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1.
Life Sci ; 267: 118960, 2021 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-33373654

RESUMO

AIMS: Transforming growth factor-ß (TGF-ß) mediated super-activation of urethra fibroblasts contributes to the progression of traumatic urethral stricture (TUS), and the Rho-associated kinase inhibitors, Fasudil, might be a novel therapeutic agent for TUS, but the underlying mechanisms had not been studied. MATERIALS AND METHODS: The primary urethral fibroblasts (PUFs) were isolated from rabbit urethral scar tissues and cultured in vitro, and the PUFs were subsequently treated with TGF-ß (10 µg/L) to simulate the realistic conditions of TUS pathogenesis. Next, the PUFs were exposed to Fasudil (50 µM) and autophagy inhibitor 3-methyladenine (3-MA) treatment. Genes expression was examined by Western Blot and immunofluorescence staining, and cellular functions were determined by MTT assay and Transwell assay. KEY FINDINGS: TGF-ß promoted cell proliferation, migration, autophagy, and secretion of extracellular matrix (ECM), including collagen I and collagen III, which were reversed by co-treating cells with both Fasudil and 3-MA. In addition, TGF-ß treatment decreased the expression levels of phosphorylated Akt (p-Akt) and mTOR (p-mTOR) to inactivate the Akt/mTOR pathway in the PUFs, which could be re-activated by Fasudil. Then, the fibroblasts were treated with the Pan-Akt inhibitor (GDC-0068), and we surprisingly found that GDC-0068 abrogated the inhibiting effects of Fasudil on cell autophagy and proliferation in the PUFs treated with TGF-ß. SIGNIFICANCE: Fasudil regulated Akt/mTOR pathway mediated autophagy to hamper TGF-ß-mediated super-activation in PUFs, which supported that Fasudil might be an ideal candidate therapeutic agent for TUS treatment for clinical utilization.


Assuntos
1-(5-Isoquinolinasulfonil)-2-Metilpiperazina/análogos & derivados , Fibroblastos/metabolismo , Estreitamento Uretral/metabolismo , 1-(5-Isoquinolinasulfonil)-2-Metilpiperazina/metabolismo , 1-(5-Isoquinolinasulfonil)-2-Metilpiperazina/farmacologia , Animais , Autofagia/efeitos dos fármacos , Proliferação de Células/efeitos dos fármacos , Células Cultivadas , Colágeno/metabolismo , Colágeno Tipo I/metabolismo , Fosforilação , Cultura Primária de Células , Inibidores de Proteínas Quinases/farmacologia , Proteínas Proto-Oncogênicas c-akt/metabolismo , Coelhos , Transdução de Sinais/efeitos dos fármacos , Serina-Treonina Quinases TOR/metabolismo , Fator de Crescimento Transformador beta/metabolismo , Uretra/metabolismo , Uretra/patologia , Quinases Associadas a rho/antagonistas & inibidores , Quinases Associadas a rho/metabolismo
2.
Zhonghua Nan Ke Xue ; 26(7): 595-600, 2020 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-33377713

RESUMO

Objective: To explore the methodology for the establishment of the urethral stricture model in rats, the methods of end-point imaging evaluation of the model establishment and their efficiency. METHODS: Twenty-four adult male rats were randomly divided into a blank control (n = 6) and a model group (n = 18), and the model was established by cutting the penile segment of the urethra to induce incomplete urethral rupture. Then the model rats were treated by injection of transforming growth factor-ß1 (the TGF group, n = 6) or mesenchymal stem cells (the MSC group, n = 12) into the urethral cavernosum. At 4 weeks after modeling, the urethral condition of all the rats was evaluated blindly using high-frequency ultrasound combined with water bath, followed by comparison among different groups. RESULTS: Compared with the blank controls, the model rats showed evident urethral stricture, with more significant urethral fibrous tissue hyperplasia in the TGF than in the MSC group. Ultrasonography revealed significantly narrowed echo strips (P < 0.01), decreased echo intensity and blurred echoes in some strips. The grouping of the model rats according to the assigned values to the ultrasonographic changes was consistent with the actual condition. The area under the ROC curve for distinguishing between the TGF and MSC groups was 0.972, with a sensitivity of 100.0% and a specificity of 83.3% when ultrasound assignment score was 7.5. CONCLUSIONS: High-frequency ultrasonography combined with water bath is effective for evaluating urethral stricture in rats and may give some guidance in the establishment of the urethral stricture model.


Assuntos
Uretra/diagnóstico por imagem , Estreitamento Uretral , Animais , Masculino , Transplante de Células-Tronco Mesenquimais , Ratos , Fator de Crescimento Transformador beta1/administração & dosagem , Ultrassonografia , Uretra/patologia , Estreitamento Uretral/diagnóstico por imagem
3.
Cir. pediátr ; 33(4): 200-203, oct. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-195132

RESUMO

INTRODUCCIÓN: La incidencia de traumatismos uretrales en niños es baja dado que su uretra es corta, móvil y está protegida en gran parte por el pubis. CASOS CLÍNICOS: Exponemos dos casos clínicos que ilustran la variedad de presentaciones de las lesiones en la uretra anterior. Primer niño con retención aguda de orina dos meses después de sufrir una caída a horcajadas. Posterior diagnóstico de estenosis uretral con cistouretrografía miccional seriada (CUMS). Segundo niño con incontinencia urinaria tras caída de un caballo. Hallazgo de divertículo uretral en CUMS y caracterización mediante ecografía. Ambos son tratados con cirugía diferida. COMENTARIOS: Es importante sospechar una lesión de uretra después de un traumatismo perineal. La CUMS es la prueba diagnóstica estándar. El tratamiento de elección implica uretroplastia diferida con buenos resultados, aunque presenta riesgo de incontinencia e impotencia


INTRODUCTION: The incidence of urethral trauma in children is low given that they have a short, mobile urethra, largely protected by the pubis. CLINICAL CASES: We describe two clinical cases illustrating the variety of presentations anterior urethral lesions can have. The first child had acute urinary retention two months after falling astride, with subsequent diagnosis of urethral stricture following serial voiding cystourethrogram (SVCU). The second child had urinary incontinence after falling off a horse. SVCU showed a urethral diverticulum, characterized through ultrasound imaging. Both were treated with deferred surgery. REMARKS: Urethral lesion should always be suspected after perineal trauma. SVCU is the gold standard diagnostic technique. Deferred urethroplasty is the treatment of choice, with good results, but there is a risk of incontinence and impotence


Assuntos
Humanos , Masculino , Criança , Adolescente , Uretra/lesões , Uretra/cirurgia , Estreitamento Uretral/cirurgia , Retenção Urinária/complicações , Retenção Urinária/diagnóstico por imagem , Incontinência Urinária/complicações , Estreitamento Uretral/diagnóstico por imagem , Uretra/diagnóstico por imagem , Uretra/patologia
4.
J Urol ; 204(6): 1290-1295, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32717158

RESUMO

PURPOSE: We evaluated the success of minimally invasive management of lichen sclerosus with topical and intraurethral clobetasol, as defined by improvement in patient reported outcome measures and nonprogression to surgery. MATERIALS AND METHODS: We conducted a review of our prospective ongoing quality improvement study to determine outcomes of our current standard practice for males with penile and urethral biopsy proven lichen sclerosus. Data were collected between 2011 and 2019, and included patient demographic information, medical and surgical histories, and location and extent of lichen sclerosus related pathology. The primary outcomes for this study were voiding function and voiding related quality of life, and were assessed using the AUASS (American Urological Association Symptom Score) and quality of life bother index, respectively. RESULTS: We identified 42 patients with biopsy proven lichen sclerosus related urethral stricture disease. Of these patients 85.7% were treated with intraurethral steroids alone and did not require surgical intervention. Median AUASS significantly improved from 12 to 8, and median quality of life bother index improved from 4 ("mostly dissatisfied") to 2 ("mostly satisfied"). Average stricture length of those with penile urethral disease and bulbar urethral disease was 4.8 cm (SD 3.0) and 16.2 cm (SD 6.5), respectively. Median followup was 8.4 months (IQR 2.6-26.4). CONCLUSIONS: Lichen sclerosus related urethral stricture disease can be effectively managed with intraurethral steroids. This minimally invasive management strategy improves patient reported voiding symptoms and voiding quality of life.


Assuntos
Clobetasol/administração & dosagem , Líquen Escleroso e Atrófico/tratamento farmacológico , Qualidade de Vida , Estreitamento Uretral/tratamento farmacológico , Micção/fisiologia , Administração Tópica , Adulto , Biópsia , Seguimentos , Humanos , Líquen Escleroso e Atrófico/complicações , Líquen Escleroso e Atrófico/patologia , Líquen Escleroso e Atrófico/fisiopatologia , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente , Pênis/efeitos dos fármacos , Pênis/patologia , Estudos Prospectivos , Estudos Retrospectivos , Creme para a Pele/administração & dosagem , Resultado do Tratamento , Uretra/efeitos dos fármacos , Uretra/patologia , Estreitamento Uretral/etiologia , Estreitamento Uretral/patologia , Estreitamento Uretral/fisiopatologia
5.
J Urol ; 204(5): 989-995, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32501135

RESUMO

PURPOSE: Controversy exists regarding the optimal urethroplasty technique, particularly for long bulbar urethral strictures requiring buccal mucosal graft. We assessed the relative outcomes of augmented anastomotic urethroplasty vs dorsal onlay in the setting of bulbar urethroplasty using a dorsal buccal mucosal graft. MATERIALS AND METHODS: A retrospective review was performed on all patients who underwent bulbar urethroplasty with dorsal buccal mucosal graft between October 2003 and March 2019. Around 2011 institutional technique shifted from routinely performing transecting augmented anastomotic urethroplasty to nontransecting dorsal onlay. Anastomotic urethroplasty without buccal mucosal graft, ventral onlay, staged, flap and circumferential reconstructions were excluded. The primary outcome was stricture recurrence defined as less than 16Fr on cystoscopy. Secondary outcomes included 90-day complications and de novo erectile dysfunction at 6 months. RESULTS: Of the 836 patients who underwent bulbar urethroplasty during the study period 507 met inclusion criteria. Of these, 221 patients received an augmented anastomotic urethroplasty while 286 underwent dorsal onlay urethroplasty. Mean patient age and stricture length were 45.4±14.8 years and 4.4±1.5 cm, respectively. Overall success rate was 93.9% (476 of 507) with a mean followup of 78.9 months. On multivariate analysis augmented anastomotic urethroplasty (HR 4.8, p=0.002), increasing stricture length (HR 1.2, p=0.002) and iatrogenic strictures (HR 3.2, p=0.03) were independently associated with stricture recurrence, while comorbidity (p=0.06), prior endoscopic treatment (p=0.41), prior urethroplasty (p=0.89) and other etiologies were not. There was no difference between cohorts with respect to Clavien 2 or greater complications (3.6% vs 4.2%, p=0.74) or de novo erectile dysfunction (5.9% vs 5.6%, p=0.89). CONCLUSIONS: Augmented anastomotic urethroplasty is independently associated with stricture recurrence when compared to a pure dorsal onlay technique.


Assuntos
Mucosa Bucal/transplante , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Retalhos Cirúrgicos/efeitos adversos , Estreitamento Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Adulto , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Reconstrutivos/métodos , Recidiva , Estudos Retrospectivos , Retalhos Cirúrgicos/transplante , Falha de Tratamento , Resultado do Tratamento , Uretra/patologia , Uretra/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
6.
Medicine (Baltimore) ; 99(26): e20803, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590764

RESUMO

RATIONALE: Voiding difficulty is more common in males, although it is not uncommon in females. Female voiding difficulty can be caused by iatrogenic, anatomic, and neurogenic factors, and specifically urethra stricture, impaired detrusor contractility, primary bladder neck obstruction, and detrusor-external sphincter dyssynergia. Labial adhesion is a rare cause of female voiding difficulty.The incidence of labial fusion has been reported to be 0.6% to 1.4% in children; however, the incidence in the elderly has yet to be fully elucidated. PATIENT CONCERNS: We present the case of a postmenopausal and sexually inactive 76-year-old female patient who had nearly total vaginal and urethral occlusion due to labial adhesion. She had no underlying diseases and came to our clinic with a 10-month history of voiding difficulty, postmicturition dribbling, and involuntary urinary leakage when getting up. DIAGNOSIS: A genital examination revealed nearly total fusion of the labia minor with only a 3-mm pinhole opening at the posterior end. INTERVENTIONS: Treatment included surgical separation, the local application of estrogen cream, and self-dilatation. She also received an antimuscarinic agent to treat overactive bladder secondary to bladder outlet obstruction which was caused by labial adhesion. OUTCOMES: No surgical complications occurred. Moreover, no labial adhesion or voiding dysfunction was found immediately after the surgery or after 6 months of follow-up. LESSONS SUBSECTIONS: Genital examinations are a basic but very important noninvasive skill for physicians. This case report highlights that genital examinations should be a priority for patients with gynecological or urological symptoms.


Assuntos
Estrogênios/administração & dosagem , Obstrução do Colo da Bexiga Urinária , Bexiga Urinária Hiperativa , Procedimentos Cirúrgicos Urogenitais/métodos , Doenças da Vulva , Idoso , Feminino , Humanos , Antagonistas Muscarínicos/uso terapêutico , Pós-Menopausa , Resultado do Tratamento , Uretra/patologia , Uretra/fisiopatologia , Obstrução do Colo da Bexiga Urinária/etiologia , Obstrução do Colo da Bexiga Urinária/fisiopatologia , Obstrução do Colo da Bexiga Urinária/cirurgia , Bexiga Urinária Hiperativa/tratamento farmacológico , Bexiga Urinária Hiperativa/etiologia , Micção , Cremes, Espumas e Géis Vaginais/administração & dosagem , Doenças da Vulva/complicações , Doenças da Vulva/diagnóstico , Doenças da Vulva/fisiopatologia , Doenças da Vulva/cirurgia
7.
Clin Imaging ; 67: 68-71, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32526660

RESUMO

We are presenting a compelling case of a 61-year-old female with a history of appendiceal mucinous adenocarcinoma (AMA) with a new complaint of irritative lower urinary tract symptoms. Magnetic resonance imaging (MRI) showed a semi-circumferential, T2 hyperintense, rim enhancing, and lacking restricted diffusion lesion involving the urethra and infiltrating the right perineal and internal obturator muscles. The suspected differential diagnosis was urethral malignancy, based on her cancer history and MRI findings. After interdisciplinary consensus, the patient underwent excision of the lesion, and pathology was consistent with metastasis from the primary tumor. The urethra is a rare site of primary malignancy and metastatic disease. In particular, a non-contiguous metastatic disease involving the urethra is exceedingly rare. To the best of our knowledge, this is the first report of an AMA metastasizing to the urethra.


Assuntos
Adenocarcinoma Mucinoso/diagnóstico por imagem , Neoplasias do Apêndice/diagnóstico por imagem , Neoplasias Uretrais/diagnóstico por imagem , Adenocarcinoma Mucinoso/patologia , Neoplasias do Apêndice/patologia , Diagnóstico Diferencial , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Coxa da Perna/patologia , Uretra/patologia , Neoplasias Uretrais/patologia
8.
PLoS One ; 15(6): e0233753, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32479537

RESUMO

BACKGROUND: Neisseria gonorrhoeae (gonococcus) is the etiologic agent for the sexually transmitted Infection gonorrhea, a disease with a significant global public health impact. The treatment regimen for gonorrhea has been changed frequently over the past few decades due to the organism's propensity for developing antibiotic resistance. This study investigated antimicrobial susceptibility patterns of quinolones, third-generation cephalosporin, and other relevant antimicrobials found in N. gonorrhoeae isolated from men presenting with urethral discharge at selected healthcare facilities in Addis Ababa, Ethiopia, with the aim of revising the national treatment regimen based on the information generated from this study. METHODS: A total of 599 male patients presenting with urethral discharge were included in the current study. Urethral discharge specimens were cultured on Modified Thayer Martín media and suspected gonococcal colonies were confirmed using Oxidase and Superoxol tests followed by identification through a commercial kit (API-NHR). Antimicrobial susceptibility testing was performed by the Kirby-Bauer disc diffusion method using ciprofloxacin (5µg), ceftriaxone (30µg), cefixime (5µg), cefoxitin (30 µg), penicillin (10µg) and spectinomycin (100 µg) on enriched GC agar. Minimum Inhibitory Concentration (MIC) was also carried out using concentration gradient strips (E-tests) of the same antimicrobial agents. RESULTS: The prevalence of gonococcal isolates in the current study was 69%. Out of the 361 gonococcal isolates, close to 68% were fluoroquinolone non-susceptible, with 60% resistant and 7% having an intermediate status. However, all tested isolates were susceptible to ceftriaxone. In addition, all of the isolates have shown reduced non-susceptibility to spectinomycin and cefoxitin. CONCLUSION: The prevalence of gonococcal isolates in men presenting with urethral discharge at selected healthcare facilities in Addis Ababa, Ethiopia was found to be high. The high level of fluoroquinolone resistance observed in gonococcal isolates recovered in this study necessitates revision of the national syndromic treatment guideline.


Assuntos
Resistência Microbiana a Medicamentos , Gonorreia/microbiologia , Neisseria gonorrhoeae/efeitos dos fármacos , Adulto , Antibacterianos/farmacologia , Líquidos Corporais/microbiologia , Cefalosporinas/farmacologia , Gonorreia/patologia , Humanos , Masculino , Neisseria gonorrhoeae/patogenicidade , Uretra/microbiologia , Uretra/patologia
9.
Exp Mol Pathol ; 115: 104452, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32413360

RESUMO

BACKGROUND: Hypospadias, as a congenital disorder of the urethra, is the second most common birth abnormality of the male reproductive system. This study primarily investigates the effects of microRNA-494 (miR-494) on the transforming growth factor-ß1 (TGF-ß1)/Smads signaling pathway and on the development of hypospadias by binding to neural precursor cell expressed developmentally downregulated gene 4-like (Nedd4L). METHODS: We induced a mouse model of hypospadias through di-(2-ethylhexyl) phthalate treatment. The underlying regulatory mechanisms of miR-494 in this model were analyzed upon treatment of miR-494 mimic, miR-494 inhibitor, or small interfering RNA against Nedd4L in urethral epithelial cells isolated from mice with hypospadias. We then verified the binding site between miR-494 and Nedd4L and applied a gain- and loss-of-function approach to determine the effects of miR-494 on cell proliferation, cycle distribution, and apoptosis. RESULTS: Male mice with hypospadias exhibited significantly higher miR-494 expression and lower Nedd4L expression in urethral tissues than normal male mice. Nedd4L was verified as a target gene of miR-494. Treatment with miR-494 inhibitor suppressed the activation of the TGF-ß1/Smads signaling pathway, whereas down-regulation of miR-494 exerted protective effects on urethral epithelial cells by impeding cell proliferation and inducing cell apoptosis. CONCLUSIONS: The study indicates that downregulation of miR-494 inhibits the TGF-ß1/Smads signaling pathway and prevents the development of hypospadias through upregulating Nedd4L.


Assuntos
Regulação para Baixo/genética , Hipospadia/genética , Hipospadia/prevenção & controle , MicroRNAs/genética , Ubiquitina-Proteína Ligases Nedd4/genética , Transdução de Sinais , Proteínas Smad/metabolismo , Fator de Crescimento Transformador beta1/metabolismo , Regulação para Cima/genética , Animais , Apoptose/genética , Sequência de Bases , Ciclo Celular/genética , Proliferação de Células/genética , Células Epiteliais/metabolismo , Células Epiteliais/patologia , Feminino , Hipospadia/patologia , Masculino , Camundongos , MicroRNAs/metabolismo , Ubiquitina-Proteína Ligases Nedd4/metabolismo , Uretra/patologia
10.
Arch. esp. urol. (Ed. impr.) ; 73(4): 281-292, mayo 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-192988

RESUMO

OBJETIVOS: Conocer en mayor detalle la práctica clínica habitual de la exploración física (EF) del Síndrome de Dolor Vesical (SDV) y evaluar los cambios en síntomas y Calidad de Vida Relacionada con la Salud (CVRS) según los resultados de la EF. MATERIAL Y MÉTODOS: Estudio epidemiológico, observacional, nacional y multicéntrico que incluyó 319 pacientes con SDV (79 de nuevo diagnóstico y 240 en seguimiento). Se recogieron datos demográficos y clínicos. El estudio diagnóstico se realizó según práctica clínica habitual, incluyendo según el caso: EF y biopsia. Las pacientes cumplimentaron los cuestionarios "BladderPain/Interstitial Cystitis-Symptom Score" (BPIC-SS) y "EuroQoL-5D-5L" (EQ-5D-5L). Para describir las variables continuas se utilizaron la media, desviación estándar (DE) y cuartiles analizados y para las cualitativas, el número y porcentaje de pacientes por categoría de respuesta. Los resultados de los cuestionarios se describieron según la escala visual analógica (EVA). Se evaluó el estado de salud en pacientes con dolor miofascial. RESULTADOS: Se realizó EF en 296 casos. El 28,4% de los pacientes presentaban dolor miofascial. La variación de la puntuación BPIC-SS en los pacientes explorados fue de 7,77 puntos, en comparación con los 1,73 en los no explorados. Las variaciones en EQ-5D-5L fueron 0,13 y 0,04 puntos, respectivamente. CONCLUSIONES: La implicación miofascial se observó en el 28,4% de los 296 casos de SDV sometidos a EF. Es importante implementar un método sistemático e integral de EF a nivel nacional para lograr una caracterización más precisa del SDV y una mejor evolución de los síntomas y CVRS del paciente


OBJECTIVES: To describe in more detail the usual clinical practice regarding physical examination (PE) in Bladder Pain Syndrome (BPS) and to evaluate if the performance of PE relates to changes in severity of symptoms and in Health Related Quality of Life (HRQoL). MATERIAL AND METHODS: Epidemiological, observational, national and multicentric study that included 319 patients with BPS (79 of new diagnosis and 240 in follow-up). Demographic and clinical data were collected. The diagnostic study was performed according to the usual clinical practice, including as the case: PE and biopsy. The patients completed the "Bladder Pain/ Interstitial Cystitis Symptom Score" (BPIC-SS) and "EuroQoL- 5D-5L" (EQ-5D-5L) questionnaires. To describe the continuous variables, the mean, standard deviation (SD) and quartiles analyzed were used, and for categorical variables, number and percentage of patients by response category. The questionnaires' results were described according to the visual analog scale (VAS). Health status was evaluated in patients with myofascial pain. RESULTS: PE was performed in 296 cases. 28.4% of the patients presented pelvic myofascial pain. The variation of the BPIC-SS score in the explored patients was 7.77 points, compared to 1.73 in the unexplored ones. The variations in EQ-5D-5L were 0.13 and 0.04 points, respectively. CONCLUSIONS: Myofascial involvement was observed in 28.4% of the 296 cases of BPS who received a PE. It is important to implement a systematic, comprehensive method of PE at the national level in order to achieve a more precise characterization of BPS and a better evolution of the patient's symptoms and HRQoL


Assuntos
Humanos , Exame Físico , Uretra/patologia , Dor Crônica/terapia , Doenças da Bexiga Urinária/terapia , Manejo da Dor , Biópsia , Inquéritos e Questionários , Comunicação Interdisciplinar , Dor Facial/etiologia , Dor Pélvica , Cistite Intersticial/terapia
12.
Taiwan J Obstet Gynecol ; 59(1): 150-153, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32039785

RESUMO

OBJECTIVE: Tumors in the periurethral area can be a rare clinical entity with many difficulties not only in the diagnosis, as well as in the treatment plan. Skene's gland adenocarcinoma accounts for less than 0.003% of all female urethral malignant neoplasms. CASE REPORT: This report describes an extremely rare case of woman with a poorly differentiated carcinoma arising from the periurethral glands. CONCLUSIONS: Reporting of such rare cases enhance the understanding of the biological behavior of such tumors and the best treatment plan as well. This case report highlights the need for multidisciplinary approach of such rare cases, the lack of experience for such cases and the fact that the optimal treatment plan is very critical for the best prognosis of these patients.


Assuntos
Carcinoma/diagnóstico , Equipe de Assistência ao Paciente , Neoplasias Uretrais/diagnóstico , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Uretra/patologia
13.
Neurourol Urodyn ; 39(3): 898-906, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32050054

RESUMO

BACKGROUND: Although pelvic floor dysfunction (PFD) has a multifactorial etiology, pregnancy and childbirth are considered crucial events predisposing to urinary incontinence as well as pelvic organ prolapse, which are highly prevalent. Rats are the most frequently used animal model and pudendal nerve crush (PNC) and vaginal distension (VD) are often used to mimic vaginal delivery. OBJECTIVE: To document the time course of events after simulated vaginal delivery (SVD) on the urethral sphincter and the vaginal smooth muscle layer. MATERIALS AND METHODS: Virgin female Sprague-Dawley rats were subjected to SVD (PNC + VD) or sham surgery and evaluated at 7, 14, 21, and 42 days after the injury. Urethral function was determined in vivo by microultrasound during cystometry and vaginal smooth muscle layer was harvested for in vitro pharmacologic investigation by isometric tension recording. Furthermore, vaginal and urethral samples were investigated by immunohistochemistry and real-time quantitative polymerase chain reaction. RESULTS: Microultrasound showed no bursting of the urethral sphincter in the SVD group at 7 days with a functional recovery starting at 14 days, and normal bursting at 21 and 42 days. Vaginal smooth muscle showed higher sensitivity to carbachol at 14 and 21 days after injury; however, at 42 days, its sensitivity decreased when compared with sham. CONCLUSION: SVD induces urethral dysfunction and a shift in vaginal smooth muscle contractile responses to carbachol.


Assuntos
Contração Muscular/fisiologia , Músculo Liso/fisiopatologia , Parto , Nervo Pudendo/lesões , Recuperação de Função Fisiológica/fisiologia , Uretra/fisiopatologia , Vagina/fisiopatologia , Animais , Carbacol/farmacologia , Agonistas Colinérgicos/farmacologia , Parto Obstétrico/efeitos adversos , Feminino , Modelos Animais , Contração Muscular/efeitos dos fármacos , Músculo Esquelético/patologia , Músculo Esquelético/fisiopatologia , Músculo Liso/efeitos dos fármacos , Gravidez , Ratos , Ratos Sprague-Dawley , Ultrassonografia , Uretra/diagnóstico por imagem , Uretra/patologia , Incontinência Urinária/fisiopatologia , Vagina/efeitos dos fármacos , Vagina/patologia
14.
Sci Rep ; 10(1): 1718, 2020 02 03.
Artigo em Inglês | MEDLINE | ID: mdl-32015355

RESUMO

To determine the association of opening the paravesical space in relation to its occurrence of de novo SUI in an animal model. Thirty five female Sprague Dawley rats were divided into 5 groups of 7 rats each: Control group, Sham groups(F, H), and Study groups(MF, MH). Groups labeled with "F" had the paravesical space opened, "H" had tissue dissection with no opening of the space, and "M" had mesh implanted inside the vaginal wall. Urodynamic studies, immunohistochemical analysis, and western blot were done at day 40. The mean weight and age of 35 rats were 302.1 ± 25.1 grams and 12.8 ± 1.2 weeks old. No significant differences were noted among the control, Sham F, Sham H, Study MF, and Study MH on the voiding pressure and voided volume. The Sham F and Study MF (opened paravesical space) groups had significantly lower values on leak point pressures (LPP) (p = 0.026; p < 0.001) and shorter voiding intervals (p = 0.032; p = 0.005) when compared to other groups. Immunohistochemical analysis showed IL-1 and TNF-α to be intensely increased for the Study MF group (p = 0.003; p = <0.001). MMP-2 and CD 31 markers were also significantly higher in the Study MH and MF group. NGF expression was significantly increased in the Study MF and Sham F groups. Thus, opening of the paravesical space causes an increased inflammatory reaction, which leads to tissue destruction and lower urinary tract dysfunction, exemplified in the study with low leak point pressure and shortened voiding intervals.


Assuntos
Inflamação/imunologia , Sintomas do Trato Urinário Inferior/imunologia , Prolapso de Órgão Pélvico/cirurgia , Pelve/anatomia & histologia , Uretra/metabolismo , Animais , Modelos Animais de Doenças , Feminino , Humanos , Interleucina-1/metabolismo , Metaloproteinase 2 da Matriz/metabolismo , Fator de Crescimento Neural/metabolismo , Pelve/cirurgia , Molécula-1 de Adesão Celular Endotelial a Plaquetas/metabolismo , Ratos , Ratos Sprague-Dawley , Fator de Necrose Tumoral alfa/metabolismo , Uretra/patologia , Urodinâmica , Procedimentos Cirúrgicos Urogenitais
15.
PLoS One ; 15(2): e0228467, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32040516

RESUMO

Urethritis, or inflammation of the urethra, is one of the most common reasons men seek clinical care. Sexually transmitted pathogens including Neisseria gonorrhoeae are responsible for over half of the symptomatic urethritis cases in U.S. men. Recently, clinics in Indianapolis, Columbus, Atlanta, and other U.S. cities began to note increasing numbers of men presenting with urethritis and Gram-negative intracellular diplococci in their urethral smears who test negative for N. gonorrhoeae. Many of these discordant cases, which have periodically reached highs of more than 25% of presumed gonococcal cases in some sexually transmitted infection clinics in the U.S. Midwest, are infected with strains in a novel urethrotropic clade of Neisseria meningitidis ST-11 (US_NmUC). However, no cultivation-independent tests are available for the US_NmUC strains, and prior studies relied on microbial culture and genome sequencing to identify them. Here, we describe a PCR test that can identify the US_NmUC strains and distinguish them from commensal and invasive N. meningitidis strains as well as N. gonorrhoeae. Our SimpleProbe®-based real-time PCR assay targets a conserved nucleotide substitution in a horizontally acquired region of US_NmUC strain genomes. We applied the assay to 241 urine specimens whose microbial compositions had previously been determined by deep shotgun metagenomic sequencing. The assay detected the single US_NmUC positive case in this cohort, with no false positives. Overall, our simple and readily adaptable assay could facilitate investigation of the pathogenesis and epidemiology of the US_NmUC clade.


Assuntos
Neisseria meningitidis/genética , Reação em Cadeia da Polimerase em Tempo Real/métodos , Uretrite/microbiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Reações Falso-Positivas , Gonorreia/diagnóstico , Gonorreia/epidemiologia , Gonorreia/microbiologia , Gonorreia/urina , Humanos , Masculino , Pessoa de Meia-Idade , Neisseria gonorrhoeae/genética , Neisseria gonorrhoeae/isolamento & purificação , Neisseria meningitidis/classificação , Neisseria meningitidis/isolamento & purificação , Polimorfismo de Nucleotídeo Único , Doenças Bacterianas Sexualmente Transmissíveis/diagnóstico , Doenças Bacterianas Sexualmente Transmissíveis/epidemiologia , Doenças Bacterianas Sexualmente Transmissíveis/microbiologia , Doenças Bacterianas Sexualmente Transmissíveis/urina , Estados Unidos/epidemiologia , Uretra/microbiologia , Uretra/patologia , Uretrite/diagnóstico , Urinálise/métodos , Sequenciamento Completo do Genoma , Adulto Jovem
16.
Neurourol Urodyn ; 39(2): 625-632, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31961960

RESUMO

AIM: To elucidate the precise cellular and molecular mechanisms that underlie urethral fibrogenesis. METHODS: Endoluminal electrocautery injury (using Karl Storz 10 Fr. Pediatric urethroscope) was employed in male rabbits (n = 6) to create mucosal injury. Retrograde urethrogram (RUG) and endoluminal ultrasound techniques were used to assess severity and changes in luminal cross-sectional area. Six control rabbits were subjected to sham injury, in which the electrocautery was inserted but not powered. Urethral tissues were harvested 30 days postinjury and subjected to RNA sequencing and quantitative polymerase chain reaction (qPCR) to determine changes in gene expression. Histological, immunostaining, and Western blot studies were used to determine changes in protein expression of known markers of fibrosis (eg, collagen, Integrinαv, GIV/Girdin, transforming growth factor-ß (TGF-ß), and pSMAD1,2,3). RESULTS: Trichrome staining confirmed increased connective tissue in urethral scar tissues. Immunostaining revealed a potential role for epithelial to mesenchymal cell transition (EMT) and positive labeling for all fibrotic markers (eg, collagen-1, Integrin αv, GIV/Girdin, transforming growth factor-ß (TGF-ß), and SMAD1,2,3). Western blot analysis confirmed increased protein levels of these fibrotic markers. CONCLUSION: Our RNA sequencing and qPCR studies, in conjunction with our protein data, suggest that urethral mucosal fibrogenesis may be mediated by novel fibrogenic signaling pathways involving Wnt-ß catenin, TGF-ß, GIV/Girdin, and EMT which lead to increased collagen deposition. Therapeutic strategies targeting these pathways may be beneficial in attenuating fibrogenesis and stricture progression.


Assuntos
Transição Epitelial-Mesenquimal/fisiologia , Fibrose/metabolismo , Uretra/metabolismo , Via de Sinalização Wnt/fisiologia , beta Catenina/metabolismo , Animais , Modelos Animais de Doenças , Fibrose/patologia , Masculino , Coelhos , Fator de Crescimento Transformador beta/metabolismo , Uretra/patologia
17.
Urology ; 137: 183-189, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31926195

RESUMO

OBJECTIVE: To characterize the bulbospongiosus muscle (BSM) in patients with bulbar urethral strictures. MATERIALS AND METHODS: We studied 21 patients divided into 2 groups: Stricture Group (n = 14; mean age = 62.00 years) with bulbar stricture submitted to open urethroplasty; and Control Group (n = 7; mean age = 60.14 years) with penile strictures (hypospadias cripples, penile cancer and/or penile infection) who were submitted to perineal urethrostomy. Samples of the BSM were dissected and histologic sections were stained by histochemical and immunohistochemical techniques. Histomorphometric analyzes were performed on photomicrographs. Means were statistically compared using the unpaired Student t test and the Mann-Whitney test (P <.05). RESULTS: The etiology of bulbar urethral stricture was idiopathic in 2 cases (14.29%), post-TURP in 6 (42.86%), post open radical prostatectomy in 5 (35.71%) and post open prostatectomy in 1 case (7.14%). The average length of the stricture was 2.08 cm. The only parameter analyzed with significant difference between the groups was the vessels (significant difference between the control group: 5.11 ± 1.98% and stricture group: 3.57 ± 1.32%, P = .0460). The quantitative analysis of collagen (Control Group: 10.63 ± 5.37% and Stricture Group: 10.83 ± 4.55%, P = .9296); diameter of BSM muscle fibers (Control Group: 41.71 ± 14.63 µm and Stricture Group: 40.11 ± 8.59 µm, P = .76 and elastic system fibers (Control Group; 3.83 ± 1.54% and Stricture Group: 5.43 ± 2.90%, P = .2601) showed no significant difference. CONCLUSIONS: Histologic analysis showed a significant decrease of the BSM vessels in urethral stricture, without changes in elastic fibers, collagen, nerves, and muscle fiber diameter. These findings show that the bulbar urethral stricture causes minimal alterations in the structure of the BSM.


Assuntos
Doenças do Pênis , Pênis , Complicações Pós-Operatórias , Uretra , Estreitamento Uretral , Procedimentos Cirúrgicos Urológicos , Pesos e Medidas Corporais/métodos , Brasil , Constrição Patológica , Correlação de Dados , Técnicas de Imagem por Elasticidade/métodos , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Doenças do Pênis/diagnóstico , Doenças do Pênis/etiologia , Pênis/patologia , Pênis/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/patologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Uretra/irrigação sanguínea , Uretra/inervação , Uretra/patologia , Uretra/cirurgia , Estreitamento Uretral/diagnóstico , Estreitamento Uretral/epidemiologia , Estreitamento Uretral/etiologia , Estreitamento Uretral/patologia , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Procedimentos Cirúrgicos Urológicos/métodos
18.
Asian J Androl ; 22(1): 60-63, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31736473

RESUMO

The use of artificial urinary sphincter (AUS) for the treatment of stress urinary incontinence has become more prevalent, especially in the "prostate-specific antigen (PSA)-era", when more patients are treated for localized prostate cancer. The first widely accepted device was the AMS 800, but since then, other devices have also entered the market. While efficacy has increased with improvements in technology and technique, and patient satisfaction is high, AUS implantation still has inherent risks and complications of any implant surgery, in addition to the unique challenges of urethral complications that may be associated with the cuff. Furthermore, the unique nature of the AUS, with a control pump, reservoir, balloon cuff, and connecting tubing, means that mechanical complications can also arise from these individual parts. This article aims to present and summarize the current literature on the management of complications of AUS, especially urethral atrophy. We conducted a literature search on PubMed from January 1990 to December 2018 on AUS complications and their management. We review the various potential complications and their management. AUS complications are either mechanical or nonmechanical complications. Mechanical complications usually involve malfunction of the AUS. Nonmechanical complications include infection, urethral atrophy, cuff erosion, and stricture. Challenges exist especially in the management of urethral atrophy, with both tandem implants, transcorporal cuffs, and cuff downsizing all postulated as potential remedies. Although complications from AUS implants are not common, knowledge of the management of these issues are crucial to ensure care for patients with these implants. Further studies are needed to further evaluate these techniques.


Assuntos
Complicações Pós-Operatórias/terapia , Falha de Prótese , Infecções Relacionadas à Prótese/terapia , Uretra/patologia , Doenças Uretrais/terapia , Estreitamento Uretral/cirurgia , Incontinência Urinária por Estresse/cirurgia , Esfíncter Urinário Artificial , Atrofia , Humanos , Complicações Pós-Operatórias/epidemiologia , Implantação de Prótese , Infecções Relacionadas à Prótese/epidemiologia , Doenças Uretrais/epidemiologia , Estreitamento Uretral/epidemiologia
19.
J Urol ; 203(4): 773-778, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31621469

RESUMO

PURPOSE: Urethroplasty of lichen sclerosus strictures has a significantly higher failure rate than strictures due to other causes. We sought to determine predictors of urethroplasty failure in men with lichen sclerosus urethral stricture disease by evaluating protein expression profiles. MATERIALS AND METHODS: Urethral tissue was excised from patients with lichen sclerosus who were undergoing urethroplasty of urethral stricture disease at a single institution. A tissue microarray was created with cores from each sample. Immunohistochemistry was performed to compare protein expression related to inflammation, cell cycle disruption, oxidative stress, hormone receptor status and infection. Stricture recurrence was defined by the need for a subsequent unanticipated procedure for urethral stricture disease. RESULTS: We evaluated 50 men with lichen sclerosus urethral stricture disease, including 31 with successful reconstruction and 19 with recurrent stricture. Recurrent strictures expressed lower levels of several inflammatory markers and had a lower Ki-67 mitotic index and significantly higher vascular endothelial growth factor levels than nonrecurrent strictures. CONCLUSIONS: To our knowledge this is the first study to use tissue protein expression to identify risk factors for urethroplasty failure among men with lichen sclerosus urethral stricture disease. Our findings suggest that recurrent lichen sclerosus strictures demonstrate a suppressed inflammatory response, a decreased cell turnover rate, and poor oxygenation and nutrient delivery. Prospective studies are needed to clarify the role of these pathways in the pathophysiology of lichen sclerosus urethral stricture disease, determine whether preoperative biopsy can predict urethroplasty success, help counsel patients and develop future treatments.


Assuntos
Líquen Escleroso e Atrófico/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Uretra/patologia , Estreitamento Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Biomarcadores/análise , Biomarcadores/metabolismo , Biópsia , Feminino , Seguimentos , Perfilação da Expressão Gênica , Humanos , Imuno-Histoquímica , Líquen Escleroso e Atrófico/complicações , Líquen Escleroso e Atrófico/patologia , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Prognóstico , Estudos Prospectivos , Recidiva , Reoperação/estatística & dados numéricos , Análise Serial de Tecidos , Resultado do Tratamento , Uretra/cirurgia , Estreitamento Uretral/etiologia , Estreitamento Uretral/patologia
20.
Urology ; 135: 139-145, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31586471

RESUMO

OBJECTIVE: To examine the most cited literature in urethral reconstruction, review types of work published, and observe research trends. METHODS: The Web of Sciences Sci-Expanded Index was used to conduct a search for urethral reconstruction. References were assessed for relevance to urethral reconstruction by 2 independent reviewers and a final list of the top 100 articles ranked by citation count was obtained. For each article, citation count, publication date, corresponding author, origin institution, origin country, topic area, study design, level of evidence, and origin journal were collected. RESULTS: The mean citation count per publication was 108 (median = 94.5; range = 69-366, SD = 43) with a total of 10,874 citations for all papers since 1970. The top 100 articles were published between 1973 and 2011, came from 19 different countries and 16 different journals. Nearly half were case series and most studies were Level III evidence or lower. The United States was the largest contributor to the top 100 with 56 publications, followed by Italy (14), England (12), and Egypt (7). "Outcomes of surgical treatment for urethral stricture disease" was the most prevalent topic area comprising 55 articles in the top 100, with most articles including descriptions or outcomes of novel surgical techniques. CONCLUSION: In this study, we discovered that the most cited literature in the field of urethral reconstruction is singularly focused and lacking in high levels of evidence. The top 100 cited articles originate primarily from the United States, focus on short-term outcomes after surgical treatment for urethral stricture disease, and are predominantly case series.


Assuntos
Bibliometria , Procedimentos Cirúrgicos Reconstrutivos/métodos , Uretra/cirurgia , Estreitamento Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Humanos , Masculino , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Uretra/patologia , Estreitamento Uretral/patologia , Procedimentos Cirúrgicos Urológicos Masculinos/estatística & dados numéricos
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