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Morphological changes of urethral skeletal muscle in stress urinary incontinence
4th Baltic Meeting in conjunction with the EAU, 26-27 May 2017, Vilnius, Lithuania
27
Morphological changes of urethral skeletal muscle in stress urinary incontinence Eur Urol Suppl 2017; 16(5);e2193
Iatsyna O.1, Vernigorodsky S.2, Yalovenko K.3 1
National Institute of Urology, Laboratory of Neurourology, Kiev, Ukraine, 2Vinnytsia National Medical University. N.I. Pirogov, Dept. of Pathological Anatomy, Forensic Science and Law, Vinnytsa, Ukraine, 3 Week-End Clinic, Dept. of Gynaecology, Kiev, Ukraine INTRODUCTION & OBJECTIVES: Stress urinary incontinence (SUI) is a general issue that can influence the quality of life. In SUI, a distinction can be made between mechanical and functional problems of the sphincter mechanism provoked by myogenic, neurogenic, hormonal, or iatrogenic factors as well as changes in connective tissue. Collagen`s function is to be responsible for the tensile strength and integrity, while elastin insures elasticity to the tissues. The main aim of this research is to make an analysis of the effects of electrical stimulation (ES) of the pelvic floor on the urethral skeletal muscle (USM), depict the morphological transformation of the USM, estimate the dissemination of I, III collagen types and elastic fibres together with its possible implication in the pathogenesis of SUI. MATERIAL & METHODS: Periurethral muscle biopsies were taken from sixty women considering the age range of 42-72 years old. Biopsis were taken during tension-free vaginal tape (TVT) procedure and gynecologic procedures. The patients were separated into the following groups: 1. 36 women with SUI that went through the TVT manipulation e with ES (SUIES) 2. 13 women with SUI/TVT who did not get ES (SUI) 3. 11 patients who had gynecologic operations (CV). The patients gave their written informed agreement. The variables were statistically succumbed to analysis. Tissues were put into paraffin and cut into 4 μm thick cross- sections. The existence of I and III type collagen was defined by immunohistochemical method. Elementary antibody was purified by rabbit antihuman collagen of type I, 1:800 (Novatec Inc., Baltimore, MD, USA) and rabbit monoclonal anti-human collagen of type III (Novatec Inc.). Morphometric estimation was made with the help of image analysis software (Quick PHOTO MICRO 2.3). The slides were analyzed and photographed with a light microscope (Olympus BX41™). RESULTS: We disclosed an irregular, fragmented dissemination of the protein elastin in all cases where increasing age takes place, with no difference if they were SUI or not. We found fragmented elastic fibers of different sizes between collagen fibers, fibrocytes and smooth muscle cells. Specific distinctions between the elastic fiber system of continent and stress incontinent women were not detectable. No significant differences between groups with regard to percentage of collagen fibers were found, but in
Eur Urol Suppl 2017; 16(5);e2193
4th Baltic Meeting in conjunction with the EAU, 26-27 May 2017, Vilnius, Lithuania
27
Morphological changes of urethral skeletal muscle in stress urinary incontinence Eur Urol Suppl 2017; 16(5);e2194
SUI and SUIES groups we detected the lower ratio of type I over type III collagen around the urethra compared with that of CV. It turns out that type of collagen has a considerable role in the sustenance of urinary abstinence but the mechanism by which collagen metabolism is changed, stays unknown. The percentage of muscle fibers was determined in all the groups of patients. There was a considerable inequality only between SUIES and SUI without ES (p < 0.05). The SUIES group had bigger skeletal muscle content and percentage in each muscle fascicle. On electromyography, patients with SUIES had incredibly more fibrillation potentials, fewer motor unit action potentials, a higher percentage of polyphasia, and less maximum voluntary electrical activity than CV SUI and SUI without ES. CONCLUSIONS: Protracted functional electric stimulation of the pelvic floor stimulated an increase in periurethral muscle thickness in SUI group patients. We can commend to apply the peripheral ES as an actual alternative in the therapy of women SUI before TVT manipulation.
Eur Urol Suppl 2017; 16(5);e2194 Powered by TCPDF (www.tcpdf.org)
27
Morphological changes of urethral skeletal muscle in stress urinary incontinence Eur Urol Suppl 2017; 16(5);e2193
Iatsyna O.1, Vernigorodsky S.2, Yalovenko K.3 1
National Institute of Urology, Laboratory of Neurourology, Kiev, Ukraine, 2Vinnytsia National Medical University. N.I. Pirogov, Dept. of Pathological Anatomy, Forensic Science and Law, Vinnytsa, Ukraine, 3 Week-End Clinic, Dept. of Gynaecology, Kiev, Ukraine INTRODUCTION & OBJECTIVES: Stress urinary incontinence (SUI) is a general issue that can influence the quality of life. In SUI, a distinction can be made between mechanical and functional problems of the sphincter mechanism provoked by myogenic, neurogenic, hormonal, or iatrogenic factors as well as changes in connective tissue. Collagen`s function is to be responsible for the tensile strength and integrity, while elastin insures elasticity to the tissues. The main aim of this research is to make an analysis of the effects of electrical stimulation (ES) of the pelvic floor on the urethral skeletal muscle (USM), depict the morphological transformation of the USM, estimate the dissemination of I, III collagen types and elastic fibres together with its possible implication in the pathogenesis of SUI. MATERIAL & METHODS: Periurethral muscle biopsies were taken from sixty women considering the age range of 42-72 years old. Biopsis were taken during tension-free vaginal tape (TVT) procedure and gynecologic procedures. The patients were separated into the following groups: 1. 36 women with SUI that went through the TVT manipulation e with ES (SUIES) 2. 13 women with SUI/TVT who did not get ES (SUI) 3. 11 patients who had gynecologic operations (CV). The patients gave their written informed agreement. The variables were statistically succumbed to analysis. Tissues were put into paraffin and cut into 4 μm thick cross- sections. The existence of I and III type collagen was defined by immunohistochemical method. Elementary antibody was purified by rabbit antihuman collagen of type I, 1:800 (Novatec Inc., Baltimore, MD, USA) and rabbit monoclonal anti-human collagen of type III (Novatec Inc.). Morphometric estimation was made with the help of image analysis software (Quick PHOTO MICRO 2.3). The slides were analyzed and photographed with a light microscope (Olympus BX41™). RESULTS: We disclosed an irregular, fragmented dissemination of the protein elastin in all cases where increasing age takes place, with no difference if they were SUI or not. We found fragmented elastic fibers of different sizes between collagen fibers, fibrocytes and smooth muscle cells. Specific distinctions between the elastic fiber system of continent and stress incontinent women were not detectable. No significant differences between groups with regard to percentage of collagen fibers were found, but in
Eur Urol Suppl 2017; 16(5);e2193
4th Baltic Meeting in conjunction with the EAU, 26-27 May 2017, Vilnius, Lithuania
27
Morphological changes of urethral skeletal muscle in stress urinary incontinence Eur Urol Suppl 2017; 16(5);e2194
SUI and SUIES groups we detected the lower ratio of type I over type III collagen around the urethra compared with that of CV. It turns out that type of collagen has a considerable role in the sustenance of urinary abstinence but the mechanism by which collagen metabolism is changed, stays unknown. The percentage of muscle fibers was determined in all the groups of patients. There was a considerable inequality only between SUIES and SUI without ES (p < 0.05). The SUIES group had bigger skeletal muscle content and percentage in each muscle fascicle. On electromyography, patients with SUIES had incredibly more fibrillation potentials, fewer motor unit action potentials, a higher percentage of polyphasia, and less maximum voluntary electrical activity than CV SUI and SUI without ES. CONCLUSIONS: Protracted functional electric stimulation of the pelvic floor stimulated an increase in periurethral muscle thickness in SUI group patients. We can commend to apply the peripheral ES as an actual alternative in the therapy of women SUI before TVT manipulation.
Eur Urol Suppl 2017; 16(5);e2194 Powered by TCPDF (www.tcpdf.org)