Midurethral sling placement disrupts periurethral neurovascular and glandular structures near anterior vaginal wall: Potential role in female sexual dysfunction
Gaudet, D1; Clohosey , DG1; Hannan, JL2; Goldstein, SW3; Szell, N4; Komisarek, BR5; Harvey, MA1; Johnston, S1; Kawaja, MD1; Ghasmlou, N1; MacKenzie, L1; Goldstein, I3; Adams, MA1
1: Queen's University, Canada; 2: East Carolina University, USA; 3: San Diego Sexual Medicine, USA; 4: Memorial Hospital, USA; 5: Rutgers University, USA
Objective: Midurethral sling (MUS) surgery is successful at managing stress urinary incontinence and sexual satisfaction improves due to less urine leakage in the majority of women. In contrast, MUS adversely impacts orgasmic function and satisfaction in 1 of 11 women. The anatomy of the female of periurethral tissue adjacent to the anterior vaginal wall is not well characterized. Additionally, the impact of MUS surgery on the disruption of this tissue and its impact on sexual function is not well understood. This study histologically characterizes the vascular, neuronal and glandular structures in periurethral tissue of female cadavers before and after a MUS surgical simulation.
Materials and Methods: Tissue was harvested from female cadavers (n=7) to identify the anatomy of the periurethral space. Unembalmed female cadavers (n=3) were also assessed following the placement of a modified blue dyed fascia transobturator MUS by a urogynaecologist. The periurethral tissue excised was bordered by the anterior vaginal wall, urethra, and pubic bone including sections from external genitalia to bladder neck (2x2x4 cm). All tissues were serially cross sectioned and stained with hematoxylin and eosin (H&E) to visualize locations of blood vessels, nerves, and glandular tissues. Additional immunohistochemistry was performed to protein gene product 9.5 (PGP 9.5; neuronal marker) and prostate specific antigen (PSA; glandular cells).
Results: Histological analyses show that the periurethral space in women contains numerous PSA-positive glandular structures, as well as many nerve fibers and bundles, and blood vessels. Furthermore, the glandular structures are highly innervated. MUS placement clearly shows transection of PSA-positive glandular tissue and disruption of the vasculature and neuronal structures in the periurethral space next to the anterior vaginal wall.
Conclusions: These data demonstrate that MUS placement interrupts tissue with glandular, vascular, and neuronal structures within the periurethral space adjacent to the anterior vaginal wall. Disruption of the prostatic glandular tissue and neurovascular structures may be a root cause of orgasmic dysfunction and diminished sexual satisfaction evident in women following MUS implantation.
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