Abdominal ultrasound in amazonian manatee (Trichechus inunguis) (Natterer, 1883) / Ultrassonografia abdominal em peixe boi amazônico (Trichechus inunguis (Natterer, 1883)

Morphophysiological species researches are fundamental, and diagnostic imaging is an excellent technique, already used in wild animals, with great application, not invasive and provide real-time information of each body. Amazonian manatees are on the list of endangered animals classified in the vulnerable category and knowledge of the normal pattern of ultrasound anatomy of organs and tissues is important for the maintenance and well-being of captive specimens contributing to reintroduction actions. The objective of the study was to standardize the examination technique and describe the ultrasound findings of the liver, gallbladder, stomach, urinary bladder and the subcutaneous tissue of the abdominal region in Trichechus inunguis, in order to contribute with the anatomical and sonographic knowledge and assist in the diagnosis and prognosis diseases. The study used 18 animals to describe the normal sonographic anatomy in the abdominal cavity of the Amazonian manatee. During abdominal scan, it was possible to visualize the features of the liver, gallbladder, stomach, urinary bladder obtained satisfactory results in this study. Therefore, other structures were not primarily identified by the reduced time, lots of fat and gases in intestines of animals.

Pesquisas morfofisiológicas em espécies selvagens são fundamentais, e o diagnóstico por imagem é uma excelente técnica, já usada e com grande aplicação, não invasiva e que fornece informações em tempo real de cada órgão. Peixes-boi-amazônico encontram-se na lista de animais ameaçados de extinção classificados na categoria vulnerável e o conhecimento do padrão normal da anatomia ultrassonográfica de órgãos e tecidos é importante para a manutenção e bem-estar de espécimes em cativeiro contribuindo para ações de reintrodução. O objetivo deste estudo foi padronizar a técnica de exame e descrever os achados ultrassonográficos do fígado, vesícula biliar, estômago, vesícula urinária e o tecido subcutâneo da região abdominal em Trichechus inunguis, de modo a contribuir com o conhecimento anátomo-sonográfico e auxiliar no diagnóstico e prognóstico de doenças. O estudo utilizou 18 animais para descrever a anatomia ultrassonográfica normal na cavidade abdominal de peixe-boi amazônico. Durante a varredura abdominal foi possível visualizar as características dos órgãos obtendo resultados satisfatórios neste estudo, concluindo ser uma técnica eficiente para avaliação de determinados órgãos abdominais em peixe-boi amazônico. Entretanto, outras estruturas não foram identificadas principalmente pelo tempo reduzido, muita gordura e gases nos intestinos dos animais.

Anatomia e histologia do trato urinário do macaco-prego (Sapajus apella) / Anatomy and histology of the urinary tract in the capuchin monkey (Sapajus apella

Sapajus apella é um primata do Novo Mundo de porte médio e com distribuição geográfica desde a América do Sul até a Argentina. São bons modelos para estudo e nos últimos anos vêm sendo amplamente utilizados para este fim. A destruição progressiva do habitat natural desses animais os tem levado a migrarem para outras regiões, tornando-os, assim, mais susceptíveis à caça predatória. A necessidade de preservação das espécies silvestres desperta interesse por um maior conhecimento anatômico e clínico para estes animais. O presente estudo teve como objetivo examinar e descrever os aspectos morfológicos, quanto a anatomia macroscópica e microscópica dos órgãos do sistema urinário de fêmeas da espécie Sapajus apella visando estender o conhecimento anatômico para esta espécie. Foram utilizadas quatro fêmeas, oriundas do Centro Nacional de Primatas de Ananindeua/PA. istema urinário de S. apella apresenta características similares a outros primatas tanto humanos quanto não humanos e aos animais domésticos. Os rins apresentaram aspectos macroscópicos semelhantes aos rins de humanos, mas com a mesma classificação de outros primatas não humanos e alguns animais domésticos. A bexiga assemelhou-se aos animais domésticos e aos primatas de maneira geral, humano e não humano. O mesmo ocorreu quando analisamos estes órgãos histologicamente.

Sapajus apella is a primate of the New World of midsize and with geographical distribution from South America to Argentina. Good models for the study and in recent years have been widely used for this purpose. The progressive destruction of the natural habitat of these animals has led to migrate to other regions, thus making them more susceptible to hunting predator. The need for the preservation of wild species arouses interest by a greater anatomic and clinical knowledge of these animals. The present study was aimed to examine and describe the morphological aspects, as far as the macroscopic and microscopic anatomy of the organs of the urinary system of female Sapajus apella aiming to extend the anatomical knowledge for this species. Four females were used, from the National Center of Primates in Ananindeua - PA. The urinary system of S. apella has similar characteristics to other primates both human and non-human and domestic animals. The kidneys showed macroscopic aspects similar to the kidneys of humans, but with the same classification of other non-human primates and some domestic animals. The bladder was similar to domestic animals and primates in general, human and non-human. The same occurred when we analyze these components histologically.

Human Urine-derived Stem Cells Seeded Surface Modified Composite Scaffold Grafts for Bladder Reconstruction in a Rat Model

We conducted this study to investigate the synergistic effect of human urine-derived stem cells (USCs) and surface modified composite scaffold for bladder reconstruction in a rat model. The composite scaffold (Polycaprolactone/Pluronic F127/3 wt% bladder submucosa matrix) was fabricated using an immersion precipitation method, and heparin was immobilized on the surface via covalent conjugation. Basic fibroblast growth factor (bFGF) was loaded onto the heparin-immobilized scaffold by a simple dipping method. In maximal bladder capacity and compliance analysis at 8 weeks post operation, the USCs-scaffold(heparin-bFGF) group showed significant functional improvement (2.34 ± 0.25 mL and 55.09 ± 11.81 microL/cm H2O) compared to the other groups (2.60 ± 0.23 mL and 56.14 ± 9.00 microL/cm H2O for the control group, 1.46 ± 0.18 mL and 34.27 ± 4.42 microL/cm H2O for the partial cystectomy group, 1.76 ± 0.22 mL and 35.62 ± 6.69 microL/cm H2O for the scaffold group, and 1.92 ± 0.29 mL and 40.74 ± 7.88 microL/cm H2O for the scaffold(heparin-bFGF) group, respectively). In histological and immunohistochemical analysis, the USC-scaffold(heparin-bFGF) group showed pronounced, well-differentiated, and organized smooth muscle bundle formation, a multi-layered and pan-cytokeratin-positive urothelium, and high condensation of submucosal area. The USCs seeded scaffold(heparin-bFGF) exhibits significantly increased bladder capacity, compliance, regeneration of smooth muscle tissue, multi-layered urothelium, and condensed submucosa layers at the in vivo study.

Avaliação histopatológica de órgãos reprodutivos e bexiga de fêmeas suínas descartadas / Histopathology of reproductive organs and bladder of culled sows

Em um sistema intensivo de produção de suínos, as falhas reprodutivas são uma das principais razões de descarte de matrizes e queda nos índices produtivos. A infecção urinária (cistite) e as endometrites são consideradas importantes causas de descarte em fêmeas suínas, por terem consequências reprodutivas relevantes e elevarem a taxa de reposição do plantel. O presente estudo teve o objetivo de avaliar o aparelho reprodutivo e a bexiga de fêmeas suínas de descarte normal de granjas, bem como investigar a existência de relação entre as patologias encontradas. Foram examinadas 79 matrizes suínas oriundas de 20 rebanhos localizados no Estado de Santa Catarina. De cada fêmea foram coletados os ovários, fragmentos de útero e bexiga. Dentre as fêmeas avaliadas, 32 (40,5%) tinham diferentes graduações de cistite, 24 (30,4%) tinham algum tipo de inflamação uterina, e 9 (11,4%) estavam em anestro, com ovários inativos. Contudo, não foi observada dependência significativa entre cistite e endometrite nas amostras analisadas.

Reproductive failures are the major reasons for removal of sows and decrease of production rates in an intensive swine production system. Urinary infection and endometritis are considered important causes for culling of sows, due to relevant reproductive consequences and increase of the replacement rates. The present study aimed to evaluate the reproductive and urinary system of culled sows, as well as investigate the occurrence of cystitis and endometritis in analyzed sows. Samples, such as ovaries, uterus fragments and bladder were collected from 79 sows originated from 20 farms of Santa Catarina State. Results showed that, 32 (40,5%) analyzed sows presented cystitis in different levels, 24 (30,4%) had some class of uterine inflammation, and 9 (11,4%) were in anestrous, with inactive ovaries. However, unsignificative dependence between cystitis and endometritis in analyzed samples was observed.

Analysis of ureteral length in adult cadavers

Introduction In some occasions, correlations between human structures can help planning surgical intra-abdominal interventions. The previous determination of ureteral length helps pre-operatory planning of surgeries, reduces costs of auxiliary exams, the correct choice of double-J catheter with low morbidity and fewer symptoms, and an adequate adhesion to treatment. Objective To evaluate ureteral length in adult cadavers and to analyze its correlation with anthropometric measures. Materials and Methods: From April 2009 to January 2012 we determined ureteral length of adult cadavers submitted to necropsy and obtained the following measures: height, distance from shoulder to wrist, elbow-wrist, xiphoid appendix-umbilicus, umbilicus-pubis, xiphoid appendix-pubis and between iliac spines. We analyzed the correlations between ureteral length and those anthropometric measures. Results We dissected 115 ureters from 115 adult corpses from April 2009 to January 2012. Median ureteral length didn't vary between sexes or according to height. It was observed no correlation among ureteral length and all considered anthropometric measures in all analyzed subgroups and in general population. There were no significant differences between right and left ureteral measures. Conclusions There is no difference of ureteral length in relation to height or gender (male or female). There is no significant correlation among ureteral length and the considered anthropometric measures. .

Histomorphometry of the vesicourethral

To evaluate the elastic system fibers in the vesicourethral junction of wistar rats at different ages, histological and histomorphometric studies were conducted. The histology study of the elastic system fibers for selective staining methods showed the presence of three types of elastic fibers. In all age groups studied, histology study satisfactorily showed the structurals differences between the mature elastic fibers, elaunin and oxytalan fibers, which were located among the intercellular spaces of the muscular layer as well as between collagen fibers. Histomorphometric studies have revealed that with the advanced age, there is a decrease in the linear density of the mature elastic and oxytalan fibers, while the linear density of elaunin fibers has increased. Thus, it could be inferred that in the vesicourethral junction of old animals, there is a fall in the elasticity, elastic recoil and anchorage properties due a loss of elastin and microfibrils, but they are compensated by the elaunin fibers, since they show intermediate characteristics between mature elastic fibers and oxytalan fibers. It could be concluded that the aging process of the elastic fibers in the vesicourethral junction does not contribute alone and directly in the urinary incontinence state, but it compensates and gives muscular support, mainly due to the increase of the elaunin fibers, what makes the elastic system in the vesicourethral junction responsible for the maintenance of the urinary continence.

Anatomical features of the urethra and urinary bladder catheterization in female mice and rats. An essential translational tool / Características anatômicas da cateterização da uretra e bexiga de camundongos e ratos fêmeas. Instrumento essencial na pesquisa pré clínica

PURPOSE: To present fundamental anatomical aspects and technical skills necessary to urethra and urinary bladder catheterization in female mice and rats. METHODS: Urethral and bladder catheterization has been widely utilized for carcinogenesis and cancer research and still remains very useful in several applications: from toxicological purposes as well as inflammatory and infectious conditions to functional aspects as bladder dynamics and vesicoureteral reflux, among many others. RESULTS: Animal models are in the center of translational research and those involving rodents are the most important nowadays due to several advantages including human reproducibility, easy handling and low cost. CONCLUSIONS: Although technical and anatomical pearls for rodent urethral and bladder access are presented as tackles to the advancement of lower urinary tract preclinical investigation in a broaden sight, restriction to female animals hampers the male microenvironment, demanding future advances.

OBJETIVO: Apresentar aspectos anatômicos fundamentais e habilidades técnicas necessárias para cateterismo da uretra e bexiga em ratos e camundongos fêmeas. MÉTODOS: Cateterismo vesical tem sido amplamente utilizado na pesquisa do câncer e carcinogênese, além de várias outras aplicações, desde fins toxicológicos, condições inflamatórias e infecciosas até aspectos funcionais como a dinâmica vesical e refluxo vesico-ureteral, entre muitos outros. RESULTADOS: Os modelos animais estão no centro da investigação de translação e os roedores são os mais importantes devido a várias vantagens, incluindo reprodutibilidade humana, o fácil manuseio e baixo custo. CONCLUSÕES: Apesar de permitir o desenvolvimento da investigação pré-clínica do trato urinário inferior, o modelo se restringe aos animais do sexo feminino, de modo que avanços futuros são necessários.

Análisis del volumen rectal en pacientes con cáncer de próstata: temprano durante la radioterapia conformada / Analysis of rectal volume in patients with early prostate cancer: during the 3D radiation therapy

Se realiza un estudio observacional, descriptivo y cuantitativo, con descripción numérica de los datos, con el objetivo de determinar el cambio del volumen rectal en noventa pacientes con cáncer de próstata durante el tratamiento radiante. Utilizamos técnica de radioterapia conformada y tres dimensiones. El método complementario elegido para valorar el cambio del volumen de la ampolla rectal fue una tomografía axial computarizada de pelvis durante el tratamiento radiante. En el 86% de pacientes se evidenció la ampolla rectal con material fecal y gaseoso; y en 14% restante se encontraba vacía. Los diámetros promedios fueron de: 23,4 mm para ampolla rectal vacía y 32,8 mm para la ampolla rectal dilatada, los cambios del volumen rectal alteran la posición del volumen blanco de tratamiento radiante (próstata). Recomendamos efectuar la radioterapia entre las 15 y las 18 horas de acuerdo a la fisiología y practicar a todo paciente una manometría ano-rectal.

We realized a study observational, descriptive and quantitative with numeric description of date, we carry out this work to determine the change of rectal volume in 90 patients with diagnostic of prostate cancer during radiant treatment. We utilize conformal radiation therapy technique in tree dimension. The complementary method used to valor the changes in the volume of the rectal was axial computer tomography of the pelvis during the radiation treatment. In 86% of patients we evidence the rectal blister with fecal and gaseous material the rest 14% blister was empty. The average of diameters were 23.4 mm to the blister empty and 38.8 mm to the rectal dilated blister, the changes in the rectal volume alter the volume target of the radiation treatment (prostate). Recommend do the radiation therapy between the 15 and 18 hours in relation with physiology and practice to all patients a rectal manometer study.

Quantificação digital da imunoexpressão de receptores adrenérgicos e terminações nervosas no detrusor de portadores da síndrome de prune belly / Digital quantification of the imunoexpression of adrenergic receptors and nervous terminations in the detrusor of patients with prune belly syndrome

INTRODUÇÃO: A síndrome de prune belly (PBS) é caracterizada por uma tríade com flacidez da parede abdominal, criptorquidia bilateral e malformações do trato urinário que compreende bexiga de capacidade aumentada, com complacência elevada, hipossensibilidade, hipocontratilidade, com divertículo ou fístula uracal e resíduo pós-miccional elevado. Alguns autores recomendam tratamento clínico, porém outros propõe correção cirúrgica, com reconstrução da via urinária incluindo ureteroplastia e cistoplastia redutoras, orquidopexia e abdominoplastia. Mesmo após a cirurgia, alguns doentes necessitam de cateterismo limpo intermitente. A inervação vesical determina seu funcionamento, mediado por neuroreceptores na junção neuromuscular. Os adrenoreceptores a1 estão relacionados à contratilidade detrusora e o b3 ao seu relaxamento, e certas condições como obstrução infravesical levam à hiperexpressão de receptores a1. O objetivo da presente pesquisa é verificar se no detrusor de doentes com PBS há alteração na densidade de terminações nervosas, hiper ou hipoexpressão de receptores adrenérgicos a1a, a1b, a1d e b3 e proporção anormal dos tecidos muscular e conectivo. MÉTODO Trata-se de estudo retrospectivo de caso-controle que envolveu 14 espécimes de detrusor de doentes com PBS operados entre 1985 a 2005 no Hospital das Clínicas da FMUSP. Dois grupos foram constituídos como controle: 13 fragmentos de bexiga de doentes submetidos à prostatectomia radical no Departamento de Urologia da Universidade de Mainz, com urodinâmica pré-operatória normal (GC1), e cinco fragmentos de bexiga de crianças submetidas à necrópsia no SVOC-USP, sem anomalias neurológicas e de trato urinário. A coloração de van Gieson foi realizada para análise da proporção músculo/tecido conectivo, e a reação imunohistoquímica para os anticorpos policlonais anti-proteína S100 e antiadrenoreceptores a1a, a1b, a1d e b3. A coloração castanho foi considerada evidência da expressão do adrenoreceptor...

INTRODUCTION: Prune belly syndrome (PBS) is charactherized by a triad of abdominal wall flaccidity, bilateral criptorchidism and urinary tract malformation, that includes a large-capacity bladder, with high detrusor compliance, low sensibility and contractility, associated to urachal diverticulum or fistula and elevated post void residual volumes. Some autors recommend clinical treatment, but others propose surgery correction, with urinary tract reconstruction, including reductive ureteroplasty and cystoplasty, orchidopexy and abdominoplasty. Even after surgery, some patients need intermittent catheterism. The detrusor innervation determines its function, mediated by neuroceptors at the neuromuscular junction. The a1 adrenoceptors are related to detrusor contractility and b3 to relaxation, and some conditions, like infravesical obstruction, lead to a1 adrenoceptor up-regulation. The objective of this work is to verify whether, in the detrusor from patients with PBS, there is altered nerve density, up or down-regulation of a1a, a1b, a1d and b3 adrenergic receptors and if there is an abnormal proportion between muscle and connective tissue. MATERIALS AND METHODS A retrospective case-control study was performed involving 14 detrusor specimens from patients with PBS, who underwent surgical treatment between 1985 an 2005 at University of São Paulo, Medical School Hospital. Two groups were taken as control: 13 bladder fragments from patients who underwent radical prostatectomy at Department of Urology of Mainz University, with normal urodynamic study prior to the surgery (GC1) and 5 bladder fragments from children submitted to autopsy at SVOC-USP, with no neurological or urinary tract malformation (GC2). Staining was performed using the van Gieson dye to analyse the proportion between muscle and connective tissue, and immunohistochemical reaction was employed, with polyclonal antibodies against S100 protein, as well as a1a, a1b, a1d and b3 adrenoceptors. Brown...

Avicenna's canon of medicine and modern urology. Part I: bladder and its diseases

Studying the Avicenna's Canon of Medicine, provides noteworthy information on the subjects related to urology. Some examples of these amazing items have been confirmed by the modern urology: explaining the 2-stage function of the bladder [filling and emptying stages]; indirect pointing to a scientific law, named later as the Laplace's law, which is applicable to bladder physiology and explains intravesical pressure stability; describing the bladder layers and strength of the urothelial layer, which was later proved to be due to the tight junctions; describing the intramural ureter and its antireflux mechanism; scientific classifying the urethral and bladder diseases; and describing meticulously the semiology and epidemiology of bladder calculi. Avicenna has also pointed to inversion therapy in the treatment of urinary calculi, grating sign in bladder calculi, manipulation methods for treatment of bladder calculi, and finally, the Crede maneuver. His methodology is completely scientific, based on experiments and truly a basis of the modern medicine. This article is a review of Avicenna's views in medicine and their comparison with the modern urology

Mecanismos de continência e teoria integral da incontinência urinária feminina / Continence mechanisms and the integral theory of female urinary incontinence

É um tradicional conceito em Medicina que toda disfunção está relacionada a defeitos anatômicos. Isto levou à elaboração de várias teorias, nas quais as alterações morfológicas seriam fatores causais para a incontinência urinária. Talvez a teoria que mais se firmou ao longo do tempo foi a de Enhorning que, em 1967, elaborou a Teoria de equalização da pressão intra-abdominal, segundo a qual a condição básica para a continência urinária é a topografia intra-abdominal do colo vesical. Esta teoria foi aceita durante muito tempo como explicação satisfatória para a gênese da incontinência urinária, muito embora, algumas constatações colocassem dúvidas sobre seus princípios. As contradições da teoria proposta por Enhorning motivaram Petros e Ulmsten, 1990, a elaborarem nova explicação para a gênese da IUE. Nesse âmbito, propuseram a chamada Teoria integral da incontinência urinária feminina. Segundo esta teoria, os sintomas decorrentes da IUE e da hiperatividade vesical seriam secundários, por diferentes razões, à frouxidão da vagina e de seus ligamentos de suporte, resultado da alteração do tecido conectivo.

Anatomical and ultrasonographic [transv aginal and transperineal] assessment of the urethrovesical junction in continent volunteer women: a prospective study

Urinary incontinence is a distressing condition which leads to medical and psychological problems in women. Intrinsic and extrinsic properties of the urethrovesical junction [bladder neck] allow maintenance of urinary continence at rest and with activity. The goal of this study was to clarify the anatomical structures responsible for the urinary continence control system. Also, to set a basis for ultrasonographic evaluation of the urethrovesical junction [bladder neck] through transvaginal and transperineal approaches. Prospective study done in Anatomy department and University teaching hospital. Anatomic study: Ten human female cadavers were used. Dissection of the abdominopelvic region and sagittal sections were made. Assessment of the position of the urethrovesical junction [bladder neck] in relation to the symphysis pubis was done. The following parameters were measured: Distance between bladder neck and the posterior midpoint of symphysis pubis [distance 1], -Distance between bladder neck and lower border of the symphysis pubis [distance 2], -Posterior urethrovesical angle. Ultrasonographic study: One hundred healthy continent volunteer women were examined by transvaginal [with empty and full bladder] and transperineal ultrasonography [with full bladder] for evaluation of the bladder neck at rest and during straining. Measurements of distance 1, distance 2, Posterior urethrovesical angle, and bladder neck descent during straining were done. The anatomical study revealed that the urethral support system consisted of anterior vaginal wall, endopelvic fascia, arcus tendineus fasciae pelvis, and levator ani muscles. Distance 1 ranged between 12 to 24 mm with a mean of 16 mm, while distance 2 ranged between 15 to 33 mm with a mean of 23 mm and the posterior urethrovesical angle ranged between 70 to 85 degrees with a mean of 80 degrees. The ultrasonographic study revealed that: a-In empty bladder: distance 1 ranged betweenli and 16 mm with a mean of 12.5 +/- 3.5 mm at rest and between 13 to 18 mm with a mean of 14 +/- 4.' mm during straining, while distance 2 ranged between 12 to 18 mm with a mean of 14 +/- 3.9 mm at rest and between 15 to 20 mm with a mean of 16 +/- 5.1 mm during straining. Bladder neck descent during straining ranged between 1 to 5 mm with a mean of 2.5 +/- 1.1 mm. b-In full bladder: distance 1-ranged between 10 to 15 mm with a mean of 11.5 +/- 3.4 mm at rest, while during straining it ranged between 14 to 20 mm with a mean 15 +/- 4.5 mm. Distance 2-ranged between 11 to 16 mm with a mean 12 +/- 3.3 mm at rest; while during straining it ranged between 17 to 24 mm with a mean 18.5 +/- 4.4 mm. Bladder neck descent during straining ranged between 1 to 8 mm with a mean of 4.5 +/- 1.5 mm. The urethrovesical angle was acute at rest and right angle during straining in empty urinary bladder, to turn into right angle at rest and slightly obtuse during straining in full urinary bladder. Understanding of the normal anatomical urethral support system with special reference to urethrovesical junction and ultrasonographic evaluation of the urethrovesical angle in healthy women can help the urogynecologists in the correct diagnosis and management of female genuine stress incontinence

functional anatomy of the uretero-vesical junction. A historical review

This paper evaluates the progress of anatomy and dissection during the Middle Ages both in Europe and in the Muslim World. For that purpose, the functional anatomy of the ureterovesical junction and the mechanism of micturition were studied both in the works of Galen [130-200 AD] and in the works of 6 Islamic medical scholars who lived in the period from the ninth to the thirteenth centuries AD [Alrazi, Alzahrawi, Ibn Sina, Al-Baghdadi, Ibn El Nefis and Ibn El Quff]. The study relied, only, on original sources in the form of authentic editions and manuscripts. In general, the ideas and findings of those 6 Islamic physicians, as regard the anti-reflux and the micturition mechanisms, differed and contradicted with those of Galen but conformed well with our present day concepts

Evaluación de la unión uretro-vesical por ultrasonografía vía transperineal / Evaluation of the urethro vesical joint by transperineal ultrasonography

Se describe la evaluación ultrasonográfica transperineal de la movilidad de la unión uretro-vesical en 216 pacientes en reposo y bajo presión. Se la compara con el procedimiento de Q tip, demostrándose la utilidad de este examen simple y no invasivo

Bilateral bladder flaps sling for sphincteric incontinence: surgical and histochemical study

In animal model of 10 female rabbits, extramucosal [or stripped mucosa] flap of anterior bladder wall [1 cm length and 0.4 mm width] was divided into its midline with intact base just proximal to BN. Each flap was then turn to pass under the mobilized BN and proximal urethra to contralateral side pelvis and sutured to anterior rectus fascia under mild tension, with urethral catheter in place. After 2 days, 1, 2 and 4 weeks flaps were subjected for gross [length, width and tension], histochemical [H and E, Mallory trichrome, Van Gieson, and Orceine stains] and microscopic examinations. Statistical analysis is based on paired samples T-test. Results showed that, flaps were vital, tense, flat, and maintained their length [P >0.2]. There is significant increase in flaps width and thickness [P <003]. Histological results included hypertrophy and maintained length of muscle bundles, and significant increase and regular distribution of elastin and collagen. Blood vessels and nerves are preserved. There is no dystrophic change

Transtornos miccionales asociados a la hiperplasia prostática benigna: papel del músculo detrusor en los resultados de la cirugía sobre la salida vesical: (revision clínica) / Miccionals dosorders asociated yo prostatic enlargement: áper of detrusor muscle in the resulting of surgery of vesical exit: (clinical revision)

Evidenciar el alcance que tiene el comportamiento del músculo detrusor de la vejiga, sobre los resultados de la Cirugía Prostática, analizando trabajos de Investigación reportados en los últimos diez años, que satisfacen las expectativas de los autores, para el desarrollo del presente tema. Las conclusiones obtenidas, colocan a los métodos diagnósticos preoperatorios, utilizados en los pacientes con salida vesical obstructiva, con resultados, verdaderamente paradójicos. Se obtiene además, conclusiones en lo referente a la importancia del músculo detrusor de la vejiga, en los resultados obtenidos con la cirugía de alivio de la salida vesical (cualquiera sea su modalidad), enfoncando aspectos como histopatología del músculo detrusor en relación a la obstrucción infravesical, comportamiento uroneurológico y urodinámico en dichos pacientes, tanto antes, como después de la cirugía de alivio de la salida vesical. Sin duda alguna se esta haciendo una mejor, y mas lógica selección de pacientes, para someterse a Cirugía de alivio de la salida vesical, al enfocar no solo los aspectos convencionales en lo referente a los motivos orgánicos y funcionales de la obstrucción urinaria infravesical, sino a un mejor y mas completo entendimiento de la función del detrusor en relación a los transtornos miccionales, que tanto afectan al hombre por arriba de los cincuenta años, y que pudiera ser el aspecto ignorado por los Urólogos en aquellos pacientes que no obtienen de la cirugía los resultados esperados. Por todo lo antes mencionado, se están obteniendo también mejores resultados a corto y a largo plazo y con esto, se esta recolocando a la Cirugía Prostática en el lugar de vanguardia que siempre ha tenido, tiene y tendra en el mundo urológico, como parte del tratamiento de la Salida Vesical obstructiva. Al no tomar en cuenta éste factor perturbación en los resultados de la cirugía Prostática se ha querido desprestigiar el procedimiento quirúrgico denominado aun, en el mundo entero, el estandar de oro, del tratamiento para la obstrucción infravesical ocasionada por la Glandula Prostática

Laparoscopic extraperitoneal bladder neck suspension (LEBNS) for stress urinary incontinence

Seventy-nine patients of bladder neck suspension using an extraperitoneal variation of laparoscopic surgery were performed for the treatment of stress urinary incontinence. Using a balloon dissector the anterior vesical pelvic space is secured. The bladder neck suspension similar to the Burch operation was performed through a laparoscopic procedure. Symptoms of patients were assessed preoperatively and at one and six months following surgery. Operative times and complications were also evaluated. Success rate was 89.8% at six months. Complications such as bladder perforations were observed. Laparoscopic extraperitoneal bladder neck suspension-(LEBNS) is a viable option to the conventional methods of suspension, it has definite cosmetic advantages, is devoid of intraperitoneal dissection and adhesion, and has a comparable success rate.

La túnica muscularis mucosae de la vejiga urinaria: distribución y características regionales / The muscularis mucosae tunic of the urinary bladder: distribution and sectional distribution

El reconocimiento de bandas de músculo liso (ML) en la lámina propia (LP) de la vejiga urinaria es un hallazgo reciente. Con el objeto de establecer su distribución regional se analizaron cerca de 200 cortes histológicos tomados de 8 vejigas no patológicas de autopsias consecutivas. En cada caso se obtuvieron 6 cortes de 2,5 x 0,5 cmc de cada una de las siguientes regiones : Pared Anterior (PA), Pared Posterior (PP), Trígono (T) y Cuello (C). Se confeccionó un protocolo consignando el porcentaje de ML en PL en una escala de 0 a 100 por ciento con intervalos de 10. Se calcularon promedios y desvío standard de los valores hallados por caso y región. Se determinó el patrón de distribución según los criterios de Ro y Col (Am J Surg Pathol 11(9), 1987). Resultados : N§ de casos : 8. Edad promedio : 60 (rango 47-71). Sexo : M6, F2. Porcentajes promedio totales de ML en LP por región y Desvío St. : PA 25/21, PP : 17/15; T : 21/15, C : 20/15. Porcentajes promedio por caso y Desvío St. : 1) 23/17; 2) 9/6; 3) 23/18; 4) 31/30; 5) 11/9; 6) 26/17; 7) 17/8; 8) 26/10. Se observó frecuente coexistencia de patrones y combinación de ausencia y presencia de ML en la misma vejiga y en la misma región. La comparación de porcentajes promedio por caso, región y sexo no mostró diferencias significativas. La gran dispersión de valores y superposición de patrones indican que la distribución de ML en LP es heterogénea y aleatoria. Un corte al azar puede no reprentar la situación en el resto de la vejiga.