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.

Reconstruction of Obliterated Vesicourethral Junction: Use of the Bulbar Urethra as a Continent Valve.

Reconstruction of the obliterated vesicourethral junction is both complex and difficult. Here, we report an innovative method using a mobilized bulbar urethra as a continent valve. Three patients with major problems at the vesicourethral junction underwent continent valve reconstruction. In cases 1 and 2, in which there were problems at the anastomosing site after radical prostatectomy, the bladder wall was closed, wedge resection of the midline pubic bone was performed, and a fully mobilized bulbar urethra was implanted submucosally into the anterior bladder wall. In case 2, augmentation cystoplasty using an ileal segment was required due to the small capacity of the bladder. In case 3, in which there was posterior urethra disruption associated with pelvic fracture, the bulbar urethra was implanted into the bladder wall in the same manner as in cases 1 and 2 without pubectomy. The postoperative follow-up periods were 48, 36, and 12 months, respectively. In all patients, urinary management was achieved by self-catheterization postoperatively, and the patients were satisfied with their status. This newly devised continent valve construction using a bulbar urethra is effective for reconstruction of the obliterated vesicourethral junction, which markedly improves patients' quality of life.