Presentation Authors: Olivia Giovannetti, Madeline Monaghan, Kingston, Canada, Johanna Hannan*, Greenville, NC, Barry Komisaruk, Newark, NJ, Sue Goldstein, Irwin Goldstein, San Diego, CA, Michael Adams, Kingston, Canada
Introduction: The female periurethral tissue (FPT) contains numerous glands staining positive for prostate specific acid. These glands are surrounded by neuronal and vascular structures, and may have physiologic contribution to sexual function. The PFT is located adjacent to the anterior vaginal wall epithelium and surrounds the urethra passing distally from the bladder neck to the meatus. Decreased sexual function, especially lowered orgasm satisfaction has been reported following mid-urethral sling procedures to treat stress urinary incontinence, and requires further investigation of this possible iatrogenic effect. Cadaver studies have shown the mid-urethral sling transects through the glandular, neuronal, and vascular structures of the PFT. The goal of this new research is to further histologically characterize the PFT and examine patterns of innervation in relation to its specific morphological features.
Methods: Histologic and immunohistochemical investigations of glandular, vascular, and nervous structures of the FPT were examined from three fresh human female cadavers. The region of PFT examined was located in the same location of implanted mid-urethral slings.
Results: Positive staining for Anti-Nav 1.8 (sodium channel NaV 1.8), Anti-TH (tyrosine hydroxylase), and Anti-ChAT (choline acetyl transferase) indicated the presence of sensory, sympathetic, and parasympathetic innervation, respectively. The patterns of innervation of glandular and vascular structures varied depending on the type of innervation received. Nerve fibers were also located and stained positively for these three specific stains. Not all nerve subpopulations that stained positively for PGP9.5 were identified with the specific immunohistochemistry used in this investigation, and further immunohistochemistry is needed to stain for possible non-adrenergic non-cholinergic innervation. The qualitative analysis of serial tissue sections demonstrated multiple types of innervation of blood vessels and glandular tissue, and the existence of nerve fibers.
Conclusions: The glandular, vascular, and neuronal structures of the FPT have multiple types of innervation consistent with a physiologic functioning organ, likely involved in female sexual response. Future studies will aim to: 1) further classify the subpopulations of nerves to correlate nerve type with female sexual responses, and 2) assess surgical modifications of mid-urethral sling placements to reduce risk of post-surgical sexual dysfunction.