Diagnostic radiology findings and spectrum of therapeutic interventions in gynaecological and urogenital vascular anomalies.

Vascular anomalies represent a rare congenital disease with manifestation at diverse anatomical sights and presenting with heterogenous symptoms. Undetected, they can progress and create acute and chronic complications with functional impairment. The manifestation in the female and male pelvis and the urogenital tract represents a multidisciplinary challenge for physicians. Especially outpatient management in gynaecology and urology is affected. Diagnostic Radiology holds an important supportive role in early diagnosis of the underlying urogenital vascular anomaly and referral to interventional radiology, either for minimal invasive treatment, or to surgery for further assessment. This pictorial review creates awareness for the spectrum of vascular anomalies of the gynaecological and urogenital tract, their characteristic imaging findings and dedicated interventional treatment options. The individual description of vascular anomalies, based on an appropriate nomenclature and classification standard, is a guide for radiologists to distinguish the underlying vascular anomaly from other vascular disorders and to accelerate diagnosis as well as therapeutic proceedings. In consequence, interdisciplinary management of patients with vascular anomalies of the female and male pelvis will benefit.

Urogenital schistosomiasis is associated with signatures of microbiome dysbiosis in Nigerian adolescents.

Urogenital schistosomiasis is a neglected tropical disease caused by the parasite Schistosoma haematobium, which resides in the vasculature surrounding the urogenital system. Previous work has suggested that helminthic infections can affect the intestinal microbiome, and we hypothesized that S. haematobium infection could result in an alteration of immune system-microbiota homeostasis and impact the composition of the gut microbiota. To address this question, we compared the fecal microbiomes of infected and uninfected schoolchildren from the Argungu Local Government Area of Kebbi State, Nigeria, detecting significant differences in community composition between the two groups. Most remarkably, we observed a decreased abundance of Firmicutes and increased abundance of Proteobacteria - a shift in community structure which has been previously associated with dysbiosis. More specifically, we detected a number of changes in lower taxa reminiscent of inflammation-associated dysbiosis, including decreases in Clostridiales and increases in Moraxellaceae, Veillonellaceae, Pasteurellaceae, and Desulfovibrionaceae. Functional potential analysis also revealed an enrichment in orthologs of urease, which has been linked to dysbiosis and inflammation. Overall, our analysis indicates that S. haematobium infection is associated with perturbations in the gut microbiota and may point to microbiome disruption as an additional consequence of schistosome infection.

Migration pathways of sacral neural crest during development of lower urogenital tract innervation.

The migration and fate of cranial and vagal neural crest-derived progenitor cells (NCPCs) have been extensively studied; however, much less is known about sacral NCPCs particularly in regard to their distribution in the urogenital system. To construct a spatiotemporal map of NCPC migration pathways into the developing lower urinary tract, we utilized the Sox10-H2BVenus transgene to visualize NCPCs expressing Sox10. Our aim was to define the relationship of Sox10-expressing NCPCs relative to bladder innervation, smooth muscle differentiation, and vascularization through fetal development into adulthood. Sacral NCPC migration is a highly regimented, specifically timed process, with several potential regulatory mileposts. Neuronal differentiation occurs concomitantly with sacral NCPC migration, and neuronal cell bodies are present even before the pelvic ganglia coalesce. Sacral NCPCs reside within the pelvic ganglia anlagen through 13.5 days post coitum (dpc), after which they begin streaming into the bladder body in progressive waves. Smooth muscle differentiation and vascularization of the bladder initiate prior to innervation and appear to be independent processes. In adult bladder, the majority of Sox10+ cells express the glial marker S100ß, consistent with Sox10 being a glial marker in other tissues. However, rare Sox10+ NCPCs are seen in close proximity to blood vessels and not all are S100ß+, suggesting either glial heterogeneity or a potential nonglial role for Sox10+ cells along vasculature. Taken together, the developmental atlas of Sox10+ NCPC migration and distribution profile of these cells in adult bladder provided here will serve as a roadmap for future investigation in mouse models of lower urinary tract dysfunction.

Surgical anatomy of urogenital diaphragm and course of its vessels in exstrophy-epispadias.

OBJECTIVES: To report the surgical anatomy of the muscles of the urogenital diaphragm and the pattern of its vessels in the classic exstrophy bladder and incontinent epispadias. METHODS: A total of 11 patients, 9 with unoperated classic exstrophy and 2 with incontinent epispadias, who were >5 years old at presentation, were selected for the present study. Magnetic resonance imaging of the pelvis was performed using a 3.0 T magnetic resonance imaging scanner and an 8-channel coil. Computed tomography was performed for 5 patients using a multidetector row helical computed tomography scanner. Angiograms of the vessels of the urogenital diaphragm were also obtained using magnetic resonance imaging and computed tomography. RESULTS: A central perineal body was seen in all the patients, with attachment of the bulbospongiosus anteriorly, superficial transverse perinei laterally, and anal sphincter posteriorly. At the root of corpora, the ischiocavernosus muscle was also seen. The triangle among the ischiocavernosus, bulbospongiosus, and superficial transverse perinei muscle was accentuated and contained the perineal artery, indirectly indicating the course of the perineal nerve. The dorsal penile artery was nearer to the posterior edge of the ischiopubic ramus, before coursing on the lateral aspect of the anterior segment of the corpora. The deep transverse perinei muscle and laid open external urethral sphincter were also seen in the proximal planes of the urogenital diaphragm. CONCLUSIONS: First, all the muscles of the urogenital diaphragm, including the external urethral sphincter, were present in the exstrophy bladder. Second, the perineal artery and its sphincteric branches were in the triangular space between the ischiocavernosus, bulbospongiosus, and superficial transverse perinei muscle. Finally, the dorsal penile artery ran along the inner edge of the ischiopubic ramus before lying on lateral aspect of the corpora.

[Vasculitis in the trunk: Imaging patterns of typical organ manifestations due to primary vasculitis of small and medium sized vessels]. / Vaskulitiden am Körperstamm: Bildgebende Diagnostik typischer Organmanifestationen der primären Vaskulitiden mittelgroßer und kleiner Gefäße.

Vasculitis of small and medium sized vessels mostly affects several organ systems and causes unspecific symptoms. The trunk, lungs, heart and the gastrointestinal and urogenital tracts are most frequently involved. Due to an unclear clinical picture imaging is part and parcel of diagnostics. The knowledge of typical and rare imaging patterns as well as knowledge of the correct imaging method is crucial for classification. Projection radiography is still the gold standard for imaging of the lungs. Using computed tomography discrete ground-glass pattern opacities, nodules and consolidations can be depicted. In the abdomen computed tomography and magnetic resonance imaging can depict swelling of the intestinal wall. Digital subtraction angiography may contribute to further differentiation and reveal microaneurysms in cases of polyarteriitis nodosa.

[New perspectives in studies of the urogenital tract microcirculation--a decade of experience in Szeged, Hungary]. / Az urogenitális traktus mikrokeringési kutatásainak módszerei, új perspektívái--egy évtized szegedi tapasztalatai.

Investigations in microcirculation are an essential way to understand basic pathologic mechanisms and detect early signs of various diseases. Up until the last decade there was only limited amount of information available in the field of urological microcirculation. Due to advanced technologies, new methods and international cooperation of the research team of University of Szeged, promising new data became available in this interesting field.

Single-organ vasculitis.

PURPOSE OF REVIEW: To provide a critical analysis of a rare disorder, single-organ vasculitis, emphasizing those organs in which the excision of the vasculitic lesion can be curative. To recommend a rational approach to diagnosis, longitudinal follow-up and treatment. RECENT FINDINGS: Patients with focal single-organ vasculitis affecting abdominal and genitourinary organs, breast and aorta have been reported as individual cases and small series. Single-organ vasculitis differs from systemic forms of vasculitis in disease expression and prognosis. Occasionally, what appears to be a localized process evolves into a systemic disease. Depending on the organ affected, some clinical, serological and histopathologic features may be helpful in predicting the extent of the vasculitic process. With the exception of severe ischemic or hemorrhagic complications affecting the abdominal organs and dissection or rupture of the aortic arch, the prognosis of focal single-organ vasculitis tends to be excellent. Resection of the inflammatory lesion may be curative. SUMMARY: The diagnosis of focal single-organ vasculitis is always presumptive and requires exclusion of systemic illness at the time of diagnosis as well as throughout the period of continued care. Clues from clinical symptoms, laboratory tests and histopathologic features at the time of diagnosis may assist in devising surveillance strategies.

Effects of doxazosin on blood flow and mRNA expression of nitric oxide synthase in the spontaneously hypertensive rat genitourinary tract.

Hypertension may impact pelvic arterial blood flow resulting in reduction of nitric oxide synthase (NOS) levels. Although doxazosin, an alpha(1)-adrenoceptor antagonist, has been shown to improve erectile dysfunction as well as benign prostatic hyperplasia (BPH) and hypertension, it is not clear whether these improvements using doxazosin are primarily due to direct actions on the prostate, urinary bladder and penis, possibly via inhibition of vascular alpha(1)-adrenoceptors, or other sites of actions. Therefore, we investigated effects of doxazosin to the spontaneously hypertensive rat (SHR) on blood flow and NOS levels in the genitourinary tract. Four groups of rats were assessed: group 1, SHRs treated with doxazosin (30 mg/kg/day) for 4 weeks; group 2, SHRs treated with nifedipine (30 mg/kg/day) for 4 weeks; group 3, untreated SHRs; and group 4, untreated Wistar-Kyoto (WKY) rats. Blood flow to the ventral prostate, dorsolateral prostate, urinary bladder and penis was determined using a fluorescent microsphere infusion technique. Expression levels of nNOS and eNOS mRNAs were quantified by real-time RT-PCR using SYBR Green I. Blood flow to the ventral prostate, dorsolateral prostate, urinary bladder and penis was significantly lower in untreated SHRs than WKY rats. Treatment with doxazosin increased blood flow to each tissue studied in SHRs. RT-PCR data indicated that untreated SHRs had lower mRNA expression levels of nNOS in the bladder and penis and eNOS in the penis than WKY rats and that administration of doxazosin to the SHR caused an increase in expression levels of these genes, i.e., up-regulation of nNOS in the bladder and penis and eNOS in the penis. However, nifedipine had no significant effects on blood flow and NOS levels in the SHR genitourinary tract. Our data demonstrate that doxazosin treatment causes differential alterations in blood flow and NOS levels in the SHR genitourinary tract. These findings may provide insight into the beneficial effects of alpha(1)-adrenoceptor antagonists, on prostate, bladder and penile function, when used to treat symptoms of BPH and elevated blood pressure.

Blunt abdominal trauma: current imaging techniques and CT findings in patients with solid organ, bowel, and mesenteric injury.

Imaging plays a critical role in the evaluation of patients with blunt abdominal trauma. In most institutions, computed tomography (CT) is the modality of choice when evaluating such patients. The purpose of this review is to highlight current techniques in trauma imaging and to review CT findings associated with solid organ, bowel, mesenteric, and diaphragmatic injury. In particular, emphasis is placed on the use of multidetector CT technology (MDCT), especially 64-row detector CT. The role of various techniques, including the use of oral and intravenous contrast, as well as the potential benefit of delayed imaging, is discussed.

Imaging of genitourinary trauma.

The kidney, bladder and male urethra are the organs typically injured by blunt and penetrating trauma to the urinary tract, whereas the ureter is only rarely injured. The staging of genitourinary tract trauma has recently gained tremendous significance due to improvements in ultrasound, CT and MRI, including contrast-enhanced magnetic resonance angiography, and has become a helpful tool for decision making with regard to conservative and surgical management. Furthermore, interventional radiology may be helpful to control hemorrhage from vessels in the pelvic region that may not be easily accessed by open surgery. Therefore, this pictorial essay gives examples of the radiological presentation of genitourinary trauma and describes technical details of the diagnostic imaging modalities used.

Estudo morfológico dos componentes do pedículo ovariano de cabra / Morphologic study of the ovarian pedicle components in goat

Introdução - Este trabalho teve como objetivo estudar a morfologia dos componentes de pedículos ovarianos de cabras, com intuito de identificar também a possibilidade de passagem de substâncias do sangue venoso procedente do útero para o sangue arterial ovariano, fato importante no processo de reprodução. Método - Pedículos ovarianos de 15 cabras adultas foram estudados mediantes cortes histológicos de 6 micrômetros de espessura de diferentes segmentos corados segundo os métodos de Hematoxilina e Eosina, tricômico de Masson, van Gieson, Verhoeff, reticulina de Gomori e Picrosirius-red. Os componentes vasculares também foram examinados após injeção de látex corado, emulsão de sulfato de bário, acetato de vinil e tinta da China, seguidos, respectivamente pelas técnicas de dissecção, exames radiográficos, corrosão em ácido sulfúrico a 30% e exames histológicos. Resultados - Foram descritos os aspectos histológicos dos vasos do pedículo ovariano, seus envoltórios, suas relações e constituição do tecido conjuntivo intervascular. Foi identificada ainda a passagem de tinta da China do sistema venoso uterino para a artéria ovárica. Conclusão - Os achados permitem concluir que, nesta espécie, existe a possibilidade de passagem direta de substâncias do sistema venoso uterino para o sistema arterial ovariano.

Effect of vaginal distension on blood flow and hypoxia of urogenital organs of the female rat.

Vaginal delivery of children causes traumatic injury to tissues of the pelvic floor and is correlated with stress urinary incontinence; however, the exact mechanism of organ and tissue injury leading to incontinence development is unknown. The purpose of this project was to test the hypothesis that vaginal distension results in decreased blood flow to, and hypoxia of, the urogenital organs responsible for continence, which would suggest an ischemic and/or reperfusion mechanism of injury. Thirteen female rats underwent vaginal distension for 1 h. Thirteen age-matched rats were sham-distended controls. Blood flow to the bladder, urethra, and vagina were determined using a microsphere technique. Hypoxia of these organs was determined by immunohistochemistry. Blood flow to all three organs was significantly decreased just before release of vaginal distension. Bladder blood flow decreased further immediately after release of vaginal distension and continued to be significantly decreased 15 min after the release. Blood flow to both the urethra and vagina tripled immediately after release, inducing a rapid return to normal values. Vaginal distension resulted in extensive smooth muscle hypoxia of the bladder, as well as extensive hypoxia of the vaginal epithelium and urethral hypoxia. Bladders from sham-distended rats demonstrated urothelial hypoxia as well as focal hypoxic areas of the detrusor muscle. We have clearly demonstrated that vaginal distension results in decreased blood flow to, and hypoxia of, the bladder, urethra, and vagina, supportive of hypoxic injury as a possible mechanism of injury leading to stress urinary incontinence.

[New techniques in uro-sonography]. / Neue Techniken der Urosonographie.

New sonographic techniques in urology, together with their principles of operation, will be presented. Together with the utilization of broadband ultrasound scanners and digital beam formers, leading to better spatial resolution and increased line density in ultrasound imaging, panorama sonography enables the outline of wide lateral regions independent of the width of the scanner. Spatial compound sonography achieves a comparatively better visualization of details in the b-mode image than has yet been available. The continuously improved 3-D, now leading to 4-D, techniques, which means real time capabilities, make the visualization of unrestricted imaging planes, which are not seen in conventional 2-D techniques, possible. The second harmonic imaging technique, including the special applications tissue harmonic imaging (THI) and contrast harmonic imaging (CHI), uses special ultrasound signal processing procedures for capturing and evaluating tissue hemoperfusion-here in combination with ultrasound contrast agents (UCA). Furthermore, microvascular imaging (MVI) enables the visualization of perfusion in tissues reaching the microcirculation regions. This leads to new possibilities for the assessment of pathological perfusion patterns, e.g. in andrology (perfusion of testicles) and uro-oncology (hyperperfusion of malignant regions).

Flap technology for reconstructions of urogenital organs.

PURPOSE OF REVIEW: The purpose of this review is to summarize the different reconstructive options for urogenital indications. The development of various flap techniques to restore congenital and acquired urogenital defects is presented. RECENT FINDINGS: Various reconstructive techniques have been demonstrated recently. On the basis of the reconstructive requirements, two main techniques can be defined: the standard local or regional flap technique (pedicled flap) and the more sophisticated microvascular free flap technique. Free tissue transplantation (transfer) is a procedure that involves microvascular transplantation of a flap (a fasciocutaneous, muscle or composite flap) in one stage from a donor site in the body to a distant recipient site. The viability of the transplanted flap is maintained by microvascular anastomosis between the flap's vessels (at least one artery and one vein) and recipient vessels. Re-innervation and functioning muscle contraction is achieved by suturing the vessels and a motor nerve in the recipient area to a motor nerve of a free transplanted muscle. After regeneration of the nerve and re-innervation of the transplanted muscle, a functioning free transplanted muscle offers enough contractile capacity and strength to replace the function of the missing muscles at the recipient site. The technique of microvascular free tissue transfer necessitates extensive experience in microvascular technique and this approach could be efficiently applied in cooperation with other specialists. Recent studies show the development and clinical application of these new surgical techniques in urology (e.g. in the treatment of bladder acontractility using innervated free latissimus dorsi muscle and in the use of a free microvascular fillet lower leg flap for the reconstruction of a large pelvic-floor defect). SUMMARY: Various reconstructive requirements define the techniques for reconstruction. The main principle is to obtain optimal anatomical and functional reconstruction with minimal donor site morbidity. Depending on the etiology of the defect, different reconstructive options are available to optimize the reconstructive result. Optimal reconstruction might best be achieved by adopting an interdisciplinary approach in which the primary objective is to provide the best possible outcome for each patient. This review presents the main indications for and principles of flap selection according to the reconstructive requirements.

Topography of the pelvic autonomic nervous system and its potential impact on surgical intervention in the pelvis.

Bladder, bowel, and sexual dysfunction caused by iatrogenic lesions of the inferior hypogastric plexus (IHP) are well known and commonly tolerated in pelvic surgery. Because the pelvic autonomic nerves are difficult to define and dissect in surgery, and their importance often ignored, we conducted a gross anatomic study of 90 adult and four fetal hemipelves. Using various non-surgical approaches, the anatomic relations and pathways of the IHP were dissected. The IHP extended from the sacrum to the genital organs at the level of the lower sacral vertebrae. It originated from three different sources: the hypogastric nerve, the sacral splanchnic nerves from the sacral sympathetic trunk (mostly the S2 ganglion), and the pelvic splanchnic nerves, which branched primarily from the third and fourth sacral ventral rami. These fibers converge to form a uniform nerve plate medial to the vascular layer and deep to the peritoneum. The posterior portion of the IHP supplied the rectum and the anterior portion of the urogenital organs; nerve fibers traveled directly from the IHP to the anterolateral wall of the rectum and to the inferolateral and posterolateral aspects of the urogenital organs. The autonomic supply from the IHP was supplemented by nerves accompanying the ureter and the arteries. An understanding of the location of the autonomic pelvic network, including important landmarks, should help prevent iatrogenic injury through the adoption of surgical techniques that reduce or prevent postoperative autonomic dysfunction.

Distribution of neuropeptide Y Y1 receptors in rodent peripheral tissues.

Using a sensitive immunohistochemical technique, the localization of neuropeptide Y (NPY) Y1-receptor (Y1R)-like immunoreactivity (LI) was studied in various peripheral tissues of rat. Wild-type (WT) and Y1R-knockout (KO) mice were also analyzed. Y1R-LI was found in small arteries and arterioles in many tissues, with particularly high levels in the thyroid and parathyroid glands. In the thyroid gland, Y1R-LI was seen in blood vessel walls lacking alpha-smooth muscle actin, i.e., perhaps in endothelial cells of capillaries. Larger arteries lacked detectable Y1R-LI. A distinct Y1R-immunoreactive (IR) reticulum was seen in the WT mouse spleen, but not in Y1R-KO mouse or rat. In the gastrointestinal tract, Y1R-positive neurons were observed in the myenteric plexus, and a few enteroendocrine cells were Y1R-IR. Some cells in islets of Langerhans in the pancreas were Y1R-positive, and double immunostaining showed coexistence with somatostatin in D-cells. In the urogenital tract, Y1R-LI was observed in the collecting tubule cells of the renal papillae and in some epithelial cells of the seminal vesicle. Some chromaffin cells of adrenal medulla were positive for Y1R. The problem of the specificity of the Y1R-LI is evaluated using adsorption tests as well as comparisons among rat, WT mouse, and mouse with deleted Y1R. Our findings support many earlier studies based on other methodologies, showing that Y1Rs on smooth muscle cells of blood vessels mediate NPY-induced vasoconstriction in various organs. In addition, Y1Rs in other cells in parenchymal tissues of several organs suggest nonvascular effects of NPY via the Y1R.

Maternal recognition of pregnancy in marsupials.

Pregnancy in kangaroos and wallabies (macropodid marsupials) induces multiple unilateral responses in the reproductive system that override those related to proximity to the single corpus luteum on one ovary or to the follicle on the contralateral ovary. This situation is in contrast to most other non-macropodid marsupials, in which the responses are dependent on the corpus luteum. There is now good evidence that these unilateral responses in macropodids are controlled by the feto-placental unit acting locally to stimulate the endometrium and myometrium. Pregnancy also influences the duration of the oestrous cycle and maternal behaviour. The stimuli responsible for these effects probably include paracrine, endocrine and mechanical stimuli resulting from uterine stretch. Taken together, these unilateral responses demonstrate that there is a refined maternal recognition of pregnancy in at least the macropodid marsupials.

Pathology and angiographical studies on urogenital organ system induced by idiopathic hemorrhage in male E1 mice.

Urogenital organ system induced by idiopathic hemorrhage in sudden died male E1 mice were investigated macro- and histopathologically and angiographically. The mortality of the male E1 mice with brief life span was 85% during observation period for 33 weeks, and about half of the male E1 mice died between 10-week-old and 20-week-old. In all dead mice, urine retention was prominent, and the seminal vesicle or the coagulating gland, especially the bulbocavernosus muscle had severe hemorrhage. There was coagulated blood mass in the urethral lumen and the lumen of the seminal vesicle and the coagulating gland. Further, in pars spongiosa, coagulated blood mass occupied the most area of the corpus spongiosum penis and corpus cavernosum penis with severe hemorrhage. Angiographically, the penile artery in not affected male E1 mice was thinner than that in control mice.

[Morphology and development of the arteries of the deferential duct, the pelvic section of the urethra, vesicular and prostate glands in cattle in the fetal and neonatal periods]. / Morfologia i rozwój tetnic nasieniowodu, czesci miednicznej cewki moczowej, gruczolu pecherzykowego i gruczolu krokowego u bydla w okresie plodowym i neonatalnym.

The experiments were carried out with 70 cattle male fetuses coming from 8th to 40th week of pregnancy and with 8 newborns aged from 1 to 14 days of life. The pelvic arteries were filled up--through aorta--with rubber latex stained with pigments by means of automatic devices of own design and construction. The age of the fetuses was determined with the Kantorova method. On the grounds of the investigation it has been found that the ductus deferens, the fore-part or urethra, vesicular and prostatic glands in cattle fetuses and newborns are supplied with blood by following arteries: 1) rami ductus deferentis aa. testiculares, 2) arteriae ductus deferentis and 3) aa. prostaticae. In cattle fetuses and newborns the above mentioned twin vessels undergo several developmental quantitative and qualitative transformations. Least of all the transformations pertain to rami ductus deferentis aa. testiculares. As for the arteries of ductus deferens there was observed mutability of mainly individual character, not related to the age of the animal. It concerned, first of all, the variety of places and ways of departure of the arteries from the superior vessels. Finally, developmental transformations of the prostatic arteries manifested considerable dependence on the age of the animals, in this respect differing significantly from those mentioned previously. Generally one can state that the developmental mutability of the arteries studied was almost always superimposed by high-degree individual mutability of those vessels, which so far has not been clearly marked in specialist literature.