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Background: Pelvic floor dysfunction (PFD), mainly including stress urinary incontinence (SUI) and pelvic organ prolapse (POP), is escalating at an alarming rate globally, bringing a significant economic burden. The incapacity of nerves and muscles to regenerate following damage incurred during vaginal delivery potentially stands as a pivotal mechanism contributing to PFD. Objectives: While a consensus on the precise role and mechanism of the pelvic nerve in the pathogenesis of PFD remains elusive, numerous studies have delved into the relationship between PFD and the pelvic nerve. The analysis aims to elucidate the intricate workings of pelvic nerves in the context of these conditions, encompassing their mechanisms of action, the design of animal models, assessment methods, and the trajectory of research, and provides a foundation and inspiration for future neuro-centric investigations into PFD. Search Strategy: To encompass all potentially pertinent articles, four independent investigators conducted a thorough search on both PubMed and CNKI, with the last search executed on January 20, 2024. The retrieval process amalgamated all pertinent Medical Subject Headings (MeSH) terms. Selection Criteria: Records excluded Review, Book, etc.; retrieved; full text found; SUI and POP; assessment methods related pelvic nerve. Data Collection and Analysis: Five independent investigators extracted a range of data from each study using a standardized data-collecting form: article, title, first author, publication year, experimental groups, evaluation time, evaluation method, conclusions. All relevant data is contained within the 61 included articles. Main Results: This systematic review includes a total of 61 articles, including 32 animal or cell research, 12 human tissue research, and 17 clinical research. The vaginal dilation (VD) model, utilizing a 3ml balloon to expand the vagina for 4 hours and the pudendal nerve transection (PNT) model, achieved through the bilateral crushing of pudendal nerves, and the assessment of neurological damage in women tissue samples are currently well-established. Various electrical stimulation treatments, including Sacral neuromodulation, Electroacupuncture, Transcutaneous Mechanical Nerve Stimulation (TMNS), Electrical stimulation of pudendal nerve (EPNS), targeting the pelvic nerve have also been proven effective. Conclusions: The animal model related to POP and SUI are currently well-established, which have significantly different stress areas within the pelvic floor structure with human. Consequently, the findings derived from all animal models should be applied to human subjects with careful consideration. The precise mechanism of pelvic nerves in POP remains elusive based on existing research, however, relevant literature research generally believes that the pathogenesis of POP and SUI is closely related to the pelvic nerve. This highlighting a direction that demands additional endeavors and potentially necessitates further relevant experimental studies for validation.
Shen et al. (Thu,) studied this question.