International Urogynecology Journal

, Volume 21, Issue 10, pp 1231–1236 | Cite as

Extraordinary muscular structure leads to urethral injury after vaginal delivery in animal study

  • Hung-Yen Chin
  • Eileen Changchien
  • Chi-Hsin Chiang
  • Hsiu-Ping Yang
Original Article

Abstract

Introduction and hypothesis

The aim of this study is to explore causality of birth trauma after vaginal delivery and anatomical findings.

Methods

A total of 28 virgin mice were studied. Treatment groups received vaginal distention. Specimens were collected and subjected to the following fluorescence stains: progenitor cell (c-kit), smooth muscle (SMA), fibroblast (vimentin), and skeleton muscle (Masson’s trichrome). Confocal microscopy was used to screen all of the urogenital tissue to localize the stained cells.

Results

Fibroblasts were spread all over perivaginal and urethral surroundings. Progenitor cells appeared at urethral–vagina intersection and urethral circle. They were noticeable only within smooth muscle layer. Two extraordinary skeleton muscle bands appeared on the urethra bilaterally.

Conclusions

Our study demonstrates existence of muscle bands at the bilateral urethra. They can limit the mobility of urethra during vaginal delivery and thereby cause urethra injury. Progenitor cells are located only in the smooth muscle of the urethral circle.

Keywords

Birth trauma Fibrosis Stem cells Urethral injury Urinary incontinence Urogenital structure 

Notes

Acknowledgement

The study was granted approval from Chang Gung Memorial Hospital with the registration number of CMRPG260481.

Conflicts of interest

None.

References

  1. 1.
    Locher JL, Burgio KL (1996) Epidemiology of incontinence. In: Ostergard DR, Bent AE (eds) Urogynecology and urodynamics. Theory and practice, 4th edn. Williams & Wilkins, Baltimore, pp 67–75Google Scholar
  2. 2.
    Rortveit G, Daltveit AK, Harnnestard YS, Hunskaar S (2003) Urinary incontinence after vaginal delivery or Cesarean section. N Engl Med 348:900–907CrossRefGoogle Scholar
  3. 3.
    Damaser MS, Whitbeck C, Chichester P, Levin RM (2005) Effect of vaginal distension on blood flow and hypoxia of urogenital organs of the female rat. J Appl Physio 98:1884–1890CrossRefGoogle Scholar
  4. 4.
    Sievert KD, Bakircioglu ME, Tasi T, Dahms SE, Nunes L, Lue TF (2001) The effect of simulated birth trauma and/or ovariectomy on rodent continence mechanism. Part I: functional and structural change. The J of Urology 166:311–317CrossRefGoogle Scholar
  5. 5.
    Debodinance P, Delporte P, Engrand JB, Boulogne M (2002) Tension-free vaginal tape (TVT) in the treatment of stress incontinence: 3 years experience involving 256 operations. Eur J Obstet Gynecol Reprod Biol 105:49–58CrossRefPubMedGoogle Scholar
  6. 6.
    Rezapour M, Falconer C, Ulmsten U (2001) Tension-free vaginal tape (TVT) in stress incontinent women with intrinsic sphincter deficiency (ISD)—a long-term follow-up. Int Urogynecol J 2:S12–S14CrossRefGoogle Scholar
  7. 7.
    Lo TS, Horng SG, Liang CC, Lee SJ, Soong YK (2004) Ultrasound assessment of mid-urethra tape at three-year follow-up after tension-free vaginal tape procedure. Urology 63:671–675CrossRefPubMedGoogle Scholar
  8. 8.
    Meshcia M, Pifarotti P, Gattei U, Bertozzi R (2007) Tension-free vaginal tape: analysis of risk factors for failures. Int Urogynecol J 18:419–422CrossRefGoogle Scholar
  9. 9.
    Liapis A, Bakas P, Creatsas G (2008) Long-term efficacy of tension-free vaginal tape in the management of stress urinary incontinence in women: efficacy at 5- and 7-year follow-up. Int Urogynecol J 19:1509–1512CrossRefGoogle Scholar
  10. 10.
    Lo TS, Wang AC, Horng SG, Liang CC, Soong YK (2001) Ultrasonographic and urodynamic evaluation after tension free vagina tape procedure (TVT). Acta Obstet Gynecol Scand 80:65–70CrossRefPubMedGoogle Scholar
  11. 11.
    Oberpenning F, Meng J, Yoo JJ, Atala A (1999) De novo reconstitution of a functional mammalian urinary bladder by tissue engineering. Nat Biotechnol 17:149–155CrossRefPubMedGoogle Scholar
  12. 12.
    Jankowski RJ, Deasy BM, Huard J (2002) Review: muscle-derived stem cells. Gene Therapy 9:642–647CrossRefPubMedGoogle Scholar
  13. 13.
    Kwon D, Kim Y, Pruchnic R, Jankowski R, Usiene I, de Miguel F, Huard J, Chancellor MB (2006) Periurethral cellular injection: comparison of muscle-derived progenitor cells and fibroblasts with regard to efficacy and tissue contractility in an animal model of stress urinary incontinence. Urology 68:449–454CrossRefPubMedGoogle Scholar
  14. 14.
    Ham R, Veomett M (1980) Mechanism of development. Mosby, St Loius, pp 5–107Google Scholar
  15. 15.
    Damaser MS, King CB, Ferguson C, Kim FJ, Kerns JM (2003) Functional and neuroanatomical effects of vaginal distention and pudendal nerve crush in the female rat. J Urol 170:1027–1031CrossRefPubMedGoogle Scholar
  16. 16.
    Brown JS, Seeley DG, Fong J, Black DM, Ensrud KE, Grady D (1996) Urinary incontinence in older women: who is at risk? Obstet Gynecol 86:715–721CrossRefGoogle Scholar
  17. 17.
    Matusi J, Wakabayashi T, Asada M, Yoshimatsu K, Okada M (2004) Stem cell Factor/c-kit signaling promotes the survival migration, and capillary tube formation of human umbilica vein endothelial cells. J Biol Chem 279:18600–18607CrossRefGoogle Scholar
  18. 18.
    Petros PP, Woodman PJ (2008) The integral theory of continence. Int Urogynecol J 19:35–40CrossRefGoogle Scholar
  19. 19.
    Tetzschner T, Sorensen M, Jonsson L, Lose G, Christiansen J (1997) Delivery and pudendal nerve function. Acta obstet Gynecol Scand 76:324–331PubMedGoogle Scholar
  20. 20.
    Summit RL, Bent AE, Ostergard DR (1990) The pathophysiology of genuine stress incontinence. Int Urogynecol J 1:12–18CrossRefGoogle Scholar
  21. 21.
    Lee JY, Cannon TW, Prunchnic P, Fraser MO, Huard J, Chancellor MB (2003) The effects of periurethral muscle-derived stem cell injection on leak point pressure in a rat model of stress urinary incontinence. Int Urogynecol J 14:31–37CrossRefGoogle Scholar

Copyright information

© The International Urogynecological Association 2010

Authors and Affiliations

  • Hung-Yen Chin
    • 1
    • 3
  • Eileen Changchien
    • 2
  • Chi-Hsin Chiang
    • 3
  • Hsiu-Ping Yang
    • 3
  1. 1.Medical SchoolChang Gung UniversityTao-YuanRepublic of China
  2. 2.R & D, Standard Chemical and Pharmaceutical. Co., LtdTainanRepublic of China
  3. 3.Department of Obstetrics and GynecologyChang Gung Memorial HospitalKeelungRepublic of China

Personalised recommendations