Childbirth Injury Research Articles

Obstetric Vesico-vaginal Fistulae: A Documentary Review of Women Managed in Mendefera Zonal Referral and National Fistula Hospital, Eritrea

Background: obstetric fistula is a devastating childbirth injury as a result of obstructed labor. It leads to chronic urinary incontinence and, in most cases, significant physical and emotional suffering. Its prevalence is high in Sab-Sahara African and South Asian countries. The objective of this study is to determine the incidence and describe the characteristics of women with obstetric Vesico-vaginal fistula. Methods: A retrospective cross-sectional study was conducted in all obstetric vesico-vaginal fistula patients. Patient identification performed through review of prerecorded logbook and patient card describing each patient admitted to fistula ward over a period of five years from January 1st 2014 to December 31, 2018. Medical records were reviewed to obtain data on socio-demographic and obstetric characteristics, clinical details, and treatment. Statistical analysis was performed using STATA-9. Results: There were 146 women with Vesico-vaginal fistula (VVF) admitted to the fistula hospital over the study period; of which 144 of them were obstetric fistula. During the study period the total number of health facility deliveries in Eritrea was 217,119 giving an estimated rate of obstetric VVF of 0.7/1000 facility deliveries. The median age, parity, and number of live births was 30, 3, and 2, respectively. One quarter (n=37) of the cases being in the age group of 20years or younger. The highest incidence of VVF (38%) was observed in Primiparous. 75% gave birth in a health facility, 54% of deliveries were by caesarean section, and 80% of babies were stillborn. 77% of repairs were successful. Conclusion: The incidence of fistula in Eritrea is relatively low as compared to other sub-Saharan African countries. In this study, age at fistula development was older than usually found, which might be due to poor access to emergency obstetric care (EmOC) that contributed more to this problem.

Leaving no one behind: Is the achievement of the Sustainable Development Goals possible without securing the dignity, rights, and well-being of those who are "invisible"?

The persistence of obstetric fistula—a devastating childbirth injury occurring largely among poor, marginalized women and girls—constitutes a human rights violation and a public health crisis. The Sustainable Development Goals (SDGs) aim to “leave no one behind.” Failing to eliminate fistula jeopardizes attainment of several of the SDGs. Member States of the United Nations adopted a UN Resolution on ending fistula in 2018, calling for an end to fistula within a decade. Building upon recommendations of the UN Secretary General's 2018 Report on Obstetric Fistula, the Resolution calls for significantly increased commitments and investments to end fistula. Crucial interventions for eliminating fistula include high‐quality, equitable, accessible health systems; implementing costed national strategies for eliminating fistula; integrating fistula into national plans to achieve the SDGs; strengthening national fistula task forces; and significantly increased, sustained financial support. Fistula elimination necessitates protecting women's/girls’ human rights and addressing social determinants that affect women's/girls’ ability to “survive, thrive and transform,” including social and economic inequities; gender‐based violence; child marriage and early childbearing; and access to education. Enhanced awareness‐raising and advocacy; improved research, data, monitoring and evaluation; holistic social reintegration and survivor empowerment; and community engagement are additional key strategies for realizing this ambitious goal.

Comparing birth experience and birth outcome of vaginal births between induced and spontaneous onset of labour: a prospective study.

In developed countries, around 25% of all births involve labour induction. Studies have indicated that labour induction negatively influences the birth experience as well as the birth process. However, the impact of labour induction when only considering vaginal deliveries has not been studied yet, which was the purpose of the present study. 186 women who gave birth vaginally took part in this prospective study. 95 women gave birth after spontaneous onset of labour (SL-group) and 91 women received a labour induction (LI-group). Eight to 72h after birth, the women filled in the revised version of the standardised Childbirth Experience Questionnaire, which examines the birth experience in four dimensions (Own Capacity, Perceived Safety, Participation and Professional Support). Medical details regarding birth and fetal outcomes were taken from the medical records. Birth outcomes (the number of epidural anaesthesia, the duration of birth, birth risks and childbirth injuries) as well as fetal outcomes (APGAR after 1 and 5min and arterial cord pH) did not differ between the groups. Regarding the subjective birth experience, the LI-group indicated significantly lower values for Perceived Safety and Participation compared to the SL-group, while there were no differences for the dimensions Own Capacity and Professional Support. Successful labour induction resulting in a vaginal birth did not negatively influence birth and fetal outcomes and only partly affected the women's birth experience. The negative impact of labour induction on the dimensions Perceived Safety and Participation should sensitize midwives in order to provide optimal support.

Abstract 214: Stroke Epidemiology in the State of Maine 2010-2014

Purpose: Maine’s stroke prevalence/mortality is highest of New England states, yet US mortality rates are in decline overall. We hypothesized that the epidemiology of stroke in Maine has unique characteristics to explain the disparity; that a high mortality rate is due to geography, aging and non-traditional factors such as polysubstance abuse or cancer. Objective: This study aims to identify local determinants for in hospital mortality stroke in Maine, comparing demographics, clinical factors and access to certified stroke centers. Design/ Methods: As a descriptive study using all Maine inpatient stroke related discharge data: demographics, diagnosis, procedure codes and disposition from Maine Health Data Organization (MHDO), stroke was classified as ischemic, hemorrhagic, and Transient Cerebral Ischemia. Traditional risk factors include: age, sex, hypertension, diabetes mellitus, tobacco use, atrial fibrillation, left ventricular hypertrophy and dyslipidemia. Clinical nontraditional risk factors: sleep apnea, neoplasm, mental disorders and polysubstance and alcohol abuse. Zip codes were used to determine driving distance of one hour or more from certified stroke centers; Maine has only three. Statistical Analysis: Cases with complete data were included. Excluded were diagnostic codes for pregnancy, childbirth, puerperium, preeclampsia, eclampsia or traumatic brain injury; cases of ICD-9-CM codes for epidural and subdural hematoma; and ill-defined cerebrovascular disease or late effects of cerebrovascular disease. Descriptive statistics identified stroke characteristic. Multiple linear regression analyses identified associations between in hospital mortality due to stroke and age, gender, clinical factors, and driving distances to identify the independent predictors. Analyses were done using SPSS software version 21. Results: From 2010-2014, 13,857 hospital stroke diagnoses represented 2% of all Maine discharges. Mean age for all stroke events was 73 (± 14 years), and 52% were female. Overall, ischemic strokes accounted for 66% of all stroke discharges followed by TIA (19%) and hemorrhagic (15%). There were no statistically significant changes in mortality rate during the five year period. A Multiple logistic regression model showed associations with older age, atrial fibrillation, neoplasm, and more than one hour to a certified stroke center; and a negative trend for traditional factors. Maine had lower prevalence of Hypertension, Diabetes mellitus and tobacco use when compared with national rates (50% vs. 74%; 24.6% vs. 30%; 13.6% vs. 17% respectively). Conclusion: Maine local determinants for in hospital stroke mortality include: limited access to a certified stroke center and an older population. Other concomitants conditions for risk include atrial fibrillation and neoplasm.

Demographic and Clinical Profiles of Blood Transfusion Recipients at a Teaching and Referral Hospital in Kenya

Background: Blood transfusion is an essential component of modern health care. It is required universally to manage various medical, surgical and obstetric conditions. Establishing the profiles of blood recipients would help in predicting the long term needs of blood transfusion as changing patterns of populations, diseases and health care will result in changing demands for blood and blood components. The objective of the study was to determine the pattern of blood use in terms of demographic and clinical profiles of the recipients. Methods: A hospital based medical chart review of 384 patients who were transfused from June 2013 to November 2013 was carried out. Systematic random sampling method was used; data were collected using a structured data collection form and was analyzed using frequency tables. Results: The median age of the recipients was 31.5 years (IQR 13, 45.8) and the range was 0 to 89 years. Females comprised 55.2% of the recipients, of which 57.7% were in the reproductive age group (15 - 49 years). The majority of the recipients (60%) were from surgical and medical wards. The main indication of the transfusion was anaemia (62.8%) and most of the transfused patients were being treated for neoplasms (23.2%), pregnancy and childbirth related conditions (11.7%), injuries (11.5%) and infections (11.4%). Conclusion: Majority of the transfused patients were relatively young and were females. Anemia was the main indication of the transfusion and most of the transfused recipients presented with neoplasms, pregnancy and childbirth related conditions, infections and injuries.

Enhancing Holistic Care of Patients with Obstetric Fistula and Other Childbirth Injuries -TERREWODE’s Experience of Developing a Dedicated Fistula Hospital in Uganda

Aims: To document experiences of establishing state of the art women’s hospital offering holistic care to women with obstetric fistula and other child birth injuries. The care includes comprehensive treatment and management of the affected women, reintegration services that support the restoration of women’s dignity and clinical for prevention
 Methods: TERREWODE Women’s Community Hospital (TWCH) founded in 2016 is a subsidiary of The Association for Rehabilitation and Re-Orientation of Women for Development (TERREWODE), a Ugandan Non-Government Organization. We received, funding and support from International Fistula Alliance ,Ugandan Fistula Fund for TERREWODE, Catherine Hamlin Fistula Foundation, Hamlin Fistula USA and Hamlin Fistula Ethiopia.
 Results: The first phase has a 30-bed fistula surgical block and 30-bed rehabilitation and reintegration center, in addition to administration, catering and support facilities. This community-focused hospital will provide holistic routine care to patients with obstetric fistula and other childbirth injuries. It will also conduct: health education, research, Continuous Professional Development, patient rehabilitation and reintegration. On completion other services will include: conducting deliveries, neonatal care, and Antenatal care and family planning services. Up to 600 surgeries annually will be conducted in the unit. This will decongest public health facilities and reduce current backlog. Our critical success factors include: ability to attract and retain highly qualified and self-motivated personnel; our relationship with key stakeholders including Ministry of Health, suppliers, development partners and our target beneficiaries.
 Conclusions: It is possible with collaboration to establish specialized units offering quality care to women with birth trauma. Our experience can be replicated in other settings.

Childbirth injuries encountered on outreach in remote RDCongo

Aims: This paper describes childbirth injuries encountered in remote DR Congo. Causes of identified injuries and their surgical repair outcomes are outlined.
 Methods: Through community awareness activities, patients with urinary or fecal incontinence were mobilized to report for care. Records from patients examined during outreach surgical camps in the Nord-Ubangi province from January to June 2018 were reviewed.
 Results: A total of 151 patients, ages 16-72 years, were attended for urinary and/or fecal incontinence after childbirth. Among 105patients who reported with urinary incontinence, 103 had vesico-vaginal fistulae that were classified as type I or type II (77 (77/103, 74.8%) patients) and type III of Waaldjik (26 (25.2%) patients). Two patients had urinary incontinence secondary to a small bladder.Among 46 patients who came complaining of fecal incontinence, 15 (15/46, 32.6%) patients had recto-vaginal fistulae while 31 (31/46, 67.4%) patients had third or fourth degree perineal tears.
 Vaginal delivery (79.2%), caesarean section (16.1%) and hysterectomy (4.7%) caused observed injuries.84.2% of the urinary incontinence group and 86.7% of the fecal incontinence group were dry and continent after repair.
 Conclusions: Genito-urinary fistulae were predominant among childbirth injuries encountered in remote DRCongo. Vaginal delivery was the leading cause of childbirth injuries. Surgical repair success rates were high.

Fate of mesoangioblasts in a vaginal birth injury model: influence of the route of administration

Currently cell therapy is considered as an experimental strategy to assist the healing process following simulated vaginal birth injury in rats, boosting the functional and morphologic recovery of pelvic floor muscles and nerves. However, the optimal administration route and dose still need to be determined. Mesangioblasts theoretically have the advantage that they can differentiate in skeletal and smooth muscle. We investigated the fate of mesoangioblasts transduced with luciferase and green fluorescent protein reporter genes (rMABseGFP/fLUC) using bioluminescence, immunofluorescence and RT-PCR in rats undergoing simulated birth injury. rMABseGFP/fLUC were injected locally, intravenously and intra-arterially (common iliacs and aorta). Intra-arterial delivery resulted in the highest amount of rMABseGFP/fLUC in the pelvic organs region and in a more homogeneous distribution over all relevant pelvic organs. Sham controls showed that the presence of the injury is important for recruitment of intra-arterially injected rMABseGFP/fLUC. Injection through the aorta or bilaterally in the common iliac arteries resulted in comparable numbers of rMABseGFP/fLUC in the pelvic organs, yet aortic injection was faster and gave less complications.

Out of the shadows and 6000 reasons to celebrate: An update from FIGO's fistula surgery training initiative.

Obstetric fistula is a devastating childbirth injury caused by unrelieved obstructed labor. Obstetric fistula leads to chronic incontinence and, in most cases, significant physical and emotional suffering. The condition continues to blight the lives of 1-2 million women in low-resource settings, with 50000-100000 new cases each year adding to the backlog. A trained, skilled fistula surgeon is essential to repair an obstetric fistula; however, owing to a global shortage of these surgeons, few women are able to receive life-restoring treatment. In 2011, to address the treatment gap, FIGO and partners released the Global Competency-Based Fistula Surgery Training Manual, the first standardized curriculum to train fistula surgeons. To increase the number of fistula surgeons, the FIGO Fistula Surgery Training Initiative was launched in 2012, and FIGO Fellows started to enter the program to train as fistula surgeons. Following a funding boost in 2014, the initiative has grown considerably. With 52 fellows involved and a new Expert Advisory Group in place, the program is achieving major milestones, with a record-breaking number of fistula repairs performed by FIGO Fellows in 2017, bringing the total number of repairs since the start of the project to more than 6000.

Pathologic Remodeling of Endoneurial Tubules in Human Neuromas.

Background: Laminins are extracellular matrix proteins that participate in endoneurial tubule formation and are important in the regeneration of nerves after injury. They act as scaffolds to guide nerves to distal targets and play a key role in neurite outgrowth. Because there is evidence that laminin architecture affects nerve regeneration, we evaluated endoneurial tubules by examining the laminin structure in clinical samples from patients with nerve injuries.Methods: In a retrospective review of eight nerve injury cases, we evaluated nerve histology in relation to clinical history and injury type. The immunohistochemical delineation of the laminin structure in relationship with the neuroma type was performed.Results: Five cases of upper-trunk stretch injuries—four from childbirth injury and one from a motorcycle accident—and three cases of nerve laceration leading to neuroma formation were examined. In the upper-trunk stretch injuries, avulsed nerves demonstrated no neuroma formation with a linear laminin architecture and a regular Schwann cell arrangement, but increased fibrous tissue deposition. For neuromas-in-continuity after a stretch injury, laminin immunohistochemistry demonstrated a double-lumen laminin tubule, with encapsulation of the Schwann cells and axonal processes. Nerve laceration leading to stump neuroma formation had a similar double-lumen laminin tubule, but less severe fibrosis.Conclusions: In nerve injuries with regenerative capacity, endoneurial tubules become pathologically disorganized. A double-lumen endoneurial tubule of unclear significance develops. The consistency of this pattern potentially suggests a reproducible pathophysiologic process. Further exploration of this pathophysiologic healing may provide insight into the failure of programmed peripheral nerve regeneration after injury.

Effect of Pregnancy and Delivery on Cytokine Expression in a Mouse Model of Pelvic Organ Prolapse.

The aim of this study was to determine the effect of pregnancy and delivery mode on cytokine expression in the pelvic organs and serum of lysyl oxidase like-1 knockout (LOXL1 KO) mice, which develop pelvic organ prolapse after delivery. Bladder, urethra, vagina, rectum, and blood were harvested from female LOXL1 KO mice during pregnancy, after vaginal or cesarean delivery, and from sham cesarean and unmanipulated controls. Pelvic organs and blood were also harvested from pregnant and vaginally delivered wild-type (WT) mice and from unmanipulated female virgin WT controls. Specimens were assessed using quantitative real-time reverse transcription polymerase chain reaction and/or enzyme-linked immunosorbent assay. Both CXCL12 and CCL7 mRNA were significantly up-regulated in the vagina, urethra, bladder, and rectum of pregnant LOXL1 KO mice compared with pregnant WT mice, suggesting systemic dysregulation of both of these cytokines in LOXL1 KO mice as a response to pregnancy.The differences in cytokine expression between LOXL1 KO and WT mice in pregnancy persisted after vaginal delivery. CCL7 gene expression increases faster and to a greater extent in LOXL1 KO mice, translating to longer lasting increases in CCL7 in serum of LOXL1 KO mice after vaginal delivery, compared with pregnant mice. Lysyl oxidase like-1 KO mice have an increased cytokine response to pregnancy perhaps because they are less able to reform and re-cross-link stretched elastin to accommodate pups, and this resultant tissue stretches during pregnancy. The up-regulation of CCL7 after delivery could provide an indicator of level of childbirth injury, to which the urethra and vagina seem to be particularly vulnerable.

An investigation of the relationship between autonomy, childbirth practices, and obstetric fistula among women in rural Lilongwe District, Malawi

BackgroundObstetric fistula is a childbirth injury caused by prolonged obstructed labor that results in destruction of the tissue wall between the vagina and bladder. Although obstetric fistula is directly caused by prolonged obstructed labor, many other factors indirectly increase fistula risk. Some research suggests that many women in rural Malawi have limited autonomy and decision-making power in their households. We hypothesize that women’s limited autonomy may play a role in reinforcing childbirth practices that increase the risk of obstetric fistula in this setting by hindering access to emergency care and further prolonging obstructed labor.MethodsA medical student at Baylor College of Medicine partnered with a Malawian research assistant in July 2015 to conduct in-depth qualitative interviews in Chichewa with 25 women living within the McGuire Wellness Centre’s catchment area (rural Central Lilongwe District) who had received obstetric fistula repair surgery.ResultsThis study assessed whether women’s limited autonomy in rural Malawi reinforces childbearing practices that increase risk of obstetric fistula. We considered four dimensions of autonomy: sexual and reproductive decision-making, decision-making related to healthcare utilization, freedom of movement, and discretion over earned income. We found that participants had limited autonomy in these domains. For example, many women felt pressured by their husbands, families, and communities to become pregnant within three months of marriage; women often needed to seek permission from their husbands before leaving their homes to visit the clinic; and women were frequently prevented from delivering at the hospital by older women in the community.ConclusionsMany of the obstetric fistula patients in our sample had limited autonomy in several or all of the aforementioned domains, and their limited autonomy often led both directly and indirectly to an increased risk of prolonged labor and fistula. Reducing the prevalence of fistula in Malawi requires a broad understanding of the causes of fistula, so we recommend that the relationship between women’s autonomy and fistula risk undergo further investigation.

Cell-based secondary prevention of childbirth-induced pelvic floor trauma.

With advancing population age, pelvic-floor dysfunction (PFD) will affect an increasing number of women. Many of these women wish to maintain active lifestyles, indicating an urgent need for effective strategies to treat or, preferably, prevent the occurrence of PFD. Childbirth and pregnancy have both long been recognized as crucial contributing factors in the pathophysiology of PFD. Vaginal delivery of a child is a serious traumatic event, causing anatomical and functional changes in the pelvic floor. Similar changes to those experienced during childbirth can be found in symptomatic women, often many years after delivery. Thus, women with such PFD symptoms might have incompletely recovered from the trauma caused by vaginal delivery. This hypothesis creates the possibility that preventive measures can be initiated around the time of delivery. Secondary prevention has been shown to be beneficial in patients with many other chronic conditions. The current general consensus is that clinicians should aim to minimize the extent of damage during delivery, and aim to optimize healing processes after delivery, therefore preventing later dysfunction. A substantial amount of research investigating the potential of stem-cell injections as a therapeutic strategy for achieving this purpose is currently ongoing. Data from small animal models have demonstrated positive effects of mesenchymal stem-cell injections on the healing process following simulated vaginal birth injury.

The influence of pregnancy on simulated vaginal birth injury in a rat model

The influence of pregnancy on simulated vaginal birth injury in a rat model

Optimal delivery route of mesoangioblasts for stem cell therapy in rat model for simulated vaginal birth injury

Optimal delivery route of mesoangioblasts for stem cell therapy in rat model for simulated vaginal birth injury

Obstetric fistula and sociocultural practices in Hausa community of Northern Nigeria.

Obstetric Fistula is a childbirth injury that disproportionately affects women in sub-Saharan Africa. Although poverty plays an important role in perpetuating obstetric fistula, sociocultural practices has a significant influence on susceptibility to the condition. This paper aims to explore narratives in the literature on obstetric fistula in the context of Hausa ethno-lingual community of Northern Nigeria and the potential role of nurses and midwives in addressing obstetric fistula. Three major cultural practices predispose Hausa women to obstetric fistula: early marriages and early child bearing; unskilled birth attendance and female circumcision and sociocultural constraints to healthcare access for women during childbirth. There is a failure to implement the International rights of the girl child in Nigeria which makes early child marriage persist. The Hausa tradition constrains the decision making power of women for seeking health care during childbirth. In addition, there is a shortage of nurses and midwives to provide healthcare service to women during childbirth. To improve health access for women, there is a need to increase political commitment and budget for health human resource distribution to underserved areas in the Hausa community. There is also a need to advance power and voice of women to resist oppressive traditions and to provide them with empowerment opportunities to improve their social status. The practice of traditional birth attendants can be regulated and the primary health care services strengthened.

Unsettling the fistula narrative: cultural pathology, biomedical redemption, and inequities of health access in Niger and Ethiopia

ABSTRACTObstetric fistula, a maternal childbirth injury that results in chronic incontinence, affects an estimated one million women in the global south. In the course of media and donor coverage on this condition, fistula sufferers have been branded as ‘child brides’ who, following the onset of their incontinence, become social pariahs and eventually find physical and social redemption through surgical repair. This narrative framing pits the violence of ‘culture’ against the potency of biomedical salvation. Based on over two years of ethnographic research at fistula repair centres in Niger and Ethiopia, this paper challenges this narrative and argues that most women with obstetric fistula remain embedded in social relations, receive continued familial support, and, unexpectedly, experience ambiguous surgical outcomes. This paper interrogates the existing logics of the fistula narrative that have had the unintended effects of obscuring global structural inequalities and diverting attention away from systemic health access reforms.

Experiences of social support among women presenting for obstetric fistula repair surgery in Tanzania.

ObjectiveAn obstetric fistula is a childbirth injury resulting in uncontrollable leakage of urine and/or feces and can lead to physical and psychological challenges, including social isolation. Prior to and after fistula repair surgery, social support can help a woman to reintegrate into her community. The aim of this study was to preliminarily examine the experiences of social support among Tanzanian women presenting with obstetric fistula in the periods immediately preceding obstetric fistula repair surgery and following reintegration.Patients and methodsThe study used a mixed-methods design to analyze cross-sectional surveys (n=59) and in-depth interviews (n=20).ResultsWomen reported widely varying levels of social support from family members and partners, with half of the sample reporting overall high levels of social support. For women experiencing lower levels of support, fistula often exacerbated existing problems in relationships, sometimes directly causing separation or divorce. Many women were assertive and resilient with regard to advocating for their fistula care and relationship needs.ConclusionOur data suggest that while some women endure negative social experiences following an obstetric fistula and require additional resources and services, many women report high levels of social support from family members and partners, which may be harnessed to improve the holistic care for patients.

Therapeutic Potential of Adipose-derived Stem Cell-based Microtissues in a Rat Model of Stress Urinary Incontinence

To examine the potential and mechanism of 3-dimensional cultures of adipose-derived stem cells (ADSCs) in the treatment of stress urinary incontinence (SUI) in a rat model simulating menopause combined with preceding childbirth injury. ADSCs were used to generate microtissues (MTs) with a hanging drop method. Forty-eight postpartum Sprague-Dawley rats were developed as SUI models after 4 hours of vagina dilation followed by bilateral ovariectomy. Ten rats that underwent sham ovariectomy without vagina dilation served as the control group. The SUI rats were divided into 3 groups and received urethral injection of phosphate-buffered saline, ADSCs, and MTs. Specimens were harvested for histology examination and ADSCs tracking at days 1, 3, 7, and 28 (n = 3) postinjection. At day 28, the remaining rats were examined for voiding function. Western blot, immunofluorescence, and immunohistochemistry staining were performed to examine histological changes and cytokine expression. The voiding function and histopathological structures were better recovered in the MT group than in the ADSC group. Compared with ADSCs, MTs express higher level of vascular endothelial growth factor and TNFα-stimulated gene/protein 6 in vitro, and represented a higher retention rate in vivo. Urethral injection of MTs better restored voiding function than ADSCs.

AB102. Therapeutic potential of adipose-derived stem cells-based micro-tissues in a rat model of stress urinary incontinence

ObjectiveTraditional two-dimensional (2D) cell culture of adipose-derived stem cells (ADSCs) to halt stress urinary incontinence (SUI) progression have low retention rate and limited function recuperation poorly mimicking in vivo conditions. This study aims to examine the potential and mechanism of three-dimensional (3D) cultures of ADSCs in the treatment of SUI in a rat model simulating childbirth injury.MethodsADSCs were used to generate microtissues (MTs) with a hanging drop method. A total of 48 postpartum Sprague-Dawley rats were developed SUI models by 4 hours vagina dilation (VD) followed by bilateral ovariectomy (OV). Ten rats underwent sham OV without VD served as control group. The SUI rats were divided into three groups and received urethral injection of PBS, ADSCs and MTs. Specimens were harvested for histology examination and ADSCs tracking at day 1, 3, 7, 28 (n=3) post-injection. At day 28, the remaining rats were examined for voiding function. Western blot, immunofluorescence and immunohistochemistry staining were performed to examine histological changes and cytokines expression.ResultsThe voiding function and histopathological structures were better recovered in MTs group than those in ADSCs group. Compared with ADSCs, MTs express higher level of vascular endothelia growth factor (VEGF), TNFα stimulated gene/protein 6 (TSG-6) in vitro and represented a higher retention rate in vivo.ConclusionsUrethral injection of MTs better restored the voiding function than ADSCs.