Long-term efficacy of AdVance obturator sling and artificial urethral sphincter in treatment of male stress urinary incontinence / 中华泌尿外科杂志

Objective:To evaluate the long-term efficacy of AdVance sling bulbar urethral suspension and artificial urethral sphincter (AUS) implantation in the treatment of moderate to severe male stress urinary incontinence.Methods:The clinical data of 12 male patients with urinary incontinence who underwent surgical treatment in Peking University People's Hospital from June 2011 to June 2017 were retrospectively analyzed. The median age was 75(64-80) years. There were 9 cases after radical prostatectomy and 3 cases after transurethral prostatectomy. Patients had a median history of urinary incontinence of 3(1-9) years, and needed an average of 8(5-10) pads per day. Among them, 5 patients had moderate urinary incontinence and 7 patients had severe urinary incontinence. All patients underwent urinary incontinence surgery for the first time. Among the 12 patients, 6 received AdVance sling ball urethral suspension (AdVance group), and 6 received AUS implantation (AUS group). The median age of the AdVance group was 72 (64-73) years. The median number of pads used daily was 6 (5-8) tablets. Urinary incontinence Quality of Life questionnaire (I-QOL) score was (15.0±5.4). Five patients had moderate urinary incontinence and one patient had severe urinary incontinence. In the AUS group, the median age was 78(76-80) years old, the median daily pad use was 8(6-10) tablets, and the I-QOL score was (16.7±5.1), all of which were severe urinary incontinence. The daily pad usage, I-QOL and postoperative complications were recorded at 1 and 5 years after operation.Results:All patients completed the operation successfully. The postoperative follow-up was 5-7 years (mean 5.5 years). In AdVance group, 1 patient with severe urinary incontinence had no significant improvement in postoperative symptoms at 1 year after operation. The other 5 patients showed significant improvement in urinary incontinence symptoms. In the AdVance group, the median number of pads used per day was 2.5 (1-10), and the I-QOL score was (75.0±28.1), which were all significantly improved compared with that before operation ( P<0.05). The median number of pads used per day in the AdVance group 5 years after operation was 2.5(1-10), and the I-QOL score was (78.3±29.3), which were significantly improved compared with those before operation (all P<0.01). In the AUS group, no pad was needed at 1 year after operation, which was significantly improved compared with that before operation ( P<0.01). Urethral erosion occurred in 2 cases 3 years after operation, and the AUS was removed. Urinary incontinence recurred and returned to the preoperative state without reoperation. The other 4 cases did not need to use the pad 5 years after operation. In AdVance group, 3 patients had perineal pain within 3 months after operation, which was related to activity and relieved spontaneously. No wound infection, urethral erosion and other complications occurred. Urethral erosion occurred in 3 cases in AUS group. Conclusions:AdVance sling ball urethral suspension is effective for patients with moderate stress urinary incontinence and has fewer complications. AUS implantation is effective for patients with severe male stress urinary incontinence. However, the long-term complications of this operation may affect the postoperative efficacy.

Prevalence and risk factors for urinary incontinence in bitches five years after ovariohysterectomy / [Prevalência e fatores de risco para incontinência urinária em cadelas cinco anos após ovário histerectomia]

Ovariohysterectomy (OHE) is the most performed elective surgery in veterinary medicine. Although this procedure brings benefits both to the animal and public health, acquired urinary incontinence is a possible complication resultant from it. The aim of this study was to determine the prevalence of urinary incontinence and evaluate size, breed, and time of surgery as risk factors in a population of spayed female dogs in the Hospital de Clínicas Veterinárias da Universidade Federal do Rio Grande do Sul, in the year of 2013, through the use of a multiple-choice screening instrument. Identified estimated prevalence was 11.27% and main risk factors were as follows: large size (OR = 7.12 IC95% = 1.42 - 35.67), Rottweiler breed (OR = 8.92; IC95% = 5.25 - 15.15), Pit-bull breed (OR = 4.14; IC95% = 2.19 - 7.83), and Labrador breed (OR = 2.73; IC95% = 1.53 - 4.87). Time of surgery was not considered a risk factor for urinary incontinence in this population (OR = 1.45; IC95% = 0.86 - 2.40). Even though most owners reported a small impact on their relationship with the animal, urinary incontinence hazard should be addressed before spaying.(AU)

A ovário-histerectomia (OHE) é a cirurgia eletiva mais realizada em medicina veterinária. Embora seja um procedimento que beneficie a saúde pública e do animal, a incontinência urinária adquirida é uma complicação possível resultante desse procedimento. O objetivo deste estudo foi determinar a prevalência de incontinência urinária e avaliar porte, raça e momento da castração como fatores de risco em uma população de cadelas castradas no HCV/UFRGS, no ano de 2013, através do uso de um instrumento de triagem de múltipla escolha. A prevalência estimada foi de 11,27% e os principais fatores de risco foram: grande porte (OR = 7,12 IC95% = 1,42 - 35,67), raça Rottweiler (OR = 8,92; IC95% = 5,25 - 15,15), raça Pitbull (OR = 4,14; IC95% = 2,19 - 7,83) e raça Labrador (OR = 2,73; IC95% = 1,53 - 4,87). O tempo da cirurgia não foi considerado fator de risco para incontinência urinária nessa população (OR = 1,45; IC95% = 0,86 - 2,40). Embora a maioria dos proprietários tenha relatado um pequeno impacto no relacionamento com o animal, a possibilidade de incontinência urinária deve ser devidamente discutida antes da castração.(AU)

Alteración en la coordinación miccional: reporte de caso del síndrome de Fowler / Alteration in the micturition coordination: case report of Fowler's syndrome

Resumen ANTECEDENTES: El síndrome de Fowler es poco común, con predominio en mujeres jóvenes; se caracteriza por una actividad anormal, con contracciones repetidas en el esfínter uretral externo, en ausencia de enfermedad neurológica. CASO CLÍNICO: Paciente de 51 años, acudió a consulta por prolapso de órganos pélvicos con sensación de masa en la vagina y dificultad para orinar. En la videourodinamia se apreció una onda intermitente, con hipoactividad del detrusor y micción no coordinada, sin incontinencia, hallazgos característicos del síndrome de Fowler. Se le indicó terapia de aprendizaje de relajación del esfínter para coordinar la micción, posteriormente neuromodulación sacra. Durante el seguimiento se observó mejor coordinación y satisfacción después de orinar. CONCLUSIONES: La micción es un proceso complejo, que implica la integridad de la vía urinaria inferior y adecuado sinergismo con el sistema nervioso central, autónomo y somático. La falla en alguna de estas estructuras podría ocasionar un patrón miccional obstructivo.

Abstract BACKGROUND: Fowler's syndrome is a rare phenomenon mainly in young women in reproductive age with abnormal, repeated contractions in the external urethral sphincter without a neurological disease. CLINICAL CASE: 51-year-old woman with pelvic organ prolapse, symptoms of vaginal bulge and difficult micturition. A videourodynamic study was done showing intermittent waveform, detrusor hypoactivity and uncoordinated micturition without incontinence, suggestive of Fowler's syndrome. The patient underwent therapy for sphincter relaxation and sacral neuromodulation with good response. In the follow up with clinical improvement, referring being satisfied after micturition. CONCLUSIONS: Micturition is a complex process that needs integrity of the lower urinary tract and synergy between this and the central nervous system, autonomous and somatic. Failure in any of these structures can result in an obstructive pattern.

Effect and safety of botulinum toxin A injection in external urethral sphincter for male patients with neurogenic detrusor underactivity / 中华泌尿外科杂志

Objective To assess clinical effect and safety of botulinum toxin A injection in external urethral sphincter for male patient with neurogenic detrusor underactivity (DU).Methods A prospective and self-controlled trail was conducted from August 2012 to October 2017.Male patients with nerve injury,dysuria more than 6 months,DU (bladder contractility index less than 100) were enrolled in this study.Exclusion criteria included patients with acute urinary tract infection,bladder stone,benign prostate hyperplasia,urethral stricture and urethral diverticulum.100 IU BTX-A was dissolved in 4ml normal saline,and the solution of BTX-A was injected into 4 different points(3-o'clock,6-o'clock,9-o'clock,and 12-o'clock) in external urinary sphincter with each point of 1ml solution.Patients were evaluated at baseline and 12 weeks after injection.The outcomes included post void residual (PVR),maximum flow rate (Qmax),maximum detrusor pressure during voiding phases (Pdet.max),maximum urethral closure pressure (MUCP),the case number of intermittent catheterization (IC) and the score of quality of life (QOL score).Adverse events were also recorded.Results A total of 58 male patients (all from Guangdong provincial work injury rehabilitation hospital) with mean age 28.6 years suffered from cerebral palsy (n =2),cerebrovascular accident(n =19)and spinal cord injury(n =37) were included into the study.Compared to baseline data,significant difference were observed at week 12 in PVR (56.68 ml vs.280.11 ml,P ＜ 0.001),Pdet.max (23.95 cmH2O vs.30.01 cmH2O,P =0.019),Qmax(6.74 ml/s vs.3.28 ml/s,P =0.042),MUCP(48.25 cmH2O vs.79.34 cmH2O,P ＜0.001),the case number of IC(40 vs.58,P ＜0.001) and QOL score(3.63 vs.5.22,P ＜ 0.001) respectively.5 cases developed perineal pain and 16 cases developed mild transient haematuria.These adverse events were disappeared by medical symptomatic treatment during 3-5 days.Conclusions BTX-A externalurethral sphincter injections help reduce urethra resistance and also improve the quality of life for patients with neurogenic detrusor underactivity.

Effect and safety of botulinum toxin A injection in external urethral sphincter for male patients with neurogenic detrusor underactivity / 中华泌尿外科杂志

Objective@#To assess clinical effect and safety of botulinum toxin A injection in external urethral sphincter for male patient with neurogenic detrusor underactivity(DU).@*Methods@#A prospective and self-controlled trail was conducted from August 2012 to October 2017. Male patients with nerve injury, dysuria more than 6 months, DU(bladder contractility index less than 100) were enrolled in this study. Exclusion criteria included patients with acute urinary tract infection, bladder stone, benign prostate hyperplasia, urethral stricture and urethral diverticulum.100 IU BTX-A was dissolved in 4ml normal saline, and the solution of BTX- A was injected into 4 different points(3-o’clock, 6-o’clock, 9-o’clock, and 12-o’clock) in external urinary sphincter with each point of 1ml solution. Patients were evaluated at baseline and 12 weeks after injection. The outcomes included post void residual (PVR), maximum flow rate (Qmax), maximum detrusor pressure during voiding phases (Pdet.max), maximum urethral closure pressure (MUCP), the case number of intermittent catheterization (IC)and the score of quality of life (QOL score). Adverse events were also recorded.@*Results@#A total of 58 male patients (all from Guangdong provincial work injury rehabilitation hospital)with mean age 28.6 years suffered from cerebral palsy (n=2), cerebrovascular accident(n=19)and spinal cord injury(n=37) were included into the study. Compared to baseline data, significant difference were observed at week 12 in PVR (56.68 ml vs. 280.11 ml, P<0.001), Pdet.max(23.95 cmH2O vs. 30.01 cmH2O, P=0.019), Qmax(6.74 ml/s vs. 3.28 ml/s, P=0.042), MUCP(48.25 cmH2O vs. 79.34 cmH2O, P<0.001), the case number of IC(40 vs. 58, P<0.001) and QOL score(3.63 vs.5.22, P<0.001) respectively. 5 cases developed perineal pain and 16 cases developed mild transient haematuria. These adverse events were disappeared by medical symptomatic treatment during 3-5 days.@*Conclusions@#BTX-A externalurethral sphincter injections help reduce urethra resistance and also improve the quality of life for patients with neurogenic detrusor underactivity.

Ocorrência de incontinência urinária em cadelas castradas no Hospital Veterinário da universidade Anhmebi-Morumbi, São Paulo, Brasil / Occurrence of urinary incontinence in spayed bitches at the Veterinary Hospital of the Anhembi-Morumbi University, São Paulo, Brazil

Incontinência urinária (IU) pode ocorrer após castração de cadelas, quando há diminuição nos níveis circulantes de hormônios esteroides e aumento nos de gonadotrofinas, além de alteração funcional no esfíncter uretral. Para determi- nar a ocorrência da IU em cadelas castradas no Hospital Veterinário da Universidade Anhembi-Morumbi, os prontuá- rios de cadelas esterilizadas no período 2002-2009 foram analisados de agosto de 2010 a março de 2011. Foi feito conta- to telefônico com os proprietários para investigar um possível desenvolvimento de IU após a castração. Nesse período, foram contatados osproprietários de 227 cadelas. Destas, 73 (32,2%) vieram a óbito sem sintoma de IU pós-castração, 146 (64,3%) não apresentaram IU e oito (3,5%) desenvolveram IU no período de 3,8 ± 1,6 anos após castração.

Urinary incontinence (UI) can occur in bitches after spaying due to a functional alteration in the urethral sphincter. which may be caused by a number of different causes among which a decrease in the blood levels of steroidal hormones or an increase in gonadotropin in order to determine the occurrence of UI in spayed bitches at the Veterinary Hospital, University Anhembi-Morumbi, the medical records of spayed bitches in the period 2002-2009 were examined from August 2010 to March 2011. The owners of 227 bitches were contacted by telephone to search for development of UI after spaying. Of these, 73 (32.2%) died with no symptom of UI, 146 (64.3%) did not develop UI, and eight (3.5%) de- veloped UI in the period of 3.8 ± 1.6 years after castration.

Development of a rabbit's urethral sphincter deficiency animal model for anatomical-functional evaluation

OBJECTIVE: The aim of the study was to develop a new durable animal model (using rabbits) for anatomical-functional evaluation of urethral sphincter deficiency. MATERIALS AND METHODS: A total of 40 New Zealand male rabbits, weighting 2.500 kg to 3.100 kg, were evaluated to develop an incontinent animal model. Thirty-two animals underwent urethrolysis and 8 animals received sham operation. Before and at 2, 4, 8 and 12 weeks after urethrolysis or sham operation, it was performed cystometry and leak point pressure (LPP) evaluation with different bladder distension volumes (10, 20, 30 mL). In each time point, 10 animals (8 from the study group and 2 from the sham group) were sacrificed to harvest the bladder and urethra. The samples were evaluated by H&E and Masson's Trichrome to determine urethral morphology and collagen/smooth muscle density. RESULTS: Twelve weeks after urethrolysis, it was observed a significant decrease in LPP regardless the bladder volume (from 33.7 ± 6.6 to 12.8 ± 2.2 cmH2O). The histological analysis evidenced a decrease of 22% in smooth muscle density with a proportional increase in the collagen, vessels and elastin density (p < 0.01). CONCLUSIONS: Transabdominal urethrolysis develops urethral sphincter insufficiency in rabbits, with significant decrease in LPP associated with decrease of smooth muscle fibers and increase of collagen density. This animal model can be used to test autologous cell therapy for stress urinary incontinence treatment.

The diagnostic value of urethral sphincter electromyography in patients with multiple system atrophy / 中华内科杂志

Objective To analyze diagnostic evaluation of urethral sphincter electromyography (US-EMGs) for patients with multiple system atrophy (MSA).Methods Totally 15 patients who were diagnosed as MSA were examined as treatment group while 17 non-MSA patients were examined as controls.US-EMGs were performed in the both groups.Spontaneous activities when relax,parameters of motor unit potentials(MUPs) mean duration and amplitude,percentage of polyphasic ware,satellite potential,recruitment potentials and amplitude when strong contraction were recorded and analyzed.Results USEMGs changes of various abnormalities were found in 13 cases (86.7％) in MSA group.There were significant differences of electromyographic findings between the MSA group and control group including MUPs mean duration[(12.79 ±3.18)ms vs (9.49 ± 1.51)ms] and amplitude[(828.53 ±459.89) μV vs (378.76 ± 152.26) μV] as well as recruitment potentials [(11.47 ± 21.55) ％ vs (8.23 ± 10.74) ％] and amplitude [(2.19 ± 1.24) mV vs (0.75 ± 0.42) mV] when strong contraction (all P values ＜ 0.05).Conclusions There is certain value of US-EMGs for the diagnosis of MSA.It could be used as a routine electrophysiological method for the patients who are suspected of MSA.It could be a supplement of externalanal sphincter electromyography.

Alternativas a la vía transuretral para la inyección de toxina botulínica en esfínter urinario / Botulinum toxin inyection in urinary sphincter: alternative approaches

Objetivo: Presentamos las vías transrectal en varones y transvaginal en mujeres como alternativas a la vía transuretral para la inyección de toxina botulínica (TB) en esfínter urinario, así como nuestros resultados. Material y Método: Se inyectó TB en esfínter urinario a 9 pacientes entre diciembre de 2008 y agosto de 2010para el tratamiento de distintas disfunciones de vaciado refractarias a tratamiento convencional. La vía utilizada fue transrectal en 7 varones y transvaginal en 2 mujeres. Las dosis utilizadas oscilaron entre 50 y200 U. Registramos resultados y complicaciones. Resultados: Obtuvimos resultados satisfactorios en 6pacientes (66 por ciento) según criterios clínicos. La duración del efecto osciló entre los 3 y 7 meses. No registramos complicaciones significativas relacionadas con la inyección y la tolerancia al dolor fue buena. Conclusiones: La vía transrectal en varones y transvaginal en mujeres son alternativas válidas y seguras para la inyección de TB en esfínter urinario.

Objective: To present our institution experience and outcomes with transrectal and transvaginal injection of botulinum toxin (TB) in urinary sphincter to treat voiding disfunction. Material and methods: We injected TB in 9 patients since December 2008 to august 2010 in order to treat different voiding disfunctions. We use the transrectal approach in 7 men and the transvaginal method in 2 women. The dose used ranged from 50 to 200 units. Outcomes and complications were registered. Results: Satisfactory outcomes were obtained in 6 patients (66 pert cent) according to clinical criteria. The duration of the effect was from 3 to 7 months. No major complications were registered and pain was well tolerated. Conclusions: Transrectal and transvaginal approaches are effective and safe for the injection of TB in urinary sphincter.

Incontinência urinária após gonadectomia em fêmeas caninas / Urinary incontinence after gonadectomy in female dogs

A incontinência urinária adquirida é uma condição debilitante e, muitas vezes, incurável que acomete fêmeas castradas e raramente fêmeas inteiras ou machos. A manifestação clínica pode ocorrer em qualquer momento após a gonadectomia e resulta em graves problemas no manejo do paciente. Os mecanismos que desencadeiam a incontinência após ovariectomia envolvem decréscimo na pressão de fechamento uretral, alterações hormonais, aumento na deposição de colágeno na musculatura lisa da bexiga, diminuição na contratilidade do músculo detrusor e redução na resposta aos estímulos elétricos e ao carbachol. O diagnóstico é realizado pelo histórico do animal, pelo exame físico, pelos exames laboratoriais, pelo perfil de pressão uretral, pela ultrassonografia e pelas radiografias abdominais. O tratamento clínico envolve utilização de fármacos -adrenérgicos, estrógenos, análogos de GnRH e agentes antidepressivos. As técnicas cirúrgicas recomendadas correspondem à uretropexia, cistouretropexia, aplicação de colágeno na uretra e colpossuspensão. Melhor compreensão da etiologia, da fisiopatologia, dos métodos de diagnóstico e tratamentos é fundamental em razão do pouco conhecimento e da identificação dessa condição no Brasil.

Acquired urinary incontinence is a debilitating, incurable condition, prevalent in spayed bitches and rarely seen in entire bitches or males. In bitches, acquired urinary incontinence can occur anytime from one week after neutering and is associated with severe management problems. Incontinence in neutered bitches can be associated with a decrease in maximal urethral closure pressure, hormonal changes and increase in the percentage of collagen in the bladder wall. It's also associated to a reduced contractility of the detrusor muscle, decrease in the magnitude of response of the bladder wall to both carbachol and eletrical field stimulation, and there are risk factors involved. The diagnosis is established based on historical findings, physical examination, laboratorial exams, urethral pressure profilometry, ultrasonography and abdominal radiographs. The medical management involves the appliance of -adrenergics agonists, oestrogens, GnRH analogues and antidepressive agents. Surgical recommendation management corresponds to urethropexy, cistourethropexy, endoscopic periurethral injection and colposuspension. The better understanding A better comprehension of etiology, physiopathology, diagnosis methods and treatment could provide significant benefits considering the lack of knowledge and diagnoses of this clinical condition in Brazil.

Influence of periurethral injection of insulin-like growth factor-Ⅰ on the expression of IGF-Ⅰ and IGF-Ⅱ mRNA following urethral sphincter muscle injury in female rats / 中华泌尿外科杂志

Objective To investigate the effect of periurethral injection of insulin-like growth factor(IGF)-Ⅰ on the expression of IGF-Ⅰ and IGF-Ⅱ mRNA during regeneration period following urethral sphincter muscle injury in female rats. Methods Model of urethral sphincter muscle injury was made in female virgin SD rats (n=50) by intravaginal balloon inflation. Then the rats were divid-ed randomly into treatment group (n= 25) and control group (n= 25), treatment group accepted peri-urethral injection of 1.0μg human IGF-Ⅱ to the middle urethral muscle, control group accepted nor-mal saline injection. Five rats in each group were sacrificed at 2, 4, 6, 8, 14 day respectively and the whole urethra specimens were processed for RT-PCR to detect the expression of IGF-Ⅰ ,Ⅱ mRNA. A normal control group (n = 5) was set without intravaginal balloon inflation and injection. Results The expression of IGF-Ⅰ mRNA in control group increased at day 4, 6, 8, 14, the IGF-Ⅰ/β-actin ra-tios were 0. 58±0.15, 1.73±0.31, 2.30±0.29, 0. 46±0. 06. The expression of IGF-Ⅰ mRNA in treatment group increased at all time points, as 0. 69±0.21, 1.45±0.17, 2.25±0.45, 2.90±0.49, 1.92±0. 31. The difference was significant on day 4, 14(P<0.01), and day 8 (P<0.05) compared with the control group. The expression of IGF-Ⅱ mRNA in control group increased at day 4, 6, 8, as 0.42±0. 14, 1.51±0. 59, 1.31±1.04. The expression of IGF-Ⅱ mRNA in treatment group in-creased at day 4, 6, 8, 14, as 1.04±0.23, 1.94±0.29, 1.75±0.41, 0. 81±0.15. The significant difference was noted on day 4 (P<0. 01)compared with the control group. No expression of IGF-Ⅰand Ⅱ mRNA in the normal control group. Conclusions The expression of endogenous IGF-Ⅰ and IGF-Ⅱ mRNA was up-regulated by periurethral injection of IGF-Ⅰ during regeneration period follow-ing urethral sphincter muscle injury in female rat. Our findings suggest that IGF-Ⅰ facilitates the re-generation of the urethral muscles and may play a role in treatment of stress urinary incontinence in-duced by urethral sphincter muscle dysfunction.

Effects of Nitroglycerin on Urethral Sphincter Strips Tension of Chronic Complete Spinal Cord Injured Female Rats in Vitro / 中国康复理论与实践

@#Objective To study the effects of nitroglycerin on urethral sphincter of chronic complete spinal cord injury female rats in vitro. Methods 30 SD female rats with 3 months old were transected at T10 spinal cord. After 8 weeks, the 10 rats with BBB scores ≤5 were selected as experimental group, and other 10 normal rats as control group. The difference of tension in both proximal segment (urethral smooth muscle strips) and distal segment (external urethral sphincter muscle strips) were surveyed before and after nitroglycerin 0.5 mg administration in bath. Results The tension of distal segment in control group reduced from (640.50±91.79) mg to (597.50±92.61) mg, and from (485.50±68.94) mg to (459.90±69.51) mg in experimental group. The difference between proximal segment and distal segment were (222.30±12.14) mg and (42.00±7.86) mg before and after administration in control group, and were (223.00±15.78) mg and (25.60±5.17) mg in experimental group. Conclusion The administration of nitroglycerin 0.5 mg in bath can reduce the tension of both urethral smooth muscle and external urethral sphincter in both normal and spinal cord injured rats. The relaxative effect on external urethral sphincter muscle of normal rats exceed that of injured ones, but approximate on urethral smooth muscle.

Disposition of the striated urethral sphincter and its relation to the prostate in human fetuses

OBJECTIVE: To describe the arrangement of the muscle fibers of the striated urethral sphincter and its relationship with the prostate during the fetal period in humans. MATERIALS AND METHODS: We analyzed 17 prostates from well preserved fresh human fetuses ranging in age from 10 to 31 weeks postconception (WPC). Transversal sections were obtained and stained with Gomori's trichrome and immunolabeled with anti alpha-actin antibody. RESULTS: We found that the urethral striated sphincter (rabdosphincter) is located on the periphery of the smooth muscle and there was no merge between striated and smooth muscle fibers in any fetal period. In the prostate apex, the striated sphincter shows a circular arrangement and covers completely the urethra externally, whereas adjacent to verumontanum, it looks like a "horseshoe" and covers only the anterior and lateral surfaces of the urethra. Near the bladder neck, in fetuses younger than 20 WPC, we have found striated muscle fibers only at the anterior surface of the prostate, while in fetuses older than 20 WPC, the striated muscle covers the anterior and lateral surfaces of the prostate. CONCLUSIONS: The urethral sphincter muscle covers the anterior and lateral surfaces of the urethra in all fetuses older than 20 WPC, close to the bladder neck and at the distal prostate. In the region of the prostate apex, the urethral sphincter covers completely the urethra circularly. The knowledge of the normal anatomy of the urethral sphincter in fetuses could be important to understand its alterations in congenital anomalies involving the base of the bladder, the bladder neck and the proximal urethra.

Anatomical Features of Male Rat Urethra and Comparison of Urethral Sphincter Contractility according to Different Urethral Strip Orientations / 대한비뇨기과학회지

PURPOSE: The aim of the study was to clarify the anatomy of the male rat urethra, and to establish a more accurate and consistent method for analyzing external urethral sphincter (EUS) contractility based on this clarified anatomy by comparing different muscle strip orientations. MATERIALS AND METHODS: The whole urethra in male rats was investigated histologically using H/E and immunohistochemical staining. The contractility of the spiral (S) orientation of the entire proximal urethral (EUS) was then compared with the transverse (T) and the ring (R) orientations of the optimal portion, via electrical stimulation in an organ bath. RESULTS: In male rats, the urethral tract consisted of following parts: proximal urethra, transient urethra, urethral diverticula, and penile urethra. Throughout the proximal urethra, a layer of striated muscle fibers encircled the smooth muscle layers. The EUS contraction of the S, TM (Transverse, Middle of proximal urethra) and RM (Ring, Middle of proximal urethra) groups were 4.66+/-0.33mN, 2.92+/-0.33mN and 2.47+/-0.38mN, respectively. The strength of the EUS contraction of the S group was significantly higher than that of the TM. Group, but after adjusting the length, there was no statistically significant difference between the two groups. CONCLUSIONS: Unlike previous studies, showing striated muscle fibers limited to the lower half of the proximal urethra, we noted them throughout the whole proximal urethra. From our results, the spiral orientation of the entire urethra was found to be the optimal configuration for evaluating the contractility of the EUS using fast twitch muscle contractile testing.

Sensitivity of Transrectal Ultrasonography and Voiding Cystourethrography for Appearing of the Opening of Bladder Neck or External Sphincter

OBJECTIVE: To compare the sensitivity of transrectal ultrasonography (TRUS) and voiding cystourethrography (VCUG) in assessing the opening of bladder neck and external urethral sphincter during the filling phase and voiding phase. METHOD: TRUS and VCUG were performed for visualizing the opening of bladder neck and external sphincter in 36 patients with a neurogenic bladder dysfunction and the sensitivity of two techniques was compared. The finding was considered to be a true positive when the opening of internal or external sphincter was visualized on either one of TRUS or VCUG. RESULTS: The sensitivity of TRUS was significantly higher than VCUG in visualizing the opening of bladder neck during the filling phase. However, there was no significant difference in the sensitivity of two techniques for the opening of external sphincter during filling phase or the opening of internal and external sphincters during voiding phase. CONCLUSION: The results demonstrate that the TRUS provides a satisfactory information and can be an alternative method to the radiological VCUG in visualizing the opening of bladder neck or external sphincter.

Effect of Transrectal Probe Insertion on the Opening of Internal Urethral Sphincter

OBJECTIVE: To evaluate the effect of a transrectal probe on the opening of internal urethral sphincter. METHOD: Twenty-five patients with a neurogenic bladder dysfunction were included in this study. For the transrectal ultrasonography (TRUS), a transrectal probe was inserted into the rectum before the bladder was filled. Internal urethral sphincter opening was investigated during the filling and voiding phases. The bladder was emptied and the probe was introduced intrarectally after the bladder filling for the investigation of internal urethral sphincter opening. Twelve subjects underwent an additional cystometry for the recording of maximal intravesical pressure with and without transrectal probe. RESULTS: There was no significant difference in the sensitivity of TRUS for the opening of internal urethral sphincter with insertion of the probe before or after the bladder filling. There was no significant change of the maximal intravesical pressure with or without the probe in the rectum. CONCLUSION: The results demonstrate that transrectal probe for TRUS does not cause a reflex effect on the opening of internal urethral sphincter.

10-year Experience with Artificial Urethral Sphincter / 대한비뇨기과학회지

Urinary incontinence is a relatively common and potentially disabling disease affecting the life quality of a patient. Many successful series in the treatment of incontinence by medical or surgical therapy using autologous materials have been reported. However, those who have structural abnormalities, injury around the urethra, and derangements in the nervous system could not be benefited by such treatments. In other countries, the artificial urethral sphincter, introduced in 1972, have achieved satisfactory results and then increased in use; but in Korea, it was not widely used because of many limitations and obstacles. Based on our ten-year experience with 10 cases of implantation of artificial urethral sphincter from 1987 to 1996, we tried to elucidate the present status, problems, and the possible ways of improvements of its use within this country. A total of ten male patients underwent implantations of the AMS Model 800 artificial urethral sphincter. Mean age was 34.5 (17-43) years. Mean follow-up was 4.2 (0.5-10) years. Two patients were spinal cord injury patients, 2 meningomyeloceles, and 6 posterior urethral injuries. Two patients had the prosthesis removed due to infection and cuff erosion. In the other 8 patients, 6 were dry (75.0 %) and 1 was improved (12.5 %) and 1 was wet (12.5 %). The revision rate was 20% (2/10) and overall improvement of incontinence was observed in 7 (87%) patients. The reasons for the low incidence of the implantation of artificial urinary sphincter in this country are as follows. According to the other reports, the most common application of artificial urinary sphincter in the west is in the post-prostatectomy incontinence accounting for about 60% of artificial urinary sphincter implantation whereas in this country, the majority of cases are patients who had trauma. Since radical prostatectomy has not been established well in the country (in the recent 4 years, totally only 53 cases were performed) and also the excellent performance of the transurethral surgery making the incidence of incontinence low, could be one of the reasons. In addition, the high price of the prosthesis over 4 million won and operation fee of 3 to 6 million won is a formidable burden to most patients. In the view of mechanical problem, the cuff size of the urethra in the oriental people is observed smaller than the western, and we must let the company prepare the cuff set of smaller size. In conclusion, if we solve those problems in our country, the artificial urethral sphincter is an effective device for treatment of urinary incontinence in patients who have failed more conservative modes of therapy.