Effect of myogenic stem cells on the integrity and histomorphology of repaired transected external anal sphincter.

INTRODUCTION AND HYPOTHESIS: The objective was to evaluate the effect of myogenic stem cells on histological properties and the volume of striated muscle of the external anal sphincter after transection and repair. METHODS: Histological analysis was performed on the external anal sphincters of 40 young female rats euthanized at 7 or 90 days after transection and repair and randomization to injection of either phosphate buffered solution (PBS) or myogenic stem cells (SC) at the transection site. Sphincter complexes, previously evaluated for neurophysiological function, were processed for histology and analyzed for possible disruption, amount of inflammation, and volume of striated muscle. The relationship between the muscular disruption and contractile force of sphincters was evaluated. RESULTS: Disruption was seen in 100 % of sphincters 7 days after repair for both SC and control animals. Eighty-nine percent of controls and 78% of SC-administered animals had intact sphincters at 90 days. Significant inflammatory infiltrate was seen in repaired anal sphincters for both the PBS and the SC groups at 7 days, and persisted at 90 days, with no difference between treatment groups. Striated muscle volume increased from 7 to 90 days for both control and SC-administered animals. Although there was no difference in volume between treatments, there was substantial temporal improvement in contractile force generation of the sphincters receiving SC compared with those receiving PBS. CONCLUSION: In this animal model, administration of myogenic stem cells to transected/repaired anal sphincters did not alter the amount of inflammation nor the volume of striated muscle, suggesting that stem cells might improve contractile function through other cellular processes.

Apical vaginal prolapse surgery: practice patterns and factors guiding route of repair.

OBJECTIVES: Describe current trends for repair of primary and recurrent apical vaginal prolapse using 4 different approaches, namely, transvaginal native (TVN) tissue, transvaginal using graft, laparotomy, or laparoscopic/robotic, and to determine which factors influence decision for favored approach. METHODS: A 15-item survey was distributed to attendees of the 2011 Society of Gynecologic Surgeons meeting. Demographic data and percentages of routes of repair were collected. Twenty factors were graded on the importance for influencing surgical approach. RESULTS: Transvaginal native tissue was the preferred route for primary repair (mean, 53.0%), and laparoscopic/robotic for recurrent repair (33.8%). Surgeons in academic practices, without formal postresidency training, and with lower surgical volumes were more likely to elect TVN for primary repair than alternatives. Important factors in selection of surgical approach included patient age and severity of medical comorbidities. CONCLUSIONS: Among the Society of Gynecologic Surgeons meeting attendees, TVN is the preferred primary route for apical prolapse repair. Laparoscopic-assisted repairs are more common for recurrent prolapse.