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1 Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio, United States; Research Service, Louis Stokes Cleveland VA Medical Center, 10701 East Boulevard, Cleveland, Ohio, 44106, United States
2 Glickman Urological Institute, Cleveland Clinic, Cleveland, Ohio, United States
3 Research Service, Hines VA Hospital, Hines, Illinois, United States
4 Rush University, United States
* To whom correspondence should be addressed. E-mail: damasem{at}ccf.org.
The pudendal nerve innervates the external urethral sphincter (EUS) and is among the tissues injured during childbirth, which may lead to symptoms of stress urinary incontinence (SUI). To understand the mechanisms of injury and repair, urethral leak point pressure (LPP) was measured 4 days, 2 weeks, or 6 weeks after bilateral pudendal nerve crush. Morphometric changes in the distal nerve and EUS were examined using light and electron microscopy. To determine if recovery resulted from pudendal neuroregeneration, LPP was measured before and after pudendal nerve transection 2 weeks after nerve crush. LPP was significantly decreased 4 days after pudendal nerve crush compared to sham animals as well as 2 or 6 weeks after nerve crush. LPP was not significantly different 2 or 6 weeks after nerve crush compared to sham animals, suggesting that urethral function had returned to normal. Four days after pudendal nerve crush, the EUS branch of the pudendal nerve distal to the injury site showed evidence of nerve degeneration, and the EUS appeared disrupted. Two weeks after nerve crush, the distal nerve and EUS both showed evidence of both nerve degeneration and recovery. Two weeks after nerve crush, LPP was significantly decreased after nerve transection. Six weeks after nerve injury, evidence of neuroregeneration was observed in the pudendal nerve and the EUS. This study has demonstrated that functional recovery and neuroregeneration are significant 2 weeks after nerve crush although by anatomic assessment, recovery appears incomplete, suggesting that 2 weeks represents an early time point of initial neuroregeneration.
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