John C. Kefer MD, PhD, Firouz Daneshgari, MD

Glickman Urological Institute, Cleveland Clinic, Cleveland, OH

Introduction: The detailed studies of the female urethra by Petros and Ulmsten indicate that a deficient pubo-urethral ligament (PUL) may lead to urethral mobility and stress urinary incontinence (SUI). The PUL attachments lie between the ventral surface of the urethra and the pubic bone, and Petros and Ulmsten have described the role of the PUL as an “integral theory” into the pathophysiology of SUI. Hypermobility of the PUL has been demonstrated in women with SUI, but the precise functional changes of PUL-deficiency remain unclear. We investigated the role of PUL-deficiency in altering leak point pressures (LPP) in a rat model of SUI.

Materials and Methods: A total of 22 female age-matched Sprague-Dawley rats (Harlan, Indianapolis, Indiana) were randomly assigned to 1 of 5 groups: PUL-transection or sham-PUL transection with LPP measured at 4 days or 10 days post-op, and pudendal nerve transection (PNT) with LPP measured at 4 days post-op. Four or ten days post-procedure the leak point pressure was determined using anesthesia in each animal via a previously implanted suprapubic catheter. Wilcoxon rank sum tests were used to evaluate whether levels of measurements differed across and between groups

Results: The PUL-transection group demonstrated significantly decreased LPP compared to the sham group at 4 days (16.3 cm vs. 36.6 cm H2O, p<0.00001) and 10 days (17.6 vs. 31.2 cm H2O, p<0.00001). The PNT group was also significantly lower than the sham group at 4 days (14.5 vs. 36.6 cm H2O, p<0.00001), and there was no difference between the PUL-transection group and the PNT group at 4 days (16.3 vs. 14.5 cmH20, p<0.44).

Conclusion: The data demonstrate that deficiency of the PUL plays a role in SUI. Our newly created PUL-deficient rat model decreases the LPP leading to SUI in the short-term. This animal model could be used to address research questions related to SUI and its treatment relevant to the pubo-urethral ligament.

UroToday.com Coverage of SUFU 2007

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