A tissue‐engineered suburethral sling in an animal model of stress urinary incontinence

Cannon, Tracy W.; Sweeney, Danielle D.; Conway, Deidre A.; Izumi, Kiyotaka; Yoshimura, Naoki; Sacks, Michael S.; Chancellor, Michael B.

doi:10.1111/j.1464-410x.2005.05702.x

Cited by 43 publications

(36 citation statements)

References 30 publications

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“…48 Therefore, an animal model of a rat sling procedure has been developed for use in investigative studies, 13,14,49 resulting in increased urethral resistance in the short and long term. 13,14,49 In an experiment in which the suburethral portion of the sling was cut immediately after placement LPP 6 weeks later was significantly higher than in a sham sling preparation and comparable to that in an intact sling preparation. 50 Peak micturition pressure was not significantly different among the 3 groups, indicating the absence of bladder outlet obstruction after the sling procedure.…”

Section: Treatment Testing Slingsmentioning

confidence: 99%

Animal Models of Female Stress Urinary Incontinence

et al. 2008

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Purpose-Urinary incontinence affects 40% of women in the United States and stress urinary incontinence accounts for a large portion of affected patients. As defined by the International Continence Society, stress urinary incontinence is the involuntary leakage of urine upon effort, exertion, sneezing or coughing. Since the ultimate success of long-term management for any condition is based on an understanding of its pathophysiology, and because the pathophysiology of stress urinary incontinence is incompletely defined, animal models have recently been developed to better understand stress urinary incontinence and develop novel treatment alternatives.Materials and Methods-Several animal models for urethral dysfunction have emerged in the last few years, including those based on pathophysiological theories of urethral sphincter dysfunction that were designed to simulate maternal birth trauma. Other models have focused on the creation of a durable model of dysfunction for investigating novel treatments.Results-Since animals cannot express intent, these animal models have focused on measuring decreased urethral resistance. The most widely used methods are the sneeze test, the tilt table technique and the leak point pressure test. Newer techniques include abdominal leak point pressure, urethral pressure measurement and retrograde urethral perfusion pressure. In addition to the advantages and disadvantages of each technique, all methods measure the composite contribution to urethral resistance from smooth and striated muscle, urethral closure and connective tissue, although none measures intent.Conclusions-We critically reviewed the different models of stress urinary incontinence and urethral dysfunction as well as the different methods of measuring urethral resistance. Keywords urethra; urinary incontinence; stress; female; urodynamics; models; animal Urinary incontinence affects 40% of women in the United States. SUI, the involuntary leakage of urine upon effort, exertion, sneezing or coughing, accounts for a large portion of affected patients. More than 165,000 surgical procedures are performed for SUI in the United States. It is estimated that a third of the procedures that are performed to treat SUI are done in patients with recurrent disease. These currently performed procedures for SUI are based on compensatory and nonphysiological mechanisms. Since the ultimate success of the long-term management of any condition is based on an understanding of its pathophysiology, and because †Correspondence:

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Section: Treatment Testing Slingsmentioning

confidence: 99%

Animal Models of Female Stress Urinary Incontinence

et al. 2008

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“…Recently, several kinds of methods for measuring the LPP have been developed in animal experiments (3,7,8,14,15,24); however, these methods are not accompanied by an abrupt increment of abdominal pressure, except for the sneeze LPP (7,15). In this study, a unique method for evaluating the urethral resistance during momentary elevation of abdominal pressure by electrical stimulation of the abdominal muscles was developed, the role of nervemediated urethral closing reflexes in the urethral resistance under momentary stress condition was clarified, and the effects of duloxetine on the reflex urethral closure and the urethral resistance were studied.…”

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Involvement of reflex urethral closure mechanisms in urethral resistance under momentary stress condition induced by electrical stimulation of rat abdomen

Izumi¹,

Hashimoto²

2007

American Journal of Physiology-Renal Physiology

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Kamo I, Hashimoto T. Involvement of reflex urethral closure mechanisms in urethral resistance under momentary stress condition induced by electrical stimulation of rat abdomen. Am J Physiol Renal Physiol 293: F920-F926, 2007. First published July 11, 2007; doi:10.1152/ajprenal.00466.2006.-A novel method for evaluating the urethral resistance during abrupt elevation of abdominal pressure was developed in spinalized female rats under urethane anesthesia. Electrical stimulation of abdominal muscles for 1 s induced increases in both the intra-abdominal and the intravesical pressure in a stimulusdependent manner, and the bladder response was almost lost when the abdomen was opened. The lowest intravesical pressure during electrical stimulation that induced fluid leakage from the urethral orifice (leak point pressure) and the maximal intravesical pressure without urine leakage below the leak point pressure were evaluated as the indexes of urethral resistance. Lower urethral resistance was obtained in the rats whose pelvic nerves or somatic nerves containing pudendal nerves and nerves to iliococcygeus/pubococcygeus muscles were transected bilaterally. In contrast, transection of bilateral hypogastric nerves showed smaller effects. Duloxetine, a drug for stress urinary incontinence, enlarged the reflex urethral closing contractions that were induced by an increase in intravesical pressure and measured using a microtip transducer catheter in the middle urethra. This drug also increased the urethral resistance (leak point pressure), whereas it did not show any effect in the rats whose pelvic nerves were bilaterally transected, showing that the augmentation of the reflex urethral closure by the drug resulted in the elevation of the urethral resistance. From these findings, it was concluded that during momentary elevation of abdominal pressure, the reflex urethral closure mechanisms via bladder-spinal cord-urethral sphincter and pelvic floor muscles greatly contribute to the increase in the urethral resistance to prevent the urinary incontinence. stress urinary incontinence; leak point pressure; reflex urethral closing responses; duloxetine STRESS URINARY INCONTINENCE (SUI) is defined as the involuntary loss of urine during increments of abdominal pressure (stress condition) such as sneezing and coughing in the absence of bladder contractions (5,22). This disorder is very common in women over middle age and generally occurs as a result of defects in the various passive and reflex mechanisms that maintain urethral closure in the presence of elevated abdominal pressure (1, 4, 23). Recently, the nerve-mediated reflex urethral closure mechanisms have been considered to contribute to the urethral resistance during events causing elevation of intravesical pressure (P ves ) in rats (14). Electrophysiological studies also have provided evidence indicating functions of the glutamate-mediated bladder-to-urethra reflexes in rats (6,16,17). With the accumulation of findings of active urethral closure mechanisms, pharmacotherapy by dr...

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“…Abdominal leak point pressure is a test assessing the function of the urethra. Maximum urethral closure pressure and leak point pressure have been used to determine the severity of incontinence, the guidelines for therapy, and the evaluation of treatment outcomes [5,21]. The reflex activity of the bladder to urethra contributes to the maintenance of high leak point pressure during abdominal compression and increases passive intravesical pressure [22].…”

Section: Discussionmentioning

confidence: 99%

Effect of Treadmill Exercise on Leak-point pressure and Neuronal Activation in Brain of Rats with Stress Urinary Incontinence

Kim

et al. 2010

Int Neurourol J

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Purpose: Stress urinary incontinence (SUI) commonly occurs in women, and it causes enormous impact on quality of life. Surgery, drugs, and exercise have been recommended for the treatment of this disease. Among these exercise is also known to be effective for relieving thesymptoms of SUI, however, the efficacy and underlying mechanisms of exercise on SUI are poorly understood. In the present study, we investigated the effect of treadmill exercise on abdominal leak-point pressure and neuronal activity in the medial preoptic nucleus (MPA), ventrolateral periaqueductal gray (vlPAG), and pontine micturition center (PMC) following urethrolysis in rats. Materials and Methods: Adult female Sprague-Dawley rats, weighing 250±10 g (9 weeks old), were used in this study. After having undergone transabdominal urethrolysis to induce SUI, the rats were divided into three groups (n=6 in each group): a sham operation group, an SUI-induced group, and an SUI-induced and treadmill exercise group. The rats in the exercise group performed treadmill running for 30 min once a day starting 2 weeks after the induction of SUI and continuing for 4 weeks after surgery. For this study, determination of abdominal leak point pressure and immunohistochemistry for c-Fos in the brain were performed. Results: Induction of transabdominal urethrolysis significantly reduced the abdominal leak point pressure, thereby contributing to the induction of SUI. In contrast, abdominal leak point pressure was significantly improved by treadmill exercise. The expression of c-Fosin the MPA, vlPAG, and PMC, the brain areas relating to micturition, was enhanced by the induction of SUI, whereas treadmill exercise significantly suppressed SUI-induced c-Fos expression, suggesting that neuronal activation in the micturition centers was suppressed by treadmill exercise. Conclusion:The present results suggest that treadmill exercise may be an effective therapeutic modality for ameliorating the symptoms of SUI. Int Neurourol J 2010;14:141-8.

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A tissue‐engineered suburethral sling in an animal model of stress urinary incontinence

Cited by 43 publications

References 30 publications

Animal Models of Female Stress Urinary Incontinence

Animal Models of Female Stress Urinary Incontinence

Involvement of reflex urethral closure mechanisms in urethral resistance under momentary stress condition induced by electrical stimulation of rat abdomen

Effect of Treadmill Exercise on Leak-point pressure and Neuronal Activation in Brain of Rats with Stress Urinary Incontinence

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