延迟低强度体外冲击波疗法治疗压力性尿失禁不可逆大鼠模型。
Delayed Treatment With Low-intensity Extracorporeal Shock Wave Therapy in an Irreversible Rat Model of Stress Urinary Incontinence.
机构信息
Department of Urology, Knuppe Molecular Urology Laboratory, School of Medicine, University of California, San Francisco, CA.
Department of Urology, Knuppe Molecular Urology Laboratory, School of Medicine, University of California, San Francisco, CA.
出版信息
Urology. 2020 Jul;141:187.e1-187.e7. doi: 10.1016/j.urology.2020.03.035. Epub 2020 Apr 10.
OBJECTIVE
To determine the outcomes and mechanisms of delayed low-intensity extracorporeal shock wave therapy (Li-ESWT) in a rat model of irreversible stress urinary incontinence (SUI).
MATERIALS AND METHODS
Twenty-four female Sprague-Dawley rats were randomly assigned into 3 groups: sham control, vaginal balloon dilation + β-aminopropionitrile (BAPN; SUI group), and vaginal balloon dilation + BAPN + treatment with Li-ESWT (SUI-Li-ESWT group). An irreversible SUI model was developed by inhibiting the urethral structural recovery with BAPN daily for 5 weeks. Thereafter, in the SUI-Li-ESWT group, Li-ESWT was administered twice per week for 2 weeks. After a 1-week washout, all 24 rats were evaluated with functional and histologic studies at 17 weeks of age. Endogenous progenitor cells were detected via the EdU-labeling method.
RESULTS
Functional analysis with leak point pressure testing showed that the SUI-Li-ESWT group had significantly higher leak point pressures compared with untreated rats. Increased urethral and vaginal smooth and striated muscle content and increased thickness of the vaginal wall were noted in the SUI-Li-ESWT group. The SUI group had significantly decreased neuronal nitric oxide /tyrosine hydroxylase positive nerves ratio in the smooth muscle layers of the urethra, while the SUI-Li-ESWT group had neuronal nitric oxide/tyrosine hydroxylase+ nerves ratio similar to that of the control group. The continuality of urothelial cell lining was also improved in the SUI-Li-ESWT group. In addition, there were significantly increased EdU-positive cells in the SUI-Li-ESWT group.
CONCLUSION
Li-ESWT appears to increase smooth muscle content in the urethra and the vagina, increase the thickness of urethral wall, improve striated muscle content and neuromuscular junctions, restore the integrity of the urothelium, and increase the number of EdU-retaining progenitor cells in the urethral wall.
目的
在不可逆性压力性尿失禁（SUI）大鼠模型中，确定延迟低强度体外冲击波疗法（Li-ESWT）的结果和机制。
材料与方法
将 24 只雌性 Sprague-Dawley 大鼠随机分为 3 组：假手术对照、阴道球囊扩张+β-氨基丙腈（BAPN；SUI 组）和阴道球囊扩张+BAPN+Li-ESWT 治疗（SUI-Li-ESWT 组）。通过每天给予 BAPN 抑制尿道结构恢复，建立不可逆性 SUI 模型 5 周。此后，在 SUI-Li-ESWT 组中，每周给予 Li-ESWT 2 次，共 2 周。1 周洗脱期后，所有 24 只大鼠在 17 周龄时进行功能和组织学评估。通过 EdU 标记法检测内源性祖细胞。
结果
漏点压力测试的功能分析显示，SUI-Li-ESWT 组的漏点压力明显高于未治疗的大鼠。SUI-Li-ESWT 组尿道和阴道平滑肌和横纹肌含量增加，阴道壁厚度增加。SUI 组尿道平滑肌层中神经元型一氧化氮/酪氨酸羟化酶阳性神经的比例显著降低，而 SUI-Li-ESWT 组的神经元型一氧化氮/酪氨酸羟化酶+神经的比例与对照组相似。SUI-Li-ESWT 组的尿路上皮细胞衬里连续性也得到改善。此外，SUI-Li-ESWT 组的 EdU 阳性细胞明显增多。
结论
Li-ESWT 似乎增加了尿道和阴道的平滑肌含量，增加了尿道壁的厚度，改善了横纹肌含量和神经肌肉接头，恢复了尿路上皮的完整性，并增加了尿道壁中保留 EdU 的祖细胞数量。
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