Tension-free vaginal tape after failed cystoscopic transurethral injections for stress urinary incontinence.

This case series aims to determine the feasibility of performing a tension-free vaginal tape procedure after failed transurethral injection treatment in women with stress urinary incontinence.

A 5-year prospective follow-up study of vaginal surgery for pelvic organ prolapse.

The objective of this study was to evaluate anatomic, functional, short- and long-term outcome of vaginal surgery for pelvic organ prolapse. This was a prospective observational study of 185 consecutive women planned for vaginal prolapse reconstructive surgery. Stage of prolapse, urinary incontinence (UI), bowel and mechanical symptoms were assessed preoperatively and at 1, 3 and 5 years postoperatively. The mean follow-up time was 53 months. The anatomic recurrence rate was 41.1% but less than half of them were symptomatic. Anterior compartment was most prone for recurrence and the majority of the recurrences took place within the first year. UI remained at the same level at 1-year follow-up. De novo urge occurred in 22.6% and de novo stress incontinence in 6.0%. An improvement was seen in difficulty in emptying bowel 1 year after surgery (54%). Patients were primarily cured from mechanical symptoms. Re-operation rate was 9.7%; if additional operation for incontinence was included, it was13.5%.

Nitric oxide increases endocervical secretion at the ovulatory phase in the female.

BACKGROUND: Uterine cervical mucus is crucial for reproduction, facilitating sperm transport and survival in certain mammals. Cholinergic autonomic nervous secretory innervation has been established, and modulation of secretion by prostaglandins and non-steroidal anti-inflammatory drugs has been postulated. It has been suggested that glandular nitric oxide (NO) production is a prerequisite for the autonomic cholinergic nervous modulation of cervical, endometrial, and the seminal vesicle secretion in the guinea pig. Most secretory genital tract cells, female as well as male, seem to display NO synthase activity. METHODS: Cervical secretion at ovulation time was studied in 10 women with regular menstruation. In an in vivo model with repeated collection of mucus samples during four 60-min periods, the amount of mucus was estimated in a control experimental series and in an experimental series following sublingual administration of the NO donor nitroglycerin. RESULTS: This nitroglycerin administration markedly increased cervical secretion, while no changes in cervical secretion were seen in the control experimental series. CONCLUSIONS: The results suggest that glandular NO production increases cervical secretion. Thus, cervical secretion may, apart from hormonal regulation, be influenced by the autonomic nervous system, and in addition, NO may be a prerequisite for this influence. This in turn may have implications on fertilization and fertility regulation.

Nitric oxide as putative second messenger in nerve-induced cervical gland secretion in the guinea-pig.

Uterine cervical secretory cells receive a sympathetic cholinergic secretomotor innervation. It has been suggested that glandular nitric oxide (NO) production is a prerequisite for muscarinic-induced carbohydrate secretion in the endometrium and the seminal vesicle. A similar pattern for nerve-induced carbohydrate secretion in the cervix could be assumed. Nitric oxide synthase (NOS) activity was evaluated via formation of L-citrulline from L-arginine. The NADPH-diaphorase nitroblue technique was used for histochemical investigation. The cervix with the adjacent hypogastric nerve was placed in an isolated organ bath and the secretion was evaluated as an amount of carbohydrate. A calcium-dependent formation of citrulline was found in the cervix indicating NO formation. Strong NADPH-staining cells were found in the glandular ducts and in the glandular linings of the cervix. Stimulation of the hypogastric nerve induced carbohydrate secretion, which was inhibited by N-nitro-L-arginine methyl ester (L-NAME). D-NAME did not affect the secretory response. Carbachol and the NO donor glyceryl trinitrate (GTN) induced carbohydrate secretion in the cervical glands. No synergistic effect was noted probably due to an all-or-none type of secretion. N-nitro-L-arginine (L-NNA) and L-NAME inhibited carbachol-induced secretion. The results suggest that glandular NO production is a prerequisite for the autonomic nervous modulation of cervical secretion in the guinea-pig. This could have implications regarding fertility and fecundity.