Autologous rectus abdominis fascia sling surgery following unsuccessful synthetic midurethral sling

Introduction

We performed autologous rectus abdominis fascia sling surgery using Advantage™ following an unsuccessful synthetic midurethral sling.

Case presentation

At the age of 76 years, the patient experienced stress urinary incontinence recurrence. A 1-h pad test resulted in 259 g of leakage. A pressure flow study verified urine leakage while coughing and straining without detrusor overactivity. Abdominal leak point pressure was 10 cmH2O. Autologous rectus abdominis fascia sling surgery was performed using Advantage™. One month postoperatively, a 1-h pad test resulted in 0 g of leakage.

Conclusion

We believe that this method will allow the fascia sling procedure to be performed reliably even if one is unfamiliar with conventional autologous rectus abdominis fascia sling surgery.

Prostaglandin D2 effects and DP1 /DP2 receptor distribution in guinea pig urinary bladder out-flow region

The proximal urethra and urinary bladder trigone play important roles in continence. We have previously shown that PGD₂ is released from guinea pig bladder urothelium/suburothelium and can inhibit detrusor contractile responses. We presently wished to investigate PGD₂ actions in guinea pig out‐flow region and the distribution of DP₁/DP₂ receptors. The effects of PGD₂ on urothelium‐intact trigone and proximal urethra contractility were studied in organ bath experiments. Expression of DP₁/DP₂ receptor proteins was analysed by western blot. Immunohistochemistry was used to identify distribution of DP₁/DP₂ receptors. PGD₂ in a dose‐dependent manner inhibited trigone contractions induced by electrical field stimulation (EFS) and inhibited spontaneous contractions of the proximal urethra. PGD₂ was equally (trigone) or slightly less potent (urethra) compared with PGE₂. Expression of DP₁ and DP₂ receptors was found in male guinea pig bladder trigone, neck and proximal urethra. In the trigone and proximal urethra, DP₁ receptors were found on the membrane of smooth muscle cells and weak immunoreactivty was observed in the urothelium. DP₂ receptors were distributed more widespread, weakly and evenly in the urothelium and smooth muscles. Inhibitory effects by PGD₂ on motor activity of guinea pig trigone and proximal urethra are consistent with finding DP₁ and DP₂ receptors located in the urothelium and smooth muscle cells of the trigone and proximal urethra, and PGD₂ may therefore be a modulator of the bladder out‐flow region, possibly having a function in regulation of micturition and a role in overactive bladder syndrome.

The distribution of muscles fibers and their types in the female rat urethra: cytoarchitecture and three-dimensional reconstruction

An attempt to explore urethral cytoarchitecture including the distribution of smooth muscles and fast and slow striated muscles of adult female Sprague Dawley rat--a popular model in studying lower urinary tract function. Histological and immunohistochemical stainings were carried out to investigate the distribution of urethral muscle fibers and motor end plates. The urethral sphincter was furthermore three-dimensionally reconstructed from serial histological sections. The mucosa at the distal urethra was significantly thicker than that of other segments. A prominent inner longitudinal and outer circular layer of smooth muscles covered the proximal end of urethra. Thick circular smooth muscles of the bladder neck region (urethral portion) decreased significantly distalward and longitudinal smooth muscles became 2- to 3-fold thicker in the rest of the urethra. An additional layer of striated muscles appeared externally after neck region (urethra) and in association with motor end plates ran throughout the remaining urethra as the striated sphincter layer. Most striated muscles were fast fibers while relatively fewer slow fibers often concentrated at the periphery. A pair of extraneous striated muscles, resembling the human urethrovaginal sphincter muscles, connected both sides of mainly the distal vagina to the dorsal striated muscles in the wall of the middle urethra. The tension provided by this pair of muscles, and in conjunction with the striated sphincter of the urethral wall, was likely to function to suspend the middle urethra and facilitates its closure. Comprehensive morphological data of urethral sphincter offers solid basis for researchers conducting studies on dysfunction of bladder outlet.