The impact of cesarean delivery on pelvic floor dysfunction in lysyl oxidase like-1 knockout mice.

OBJECTIVE: : Lysyl oxidase like-1 (LOXL1) knockout mice have abnormal elastic fiber homeostasis and frequently develop pelvic floor dysfunction after pregnancy and delivery. The objective of this study was to test the hypothesis that tissue changes associated with vaginal delivery lead to pelvic floor dysfunction as a result of abnormal elastic fiber homeostasis. METHODS: : Female LOXL1 knockout mice delivered either spontaneously or by cesarean delivery. Mice were assessed weekly for pelvic organ prolapse (POP). At 12 weeks postpartum, lower urinary tract function was assessed by cystometry and leak-point pressure testing. Urethrovaginal cross-sections were analyzed using a histologic grading scale to assess elastin fiber disorganization. RESULTS: : A total of 39 mice delivered by spontaneous vaginal delivery and 36 by cesarean delivery. Twelve weeks after spontaneous vaginal delivery or cesarean delivery, 23 (59%) and 11 (31%) mice had developed POP, respectively. The mean time to develop POP was 7.2 weeks after spontaneous vaginal delivery and 10.5 weeks after cesarean delivery (log rank, P = 0.0008). The Cox proportional hazard ratio was 0.55 (95% confidence interval, 0.38-0.79). Mice with POP had increased frequency of bladder contractions not associated with voiding during cystometry (P = 0.02). POP, but not mode of delivery, was associated with increased elastic fiber disorganization. CONCLUSIONS: : Cesarean delivery delays the development of POP in LOXL1 knockout mice. POP is associated with increased bladder contraction frequency and increased elastic fiber disorganization in the urethra and vagina. The mechanisms underlying these findings warrant further investigation.

Anatomic relationships of the tension-free vaginal mesh trocars.

OBJECTIVE: The objective of the study was to describe the distances between the major anatomic structures to the path of the tension-free vaginal mesh (TVM) trocars. STUDY DESIGN: Four anterior transobturator and 2 posterior ischiorectal TVM trocars were inserted bilaterally into 8 fresh frozen cadavers. Dissections were performed and mean distances (95% confidence interval) were measured between the closest points along the trocar's path and significant anatomic structures. RESULTS: The mean distances between both anterior transobturator trocars and the medial branch of the obturator vessels were 0.8 cm (range, 0.6 to 1.0) and 0.7 cm (range, 0.4 to 1.1), and bladder were 0.7 cm (range, 0.5 to 0.9) and 1.3 cm (range, 0.8 to 1.9), respectively. The mean distances between the posterior trocar and the rectum and inferior rectal vessels were 0.8 cm (range, 0.6 to 1.0) and 0.9 cm (range, 0.7 to 1.1), respectively. CONCLUSION: The bladder and medial branch of the obturator vessel may be at risk of injury during the passage of the anterior trocars, whereas the rectum and inferior rectal vessels may be at risk during the passage of the posterior trocar.

Perioperative complications and adverse events of the MONARC transobturator tape, compared with the tension-free vaginal tape.

OBJECTIVE: The objective of the study was to compare the incidence of perioperative complications of the MONARC transobturator tape with the tension-free vaginal tape in women undergoing surgical treatment for stress urinary incontinence. STUDY DESIGN: A retrospective review of all patients undergoing either a transobturator tape or tension-free vaginal tape between January 2003 and August 2005 was performed. The incidence of intraoperative and postoperative (6 weeks or less) complications was compared between groups. RESULTS: Two hundred five women underwent a transobturator tape and 213 women underwent a tension-free vaginal tape during the study period. Tension-free vaginal tape resulted in a significantly higher rate of bladder perforation than did transobturator tape (11 of 213 [5%] versus 0 of 205 [0%], P < .001). Postoperatively, subjects who received tension-free vaginal tape were significantly more likely to require urethrolysis for voiding dysfunction or urinary urgency (adjusted odds ratio 3.2 [95% confidence interval 1.2 to 10.1], P = .026) and more likely to use anticholinergic medications (adjusted odds ratio 2.1 [95% confidence interval 1.02 to 4.70], P = .046) than those who received a transobturator tape. CONCLUSION: Transobturator tape is associated with a lower rate of bladder injury, a decreased incidence of postoperative anticholinergic medication use, and fewer urethrolyses for postoperative voiding dysfunction or urinary urgency than tension-free vaginal tape.