor branch of the sacral plexus (MBSP). The aim of the present study was to determine in female rats the contribution of these somatomotor pathways and urethral sensory innervation from the dorsal nerve of the clitoris on urinary continence and voiding. EUS electromyographic (EMG) activity during cystometry, leak point pressure (LPP), and voiding efficiency (VE) were assessed in anesthetized virgin Sprague-Dawley female rats before and after transection of the above nerve branches. Transection of the MBSP eliminated EUS EMG, decreased LPP by 50%, and significantly reduced bladder contraction duration, peak pressure, intercontraction interval, and VE. Transection of the ABPD or ABLT decreased EUS EMG discharge and LPP by 25% but did not affect VE. Transection of the dorsal nerve of the clitoris did not affect LPP but reduced contraction duration, peak pressure, intercontraction interval, and VE. We conclude that somatomotor control of micturition is provided by the MBSP with axons travelling through the ABPD and ABLT. Partial somatomotor urethral denervation induces mild urinary incontinence, whereas partial afferent denervation induces voiding dysfunction. ABPD and ABLT pathways could represent a safeguard ensuring innervation to the EUS in case of upper nerve damage. Detailed knowledge of neuroanatomy and functional innervation of the urethra will enable more accurate animal models of neural development, disease, and dysfunction in the future.
Collapse
Affiliation(s)
- Yolanda Cruz
- Centro Tlaxcala Biología de la Conducta, Universidad Autónoma de Tlaxcala, Tlaxcala, México
| | - César Pastelín
- Centro Tlaxcala Biología de la Conducta, Universidad Autónoma de Tlaxcala, Tlaxcala, México; Doctorado en Neuroetología, Universidad Veracruzana, Xalapa, Veracruz, México
| | - Brian M Balog
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio
| | - Paul J Zaszczurynski
- Advanced Platform Technology Center, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio; and
| | - Margot S Damaser
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio; Advanced Platform Technology Center, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio; and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
24
|
Song QX, Chermansky CJ, Birder LA, Li L, Damaser MS. Brain-derived neurotrophic factor in urinary continence and incontinence. Nat Rev Urol 2014; 11:579-88. [PMID: 25224451 DOI: 10.1038/nrurol.2014.244] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Urinary incontinence adversely affects quality of life and results in an increased financial burden for the elderly. Accumulating evidence suggests a connection between neurotrophins, such as brain-derived neurotrophic factor (BDNF), and lower urinary tract function, particularly with regard to normal physiological function and the pathophysiological mechanisms of stress urinary incontinence (SUI) and bladder pain syndrome/interstitial cystitis (BPS/IC). The interaction between BDNF and glutamate receptors affects both bladder and external urethral sphincter function during micturition. Clinical findings indicate reduced BDNF levels in antepartum and postpartum women, potentially correlating with postpartum SUI. Experiments with animal models demonstrate that BDNF is decreased after simulated childbirth injury, thereby impeding the recovery of injured nerves and the restoration of continence. Treatment with exogenous BDNF facilitates neural recovery and the restoration of continence. Serotonin and noradrenaline reuptake inhibitors, used to treat both depression and SUI, result in enhanced BDNF levels. Understanding the neurophysiological roles of BDNF in maintaining normal urinary function and in the pathogenesis of SUI and BPS/IC could lead to future therapies based on these mechanisms.
Collapse
Affiliation(s)
- Qi-Xiang Song
- Department of Urology, Changhai Hospital, Shanghai, PR China
| | - Christopher J Chermansky
- Department of Urology, University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA 15261, USA
| | - Lori A Birder
- Department of Medicine, University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA 15261, USA
| | - Longkun Li
- Department of Urology, Second Affiliated Hospital of TMMU, Chongqing, PR China
| | - Margot S Damaser
- Department of Biomedical Engineering, The Cleveland Clinic, 9500 Euclid Avenue ND20, Cleveland, OH 44195, USA
| |
Collapse
|
25
|
Izumi H, Kaiho Y, Miyazato M, Kawamorita N, Nakagawa H, Arai Y. Effects of phosphodiesterase type 5 inhibitor, tadalafil, on continence reflex in rats. Int Urogynecol J 2014; 25:1721-7. [PMID: 24988889 DOI: 10.1007/s00192-014-2453-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 06/10/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Effects of tadalafil, a phosphodiesterase type 5 inhibitor, on the urethral continence reflex induced by sneezing were investigated. METHODS The amplitude of urethral pressure responses during sneezing (A-URS) and urethral baseline pressure (UBP) were measured in female rats using a microtransducer-tipped catheter. Sneeze leak-point pressure (S-LPP), defined as the lowest amount of pressure required to induce fluid leakage from the urethral orifice during sneezing, was measured in rats with stress urinary incontinence (SUI) induced by vaginal distension. Values were determined before and after tadalafil administration. RESULTS Tadalafil dose dependently and significantly decreased A-URS and S-LPP. At the highest dose tested (6.0 mg/kg), A-URS and S-LPP decreased from 49.7 to 32.3 and from 63.9 to 44.2 cmH2O, respectively, whereas UBP did not significantly change. CONCLUSIONS Tadalafil attenuated the sneeze-induced urethral continence reflex by relaxing the striated muscles of the external urethral sphincter.
Collapse
Affiliation(s)
- Hideaki Izumi
- Department of Urology, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aoba-ku, Sendai, 980-8574, Japan
| | | | | | | | | | | |
Collapse
|
26
|
Song QX, Balog BM, Kerns J, Lin DL, Sun Y, Damaser MS, Jiang HH. Long-term effects of simulated childbirth injury on function and innervation of the urethra. Neurourol Urodyn 2014; 34:381-6. [PMID: 24501018 DOI: 10.1002/nau.22561] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 12/19/2013] [Indexed: 11/09/2022]
Abstract
AIMS Pudendal nerve and external urethral sphincter (EUS) injury during vaginal delivery are risk factors for stress urinary incontinence (SUI). Although most patients with short-term postpartum SUI regain continence within 1 year, they have a higher predisposition to develop recurrent SUI years later, suggesting a possible mechanistic relationship. In contrast, animal models generally recover spontaneously and have not been studied much in the long term. The aim of this study was to investigate the long-term effects of simulated childbirth injury in rats. METHODS Thirty-four Sprague-Dawley female rats underwent sham injury or pudendal nerve crush and vaginal distension (PNC + VD), a simulated childbirth injury. Nine weeks later, leak point pressure (LPP) and EUS electromyography (EMG) were recorded simultaneously. The pudendal nerve was harvested for histological analysis. EUS neuromuscular junctions (NMJs) and their innervation were qualitatively assessed using immunofluorescence. A t-test was used to compare quantitative outcomes between groups, with P < 0.05 indicating a significant difference. RESULTS There was no significant difference in LPP or EUS EMG amplitude or firing rate between the two groups. Nonetheless after PNC + VD, NMJs in the EUS were diffuse and were innervated by tortuous and multiple axons, demonstrating that reinnervation of the EUS was still in progress. CONCLUSIONS Although continence function recovered 9 weeks after simulated childbirth injury, innervation of EUS was not complete at this time point, suggestive of persistent neurogenic deficiency which when compounded by the effects of aging may lead to a delayed recurrence of SUI in this animal model with increased age.
Collapse
Affiliation(s)
- Qi-Xiang Song
- Department of Biomedical Engineering, The Cleveland Clinic, Cleveland, Ohio; Department of Urology, Changhai Hospital, The Second Military Medical University, Shanghai, People's Republic of China; Advanced Platform Technology Rehabilitation R&D Center of Excellence, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
| | | | | | | | | | | | | |
Collapse
|
27
|
Hakim L, Endo M, Feola A, Soebadi DM, Deprest J, De Ridder D, Albersen M, Van der Aa F. High-frequency micro-ultrasound: a novel method to assess external urethral sphincter function in rats following simulated birth injury. Neurourol Urodyn 2014; 34:264-9. [PMID: 24436081 DOI: 10.1002/nau.22555] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 12/02/2013] [Indexed: 11/08/2022]
Abstract
AIMS We evaluated external urethral sphincter (EUS) function using high-frequency micro-ultrasound (US) in rats that were either uninjured (Control, C) or underwent vaginal distension (VD) as a substitute for vaginal birth injury induced stress urinary incontinence (SUI). METHODS Thirteen female nulliparous Sprague-Dawley rats of 12 weeks were divided into two groups, either C (n = 6) or VD (n = 7). Vaginal balloon distension was performed under pentobarbital anesthesia for 4 hours. Five days after the injury, all animals underwent US assessment of the urethra during high-rate bladder filling and urine leakage/voiding. Urinary leakage, the presence, absence, and pattern of EUS bursting during the voiding phase were registered, and pre-determined parameters of intercontraction interval (ICI), length of contraction (LOC), and rate of contraction (ROC) were registered. RESULTS Our ultrasound findings consistently showed the presence of rhythmic EUS bursting in all of the C rats (6/6), which were absent in all VD rats (0/7). The mean of ROC, ICI, and LOC in C group were 3.02 ± 0.12 contractions/sec, 471.43 ± 17.9 msec, and 103.41 ± 3.28 msec, respectively. CONCLUSIONS Pre-determined parameters of LOC, ICI, and ROC during US provide objective and measurable data on EUS function. US showed the total disappearance of EUS bursting in the VD group as compared to the C group. These results indicate that ultrasound testing may become a valuable non-invasive tool in future translational studies to investigate SUI/urethral function in rat models.
Collapse
Affiliation(s)
- Lukman Hakim
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Urology, Airlangga University School of Medicine/Dr. Soetomo General Hospital, Surabaya, Indonesia
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Hijaz AK, Grimberg KO, Tao M, Schmotzer B, Sadeghi Z, Lin YH, Kavran M, Ozer A, Xiao N, Daneshgari F. Stem cell homing factor, CCL7, expression in mouse models of stress urinary incontinence. Female Pelvic Med Reconstr Surg 2013; 19:356-61. [PMID: 24165450 DOI: 10.1097/spv.0b013e3182a331a9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Animal models of vaginal distention (VD) have demonstrated increased expression of chemokine (C-C motif) ligand 7 (CCL7) In this study, we investigated the expression of CCL7 in mice models of simulated birth trauma-induced urinary incontinence using VD and pudendal nerve transection (PNT). METHODS Forty-nine mice were divided into 6 groups: VD, sham VD, PNT, sham PNT, anesthesia, and age-matched controls. The urethra, vagina, and rectum were harvested for the expression of CCL7 immediately or 24 hours after assigned procedure. Venous sampling for quantification of serum CCL7 was also performed. An analysis of variance model was used to compare the relative expression of CCL7 in each group. RESULTS Urethral CCL7 expression in the VD group was significantly higher than control group after 24 hours (P < 0.01). There was no difference in the urethral CCL7 expression in PNT, sham PNT, sham VD, or anesthesia groups compared with the controls. No statistically significant difference was noted in the vaginal and rectal expression of CCL7 between any of the groups except for sham PNT. Statistically significant differences were noted in the serum CCL7 expression in the VD, PNT, and sham PNT (P < 0.01 in all) groups after 24 hours compared with the control group. CONCLUSIONS This study demonstrates overexpression of urethral CCL7 after VD but not PNT. This suggests that nerve injury does not contribute to the CCL7 overexpression. The overexpression of CCL7 in the serum of mice after VD suggests a translational potential where CCL7 measurement could be used as a surrogate for injury after delivery.
Collapse
Affiliation(s)
- Adonis K Hijaz
- From the *Department of Urology, Case Western Reserve University; Urology Institute, University Hospitals Case Medical Center, Cleveland, OH, †Center for Clinical Investigation, Case Western Reserve University, University Hospitals Case Medical Center, Cleveland, OH; ‡Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan; and §Department of Urology, Lanzhou University Second Hospital, Lanzhou, China
| | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Juárez R, Cruz Y. Urinary and ejaculatory dysfunction induced by denervation of specific striated muscles anatomically related to the urethra in male rats. Neurourol Urodyn 2013; 33:437-42. [DOI: 10.1002/nau.22432] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 04/18/2013] [Indexed: 01/23/2023]
Affiliation(s)
- Raúl Juárez
- Maestría en Ciencias Biológicas; Universidad Autónoma de Tlaxcala; Tlaxcala México
| | - Yolanda Cruz
- Centro Tlaxcala de Biología de la Conducta; Universidad Autónoma de Tlaxcala; Tlaxcala México
| |
Collapse
|
30
|
Jiang HH, Gill BC, Dissaranan C, Zutshi M, Balog BM, Lin D, Damaser MS. Effects of acute selective pudendal nerve electrical stimulation after simulated childbirth injury. Am J Physiol Renal Physiol 2013; 304:F239-47. [PMID: 23152293 PMCID: PMC3566519 DOI: 10.1152/ajprenal.00235.2012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 11/12/2012] [Indexed: 11/22/2022] Open
Abstract
During childbirth, a combinatorial injury occurs and can result in stress urinary incontinence (SUI). Simulated childbirth injury, consisting of vaginal distension (VD) and pudendal nerve crush (PNC), results in slowed recovery of continence, as well as decreased expression of brain-derived neurotrophic factor (BDNF), a regenerative cytokine. Electrical stimulation has been shown to upregulate BDNF in motor neurons and facilitate axon regrowth through the increase of β(II)-tubulin expression after injury. In this study, female rats underwent selective pudendal nerve motor branch (PNMB) stimulation after simulated childbirth injury or sham injury to determine whether such stimulation affects bladder and anal function after injury and whether the stimulation increases BDNF expression in Onuf's nucleus after injury. Rats received 4 h of VD followed by bilateral PNC and 1 h of subthreshold electrical stimulation of the left PNMB and sham stimulation of the right PNMB. Rats underwent filling cystometry and anal pressure recording before, during, and after the stimulation. Bladder and anal contractile function were partially disrupted after injury. PNMB stimulation temporarily inhibited bladder contraction after injury. Two days and 1 wk after injury, BDNF expression in Onuf's nucleus of the stimulated side was significantly increased compared with the sham-stimulated side, whereas β(II)-tubulin expression in Onuf's nucleus of the stimulated side was significantly increased only 1 wk after injury. Acute electrical stimulation of the pudendal nerve proximal to the crush site upregulates BDNF and β(II)-tubulin in Onuf's nucleus after simulated childbirth injury, which could be a potential preventive option for SUI after childbirth injury.
Collapse
Affiliation(s)
- Hai-Hong Jiang
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH 44195, USA.
| | | | | | | | | | | | | |
Collapse
|
31
|
Abstract
OBJECTIVE Stimulation of the pudendal nerve or the anal sphincter could provide therapeutic options for fecal incontinence with little involvement of other organs. The goal of this project was to assess the effects of pudendal nerve and anal sphincter stimulation on bladder and anal pressures. DESIGN Ten virgin female Sprague Dawley rats were randomly allocated to control (n = 2), perianal stimulation (n = 4), and pudendal nerve stimulation (n = 4) groups. A monopolar electrode was hooked to the pudendal nerve or placed on the anal sphincter. Aballoon catheter was inserted into the anus to measure anal pressure, and a catheter was inserted into the bladder via the urethra to measure bladder pressure. Bladder and anal pressures were measured with different electrical stimulation parameters and different timing of electrical stimulation relative to spontaneous anal sphincter contractions. RESULTS Increasing stimulation current had the most dramatic effect on both anal and bladder pressures. An immediate increase in anal pressure was observed when stimulating either the anal sphincter or the pudendal nerve at stimulation values of 1 mA or 2 mA. No increase in anal pressure was observed for lower current values. Bladder pressure increased at high current during anal sphincter stimulation, but not as much as during pudendal nerve stimulation. Increased bladder pressure during anal sphincter stimulation was due to contraction of the abdominal muscles. CONCLUSION Electrical stimulation caused an increase in anal pressures with bladder involvement only at high current. These initial results suggest that electrical stimulation can increase anal sphincter pressure, enhancing continence control.
Collapse
|
32
|
|
33
|
Skaff M, Pinto E, Leite KRM, Almeida FG. Development of a rabbit's urethral sphincter deficiency animal model for anatomical-functional evaluation. Int Braz J Urol 2012; 38:17-24. [PMID: 22397778 DOI: 10.1590/s1677-55382012000100003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2011] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The aim of the study was to develop a new durable animal model (using rabbits) for anatomical-functional evaluation of urethral sphincter deficiency. MATERIALS AND METHODS A total of 40 New Zealand male rabbits, weighting 2.500 kg to 3.100 kg, were evaluated to develop an incontinent animal model. Thirty-two animals underwent urethrolysis and 8 animals received sham operation. Before and at 2, 4, 8 and 12 weeks after urethrolysis or sham operation, it was performed cystometry and leak point pressure (LPP) evaluation with different bladder distension volumes (10, 20, 30 mL). In each time point, 10 animals (8 from the study group and 2 from the sham group) were sacrificed to harvest the bladder and urethra. The samples were evaluated by H&E and Masson 's Trichrome to determine urethral morphology and collagen/smooth muscle density. RESULTS Twelve weeks after urethrolysis, it was observed a significant decrease in LPP regardless the bladder volume (from 33.7 ± 6.6 to 12.8 ± 2.2 cmH₂O). The histological analysis evidenced a decrease of 22% in smooth muscle density with a proportional increase in the collagen, vessels and elastin density (p < 0.01). CONCLUSIONS Transabdominal urethrolysis develops urethral sphincter insufficiency in rabbits, with significant decrease in LPP associated with decrease of smooth muscle fibers and increase of collagen density. This animal model can be used to test autologous cell therapy for stress urinary incontinence treatment.
Collapse
Affiliation(s)
- M Skaff
- Department of Urology, School of Medicine at Federal University of Sao Paulo, Sao Paulo, Brazil
| | | | | | | |
Collapse
|
34
|
Koike Y, Furuta A, Suzuki Y, Honda M, Naruoka T, Asano K, Egawa S, Yoshimura N. Pathophysiology of urinary incontinence in murine models. Int J Urol 2012; 20:64-71. [PMID: 23126617 DOI: 10.1111/j.1442-2042.2012.03225.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Accepted: 10/03/2012] [Indexed: 12/14/2022]
Abstract
Urethral closure mechanisms under stress conditions consist of passive urethral closure involving connective tissues, fascia and/or ligaments in the pelvis and active urethral closure mediated by hypogastric, pelvic and pudendal nerves. Furthermore, we have previously reported that the active urethral closure mechanism might be divided into two categories: (i) the central nervous control passing onto Onuf's nucleus under sneezing or coughing; and (ii) the bladder-to-urethral spinal reflex under Valsalva-like stress conditions, such as laughing, exercise or lifting heavy objects. There are over 200 million people worldwide with urinary incontinence, a condition that is associated with a significant social impact and reduced quality of life. Therefore, basic research for urinary continence mechanisms in response to different stress conditions can play an essential role in developing treatments for stress urinary incontinence. It has been clinically shown that the etiology of stress urinary incontinence is divided into urethral hypermobility and intrinsic sphincter deficiency, which could respectively correspond to passive and active urethral closure dysfunction. In this review, we summarize the representative stress urinary incontinence animal models and the methods to measure leak point pressures under stress conditions, and then highlight stress-induced urinary continence mechanisms mediated by active urethral closure mechanisms, as well as future pharmacological treatments of stress urinary incontinence. In addition, we introduce our previous reports including sex differences in urethral closure mechanisms under stress conditions and urethral compensatory mechanisms to maintain urinary continence after pudendal nerve injury in female rats.
Collapse
Affiliation(s)
- Yusuke Koike
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Sajadi KP, Lin DL, Steward JE, Balog B, Dissaranan C, Zaszczurynski P, Gill BC, Jiang HH, Kerns JM, Damaser MS. Pudendal nerve stretch reduces external urethral sphincter activity in rats. J Urol 2012; 188:1389-95. [PMID: 22906665 DOI: 10.1016/j.juro.2012.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Indexed: 11/29/2022]
Abstract
PURPOSE Most animal models of stress urinary incontinence simulate maternal injuries of childbirth since delivery is a major risk factor but they do not reproduce the nerve stretch known to occur during human childbirth. We hypothesized that pudendal nerve stretch produces reversible dysfunction of the external urethral sphincter. MATERIALS AND METHODS Female virgin Sprague-Dawley® rats were anesthetized with urethane. Bilateral pudendal nerve stretch or sham injury was performed for 5 minutes. External urethral sphincter electromyography and leak point pressure were recorded immediately before and after, and 10, 30, 60 and 120 minutes after pudendal nerve stretch. Post-pudendal nerve stretch results were compared to prestretch values and to values in sham injured animals. The pudendal nerves underwent qualitative histological assessment. The nucleus of Onuf was evaluated by immunohistochemistry and polymerase chain reaction for β-APP and c-Fos expression as markers of neuronal activity and injury. RESULTS A total of 14 rats underwent bilateral pudendal nerve stretch (9) or sham injury (5). Each nerve was stretched a mean ± SEM of 74% ± 18% on the left side and 63% ± 13% on the right side. Electromyography amplitude decreased significantly immediately after stretch compared to before stretch and after sham injury (p = 0.003) but it recovered by 30 minutes after stretch. There was no significant change in leak point pressure at any time. Two hours after injury histology showed occasional neuronal degeneration. β-APP and c-Fos expression was similar in the 2 groups. CONCLUSIONS Acute pudendal nerve stretch produces reversible electrophysiological dysfunction but without leak point pressure impairment. Pudendal nerve stretch shows promise in modeling injury. It should be tested as part of a multi-injury, chronic, physiological model of human childbirth injury.
Collapse
Affiliation(s)
- Kamran P Sajadi
- Division of Urology, Oregon Health and Science University, Portland, Oregon 97232, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Juárez M, Hernández I, Cruz Y. Genitourinary dysfunction in male rats after bilateral neurectomy of the motor branch of the sacral plexus. Neurourol Urodyn 2012; 31:1288-93. [PMID: 22447388 DOI: 10.1002/nau.22242] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Accepted: 02/22/2012] [Indexed: 12/18/2022]
Abstract
AIMS To determine the contribution of the striated musculature anatomically related to the urethra on urinary continence in conscious male rats. We tested whether the bilateral neurectomy of the motor branch of the sacral plexus (MBSP), a nerve that innervates the bulbospongiosus, ischiocavernosus, and external urethral sphincter, is a reliable procedure to induce changes in voiding pattern that can be used as indicators of urinary incontinence in unanesthetized male rats. METHODS Micturition behavior was videotaped and urinary parameters measured 24 h before and at day 2 and 10 after surgery. RESULTS Intact animals have a stereotyped behavior of micturition consisting in urination in the corner of the cage. Neurectomized animals lost place preference for voiding demonstrated by leakage of urine throughout the cage while eating, walking, or sleeping. Voiding frequency was double and voiding duration was triple the amount before surgery. Urine flow rate and voiding volume were also significantly decreased. Necropsy showed that 10 days post-denervation semen material was accumulated in the urethra and in the bladder. CONCLUSION In male rats the perineal striated muscles are crucial to maintaining normal urinary continence, preventing retrograde ejaculation, and to expelling urine and seminal secretions. Bilateral neurectomy of the MBSP may not be appropriate for long term survival urinary studies because effects on urinary parameters can be contaminated and/or masked by impaired seminal fluid expulsion, as a consequence of impairment of striated urethral muscle function.
Collapse
Affiliation(s)
- Margarita Juárez
- Centro Tlaxcala de Biología de la Conducta, Universidad Autónoma de Tlaxcala, Tlaxcala, México
| | | | | |
Collapse
|
37
|
Yoshimura N, Miyazato M. Neurophysiology and therapeutic receptor targets for stress urinary incontinence. Int J Urol 2012; 19:524-37. [PMID: 22404481 DOI: 10.1111/j.1442-2042.2012.02976.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Stress urinary incontinence is the most common type of urinary incontinence in women. Stress urinary incontinence involves involuntary leakage of urine in response to abdominal pressure caused by activities, such as sneezing and coughing. The condition affects millions of women worldwide, causing physical discomfort as well as social distress and even social isolation. This type of incontinence is often seen in women after middle age and it can be caused by impaired closure mechanisms of the urethra as a result of a weak pelvic floor or poorly supported urethral sphincter (urethral hypermobility) and/or a damaged urethral sphincter system (intrinsic sphincter deficiency). Until recently, stress urinary incontinence has been approached by clinicians as a purely anatomic problem as a result of urethral hypermobility requiring behavioral or surgical therapy. However, intrinsic sphincter deficiency has been reported to be more significantly associated with stress urinary incontinence than urethral hypermobility. Extensive basic and clinical research has enhanced our understanding of the complex neural circuitry regulating normal function of the lower urinary tract, as well as the pathophysiological mechanisms that might underlie the development of stress urinary incontinence and lead to the development of potential novel strategies for pharmacotherapy of stress urinary incontinence. Therapeutic targets include adrenergic and serotonergic receptors in the spinal cord, and adrenergic receptors at the urethral sphincter, which can enhance urethral reflex activity during stress conditions and increase baseline urethral pressure, respectively. This article therefore reviews the recent advances in stress urinary incontinence research and discusses the neurophysiology of urethral continence reflexes, the etiology of stress urinary incontinence and potential targets for pharmacotherapy of stress urinary incontinence.
Collapse
Affiliation(s)
- Naoki Yoshimura
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
| | | |
Collapse
|
38
|
Salcedo L, Sopko N, Jiang HH, Damaser M, Penn M, Zutshi M. Chemokine upregulation in response to anal sphincter and pudendal nerve injury: potential signals for stem cell homing. Int J Colorectal Dis 2011; 26:1577-81. [PMID: 21706136 DOI: 10.1007/s00384-011-1269-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/10/2011] [Indexed: 02/04/2023]
Abstract
PURPOSE Stromal derived factor-1 (SDF-1) and monocyte chemotactic protein-3 (MCP-3) are signals forcing the migration of bone marrow-derived stem cells to ischemic tissue. This study investigates SDF-1 and MCP-3 expression following direct injury to the anal sphincter and pudendal nerve and to determine if these same mechanisms have any role. METHODS Chemokine expression was studied after anal sphincter injury in female rats after either a sphincterotomy (n = 15), pudendal nerve crush (PNC; n = 15), sham pudendal nerve crush (n = 15), or acted as unmanipulated controls (n = 5). Analysis was done at 1 h and 10 and 21 days after injury. RESULTS After injury, SDF-1 expression increased 40.2 ± 6.42 (P = 0.01) at 1 h and 28.2 ± 2.37 (P = 0.01) at 10 days, respectively, compared to controls. Likewise, MCP-3 expression increased 40.8 ± 8.17 (P = 0.02) at the same intervals compared to controls. After PNC, SDF-1 expression increased 46.4 ± 6.01 (P = 0.02) and 50.6 ± 10.11 (P = 0.01), and MCP-3 expression increased 46.3 ± 7.76 (P = 0.03) and 190.8 ± 22.15 (P = 0.01), respectively, at the same time intervals compared to controls. However, when PNC was compared to sham injured, a significant increase was seen in SDF-1 and MCP-3 at 10 days. At 21 days, PNC compared to sham injured was significantly low in expression for both SDF-1 and MCP-3 (P < 0.05). CONCLUSIONS Direct anal sphincter injury results in higher levels of SDF-1 and MCP-3 expression soon after injury, whereas denervation via pudendal nerve crush results in greater SDF-1 and MCP-3 expression 10 days after injury. Chemokine overexpression suggests the potential for cell-based therapeutic strategies.
Collapse
Affiliation(s)
- Levilester Salcedo
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | | | | | | | | | | |
Collapse
|
39
|
Boncher N, Vricella G, Kavran M, Xiao N, Hijaz A. Setting a new standard: updating the vaginal distention translational model for stress urinary incontinence. Neurourol Urodyn 2011; 31:190-4. [PMID: 22038896 DOI: 10.1002/nau.21168] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 05/10/2011] [Indexed: 11/08/2022]
Abstract
AIMS The vaginal distention (VD) translational model for postpartum stress urinary incontinence (SUI) is potentially biased for use in evaluating animals with increasing phenotypic size (obesity) due to a fixed VD volume. Our study had three principle and two secondary aims. First, to examine both ex vivo and in vivo catheter pressure changes during volume distention. Secondly, to determine mean pressure at current volume standard for use as target pressure (TP) for VD under isobaric (IB) conditions. Thirdly, to demonstrate feasibility and equivalence of VD at TP versus isovolumetric (IV) standard. Secondary aims were to demonstrate decreased variability (IB vs. IV) and to review the effect of weight. METHODS Ten French modified Foley catheters were inflated sequentially to 3.0 ml while connected (both in vivo and ex vivo) to a pressure transducer. Mean result generated TP. Thirty Sprague-Dawley rats (280-300 g) were then randomized to one of three groups: IV, IB at TP, or sham VD. Student's t-test was used to compare groups' leak point pressures (LPP) and simple linear regression was used to evaluate the effect of weight as a continuous variable. RESULTS Catheter pressure/volume responses were demonstrated. Calculated TP was 531 mm Hg. LPP under conditions of IB and IV were statistically equivalent and were statistically lower than Sham. Variability was not statistically different between IB and IV groups. When treated as a continuous variable, weight had no effect on LPP. CONCLUSIONS VD injury based on TP is feasible and reproducible. Understanding catheter pressure dynamics is valuable for investigating alternative rat phenotypes.
Collapse
Affiliation(s)
- Nicholas Boncher
- Department of Urology, Case Western Reserve University, Cleveland, Ohio 44113, USA
| | | | | | | | | |
Collapse
|
40
|
Kakizaki H, Kita M, Wada N. Models for sensory neurons of dorsal root ganglia and stress urinary incontinence. Neurourol Urodyn 2011; 30:653-7. [PMID: 21661009 DOI: 10.1002/nau.21138] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
AIMS To discuss (1) animal models for investigating bladder afferent pathways from the spinal cord to the brain and (2) animal models of stress urinary incontinence (SUI) with a special emphasis on functional and histopathological characteristics of each model. METHODS Literature review of spinal mechanisms of bladder afferent pathways and animal models of SUI. RESULTS Electrophysiological studies in the rat using pelvic nerve stimulation and recording of evoked potentials in the periaqueductal gray (PAG) prove to be a valuable tool to examine spinal mechanisms of bladder afferent pathways. Animal models of SUI in the rat include vaginal distention as simulated birth trauma, pudendal nerve crush or transection, urethral sphincter injury by electrocauterization, transabdominal urethrolysis, periurethral botulinum-A toxin injection, and pubo-urethral ligament transection. Functional and histopathological changes in the continence mechanism after injury are different between models. CONCLUSIONS Using animal models for sensory neurons, intrathecal and intravenous administration of certain drugs can be tested whether they affect the bladder afferent pathways from the spinal cord to the PAG. Animal models of SUI can serve as a tool to develop new pharmacologic therapies or periurethral injection therapies using stem cell implants.
Collapse
Affiliation(s)
- Hidehiro Kakizaki
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan.
| | | | | |
Collapse
|
41
|
Haworth DJ, Kitta T, Morelli B, Chew DW, Yoshimura N, de Groat WC, Vorp DA. Strain-dependent urethral response. Neurourol Urodyn 2011; 30:1652-8. [PMID: 21826722 DOI: 10.1002/nau.21158] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Accepted: 04/29/2011] [Indexed: 11/10/2022]
Abstract
AIMS The Sprague-Dawley (SD) rat, an out-bred, all-purpose strain, has served well for lower urinary tract research. However, to test new cellular therapies for conditions such as stress urinary incontinence, an in-bred rat strain with immune tolerance, such as the Lewis rat, may be more useful. The objective of this study was to reveal any differences in lower urinary tract continence mechanisms between the Lewis and SD rat. METHODS The contribution of (1) the striated and smooth muscle to the mechanical and functional properties of the urethra in vitro, and (2) the striated sphincter to leak point pressure (LPP) and reflex continence mechanisms in vivo were assessed in normal (control) Lewis and SD rats and in a model of stress urinary incontinence produced by bilateral pudendal nerve transection. RESULTS Control, Lewis rats had significantly lower LPP, significantly less fast-twitch skeletal muscle and relied less on the striated sphincter for continence than control, SD rats, as indicated by the failure of neuromuscular blockade with alpha-bungarotoxin to reduce LPP. Nerve transection significantly decreased LPP in the SD rat, but not in the Lewis rat. Although the Lewis urethra contained more smooth muscle than the SD rat, it was less active in vitro as indicated by a low urethral baseline pressure and lack of response to phenylephrine. CONCLUSIONS We have observed distinct differences in functional and mechanical properties of the SD and Lewis urethra and have shown that the Lewis rat may not be suitable as a chronic model of SUI via nerve transection.
Collapse
Affiliation(s)
- Donna J Haworth
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | | | | |
Collapse
|
42
|
Wu G, Song Y, Zheng X, Jiang Z. Adipose-derived stromal cell transplantation for treatment of stress urinary incontinence. Tissue Cell 2011; 43:246-53. [PMID: 21704350 DOI: 10.1016/j.tice.2011.04.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Revised: 04/29/2011] [Accepted: 04/29/2011] [Indexed: 01/23/2023]
Abstract
We aimed to investigate the application of adipose-derived stromal cells in the treatment of stress urinary incontinence (SUI). Animal models of stress urinary incontinence were established with Sprague-Dawley female rats by complete cutting of the pudendal nerve. Rat adipose-derived stromal cells were isolated, cultured and successfully transplanted into animal models. Effects of stem cell transplantation were evaluated through urodynamic testing and morphologic changes of the urethra and surrounding tissues before and after transplantation. Main urodynamic outcome measures were measured. Intra-bladder pressure and leak point pressure were measured during filling phase. Morphologic examinations were performed. Transplantation of adipose-derived stem cells significantly strengthened local urethral muscle layers and significantly improved the morphology and function of sphincters. Urodynamic testing showed significant improvements in maximum bladder capacity, abdominal leak point pressure, maximum urethral closure pressure, and functional urethral length. Morphologic changes and significant improvement in urination control were consistent over time. It was concluded that periurethral injection of adipose-derived stromal cells improves function of the striated urethral sphincter, resulting in therapeutic effects on SUI. Reconstruction of the pelvic floor through transplantation of adipose-derived cells is a minimally invasive and effective treatment for SUI.
Collapse
Affiliation(s)
- GuiZhu Wu
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
| | | | | | | |
Collapse
|
43
|
Phull HS, Pan HQ, Butler RS, Hansel DE, Damaser MS. Vulnerability of continence structures to injury by simulated childbirth. Am J Physiol Renal Physiol 2011; 301:F641-9. [PMID: 21613415 DOI: 10.1152/ajprenal.00120.2011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The goal of this study was to examine acute morphological changes, edema, muscle damage, inflammation, and hypoxia in urethral and vaginal tissues with increasing duration of vaginal distension (VD) in a rat model. Twenty-nine virgin Sprague-Dawley rats underwent VD under anesthesia with the use of a modified Foley catheter inserted into the vagina and filled with saline for 0, 1, 4, or 6 h. Control animals were anesthetized for 4 h without catheter placement. Urogenital organs were harvested after intracardiac perfusion of fixative. Tissues were embedded, sectioned, and stained with Masson's trichrome or hematoxylin and eosin stains. Regions of hypoxia were measured by hypoxyprobe-1 immunohistochemistry. Within 1 h of VD, the urethra became vertically elongated and displaced anteriorly. Edema was most prominent in the external urethral sphincter (EUS) and urethral/vaginal septum within 4 h of VD, while muscle disruption and fragmentation of the EUS occurred after 6 h. Inflammatory damage was characterized by the presence of polymorphonuclear leukocytes in vessels and tissues after 4 h of VD, with the greatest degree of infiltration occurring in the EUS. Hypoxia localized mostly to the vaginal lamina propria, urethral smooth muscle, and EUS within 4 h of VD. Increasing duration of VD caused progressively greater tissue edema, muscle damage, and morphological changes in the urethra and vagina. The EUS underwent the greatest insult, demonstrating its vulnerability to childbirth injury.
Collapse
Affiliation(s)
- Hardeep S Phull
- Dept. of Biomedical Engineering, Lerner Research Institute, The Cleveland Clinic, OH 44195, USA
| | | | | | | | | |
Collapse
|
44
|
Chen SC, Cheng CL, Fan WJ, Chen JJJ, Lai CH, Peng CW. Effect of a 5-HT1A receptor agonist (8-OH-DPAT) on external urethral sphincter activity in a rat model of pudendal nerve injury. Am J Physiol Regul Integr Comp Physiol 2011; 301:R225-35. [PMID: 21490366 DOI: 10.1152/ajpregu.00260.2010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Although serotonergic agents have been used to treat patients with stress urinary incontinence, the characteristics of the external urethral sphincter (EUS) activity activated by 5-HT receptors have not been extensively studied. This study examined the effects of the 5-HT(1A) receptor agonist, 8-hydroxy-2-(di-n-propylamino)tetralin (8-OH-DPAT), on the EUS-electromyography and resistance of the urethra in a rat model with bilateral pudendal nerve injury (BPNI). Two measurements were utilized to assess the effects of the drug on bladder and urethral functions: the simultaneous recordings of transvesical pressure under isovolumetric conditions [isovolumetric intravesical pressure (IVP)] and urethral perfusion pressure, and the simultaneous recordings of IVP during continuously isotonic transvesical infusion with an open urethra (isotonic IVP) and EUS-electromyography. This study also evaluated the urethral continence using leak point pressure testing. The urethral perfusion pressure and leak point pressure measurements of BPNI rats reveal that 8-OH-DPAT significantly increased urethral resistance during the bladder storage phase, yet decreased resistance during the voiding phase. The entire EUS burst period was significantly prolonged, within which the average silent period increased and the frequency of burst discharges decreased. 8-OH-DPAT also improved the voiding efficiency, as evidenced by the detection of decreases in the contraction amplitude and residual volume, with increases in contraction duration and voided volume. These findings suggest that 8-OH-DPAT not only improved continence function, but also elevated the voiding function in a BPNI rat model.
Collapse
Affiliation(s)
- Shih-Ching Chen
- Dept. of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, No. 250, Wuxing St., Taipei 11031, Taiwan
| | | | | | | | | | | |
Collapse
|
45
|
Furuta A, Suzuki Y, Asano K, de Groat WC, Egawa S, Yoshimura N. Urethral compensatory mechanisms to maintain urinary continence after pudendal nerve injury in female rats. Int Urogynecol J 2011; 22:963-70. [PMID: 21445696 DOI: 10.1007/s00192-011-1403-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2010] [Accepted: 02/20/2011] [Indexed: 02/05/2023]
Abstract
INTRODUCTION AND HYPOTHESIS This study was conducted to investigate the urethral compensatory mechanisms to maintain urinary continence after pudendal nerve injury. METHODS In naive, acute pudendal nerve transection (PNT) and 4 weeks after PNT (PNT-4w) female rats, leak point pressures (LPPs) during bladder compression were measured before and after the application of hexamethonium (C6), propranolol, and N (ω)-nitro-L: -arginine-methyl ester (L: -NAME), or terazosin and atropine. Responses to carbachol and phenylephrine of proximal and middle urethral muscle strips from naive and PNT-4w rats were also examined. RESULTS LPPs were significantly decreased in PNT rats but not in PNT-4w rats. LPPs in PNT rats were significantly increased by C6 or L-NAME while LPPs in PNT-4w rats were significantly decreased by C6, or terazosin and atropine. Excitatory responses to carbachol and phenylephrine in the proximal urethral muscle were significantly larger in PNT-4w rats. CONCLUSIONS These results suggest that α(1)-adrenoceptor and muscarinic receptor-mediated contractility is upregulated in the proximal urethra 4 weeks after PNT.
Collapse
Affiliation(s)
- Akira Furuta
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | | | | | | | | | | |
Collapse
|
46
|
Abstract
Stress urinary incontinence (SUI) is highly prevalent. As of now, there is no minimally invasive long-term treatment available. Adult stem cells are nonimmunogenic and have the ability to self-renew and to differentiate into multiple cell types. Over the past decade, in vivo studies have described periurethral injections of adult-derived stem cells for the treatment of SUI. The ultimate goal has been to achieve a permanent cure for SUI by restoration of the intrinsic and extrinsic urethral sphincter and the surrounding connective tissue, including peripheral nerves and blood vessels. For this purpose, future studies need to focus on delivery systems, cell survival, and functional improvement of the urethral closure mechanism, including improvement of innervation and vascularization.
Collapse
Affiliation(s)
- Andrea Staack
- UCLA School of Medicine, 200 Medical Plaza, Suite 240, Los Angeles, CA 90095 USA
| | - Larissa V. Rodríguez
- UCLA School of Medicine, 200 Medical Plaza, Suite 240, Los Angeles, CA 90095 USA
| |
Collapse
|
47
|
Abstract
Stress urinary incontinence (SUI) is a common health problem significantly affecting the quality of life of women worldwide. Animal models that simulate SUI enable the assessment of the mechanism of risk factors for SUI in a controlled fashion, including childbirth injuries, and enable preclinical testing of new treatments and therapies for SUI. Animal models that simulate childbirth are presently being utilized to determine the mechanisms of the maternal injuries of childbirth that lead to SUI with the goal of developing prophylactic treatments. Methods of assessing SUI in animals that mimic diagnostic methods used clinically have been developed to evaluate the animal models. Use of these animal models to test innovative treatment strategies has the potential to improve clinical management of SUI. This chapter provides a review of the available animal models of SUI, as well as a review of the methods of assessing SUI in animal models, and potential treatments that have been tested on these models.
Collapse
Affiliation(s)
- Hai-Hong Jiang
- Biomedical Engineering Department, The Cleveland Clinic, 9500 Euclid Ave. ND20, Cleveland, OH 44195, USA
| | - Margot S. Damaser
- Biomedical Engineering Department, The Cleveland Clinic, 9500 Euclid Ave. ND20, Cleveland, OH 44195, USA
| |
Collapse
|
48
|
Breyer BN, Wang G, Lin G, Shindel AW, Yang R, Lin CS, Lue TF. The effect of long-term hormonal treatment on voiding patterns during filling cystometry and on urethral histology in a postpartum, ovariectomized female rat. BJU Int 2010; 106:1775-81. [PMID: 20201831 PMCID: PMC2912975 DOI: 10.1111/j.1464-410x.2010.09268.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To study whether long-term treatment with oestrogen (E(2) ), selective E(2) receptor modulators (SERMs), or growth hormone (GH) can prevent the development of abnormal voiding patterns during filling cystometry (CMG) in a postpartum, ovariectomized (Ovx) female rat. MATERIALS AND METHODS Immediately after spontaneous delivery, 60 primiparous Sprague-Dawley rats were randomly divided into six equal groups. One group served as uninjured sham controls and five groups underwent intravaginal balloon dilatation. On day seven, previously dilated rats underwent bilateral Ovx and implantation of a subcutaneous hormone-delivery pump. The five treatment groups received normal saline (control), E(2) , raloxifene, levormeloxifene, or GH for 7 weeks. Conscious CMG was performed 7 weeks after Ovx. Urethral sphincter tissue was harvested for elastin immunohistochemistry and real-time polymerase chain reaction of α(1A) -adrenoceptor mRNA. RESULTS No abnormal voiding patterns were detected in the group treated with GH. The E(2) , raloxifene and levormeloxifene groups had greater detrusor overactivity and urethral relaxation incontinence than control rats. The raloxifene group had a significantly lower baseline bladder pressure and opening pressure. GH-treated rats had higher elastin content in the urethra. Urethral α(1A) -adrenoceptor mRNA concentration was significantly lower in the SERM-treated rats compared with controls. CONCLUSIONS GH prevents the development of abnormal voiding patterns during filling CMG in a rat model of parturition-induced incontinence; E(2) and SERMs may worsen voiding patterns.
Collapse
Affiliation(s)
- Benjamin N Breyer
- Department of Urology, Knuppe Molecular Urology Laboratory, University of California, San Francisco, CA, USA
| | | | | | | | | | | | | |
Collapse
|
49
|
Corcos J, Loutochin O, Campeau L, Eliopoulos N, Bouchentouf M, Blok B, Galipeau J. Bone marrow mesenchymal stromal cell therapy for external urethral sphincter restoration in a rat model of stress urinary incontinence. Neurourol Urodyn 2010; 30:447-55. [PMID: 21412824 DOI: 10.1002/nau.20998] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Accepted: 07/12/2010] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To assess the effect of intra-sphincteric injections of bone marrow mesenchymal stromal cells (MSCs) on Valsalva leak point pressure (VLPP) changes in an animal model of stress urinary incontinence (SUI). MATERIALS AND METHODS Twenty-four female Sprague-Dawley rats underwent bilateral pudendal nerve section to induce SUI. Six rats were SUI controls, 6 received periurethral injection of Plasma-Lyte (SUI placebo control) and 12 were given periurethral injection of PKH26-labeled MSCs. Four weeks after injection, conscious cystometry was undertaken in animals and VLPP recorded. All groups were sacrificed, and frozen urethra sections were submitted to pathology and immunohistochemistry assessment. RESULTS Rat MSCs were positive for the cell surface antigens CD44, CD73, CD90, and RT1A, and negative for CD31, CD45, and RT1B, confirming their stem cell phenotype. In vitro, differentiated MSCs expressed α-smooth muscle actin (SMA) and desmin, markers of smooth and striated muscles in vivo. Immunohistochemistry of rat urethras revealed PKH26-labeled MSCs in situ and at the injection site. LPP was significantly improved in animals injected with MSCs. Mean LPP was 24.28 ± 1.47 cmH(2) O in rats implanted with MSCs and 16.21 ± 1.26 cmH(2) O in SUI controls (P<0.001). Atrophic urethras with implanted MSCs were positively stained for myosin heavy chain and desmin. CONCLUSION Rat MSCs have the ability to differentiate and skew their phenotype towards smooth and striated muscles, as demonstrated by SMA up-regulation and desmin expression. Periurethral injection of MSCs in an animal model of SUI restored the damaged external urethral sphincter and significantly improved VLPP.
Collapse
Affiliation(s)
- Jacques Corcos
- Division of Urology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
| | | | | | | | | | | | | |
Collapse
|
50
|
Xu Y, Song YF, Lin ZX. Transplantation of muscle-derived stem cells plus biodegradable fibrin glue restores the urethral sphincter in a pudendal nerve-transected rat model. Braz J Med Biol Res 2010; 43:1076-83. [PMID: 21088804 DOI: 10.1590/s0100-879x2010007500112] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Accepted: 09/27/2010] [Indexed: 12/16/2022] Open
Abstract
We investigated whether fibrin glue (FG) could promote urethral sphincter restoration in muscle-derived stem cell (MDSC)-based injection therapies in a pudendal nerve-transected (PNT) rat, which was used as a stress urinary incontinence (SUI) model. MDSCs were purified from the gastrocnemius muscles of 4-week-old inbred female SPF Wistar rats and labeled with green fluorescent protein. Animals were divided into five groups (N = 15): sham (S), PNT (D), PNT+FG injection (F), PNT+MDSC injection (M), and PNT+MDSC+FG injection (FM). Each group was subdivided into 1- and 4-week groups. One and 4 weeks after injection into the proximal urethra, leak point pressure (LPP) was measured to assess urethral resistance function. Histology and immunohistochemistry were performed 4 weeks after injection. LPP was increased significantly in FM and M animals after implantation compared to group D (P < 0.01), but was not different from group S. LPP was slightly higher in the FM group than in the M group but there was no significant difference between them at different times. Histological and immunohistochemical examination demonstrated increased numbers of surviving MDSCs (109 ± 19 vs 82 ± 11/hpf, P = 0.026), increased muscle/collagen ratio (0.40 ± 0.02 vs 0.34 ± 0.02, P = 0.044), as well as increased microvessel density (16.9 ± 0.6 vs 14.1 ± 0.4/hpf, P = 0.001) at the injection sites in FM compared to M animals. Fibrin glue may potentially improve the action of transplanted MDSCs to restore the histology and function of the urethral sphincter in a SUI rat model. Injection of MDSCs with fibrin glue may provide a novel cellular therapy method for SUI.
Collapse
Affiliation(s)
- Y Xu
- Fuzong Clinical College, Fujian Medical University, Fuzhou, Fujian, China
| | | | | |
Collapse
|