title: Abnormalities of somatic peptide-containing nerves supplying the pelvic floor of women with genitourinary prolapse and stress urinary incontinence.
abstract: OBJECTIVE
  To test the hypothesis that genital prolapse may be related to peripheral nerve abnormalities, we examined the changes occurring to peptide-containing nerve processes supplying the periurethral muscles in women with stress urinary incontinence associated with prolapse.
  
  
  METHODS
  Thirty patients with genital prolapse and 10 age-matched control subjects entered the study. All patients were evaluated by urodynamic investigations. Ten of 30 patients had pure stress urinary incontinence; none of the control subjects was incontinent. During surgery, four biopsy samples were obtained from each woman from the periurethral and perirectal muscles. The muscle sections were processed for immunohistochemistry using specific antibodies to glial (S-100 protein) and general neuronal markers (neuron-specific enolase) and neuropeptides, including neuropeptide Y, vasoactive intestinal polypeptide, and substance P. The evaluation of immunolabeled nerves was based on a semiquantitative analysis that allowed for a four-point ordinate scale score.
  
  
  RESULTS
  S-100 and neuron-specific enolase immunoreactive nerve fibers, running either singly or in small bundles, along with a dense network of neural processes containing neuropeptide Y, vasoactive intestinal polypeptide, and substance P, were found throughout the connective tissue and striated muscle of the control specimens. In contrast, in the muscle specimens from those with genitourinary prolapse, both the density and the intensity of neuropeptide Y, vasoactive intestinal polypeptide, and substance P immunoreactive nerves were markedly reduced compared with the control specimens.
  
  
  CONCLUSIONS
  The evidence of a reduced peptide-containing nerve supply to the perineal muscles provides a morphologic basis suggesting that neural abnormalities contribute to the pathogenesis of genital prolapse and urinary incontinence.
authors.affiliation: Department of Obstetrics and Gynecology, St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Busacchi
authors.forename: T
authors.initials: T
authors.lastname: Perri
authors.forename: R
authors.initials: R
authors.lastname: Paradisi
authors.forename: C
authors.initials: C
authors.lastname: Oliverio
authors.forename: D
authors.initials: D
authors.lastname: Santini
authors.forename: S
authors.initials: S
authors.lastname: Guerrini
authors.forename: G
authors.initials: G
authors.lastname: Barbara
authors.forename: V
authors.initials: V
authors.lastname: Stanghellini
authors.forename: R
authors.initials: R
authors.lastname: Corinaldesi
authors.forename: R
authors.initials: R
authors.lastname: De Giorgio
mesh_terms: D000368:Aged; D015415:Biomarkers; D001706:Biopsy; D001724:Birth Weight; D003238:Connective Tissue / Q000294:innervation; D003714:Denervation; D005260:Female; D006801:Humans; D008875:Middle Aged; D008959:Models, Neurological; D018482:Muscle, Skeletal / Q000294:innervation / Q000473:pathology; D009419:Nerve Tissue Proteins / Q000032:analysis*; D009474:Neurons / Q000737:chemistry*; D009478:Neuropeptide Y / Q000032:analysis; D009479:Neuropeptides / Q000032:analysis*; D009765:Obesity / Q000150:complications; D010298:Parity; D017773:Pelvic Floor / Q000294:innervation*; D010523:Peripheral Nervous System Diseases / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism; D010751:Phosphopyruvate Hydratase / Q000032:analysis; D017698:Postmenopause; D012007:Rectum / Q000294:innervation; D009418:S100 Proteins / Q000032:analysis; D013373:Substance P / Q000032:analysis; D014521:Urethra / Q000294:innervation; D014550:Urinary Incontinence, Stress / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D014596:Uterine Prolapse / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D014660:Vasoactive Intestinal Peptide / Q000032:analysis
chemical_list: D015415:Biomarkers; D009419:Nerve Tissue Proteins; D009478:Neuropeptide Y; D009479:Neuropeptides; D009418:S100 Proteins; D013373:Substance P; D014660:Vasoactive Intestinal Peptide; D010751:Phosphopyruvate Hydratase