Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, K7L 3N6, Canada.
Obstetrics and Gynaecology, Kingston General Hospital, Kingston, ON, K7L 2V7, Canada.
J Sex Med. 2023 Apr 27;20(5):612-625. doi: 10.1093/jsxmed/qdac046.
There is evidence of glandular tissue in the region of the anterior vaginal wall-female periurethral tissue (AVW-FPT) that has similar morphology and immunohistochemistry to the prostate in men. Surgical injury to this tissue has been suggested as a potential cause of sexual dysfunction following midurethral sling (MUS) procedures. However, the anatomy and embryology of these glands have not been fully resolved. This has led to difficulties in classifying this tissue as a prostate and defining its clinical significance related to MUS procedures.
To describe the histological and immunohistochemical characteristics of the female periurethral glands using markers of prostate tissue and innervation and to examine their anatomical relationships to an implanted MUS.
Using gross and fine dissection, the AVW-FPT was dissected from 9 cadavers. Prior to dissection, 2 cadavers underwent simulation of the MUS procedure by a urogynecologist. Samples were paraffin embedded and serially sectioned. Immunohistochemistry was performed using markers of prostate tissue and innervation.
Immunohistochemical localization of markers for prostatic tissue and innervation of the glandular tissue of the AVW-FPT, including the region of MUS implantation.
Female periurethral glands were immunoreactive for markers of male prostatic tissue, including prostate-specific antigen, androgen receptor, HOXB13, and NKX3.1. Markers of innervation (protein gene product 9.5, choline acetyl transferase, and vasoactive intestinal polypeptide) also localized to certain regions of the glandular tissue and associated blood supply. Surgical simulation of the MUS procedure demonstrated that some periurethral glands are located in close proximity to an implanted sling.
The AVW-FPT contains glandular tissue in the surgical field of MUS implantation. Iatrogenic damage to the female periurethral glands and the associated innervation during surgery could explain the negative impacts on sexual dysfunction reported following MUS procedures.
This is the first study to characterize the female periurethral glands using markers of prostatic tissue in concert with markers of general and autonomic innervation and characterize their anatomical relationships within the surgical field of MUS implantation. The small sample size is a limitation of this study.
We provide further evidence that the AVW-FPT contains innervated glands that are phenotypically similar to the male prostate and may share a common embryonic origin. The microscopic and immunohistochemical features of the periurethral glands may be indicative of their functional capacity in sexual responses. The location of these glands in the surgical field of MUS procedures underscores the clinical significance of this tissue.
在前阴道壁-女性尿道周围组织（AVW-FPT）区域存在类似男性前列腺的形态和免疫组织化学特征的腺组织。有人认为，在进行尿道中段吊带（MUS）手术时，对这些组织的外科损伤可能是导致性功能障碍的潜在原因。然而，这些腺体的解剖结构和胚胎学尚未完全确定。这导致将这些组织归类为前列腺并确定其与 MUS 手术相关的临床意义存在困难。
使用前列腺组织和神经支配的标志物描述女性尿道周围腺的组织学和免疫组织化学特征，并检查其与植入的 MUS 之间的解剖关系。
使用大体和精细解剖，从 9 具尸体中解剖出 AVW-FPT。在解剖之前，2 具尸体由泌尿科医生模拟 MUS 手术。将标本石蜡包埋并连续切片。使用前列腺组织和神经支配的标志物进行免疫组织化学染色。
女性尿道周围腺对男性前列腺组织的标志物呈免疫反应性，包括前列腺特异性抗原、雄激素受体、HOXB13 和 NKX3.1。神经支配的标志物（蛋白基因产物 9.5、胆碱乙酰转移酶和血管活性肠肽）也定位于腺组织的某些区域及其相关的血液供应。MUS 手术模拟表明，一些尿道周围腺位于植入吊带的附近。
AVW-FPT 包含 MUS 植入手术部位的腺组织。手术过程中对女性尿道周围腺及其相关神经的医源性损伤可以解释 MUS 手术后报告的性功能障碍的负面影响。
这是第一项使用前列腺组织标志物结合一般和自主神经支配标志物来描述女性尿道周围腺，并描述其在 MUS 植入手术部位内解剖关系的研究。样本量小是本研究的局限性。
我们提供了进一步的证据表明，AVW-FPT 包含具有类似男性前列腺表型的受神经支配的腺，并且可能具有共同的胚胎起源。尿道周围腺的微观和免疫组织化学特征可能表明其在性反应中的功能能力。这些腺体在 MUS 手术的手术部位的位置突出了该组织的临床意义。
