Gross Anatomy of Urethra and Penis in Uncastrated and Castrated Buck of Black Bengal Goat

SUMMARY: Urethral process, sigmoid flexure, urethra at the pelvic arch and neck of urinary bladder in goats are very much prone to form obstructive urolithiasis. The present study was carried out to establish baseline work on the normal measurement of the urethral passage and different segments of penis of uncastrated and castrated Black Bengal (BB) goat which will be supportive for obstructive urolithiasis management. Different segment of penis along with urethra of 25 uncastrated and 25 castrated male Black Bengal goats were collected from different slaughter house of Chattogram City Corporation. The length and diameter of male urethra and different segment of penis in uncastrated buck were significantly higher (p<.001) than castrated buck. The length of the pelvic urethra was 5.88 ± 0.111 cm and 4.58 ± 0.15 cm in uncastrated and castrated buck respectively. The length of the neck of urinary bladder; root, body, sigmoid flexure, glans penis and urethral process of the penis in uncastrated and castrated buck were 0.688 ± 0.156 cm and 0.38 ± 0.048 cm, 5.02 ± 0.09 cm and 4.24±0.10 cm, 23.48 ± 0.37 cm and 22.74 ± 0.43 cm, 9.2 ± 0.107 cm and 8.18 ± 0.29 cm, 1.92 ± 0.032 cm and 1.44 ± 0.10 cm, 2.32 ± 0.029 cm and 1.78 ± 0.07 cm respectively. The diameter of the neck of urinary bladder, root, body, sigmoid flexure, glans penis and urethral process of the penis in uncastrated and castrated buck were 1.94 ± 0.041 cm and 1.44 ± 0.05 cm, 3.7 ± 0.049 cm and 3.3 ± 0.144 cm, 2.63 ± 0.066 cm and 1.86 ± 0.08 cm, 2.77 ± 0.90 cm and 2.18 ± 0.07 cm , 1.81 ± 0.034 cm and 1.4 ± 0.06 cm, 0.66 ± 0.014 cm and 0.56 ± 0.05 cm respectively. Finally, total lengths of penis in uncastrated and castrated buck were 30.42±0.459 cm and 28.42±0.553 cm respectively. The length and diameter of the neck of the urinary bladder, root, sigmoid flexure, urethral process of the penis are clinically more important for obstructive urolithiasis.

RESUMEN: El proceso uretral, el ángulo sigmoideo, la uretra en el arco pélvico y el cuello de la vejiga urinaria en las cabras son muy propensos a formar urolitiasis obstructiva. El presente estudio se llevó a cabo para establecer un trabajo de referencia sobre la medición normal del pasaje uretral y diferentes segmentos de pene de cabra de Bengala Negra (BB) no castrada y castrada, que serán de apoyo para el manejo de la urolitiasis obstructiva. Se recolectaron diferentes segmentos de pene junto con la uretra de 25 machos de cabras de Bengala negras sin castrar y 25 castrados de diferentes mataderos de Chattogram City Corporation. La longitud y el diámetro de la uretra y los diferentes segmentos del pene en el macho no castrado fueron significativamente más altos (p <0,001) que en el macho castrado. La longitud de la uretra pélvica fue de 5,88 ± 0,111 cm y 4,58 ± 0,15 cm en animales sin castrar y castrados, respectivamente. La longitud del cuello de la vejiga urinaria; raíz, cuerpo, flexión sigmoidea, glande del pene y proceso uretral del pene en el macho sin castrar y castrado fueron 0,688 ± 0,156 cm y 0,38 ± 0,048 cm, 5,02 ± 0,09 cm y 4,24 ± 0,10 cm, 23,48 ± 0,37 cm y 22,74 ± 0,43 cm , 9,2 ± 0,107 cm y 8,18 ± 0,29 cm, 1,92 ± 0,032 cm y 1,44 ± 0,10 cm, 2,32 ± 0,029 cm y 1,78 ± 0,07 cm, respectivamente. El diámetro del cuello de la vejiga urinaria, la raíz, el cuerpo, el ángulo sigmoide, el glande del pene y el proceso uretral del pene en el macho no castrado y castrado fueron 1,94 ± 0,041 cm y 1,44 ± 0,05 cm, 3,7 ± 0,049 cm y 3,3 ± 0,144 cm. 2,63 ± 0,066 cm y 1,86 ± 0,08 cm, 2,77 ± 0,90 cm y 2,18 ± 0,07 cm, 1,81 ± 0,034 cm y 1,4 ± 0,06 cm, 0,66 ± 0,014 cm y 0,56 ± 0,05 cm respectivamente. Finalmente, las longitudes totales de pene en machos castrados y no castrados fueron de 30,42 ± 0,459 cm y 28,42 ± 0,553 cm respectivamente. La longitud y el diámetro del cuello de la vejiga urinaria, la raíz, el ángulo sigmoideo y el proceso uretral del pene son clínicamente más importantes para la urolitiasis obstructiva.

Urethral dysfunction due to alloxan-induced diabetes. Urodynamic evaluation and action of sildenafil citrate

To evaluate the effect of diabetes mellitus and of sildenafil citrate on female urethral function. Twenty nine female rats were divided into four groups: G1 - (n=9), normal rats; G2 - (n=6), normal rats treated with sildenafil citrate; G3 - (n=9) rats with alloxan-induced diabetes; G4 - (n=5) rats with alloxan-induced diabetes treated with sildenafil citrate. Under anesthesia, urodynamic evaluation was performed by cystometry and urethral pressure simultaneously. A significant increase in urethral pressure was observed during micturition. Sildenafil citrate can partially reduced urethral pressure in diabetic female rats.

Canine perineal hypospadias / Hipospadia perineal canina

Canine hypospadias is a rare condition that can occur in male and female dogs. Affected animals may present signs of urinary incontinence, recurrent urinary tract infections, periurethral dermatitis or can remain asymptomatic. Periurethral hypospadias in a 14-week-old mongrel dog and its surgical repair are addressed.

Hipospadia canina é uma condição rara que pode ocorrer em cães machos e fêmeas. Animais afetados podem apresentar sinais de incontinência urinária, infecções recorrentes do trato urinário, dermatite periuretral ou podem permanecer assintomáticos. Hipospadia periuretral em cão de 14 semanas de idade, sem raça definida, e sua reparação cirúrgica são abordadas.

Aspectos morfológicos da uretra de ratas após eletroestimulação do assoalho pélvico / Morphological aspects of the urethra in female rats after electrical stimulation of the pelvic floor

OBJETIVO: Avaliar os efeitos da eletroestimulação (ES) do assoalho pélvico na uretra de ratas. MÉTODOS: Quarenta ratas adultas foram distribuídas, randomicamente, em quatro grupos com dez animais cada: Ctrl - sem intervenção; Sham - não foi submetido a ES, recebeu um eletrodo dentro da vagina; Exp6 - submetido a seis sessões de ES do assoalho pélvico; e Exp12 - submetido a 12 sessões de ES do assoalho pélvico. Ao final do experimento, todos os animais foram anestesiados, e o terço médio da uretra foi retirado, fixado em líquido de Bouin e processado para estudo histomorfométrico. Alguns cortes foram corados pela hematoxilina e eosina, para descrição morfológica e morfométrica, e outros, pelo picrosirius red, para avaliação do colágeno total. As espessuras da camada muscular e do epitélio foram obtidas, nos 4 quadrantes da uretra, pela realização de 20 medições em cada animal. O número de vasos sanguíneos presentes na lâmina própria foi obtido nos quatro quadrantes, em uma área de 10³ mm² por quadrante, sendo as imagens obtidas pelo programa de análise de imagens AxioVision® REL 4.3 (Carl Zeiss). A proporção de colágeno e de fibras musculares foi obtida de duas imagens por quadrante, de cada lâmina da uretra corada pelo picrosirius red, com auxílio do programa Imagelab®. Os dados foram submetidos à análise de variância (ANOVA) e ao teste de comparações múltiplas de Tukey-Kramer (p<0,05). RESULTADOS: A morfometria do colágeno, número de vasos sanguíneos e espessura do epitélio não mostraram alterações significantes. No entanto, a espessura do tecido muscular periuretral mostrou aumento significante no grupo Exp12 em relação aos outros grupos (Exp12*>Exp6==Ctrl==Sham; *p<0,05). CONCLUSÃO: A eletroestimulação funcional prolongada do assoalho pélvico induziu aumento na espessura da camada muscular periuretral em ratas.

PURPOSE: To evaluate the effects of electrical stimulation (ES) of the pelvic floor on the urethra of female rats. METHODS: Forty adult rats were divided at random into four groups of ten animals each: Ctrl - without intervention; Sham - not submitted to ES, but with an electrode inserted into the vagina; Exp6 - submitted to six sessions of ES of the pelvic floor, and Exp12 - submitted to 12 sessions of ES of the pelvic floor. At the end of the experiment, all animals were anesthetized and the middle third of the urethra was removed, fixed in Bouin's fluid and processed for histomorphometric study. Sections were stained with hematoxylin and eosin for morphological and morphometric description, and others were stained with picrosirius red for the quantitation of total collagen. The thicknesses of the muscle layer and of the epithelium were determined, in 4 quadrants of the urethra, by performing 20 measurements per animal. The number of blood vessels present in the lamina propria was counted in the four quadrants over an area of 10³ µm² per quadrant and the images were obtained using the image analysis program AxioVision® REL 4.3 (Carl Zeiss). The collagen and muscle fiber ratios in the urethrae were calculated from two images per quadrant of every slice stained with picrosirius red, employing the Imagelab® Program. Data were subjected to analysis of variance (ANOVA) and the Tukey-Kramer multiple comparison test (p<0.05). RESULTS: The morphometry of the collagen, number of blood vessels and thickness of the epithelium showed no significant changes; however, the thickness of the periurethral muscle tissue increased significantly in Exp12 group, compared to the other groups (Exp12*>Exp6==Ctrl==Sham; *p<0.05). CONCLUSION: Prolonged functional electric stimulation of the pelvic floor induced an increase in periurethral muscle thickness in rats.

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.

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.

Importância do modelo animal para testar hipóteses sobre a fisiopatologia do binômio diabetes e incontinência urinária feminina / Importance of animal model to test hypotheses about the pathophysiology of the binomial diabetes and female urinary incontinence

Objetivos: discutir a importância do estudo de modelos animais para testar hipóteses sobre os mecanismos de continência urinária e fisiopatologia do binômio diabetes incontinência urinária.Fonte de Dados: foi realizada revisão de literatura no PubMed e SciELO. Os descritores utilizados foram diabetes, urinary incontinence, urethra, human e rats.Síntese dos Dados: existe forte correlação entre a gênese da incontinência urinária e o diabetes mellitus. Devido à similaridade entre a distribuição normal da musculatura estriada e da neuroanatomia da uretra em mulheres e em ratas, estes modelos animais vêm sendo cada vez mais utilizados nas pesquisas sobre esses distúrbios.Conclusões: o uso de ratas como modelo animal é apropriado para estudos experimentais que testam hipóteses sobre os mecanismos de continência e a fisiopatologia do binômio diabetes mellitus e incontinência urinária, possibilitando assim, soluções de grande valia na prática clínica.

Aims: To discuss the importance of studying animal models to test hypotheses about the mechanisms of urinary continence and pathophysiology of diabetes and urinary incontinence.Source of Data: A literature review was conducted in PubMed and SciELO. The key words used were diabetes, urinary incontinence, urethra, human and rats.Summary of Findings: There is a strong relation between the genesis of urinary incontinence and diabetes mellitus. Due to the similarity of normal distribution of skeletal muscle and urethra anatomy between humans and rats, these animal models have been used in current research about these disorders.Conclusions: The use of rats as an animal model is suitable for experimental studies that test hypotheses about the mechanisms of continence and pathophysiology of the binomial diabetes mellitus and urinary incontinence, thus enabling solutions of great value in clinical practice.

Fibroelastic components of the vesicourethral junction of rats in the aging process / Componentes fibroelásticos de la unión vesicouretral de ratas en el proceso de envejecimiento

The vesicourethral junction comprising the vesical trigone, is relevant in setting and positioning of the urinary bladder, along with the vesical neck, fixed by lateral ligaments of the bladder and tendinous arch of the pelvis fascia. Namely,the puboprostatic ligament (men) and the pubovesical (women). The circular set elastic fibers in this junction are important and valuable in the elasticity and plasticity of the area, allowing quick expansion and withdrawal with the flow of urine, and associated to smooth muscle tissue and nerve control form an important collective to maintain urinary continence. The objective of the present study is to describe the elastic system in the vesicouretral junction in relation to aging and its involvement in the states of urinary continence and incontinence, as well as the study of the vesicouretral junction in various age groups while evaluating with electron transmission microscopy. To carry out the study, 12 Wistar rats were used, divided into groups: neonate (4 animals), adult group (4 animals) and aged group (4 animals). Electron transmission microscopy with use of tanic acid technique associated to glutaraldehyde fixation, satisfactorily showed the extreme structural differences between mature elaunin and oxytalan fibers present between intercelular spaces and bundles of collagen fibers. The phases of elastogenesis in neonate animals and degradation of the elastic system of older animals were also evaluated.

La unión vesico-uretral, componente del trígono vesical, posee una relevante importancia en la fijación y posicionamiento de la vejiga urinaria conjuntamente con el cuello vesical, fijado por los ligamentos laterales de la vejiga y arco tendinoso de la fascia de la pelvis. Principalmente, sus componentes anteriores son: el ligamento puboprostático en los hombres y el ligamento pubovesical en las mujeres. Las fibras elásticas dispuestas circularmente en esta unión, son de valiosa importancia en la elasticidad y plasticidad de la región, permitiendo expansión y retiro rápido con el flujo de la orina, y asociado a musculatura lisa y control nervioso forman un conjunto importante para el mantenimiento de la continencia urinaria. Debido a existencia de puntos no esclarecidos en esta región en relación al sistema elástico y su participación en los estados de continencia/incontinencia urinaria, el presente trabajo tiene por objetivo el estudio de la unión vesico-uretral evaluándola en diferentes grupos etarios, a través de la microscopía electrónica de transmisión. Fueron utilizados 12 ratones Wistar, divididos en grupo de neonatos (4 animales), grupo adulto (4 animales) y grupo de ratones viejos (4 animales). La microscopía electrónica de transmisión, con uso de la técnica del ácido tánico asociado al fijador glutaraldeído, mostró satisfactoriamente las diferencias ultraestructurales entre las fibras elásticas maduras, elaunínicas y oxitalánicas, presentes entre los espacios intercelulares de las células musculares y haces de fibras colágenas, y también fases de elastogénesis en animales neonatos y envejecimiento y degradación del sistema elástico en los animales mayores.

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.

Análise histológica das glândulas uretrais da capivara (Hydrochoerus hydrochaeris) / Histological analysis of urethral glands of the capybara (Hydrochoerus hydrochaeris)

Para realização do estudo microscópico das glândulas anexas à uretra masculina, foram utilizadas duas capivaras (Hydrochoerus hydrocaeris), adultas, das quais foram coletados fragmentos das glândulas genitais acessórias, imersos em solução fixadora de Bouin e lavados cuidadosamente em álcool de 70 por cento ao absoluto. A seguir foram submetidos aos processos histológicos de rotina e corados pelos métodos de Hematoxilina/Eosina e Tricrômico de Masson. Os resultados morfológicos encontrados foram: o ducto deferente possui um espessamento da parede, onde a luz permanece inalterada e sem presença de epitélio granular. A glândula vesicular possui um epitélio secretor do tipo pseudoestratificado colunar. A glândula prostática possui mucosa com pregueamentos altos e ramificados, revestido por epitélio pseudoestratificado cilíndrico. Machos de capivaras possuem glândulas vesiculares e próstata como glândulas uretrais. No material examinado não foi identificado epitélio secretor correspondente a glândula bulbouretral e morfologicamente assemelha-se aos outros histricomorfos.

To perform a microscopic study of the glands attached to the male urethra, we used two adult capybaras (Hydrochoerus hydrocaeris) from which fragments of the urethral glands were collected, immersed in Bouin's fixative solution, washed thoroughly with 70 percent to absolute alcohol, submitted to routine histological techniques and stained with hematoxylin/eosin and Masson's trichromic method. The morphological findings were: Vas deferens has a thickening of the wall without granular epithelium and with unchanged lumen; the vesicular gland has a secretory epithelium of pseudostratified columnar type; the prostate gland has a high and ramified mucous membrane covered with pseudostratified cylindrical epithelium. Male capybaras have vesicular, prostate as urethral glands. In the material examined, no secretory epithelium corresponding to bulbourethral glands was identified; morphologically it resembles to the other histricomorphs.

The length of the male urethra

PURPOSE: Catheter-based medical devices are an important component of the urologic armamentarium. To our knowledge, there is no population-based data regarding normal male urethral length. We evaluated the length of the urethra in men with normal genitourinary anatomy undergoing either Foley catheter removal or standard cystoscopy. MATERIALS AND METHODS: Male urethral length was obtained in 109 men. After study permission was obtained, the subject's penis was placed on a gentle stretch and the catheter was marked at the tip of the penis. The catheter was then removed and the distance from the mark to the beginning of the re-inflated balloon was measured. Alternatively, urethral length was measured at the time of cystoscopy, on removal of the cystoscope. Data on age, weight, and height was obtained in patients when possible. RESULTS: The mean urethral length was 22.3 cm with a standard deviation of 2.4 cm. Urethral length varied between 15 cm and 29 cm. No statistically significant correlation was found between urethral length and height, weight, body mass index (BMI), or age. CONCLUSIONS: Literature documenting the length of the normal male adult urethra is scarce. Our data adds to basic anatomic information of the male urethra and may be used to optimize genitourinary device design.

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

One stage repair of severe hypospadias: Original versus modified koyanagi technique

Although the original Koyanagi technique seemed applicable for the repair of severe hypospadias at or proximal to the penoscrotal junction, its use has resulted in a high complication rate. The technique was modified to ensure better vascularity of the flaps. The purpose of this study is to report the results of original Koyanagi technique and its modifications in patients with severe hypospadias. The original Koyanagi parameatal prepuital flap technique was performed in 16 boys with severe hypospadias [group I]. In a subsequent 11 patients, the modified Koyanagi technique was used to preserve blood supply to the flaps [group II] The meatus was located at or proximal to the penoscrotal junction in all patients. Moderate to severe degrees of chordee was noted in all of them. The median age of patients was 13 and 20 months at time of repair for group I and II respectively. Each patient was evaluated as regard to site of the new meatus, straightness of the phallus, and stream of urine, development of fistula, urethral or meatal stenosis, any other complication, and the need for another operation. Follow up ranged from 36 to 84 months in group I, and 3 to 36 months in group II. A fistula developed in 8 of the 27 patients [29.6%] The frequency of fistula was more common in group I [6116] than in group II [2/11]. Urethral diverticulum occurred in one patient in group II, and meatal stenosis in 2 in group I. Significant infection resulted in a regressed meatal position in 2 [one in each group]. Good cosmetic results were achieved in all except the latter 2 cases. Secondary operations were needed in 8 patients [6 in group I and 2 in group 2] The indication for secondary surgery were closure of persisted urethrocutaneous fistula in 6 patients [5 in group 1 and 1 in group 2] and regressed meatus in 2 [one in each group]. A single staged repair can be safely and effectively performed even in patients with the most severe penoscrotal hypospadias. The modified Koyanagi technique has relatively lower complication rate than original Koyanagi repair. The complication rate is acceptable considering the severity of these cases

Congenital urethral anomalies in boys. Part I: Posterior Urethral valves

The aims of this review are one, to consider that congenital urethral anomalies are not a simple disease entity in all patients. This is accomplished by reviewing the evidence for presence of posterior urethral valve subtypes and comorbidity of various unexplained clinical conditions in some children leading to chronic renal failure. The review's second aim is to describe the effects of fetal lower urinary tract obstruction on postnatal bladder function and the consequence of bladder dysfunction on the remaining postnatal renal function. The literature was extensively reviewed concerning the different types of congenital urethral outlet obstruction presentations, diagnosis, different types of treatment modalities, morbidity, mortality, and new concepts for this old problem. These findings were compared with conventional approaches to these anomalies. The 739 published papers on posterior urethral valves were evaluated, and a quarter of those are addressed. All radiologic presentations and figures in this review were selected from among the records of Iranian patients treated by the author during the last 25 years. A significant overlap of presentation before antenatally diagnosed era was observed. The natural history of these anomalies is becoming clear and the hypothesis of posterior urethral diaphragm is popular among several investigators in comparison to the original valves classification by Young in 1903. Further molecular investigation of the urinary tract is needed to better understand the pathophysiology of renal and bladder function in children who are born with antenatally diagnosed congenital urethral obstruction. These anomalies must be treated by urologists with a vast experience with valves and other rare congenital urethral anomalies

The Relationship between Maximal Urethral Closure Pressure and Functional Urethral Length in Anterior Vaginal Wall Prolapse Patients According to Stage and Age

MUCP (Maximal urethral closure pressure) is known to be increased in patients with vaginal wall prolapse due to the mechanical obstruction of the urethra. However, urethral function following reduction has not yet been completely elucidated. Predicting postoperative urethral function may provide patients with important, additional information prior to surgery. Thus, this study was performed to evaluate the relationship between MUCP and functional urethral length (FUL) according to stage and age in anterior vaginal wall prolapse patients. 139 patients diagnosed with anterior vaginal wall prolapse at Yonsei University Medical College (YUMC) from March 1999 to May 2003 who had underwent urethral pressure profilometry following reduction were included in this study. The stage of pelvic organ prolapse (POP) was determined according to the dependent portion of the anterior vaginal wall (Aa, Ba). (By International Continence Society's POP Quantification system) Patients were divided into one of four age groups: patients in their 40s (n=13), 50s (n=53), 60s (n=54), and 70 and over (n=16). No difference in MUCP was found between the age groups. The FUL of patients in their 40s was shorter than that of patient's in their 50s and 60s. Patients were also divided into stages: stage II (n=35), stage III (n=76), and stage IV (n=25). No significant difference in MUCP was found according to stage and FUL. However, a significant difference was noted between stage III and IV as stage IV was longer. Anterior vaginal wall prolapse is known to affect urethral function due to prolapse itself, but according to our study, prolapse itself did not alter urethral function. This suggests that, regardless of age and stage, prolapse corrective surgery does not affect the urethral function.

Evaluación ultrasonográfica en uroginecología / Ultrasonographic evaluation in urogynecology

Se revisa la importancia del ultrasonido bidimensional introital y transvaginal en el estudio de la uretra, vejiga y como apoyo diagnóstico en la incontinencia de orina de esfuerzo. Destacando además la importancia de éste en el control postoperatorio. Se trata de un examen de bajo costo, no invasivo, y sin contraindicaciones.

The Predictive Values of Various Parameters in the Diagnosis of Stress Urinary Incontinence

The Maximum Urethral Closure Pressure (MUCP) and Functional Urethral Length (FUL) are significant parameters of the Urethral Pressure Profile (UPP), while the Q-tip angle and Bladder Neck Descent (BND) are the significant parameters of urethral hypermobility. We performed a study to evaluate the effects and predictive values of each of these parameters in the diagnosis of Stress Urinary Incontinence (SUI). A retrospective study was done involving 90 SUI patients and 38 non-SUI patients who underwent urodynamic study, Q-tip test and perineal ultrasound at Yonsei Medical Center between January, 1999 and February, 2002. There was no statistical difference between the SUI and non-SUI groups in terms of mean age, delivery history, menopausal age and body mass index. While the FUL and Q-tip angle showed significant differences (33.18 +/- 19.55 vs 33.12 +/- 13.37 mm, p=0.002; 65.94 +/- 21.69 vs 56.45 +/- 26.53 degrees, p=0.02, respectively) neither the MUCP nor the BND showed any significant difference between the two groups (60.06 +/- 29.92 vs 48.97 +/- 42.95 cmH2O, p > 0.05; 1.09 +/- 0.75 vs 0.85 +/- 0.76 cm, p > 0.05; 0.71 +/- 0.80 vs 0.53 +/- 0.72 cm, p > 0.05). The odds ratios for the FUL and Q-tip angle were 1.038 (1.014, 1.061) and 1.017 (1.001, 1.033), respectively. The FUL and Q-tip angle had cut-off values of 1.36 cm (sensitivity: 68.8%, specificity : 54.1%, PPV : 73.8%, NPV : 48.1%) and 20.47 degrees (sensitivity : 93.3%, specificity : 18.17%, PPV : 68.2%, NPV : 60%), respectively, in the diagnosis of SUI. The area under the curve (AUC) of the FUL and Q-tip angle were on average 0.625 (p=0.0016) and 0.575 (p=0.0012), respectively. Both the FUL and Q-tip angle showed a significant difference between SUI patients and the normal group. However, their value as a diagnostic tool was trivial, and since their sensitivity, specificity, positive predictive value and negative predictive value showed inconsistent results at each cut-off value, it would be difficult to apply them to clinical use. A further study is required to set-up standard diagnostic values of these variables for clinical use.

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

Reconstrucción precoz de la ruptura completa de la uretra posterior en niños / Perineal reconstruction of complete posterior urethral rupture in children

Dieciséis niños con ruptura completa de la uretra posterior fueron admitidos en la clínica quirúrgica pediátrica del Hospital de la Restauraciónen el período de Septiembre de 1986 hasta Octubre de1996. Todos los niños fueron sometidos a cistostomia suprapúbicacomo tratamiento inicial. En once se realizó la reconstrucción uretral primaria por vía perineal entre 6 horas y 7 días de su admisión. Se mantuvo una sonda de Foley transuretral durante 15 días. Tras evaluar laanastomosis por cistouretrograma miccional se retiró la cistostomia suprapúbica. Solamente un niño esta incontinente seis meses después de la cirugía. Un paciente necesitó una reoperación y dos requirieron dilataciones uretrales. Los resultados obtenidos fueron mejores en relación a los otros operados tardíamente por vía perineal o sagital posterior