Urogynecology in obstetrics: impact of pregnancy and delivery on pelvic floor disorders, a prospective longitudinal observational pilot study.

PURPOSE: To assess changes in the pelvic floor anatomy that cause pelvic floor disorders (PFDs) in primigravidae during and after pregnancy and to evaluate their impact on women's quality of life (QoL). METHODS: POP-Q and translabial ultrasound examination was performed in the third trimester and 3 months after delivery in a cohort of primigravidae with singleton pregnancy delivering in a tertiary center. Results were analyzed regarding mode of delivery and other pre- and peripartal factors. Two individualized detailed questionnaires were distributed at 3 months and at 12 months after childbirth to determinate QoL. RESULTS: We recruited 45 women, of whom 17 delivered vaginally (VD), 11 received a vacuum extraction delivery (VE) and 17 a Cesarean section in labor (CS). When comparing third-trimester sonography to 3 months after delivery, bladder neck mobility increased significantly in each delivery group and hiatal area increased significantly in the VD group. A LAM avulsion was found in two women after VE. Connective tissue weakness (p = 0.0483) and fetal weight at birth (p = 0.0384) were identified as significant risk factors for the occurrence of PFDs in a multivariant regression analysis. Urinary incontinence was most common with 15% and 11% of cases at 3, respectively, 12 months after delivery. 42% of women reported discomfort during sexual intercourse, 3 months after delivery and 24% 12 months postpartum. Although 93% of women engage a midwife after delivery, only 56% participated in pelvic floor muscle training. CONCLUSION: Connective tissue weakness and high fetal weight at birth are important risk factors for the occurrence of PFDs. Nevertheless, more parturients should participate in postpartal care services to prevent future PFDs.

Three-Dimensional Peripheral Bloodstream Model of the Uterus for Laparoscopic Radical Hysterectomy.

Trainees require extensive experience to perform radical hysterectomy. Before starting training during an actual operation, trainees should be familiar with the pelvic anatomy and should simulate surgical procedures. Many simulators are available for virtual reality training of laparoscopic operations, but they are very expensive. The materials required to construct our model included sponges and colored wires sold in home improvement stores that allowed for superior cost effectiveness. The model represented almost all peripheral vessels and nerves around the uterus, including the minor vessels. Attaching and detaching the vessels was easy, facilitating reconstruction of the dissected vessels. The wires were easy to bend, ensuring high operability. This model allows for the simulation of laparoscopic radical hysterectomy in a dry box. Our model was superior to a 2-dimensional picture for the memorization of branching and positional relationships of the blood vessels. Comparison of our model with actual operative videos showed that the dry box provided an identical surgical view of an actual laparoscopic radical hysterectomy. We developed a peripheral bloodstream model of the uterus for repeated simulation of laparoscopic radical hysterectomy with an actual surgical view using a dry box.

From the heart to the bladder-particularities of ventricular shunt topography and the current status of cerebrospinal fluid diversion sites.

Hydrocephalus represents the pathological elevation of cerebrospinal fluid (CSF) levels as a consequence of various embryological or acquired defects. Although the classic method of treatment is by means of diverting the CSF from the ventricular system towards the peritoneum, there are other sites of diversion that have proven their efficiency through time, in the context of complications related to the more common option of intraperitoneal insertion. The aim of the review is to assess and organize a database of all the types of shunt locations from the oldest shunt attempts until present, using Pubmed and Medline and to underline the particularities related to technique, indications, complications and associated epidemiological background. Current literature reveals up to 36 sites of diversion of CSF with a diverse topography varying from cephalic regions such as venous sinuses or mastoid bone, thoracic elements such as the heart or the pleura and abdominopelvic segments such as the peritoneum or the urinary bladder. Several atypical locations were studied such as the fallopian and intestinal shunts. Although ventriculoperitoneal and ventriculoatrial shunts are the most commonly used shunts today, there are some systems such as the ventriculosinusal and ventriculolymphatic shunts that prove to be equally as efficient. The successful treatment of hydrocephalus requires a complete comprehension of the indications and therapeutic options and a reliable evaluation of the risks and possible complications. The profile of cerebral ventricular shunts is highly dynamic and the spectrum of cerebrospinal fluid diversion offers multiple solutions in the benefit of the patient.

Retrograde CT urethrography using a power injector quantitatively reveals effects of bladder distension on urethral size in healthy male Beagle dogs.

Quantitative analysis of the normal retrograde urethrogram is well reported in radiography, but studies on CT urethrography are lacking. Recently, a method of retrograde CT urethrography using a power injector was described. The purpose of the current, prospective, analytical study was to quantify the urethral size of five, healthy, intact, male Beagle dogs using retrograde CT urethrography and a power injector. With the injection rate of the power injector set at 0.3 mL/s, 1 mL/kg of diluted contrast medium (15 mg I/mL) was injected, and a CT examination was performed. The state of the initial urethrogram taken was defined as "empty bladder." The same procedures were repeated with the injection of an additional 1 mL/kg of diluted contrast medium until the ureteral reflux was seen (distended bladder). There was a significant difference in volumes between the empty and distended bladder, but the membranous urethra showed the least difference (P = .0044) among the three regions (P < .0001 for the prostatic and penile urethra). Urethral diameters at six sites were measured from sagittal images, and the sites of measurements were adopted from the earlier radiographic studies. The most significant difference in the urethral diameters between the empty and distended bladder occurred at the cranial and middle prostatic urethra (P < .0001). The results of this study can be useful for interpreting the results of retrograde CT urethrography. Care must be taken when narrowing is suspected at the prostatic urethra, and if necessary, further distension of the urinary bladder should be tried.

The magnetic resonance imaging appearances of the interureteric crest of the urinary bladder.

PURPOSE: This study was devised to evaluate the imaging appearances of the interureteric crest (IUC) of the bladder on magnetic resonance imaging (MRI). The primary objective was to determine how commonly the IUC was observed on pelvic MRI examinations. The secondary objectives were to determine the average size of the IUC, its MRI signal characteristics and whether there is variation between men and women. By defining the imaging findings we hope to prevent misinterpretation of normal anatomy on MRI and, therefore, prevent unnecessary further investigations and procedures. METHODS: We retrospectively reviewed 114 adult patient's magnetic resonance imaging examinations of the pelvis. Two readers independently recorded information about the presence and characteristics of the IUC with a third reader used to arbitrate in cases of disagreement. RESULTS: The IUC was demonstrated on MRI in 75% of patients. It was best observed on T2w sequences as a continual ridge of low signal intensity between the ureters. The mean AP diameter of the IUC at its mid-point on the sagittal images was 2.4 mm. CONCLUSIONS: The IUC is often seen on MRI on T2w images of a non-collapsed bladder. Its characteristic appearance can be used to help the reporting radiologist confidently differentiate identify this normal structure from an area of focal bladder wall thickening that might be misinterpreted as a bladder tumor.

[The key points to comprehend the pelvic fascia].

Pelvic fascia is considered to be one controversial human anatomic structure. According to the characteristics of specialized surgery, colorectal surgeons, gynecologic surgeons and urologic surgeons respectively marked the pelvic fascia, but the naming is not unified. For some specific anatomic structures (such as pelvic plexus), different scholars have different descriptions of their positions. The lack of standard anatomic terms makes it difficult to understand the corresponding anatomic structures, and also hinders the communication between disciplines. Combined with autopsy research, surgical observation and literature review, we discussed the common puzzles of pelvic clinical anatomy. The main points of this article are as follows. (1) Urogenital fascia and vesicohypogastric fascia are the components of visceral fascia. (2) The visceral fascia and fascia propria of rectum are two separate layers. (3) The pelvic plexus is located on the outside of the confluence of visceral fascia and Denonvilliers' fascia. (4) To understand the pelvic lateral ligament from the perspective of layers. (5) To understand pelvic fascia from a holistic perspective.

Anterior bladder wall thickness, post-void urine residue, and bladder emptying efficiency as indicators of bladder dysfunction in Nigerian men with benign prostatic hyperplasia.

BACKGROUND: Benign Prostatic Hypertrophy [BPH] is associated with voiding dysfunctions. Urodynamic study is the gold standard for diagnosis of voiding dysfunctions but is invasive. Bladder wall thickness (BWT), post-void urine residue (PVR), and bladder emptying efficiency (BEE) are noninvasive predictors of voiding dysfunction. OBJECTIVE: To study the relationship among BWT, PVR, and BEE in BPH. SUBJECTS AND METHODS: A hospital-based cross-sectional prospective study of new BPH patients at Nnamdi Azikiwe University Teaching Hospital, Nnewi. The participants had abdominal ultrasonography measurement of anterior BWT (at bladder volume ≥200 mls), prostate volume (PV), and PVR using Prosound SSD3500 (Aloka Co Ltd, Tokyo, Japan) with an abdominal probe frequency of 3.5 MHz. Then the BEE was calculated. The anterior BWT was divided into two groups: <5 mm and ≥5 mm. The data were analyzed using SPSS version 20. Pearson's correlation was used to assess correlation and the differences between the means of the two groups of BWT were compared by Mann-Whitney test. A P- Value <0.05 was considered significant. RESULTS: Seventy seven men with a mean age of 66.66 ± 10.74 years were included in the study. Sixty one percent had symptoms lasting >12 months. The average anterior BWT, PBV, PVR, BEE, PV, and PSA were 4.55 ± 1.02 mm, 260.98 ± 57.44 mls, 58.36 ± 52.94 mls, 77.98 ± 17.37%, 66.31 ± 46.38 mls, and 8.04 ± 5.97 ng/ml, respectively. There was a significant positive correlation between BWT and duration of symptoms (P = 0.044) and a significant negative correlation between BWT and BEE (P = 0.005). An insignificant positive correlation was found between BWT and PVR (P = 0.255). Fifty four (70.1%) had BWT <5 mm and 29.9% had BWT ≥5 mm. The mean IPSS (P = 0.000), PV (P = 0.032) and PVR (P = 0.020) were significantly higher in the ≥5 mm group. The ≥5 mm group also had a significantly lower BEE (P = 0.002). CONCLUSION: Voiding dysfunction was more severe in patients with BWT of 5 mm or more. There was a positive, but insignificant, correlation between anterior BWT and PVR and a significant negative correlation between BWT and BEE.

Insight and Resources From a Study of the "Impact of Sex, Androgens, and Prostate Size on C57BL/6J Mouse Urinary Physiology.

The purpose of this symposium report is to summarize information from a session 3 oral presentation at the Society of Toxicologic Pathology Annual Symposium in Raleigh, North Carolina. Mice are genetically tractable and are likely to play an important role in elucidating environmental, genetic, and aging-related mechanisms of urinary dysfunction in men. We and others have made significant strides in developing quantitative methods for assessing mouse urinary function and our collaborators recently showed that aging male mice, like men, develop urinary dysfunction. Yet, it remains unclear how mouse prostate anatomy and histology relate to urinary function. The purpose of this report is to share foundational resources for evaluating mouse prostate histology and urinary physiology from our recent publication "Impact of Sex, Androgens, and Prostate Size on C57BL/6J Mouse Urinary Physiology: Functional Assessment." We will begin with a review of prostatic embryology in men and mice, then move to comparative histology resources, and conclude with quantitative measures of rodent urinary physiology.

Bladder volume correction factors measured with 3D ultrasound and BladderScan.

INTRODUCTION: The aim of this study was to investigate conventional 3D ultrasound and portable BladderScan volume measurements and implement correction factors to ensure accurate volume metrics. MATERIALS AND METHODS: Healthy participants without urinary urgency were recruited for a prospective hydration study in which three consecutive voids were analyzed for two separate visits. Just before and after voiding, 3D ultrasound and BladderScan volumes were measured. Estimated voided volumes were calculated as the volume immediately prior to void minus any post void residual and were compared to actual voided volumes measured using a graduated container. Percent errors were calculated, and an algebraic method was implemented to create correction factors for 3D ultrasound and BladderScan. RESULTS: Sixteen individuals completed the study, and six voids were recorded for each participant. A total of 96 volume measurements ranging from 0 mL to 1050 mL with an average of 394 +/- 26 mL were analyzed. Both 3D ultrasound and BladderScan significantly underestimated voided volumes with averages of 296 +/- 22 and 362 +/- 27, respectively. Average percent error for the 3D ultrasound group was 30.1% (pre-correction) and 20.7% (post-correction) (p < 0.01) and 22.4% (pre-correction) and 21.8% (post-correction) for the BladderScan group (p = 0.20). The voided volume correction factors for 3D ultrasound and BladderScan were 1.30 and 1.06, respectively. CONCLUSION: BladderScan and 3D ultrasound typically underestimate voided volumes. Correction factors enabled more accurate measurements of voided volumes for both 3D ultrasound and BladderScan. Accurate volume measurements will be valuable for the development of non-invasive urodynamics techniques.

Impact of bladder filling on uterine artery Doppler variables in the first trimester of pregnancy.

OBJECTIVE: Uterine artery (UtA) Doppler examination is used in the first trimester to assess the risk of developing preeclampsia, with a standardized technique. However, the impact of bladder filling on UtA circulatory impedance in pregnancy has not been previously studied. This study aimed to examine the effect of bladder distension on UtA-pulsatility index (PI) and peak systolic velocity (PSV) in the first trimester of pregnancy. METHODS: The authors conducted a prospective repeated-measure study on pregnant women presenting for first-trimester screening for preeclampsia. Right and left UtA Doppler velocimetry was first measured with a full bladder. Bladder volume was recorded. After the patients had voided their bladder, a repeat Doppler measurement was performed. The UtA PI and PSV were recorded on each side. The Wilcoxon signed-rank test was used to compare UtA variables before and after bladder voiding. RESULTS: The authors enrolled 45 patients. Mean gestational age at exam was 12.1 weeks. When women were studied with full bladder, median UtA-PI was 1.73 (inter-quartile range, [IQR] 1.49, 2.28) on the right and 1.71 (1.46, 2.11) on the left side. After bladder voiding, values were 1.83 (IQR 1.58, 2.20) and 1.78 (1.40, 2.18). The difference was not statistically significant (P = .26 and 0.80). Similarly, no difference was found in UtA-PSV before and after bladder voiding on either side (P = .22 and .70). CONCLUSION: In the first-trimester of pregnancy, bladder distension does not significantly modify uterine artery Doppler variables.

An illustrated anatomical ontology of the developing mouse lower urogenital tract.

Malformation of the urogenital tract represents a considerable paediatric burden, with many defects affecting the lower urinary tract (LUT), genital tubercle and associated structures. Understanding the molecular basis of such defects frequently draws on murine models. However, human anatomical terms do not always superimpose on the mouse, and the lack of accurate and standardised nomenclature is hampering the utility of such animal models. We previously developed an anatomical ontology for the murine urogenital system. Here, we present a comprehensive update of this ontology pertaining to mouse LUT, genital tubercle and associated reproductive structures (E10.5 to adult). Ontology changes were based on recently published insights into the cellular and gross anatomy of these structures, and on new analyses of epithelial cell types present in the pelvic urethra and regions of the bladder. Ontology changes include new structures, tissue layers and cell types within the LUT, external genitalia and lower reproductive structures. Representative illustrations, detailed text descriptions and molecular markers that selectively label muscle, nerves/ganglia and epithelia of the lower urogenital system are also presented. The revised ontology will be an important tool for researchers studying urogenital development/malformation in mouse models and will improve our capacity to appropriately interpret these with respect to the human situation.

Morphological study of the ureterovesical junction in children.

Morphological and morphometric assessment of the elements of the ureterovesical junction in children was performed in the present study in different age groups ranging from 24 weeks of gestation to 16 years old. We tried to answer the question whether, in human ontogenesis, there is a period of anatomical predisposition to primary vesicoureteral reflux. The study included 210 urinary bladders with juxtavesical parts of the ureters that had been obtained from routine autopsies. As a result of the study, we showed that provided the pregnancy is uncomplicated there is no inherited susceptibility that would account for reducing or disturbing the development of ureterovesical junction elements. Based on the analysis of our results concerning the anatomy and morphological changes taking place in the elements of the ureterovesical junction in different age groups, one could put forward a hypothesis that anatomical predisposition to primary vesicoureteral reflux occurs in age group II, i.e. between 28 and 37 weeks of gestation. The parameters that define interrelations between elements of the ureterovesical junction and that are considered essential for normal functioning of antireflux mechanism were still observed in age group VI in our study. This suggests that these relations are not unambiguous in children with normally structured and functionally competent vesicoureteral junction.

Update on multiparametric MRI of urinary bladder cancer.

While many institutions perform MRI during the work-up of urinary bladder cancer, others use MRI rarely if at all, possibly due to a variation in the reported staging accuracy and unfamiliarity with the potential benefits of performing MRI. Through increased application of functional imaging techniques including diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) imaging, there has been a resurgence of interest regarding evaluation of bladder cancer with MRI. Several recent meta-analyses have shown that MRI is accurate at differentiating between ≤T1 and T2 disease (with pooled sensitivity/specificity of ∼90/80%) and differentiating between T2 and ≥T3 disease. DWI and DCE, in combination with high-resolution T2 -weighted images, improves detection and possibly local staging accuracy of bladder cancer. High b value echo-planar DWI is particularly valuable for tumor detection. Zoomed field of view and segmented readout DWI techniques improve image quality by reducing susceptibility artifact, while methods to extract calculated high b value images save time and improve the contrast-to-noise ratio. DCE traditionally required imaging of the pelvis with high temporal but lower spatial resolution; however, advances in parallel and keyhole imaging techniques can preserve spatial resolution. The use of compressed sensing reconstruction may improve utilization of DCE of the bladder, especially when imaging the abdomen simultaneously, as in MR urography. Quantitative imaging analysis of bladder cancer using pharmacokinetic modeling of DCE, apparent diffusion coefficient values, and texture analysis may enable radiomic assessment of bladder cancer grade and stage. LEVEL OF EVIDENCE: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;48:882-896.

Evaluation of electrical impedance tomography for determination of urinary bladder volume: comparison with standard ultrasound methods in healthy volunteers.

BACKGROUND: Continuous non-invasive urinary bladder volume measurement (cystovolumetry) would allow better management of urinary tract disease. Electrical impedance tomography (EIT) represents a promising method to overcome the limitations of non-continuous ultrasound measurements. The aim of this study was to compare the measurement accuracy of EIT to standard ultrasound in healthy volunteers. METHODS: For EIT of the bladder a commercial device (Goe MF II) was used with 4 different configurations of 16 standard ECG electrodes attached to the lower abdomen of healthy participants. To estimate maximum bladder capacity (BCmax) and residual urine (RU) two ultrasound methods (US-Ellipsoid and US-L × W × H) and a bedside bladder scanner (BS), were performed at the point of urgency and after voiding. For volume reference, BCmax and RU were validated by urine collection in a weight measuring pitcher. The global impedance method was used offline to estimate BCmax and RU from EIT. RESULTS: The mean error of US-Ellipsoid (37 ± 17%) and US-L × W × H (36 ± 15%) and EIT (32 ± 18%) showed no significant differences in the estimation of BCmax (mean 743 ± 200 ml) normalized to pitcher volumetry. BS showed significantly worse accuracy (55 ± 9%). Volumetry of RU (mean 152.1 ± 64 ml) revealed comparable higher errors for both EIT (72 ± 58%) and BS (63 ± 24%) compared to US-Ellipsoid (54 ± 25%). In case of RU, EIT accuracy is dependent on electrode configuration, as the Stripes (41 ± 25%) and Matrix (38 ± 27%) configurations revealed significantly superior accuracy to the 1 × 16 (116 ± 62%) configuration. CONCLUSIONS: EIT-cystovolumetry compares well with ultrasound techniques. For estimation of RU, the selection of the EIT electrode configuration is important. Also, the development of an algorithm should consider the impact of movement artefacts. Finally, the accuracy of non-invasive ultrasound accepted as gold standard of cystovolumetry should be reconsidered.

Non-invasive evaluation of human mucosal structures by multiphoton laser scanning tomography in vitro.

BACKGROUND: Mucous membranes may be affected by various diseases and the diagnostic accessibility is limited. Multiphoton laser tomography (MPT) is a useful tool for in vivo evaluation of superficial skin structures and might also be useful for the imaging of mucosa. OBJECTIVES: In order to investigate the suitability of MPT for the evaluation of mucous membranes, tissue samples of different donors and anatomical localizations have been imaged. METHODS: Human mucosa samples from the urinary bladder, palatine tonsil and ocular conjunctiva were investigated by MPT and subsequently compared with conventional histology. RESULTS: Horizontal images of the epithelium and the underlying connective tissue were obtained using the autofluorescence and second harmonics generation signals by MPT. The stratification of multilayered epithelium was consistently reproduced. Also inflammatory changes like lymphocytic infiltrates and widened intercellular spaces were imaged in some cases. CONCLUSION: Mucous tissue samples were obtained and MPT imaging was successfully performed. In the direct comparison with histology of the same tissue samples, the characteristic morphology of the epithelia was found. Further studies are necessary in order to compare images of healthy and diseased mucosal epithelium and the use of MPT for its evaluation in vivo.

The sheath of Waldeyer is not a specific anatomical trait of the ureterovesical junction.

The function of the ureterovesical junction depends upon a peculiar structure, the adventitial fibromuscular sheath of Waldeyer, which coats the distal end of the ureter. The origin of the smooth muscle of Waldeyer's sheath (WS) is disputed. Evidence points more likely to an ureteral one. In this regard we hypothesized the WS is not specific to the distal ureter but is rather a common trait. We therefore aimed at exploring whether or not the proximal ureter is provided with a similar adventitial fibromuscular coat. We performed an immunohistochemical study on human samples of proximal ureter resulted after nephrectomies in ten patients. We applied myoid immunohistochemical markers: α-smooth muscle actin (α-SMA), desmin, and heavy chain of smooth muscle myosin (SMM) which labeled additional adventitial smooth muscle bundles, a discontinuous inner circular one applied on the muscular coat, and outer longitudinal cords specifically located on one side of the ureter, as is the case for WS. Moreover, the lamina propria myoid deep layer showed isolated smooth muscle fibers and spindle-shaped stromal cells with telocyte morphology. Our results support the idea that WS may not be a specific structure of the distal ureter, instead being just a common anatomical characteristic of the ureter.

The Null Effect of Bladder Neck Size on Incontinence Outcomes after Radical Prostatectomy.

PURPOSE: We sought to determine whether bladder neck size is associated with incontinence scores after robot-assisted laparoscopic radical prostatectomy. MATERIALS AND METHODS: Consecutive eligible patients undergoing robot-assisted laparoscopic radical prostatectomy between July 19 and December 28, 2016 were enrolled in a prospective, longitudinal, observational cohort study. The primary outcome was patient reported urinary incontinence on the EPIC (Expanded Prostate Cancer Index Composite) scale 6 and 12 weeks postoperatively. The relationship between the EPIC score of urinary incontinence and bladder neck size was evaluated by multiple regression. Predicted EPIC scores for incontinence were displayed graphically after using restricted cubic splines to model bladder neck size. RESULTS: A total of 107 patients were enrolled. The response rate was 98% and 87% at 6 and 12 weeks, respectively. Bladder neck size was not significantly associated with incontinence scores at 6 and 12 weeks. Comparing the 90th percentile for bladder neck size (18 mm) with the 10th percentile (7 mm) revealed no significant difference in adjusted EPIC scores for incontinence at 6 weeks (ß coefficient 0.88, 95% CI -10.92-12.68, p = 0.88) or at 12 weeks (ß coefficient 5.80, 95% CI -7.36-18.97, p = 0.39). CONCLUSIONS: These findings question the merit of creating an extremely small bladder neck during robot-assisted laparoscopic radical prostatectomy. We contend that doing so increases the risk of positive margins at the bladder neck without facilitating early recovery of continence.

Comparative study of the organisation and phenotypes of bladder interstitial cells in human, mouse and rat.

With most research on interstitial cells (IC) in the bladder being conducted on animal models, it remains unclear whether all structural and functional data on IC from animal models can be translated to the human context. This prompted us to compare the structural and immunohistochemical properties of IC in bladders from mouse, rat and human. Tissue samples were obtained from the bladder dome and subsequently processed for immunohistochemistry and electron microscopy. The ultrastructural properties of IC were compared by means of electron microscopy and IC were additionally characterized with single/double immunohistochemistry/immunofluorescence. Our results reveal a similar organization of the IC network in the upper lamina propria (ULP), the deep lamina propria (DLP) and the detrusor muscle in human, rat and mouse bladders. Furthermore, despite several similarities in IC phenotypes, we also found several obvious inter-species differences in IC, especially in the ULP. Most remarkably in this respect, ULP IC in human bladder predominantly displayed a myoid phenotype with abundant presence of contractile micro-filaments, while those in rat and mouse bladders showed a fibroblast phenotype. In conclusion, the organization of ULP IC, DLP IC and detrusor IC is comparable in human, rat and mouse bladders, although several obvious inter-species differences in IC phenotypes were found. The present data show that translating research data on IC in laboratory animals to the human setting should be carried out with caution.

The fascial suspension of the prostate: A cadaveric study.

AIMS: Analysis and description of the supporting fascial structure around the prostate and urethra, which needs to be preserved or restored during radical prostatectomy (RP). METHODS: Anatomical dissection of 10 male cadavers was performed and the supporting fascial structures of bladder neck, prostate, and proximal urethra were investigated. The cadavers were embalmed according to Thiel's method, which preserves a natural texture and color of tissues. RESULTS: Anteriorly, the puboprostatic ligament (PL), the dorsal vein complex, and the urethropelvic ligament form an integral structure that suspends and stabilizes the prostatic apex. Laterally, the fascia originates from the fascial tendinous arch of the pelvis and stabilizes the prostate in the central position. In the posterolateral aspect, we could demonstrate a tendineous dorsal raphe, which represents an important stabilization structure of the urethra. CONCLUSIONS: The anterior and posterior pelvic fascial structure seems to be important stabilizer for the prostate and proximal urethra. Their preservation or reconstruction during RP is mandatory to restore the anatomic and functional continuity of the bladder neck and urethra. Neurourol. Urodynam. 36:1131-1135, 2017. © 2016 Wiley Periodicals, Inc.

Comparative Anatomy of the Ovine and Female Pelvis.

BACKGROUND: Pelvic organ prolapse affects half of vaginally parous women. Several animal models are used to study its pathophysiology and treatment. Sheep are interesting because they develop spontaneously prolapse with similar risk factors as women and can be used for vaginal surgery. This study describes ovine pelvis anatomy and compares it to women's pelvis to provide anatomical tools for translational researchers. METHODS: MRI, pelvic dissections, and histology were used for detailed macro- and microscopic analysis of relevant anatomical structures in 6 nulliparous ewes. RESULTS: Although sheep are quadrupeds, the gross and microscopic anatomies are similar to the female pelvis. Principal differences are the shape and its orientation, the absence of the sacrospinous ligament and the internal obturator. The levator ani (except for the puborectalis) and the coccygeus muscle are present, yet the latter is more developed - coinciding with the tail. The dimensions and morphology of the ovine vagina is comparable. The retropubic and the rectovaginal space are accessible transvaginally. There is a wide expression of estrogen receptors with low or absent immunoreactivity in the urethral epithelium, bladder, anus and internal anal sphincter. CONCLUSION: The ovine pelvic floor has many anatomical and ultrastructural similarities to the female pelvic floor.