Mysterious ureteral migration of a wooden toothpick from the digestive tract: case report and diagnostic considerations

ABSTRACT Migration of foreign bodies into the urinary tract is a rare event. In certain instances, to unravel the way that objects arrived in the urinary tract is not easy. We report the case of an accidentally swallowed wooden toothpick that migrated and was found in the left ureterovesical junction, protruding into the bladder. Even though the computed tomography scan is widely employed to evaluate the urinary tract, this resource does not have a good sensitivity for detecting foreign bodies. Our report presents an insight into the best imaging approach if wooden toothpicks are suspected. In the present case, the endoscopic treatment was possible with an uneventful outcome and a complete resolution of symptoms.

Image-guided study of swine anatomy as a tool for urologic surgery research and training

Abstract Purpose: To describe the anatomy of the swine urinary system using computed tomography and to discuss the role of this animal as an experimental model for urological procedures. Methods: Three male Landrace pigs underwent computed tomography and the anatomy of the urinary system and renal circulation was analyzed and described. Results: In all animals, 2 kidneys, 2 ureters and one bladder were identified. Each kidney presented a single renal artery vascularization, with a mean diameter on the right of 4.45 and 5.31 mm on the left (p < 0.0001) and single renal vein drainage, with a mean diameter on the right of 5.78 and 5.82 mm on the left (p = 0.0336). The average renal length was 9.85 cm on the right and 10.30 cm on the left (p < 0.0001). The average renal volume was 113.70 cm3 on the right and 109.70 cm3 on the left (p < 0.0001). The average length of the ureter was 19.78 cm on the right and 22.08 cm on the left (p < 0.0001). The average bladder volume was 423.70 cm3. Conclusions: The data obtained show similarities with human anatomy, suggesting the viability of the swine model for planning preclinical trials, basic research, refinement in experimental surgery and surgical training for urological procedures.

Simplified method using kidney / ureter / bladder x-ray to determine the appropriate length of ureteral stents

ABSTRACT Purpose: To investigate a method to determine the appropriate length of ureteral stents, given that the stent length may lead to exacerbation of urinary symptoms if the stent crosses the bladder midline. Materials and Methods: We retrospectively reviewed the position of the distal curl of the ureteral stent using kidney/ureter/bladder (KUB) radiographs after ureteroscopic lithotripsy in 165 patients who underwent placement of 24- or 26-cm ureteral stents. According to the KUB findings, we categorized the position of the distal curl of the ureteral stent into two groups. In Group 1, the stents did not cross the midline (appropriate length); in Group 2, the stents crossed the midline (inappropriate length). We assessed several patient parameters (sex, height, body mass index, and stone side) and the index of ureteral length using KUB radiographs ("C-P") and computed tomography (CT, "P-V"). Multivariate analysis was performed to identify the most significant factors affecting the position of ureteral stents. We also calculated the cutoff points of the receiver operating characteristic (ROC) curve of C-P and P-V for the position of ureteral stents. Results: The multivariate analysis showed that C-P was the most significant factor affecting the position of ureteral stents (p < 0.001) in patients with 24- and 26-cm ureteral stents. Comparison of the ROC curves of C-P and P-V showed that C-P was superior to P-V (p < 0.01) in patients with 24- and 26-cm stents. Conclusion: The use of KUB radiographs was effective and simple in determining the appropriate length of ureteral stents.

Accidental cystectomy during laparoscopic excision of prostatic utricle cyst - a rare complication

ABSTRACT Prostatic utricle cyst is a rare congenital anomaly. Symptomatic cysts require treatment. Surgical excision is the treatment of choice, but is challenging due to close proximity to vas deferens, ejaculatory ducts, bladder, prostate, rectum and pelvic nerves. Complications include rectal injury, ureteral injury, impotence, infertility and faecal incontinence. We here report a rare complication in which bladder was accidentally removed during laparoscopic excision of prostatic utricle cyst. To best of our knowledge such a complication has never been reported previously. We also describe the possible cause of this accident and suggest ways to prevent this disastrous complication.

The role of bladder diverticula in the prevalence of acute urinary retention in patients with BPH who are candidates to surgery

ABSTRACT Introduction: The urinary bladder diverticula (BD) secondary to benign prostatic hyperplasia (BPH) is a complication that can lead to urinary stasis, stone, urinary tract infection (UTI) and tumors. It's role in acute urinary retention (AUR) is not totally understood. Objectives: To determine the effect of BD size on AUR rates in patients with BPH candidates to surgery. Subjects and Methods: We performed a retrospective cohort study of 47 patients with BPH and BD who underwent BPH surgery associated to complete bladder diverticulectomy from 2006 to 2016. We analyzed risk factors for AUR in patients with BD using univariate, multivariate and correlation analysis. Results: There was a difference in the size of the diverticula, with 6.8 cm vs. 4.5 cm among patients with and without AUR respectively (p=0.005). The ROC curve showed a correlation between the size of BD and the risk of AUR. The value of 5.15 cm presented a sensitivity of 73% and a specificity of 72%. The area under the curve was 0.75 (p=0.01). Comparing groups with BD >5.0 cm vs. ≤5.0 cm, the AUR incidence was 74% and 27.8% respectively with an OR of 2.65 (1.20-5.85) (p=0.005). In the multivariate analysis, only the size of the diverticula reached statistical significance (p=0.012). Conclusions: The diameter of BD is an independent risk factor for AUR in patients with BPH and BD who are candidates to surgery. A diameter greater than 5.15 cm increases the risk of AUR.

Overactive bladder syndrome and bladder wall thickness in patients with obstructive sleep apnea syndrome

ABSTRACT Objective The main objective of the present study was to evaluate the presence of overactive bladder (OAB) syndrome, nocturia, urgency, and urge incontinence in patients with obstructive sleep apnea syndrome (OSAS), and measure bladder wall thickness (BWT) in these patients. Materials and Methods The patient group was composed of 38 patients with OSAS. The control group was composed of 15 healthy individuals. All patients were evaluated using the Epworth Sleepiness Scale (ESS) and Overactive Bladder Symptom Score (OABSS). The bladder wall thickness was measured by transabdominal ultrasound (US). The presence of nocturia, urinary urgency, and urge incontinence were also evaluated. Results The mean OABSS was significantly higher in the patient group compared with the control group (p=0.048). The minimum oxygen saturation (Min.SO2) of patients with urgency was found to be significantly lower (p=0.014). The time spent below 90% of oxygen saturation (SO2) was significantly longer in patients with urinary urgency (p=0.009). There was no difference in BWT measurements between the patient group and the control group. There was a significant relationship between BWT values and OABSS in patients with OSAS (p=0.002). Conclusion The results of the present study suggest that OSAS is associated with OAB syndrome. As a key symptom of OAB, urgency correlates with hypoxia in cases with OSAS. Although the present study did not observe any difference in BWT measurements between the patients and the control group, there was a correlation between BWT measurements and OABSS in patients with OSAS.

Características ultrassonográficas de fígado, vesícula biliar, rins, vesícula urinária e jejuno em coelhos jovens e adultos / Ultrasound features of liver, gallbladder kidneys, urinary bladder and jejunum in young and adult rabbits

O presente trabalho descreveu características e comparou mensurações do fígado, vesícula biliar, rins, vesícula urinária e jejuno de coelhos da raça Nova Zelândia Branco (NZB) jovens e adultos. O grupo dos jovens foi composto por 39 coelhos de ambos os sexos (20 machos e 19 fêmeas), desmamados aos 30-31 dias de idade, sendo as avaliações realizadas aos 35, 56 e 77 dias de idade. O grupo dos adultos foi composto por 23 fêmeas e 15 machos, com idade superior a 6 meses, sendo realizada uma avaliação ultrassonográfica por animal. O exame consistiu na avaliação do fígado, vesícula biliar, rins direito e esquerdo, jejuno e vesícula urinária. Todos os animais foram pesados antes dos exames. O peso médio dos animais aumentou (p<0,05) dos 35 dias até a idade adulta. Tanto nos adultos quanto nos jovens, o fígado apresentou-se predominantemente isoecogênico ao rim direito e com textura homogênea. A vesícula biliar apresentou-se em formato ovoide alongado, variando de piriforme à amendoado, com conteúdo anecogênico, não sendo visível em 2,6% dos coelhos jovens e em 26,3% dos adultos. O comprimento e a largura da vesícula biliar nas idades de 35, 56, 77 dias e adultos foram: 1,06 e 0,39; 1,44 e 0,53; 1,41 e 0,58; 1,57 e 0,67cm, respectivamente. Considerando jovens e adultos, as mensurações da vesícula biliar e dos rins esquerdo e direito apresentaram correlação positiva (p<0,05) com o peso. Os rins apresentaram-se no formato de elipse e com superfície regular, com aumento (p<0,05) dos 35 dias à idade adulta. Houve correlação positiva (p<0,05) entre os volumes renais direito e esquerdo. A descrição da vesícula urinária mais encontrada (86%) foi a com conteúdo anecogênico, com pequenas estruturas ecogênicas livres no lúmen, tanto em jovens quanto em adultos. Não houve diferença (p>0,05) da espessura das camadas do jejuno entre as idades, apresentando média de 0,23 cm para todos os animais. Estes são os primeiros dados brasileiros de características ultrassonográficas de fígado, vesícula biliar, rins, jejuno e vesícula urinária para coelhos NZB de 35, 56 e 77 dias de vida e adultos.(AU)

This study described characteristics and measurements of the liver, gallbladder, kidney, urinary bladder and jejunum of young and adults New Zealand White (NZW) rabbits. The young rabbits's group was composed of 39 rabbits of both sexes (20 males and 19 females), weaned at 30-31 days of age, and the evaluations carried out at 35, 56 and 77 days of age. The adults group was composed of 23 females and 15 males, with more than 6 months of age, and one ultrasonographic evaluation per animal. The exam consisted in the evaluation of liver, gallbladder, right and left kidneys, jejunum and urinary bladder. All the animals were weighed before the evaluations. The average weight increased (p<0.05) from 35 days to adults. Both in adult and in young rabbits, the liver presented predominantly isoechogenic in relation of right kidney and with homogeneous texture. The gallbladder had an elongated ovoid shape, ranging for pear-shaped to almond, with anechogenic content, not being visible in 2.6% of young rabbits and 26.3% of adults. The length and width were 1.06 and 0.39; 1.44 and 0.53; 1.41 and 0.58; 1.57 and 0.67cm, respectively at 35, 56, 77 days and adults. For young and adults rabbits, the gallbladder and the left and right kidneys were positively correlated (p<0.05) with weight. The kidneys had an ellipse shape with smooth surface, increasing (p>0.05) from 35 days to adulthood. There was a positive correlation (p<0.05) between the right and left kidney volumes. The description of urinary bladder more frequently (86%) observed was anechogenic content, with small free echogenic structure within the lumen, both in young and in adult rabbits. There was no difference (p>0.05) in the thickness of the layers of the jejunum among ages, with the mean of 0.23cm for all animals. With the results, the first Brazilian ultrasonographic data for liver, gallbladder, kidney, jejunum and urinary bladder were defined to NZW rabbits in 35, 56 and 77days of life, as well as adults.(AU)

Laparoscopic radical cystectomy with novel orthotopic neobladder with bilateral isoperistaltic afferent limbs: initial experience

ABSTRACT Purpose To introduce a new method of constructing an orthotopic ileal neobladder with bilateral isoperistaltic afferent limbs, and to describe its clinical outcomes. Materials and Methods From January 2012 to December 2013, 16 patients underwent a new method of orthotopic ileal neobladder after laparoscopic radical cystectomy for bladder cancer. To construct the neobladder, an ileal segment 60cm long was isolated approximately 25cm proximally to the ileocecum. The proximal 20cm of the ileal segment was divided into two parts for bilateral isoperistaltic afferent limbs. The proximal 10cm of the ileal segment was moved to the distal end of the ileal segment for the right isoperistaltic afferent limb, and the remaining proximal 10cm ileal segment was reserved for the left isoperistaltic afferent limb. The remaining length of the 40cm ileal segment was detubularized along its antimesenteric border to form a reservoir. The neobladder was sutured to achieve a spherical configuration. Results All procedures were carried out successfully. The mean operative time was 330 min, mean blood loss was 328mL, and mean hospital stay was 12.5 days. The mean neobladder capacity 6 and 12 months after surgery was 300mL and 401mL, respectively. With a mean follow-up of 22.8 months, all patients achieved daytime continence and 15 achieved nighttime continence. The mean peak urinary flow rate was 11.9mL/s and 12.8mL/s at 6 and 12 months postoperatively, respectively. Conclusions This novel procedure is feasible, safe, simple to perform, and provides encouraging functional outcomes. However, comparative studies with long-term follow-up are required to prove its superiority.

Capacidad vesical funcional mediante ultrasonido en pacientes con enuresis primaria monosintomática / Functional bladder capacity by ultrasound in patients with monosymptomatic primary enuresis

La enuresis primaria monosintomática es un problema clínico común que afecta del 5 al 10% de los niños en edad escolar. La etiología exacta no se conoce, pero se ha propuesto una capacidad vesical funcional disminuida como factor predisponente. Existen pocos reportes en la literatura del uso de ultrasonido para su evaluación. Objetivo: Determinar si la capacidad vesical funcional medida por ultrasonido está disminuida en enuresis primaria monosintomática comparada con población sana. Pacientes y Método: Estudio trasversal analítico de febrero de 2014 a mayo de 2015 incluyendo 40 pacientes con enuresis y 40 sin enuresis, 5 a 15 años de edad, midiendo la capacidad vesical funcional mediante ecógrafo Siemens Acuson S2000TM con transductor 3,5 y 5 MHz por un solo operador cegado. Se realizó estadística descriptiva y analítica mediante el programa IBM SPSS 20 TM. Resultados: Los pacientes con enuresis presentaron menor capacidad vesical funcional 171,7 ml vs controles 225,5 ml (p = 0,025). Resultó factor de riesgo OR = 2,81 (IC 95%: 1,06-7,42) tener un familiar de primera línea con antecedente de enuresis y OR = 4,0 (IC 95%: 1,48-10,78) para segunda línea. La capacidad vesical funcional presentó correlación débil con la capacidad vesical normal estimada mediante la fórmula de Kaefer. Conclusión: La capacidad vesical funcional es menor en quien padece enuresis que en los que no la padecen y existe poca correlación con las fórmulas que determinan la capacidad vesical normal esperada como la de Kaefer. Se reafirmó que el antecedente hereditario de enuresis juega un papel importante como factor de riesgo.

Nocturnal enuresis is a common clinical problem affecting 5% to 10% of school-age children. Etiology is not known but a diminished functional bladder capacity it has been proposed as a predisposing factor. There exist only a few studies evaluating it by ultrasound. Objective: To identify if there is a difference of the functional bladder capacity measured by ultrasound between nocturnal enuresis group and healthy children. Patients and Method: A cross-sectional study from February 2014 to May 2015 including two groups, nocturnal enuresis and a control group of 40 patients each, 5 to 15 years old. A single blinded operator measured the functional bladder capacity by ultrasound with an Acuson S2000 SiemensTM 3.5 and 5 MHz transducer. Analytics and descriptive statistics were performed using IBM SPSS 20TM software. Results: Patients with enuresis showed a decreased functional bladder capacity vs. controls (171.7 ml vs 225.5 ml; p = 0.025). A history of first-degree relative with enuresis increased the risk of having enuresis OR = 2.81 (95% CI: 1.06-7.42), a second-degree relative presented OR = 4.0 (95% CI: 1.48-10.78). Functional bladder capacity presented a weak correlation with the bladder capacity estimated by Kaefer’s formula. Conclusion: The functional bladder capacity is lower in the patients with nocturnal enuresis when compared to control group. There is little correlation between functional bladder capacity and Kaefer’s formula to determine the normal bladder capacity. We reaffirmed that the family history with enuresis strongly increases the risk of developing nocturnal enuresis.

Ureteral stricture formation after ureteroscope treatment of impacted calculi: A prospective study

PURPOSE: Urinary calculi is a familiar disease. A well-known complication of endourological treatment for impacted ureteral stones is the formation of ureteral strictures, which has been reported to occur in 14.2% to 24% of cases. MATERIALS AND METHODS: This was a prospective study. Ureterotripsy treatment was used on patients with impacted ureteral stones. Then, after 3 months and 6 months, the condition of these patients was assessed by means of a kidney-ureter-bladder (KUB) ultrasound. If the KUB ultrasound indicated moderate to serious hydronephrosis, the patient was further assessed by means of a computed tomography intravenous urogram or retrograde pyelogram to confirm the occurrence of ureteral strictures. RESULTS: Of the 77 patients who participated in the study, 5 developed ureteral strictures. Thus, the stricture rate was 7.8%. An analysis of the intraoperative risk factors including perforation of the ureter, damage to the mucous membrane, and residual stone impacted within the ureter mucosa revealed that none of these factors contributed significantly to the formation of the ureteric strictures. The stone-related risk factors that were taken into consideration were stone size, stone impaction site, and duration of impaction. These stone factors also did not contribute significantly to the formation of the ureteral strictures. CONCLUSIONS: This prospective study failed to identify any predictable factors for ureteral stricture formation. It is proposed that all patients undergo a simple postoperative KUB ultrasound screening 3 months after undergoing endoscopic treatment for impacted ureteral stones.

Evaluation of post operative urinary bladder distention at prince Rashid Military Hospital

To assess and evaluate the occurrence of the post operative urinary distention using ultrasound technique. A total of 328 patients who underwent abdominal, neurosurgical, orthopedic and ENT surgical procedures at Prince Rashid Bin Al-Hassan Hospital between 1[st] April 2009 till 28[th] February 2010, were included in the study. Post operative urinary distention was assessed using ultrasound at the time of discharge from recovery room. The variables in the study were age, gender, type of anesthesia, type and duration of surgeries. Simple descriptive statistic [frequency and percentage] was used to describe the study variables. Of the 328 patients who were included in the study, 134 patients [40.9%] were noted to have bladder distention. Eighty-three patients [25.3%] who had bladder distention were unable to urinate within 30 minutes and underwent transient urinary catheterization. These patients were older than 55 years, experienced long surgical procedures for more than 125 minutes; the majority of them were males and received spinal anesthesia. For post operative urinary retention, it was concluded that spinal anesthesia, long duration of surgery and age of 55 years and above are at high risk of having urine retention. Ultrasound is considered a good and reliable technique to reveal bladder distention and urinary retention in these patients

Ultrasonographic imaging of the urinary tract pre and post experimental urethral obstruction in bucks

The purpose of this study is to throw a light on the validity of ultrasonographic examination of urinary tract pre and post urethral obstruction in Egyptian mixed breed non castrated bucks [male goats].Nine bucks were subjected to direct penile ligation at the distal bend of the sigmoid flexure after surgical exposure of the penis to induce urethral obstruction and subsequent urine retention. Clinical and ultrasonographic examinations were carried out immediately pre experimental urethral obstruction and continued periodically every 12 hrs, throughout 48 hrs. post experimental urethral obstruction. The Ultrasonographic appearance and measurements of urinary tract compartments were assessed and compared at different examination positions using linear array endorectal probe [7.5-2.6 MHZ] and convex array general purpose probe [6-2.6 MHZ]. Both kidneys were visualized ultrasonographically through transabdominal approach and the bladder was visualized through transabdominal and transrectal approaches in all bucks. Both of them revealed normal architexture, echogenicity and dimensions before ligation. The course of the urethra in the pelvis and in the penis was not imaged in any of the bucks before ligation. There were significant increase in kidneys and bladder dimensions after urethral obstruction. The proximal portion of the pelvic urethra was visualized clearly in all bucks 24 hrs. post urethral ligation. The course of the ureters was not visualized ultrasonographically by means of the transrectal or transbdominal approaches pre-and post experimental urethral obstruction. It could be concluded that using of ultrasonography is considered a good clinical diagnostic tool for examination of the urinary tract in bucks affected with urine retention

Urinary excretion of glycosaminoglycans and ultrasound urinary bladder wall thickness in children with refractory primary nocturnal enuresis

This study was undertaken to determine variations in the amount of glycosaminoglycans [GAGs] excreted by patients with refractory primary nocturnal enuresis [RPNE], and assessment of associated bladder dysfunction with the use of a special ultrasound [US] protocol, as prediction of pathophysiology of refractory primary nocturnal enuresis and associated bladder dysfunction. The study included 30 children with [RPNE] with mean age 7.33 +/- 2.23 and 30 healthy age matched control children with mean age 8.9 +/- 1.68 years. All patients more than 5 years old were treated for primary nocturnal enuresis [PNE] with behavioral therapy and desmopressin for at least 6 months with no response. The studied groups were subjected to the following complete medical history, physical examination, urine analysis and their urinary GAGs excretion was assessed over 24 h using the sodium tetraboratecarbazole method. Plain KUB, and abdominal ultrasound using special protocol was designed for the evaluation of bladder parameters using bladder volume and wall thickness index [BVWI%], and expected percentage bladder volume index for kidney volume. Patients with refractory primary nocturnal enuresis had higher mean values of urinary GAGs excretion than age-matched controls. Also they had low bladder capacity and thick bladder wall more than age-matched. The mean urinary GAGs contents were 38.9, and 27.5 mg/g creatinine in patients with RPNE and controls respectively; [P<0.001]. Comparing the BVWI in normal and enuretic children in correlation with functional bladder capacities we found that patients with low capacity thick bladder wall also have high GAGs excretion. Measuring urinary GAGs excretion and Ultrasound bladder wall thickness can be used as predictive pathophysiological clues, for underlying bladder dysfunction, which has an important role in the pathophysiology of enuresis especially in refractory cases. Also they can minimizing the need for invasive urodynamic study in children with RPNE for assessing bladder wall dysfunction

New treatment protocol for primary nocturnal enuresis in children according to ultrasound bladder measurements

To evaluate the response rate of various modalities of therapy in primary nocturnal enuretic children according to the ultrasound bladder volume and wall thickness index [BVWI] measurements. From February 2006 to November 2007, a total of 31 children, aged 6-12 years old were enrolled in a clinical trial. Based on BVWI they were divided into 3 groups as follows: Group 1 [BVWI <70%] was treated with oral desmopressin and oxybutynin; Group 2 [BVWI 70% to <130%] was treated with oral desmopressin. Group 3 [BVWI >130%] was treated with oral desmopressin accompanied by double-voiding technique and scheduled voiding. All of them were treated for 3 months. Significant reductions in mean bed-wetting frequency before and after first treatment cycle were observed in all groups [p<0.05]. The complete response rate was 70% in Group 1, 25% in Group 2, and 20% in Group 3. Overall, the complete and partial response rate was 9/10 [90%] children in Group 1, 13/16 [81%] in Group 2, and 3/5 [60%] in Group 3. Bedwetting frequency significantly decreased at the first and second treatment cycles in Group 2 [p<0.05] for each pair wise comparison. The proposed treatment representation according to ultrasound BVWI measurements achieves favorable response rates in children with PNE. We suggest that this treatment should be used to develop the management of enuresis in children

Correlations between the Various Methods of Estimating Prostate Volume: Transabdominal, Transrectal, and Three-Dimensional US

OBJECTIVE: To evaluate the correlations between prostate volumes estimated by transabdominal, transrectal, and three-dimensional US and the factors affecting the differences. MATERIALS AND METHODS: The prostate volumes of 94 consecutive patients were measured by both transabdominal and transrectal US. Next, the prostate volumes of 58 other patients was measured by both transrectal and three-dimensional US. We evaluated the degree of correlation and mean difference in each comparison. We also analyzed possible factors affecting the differences, such as the experiences of examiners in transrectal US, bladder volume, and prostate volume. RESULTS: In the comparison of transabdominal and transrectal US methods, the mean difference was 8.4 +/- 10.5 mL and correlation coefficient (r) was 0.775 (p 0.05). The comparison between the transrectal and three-dimensional US methods revealed a mean difference of 3.7 +/- 3.4 mL and the correlation coefficient was 0.924 for the experienced examiner. Furthermore, no significant difference existed between examiners (p > 0.05). Prostate volume measured by transrectal US showed a positive correlation with the difference for the beginner only (r = 0.405, p < 0.05). CONCLUSION: In the prostate volume estimation by US, experience in transrectal US is important in the correlation with transabdominal US, but not with three-dimensional US. Also, less experienced examiners' assessment of the prostate volume can be affected by prostate volume itself.

incidence of diverticula of urinary bladder in patients with benign prostatic hypertrophy and the comparison between cystoscopy and cystography in detecting bladder diverticula

The majorities of bladder diverticula are acquired and are secondary to either bladder outlet obstruction or the upper motor type of neurogenic bladder. This study was undertaken to increase awareness and understanding the putative role of BPH [Benign Prostatic Hyperplasia] in the development of bladder diverticula and to compare cystoscopy and cystography in detecting bladder diverticula. During a 4-month period, 106 patients with BPH, who were admitted in the hospital for surgery, were examined by cystoscopy to detect bladder diverticula. Thirty-one patients were selected randomly and underwent cystography. In this study, the rate of bladder diverticula in patients with BPH was 27.4% by cystoscopy while by cystography, it was 48%.There was a slight increase of bladder diverticula with increasing age. This research also depicted that the detection rate of diverticula cystography in of urinary bladder was much greater than that of cystoscopy. This study shows that the prevalence of bladder diverticula is considerably high. The detection rate of cystography in diverticula of urinary bladder was much greater than that of cystoscopy. Considering this high prevalence and potential complications, we suggest cystography for the early diagnosis and possible treatment of bladder diverticula in older patients with lower urinary tract symptoms

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