scholarly journals Daily bilateral pudendal nerve electrical stimulation improves recovery from stress urinary incontinence

2019 ◽  
Vol 9 (4) ◽  
pp. 20190020 ◽  
Author(s):  
Kangli Deng ◽  
Brian M. Balog ◽  
Dan Li Lin ◽  
Brett Hanzlicek ◽  
Qi-Xiang Song ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Electrical Stimulation ◽  
Stress Urinary Incontinence ◽  
Pudendal Nerve ◽  
Sprague Dawley ◽  
External Urethral Sphincter ◽  
Bdnf Expression ◽  
Nerve Crush ◽  
Sprague Dawley Rats ◽  
Point Pressure

Stress urinary incontinence (SUI) in women is strongly associated with childbirth which injures the pudendal nerve (PN) and the external urethral sphincter (EUS) during delivery. Electrical stimulation (ES) can increase brain-derived neurotrophic factor (BDNF) expression in injured neurons, activate Schwann cells and promote neuroregeneration after nerve injury. The aim of this study was to determine if more frequent ES would increase recovery from SUI in a rat model. Forty female Sprague–Dawley rats underwent either sham injury or pudendal nerve crush (PNC) and vaginal distention (VD) to establish SUI. Immediately after injury, electrodes were implanted at the pudendal nerve bilaterally. Each injured animal underwent sham ES, twice per week ES (2/week), or daily ES of 1 h duration for two weeks. Urethral and nerve function were assessed with leak point pressure (LPP), EUS electromyography and pudendal nerve sensory branch potential (PNSBP) recordings two weeks after injury. LPP was significantly increased after daily ES compared to 2/week ES. EUS neuromuscular junction innervation was decreased after injury with sham ES, but improved after 2/week or daily ES. This study demonstrates that daily bilateral ES to the pudendal nerve can accelerate recovery from SUI. Daily ES improved urethral function more than 2/week ES.

scholarly journals Electrical stimulation of the pudendal nerve promotes neuroregeneration and functional recovery from stress urinary incontinence in a rat model

2018 ◽  
Vol 315 (6) ◽  
pp. F1555-F1564 ◽  
Author(s):  
Hai-Hong Jiang ◽  
Qi-Xiang Song ◽  
Bradley C. Gill ◽  
Brian M. Balog ◽  
Raul Juarez ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Electrical Stimulation ◽  
Stress Urinary Incontinence ◽  
Rat Model ◽  
Pudendal Nerve ◽  
External Urethral Sphincter ◽  
Sham Stimulation ◽  
Point Pressure ◽  
Separate Cohort ◽  
Stimulation Of

The pudendal nerve can be injured during vaginal delivery of children, and slowed pudendal nerve regeneration has been correlated with development of stress urinary incontinence (SUI). Simultaneous injury to the pudendal nerve and its target muscle, the external urethral sphincter (EUS), during delivery likely leads to slowed neuroregeneration. The goal of this study was to determine if repeat electrical stimulation of the pudendal nerve improves SUI recovery and promotes neuroregeneration in a dual muscle and nerve injury rat model of SUI. Rats received electrical stimulation or sham stimulation of the pudendal nerve twice weekly for up to 2 wk after injury. A separate cohort of rats received sham injury and sham stimulation. Expression of brain-derived neurotrophic factor (BDNF) and βII-tubulin expression in Onuf’s nucleus were measured 2, 7, and 14 days after injury. Urodynamics, leak point pressure (LPP), and EUS electromyography (EMG) were recorded 14 days after injury. Electrical stimulation significantly increased expression of BDNF at all time points and βII-tubulin 1 and 2 wk after injury. Two weeks after injury, LPP and EUS EMG during voiding and LPP testing were significantly decreased compared with sham-injured animals. Electrical stimulation significantly increased EUS activity during voiding, although LPP did not fully recover. Repeat pudendal nerve stimulation promotes neuromuscular continence mechanism recovery possibly via a neuroregenerative response through BDNF upregulation in the pudendal motoneurons in this model of SUI. Electrical stimulation of the pudendal nerve may therefore improve recovery after childbirth and ameliorate symptoms of SUI by promoting neuroregeneration after injury.

scholarly journals Pudendal nerve injury reduces urethral outlet resistance in diabetic rats

2010 ◽  
Vol 299 (6) ◽  
pp. F1443-F1450 ◽  
Author(s):  
Hui Q. Pan ◽  
Dan L. Lin ◽  
Christopher Strauch ◽  
Robert S. Butler ◽  
Vincent M. Monnier ◽  
...  
Keyword(s):  
Nerve Injury ◽  
Pudendal Nerve ◽  
Outlet Obstruction ◽  
Diabetic Rats ◽  
Sprague Dawley ◽  
External Urethral Sphincter ◽  
Nerve Crush ◽  
Point Pressure ◽  
Functional Outlet Obstruction ◽  
Pudendal Nerve Injury

Diabetics have voiding and continence dysfunction to which elevated levels of advanced glycation end products (AGE) may contribute. In addition, pudendal nerve injury is correlated with voiding dysfunction and stress incontinence in rats. The aim of this study was to investigate whether pudendal nerve crush (PNC) in diabetic rats alters urinary function. Female virgin Sprague-Dawley rats (144) were divided equally into diabetic, diuretic, and control groups. Half of the animals in each group were subjected to PNC, and the other half to sham PNC. Diabetes was induced 8 wk before PNC or sham PNC by streptozotocin injection (35 mg/kg). Animals underwent conscious cystometry and leak point pressure (LPP) testing 4 or 13 days after PNC or sham PNC. Tissues of half the animals were tested for levels of AGEs. Qualitative histological assessment was performed in the remaining animals. Diabetic rats 4 days after PNC voided significantly greater volume in a shorter time and with significantly less pressure than after sham PNC, suggesting that diabetic rats have a functional outlet obstruction that is relieved by PNC. LPP was significantly reduced 4 days after PNC in diabetic and diuretic animals and returned to normal 13 days after PNC. Diabetic rats with PNC demonstrated increased muscle fiber disruption and atrophy of the external urethral sphincter. AGEs were significantly elevated in diabetic rats. PNC relieves a functional outlet obstruction in diabetic rats. AGEs are elevated in diabetic rats and could play a role in urinary dysfunction and recovery from PNC.

scholarly journals Dual simulated childbirth injury delays anatomic recovery

2009 ◽  
Vol 296 (2) ◽  
pp. F277-F283 ◽  
Author(s):  
Hui Q. Pan ◽  
James M. Kerns ◽  
Dan L. Lin ◽  
David Sypert ◽  
James Steward ◽  
...  
Keyword(s):  
Pudendal Nerve ◽  
Leak Point Pressure ◽  
External Urethral Sphincter ◽  
Bdnf Expression ◽  
Nerve Crush ◽  
Histological Evidence ◽  
Injury Model ◽  
Point Pressure ◽  
Urethral Function ◽  
Vaginal Distension

A dual childbirth injury model, including vaginal distension (VD) and pudendal nerve crush (PNC), may best represent the injuries seen clinically. The objective of this study was to investigate urethral function, anatomy, and neurotrophin expression after several simulated childbirth injuries. Groups of 140 rats underwent PNC, VD, PNC+VD, or neither (C). Four days after injury, all injury groups had significantly decreased leak-point pressure (LPP) compared with C rats. Ten days after injury, LPP in PNC and PNC+VD rats remained significantly lower than C rats. Three weeks after injury, LPP in all injury groups had recovered to C values. Histological evidence of injury was still evident in the external urethral sphincter (EUS) after VD and PNC+VD 10 days after injury. Three weeks after injury, the EUS of PNC+VD rats remained disrupted. One day after VD, brain-derived neurotrophic factor (BDNF) expression in the EUS was reduced, while neurotrophin-4 (NT-4) and nerve growth factor (NGF) expression was unchanged. BDNF, NT-4, and NGF expression was dramatically upregulated in the EUS after PNC. After PNC+VD, NGF expression was upregulated, and BDNF and NT-4 expression was upregulated somewhat but not to the same extent as after PNC. Ten days after injury, PNC+VD had the least number of normal nerve fascicles near the EUS, followed by PNC and VD. Twenty-one days after injury, all injury groups had fewer normal nerve fascicles, but without significant differences compared with C rats. PNC+VD therefore provides a more severe injury than PNC or VD alone.

scholarly journals Multiple doses of stem cells maintain urethral function in a model of neuromuscular injury resulting in stress urinary incontinence

2019 ◽  
Vol 317 (4) ◽  
pp. F1047-F1057
Author(s):  
Kristine Janssen ◽  
Dan Li Lin ◽  
Brett Hanzlicek ◽  
Kangli Deng ◽  
Brian M. Balog ◽  
...  
Keyword(s):  
Stem Cells ◽  
Urinary Incontinence ◽  
Single Dose ◽  
Stress Urinary Incontinence ◽  
Pudendal Nerve ◽  
Urethral Sphincter ◽  
External Urethral Sphincter ◽  
Nerve Crush ◽  
Multiple Doses ◽  
Urethral Function

Stress urinary incontinence (SUI) is more prevalent among women who deliver vaginally than women who have had a cesarean section, suggesting that tissue repair after vaginal delivery is insufficient. A single dose of mesenchymal stem cells (MSCs) has been shown to partially restore urethral function in a model of SUI. The aim of the present study was to determine if increasing the number of doses of MSCs improves urethral and pudendal nerve function and anatomy. We hypothesized that increasing the number of MSC doses would accelerate recovery from SUI compared with vehicle treatment. Rats underwent pudendal nerve crush and vaginal distension or a sham injury and were treated intravenously with vehicle or one, two, or three doses of 2 × 106 MSCs at 1 h, 7 days, and 14 days after injury. Urethral leak point pressure testing with simultaneous external urethral sphincter electromyography and pudendal nerve electroneurography were performed 21 days after injury, and the urethrovaginal complex and pudendal nerve were harvested for semiquantitative morphometry of the external urethral sphincter, urethral elastin, and pudendal nerve. Two and three doses of MSCs significantly improved peak pressure; however, a single dose of MSCs did not. Single, as well as repeated, MSC doses improved urethral integrity by restoring urethral connective tissue composition and neuromuscular structures. MSC treatment improved elastogenesis, prevented disruption of the external urethral sphincter, and enhanced pudendal nerve morphology. These results suggest that MSC therapy for postpartum incontinence and SUI can be enhanced with multiple doses.

scholarly journals Diabetes slows the recovery from urinary incontinence due to simulated childbirth in female rats

2007 ◽  
Vol 293 (2) ◽  
pp. R950-R955 ◽  
Author(s):  
Ja-Hong Kim ◽  
Xiao Huang ◽  
Guiming Liu ◽  
Courtenay Moore ◽  
James Bena ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
External Sphincter ◽  
Bladder Capacity ◽  
Diabetic Rats ◽  
Female Rats ◽  
Sprague Dawley ◽  
Leak Point Pressure ◽  
Sprague Dawley Rats ◽  
Point Pressure ◽  
Vaginal Distension

This study was done to test the hypothesis that simulated vaginal birth by vaginal distension (VD) causes more severe urinary incontinence and slower recovery in diabetic rats. After measuring baseline leak point pressure (LPP) in 16 diabetes mellitus (DM) and 16 age- and weight-matched control (Ct) female Sprague-Dawley rats, these animals underwent either VD or sham VD (sham). Four and ten days after the procedures, LPP and conscious cystometry were assessed. Tissues were then harvested and examined by light microscopy. LPP at baseline was equal among all four groups. Four days after VD, LPP in both VD groups dropped to significantly lower levels than in sham rats ( P < 0.001). Moreover, LPP in the DM+VD group was significantly lower than in the Ct+VD group. At 10 days, LPP in the Ct+VD group had recovered to its baseline value, whereas the LPP in the DM+VD group remained significantly reduced. DM rats had larger bladder capacity and longer voiding intervals than Ct rats. Histological findings included more severe damage to the external sphincter striated musculature of the urethra in DM+VD group compared with Ct+VD. In conclusion, these findings suggest that DM causes increased severity and delayed functional recovery from the effects of simulated childbirth.

scholarly journals Effects of acute selective pudendal nerve electrical stimulation after simulated childbirth injury

2013 ◽  
Vol 304 (3) ◽  
pp. F239-F247 ◽  
Author(s):  
Hai-Hong Jiang ◽  
Bradley C. Gill ◽  
Charuspong Dissaranan ◽  
Massarat Zutshi ◽  
Brian M. Balog ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Pudendal Nerve ◽  
Contractile Function ◽  
Female Rats ◽  
Bdnf Expression ◽  
Nerve Crush ◽  
Motor Branch ◽  
Onuf's Nucleus ◽  
Onuf’S Nucleus ◽  
Stimulation Of

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 βII-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 βII-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 βII-tubulin in Onuf's nucleus after simulated childbirth injury, which could be a potential preventive option for SUI after childbirth injury.

scholarly journals Analysis of continence reflexes by dynamic urethral pressure recordings in a rat stress urinary incontinence model induced by multiple simulated birth traumas

2019 ◽  
Vol 317 (4) ◽  
pp. F781-F788
Author(s):  
Joonbeom Kwon ◽  
Takahisa Suzuki ◽  
Ei-ichiro Takaoka ◽  
Nobutaka Shimizu ◽  
Takahiro Shimizu ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Stress Urinary Incontinence ◽  
Sham Group ◽  
Bladder Pressure ◽  
Multiple Birth ◽  
Urethral Pressure ◽  
Intravesical Pressure ◽  
Sprague Dawley ◽  
Pressure Elevation ◽  
Point Pressure

The present study evaluated real-time changes in urethral pressure during the storage phase using a rat model with stress urinary incontinence (SUI) induced by simulated multiple birth traumas and investigated the relationship between urethral continence function and dynamic parameters associated with the changes in urethral pressure. Sprague-Dawley rats were divided into the following two groups: the sham group, which underwent three catheterizations of the vagina without distension at 2-wk intervals, and the vaginal distension (VD) group, which underwent three VDs at 2-wk intervals. After transection of the T8–T9 spinal cord, simultaneous bladder and urethral pressure recordings were performed during intravesical pressure elevation. Urodynamic parameters such as leak point pressure (LPP), urethral baseline pressure (UBP), maximum urethral pressure (MUP), the MUP-UBP differential (dUP) during intravesical pressure elevation, the bladder pressure when urethral contraction begins (Puc), and the bladder pressure at bladder neck opening (Pno) were then measured and compared. Compared with the sham group, LPP, UBP, dUP, MUP, Puc, and Pno were significantly decreased in the VD group. Pressure differences between LPP and Pno and between LPP and UBP (LPP-UBP) were also significantly different in the two groups. However, difference values of LPP and MUP or Pno and UBP were not altered after VD. Our new methods of simultaneous recordings of dynamic changes in bladder and urethral pressures are useful to fully evaluate the functional alterations in urethral continence function in the SUI model induced by multiple VDs. Moreover, LPP-UBP values, which correspond to the difference between Valsalva LPP and maximum urethral closure pressure in clinical urodynamics, would be useful to evaluate the impaired urethral continence function after simulated birth traumas in animal models.

scholarly journals Transurethral versus suprapubic catheterization to test urethral function in rats

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kristine Janssen ◽  
Kangli Deng ◽  
Steve J. A. Majerus ◽  
Dan Li Lin ◽  
Brett Hanzlicek ◽  
...  
Keyword(s):  
Outlet Obstruction ◽  
Bladder Pressure ◽  
Sprague Dawley ◽  
External Urethral Sphincter ◽  
Emg Amplitude ◽  
Suprapubic Catheterization ◽  
Sphincter Electromyography ◽  
Significant Difference ◽  
Point Pressure ◽  
Urethral Function

AbstractTransurethral 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.

Sign in / Sign up

Export Citation Format

Share Document