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1.
Nursing ; 49(10): 49-52, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31568083

RESUMO

Urethral characterization can be difficult for patients and providers alike. This article describes an evidence-based protocol for difficult urethral catheter insertions in male patients.


Assuntos
Prática Clínica Baseada em Evidências , Guias de Prática Clínica como Assunto , Cateterismo Urinário/enfermagem , Algoritmos , Humanos , Masculino , Segurança do Paciente , Risco , Uretra/anatomia & histologia , Cateterismo Urinário/efeitos adversos , Cateterismo Urinário/métodos
2.
Eur J Radiol ; 120: 108668, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31546125

RESUMO

PURPOSE: To evaluate standardized measurements of the membranous urethra length (MUL), the membranous urethra angle (MUA) and the prostate's apex type (AT) among further clinical parameters as potential preoperative risk factors of urinary incontinence (UI) after radical prostatectomy (RP). METHOD: Our institutional review board approved this retrospective single center study. 316 patients (mean age 65 years) underwent MRI at 3 T prior to prostatectomy. MUL, MUA and AT were measured according to a standardized approach on T2w- sagittal sequences. In a second reading the inter-rater agreement for the MUL was determined. Image findings and clinical data were correlated by logistic regression to UI as evaluated by a standardized questionnaire determining the number of necessary hygiene pads (HP) at three different time points with corresponding patient subsets (one week, six months and 12 months after RP). RESULTS: There was a significant impact of the MUL on postoperative UI with odds ratios (OR) of 0.8 [p < 0.001; confidence interval (CI) 0.73-0.91], 0.8 (p = 0.01; CI 0.68-0.94) and 0.7 (p < 0.01; CI 0.56-0.89) at the respective time points. No significant impact was demonstrated regarding the MUA and AT. Of all clinical parameters there was significant impact of the patients' age and the degree of nerve-sparing surgery. Inter-rater agreement with respect to the MUL was good with an intraclass correlation coefficient of 0.82. The mean deviation of raters measuring the MUL was 1.2 mm. CONCLUSIONS: A shorter MUL in mpMRI should be considered as a risk factor of UI after RP. Standardized measurements enabling good inter-rater agreement should be considered for routine assessments to facilitate prospective classifications.


Assuntos
Prostatectomia/efeitos adversos , Neoplasias da Próstata/cirurgia , Uretra/anatomia & histologia , Incontinência Urinária/etiologia , Idoso , Humanos , Modelos Logísticos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Prostatectomia/métodos , Neoplasias da Próstata/patologia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Risco , Inquéritos e Questionários
3.
Pol J Vet Sci ; 22(1): 127-132, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30997772

RESUMO

Early castration of male small ruminants is regarded as a risk factor for urolithiasis, although the underlying correlations are still unclear. One possible reason is a deferred development of the penis and the urethra after castration. Therefore, we examined the penis and urethra of castrated and intact lambs by ultrasonography to determine the correlation between urethral area and pe- nile cross-sectional area. Ultrasonography was performed in 6-month-old Lacaune crossbred lambs (early castrated, late castrated, and intact; each group, n = 11). Sectional images at 5 loca- tions (glans penis, penile urethra, distal and proximal sigmoid flexure, and ischial arch) were ob- tained to determine the urethral and penile diameters. Urethral and penile cross-sectional areas were calculated. Grey-scale analysis of ultrasound images was performed to evaluate possible differences in the penile texture between the groups. Correlation analyses between both cross-sectional areas showed a significant general correlation for location 2 in all lambs (R = 0.52; P = 0.003), for location 3 in late-castrated lambs, and for location 5 in early-castrated lambs. Statistically significant correlations between the penile and the urethral area of castrated and intact lambs were not evident. Therefore, measurement of the penile cross-sectional area alone does not allow for accurate estimation of urethral size. Statistically significant differences con- cerning the grey-scale analysis between the groups were also not detectable. Thus, simplification of the formerly presented ultrasonographic examination of the urethra is not recommended. In animals at a risk of obstructive urolithiasis, complete urethral examina- tion is essential.


Assuntos
Orquiectomia , Pênis/anatomia & histologia , Ovinos/anatomia & histologia , Uretra/anatomia & histologia , Animais , Masculino , Ovinos/fisiologia
4.
Khirurgiia (Mosk) ; (3): 111-120, 2019.
Artigo em Russo | MEDLINE | ID: mdl-30938366

RESUMO

Robot-assisted operations as widely used in urology, gynecology, general and cardiovascular surgery are considered by many experts as a new 'gold standard' of surgical treatment of various diseases in developed countries. Robot-assisted radical prostatectomy for prostate cancer is the most common robotic procedure. Better functional outcomes of robot-assisted radical prostatectomy are due to another (new) understanding of pelvic surgical anatomy, new approach implying dissection and preservation of external urethral sphincter and neurovascular structures. Prostate neuroanatomy, various approaches to preserve neurovascular structures and own experience of nerve-sparing robot-assisted radical prostatectomy with functional results are reviewed in the article.


Assuntos
Próstata/inervação , Próstata/cirurgia , Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos , Dissecação/métodos , Humanos , Masculino , Pelve/anatomia & histologia , Pelve/inervação , Pelve/cirurgia , Próstata/anatomia & histologia , Resultado do Tratamento , Uretra/anatomia & histologia , Uretra/cirurgia
5.
Sex Med Rev ; 7(1): 167-177, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30509896

RESUMO

INTRODUCTION: The artificial urinary sphincter (AUS) has long been regarded as the gold standard for surgical correction of male stress urinary incontinence (SUI). Despite impressive rates of initial success for restoration of continence, durability may wane to the point of considering revision surgery. AIM: To provide a review of existing data as well as personal experience regarding patient selection, surgical technique, and postoperative troubleshooting for the AUS. METHODS: A systematic review of the peer-reviewed literature was performed to identify relevant and contemporary articles regarding perioperative and long-term management of the AUS. Additional input is presented based on clinical experience of the senior author. MAIN OUTCOME MEASURE: The main outcome measures are durability, patient satisfaction, mechanical failure, and urethral erosion. RESULTS: In addition to a thorough history and examination, preoperative screening should include office cystoscopy to rule out bladder neck contracture in patients with a history of radical prostatectomy. Perineal cuff placement appears superior to alternative approaches. Prior radiation and use of the 3.5-cm cuff are risk factors for future erosion. Newer findings suggest that subsequent recurrence of SUI may be due to restrictive encapsulation, rather than true atrophy, with implications for revision surgery. CONCLUSION: The AUS remains an excellent option for surgical correction of moderate to severe male SUI. Detailed preoperative evaluation and patient selection are critical. The challenge of downstream recurrent SUI after AUS can be effectively managed for most patients with a structured approach. Chouhan JD, Terlecki RP. A User's Guide for Surgery Involving the Artificial Urinary Sphincter. Sex Med Rev 2019;7:167-177.


Assuntos
Prostatectomia/efeitos adversos , Implantação de Prótese/métodos , Uretra/fisiopatologia , Incontinência Urinária por Estresse/cirurgia , Esfíncter Urinário Artificial , Humanos , Masculino , Satisfação do Paciente , Qualidade de Vida , Recuperação de Função Fisiológica , Resultado do Tratamento , Uretra/anatomia & histologia , Incontinência Urinária por Estresse/fisiopatologia , Incontinência Urinária por Estresse/psicologia
6.
J Pediatr Surg ; 54(2): 303-306, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30503195

RESUMO

AIM OF THE STUDY: The goals of urinary reconstruction in urogenital sinus and cloacal repair include: (1) positioning of the bladder neck above the urogenital diaphragm to maximize future urinary continence, and (2) creating a visible urethra that can be catheterized if needed. A recent algorithm in cloacal reconstruction proposed a urethral length of 1.5 cm as the key determinant in deciding whether to perform a total urogenital mobilization or a urogenital separation, the hypothesis being that a 1.5 cm length urethra is needed for the patient to remain dry. We wondered if the normal female urethral length correlated with this empiric technical determinant. METHODS: We reviewed voiding cystourethrograms of healthy female patients between ages 6 and 36 months and measured the patient's urethral length. RESULTS: Ninety-one children were included. The mean urethral length for patients age 6-12 months was 2.50 cm, age 12-24 months was 2.31 cm, and age 24-36 months was 2.59 cm. There was no difference between the urethral length in the three groups (p = 0.38). Of 91 patients, 87 (96%) had a urethral length >1.5 cm. CONCLUSION: A urethra of at least 1.5 cm was present in the majority of normal control patients. We believe therefore that for urogenital sinus and cloacal repair, surgeons can extrapolate that patients need a 1.5 cm urethra at the end of the reconstruction. Additional follow-up is needed to determine if this urethral length as an independent factor maintains dryness in the long term after cloacal repair. TYPE OF STUDY: Case Series. LEVEL OF EVIDENCE: III.


Assuntos
Uretra/anatomia & histologia , Pré-Escolar , Cloaca/cirurgia , Feminino , Humanos , Lactente , Recém-Nascido , Tamanho do Órgão , Procedimentos Cirúrgicos Reconstrutivos , Estudos Retrospectivos , Uretra/diagnóstico por imagem
7.
Int Urogynecol J ; 30(3): 477-482, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29656330

RESUMO

INTRODUCTION AND HYPOTHESIS: The objective was to identify risk factors for postpartum anatomic pelvic organ prolapse (aPOP) by comparing women with and without aPOP at 6 weeks postpartum with regard to pelvic floor measurements antepartum and obstetrical characteristics. METHODS: We carried out a prospective observational cohort study including nulliparous pregnant women in a Norwegian university hospital. Participants underwent clinical examinations, including pelvic organ prolapse quantification system (POP-Q) and transperineal ultrasound at gestational week 21 and at 6 weeks postpartum. Background and obstetrical information was obtained from an electronic questionnaire and from the patient's electronic medical file respectively. Associations were estimated using logistic regression analyses. The dependent variable was aPOP, defined as POP-Q stage ≥2 at 6 weeks postpartum. Independent variables were mid-pregnancy measurements of selected POP-Q variables and levator hiatus area (LHarea), delivery route, and the presence of major levator ani muscle (LAM) injuries at 6 weeks postpartum. RESULTS: A larger LHarea, a more distensible LAM, a longer distance from the meatus urethra to the anus (Gh + Pb) and a more caudal position of the anterior vaginal wall (Ba) at mid-pregnancy were risk factors for aPOP at 6 weeks postpartum, whereas delivery route and the presence of major LAM injuries were not. CONCLUSION: Prelabor differences in the pelvic floor rather than obstetrical events were risk factors for aPOP at 6 weeks postpartum.


Assuntos
Canal Anal/anatomia & histologia , Diafragma da Pelve/anatomia & histologia , Prolapso de Órgão Pélvico/epidemiologia , Uretra/anatomia & histologia , Vagina/anatomia & histologia , Adulto , Canal Anal/diagnóstico por imagem , Estudos de Casos e Controles , Parto Obstétrico , Feminino , Humanos , Noruega/epidemiologia , Diafragma da Pelve/diagnóstico por imagem , Prolapso de Órgão Pélvico/diagnóstico por imagem , Período Pós-Parto , Gravidez , Estudos Prospectivos , Fatores de Risco , Ultrassonografia , Uretra/diagnóstico por imagem , Vagina/diagnóstico por imagem , Adulto Jovem
8.
Neurourol Urodyn ; 38(1): 187-192, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30248180

RESUMO

AIM: We report the rates of artificial urinary sphincter (AUS) mechanical failure in a contemporary cohort of patients stratified by component type and size to determine if the 3.5-cm cuff is at higher risk of failure. METHODS: From 2005-2016, a total of 486 male patients with stress incontinence underwent implantation or revision of an AUS. 993 individual cases were retrospectively reviewed (465 primary placements and 528 revisions). Components were separately tallied and cases of mechanical failure were identified. Multiple variables including duration until failure and follow-up interval were collected and analyzed for each malfunction. RESULTS: After median follow-up of 31.5 months, there were 48 distinct cases of mechanical failure. The urethral cuff was the most common component to fail (n = 27, 56.3%), followed by the pressure regulating balloon (PRB) (n = 6, 12.5%), tubing (n = 6, 12.5%), and the control pump, (n = 5, 10.4%). Four (8.3%) cases did not have the source of malfunction identifiable in available records though fluid loss was evident at the time of device interrogation. Sub-analyses of cuff failure events showed that the 3.5-cm cuff had a statistically significant higher risk of failure (HR: 7.313, (P < .0001) compared to larger cuff sizes. CONCLUSIONS: While each component is prone to malfunction, our study suggests that the 3.5-cm urethral cuff is more susceptible to failure and failure events occur earlier after placement than larger cuff sizes.


Assuntos
Falha de Prótese , Esfíncter Urinário Artificial , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Oclusão com Balão , Estudos de Coortes , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Uretra/anatomia & histologia , Uretra/cirurgia , Incontinência Urinária/etiologia , Incontinência Urinária/terapia , Adulto Jovem
9.
Clin Anat ; 32(2): 244-252, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30281853

RESUMO

Because of a general lack of knowledge regarding the precise anatomy of the seminal vesicle system, efforts to use transurethral seminal vesiculoscopy (TSV) are currently constrained. We investigated 26 normal adult male specimens. Contrast medium was injected into the seminal vesicle system in 18 specimens and the openings of the ejaculatory ducts were examined with an operating microscope. India ink was injected into the urethra in four specimens to investigate the function of the ejaculatory duct valve. Another four specimens were examined histologically to identify the anatomical relationships of the seminal vesicle system. We found that the openings of the ejaculatory ducts were covered by the ejaculatory duct valve, which could be classified into two types and acted as a one-way valve. The apex of the seminal colliculus together with the right and left openings of the ejaculatory ducts formed a shape resembling an isosceles triangle. This could be used to locate the openings of the ejaculatory ducts during TSV. The ejaculatory ducts can be classified into two types according to their course. During surgery, efforts must be made to protect the ejaculatory duct valve. During inspection or surgery, the second segment and the angles of the ejaculatory ducts, particularly in Type Ib and Type II cases, require particular attention. Clin. Anat. 32:244-252, 2019. © 2018 Wiley Periodicals, Inc.


Assuntos
Ductos Ejaculatórios/anatomia & histologia , Glândulas Seminais/anatomia & histologia , Cadáver , Ductos Ejaculatórios/fisiologia , Humanos , Masculino , Uretra/anatomia & histologia
10.
Low Urin Tract Symptoms ; 11(3): 122-126, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30548814

RESUMO

OBJECTIVE: Urinary incontinence (UI) is a major prostate cancer (PCa) treatment-related morbidity. It has been reported that post-prostatectomy UI is related to the width of the pelvic floor muscles (PFM) and the length of the urethra. However, the details of these anatomical parameters are unknown. The aim of this study was to investigate whether preoperative pelvic parameters or anatomical parameters of the urethra, as measured by magnetic resonance imaging (MRI), are correlated with UI. METHODS: Between 2010 and 2017, 571 patients with localized PCa underwent robot-assisted radical prostatectomy (RARP) at Okayama University Hospital. Patients treated by a single experienced surgeon were included in the study. Preoperative prostate volume, obturator internal muscle, anal sphincter muscle, levator ani muscle (LAM), urethra wall thickness (UWT), and membranous urethral length (MUL) were measured by MRI. Patients were divided into two groups depending on leakage status 1 year after RARP using Expanded Prostate Index Composite Item 1. RESULTS: Seventy patients were included in this retrospective study. Based on leakage status, 37 and 33 patients were allocated to the no-leakage and leakage groups, respectively. There were significant differences between the two groups in age (P = 0.03), MUL (P < 0.001), UWT (P = 0.03), and LAM (P = 0.001). Multivariate logistic regression analyses revealed that MUL and LAM predicted UI 1 year after RARP. CONCLUSIONS: Pelvic parameters measured by MRI before RARP may be useful in the prediction of UI. In particular, MUL and LAM can predict postoperative UI by strict definition.


Assuntos
Imagem por Ressonância Magnética , Diafragma da Pelve/anatomia & histologia , Prostatectomia/efeitos adversos , Uretra/anatomia & histologia , Incontinência Urinária/etiologia , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Diafragma da Pelve/diagnóstico por imagem , Valor Preditivo dos Testes , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Uretra/diagnóstico por imagem
11.
Cell Rep ; 25(12): 3530-3542.e5, 2018 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-30566875

RESUMO

A comprehensive cellular anatomy of normal human prostate is essential for solving the cellular origins of benign prostatic hyperplasia and prostate cancer. The tools used to analyze the contribution of individual cell types are not robust. We provide a cellular atlas of the young adult human prostate and prostatic urethra using an iterative process of single-cell RNA sequencing (scRNA-seq) and flow cytometry on ∼98,000 cells taken from different anatomical regions. Immunohistochemistry with newly derived cell type-specific markers revealed the distribution of each epithelial and stromal cell type on whole mounts, revising our understanding of zonal anatomy. Based on discovered cell surface markers, flow cytometry antibody panels were designed to improve the purification of each cell type, with each gate confirmed by scRNA-seq. The molecular classification, anatomical distribution, and purification tools for each cell type in the human prostate create a powerful resource for experimental design in human prostate disease.


Assuntos
Próstata/anatomia & histologia , Próstata/citologia , Uretra/anatomia & histologia , Uretra/citologia , Adulto , Células Epiteliais/citologia , Humanos , Masculino , Análise de Sequência de RNA , Análise de Célula Única , Células Estromais/citologia
12.
World J Surg Oncol ; 16(1): 224, 2018 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-30445961

RESUMO

PURPOSE: We investigated that preoperative membranous urethral length (MUL) would be associated with the recovery of urinary continence after robot-assisted laparoscopic prostatectomy (RALP). PATIENTS AND METHODS: We studied 204 patients who underwent RALP between May 2013 and March 2016. All patients underwent pelvic magnetic resonance imaging (MRI) preoperatively to measure MUL. Urinary continence was defined as the use of one pad or less (safety pad). The 204 patients were divided into two groups: continence group, those who achieved recovery of continence at 3, 6, and 12 months after RALP, and incontinence group, those who did not. We retrospectively analyzed the patients in terms of preoperative clinical factors including age, body mass index (BMI), estimated prostate volume, neurovascular bundle salvage, history of preoperative hormonal therapy, and MUL. RESULTS: The safety pad use rate was 69.6%, 86.9%, and 91.1% at 3, 6, and 12 months, respectively. On univariate and multivariate analyses, MUL were significant factors in every term of recovery of urinary continence in both groups. According to the receiver operating characteristic (ROC) curve analysis, the preoperative MUL that could best predict early recovery of urinary continence at 3 months after RALP was 12 mm. CONCLUSIONS: We suggest that preoperative MUL > 12 mm would be a predictor of early recovery of urinary continence after RALP.


Assuntos
Complicações Pós-Operatórias/epidemiologia , Prostatectomia/efeitos adversos , Neoplasias da Próstata/cirurgia , Uretra/fisiopatologia , Incontinência Urinária/epidemiologia , Adulto , Idoso , Humanos , Japão/epidemiologia , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Período Pré-Operatório , Prognóstico , Próstata/patologia , Próstata/cirurgia , Prostatectomia/métodos , Neoplasias da Próstata/patologia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/métodos , Fatores de Tempo , Uretra/anatomia & histologia , Uretra/diagnóstico por imagem , Incontinência Urinária/etiologia , Incontinência Urinária/fisiopatologia
13.
Am J Obstet Gynecol ; 219(6): 597.e1-597.e8, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30278172

RESUMO

BACKGROUND: Knowledge of the retropubic space anatomy is essential for safe entry and surgical applications within this space. OBJECTIVE: The objectives of this study were to examine the gross and histologic anatomy of the retropubic urethra, paraurethral tissue, and urethrovaginal space and to correlate findings to retropubic procedures. STUDY DESIGN: Anatomic relationships of the retropubic urethra were examined grossly in unembalmed female cadavers. Measured distances included: lateral urethral wall to arcus tendineus fascia pelvis at the level of urethrovesical junction and at 1 cm distal. Other measurements included retropubic urethral length and distances from internal urethral opening to each ureteric orifice. Microscopic examination was performed at the same levels examined grossly in separate nulliparous specimens. Descriptive statistics were used for data analyses. RESULTS: In all, 25 cadavers were examined grossly. Median distance from lateral urethral wall to arcus tendineus fascia pelvis at the level of urethrovesical junction was 25 mm (range, 13-38 mm). At 1 cm distal, the median distance from aforementioned structures was 14 mm (10-26 mm). Median length of the retropubic urethra was 23 mm (range 15-30 mm). Four nulliparous specimens, ages 12 weeks, and 34, 47, and 52 years, were examined histologically. No histologic evidence of a discrete fascial layer between bladder/urethra and anterior vagina was noted at any level examined. Tissue between the urethra and the pelvic sidewall skeletal muscle was composed of dense fibrous tissue, smooth muscle bundles, scant adipose tissue, blood vessels, and nerves. The smooth muscle fibers of the vaginal muscularis interdigitated with skeletal muscle fibers in the pelvic sidewall at both levels examined. No histologic evidence of "pubourethral ligaments" within the paraurethral tissue was noticed. CONCLUSION: A 2-cm "zone of safety" exists between the urethra and arcus tendineus fascia pelvis at the urethrovesical junction level. Suture or graft placement within this region should minimize injury to the urethra, pelvic sidewall muscles, and bladder. Knowledge that the shortest length of retropubic urethra was 1.5 cm and shortest urethra to arcus tendineus fascia pelvis distance was 1 cm highlights the importance of maintaining dissection and trocar entry site close to pubic bone to avoid bladder and/or urethral injury. Histologic analysis of paraurethral tissue supports the nonexistence of pubourethral ligaments.


Assuntos
Uretra/anatomia & histologia , Vagina/anatomia & histologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cadáver , Fáscia/anatomia & histologia , Feminino , Humanos , Pessoa de Meia-Idade , Pelve/anatomia & histologia , Incontinência Urinária por Estresse/cirurgia , Procedimentos Cirúrgicos Urológicos
14.
Urol J ; 15(5): 277-279, 2018 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-30221335

RESUMO

 Purpose: The aim of this study is to explore the normal external urethral meatal and glans closure line in normal boys, and to investigate the correlation between these glans biometrics and the age of the participants. MATERIAL AND METHOD: 103 male children were asked to participate in the study during ritual circumcision. Par-ents of 94 of them (mean age 5.9 years, range 0.6-13) accepted while remaining 9 did not. Glans biometrics were measured using digital calipers. RESULT: 100% of the study participants had a vertical slit-like meatal opening located at the tip of the glans. The length of the meatal opening was 5.3 (± 1) mm and of ventral glans closure was 4.8 (±1.1) mm. Significant cor-relation between both the external meatal opening and closure lines lengths and age was observed. Moreover, the meatal opening size was correlated to the glans closure line as well (r = 0.36, confidence interval 0.14-0.54, P < .001). CONCLUSION: The site and size of the meatus opening in normal male children is consistent, and ventral glans clo-sure is equal to or slightly less than meatal length. These findings could aid in glanular reconstruction configuration during hypospadias surgery.


Assuntos
Pênis/anatomia & histologia , Uretra/anatomia & histologia , Adolescente , Fatores Etários , Pontos de Referência Anatômicos , Biometria , Criança , Pré-Escolar , Humanos , Hipospadia/cirurgia , Lactente , Masculino , Procedimentos Cirúrgicos Reconstrutivos , Valores de Referência
15.
Clin Anat ; 31(8): 1167-1176, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30113089

RESUMO

The anatomy of the rectourethralis muscle is essential for performing radical prostatectomy and proctectomy. The rectourethralis muscle is known to continue to the rectal wall posteriorly and to the membranous urethra anteriorly. However, the lateral extent of the rectourethralis muscle remains unclear. This study aimed to verify the hypothesis that the rectourethralis muscle laterally extends and directly adheres to the levator ani. Eight male cadavers were used for macroscopic dissection, and three male cadavers were used for immunohistological analysis using anti-smooth muscle and anti-skeletal muscle antibodies. The rectourethralis muscle laterally extended smooth muscle fibers both superoposteriorly and inferoanteriorly toward the levator ani. The smooth muscle fibers sandwiched the levator ani superoanteriorly and inferoanteriorly. A few smooth muscle fibers of the rectourethralis muscle inserted into the levator ani. This study clarified the spatial distribution of the rectourethralis muscle and its detailed positional relationship with the levator ani. The findings are valuable especially to urologists and anorectal surgeons for dissecting an optimal layer around the urethra and the rectum, and for avoiding rectal or urethral injuries during surgery. Clin. Anat. 31:1167-1176, 2018. © 2018 Wiley Periodicals, Inc.


Assuntos
Músculo Liso/anatomia & histologia , Diafragma da Pelve/anatomia & histologia , Reto/anatomia & histologia , Uretra/anatomia & histologia , Canal Anal/anatomia & histologia , Cadáver , Humanos , Masculino , Músculo Liso/fisiologia , Protectomia , Prostatectomia
16.
Histol Histopathol ; 33(12): 1335-1345, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29985521

RESUMO

PURPOSE: Urethral reconstruction is performed in patients with urethral strictures or for correction of congenital disorders. In the case of shortage of tissue, engineered tissue may enhance urethral reconstruction. As the corpus spongiosum (CS) is important in supporting the function of the urethra, tissue engineering of the urethra should be combined with reconstruction of a CS. For that purpose, detailed knowledge of the composition of the CS, more specifically its extracellular matrix (ECM) and vascularization is needed for scaffold design. The objective of this study is to analyze the microarchitecture of the CS through (immuno) histology and scanning electron microscopy (SEM). METHODS: The CS including the urethra of patients undergoing male-to-female genital confirming surgery was harvested. This CS was fixed and processed for either (immuno) histology or for SEM. RESULTS: Four layers could be distinguished in the CS; first a transition zone from urethra epithelium to a collagen rich layer, which was highly vascularized, followed by a second, elastin rich layer. The third layer was formed by veins, arteries and vascular spaces and the last layer showed the transition from this vascular rich region to the collagen rich tunica albuginea. In this layer collagen bundles intertwined with elastic fibres. In the CS different components of the ECM were visible and distinguishable. CONCLUSION: This study provides novel and detailed information on the microarchitecture of the CS and the distribution of vascularization, which is important for scaffold design in tissue engineering.


Assuntos
Pênis/anatomia & histologia , Uretra/anatomia & histologia , Humanos , Masculino
17.
Anat Histol Embryol ; 47(4): 372-384, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29862549

RESUMO

Morphological characterisation of the genital organs of primates may bring significant contributions to the understanding of different reproductive behaviours and support new conservation strategies. However, relevant or detailed descriptions of genital morphology of several primate species are still lacking. This study describes the gross and microscopic anatomy of the internal and external genitalia of Marca's marmoset (Mico marcai). The same organs described in other primate species were identified here, but some anatomical particularities were detected, such as absence of a dartos tunic, presence of a vas deferens ampulla, absence of spongious erectile tissue in the pelvic urethra, separation of prostate gland lobes by a longitudinal sulcus and lack of septation in the corpus cavernosus and spongiosus at the level of the shaft and free portion of the penis. Keratinised type 1 spicules arising from epidermal or dermal projections were found in the free portion of the penis. Microscopic analysis revealed a small bone (baculum) consisting of peripheral compact bone and a central, non-ossified area filled with vascular tissue at the distal end of this portion of the penis. Results of this study may support further comparative studies of primates' reproductive ecology.


Assuntos
Callithrix/anatomia & histologia , Genitália Masculina/anatomia & histologia , Animais , Peso Corporal , Glândulas Bulbouretrais/anatomia & histologia , Epididimo/anatomia & histologia , Masculino , Microtomia/instrumentação , Tamanho do Órgão , Inclusão em Parafina/instrumentação , Pênis/anatomia & histologia , Próstata/anatomia & histologia , Escroto/anatomia & histologia , Testículo/anatomia & histologia , Uretra/anatomia & histologia , Ducto Deferente/anatomia & histologia
18.
Reprod Fertil Dev ; 30(10): 1286-1297, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29622059

RESUMO

The aim of this study was to evaluate the effects of cyproterone acetate (CPA) and ethinyloestradiol (EE) alone or in combination on the female prostate of adult gerbils. Adult females were exposed for 21 days to daily oral doses of CPA (1mgkg-1), EE (10µgkg-1) or a combination of CPA and EE. Female prostatic complexes were removed, weighed and subjected to morphological, stereological, immunohistochemical and ultrastructural analyses. CPA treatment caused epithelial atrophy and decreased prostate secretory activity. The EE treatment group showed glandular hyperplasia, a high cell-proliferation index and an increase in androgen and oestrogen receptor α (AR and ERα) immunoreactivity. Combined treatment (CPA+EE) caused adverse effects, such as an increase in cell proliferation, higher AR and ERα immunoreactivity, prostatic intraepithelial neoplasia, cell degeneration and aging. In conclusion, the CPA-only treatment promoted antiandrogenic effects on the female gerbil prostate, whereas EE-only had a potent oestrogenic activity. However, when combined, EE overlapped the effects of CPA, changing the pattern of glandular hormonal regulation and stimulating the development of prostatic lesions in female gerbils.


Assuntos
Anticoncepcionais Orais Combinados/farmacologia , Receptor alfa de Estrogênio/metabolismo , Genitália Feminina/efeitos dos fármacos , Genitália Feminina/metabolismo , Gerbillinae/anatomia & histologia , Gerbillinae/metabolismo , Receptores Androgênicos/metabolismo , Estruturas Animais/anatomia & histologia , Estruturas Animais/efeitos dos fármacos , Estruturas Animais/metabolismo , Animais , Acetato de Ciproterona/farmacologia , Metilases de Modificação do DNA/metabolismo , Combinação de Medicamentos , Etinilestradiol/farmacologia , Feminino , Genitália Feminina/anatomia & histologia , Imuno-Histoquímica , Masculino , Microscopia Eletrônica de Transmissão , Antígeno Nuclear de Célula em Proliferação/metabolismo , Próstata/anatomia & histologia , Próstata/efeitos dos fármacos , Próstata/metabolismo , Regulação para Cima/efeitos dos fármacos , Uretra/anatomia & histologia , Uretra/efeitos dos fármacos , Uretra/metabolismo , Vagina/anatomia & histologia , Vagina/efeitos dos fármacos , Vagina/metabolismo
19.
Curr Urol Rep ; 19(6): 37, 2018 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-29644478

RESUMO

PURPOSE OF REVIEW: Due to the proximity of the rhabdosphincter and cavernous nerves to the membranous urethra, reconstruction of membranous urethral stricture implies a risk of urinary incontinence and erectile dysfunction. To avoid these complications, endoscopic management of membranous urethral strictures is traditionally favored, and bulboprostatic anastomosis is reserved as the main classical approach for open reconstruction of recalcitrant membranous urethral stricture. The preference for the anastomotic urethroplasty among reconstructive urologists is likely influenced by the familiarity and experience with trauma-related injuries. We review the literature focusing on the anatomy of membranous urethra and on the evolution of treatments for membranous urethral strictures. RECENT FINDINGS: Non-traumatic strictures affecting bulbomembranous urethra are typically sequelae of instrumentation, transurethral resection of the prostate, prostate cancer treatment, and pelvic irradiation. Being a different entity from trauma-related injuries where urethra is not in continuity, a new understanding of membranous urethral anatomy is necessary for the development of novel reconstruction techniques. Although efficacious and durable to achieve urethral patency, classical bulboprostatic anastomosis carries a risk of de-novo incontinence and impotence. Newer and relatively less invasive reconstructive alternatives include bulbar vessel-sparing intra-sphincteric bulboprostatic anastomosis and buccal mucosa graft augmented membranous urethroplasty techniques. The accumulated experience with these techniques is relatively scarce, but several published series present promising results. These approaches are especially indicated in patients with previous transurethral resection of the prostate in which sparing of rhabdosphincter and the cavernous nerves is important in attempt to preserve continence and potency. Additionally, introduction of buccal mucosa onlay grafts could be especially beneficial in radiation-induced strictures to avoid transection of the sphincter in continent patients, and to preserve the blood supply to the urethra for incontinent patients who will require artificial urinary sphincter placement. The evidence regarding erectile functional outcomes is less solid and this item should be furtherly investigated.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos/métodos , Estreitamento Uretral/cirurgia , Humanos , Mucosa Bucal/transplante , Retalhos Cirúrgicos , Uretra/anatomia & histologia , Uretra/cirurgia , Estreitamento Uretral/etiologia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
20.
Zoology (Jena) ; 127: 70-83, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29500059

RESUMO

The penis is the reproductive organ that ensures efficient copulation and success of internal fertilization in all species of mammals, with special challenges for bats, where copulation can occur during flight. Comparative anatomical analyses of different species of bats can contribute to a better understanding of morphological diversity of this organ, concerning organization and function. In this study, we describe the external morphology and histomorphology of the penis and baculum in eleven species of molossid bats. The present study showed that penile organization in these species displayed the basic vascular mammalian pattern and had a similar pattern concerning the presence of the tissues constituting the penis, exhibiting three types of erectile tissue (the corpus cavernosum, accessory cavernous tissue, and corpus spongiosum) around the urethra. However, certain features varied among the species, demonstrating that most species are distinguishable by glans and baculum morphology and glans histological organization. Major variations in glans morphology were genus-specific, and the greatest similarities were shared by Eumops species and N. laticaudatus. The greatest interspecific similarities occurred between M. molossus and M. rufus and between Eumops species. Save for M. molossus and M. rufus, morphology of the baculum was species-specific; and in E. perotis, it did not occur in all specimens, indicating that it is probably under selection. In the histological organization, the most evident differences were number of septa and localization of the corpora cavernosa. In species with a baculum (Molossus, Eumops and Nyctinomops species), the corpora cavernosa predominantly occupied the dorsal region of the penile glans and is associated with the proximal (basal) portion of the baculum. In species that do not have a baculum (Cynomops, Molossops and Neoplatymops species), the corpora cavernosa predominantly occupied the ventro-lateral region of the glans.


Assuntos
Quirópteros/anatomia & histologia , Pênis/anatomia & histologia , Animais , Masculino , Uretra/anatomia & histologia
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