"Locus minoris resistentiae" and connective tissue weakness in older women: a case report and literature review on pelvic organ prolapse with inguinal bladder hernia.

BACKGROUND: Conditions such as genital prolapse and hernia are known to be related to connective tissue dysfunction. In this report on cases of the rare simultaneous finding of large genital prolapse and post-prolapse repair female inguinal bladder hernia, we aim to contribute to the discussion of a possible clinical definition of connective tissue weakness, for its clinical assessment and preoperative patient counselling. CASE PRESENTATION: Three cases of medial third-grade (MIII, Aachen classification) inguinal bladder hernia developing or enlarging after successful stage-IV pelvic organ prolapse (POP) repair at a university pelvic floor centre are presented. All patients were aged ≥ 80 years with long-standing postmenopausal status. One patient was followed for 5 years and two patients were followed for 6 months. In all patients, ultrasound revealed that the hernia sac contained the urinary bladder, which had herniated through the inguinal hernia orifice. A literature search revealed only one case report of direct female inguinal bladder hernia and few investigations of the simultaneous occurrence of POP and hernia in general. CONCLUSION: The simultaneous occurrence of inguinal hernia and female POP can lead to bladder herniation following prolapse surgery in the sense of a "locus minoris resistentiae". Clinical examination for simultaneous signs of connective tissue weakness and counselling prior to pelvic reconstructive surgery could help to increase patients' compliance with further surgical treatment for hernia.

Inverse correlation between urethral length and continence before and after native tissue pelvic floor reconstruction.

Urethral length was evaluated retrospectively in patients with prolapse undergoing anterior native-tissue repair. Effects of age, prolapse stage, defect pattern, urodynamic and clinical stress test findings, and tension-free vaginal tape (TVT) surgery indication were analyzed using Mann-Whitney and Wilcoxon tests and linear and logistic regression. Of 394 patients, 61% had stage II/III and 39% had stage IV prolapse; 90% of defects were central (10% were lateral). Median pre- and postoperative urethral lengths were 14 and 22 mm (p < 0.01). Preoperative urethral length was greater with lateral defects [p < 0.01, B 6.38, 95% confidence interval (CI) 4.67-8.08] and increased stress incontinence risk (p < 0.01, odds ratio 1.07, 95% CI 1.03-1.12). Postoperative urethral length depended on prolapse stage (p < 0.01, B 1.61, 95% CI 0.85-2.38) and defect type (p = 0.02, B - 1.42, 95% CI - 2.65 to - 0.2). Postoperatively, TVT surgery was indicated in 5.1% of patients (median 9 months), who had longer urethras than those without this indication (p = 0.043). Native-tissue prolapse repair including Kelly plication increased urethral length, reflecting re-urethralization, particularly with central defects. The functional impact of urethral length in the context of connective tissue aging should be examined further.

Preweaning experience as a modifier of prenatal drug effects in rats and mice--a review.

The effects of preweaning experience in rats and mice on neuroendocrine and behavioral end points and their implications for prenatal drug effects are reviewed. The hypothalamo-pituitary-adrenal axis and the dopaminergic system were shown to be affected. Behavior related to hippocampal, adrenocortical functions and to the benzodiazepine receptor system was also modified. Other paradigms (nociception, conditioned taste aversion) exhibited susceptibility to such preweaning manipulations also. The effects of these early experiences seem to be mediated through complex factors including neuroendocrine responses of the pup to hypothermia and a permanent alteration of mother-infant interactions, with subsequent effects on neuroendocrine functions that are important for postnatal brain organization. Studies of interactions between prenatal drug effects and preweaning manipulations have been performed only with ethanol. When extending this work to other compounds, the systems and functions described above may provide some guidance in looking for possible interactions. In most cases the preweaning manipulations alleviated the effects of prenatal ethanol exposure. These findings may have important implications regarding the controversy about environmental influences affecting the outcome of exposure to neurobehavioral teratogens.

Effects of prenatal ethanol exposure and early experience on radial maze performance and conditioned taste aversion in mice.

C57BL/6 mice were intubated on gestational days 14-18 twice daily with 1.58 g/kg ethanol, 4.2 g/kg sucrose, or remained untreated. Offspring of ethanol-treated or lab chow control groups were raised either by group-housed dams and weaned on postnatal day (PND) 28 (enriched condition), or by individually housed dams and weaned on PND 21 (standard condition). Offspring of the sucrose control group were raised by individually housed dams and weaned on PND 21. Groups did not differ in pup weight or litter size. Male and female offspring were assessed for performance in an unbaited radial maze (PND 45-52) and male offspring only were tested for conditioned taste aversion (PND 54-59). As hypothesized, mice prenatally exposed to ethanol and raised under standard conditions failed to develop the conditioned taste aversion response. In contrast, subjects with in utero ethanol exposure that were raised under enriched preweaning conditions developed the taste aversion response. Maze performance improved significantly over days, but no significant effects were detected for either prenatal treatment or preweaning rearing conditions. In conclusion, enriched preweaning rearing conditions abolished the detrimental effects of prenatal ethanol exposure on conditioned taste aversion, but radial maze performance remained unaffected by any treatment in this study.

Differential effects of communal rearing and preweaning handling on open-field behavior and hot-plate latencies in mice.

On day 2 after delivery, dams of the DBA/1 mouse inbred strain (n = 20/group) with their litter were allocated to one of the following groups: NH21, nonhandling, housed 1 litter/cage, weaned on postnatal day (PND) 21;H21, handling, housed 1 litter/cage, weaned on PND 21; NH30, nonhandling, group-housed (5 litters/cage), weaned on PND 30; H30, handling, group-housed (5 litters/cage), weaned on PND 30. Two male pups of each litter were color marked on PND 2. From PND 8-21 they were removed from their cage, gently held in the experimenter's hand for 5 min/day. The two marked males of each litter were housed together after weaning, and tested in the open-field on PNDs 51-53, and one of each of these siblings was tested for hot-plate latencies on PND 54. Being raised in group-housing and weaned on PND 30 resulted in offspring exhibiting shorter latencies to initiate behavior and higher percentages of centerfield entries in the open field, hot-plate latencies, however, remained unaffected. Preweaning handling increased hot-plate latencies and the number of grooming episodes in the open field, and it decreased defecation, percent centerfield entries and open-field activity in general. It is concluded that the two forms of early experience have different effects on neurobehavioral endpoints 8 weeks after birth.

Effects of prenatal ethanol exposure and early experience on home-cage and open-field activity in mice.

-C57BL/6 mice were intubated from gestational day 14-18 twice daily with 1.58 g/kg ethanol, 4.2 g/kg sucrose, or remained untreated. Offspring of ethanol treated or lab chow control groups were raised either by group-housed dams and weaned on postnatal day (PND) 28 or by individually housed dams and weaned on PND 21. Offspring of the sucrose control group were raised by individually housed dams and weaned on PND 21. Groups did not differ in pup weight or litter size. Offspring were assessed for home-cage activity (PND 36-38) and open-field behavior (PND 40-42). Mice prenatally exposed to ethanol showed increased activity in their home cages, whereas open-field behavior was generally not different from that of control groups. Conversely, different preweaning rearing conditions had affected open-field behavior, but not home-cage activity. In conclusion, home-cage behavior was a sensitive paradigm for detecting hyperactivity subsequent to a relatively low dose of prenatal ethanol in mice, and communal nesting/late weaning vs. individual nesting/ standard weaning may be a useful preweaning environmental manipulation to study possible modifications of prenatal neurobehavioral effects.