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Objective Reconstructive surgery for pelvic organ prolapse is plagued with high failure rates possibly due to impaired healing or regeneration of the vaginal wall. Here, we tested the hypothesis that postoperative administration of local estrogen, direct injection of mesenchymal stem cells (MSCs), or both lead to improved wound healing of the injured vagina in a menopausal rat model. Methods Ovariectomized rats underwent surgical injury to the posterior vaginal wall and were randomized to treatment with placebo (n = 41), estrogen cream (n = 47), direct injection of MSCs (n = 39), or both (n = 43). Results MSCs did not survive after injection and had no appreciable effects on healing of the vaginal wall. Acute postoperative administration of vaginal estrogen altered response of the vaginal wall to injury with decreased stiffness, decreased collagen content, and decreased expression of transcripts for matrix components in the stromal compartment. Conversely, vaginal estrogen resulted in marked proliferation of the epithelial layer and increased expression of genes related to epithelial barrier function and protease inhibition. Transcripts for genes involved in chronic inflammation and adaptive immunity were also downregulated in the estrogenized epithelium. Conclusions Collectively, these data indicate that, in contrast to the reported positive effects of preoperative estrogen on the uninjured vagina, acute administration of postoperative vaginal estrogen has adverse effects on the early phase of healing of the stromal layer. In contrast, postoperative estrogen plays a positive role in healing of the vaginal epithelium after injury.

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Damage to the inferior gluteal nerve during sacrospinous ligament fixation is an unlikely source for postoperative gluteal pain. Rather, branches from S3 and/or S4 that innervate the coccygeus muscles and those coursing between the sacrospinous and sacrotuberous ligaments to supply gluteus maximus muscles are more likely to be implicated. A thorough understanding of the complex anatomy surrounding the sacrospinous ligament, limiting depth of needle penetration into the ligament, and avoiding extension of needle exit or entry point above the upper extent of sacrospinous ligament may reduce nerve entrapment and postoperative gluteal pain.

subdivided into four categories: voiding disorders, storage/irritative disorders, extrusion/erosion, and other. Cure was defined as complete resolution of all symptoms, whereas improvement was some resolution of symptoms but not complete cure. Data was evaluated by descriptive statistics and inference analysis. Results: Of the 28 patients that underwent a MUS revision, 26 (93%) were reviewed. The most common preoperative symptoms included irritative disorders (73.1%), voiding difficulties (57.7%), urge incontinence (50%), vaginal/pelvic pain (42.3%), stress urinary incontinence (34.6%), sling extrusion (23.1%), and recurrent urinary tract infection (23.1%). Two patients had sling erosions. Many patients had more than one symptom. Overall, 46.1% of patients were cured and 69.2% had resolution in at least 50% of all their symptoms. By category, sling extrusion was cured in 88.9% of patients; voiding dysfunction in 88.2%; and storage/irritative disorders in 31.5% of patients. When broken down into specific symptoms, in patients with urgency and urge incontinence, 27.3% and 46.2% had resolution of symptoms respectively, while 3 patients developed de novo urgency/urge incontinence. Stress incontinence resolved in 77.8% of patients, and there were no cases of de novo SUI. There were no cases of recurrent sling extrusion. In 66.7% of cases with recurrent urinary tract infection, the recurrence resolved; 2 patients developed de novo RUTI. When surgical technique was compared, 61.5% of cases had a sling revision only, 30.8% had sling revision plus pelvic floor surgery, and 7.7% had sling revision plus anti-incontinence procedure. Sling revision surgical techniques included sling transection (41.6%), incomplete resection (34.6%), complete resection (11.5%), and excision of sling from urethra and bladder (7.7%). No intraoperative complications occurred. When the researchers compared previous type of sling used, time to sling revision, and type of sling revision performed, there was no statistically significant difference seen in any of these variables between those subjects who had resolution of symptoms and those who did not (p \ 0.05). Conclusion: