Neuro-Urology Center, Department of Urology and Andrology, The First Affiliated Hospital of Wenzhou Medical University , Wenzhou, Zhejiang , China.
Glickman Urological and Kidney Institute, Cleveland Clinic , Cleveland, Ohio.
Am J Physiol Renal Physiol. 2018 Dec 1;315(6):F1555-F1564. doi: 10.1152/ajprenal.00431.2017. Epub 2018 Aug 22.
The pudendal nerve can be injured during vaginal delivery of children, and slowed pudendal nerve regeneration has been correlated with development of stress urinary incontinence (SUI). Simultaneous injury to the pudendal nerve and its target muscle, the external urethral sphincter (EUS), during delivery likely leads to slowed neuroregeneration. The goal of this study was to determine if repeat electrical stimulation of the pudendal nerve improves SUI recovery and promotes neuroregeneration in a dual muscle and nerve injury rat model of SUI. Rats received electrical stimulation or sham stimulation of the pudendal nerve twice weekly for up to 2 wk after injury. A separate cohort of rats received sham injury and sham stimulation. Expression of brain-derived neurotrophic factor (BDNF) and β-tubulin expression in Onuf's nucleus were measured 2, 7, and 14 days after injury. Urodynamics, leak point pressure (LPP), and EUS electromyography (EMG) were recorded 14 days after injury. Electrical stimulation significantly increased expression of BDNF at all time points and β-tubulin 1 and 2 wk after injury. Two weeks after injury, LPP and EUS EMG during voiding and LPP testing were significantly decreased compared with sham-injured animals. Electrical stimulation significantly increased EUS activity during voiding, although LPP did not fully recover. Repeat pudendal nerve stimulation promotes neuromuscular continence mechanism recovery possibly via a neuroregenerative response through BDNF upregulation in the pudendal motoneurons in this model of SUI. Electrical stimulation of the pudendal nerve may therefore improve recovery after childbirth and ameliorate symptoms of SUI by promoting neuroregeneration after injury.
阴部神经在分娩过程中可能会受伤，阴部神经再生缓慢与压力性尿失禁（SUI）的发展有关。分娩过程中同时损伤阴部神经及其靶肌肉尿道外括约肌（EUS）可能导致神经再生缓慢。本研究的目的是确定重复阴部神经电刺激是否能改善 SUI 恢复，并在 SUI 的双重肌肉和神经损伤大鼠模型中促进神经再生。大鼠在损伤后每周接受两次阴部神经电刺激或假刺激，直到 2 周。另一组大鼠接受假损伤和假刺激。在损伤后 2、7 和 14 天测量 Onuf 核中的脑源性神经营养因子（BDNF）和 β-微管蛋白表达。在损伤后 14 天记录尿动力学、漏点压（LPP）和 EUS 肌电图（EMG）。电刺激显著增加了 BDNF 在所有时间点和 β-微管蛋白 1 和 2 周后的表达。损伤后 2 周，与假损伤动物相比，排尿时和 LPP 测试时的 LPP 和 EUS EMG 显著降低。电刺激显著增加了排尿时的 EUS 活动，尽管 LPP 并未完全恢复。重复阴部神经刺激通过 BDNF 上调促进阴部运动神经元的神经再生，从而可能促进 SUI 模型中尿控机制的恢复。因此，阴部神经电刺激可能通过促进损伤后的神经再生来改善分娩后的恢复并减轻 SUI 症状。
