The contents of this page will be used as part of issue TOC only. It will not be published as part of main article.Levator avulsion is a risk factor for de novo urinary stress incontinence after transvaginal mesh surgery for cystocele repair.

Preterm premature rupture of membranes (pPROM) is a major cause of preterm birth and neonatal mortality. Reactive oxygen species (ROS) have been identified as a critical factor in the development of pPROM. Mitochondria are known to be the primary source of ROS and play a vital role in maintaining cellular function. The Nuclear erythroid 2-related factor 2 (NRF2) has been demonstrated to play a crucial role in regulating mitochondrial function. However, research exploring the impact of NRF2-regulated mitochondria on pPROM is limited. Therefore, we collected fetal membrane tissues from pPROM and spontaneous preterm labor (sPTL) puerpera, measured the expression level of NRF2, and evaluated the degree of mitochondrial damage in both groups. Additionally, we isolated human amniotic epithelial cells (hAECs) from the fetal membranes and employed siRNA to suppress NRF2 expression, enabling us to evaluate the impact of NRF2 on mitochondrial damage and ROS production. Our findings indicated that the expression level of NRF2 in pPROM fetal membranes was significantly lower than in sPTL fetal membranes, accompanied by increased mitochondrial damage. Furthermore, following the inhibition of NRF2 in hAECs, the degree of mitochondrial damage was significantly exacerbated, along with a marked increase in both cellular and mitochondrial ROS levels. The regulation of the mitochondrial metabolic process via NRF2 in fetal membranes has the potential to influence ROS production.

Purpose To estimate whether levator ani injuries increase the risk of de novo urinary stress incontinence after cystocele repairing surgery. Methods A total of 1124 women who were underwent cystocele repaired surgeries were recruited and assessed for eligibility from January,1,2012 to April,30,2021. All data related to patients and surgeries was collected and followed-up, which included general conditions, clinical examination, ultrasound results and follow-up results. Data was compared according to the follow up results. The relative risk (RR) of de novo urinary stress incontinence (SUI) with levator avulsion was calculated. Results 336 women were involved eventually. They were divided into no complication group (n=249), de novo SUI group (n=68) and other complications group (n=19). It seemed elder or obese women were more likely to get poor results after TVM repair (p＜0.05). In de novo SUI group, incidence of levator avulsion before surgery were higher than the other two groups(p=0.001). TVM can significantly change a prolapse to point Aa and Ba on POP-Q (p＜0.05). RR ratios of de novo SUI with unilateral avulsion group is 2.60 (95%CI 1.39-4.87), and 2.58(95%CI 0.82 -8.15) for bilateral group. Conclusion Unilateral levator avulsion is a risk factor of de novo SUI after cystocele repair surgery.