Bladder capacity in an elimination communication infant: a case report.

BACKGROUND: Bladder capacity is essential in assessing children with voiding dysfunction, yet it is currently unclear how best to determine a benchmark bladder capacity; various formulas have been proposed. CASE PRESENTATION: This report details the unique case of an elimination communication Caucasian infant (< 2 years old) who achieved nighttime and daytime dryness by 6 months of age. His first morning voids were measured from 8 to 20 months of age and compared with three formulas: (1) the Koff formula, a widely used formula based on fill volumes in anesthetized infants; (2) the Kaefer formula, a formula based on fill volume in nonanesthetized infants; and (3) the Holmdahl formula, a formula based on frequency-volume charts in normal infants. CONCLUSION: This infant's first morning void was found to be most consistent with Kaefer's formula. Further research is required to determine if formulas based on fill volume in nonanesthetized infants provide the more accurate benchmark bladder capacity in infants.

Abdominal ultrasound in amazonian manatee (Trichechus inunguis) (Natterer, 1883) / Ultrassonografia abdominal em peixe boi amazônico (Trichechus inunguis (Natterer, 1883)

Morphophysiological species researches are fundamental, and diagnostic imaging is an excellent technique, already used in wild animals, with great application, not invasive and provide real-time information of each body. Amazonian manatees are on the list of endangered animals classified in the vulnerable category and knowledge of the normal pattern of ultrasound anatomy of organs and tissues is important for the maintenance and well-being of captive specimens contributing to reintroduction actions. The objective of the study was to standardize the examination technique and describe the ultrasound findings of the liver, gallbladder, stomach, urinary bladder and the subcutaneous tissue of the abdominal region in Trichechus inunguis, in order to contribute with the anatomical and sonographic knowledge and assist in the diagnosis and prognosis diseases. The study used 18 animals to describe the normal sonographic anatomy in the abdominal cavity of the Amazonian manatee. During abdominal scan, it was possible to visualize the features of the liver, gallbladder, stomach, urinary bladder obtained satisfactory results in this study. Therefore, other structures were not primarily identified by the reduced time, lots of fat and gases in intestines of animals.

Pesquisas morfofisiológicas em espécies selvagens são fundamentais, e o diagnóstico por imagem é uma excelente técnica, já usada e com grande aplicação, não invasiva e que fornece informações em tempo real de cada órgão. Peixes-boi-amazônico encontram-se na lista de animais ameaçados de extinção classificados na categoria vulnerável e o conhecimento do padrão normal da anatomia ultrassonográfica de órgãos e tecidos é importante para a manutenção e bem-estar de espécimes em cativeiro contribuindo para ações de reintrodução. O objetivo deste estudo foi padronizar a técnica de exame e descrever os achados ultrassonográficos do fígado, vesícula biliar, estômago, vesícula urinária e o tecido subcutâneo da região abdominal em Trichechus inunguis, de modo a contribuir com o conhecimento anátomo-sonográfico e auxiliar no diagnóstico e prognóstico de doenças. O estudo utilizou 18 animais para descrever a anatomia ultrassonográfica normal na cavidade abdominal de peixe-boi amazônico. Durante a varredura abdominal foi possível visualizar as características dos órgãos obtendo resultados satisfatórios neste estudo, concluindo ser uma técnica eficiente para avaliação de determinados órgãos abdominais em peixe-boi amazônico. Entretanto, outras estruturas não foram identificadas principalmente pelo tempo reduzido, muita gordura e gases nos intestinos dos animais.

Panoramic Imaging Assessment of Different Bladder Phantoms - An Evaluation Study.

OBJECTIVE: To evaluate "panoramic image stitching" for cystoscopy, a novel technique to augment a urologist's field of view transoperatively in real-time during a cystoscopic "keyhole" procedure, 3-D bladder phantoms provide a suitable setting. Thus, the objective is the evaluation of different 3-D printed bladder phantoms with respect to their ability to be used for extended experiments of panoramic cystoscopy. MATERIALS AND METHODS: Five bladder phantoms with different geometries, surface textures, stiffness and materials were assessed with rigid 0- and 30-degree lenses and a video-cystoscope regarding suitability for image stitching. For panoramic image generation, we use an established real-time stitching approach successfully applied to retrospective cystoscopy image sequences from real clinical cases. For evaluation of the experiments two quality criteria were defined, namely 'completeness' (describing the internal area of the phantom that can be stitched), and 'extension' (how far does an acquired panorama extend beyond the assumed 'equator' of the phantom). RESULTS: Panoramas of all phantom and endoscope combinations were computed. Using landmarks (south pole, north pole, equator) in the phantoms, maximum extension of the panoramas was assessed. The computed panoramas yield maximum extensions between 270o (0-degree cystoscope) and 330o (video cystoscope). Deformable phantoms yield larger panoramas than the rigid models. CONCLUSION: In can be concluded that the stitching process works quite well with all evaluated phantoms. Nevertheless, a novel phantom would be needed, combing a deformable, elliptical geometry and real-type vascular texture in the inside, that can be filled with water.

Dosimetric impact of rectum and bladder anatomy and intrafractional prostate motion on hypofractionated prostate radiation therapy.

OBJECTIVE: The objective of this study was to evaluate the dosimetric impact on hypofractionated prostate radiation therapy of two geometric uncertainty sources: rectum and bladder filling and intrafractional prostate motion. MATERIALS AND METHODS: This prospective study included 544 images (375 pre-treatment cone-beam CT [CBCT] and 169 post-treatment CBCT) from 15 prostate adenocarcinoma patients. We recalculated the dose on each pre-treatment CBCT once the positioning errors were corrected. We also recalculated two dose distributions on each post-treatment CBCT, either using or not intrafractional motion correction. A correlation analysis was performed between CBCT-based dose and rectum and bladder filling as well as intrafraction prostate displacements. RESULTS: No significant differences were found between administered and planned rectal doses. However, we observed an increase in bladder dose due to a lower bladder filling in 66% of treatment fractions. These differences were reduced at the end of the fraction since the lower bladder volume was compensated by the filling during the treatment session. A statistically significant reduction in target volume coverage was observed in 27% of treatment sessions and was correlated with intrafractional prostate motion in sagittal plane > 4 mm. CONCLUSIONS: A better control of bladder filling is recommended to minimize the number of fractions in which the bladder volume is lower than planned. Fiducial mark tracking with a displacement threshold of 5 mm in any direction is recommended to ensure that the prescribed dose criteria are met.

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.

Does the bowfin gas bladder represent an intermediate stage during the lung-to-gas bladder evolutionary transition?

Whether phenotypic evolution occurs gradually through time has prompted the search for intermediate forms between the ancestral and derived states of morphological features, especially when there appears to be a discontinuous origin. The gas bladder, a derived character of the Actinopteri, is a modification of lungs, which characterize the common ancestor of bony vertebrates. While gas bladders and lungs are similar in many ways, the key morphological difference between these organs is the direction of budding from the foregut during development; essentially, the gas bladder buds dorsally and the lungs bud ventrally from the foregut. Did the shift from ventral lungs to dorsal gas bladder transition through a lateral-budding stage? To answer this question, the precise location of budding during gas bladder development in bowfin, representing the sister lineage to teleosts, has been debated. In the early 20th-century, it was suggested that the bowfin gas bladder buds laterally from the right wall of the foregut. We used nano-CT scanning to visualize the early development of the bowfin gas bladder to verify the historical studies of gas bladder developmental morphology and determine whether the direction of gas bladder budding in bowfin could be intermediate between ventrally budding lungs and dorsally budding gas bladders. We found that the bowfin gas bladder buds dorsally from the anterior foregut; however, during early development, the posterior gas bladder twists right. As development progresses, the posterior, right-hand twist becomes shallower, and the gas bladder itself shifts toward a mid-dorsal position. The budding site is definitively dorsal, despite the temporary lateral twist of the posterior gas bladder.

Evaluation of margins in pelvic lymph nodes and prostate radiotherapy and the impact of bladder and rectum on prostate position.

PURPOSE: The aims of this study were: determination of the CTV to PTV margins for prostate and pelvic lymph nodes. Investigation of the impact of registration modality (pelvic bones or prostate) on the CTV to PTV margins of pelvic lymph nodes. Investigation of the variations of bladder and rectum over the treatment course. Investigation of the impact of bladder and rectum variations on prostate position. PATIENTS AND METHODS: This study included 15 patients treated for prostate adenocarcinoma. Daily kilo voltage images and weekly CBCT scans were performed to assess prostate displacements and common and external iliac vessels motion. These data was used to calculate the CTV to PTV margins using Van Herk equation in the setting of a daily bone registration. We also compared the CTV to PTV margins of pelvic lymph nodes according to registration method; based on pelvic bone or prostate. We delineated bladder and rectum on all CBCT scans to assess their variations over treatment course at 4 anatomic levels [1.5cm above pubic bone (PB), superior edge, mid- and inferior edge of PB]. RESULTS: Using Van Herk equation, the prostate CTV to PTV margins (bone registration) were 8.03mm, 5.42mm and 8.73mm in AP, ML and SI direction with more than 97% of prostate displacements were less than 5mm. The CTV to PTV margins ranged from 3.12mm to 3.25mm for external iliac vessels and from 3.12mm to 4.18mm for common iliac vessels. Compared to registration based on prostate alignment, bone registration resulted in an important reduction of the CTV to PTV margins up to 54.3% for external iliac vessels and up to 39.6% for common iliac vessels. There was no significant variation of the mean bladder volume over the treatment course. There was a significant variation of the mean rectal volume before and after the third week of treatment. After the third week, the mean rectal volume seemed to be stable. The uni- and multivariate analysis identified the anterior wall of rectum as independent factor acting on prostate motion in AP direction at 2 levels (superior edge of, mid PB). The right rectal wall influenced the prostate motion in ML direction at inferior edge of PB. The bladder volume tends toward significance as factor acting on prostate motion in AP direction. CONCLUSIONS: We recommend CTV to PTV margins of 8mm, 6mm and 9mm in AP, ML and SI directions for prostate. And, we suggest 4mm and 5mm for external and common iliac vessels respectively. We also prefer registration based on bony landmarks to minimize bowel irradiation. More CBCT scans should be performed during the first 3weeks and especially the first week to check rectum volume.

Dosimetric Impact of Intrafraction Motion in Online-Adaptive Intensity Modulated Proton Therapy for Cervical Cancer.

PURPOSE: A method was recently developed for online-adaptive intensity modulated proton therapy (IMPT) in patients with cervical cancer. The advantage of this approach, relying on the use of tight margins, is challenged by the intrafraction target motion. The purpose of this study was to evaluate the dosimetric effect of intrafraction motion on the target owing to changes in bladder filling in patients with cervical cancer treated with online-adaptive IMPT. METHODS AND MATERIALS: In 10 patients selected to have large uterus motion induced by bladder filling, the intrafraction anatomic changes were simulated for several prefraction durations for online (automated) contouring and planning. For each scenario, the coverage of the primary target was evaluated with margins of 2.5 and 5 mm. RESULTS: Using a 5- mm planning target volume margin, median accumulated D98% was greater than 42.75 GyRBE1.1 (95% of the prescribed dose) in the case of a prefraction duration of 5 and 10 minutes. For a prefraction duration of 15 minutes, this parameter deteriorated to 42.6 GyRBE1.1. When margins were reduced to 2.5 mm, only a 5-minute duration resulted in median target D98% above 42.75 GyRBE1.1. In addition, smaller bladders were found to be associated with larger dose degradations compared with larger bladders. CONCLUSIONS: This study indicates that intrafraction anatomic changes can have a substantial dosimetric effect on target coverage in an online-adaptive IMPT scenario for patients subject to large uterus motion. A margin of 5 mm was sufficient to compensate for the intrafraction motion due to bladder filling for up to 10 minutes of prefraction time. However, compensation for the uncertainties that were disregarded in this study, by using margins or robust optimization, is also required. Furthermore, a large bladder volume restrains intrafraction target motion and is recommended for treating patients in this scenario. Assuming that online-adaptive IMPT remains beneficial as long as narrow margins are used (5 mm or below), this study demonstrates its feasibility with regard to intrafraction motion.

Anatomical Distance From the Cervicovaginal Junction to the Uterovesical Peritoneal Reflection.

OBJECTIVE: The objective of this study was to measure the anatomical distance from the cervicovaginal junction to the uterovesical peritoneal reflection (CJ-PR). METHODS: A total of 120 hysterectomy patients were selected as study subjects. The uterus was removed, and the CJ-PR distance was immediately measured. For total vaginal hysterectomy, measurement was performed intraoperatively. The cervical length was also measured postoperatively. RESULTS: The median (interquartile) CJ-PR distance for all subjects was 3.3 (2.9-3.7) cm. Comparison of premenopausal and postmenopausal women without prolapse revealed median CJ-PR distances of 3.3 (3.0-3.6) cm and 3.0 (2.6-3.4) cm, respectively. The CJ-PR distance was longer in women with prolapse (4.6 [3.7-5.6] cm) than in those without prolapse (3.2 [2.8-3.6] cm). The median cervical lengths were 3.1 (2.7-3.6) cm for postmenopausal patients without prolapse and 4.4 (3.6-5.8) cm for postmenopausal patients with prolapse. CONCLUSIONS: Knowledge of the CJ-PR distance may help gynecologists predict how far the uterovesical PR is from the anterior vaginal incision.

Architecture of female urethral supporting structures based on undeformed high-resolution sectional anatomical images.

Female urinary incontinence mainly relates to damage of female urethra supporting structures, while its anatomy and function specially in which the connective tissue part are still unclear and controversial. We study it based on 4 thin-sectional, high-resolution, transverse sectional anatomical images [Chinese Visible Human (CVH) images] and 10 high-resolution MRI images from volunteers. The female urethral supporting structures and its adjacent structures were segmented and three-dimensional (3D) reconstructed with Amira software. The urethral supporting structures include muscular and connective tissue supporting structures. Muscular supporting structures are composed of levator ani muslce and striated urethral sphincter, the connective tissue supporting structures are composed of anterior vaginal wall, pubovesical muscle, pubovesical ligament, lateral vesical ligament, and tendinous arch of pelvic fascia (TAPF). The anterior vaginal wall includes tight and loose connections between urethral, bladder, and vagina. The lateral vesical ligament connects the proximal part of the urethra to the TAPF. The pubovesical muscle is crescent shaped and continues with the detrusor of the bladder superior and directly connects the TAPF laterally. The TAPF is an obvious fibrous structure that originates at the middle-posterior surface of the pubis, travels onto the parietal pelvic fascia, and inserts posteriorly onto the ischial spine. The anterior vaginal wall, the pubovesical muscle, the lateral vesical ligament, and the TAPF create the "hammock" structure and supplement DeLancey's theory. Its support to the proximal urethra and neck of bladder is crucial to maintain stability and urinary continence during increased abdominal pressure.

Microvascular anatomy of the urinary bladder in the adult African clawed toad, Xenopus laevis: A scanning electron microscope study of vascular casts.

We studied urinary bladders of adult male and female Xenopus laevis using light microscopy of stained tissue sections and scanning electron microscopy (SEM) of vascular corrosion casts (VCCs). Results showed that bilaterally a vesical artery branched off the femoral artery. At the dorso-lateral serosal surface of the body of the bladder each artery splitted within a short distance into up to five smaller arteries that supplied body and neck regions. Arteries gave off short and long terminal arterioles, which fed the mucosal capillary meshwork. Long terminal arterioles followed dimensional changes of the bladder, while short ones anchored the capillary network to the arterial system. Capillary mesh sizes and shapes varied according to the filling state of the urinary bladder. In the highly to moderately distended (filled) bladder, capillaries were rather straight or undulated only slightly, in the contracted (emptied) bladder they undulated strongly and lay side by side. Postcapillary venules formed by two equally sized capillaries or from capillaries, which serially drained into a small postcapillary venule. Vesical venules formed a large dorsal vesical and a varying number of smaller lateral and ventral vesical veins. The dorsal vesical vein drained either directly or via the posterior hemorrhoidal vein into the common pelvic vein. Lateral and ventral vesical veins also drained into the latter. The vascular patterns found were discussed in respect to the bladder spatial movements during distention (filling) and relaxation (emptying). Furthermore, it was hypothesized that an extensively filled bladder could compress the overlaying abdominal vein forcing part of the blood otherwise drained towards the liver to be detoured via the renal portal veins to the kidneys.

Relative position of bladder neck to pubic symphysis on cystogram is a strong and reproducible predictor of early urinary continence recovery following radical prostatectomy.

OBJECTIVES: To assess whether bladder neck angle and position on cystogram predict early urinary continence in patients scheduled for early catheter removal after radical prostatectomy (RP). METHODS: A total of 103 patients undergoing open or robot-assisted RP by one expert surgeon between January and December 2019 were retrospectively analyzed. A cystogram was performed on postoperative day 3 or 4 to evaluate anastomotic leakage, and, if none or minimal, the catheter was removed. Urinary continence was evaluated with a validated questionnaire at 1 week, 1 month, and 3 months after RP. Four investigators of different experience assigned bladder neck angle and relative position of bladder neck to pubic symphysis on archived cystogram images. Association between these two parameters and urinary continence rates at different follow-up times was assessed with logistic regression analysis adjusting for patient and tumor characteristics, and surgical technique. Interobserver agreement in assigning the two parameters was measured with k statistic. RESULTS: Catheter was removed immediately after cystogram in 101 (98%) patients. On multivariable analysis, only relative position of bladder neck to pubic symphysis was an independent predictor of 1-week (odds ratio [OR] 30. 95% confidence intervals [CIs] 6-138, p < 0.001), 1-month (OR 11. 95%CIs 3.8-32, p < 0.001), and 3-month (OR 19. 95%CIs 3.6-98, p < 0.001) urinary continence. Interobserver agreement for bladder neck and relative position of bladder neck to pubic symphysis was fair to moderate, and substantial to almost perfect, respectively. CONCLUSIONS: Relative position of bladder neck to pubic symphysis on cystogram is a strong and reproducible predictor of early urinary continence after RP.

The gas bladder of Pantodon buchholzi: Structure and relationships with the vertebrae.

We report here on the histological and structural characteristics of the gas bladder, the vertebral morphology, and the bladder-vertebra relationships of the butterfly fish, Pantodon buchholzi. The bladder opens at the boundary between the pharynx and the esophagus by a middle slit. A pneumatic duct is absent. The bladder shows a dorsolateral wall that adapts to the anfractuosities of the coelomic cavity and a ventral wall in contact with the abdominal organs. The vertebral bodies are formed by an hourglass shaped autocentrum, and by an arcocentrum reduced to several longitudinal ridges. The transverse processes adopt the structure of a cage whose walls are formed by bone trabeculae of variable size and distribution pattern. The dorsolateral wall of the bladder is a membrane that covers the kidney, adapts to the irregular shape of the vertebrae, and invades the transverse processes at several points before extending laterally. However, invasion of the vertebral bodies, the presence of a labyrinth, or the formation of respiratory parenchyma were not observed. The luminal surface of this wall is a thin respiratory barrier containing a single epithelial cell type. In addition, the wall contains numerous eosinophils that may be implicated in immune defense. The bladder ventral wall is a membrane rich in collagen, vessels, smooth muscle, and nerves that lacks a respiratory barrier. Its luminal surface contains ciliated and nonciliated cells. The two cell types appear implicated in surfactant production.

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.

Bladder Volume Monitoring Using Electrical Impedance Tomography With Simultaneous Multi-Tone Tissue Stimulation and DFT-Based Impedance Calculation Inside an FPGA.

In this article, a novel method for measuring the volume of the urinary bladder non-invasively is presented that relies on the principles dictated by Electrical Impedance Tomography (EIT). The electronic prototype responsible for injecting innocuous electrical currents to the lower abdominal region and measuring the developed voltage levels is fully described, as well as the computational models for resolution of the so-called Forward and Inverse Problems in Imaging. The simultaneous multi-tone injection of current provided by a high performance Field Programmable Gate Array (FPGA), combined with impedance estimation by the Discrete Fourier Transform (DFT) constitutes a novelty in Urodynamics with potential to monitor continuously the intravesical volume of patients in a much faster and comfortable way than traditional transurethral catheterization methods. The resolution of the Inverse Problem is performed by the Gauss-Newton method with Laplacian regularization, allowing to obtain a sectional representation of the volume of urine encompassed by the bladder and surrounding body tissues. Experimentation has been carried out with synthetic phantoms and human subjects with results showing a good correlation between the levels of abdominal admittivity acquired by the EIT system and the volume of ingested water.

[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.

Multimodality Imaging Findings Postcystectomy: Postoperative Anatomy, Surgical Complications, and Surveillance Imaging.

Various surgical techniques exist for urinary diversion post cystectomy and each have different imaging features. This diverse range of surgical procedures can make imaging interpretation difficult and so familiarity with the postoperative anatomy is essential. Multiple imaging modalities and techniques are available for the radiologist's assessment including fluoroscopic studies, computed tomography, magnetic resonance, and radionuclide imaging. Knowledge of when each of these modalities is indicated and the typical imaging appearances is essential for early identification of postoperative complications and detection of tumor recurrence. This information enables the radiologist to make an accurate and early diagnosis and subsequently guide the management pathway for these patients.

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.

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.