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Objective: To investigate the effects of electroacupuncture pudendal nerve stimulation therapy combined with Kegel pelvic floor rehabilitation training on pelvic floor muscle strength, urodynamics and quality of life in patients with postpartum stress urinary incontinence (SUI). Methods: 109 patients with postpartum SUI who were treated in our hospital from June 2019 to November 2021 were selected. According to the odd and even order of admission, they were divided into two groups, of which 54 cases in the control group, they were received Kegel pelvic floor rehabilitation training, and 55 cases in the study group, they were received electroacupuncture pudendal nerve stimulation therapy combined with Kegel pelvic floor rehabilitation training. The curative effect, urine leakage, degree of urinary incontinence, pelvic floor muscle strength, urodynamics and quality of life were compared between the two groups. Results: The total clinical effective rate of the study group was higher than that of the control group (P<0.05). After treatment, all indexes of pelvic floor muscle strength (hand measured muscle strength, maximum value of class I muscle fiber and average value of class II muscle fiber) increased in the two groups, and the study group was higher than the control group (P<0.05). The amount of urine leakage and the score degree of urinary incontinence in the two groups decreased after treatment, and the study group was lower than the control group (P<0.05). After treatment, the related indexes of urodynamics [abdominal pressure leak point pressure (AL-PP), maximum urinary flow rate (Qmax) and maximum urethral closure pressure (MUCP)] increased in the two groups, and the study group was higher than the control group (P<0.05). After treatment, the scores and total scores of all dimensions (restrictive behavior, psychological influence and limited social activities) of urinary incontinence quality of life scale (I-QOL) increased in the two groups, and the study group was higher than the control group (P<0.05). Conclusion: Electroacupuncture pudendal nerve stimulation therapy combined with Kegel pelvic floor rehabilitation training can effectively improve pelvic floor muscle strength and urinary incontinence in postpartum SUI patients, reduce urinary leakage, promote the recovery of urodynamics, and then improve the quality of life of patients. [ABSTRACT FROM AUTHOR]

BACKGROUND: Cavernous nerve is one of the main nerves regulating penile erection, which is easy to be damaged in pelvis surgery and due to trauma and induce erectile dysfunction. The direct effect of stem cell-derived exosome on the regeneration of injured cavernous nerve has not been reported yet. OBJECTIVE: To observe the effect of the exosomes from adipose-derived stem cells on the regeneration of cavernous nerve. METHODS: Three-dimensional culture model of rat nerve tissue in vitro was constructed. After 24 hours of incubation, the experimental group was incubated in the RPMI-1640 medium containing penicillin-streptomycin and exosomes (1015/L) from adipose-derived stem cells. The control group was incubated in the RPMI-1640 medium. The length of axon regeneration at the incisal edge of the cavernous nerve was measured to evaluate the regeneration ability of the cavernous nerve at 2, 5 and 9 days after intervention. RESULTS AND CONCLUSION: Adipose-derived stem cells extracted from rat perirenal adipose tissue adhered with stable morphology and could be induced to differentiate into adipose, bone and cartilage. The exosomes extracted from the passage 3 adipose-derived stem cells showed similar vesicle structure with a diameter near 85 nm. In the three-dimensional culture system, the regeneration ability of the cavernous nerve itself was certain. The axon regeneration length in the experimental group was significantly longer than that in the control group at 2, 5 and 9 days after intervention. The exosomes from adipose-derived stem cells directly act on the cavernous nerve and have a significant promoting effect on nerve regeneration. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the clinical effect of pudendal nerve electroacupuncture (EAP) on urinary incontinence after radical prostatectomy., Methods: According to the time of hospital visit, we randomly divided 81 patients, aged (68.56 ± 10.47) years, with urinary incontinence after radical prostatectomy into a control (n = 40) and an observation group (n = 41), the former treated by transrectal pelvic floor biofeedback combined with electrical stimulation (qd alt, 50 min/time) and the latter by EAP stimulation of the pudendal nerve at the four sacral points (qd alt, 50 min/time), both for 12 weeks. Before, at 4, 8 and 12 weeks of and 6 months after treatment, we obtained their scores on Urinary Incontinence Questionnaire Short Form (ICI-Q-SF ), urinary incontinence quality of life (I-QOL), Visual Analogue Scale (VAS) and pelvic floor muscle strength (Glazer), and evaluated the effect of 12 weeks of treatment., Results: Compared with the baseline, the ICI-Q-SF, I-QOL, VAS and Glazer scores were significantly improved in the observation group at 4 , 8 and 12 weeks and during the 6-month follow-up (P < 0.05), even more significantly at 12 weeks and 6 months than at 4 and 8 weeks (P < 0.05), and also in the control group (P < 0.05), even more significantly at 6 months than at 12 weeks (P < 0.05). And all the indicators above were even better improved in the observation than in the control group at any point (P < 0.05). The patients in the observation group showed a markedly higher rate of total effectiveness than the controls at 12 weeks (73.17% ［30/41］ vs 37.50% ［15/40］, P < 0.05)., Conclusions: EAP stimulation of the pudendal nerve is safe and has a good long-term effect in the treatment of urinary incontinence after radical prostatectomy, and therefore can be used as a first-choice conservative therapeutic strategy for this condition.

Objective: To investigate the protective effect of human urine-derived stem cells (USCs) on erectile function and cavernous structure in rats with cavernous nerve injury (CNI)., Methods: Sixty adult male SD rats with normal sexual function were randomly divided into four groups of equal number: sham operation, bilateral CNI (BCNI) model control, phosphate buffered saline (PBS), and USC. The BCNI model was established in the latter three groups of rats by clamping the bilateral cavernous nerves. After modeling, the rats in the PBS and USC groups were treated by intracavernous injection of PBS at 200 μl and USCs at 1×106/200 μl PBS respectively for 28 days. Then, the maximum intracavernous pressure (mICP) and the ratio of mICP to mean arterial pressure (mICP/MAP) of the rats were calculated by electrical stimulation of the major pelvic ganglions, the proportion of nNOS- or NF200-positive nerve fibers in the total area of penile dorsal nerves determined by immunohistochemical staining, the levels of endothelial cell marker eNOS, smooth muscle marker α-SMA and collagen I detected by Western blot, and the smooth muscle to collagen ratio and the cell apoptosis rate in the corpus cavernosum measured by Masson staining and TUNEL, respectively., Results: After 28 days of treatment, the rats in the USC group, as compared with those in the PBS and BCNI model control groups, showed significant increases in the mICP (［81 ± 9.9］ vs ［31 ± 8.3］ and ［33 ± 4.2］ mmHg, P <0.05), mICP/MAP ratio (0.72 ± 0.05 vs 0.36 ± 0.03 and 0.35 ± 0.04, P <0.05), the proportions of nNOS-positive nerve fibers (［11.31 ± 4.22］% vs ［6.86 ± 3.08］% and ［7.29 ± 4.84］% , P <0.05) and NF200-positive nerve fibers in the total area of penile dorsal nerves (［27.31 ± 3.12］% vs ［17.38 ± 2.87］% and ［19.49 ± 4.92］%, P <0.05), the eNOS/GAPDH ratio (0.52 ± 0.08 vs 0.31 ± 0.06 and 0.33 ± 0.07, P <0.05), and the α-SMA/GAPDH ratio (1.01 ± 0.09 vs 0.36 ± 0.05 and 0.38 ± 0.04, P <0.05), but a remarkable decrease in the collagen I/GAPDH ratio (0.28 ± 0.06 vs 0.68 ± 0.04 and 0.70 ± 0.10, P <0.05). The ratio of smooth muscle to collagen in the corpus cavernosum was significantly higher in the USC than in the PBS and BCNI model control groups (17.91 ± 2.86 vs 7.70 ± 3.12 and 8.21 ± 3.83, P <0.05) while the rate of cell apoptosis markedly lower in the former than in the latter two (3.31 ± 0.83 vs 9.82 ± 0.76, P <0.01; 3.31 ± 0.83 vs 9.75 ± 0.91, P <0.05)., Conclusions: Intracavernous injection of USCs can protect the erectile function of the rat with cavernous nerve injury by protecting the nerves, improving the endothelial function, alleviating fibrosis and inhibiting cell apoptosis in the cavernous tissue.

Objective: To explore the effects of immediate and delayed intracavernous injection of bone marrow mesenchymal stem cells (BM-MSCs) on neurogenic erectile dysfunction (NED) induced by bilateral cavernous nerve injury in Sprague-Dawley (SD) rats., Methods: BM-MSCs isolated from male SD rats were cultured and identified. Twenty-eight 8-week-old male SD rats were randomly divided into four groups, sham operation, NED model control, BM-MSCs immediate, and BM-MSCs delayed, and NED models were established in the latter three groups by crushing the bilateral cavernous nerves. The rats in the sham operation and model control groups were injected intracavernously with placebo while those in the latter two with BM-MSCs immediately or 2 weeks after modeling. At 12 weeks after operation, the penile function of the rats was assessed according to the penile intracavernous pressure (ICP), mean arterial pressure (MAP), and ICP/MAP ratio obtained from different groups of rats. Then, all the animals were sacrificed and the penile cavernosal tissue collected for histological analysis., Results: At 12 weeks after modeling, both ICP and ICP/MAP were significantly increased in the BM-MSCs immediate and delayed groups as compared with those in the model control (P <0.05), and so were the ratio of smooth muscle to collagen (P <0.05) and the smooth muscle content in the corpus cavernosum (P <0.05), and the number of neurofilament (NF)-positive nerve fibers (P <0.05) and the expression of neuronal nitric oxide synthase (nNOS) in the dorsal nerves of the midshaft penis (P <0.05)., Conclusions: Intracavernous injection of BM-MSCs can improve erectile function in rats with bilateral cavernous nerve injury by elevating the smooth muscle-collagen ratio and smooth muscle content in the corpus cavernosum and thus preventing its fibrosis as well as by increasing the number of NF-positive nerve fibers and expression of nNOS in the penile dorsal nerves.