NORADRENERGIC MECHANISMS IN THE URETHRAL CONTINENCE REFLEX CONTROLLING URETHRAL SMOOTH AND STRIATED MUSCLE FUNCTION IN RATS

Vol. 179, No. 4, Supplement, Tuesday, May 20, 2008

1370 PREOPERATIVE MUCP AND VLPP FAILED TO PREDICT OUTCOME IN PATIENTS WHO UNDERWENT TRANSOBTURATOR MID-URETHRAL SLINGS Elisabetta Costantini, Massimo Lazzeri*, Antonella Giannantoni, Vittorio Bini, Luigi Mearini, Alessandro Zucchi, Massimo Porena. Perugia, Italy, and Florence, Italy. INTRODUCTION AND OBJECTIVE: To test the hypothesis that preoperative Maximum Urethral Closure Pressure (MUCP) and/or Valsalva Leak Point Pressure (VLPP) may predict mid-term (3 years) outcome of trans-obturator out-in (TOT) mid-urethra slings for female stress urinary incontinence (SUI). 0(7+2'6)LIW\QLQHSDWLHQWVPHDQDJH“UDQJH years) with SUI, were prospectively enrolled in the study and underwent TOT. The pre-operative work-up included a detailed case history, clinical, neurological and urogynaecological examination. All patients underwent a stress test at physiological maximum bladder capacity and urodynamic assessment. All patients completed two validated questionnaires on quality of life: the Urogenital Distress Inventory (UDI-6) and the Impact Incontinence Quality of life (IIQ-7). Patient satisfaction was scored by a VAS scale. They were followed-up at 3, 6, 12 months post-operatively and then annually for primary outcome variables (dry or wet) and secondary outcome variables (UDI-6, IIQ-7 and VAS scale). 3UHRSHUDWLYH08&3DQG9/33VWUDWL¿HGDV”RU!FP+2DQG”RU > 60 cmH2O respectively, were correlated with primary and secondary outcome variables. RESULTS: The mean follow-up was 30 ± 1,6 months (range  :KHQSDWLHQWVZHUHDQDO\]HGDFFRUGLQJ08&3VWUDWL¿FDWLRQ (40.6%) patients showed a MUCP > 40 cmH2O and 35 (59.4%) patients KDG D 08&3 ”  FP+2 ZKLOH DFFRUGLQJ 9/33 VWUDWL¿FDWLRQ  (66.1%) patients showed a VLPP > 60 cmH2O and 20 (33.9%) patients KDGD9/33”FP+27KHRYHUDOOREMHFWLYHFXUHUDWHZDV  SDWLHQWVZKRZHUHZHWUHSRUWHGKRZHYHUWREHLPSURYHG The objective cure rate was: 75 %(18/24) for patients with MUCP > FP+2DQG IRUWKRVHZLWK08&3”FP+2QR VWDWLVWLFDOO\VLJQL¿FDQWGLIIHUHQFHZDVUHFRUGHGS  7KHREMHFWLYH cure rate was 75.3 % (29/39) for patients with VLPP > 60 cmH2O and  IRUWKRVHZLWK9/33”FP+2S  1RVLJQL¿FDQW differences in objective cure rates emerged when patients were matched IRU08&3DQG9/33S  1RVWDWLVWLFDOO\VLJQL¿FDQWFKDQJHVZHUH recorded for secondary outcome variables (UDI-6, IIQ-7 and VAS scale) ZKHQSDWLHQWVZHUHVWUDWL¿HGDFFRUGLQJ08&3DQGRU9/33 CONCLUSIONS: These data seems to show that outcome ZDVQRWDVVRFLDWHGWRSUHRSHUDWLYH08&3”RU!RIFP+ DQGRU 9/33”RU!RIFP+ DQGFDVWGRXEWVRQWKHSUHGLFWLYHYDOXHRI MUCP and VLPP in patients who underwent TOT. Source of Funding: None

1371 ASSESSMENT OF QUALITY OF SEXUAL LIFE AFTER IN-SITU VAGINAL SLING (ISVS) FOR FEMALE STRESS URINARY INCONTINENCE Orietta Dalpiaz*, Andrea Kerschbaumer, Michael Mitterberger, Georg Bartsch, Hannes Strasser, Germar M Pinggera. Innsbruck, Austria. INTRODUCTION AND OBJECTIVE: The reported prevalence of sexual dysfunction after incontinence surgery ranges between 0.6 and 64%. An increasing number of papers have raised the issue of sexual dysfunction after urogynaecologic surgery, as this problem has a high impact on quality of life. In the present study quality of sexual life and sexual function were investigated in women who underwent in-situ intravaginal sling procedure (ISVS) for female stress urinary incontinence. METHODS: 72 women (age: 37 to 87 years) underwent ISVS between 1997 and 2002. 54 out of these 72 patients (75%) reported to be sexually active preoperatively and received the questionnaire at the follow-up visits. 29 (40%) had previously undergone hysterectomy and 19 (26%) had previously undergone different ineffective surgery for stress urinary incontinence. All women had hypermobility of the urethra. Sexual function and quality of sexual life were assessed using the German validated version of the Female Sexual Function Index questionnaire )6),G  7KH )6),G LV D LWHP TXHVWLRQQDLUH WKDW FKDUDFWHUL]HV

THE JOURNAL OF UROLOGY®

469

VL[GRPDLQVRIVH[XDOIXQFWLRQLQFOXGLQJGHVLUHDURXVDOOXEUL¿FDWLRQ orgasm, satisfaction and pain. Minimum and maximum scores are 2 (no symptoms and very satisfying sexual life) and 36 (problems in all domains), respectively. RESULTS: No intra-operative complications occurred. At the follow-up time of 36 months objective and subjective cure and improvement rates were 94% and 98%, respectively. 7 patients (9.7%) presented with a vaginal erosion of the suture material that required the complete removal of the sutures. All patients completed the questionnaire at the control visits. Median FSFI score at follow-up was 4 (range 2-36). 2 (3.7%) patients complained about dyspareunia and subsequent VH[XDOGLI¿FXOW\DIWHUVXUJHU\2QHRIWKHVHVXIIHUHGIURPFRQVLGHUDEOH discomfort and reported cessation of sexual activity postoperatively. The majority of women (96%) maintained their sexual life without changes of lifestyle and personality. CONCLUSIONS: The present results demonstrate that ISVS is an effective procedure and does not appear to dramatically affect overall sexual function in sexual active women. This procedure represents a safe alternative for the treatment of female stress urinary incontinence compared to mini-invasive tension free procedures and normally guarantees a satisfactory sexual life after surgery. Source of Funding: None

1372 NORADRENERGIC MECHANISMS IN THE URETHRAL CONTINENCE REFLEX CONTROLLING URETHRAL SMOOTH AND STRIATED MUSCLE FUNCTION IN RATS Akira Furuta*, Yasuhiro Kaiho, Masafumi Kita, Yasuyuki Suzuki, Shin Egawa, Michael B Chancellor, Naoki Yoshimura. Pittsburgh, PA, and Tokyo, Japan. INTRODUCTION AND OBJECTIVE: We have previously UHSRUWHG WKDW DFWLYH XUHWKUDO FORVXUH GXULQJ VQHH]LQJ LV PHGLDWHG E\ GLUHFWDFWLYDWLRQRISXGHQGDOQHUYHVDQGSHOYLFÀRRULQQHUYDWLQJVRPDWLF nerves and that active urethral closure induced by Valsalva-like passive intravesical pressure rises is mediated by autonomic and somatic nerves (hypogastric, pelvic and pudendal nerves). We have also reported WKDW DFWLYDWLRQ RI QRUDGUHQHUJLF SDWKZD\V FDQ HQKDQFH WKH VQHH]H LQGXFHG XUHWKUDO FRQWLQHQFH UHÀH[ 7KHUHIRUH ZH LQYHVWLJDWHG WKH UROHRIQRUDGUHQHUJLFSDWKZD\VLQWKHXUHWKUDOFRQWLQHQFHUHÀH[XQGHU Valsalva-like stress conditions. METHODS: The spinal cord was transected at T8-9 level, DQG WKH EODGGHU ZDV ¿OOHG ZLWK  PO VDOLQH VROXWLRQ LQ 6SUDJXH Dawley female rats. Under urethane anesthesia, urethral baseline pressures (UBP) and urethral pressure responses (UPR) during the lower abdominal compression were measured using a microtip transducer catheter placed at the middle urethra. Following intravenous LY  DSSOLFDWLRQ RI KH[DPHWKRQLXP &  RU ĮEXQJDURWR[LQ WR EORFN urethral smooth or striated muscle function, respectively, UBP and UPR were measured before and after i.v. application of nisoxetine (1 PJNJ DQRUHSLQHSKULQHUHXSWDNHLQKLELWRUWHUD]RVLQPJNJ DQ Į1-adrenoceptor (AR) antagonist, and medetomidine (0.3 mg/kg), an Į2-AR agonist. RESULTS: (1) Rats treated with C6 that suppressed JDQJOLRQLFWUDQVPLVVLRQWRHOLPLQDWHUHÀH[FRQWUDFWLRQRIXUHWKUDOVPRRWK PXVFOH7HUD]RVLQGLGQRWFKDQJHHLWKHU8%3RU8350HGHWRPLGLQH VLJQL¿FDQWO\GHFUHDVHG835EXWQRW8%31LVR[HWLQHGLGQRWDOWHU8%3 EXWVLJQL¿FDQWO\LQFUHDVHG835DQGWKLV835LQFUHDVHZDVFRPSOHWHO\ HOLPLQDWHG E\ WHUD]RVLQ   5DWV WUHDWHG ZLWK ĮEXQJDURWR[LQ WKDW eliminated urethral striated muscle activity: Both UBP and UPR were VLJQL¿FDQWO\GHFUHDVHGE\WHUD]RVLQ1LVR[HWLQHVLJQL¿FDQWO\LQFUHDVHG both UBP and UPR, and these increases in UBP and UPR were HOLPLQDWHGE\WHUD]RVLQ CONCLUSIONS: These results suggest that: (1) UBP and 835 LQ XUHWKUDO VPRRWK PXVFOHV DUH SRVLWLYHO\ UHJXODWHG E\ Į1-ARs, EXWQRW835LQXUHWKUDOVWULDWHGPXVFOHV 835LQXUHWKUDOVWULDWHG PXVFOHVLVQHJDWLYHO\UHJXODWHGE\Į2$5VDQG QRUHSLQHSKULQHFDQ increase both UBP and UPR in urethral smooth muscles in addition to 835LQXUHWKUDOVWULDWHGPXVFOHVE\Į1$5VDFWLYDWLRQ7KHVH¿QGLQJVZLOO be useful to understand nerve-mediated urethral closure mechanisms under Valsalva-like stress conditions. Source of Funding: NIH DK067226, AR049398.