Risk factors of postoperative sexual function in patients with urethral diverticulum and their partners: A cohort study of 83 women

ABSTRACT Introduction and Objective: Several studies have focused on the treatment and recurrence of urethral diverticulum (UD). However, few investigations have addressed sexual function in patients with UD. Therefore, we sought to examine sexual function in women affected by UD. Materials and Methods: There were 108 accepted cases involving transvaginal diverticulectomy at our institution. Ultimately, 83 women were included for further analysis, only 61 of these women had sexual partners. We collected data for the Female Sexual Function Index (FSFI) from the female patients and the Male Sexual Health Questionnaire (MSHQ) from their male partners before and after surgery. Results: Preoperatively, the UD size affected the female patient's arousal and lubrication (p=0.04), and the UD location affected their satisfaction. However, no significant between-group differences were found in the total FSFI score. For all women, sexual activity improved after surgery (p=0.0087). In addition to improvements in arousal for women with a large UD, improvements in lubrication were affected by the UD size, number and shape, increases in satisfaction scores were impacted by the UD location and shape, and pain relief was linked to the UD number and shape. Analysis of the MSHQ results revealed no between-group differences among the male partners. Conclusion: Only the UD size and location affected sexual function in women with a small UD. Surgery could improve female sexual function but did not affect the sexual function of the patient's partners.

Does MRI help in the pre - operative evaluation of pelvic fracture urethral distraction defect? - a pilot study

ABSTRACT Objectives To study the usefulness of MRI in preoperative evaluation of PFUDD. Can MRI provide additional information on urethral distraction defect (UDD) and cause of erectile dysfunction (ED)? Materials and Methods In this prospective study, consecutive male patients presenting with PFUDD were included from Feb 2011 till Dec 2012. Those with traumatic spinal cord injury and pre-existing ED were excluded. Patients were assessed using IIEF questionnaire, retrograde urethrogram and micturating cystourethrogram (RGU+MCU) and MRI pelvis. Primary end point was erectile function and secondary end point was surgical outcome. Results Twenty patients were included in this study. Fourteen patients (70%) were ≤40years; fifteen patients (75%) had ED, seven patients (35%) had severe ED. MRI findings associated with ED were longer median UDD (23mm vs. 15mm, p=0.07), cavernosal injury (100%, p=0.53), rectal injury (100%, p=0.53), retropubic scarring (60%, p=0.62) and prostatic displacement (60%, p=0.99). Twelve patients (60%) had a good surgical outcome, five (25%) had an acceptable outcome, three (15%) had a poor outcome. Poor surgical outcome was associated with rectal injury (66.7%, p=0.08), cavernosal injury (25%, p=0.19), retropubic scarring (18.1%, p=0.99) and prostatic displacement (16.7%, p=0.99). Five patients with normal erections had good surgical outcome. Three patients with ED had poor outcome (20%, p=0.20). Conclusions MRI did not offer significant advantage over MCU in the subgroup of men with normal erections. Cavernosal injury noted on MRI strongly correlated with ED. Role of MRI may be limited to the subgroup with ED or an inconclusive MCU.

Urethral dysfunction due to alloxan-induced diabetes. Urodynamic and morphological evaluation

PURPOSE: To evaluate the effect of short and long term alloxan-induced diabetes on bladder and urethral function of female rats, and also describing its correlated morphological alterations. METHODS: Thirty five female rats were divided into three groups: G1 (n=9), control group; G2 (n=17), six weeks alloxan-induced diabetic rats; G3 (n=9), 20 weeks alloxan-induced diabetic rats. Functional evaluation was performed by cystometry and simultaneous measurements of the urethral pressure during bladder filling and voiding. Morphological evaluation was also performed with measurement of bladder and urethral fibrosis and collagen content and thickness of lamina propria and smooth muscle layers. RESULTS: The peak bladder pressures and contraction amplitudes were decreased in 100% and 47% of the G3 and G2 groups respectively, when compared to control. Bladder overactivity was observed in 53% of the G2 group. CONCLUSION: Alloxan-induced diabetes urethropathty in female rat was associated to bladder morphological alterations as higher thicknesses of it lamina propria, detrusor and adventicea. .

A Importância do diagnóstico da deficiência esfincteriana uretral intrínseca em mulheres com incontinência urinária de esforço / The Importance of intrinsec sphincter urethral deficiency diagnosis in woman with effort urinary incontinence

Incontinência urinária de esforço (IUE) é conceituada como toda observação de perda involuntária de urina pelo óstio uretral externo, sincrônica ao esforço, espirro ou tosse. (Abrams et al., 2002). Tem causa multifatorial sendo elemento gerador de exclusão social, interferindo na saúde física e mental da paciente e comprometendo sua qualidade de vida. O diagnóstico da enfermidade é essencial, uma vez que a incontinência de esforço pode ser causada por deficiência esfincteriana ou por hipermobilidade da uretra. Sua diferenciação é prioridade antes de se propor tratamento cirúrgico, visto que os procedimentos de colpossuspenção retropúbicos tradicionais podem ter índices de falha de até 35 porcento em pacientes com defeito esfincteriano (Raz et al., 1992). Embora esta classificação permita distinguir duas bases fisiopatológicas distintas, é importante enfatizar que esta divisão não é absoluta. Existe espectro no qual os dois tipos podem co-existir independentemente. O termo "deficiência esfincteriana uretral intrínseca" refere-se ao subtipo de incontinência urinária de esforço causada pela inabilidade do mecanismo esfincteriano uretral em manter a coaptação da mucosa tanto no repouso quanto ao esforço físico. Difere da hipermobilidade do colo vesical por fatores de risco diferentes, maior gravidade dos sintomas e pior resposta ao tratamento (Bump et al., 1997). Esforços têm sido feitos na definição, reconhecimento, demonstração objetiva e manejo da deficiência esfincteriana intrínseca (Blaivas, 1991). Assim, a identificação pré-operatória destas pacientes é parte fundamental da propedêutica uroginecológica para o sucesso cirúrgico

Perfil de presión uretral estático en la incontinencia urinaria de la mujer / Static urethral pressure profile in woman urinary incontinence

Se estudiaron en forma prospectiva 75 pacientes del sexo femenino con incontinencia urinaria identificada desde el punto de vista clínico. Se les realizó perfil de presión uretral estático sin micción y se encontró incontinencia de urgencia en 26, de esfuerzo en 25 y de tipo mixto en 24. No hubo diferencias en la previsión vesicalbasal. La longitud funcional de la uretra sí se afecta en el tipo de urgencia, y da como resultado diferencias con respecto a la de esfuerzo y mixta. Tanto la presión máxima de cierre como la uretral máxima disminuyen conforme progresa la edad de la mujer, sin guardar relación con el tipo de incontinencia. La presión máxima de cierre y uretral máxima en la incontinencia de urgencia produce diferencias a una p en relación con las de esfuerzo y mixta. La utilidad clínica del perfil de presión uretral es un aspecto controvertido. Los datos que se informan en este artículo indican que se tiene que revalorar su posición, pues podrían ser de gran ayuda para la valoración integral de la incontinencia urinaria de urgencia.