Small Extracellular Vesicles Secreted by Peri-urethral Tissues Regulate Fibroblast Function and Contribute to the Pathogenesis of Female Stress Urinary Incontinence

Objective:This study aimed to explore the existence of small extracellular vesicles(sEVs)in peri-urethral tissues and the role of abnormal expression of sEVs in the pathogenesis of female stress urinary incontinence(SUI).Methods:sEVs were extracted from peri-urethral vaginal wall tissues using differential centrifugation and were observed by transmission electron microscopy(TEM).The number of sEVs and their protein contents were compared between SUI and control groups using nanoparticle tracking analysis(NTA)and bicinchoninic acid(BCA)protein assay.Fibroblasts were cultured separately with SUI(SsEVs group)and normal tissue sEVs(NsEVs group).Proliferation and migration of fibroblasts were compared between groups using CCK-8 and wound healing assays,respectively.Expression levels of collagenⅠandⅢwere compared among blank control(BC),NsEVs,and SsEVs groups using real-time PCR.Protein mass spectrometry was used to test the differentially expressed proteins contained in sEVs between groups.Results:sEVs were extracted and found under the electron microscope.There were significantly more sEVs extracted from the SUI group compared to the normal group.Fibroblasts showed increased proliferative and decreased migratory abilities,and expressed more collagen in the SsEVs group compared to the NsEVs and BC groups.Protein spectrum analysis demonstrated several differentially expressed targets,including components of microfibrils,elastin polymer,and anti-inflammatory factors.Conclusion:sEVs were detected in the peri-urethral tissues.SUI tissues expressed more sEVs than control.The abnormal expression of sEVs and their protein contents may contribute to the pathogenesis and progression of SUI.

Contemporary diagnostics and treatment options for female stress urinary incontinence

Stress urinary incontinence is not a deadly disease,but for the large population of women suffering from it,it is a very important issue.Especially in the continuously aging population all over the world,there is more and more need for treatment of this serious medical condition.Treatment of female stress urinary incontinence exists already for ages.In the 20th century invasive treatments like Burch colposuspension and pubovaginal slings were the mainstay of surgical treatments.The introduction of the midurethral sling made the procedure less invasive and accessible for more caregivers.Luckily there are many options available and the field is developing quickly.In recent years many new medical devices have been developed,that increase the number of treatment options available and make it possible to find a suitable solution for the individual patient based on subjective and objective results and the chances of complications.This manuscript provides an introduction to the therapeutical options that are available nowadays for female stress urinary incontinence.

Analysis of coping styles of elderly women patients with stress urinary incontinence

Objective:The aim of this study was to survey the coping style and related factors of elderly women with stress urinary incontinence(SUI)and provide a strong theoretical basis for promoting a positive coping style to improve quality of life in these patients.Methods:Cross-sectional surveys addressing SUI cognition and coping techniques of 520 elderly women patients with SUI were administered between July 2013 and February 2014.Results:Elderly women with SUI had significantly higher avoidance and acceptanceresignation scores than the normal population(p<0.05).Age,marital status,education level and stress urinary incontinence cognitive level all influenced the medical coping style of these patients.Conclusions:Elderly female patients with SUI differ in the factors that influence their coping styles;therefore,clinical and community medical staff should include a comprehensive analysis that takes these factors into consideration when working with patients with SUI to guide them in adopting a positive coping style.

Clinical value of needleless sling in treatment of female stress urinary incontinence

BACKGROUND Stress urinary incontinence(SUI)is a common disease in women.The emergence of the needle-free sling has led to a new clinical treatment for SUI in women.AIM To explore the clinical value of the needleless sling without acupuncture in the treatment of SUI in women.METHODS From February 2017 to November 2018,according to the order of admission,44 patients(mid-suspension group)were treated by tension-free transobturator urethral suspension,and 44 patients(non-acupuncture group)were treated with a needleless non-acupuncture band.The clinical effects of the two treatments were evaluated.RESULTS There was no significant difference between the two groups in the total clinical effectiveness rate(P=0.374),but intraoperative blood loss and visual analogue scale score at postoperative day 1 were significantly lower in the non-acupuncture suspension group than in the middle urethral suspension group(P=0.396).The incidence of complications in the needle-free sling group was significantly lower than that in the middle urethral suspension group(P=0.025).CONCLUSION The clinical effectiveness of acupuncture-free suspension in treating SUI in female patients is better than that of traditional tension-free transobturator mid-urethral suspension.

Needleless Contasure versus TVT-O in Women with Stress Urinary Incontinence

Objectives: The aim of this thesis is to determine the clinical effectiveness, safety and cost-effectiveness of Single Incision needleless Mini-Slings compared with tension-free Standard Mid-urethral Sling in the surgical management of female stress urinary incontinence, but with less side effects. Methods: The study will be conducted in Zagazig University Hospitals. From 2018 to Sept. 2019, 40 cases were enrolled in the study and were randomized by envelope technique at the time of surgery to either a trans-obturator vaginal tape (TOT) or Needleless anti-incontinence procedure. The patients will be divided into 2 groups: Group 1 patient treated by standard sling (TOT). Group 2 those treated by mini-sling. Parameters in perioperative period such as operating time, intraoperative hemorrhage volume, length of stay in hospital, intraoperative complications, and postoperative pain of each patient were recorded. The sample size was calculated to be 40 cases (20 cases will be treated by standard slings, 20 case will be treated by mini-sling). Results: A total of 40 patients assessed for eligibility were randomized into Needleless groups. There were no significant differences in age, body mass index, process, parity, pad test or the assessment of preoperative quality of life between the two groups. In the perioperative period, statistically significant differences between the two groups were found in operating time, intraoperative hemorrhage volume, groin pain scores at 24 h after operation and length of stay in hospital (P < 0.001). After two weeks of follow-up, a statistically significant difference between the two groups was found in groin pain/femori-bus internus pain scores, but there were no significant differences in cure rates, pad test, complications or ICIQ-SF. After 1 year, there were no significant differences between the Needleless and TOT groups in cure rates, pad test, groin pain or ICIQ-SF (P > 0.05). Both groups registered a significant improvement in the quality of life (P < 0.001), but there were no significant differences between the two groups (P > 0.05). Conclusion: We conclude that compared with the TOT surgery, single-incision Needleless sling in the treatment of female stress urinary incontinence is simpler and quicker and has less hemorrhage during surgery as well as faster recovery and it also can obviously reduce the inguinal region pains after operation and shorten hospital stays. In summary, single-incision Needleless sling is a kind of convenient, safe and effective minimally invasive surgery for urinary incontinence.

Female Stress Urinary Incontinence Treatment by Forming an Uretro-Vesical Angle with or without Mesh

Objective: To evaluate, in a comprehensive way, mesh and mesh free SUI treatment results obtained in a single center. The present study addresses the efficacy and safety of a novel surgical technique. Material & Methods: Adult female SUI patients, 184 in total, were divided within a sequential manner into two groups to be treated for SUI either with or without mesh insertion during a surgical intervention. In this novel procedure, a vertical vaginal incision from the urethra towards the bladder bottom is made and closed transversely. After the intervention the patients revisited the clinic at the 6th month. Results: 81 patients in mesh and 83 in the mesh free group completed the 2-year follow up. Based on the pad tests conducted at the end of 24-month follow up, 82% of the patients in the mesh free group and 85% in the mesh group were considered as successful if the pad test resulted with ≤2 gram. Cystocele of Grade I or II was also treated in 69 patients within the same single surgical procedure. Conclusion: The surgical outcomes of the mesh and mesh-free group were almost the same. However, though the cure rate of the mesh group was higher, it was not statistically significant. Adverse events were more frequent in the mesh group due to mesh presence.

Efficacy of biofeedback on stress urinary incontinence in women receiving pelvic floor muscle training: a meta-analysis

Background:To systematically evaluate the effect of pelvic floor muscle training with biofeedback v.s.pelvic floor muscle exercise alone on stress urinary incontinence in women.Methods:PubMed,the Cochrane Library,Web of Science,Ovid,Ebsco,PEDro,WanFang Data,VIP and CNKI databases were electronically searched to collect randomized controlled trials that meet inclusion criteria.After quality assessment,meta-analysis was conducted by RevMan 5.3 software.Results:A total of 8 randomized controlled trials were included.The results of meta-analysis supported the effectiveness of biofeedback on improving pelvic floor muscle strength(MD=4.67,95%CI(1.86,7.49),P=0.001),increasing short(up to 1 hour)pad test(SMD=−1.11,95%CI(−1.84,−0.37),P=0.003),enhancing quality of life(SMD=−0.34,95%CI(−0.67,−0.01),P=0.04)and social activity index(MD=0.1,95%CI(0.06,0.15),P<0.001).Conclusion:Pelvic floor muscle training with biofeedback could improve pelvic floor muscles’strength and help these patients integrate into society,more high quality studies are required to verify above conclusions.

Ten-Year Outcomes of Transobturator Mid-Urethral Sling for Treatment of Stress Urinary Incontinence in Hong Kong Chinese Women with or without Reconstructive Pelvic Floor Surgery

Objective: To evaluate the outcomes of transobturator mid-urethral sling (TO-MUS) with or without reconstructive pelvic floor surgery (RPFS) in Chinese women with stress urinary incontinence (SUI) after 10 years. Methods: This was a prospective observational study on Chinese women undergoing the insertion of TO-MUS with or without RPFS. All patients were assessed at 1-year and 10-year by urodynamic study (UDS). Objective cure was defined as the absence of urine leakage during provocative maneuvers on filling cystometry. Data regarding subjective outcome (patient perception), quality of life changes (Urogenital Distress Inventory-short form (UDI-6), Incontinence Impact Questionnaire-short form (IIQ-7)) and adverse events were also collected. Results: Of 104 eligible patients, 99 patients completed the 10-year evaluation. 57 patients (57.6%) underwent TO-MUS only and 42 patients (42.4%) underwent TO-MUS with concomitant RPFS. At 10-year follow-up, the overall objective cure rate was 86.9% and overall subjective cure rate was 80.8%. In TO-MUS only group, the objective and subjective cure rates at 10-year were 84.2% and 78.9% respectively. In TO-MUS with RPFS group, the objective and subjective cure rates at 10-year were 90.5% and 83.3% respectively. Compared TO-MUS only group with TO-MUS with RPFS group, there were no statistically significant differences in objective cure rate (84.2% vs. 90.5%, p = 0.55) and subjective cure rate (78.9% vs. 83.3%, p = 0.58). Conclusion: TO-MUS is an effective treatment for SUI in Hong Kong Chinese women. Concomitant RPFS during the procedure of TO-MUS does not affect the success.

Incidence and Risk Factors of De novo Stress Urinary Incontinence after Pelvic Floor Reconstruction： A Nested Case-control Study

Background： Some patients with pelvic organ prolapse may suffer from incontinence （SUI） named de novo SUI alter pelvic floor reconstruction of de novo SUI. ower urinary tract symptoms （LUTS）, especially stress urinary This study aimed to investigate the incidence and risk factors Methods： This is a nested case-control study of 533 patients who underwent pelvic floor reconstruction due to pelvic organ prolapse （POP） at the Department of Gynecology in Peking University People＇s Hospital from January 2011 to March 2013. According to the inclusion and exclusion criteria, 401 patients were enrolled in the study with the follow-up rate of 74.8% （101 patients lost to follow-up）. There were 75 patients with de novo SUI postoperatively. According to the ratio of 1：3, we ensured the number of control group （n = 225）. The preoperative urinary dynamics, POP-quantification scores, and LUTS were compared between the two groups by univariate and multivariate logistic regression analyses to investigate the risk factors of de novo SUI. Results： The incidence of de novo SUI was 25% （75/300）. Univariate analysis showed that the ratio of lower urinary tract obstruction （LUTO） before surgery in de novo SUI group was significantly higher than the control group （odds ratio [OR] = 2.1, 95% confidence interval [（7] [1.1-4.0], P = 0.022）. The interaction test of LUTO and other factors displayed that Aa value was an interaction factor. With the increasing score of Aa, the incidence of de novo SUI become higher （OR = 2.1, 95% CI [1.0-3.7], P = 0.045）. After multivariable adjustment, multiple regression analysis showed that LUTO was independently associated with a greater risk of de novo SUI after pelvic floor surgery （OR = 2.3, 95% CI [1.2-4.6], P = 0.013）. Conclusions： Preoperative LUTO in patients with POP is a high-risk factor of de novo SUI, and high score of Aa-point is related to the occurrence of de novo SUI, which might be due to the outlet obstruction caused by bladder prolapse.

Value of the pudendal nerves terminal motor latency measurements in the diagnosis of occult stress urinary incontinence

Background Occult stress urinary incontinence may lead to de novo stress urinary incontinence after pelvic floor repair surgery. A measurement of pudendal nerve terminal motor latency can reflect the integrity of the nerves. We aimed to explore the value of pudendal nerve terminal motor latency in the diagnosis of occult stress urinary incontinence in pelvic organ prolapse patients. Methods Ten patients with stress urinary incontinence （SUI group）, 10 with SUI and uterine or vaginal prolapse （POP＋SUI group） and 10 with uncomplicated uterine or vaginal prolapse （POP group） were evaluated for their pudendal nerve terminal motor latency using a keypoint electromyogram. Results The amplitude of positive waves was between 0.1 and 0.2 mV. The nerve terminal motor latency was between 1.44 and 2.38 ms. There was no significant difference in the wave amplitudes of pudendal nerve evoked action potential among the three different groups （P 〉0.05）. The pudendal nerve latency of the SUI group, POP＋SUI group and POP group were （2.9_＋0.7） seconds, （2.8_＋0.7） seconds and （1.9_＋0.5） seconds respectively. The difference between the SUI group and POP＋SUI group was not statistically significant （P 〉0.05）, whereas the difference between the SUI and POP groups and between the POP＋SUI and POP groups were statistically significant （P 〈0.05）. There was a positive correlation between pudendal nerve latency and the severity of SUI; the correlation coefficient was 0.720 （P 〈0.01）. Conclusions Patients with SUI may have some nerve demyelination injuries in the pudendal nerve but the damage might not involve the nerve axons. The measurement of pudendal nerve latency may be useful for the diagnosis of SUI in POP patients.

Surgical Treatment of Stress Urinary Incontinence in Women in the Mainland of China： Current Status and Outlook

Surgery for female stress urinary incontinence （SUI） has been making remarkable progress in recent decades. Hammock theoryi has been a milestone in explaining the etiology of SUI, as introduced by Ulmsten, illustrating that dysfunction ofpubourethral ligament and pubococcygeus is the major pathological mechanism of SUI. Anti-incontinence sling is divided into retropubic route and obturator route： retropubic route embraces ＂down-up＂ and ＂up-down＂ approach to complete puncture of sling placement and obturator route consists of ＂inside-out＂ and ＂outside-in＂ approaches to complete the puncture sling placement. Moreover, in recent years.

Burch colposuspension for stress urinary incontinence: a 14-year prospective follow-up

We aimed to evaluate the long-term effectiveness and safety of Burch colposuspension(BC) for stress urinary incontinence(SUI). In this prospective cohort study, 84 patients with SUI undergoing BC were enrolled from February 2004 to January 2010.Data on long-term subjective success and postoperative complications were collected at clinic visits and by telephone follow-up.During a mean follow-up period of 14.2 years, 68%(57/84) patients completed the follow-up. A total of 68.4% of patients(39/57) reported absence of SUI symptoms, 73.6%(42/57) were subjectively satisfied according to the Patient Global Impression of Improvement, and 68.4%(39/57) reported subjective success regarding urinary symptoms via the Urinary Distress Inventory Short Form. However, 28.1%(16/57) suffered at least one long-term postoperative complication and incident. Specifically, 1 in25(4.0%) sexually active patients reported dyspareunia, 3 patients(5.3%) had de novo overactive bladder, and 6 patients(10.5%)reported voiding dysfunction. Four patients(7.0%) reported new onset prolapse symptoms, and 3 patients(5.3%) underwent secondary urinary incontinence surgery. Our study indicated that Burch colposuspension is an effective procedure for SUI, and the cure effect was largely maintained for the 14-year follow-up period, with relatively low complication rates. BC should be considered a surgical option for SUI.

Efficacy and postoperative complication of tension-free vaginal tape-Secur for female stress urinary incontinence

Background As the third-generation tension-free tape for female stress urinary incontinence （SUI）, tension-free vaginal tape （TVT）-Secur has decreased the common complications associated with TVT and tension-free vaginal tape-transobturator （TVT-O）, such as bladder perforation and obstruction of the bladder outlet; but its efficacy and persistence were still controversial. The aim of this study was to prospectively evaluate and compare the postoperative efficacy and complication at different follow-up time.Methods Patients with SUI, who underwent lVT-Secur treatment in two hospitals from October 2008 to October 2009,were selected. By analyzing preoperative and intraoperative data and postoperative complications, the therapeutic effect and satisfaction at different follow-up stages were evaluated.Results A total of 30 female patients participated in this study. Patients were scheduled for follow-up at the 1st month,3rd month, 6th month and 12th month, while the cure rate was 83.3% （25 patients）, 66.7% （20 patients）, 63.3% （19patients） and 60.0% （18 patients） respectively and the overactive bladder （OAB） symptoms appeared in 11 patients （36.7%）, 10 patients （33.3%）, 6 patients （20%） and 7 patients （23.3%） respectively.Conclusion With the follow-up time becoming longer, TVT-Secur has a high recurrence rate of SUI, the therapeutic effect from the 3rd month to the 12th month is relatively persistent.

Application of tissue engineering in the treatment of stress urinary incontinence

Stress urinary incontinence is one of the most common diseases in urology. The main treatments for stress urinary incontinence are pharmacotherapy, physicobehavioral therapy and surgery.However, the results of present methods are not satisfactory. Tissue engineering is a newly emerging technology that may provide a novel method for the treatment of stress urinary incontinence.

Effectiveness of fractional CO2 laser in women with stress urinary incontinence

BACKGROUND： Stress urinary incontinence （SUI） is a relatively common disorder that significantly affects the quality of life. Many conservative and surgical treatment methods have been recommended for SUI, but they have major limitations. AIMS： To assess the use of the CO2 fractional laser in the treatment of SUI. METHODS： This clinical trial included 55 patients with confirmed SUI. Patients underwent fractional CO2 laser treatment 3 times at 30-day intervals. Data on age, smoking history, sexual activity, menopause, and history of hormone replacement therapy （HRT） were collected. Response to treatment was assessed by SUI severity and the level of sexual satisfaction was assessed using the visual analog scale （VAS）. Patients were evaluated at 3 different time points： before treatment, and 45 days and 6 months after the last laser treatment. RESULTS： The mean patient age was 44.4±11.4 years （range： 28 to 68 years）. Smoking history was positive in 6 patients （9.1%）; 19 （54.3%） were menopausal on HRT. The SUI severity score at baseline （before treatment） was 8.56±0.62 and decreased to 2.28 6 months after treatment （p 〈 0.0001）. The sexual satisfaction score was 3 ± 0.94 at baseline and increased to 7.87±0.93 6 months after treatment （day 180） （p 〈 0.0001, slope = ＋ 2.2） CONCLUSION： Our findings are in line with a previous study that showed the value of transvaginal CO2 fractional laser treatment for alleviation of SUI symptoms and its potential as an alternative treatment. We also observed improved sexual satisfaction in SUI patients.

Medium-term clinical efficacy and safety of single incision and modified trans-obturator mid-urethral slings for female stress urinary incontinence

Aims:To evaluate the medium term efficacy and safety of Altis and Solyx single incision slings(SIS)compared with tension-free vaginal tape(TVT)Abbrevo trans-obturator sling.We hypothesize that both SIS show little difference in efficacy and safety and perform similarly to TVT Abbrevo.Methods:We conducted an ambispective comparative cohort study of women with stress urinary incontinence who received a SIS in comparison to matched TVT Abbrevo subjects from a concurrent randomized controlled trial(RCT).Subjects were identified retrospectively,and prospectively invited for examination and questionnaires>12 months post-operatively.Exclusions included intrinsic sphincter deficiency,previous sling surgery,and others.Primary outcome was subjective cure[negative response to International Consultation Incontinence Questionnaire-Urinary Incontinence Short Form(ICIQ-UI SF)question 6,leakage during coughing/activity].Secondary outcomes include objective cure(negative cough stress test),functional outcomes,and adverse events.Results:Between 2012 and 2018,a total of 113 women received one of two SIS surgeries;Solyx(n=50)followed by the Altis(n=63);104 were available for final efficacy analysis.Mean follow-up was 21.7(Altis),46.0(Solyx),and 29.0(Abbrevo)months.Baseline characteristics were comparable between the groups.There was no significant differences in the subjective or objective cure rates between the groups,and no differences in functional outcomes such as patient global impression of improvement,and post-operative ICIQ-UI SF score.There was a low rate of mesh related complications and no differences seen between the groups.Conclusions:Despite being an underpowered study,Altis and Solyx SIS have favourable efficacy and safety profiles which are comparable to an established trans-obturator mid-urethral slings(MUS).

Inside out transobturator vaginal tape versus tention-free vaginal tape for primary female stress urinary incontinence： meta-analysis of randomized controlled trials

Background Inside out transobturator vaginal tape （TVT-O） and tension-free vaginal tape （TVT） are predominant surgical treatments for female stress urinary incontinence. This meta-analysis evaluated the complications and cure rates of TVT-O versus TVT. Methods A comprehensive literature search was conducted according to the Cochrane Collaboration methodology to identify randomized controlled clinical trials with no language restriction. Two authors independently assessed papers for eligibility and methodological quality. Estimates were measured by relative risk with 95% confidence intervals. Outcome measures were objective cure, subjective cure and complications. Quality rating for each outcome of the meta-analysis and recommendations were performed by the Grading of Recommendations Assessment, Development, and Evaluation （GRADE） system. Results Twenty randomized controlled trials met the inclusion criteria, and a pooled estimate of effectiveness and complications was made. Relative risks with 95% confidence intervals for pooled effects under the fixed effects model were： 0.20 （0.09-0.45）, for bladder injury, 0.37 （0.16-0.86） for hematoma, and 2.35 （1.57-3.51） for postoperative pain, suggesting an 80% risk reduction of bladder injury, 63% risk reduction of hematoma, and a 1.35% risk elevation for postoperative pain with TVT-O. There was no significant difference between complications of urinary tract infection 1.14 （0.78-1.65）, lower urinary tract symptoms 1.60 （0.67-3.79）, recatheterization 0.93 （0.59-1.44）, and tape erosion 0.90 （0.48-1.67）, total objective cure rate 1.06 （0.39-2.84） and for the subjective cure rate 0.98 （0.93-1.04）. The quality rating for each outcome and recommendations was high for objective cure, bladder injury, hematoma, lower urinary tract symptoms, and tape erosion and moderate for subjective cure, pain, and urinary tract infection. Conclusions TVT-O is associated with a reduced risk of bladder injury and hematoma and an elevated risk of postoperative pain. Other complications, including tape erosion,urinary tract infection, lower urinary tract symptoms, and recatheterization, are similar to those of TVT.

Effectiveness of electroacupuncture for female stress urinary incontinence: a systematic review and Meta-analysis

OBJECTIVE:To evaluate the effectiveness of electroacupuncture(EA)for female stress urinary incontinence(SUI).METHODS:We searched 12 databases electronically from inception to November 2018 without language restrictions.We included randomized controlled trials(RCTs)involving women with SUI,but excluded other types of urinary incontinence or studies that were not RCTs.Two independent reviewers extracted study characteristics,with disagreements resolved by consensus.Data were pooled and expressed as mean difference(MD)for continuous outcomes and relative risk(RR)for dichotomous outcomes,with 95%confidence intervals(CI).This study was registered with the International Prospective Register of Systematic Reviews(number CRD42018089734).RESULTS:We found very low to high level evidence that EA improved the effective rate(RR=2.03,95%CI:1.40,2.95;P=0.0002)and reduced urine leakage as measured by the 1-hour pad test(MD=3.33,95%CI:0.89,5.77;P=0.008),International Consultation on Incontinence Questionnaire Short Form score(MD=3.14,95%CI:2.42,3.85;P<0.00001),and 72-hour incontinence episodes(MD=1.17,95%CI:0.56,1.78;P=0.0002)compared with sham electroacupuncture(SA),pelvic floor muscle training,and medication.CONCLUSION:The effectiveness and safety of EA for key outcomes for women with SUI are statistically significantly better than those of SA,but most available evidence is very low or low quality.More well-designed RCTs are needed to confirm these findings.

Simultaneous penile prosthesis and male sling/artificia urinary sphincter

Erectile dysfunction （ED） and stress urinary incontinence （SUI） from urethral sphincteric deficiency is not an uncommon problem. The commonest etiology is intervention for localized prostate cancer and/or radical cystoprostatectomy for muscle invasive bladder cancer. Despite advances in surgical technology with robotic assisted laparoscopic prostatectomy and nerve sparing techniques, the rates of ED and SUI remain relatively unchanged. They both impact greatly on quality of life domains and have been associated with poor performance outcomes. Both the artificial urinary sphincter and penile prosthesis are gold standard treatments with proven efficacy, satisfaction and durability for end-stage SUI and ED respectively. Simultaneous prosthesis implantation for concurrent conditions has been well described, mostly in small retrospective series. The uptake of combination surgery has been slow due in part to technical demands of the surgery and to an extent, a heightened anxiety over potential complications. This paper aims to discuss the technical aspect of concurrent surgery for both disease entity and the current published outcomes of the various surgical techniques with this approach.

Expression and significance of lysyl oxidase-like 1 and fibulin-5 in the cardinal ligament tissue of patients with pelvic floor dysfunction

Pelvic organ prolapse （POP） is a disabling disorder in women characterized by a loss of pelvic floor support, leading to the herniation of the uterus into or through the vagina. POP is a complex problem that likely involves multiple mechanisms with limited therapies available, and is associated with defects in connective tissue including elastic fibers. This study was designed to investigate the expression of fibulin-5 and lysyl oxidase-like 1 （LOXL1） in the cardinal ligament in samples taken from the POP group compared to the non-POP group. Specimens were obtained during abdominal hysterectomy from the cardinal ligament of 53 women with POP and 25 age- and par- ity- matched women with non-POP among post-menopausal women with benign gynecologic pathology. Protein expression was evaluated using the immunohistochemical staining method. For statistical analyses, chi-square test and Spearman＇s correlation were used with the statistical package SPSS13.0 system. Our results showed that both fibulin-5 and LOXL1 expressions were decreased in the cardinal ligament in the POP group compared to the non- POP group （P 〈 0.05）. The expression of fibulin-5 and LOXL1 were correlated closely with the stage of POP, ac- companied by stress urinary incontinence and frequency of vaginal delivery （P 〈 0.05）, but had no relationship with post-menopausal state （P 〉 0.05）. The expression of fibulin-5 was positively associated with LOXL1 in POP （P 〈 0.05）. We conclude that changes in fibulin-5 and LOXL1 expression may play a role in the development of POP.