Anatomy Of Bladder Research Articles

Virtual trainer for intra-detrusor injection of botulinum toxin to treat urinary incontinence.

Here we introduce a new virtual reality (VR) based simulation system for training the urological procedure of intra-detrusor botulinum toxin (Botox®) injections into the bladder. 6 cases with different bladder anatomy and 3 subtasks are included in the curriculum; this design is guided by several expert urologists according to clinical needs and experience. These virtual bladder models can be deformed by a cystoscope model or penetrated by a needle model. Data of location and dose per injection are collected during the training. After compared among various options, magnetic motion-tracking devices are chosen and integrated onto replicas of cystoscopic instruments as the VR interface for the specific operation. A web/database based learning management platform (LMP) is developed for online data access and validation studies of the training system.

Suppression of the PI3K pathway in vivo reduces cystitis-induced bladder hypertrophy and restores bladder capacity examined by magnetic resonance imaging.

This study utilized magnetic resonance imaging (MRI) to monitor the real-time status of the urinary bladder in normal and diseased states following cyclophosphamide (CYP)-induced cystitis, and also examined the role of the phosphoinositide 3-kinase (PI3K) pathway in the regulation of urinary bladder hypertrophy in vivo. Our results showed that under MRI visualization the urinary bladder wall was significantly thickened at 8 h and 48 h post CYP injection. The intravesical volume of the urinary bladder was also markedly reduced. Treatment of the cystitis animals with a specific PI3K inhibitor LY294002 reduced cystitis-induced bladder wall thickening and enlarged the intravesical volumes. To confirm the MRI results, we performed H&E stain postmortem and examined the levels of type I collagen by real-time PCR and western blot. Inhibition of the PI3K in vivo reduced the levels of type I collagen mRNA and protein in the urinary bladder ultimately attenuating cystitis-induced bladder hypertrophy. The bladder mass calculated according to MRI data was consistent to the bladder weight measured ex vivo under each drug treatment. MRI results also showed that the urinary bladder from animals with cystitis demonstrated high magnetic signal intensity indicating considerable inflammation of the urinary bladder when compared to normal animals. This was confirmed by examination of the pro-inflammatory factors showing that interleukin (IL)-1α, IL-6 and tumor necrosis factor (TNF)α levels in the urinary bladder were increased with cystitis. Our results suggest that MRI can be a useful technique in tracing bladder anatomy and examining bladder hypertrophy in vivo during disease development and the PI3K pathway has a critical role in regulating bladder hypertrophy during cystitis.

SU‐E‐T‐281: Reduction of Treatment Times in CyberKnife Prostate SBRT Using a Water Filled Rectal Balloon

Purpose:To illustrate 25% reduction in CyberKnife prostate SBRT treatment times using a water filled rectal balloon.Methods:We perform prostate SBRT using a 3800cGy in 4 fraction regimen prescribed between 51% 59% iso‐dose lines to 95% of PTV using a CyberKnife System. The resultant heterogeneous dosimetry is analogous to HDR dosimetry. Our patients are treated in a feet first supine position to decrease treatment couch sag and also to position the prostate anatomy closer to the robot. CT imaging is performed with a Radiadyne Immobiloc rectal balloon filled with 45‐50cc water placed firmly inside the patient's rectum. A treatment plan is developed from this CT study using Multiplan. The patient is treated every other day for 4 days using the rectal balloon for each fraction. Gold fiducials previously implanted inside the prostate are used for tracking by the CyberKnife system.Results:Critical structures comprise the usual GU anatomy of bladder, rectum, urethra, femoral‐heads along with emphasis on doses to anterior rectal wall and rectal mucosa. The water filled rectal balloon localizes the rectum, which enables the physician to accurately contour both anterior rectal wall, and rectal mucosa. The balloon also has a gas release valve enabling better patient comfort. Rectum localization enables the CyberKnife system to make fewer corrections resulting in fewer treatment interruptions and time lost to re‐adjustment for rectal motion, bowel filling and gas creation. Effective treatment times are reduced by 25% to approximately 45 minutes. Adoption of the balloon has required minimal change to our planning strategy and plan evaluation process.Conclusion:Patient follow‐up comparisons show no difference in effectiveness of treatment with and without balloons We conclude that rectal balloons enhance patient comfort and decrease effective treatment times.

SU-E-J-214: Comparative Assessment On IGRT On Partial Bladder Cancer Treatment Between CT-On-Rails (CTOR) and KV Cone Beam CT (CBCT)

Purpose: Image-Guided radiation therapy(IGRT) depends on reliable online patient-specific anatomy information to address random and progressive anatomy changes. Large margins have been suggested to bladder cancer treatment due to large daily bladder anatomy variation. KV Cone beam CT(CBCT) has been used in IGRT localization prevalently; however, its lack of soft tissue contrast makes clinicians hesitate to perform daily soft tissue alignment with CBCT for partial bladder cancer treatment. This study compares the localization uncertainties of bladder cancer IGRT using CTon- Rails(CTOR) and CBCT. Methods: Three T2N0M0 bladder cancer patients (total of 66 Gy to partial bladder alone) were localized daily with either CTOR or CBCT for their entire treatment course. A total of 71 sets of CTOR and 22 sets of CBCT images were acquired and registered with original planning CT scans by radiation therapists and approved by radiation oncologists for the daily treatment. CTOR scanning entailed 2mm slice thickness, 0.98mm axial voxel size, 120kVp and 240mAs. CBCT used a half fan pelvis protocol from Varian OBI system with 2mm slice thickness, 0.98axial voxel size, 125kVp, and 680mAs. Daily localization distribution was compared. Accuracy of CTOR and CBCT on partial bladder alignment was also evaluated by comparing bladder PTV coverage. Results: 1cm all around PTV margins were used in every patient except target superior limit margin to 0mm due to bowel constraint. Daily shifts on CTOR averaged to 0.48, 0.24, 0.19 mms(SI,Lat,AP directions); CBCT averaged to 0.43, 0.09, 0.19 mms(SI,Lat,AP directions). The CTOR daily localization showed superior results of V100% of PTV(102% CTOR vs. 89% CBCT) and bowel(Dmax 69.5Gy vs. 78Gy CBCT). CTOR images showed much higher contrast on bladder PTV alignment. Conclusion: CTOR daily localization for IGRT is more dosimetrically beneficial for partial bladder cancer treatment than kV CBCT localization and provided better soft tissue PTV identification.

Improved estimates of the radiation absorbed dose to the urinary bladder wall

Specific absorbed fractions (SAFs) have been calculated as a function of the content in the urinary bladder in order to allow more realistic calculations of the absorbed dose to the bladder wall. The SAFs were calculated using the urinary bladder anatomy from the ICRP male and female adult reference computational phantoms. The urinary bladder and its content were approximated by a sphere with a wall of constant mass, where the thickness of the wall depended on the amount of urine in the bladder. SAFs were calculated for males and females with 17 different urinary bladder volumes from 10 to 800 mL, using the Monte Carlo computer program MCNP5, at 25 energies of mono-energetic photons and electrons ranging from 10 KeV to 10 MeV. The decay was assumed to be homogeneously distributed in the urinary bladder content and the urinary bladder wall, and the mean absorbed dose to the urinary bladder wall was calculated. The Monte Carlo simulations were validated against measurements made with thermoluminescent dosimeters. The SAFs obtained for a urine volume of 200 mL were compared to the values calculated for the urinary bladder wall using the adult reference computational phantoms. The mean absorbed dose to the urinary wall from 18F-FDG was found to be 77 µGy/MBq formales and 86 µGy/MBq for females, while for 99mTc-DTPA the mean absorbed doses were 80 µGy/MBq for males and 86 µGy/MBq for females. Compared to calculations using a constant value of the SAF from the adult reference computational phantoms, the mean absorbed doses to the bladder wall were 60% higher for 18F-FDG and 30% higher for 99mTc-DTPA using the new SAFs.

Lower Urinary Tract Urological Abnormalities and Urodynamic Findings of Physiological Urinary Incontinence Versus Non-mono Symptomatic Nocturnal Enuresis in Children.

Background:Although 98% of children attain daytime bladder control by three years of age, urinary incontinence is regarded physiological up to the fifth year of life.Objectives:This study aimed to assess whether lower urinary tract urological abnormalities and abnormal urodynamic findings are infrequent in children with physiological urinary incontinence in contrast to those with non-monosymptomatic nocturnal enuresis (NMNE).Patients and Methods:During a three-year period (2007-2009), 66 neurologically normal children including 51 children (34 girls, 17 boys) older than five years of age with NMNE and intermittent daytime incontinence, and 15 children with physiological urinary incontinence (eight girls and seven boys) aged four to five years of age without any known urological abnormalities were enrolled in the study. Patients with neurologic deficits or known urological anomalies were excluded from the study. Kidney-bladder ultrasonography, voiding cystourethrography (VCUG), and urodynamic studies were performed to evaluate the anatomy of urinary tract and bladder function.Results:Urinary tract infection was found in 23 (34.8%) children, 17 (33.3%) and 6 (40%) patients with NMNE and physiological urinary incontinence, respectively. Out of 48 patients who underwent VCUG, vesicoureteral reflux (VUR) was found in seven and eight children younger and older than five years of age, respectively. Abnormal urodynamic findings were reported in 5 (62.5%) of eight children younger than five-year-old, and 14 (63.6%) of 22 patients older than 5-year-old.Conclusions:VUR might be more frequent in children with physiological urinary incontinence than the normal population, and might be as common as NMNE with intermittent daytime incontinence.

Epidemiology and etiology of benign prostatic hyperplasia and bladder outlet obstruction

Benign prostatic hyperplasia (BPH) is a histological diagnosis associated with unregulated proliferation of connective tissue, smooth muscle and glandular epithelium. BPH may compress the urethra and result in anatomic bladder outlet obstruction (BOO); BOO may present as lower urinary tract symptoms (LUTS), infections, retention and other adverse events. BPH and BOO have a significant impact on the health of older men and health-care costs. As the world population ages, the incidence and prevalence of BPH and LUTS have increased rapidly. Although non-modifiable risk factors – including age, genetics and geography – play significant roles in the etiology of BPH and BOO, recent data have revealed modifiable risk factors that present new opportunities for treatment and prevention, including sex steroid hormones, the metabolic syndrome and cardiovascular disease, obesity, diabetes, diet, physical activity and inflammation. We review the natural history, definitions and key risk factors of BPH and BOO in epidemiological studies.

Motion Correction for MR Cystography by an Image Processing Approach

Magnetic resonance (MR) cystography or MR-based virtual cystoscopy is a promising new technology to evaluate the entire bladder in a fully noninvasive manner. It requires the anatomical bladder images be acquired at high spatial resolution and with adequate signal-to-noise ratio (SNR). This often leads to a long-time scan (>5 min) and results in image artifacts due to involuntary bladder motion and deformation. In this paper, we investigated an image-processing approach to mitigate the problem of motion and deformation. Instead of a traditional single long-time scan, six repeated short-time scans (each of approximately 1 min) were acquired for the purpose of shifting bladder motion from intrascan into interscans. Then, the interscan motions were addressed by registering the short-time scans to a selected reference and finally forming a single average motion-corrected image. To evaluate the presented approach, three types of images were generated: 1) the motion-corrected image by registration and average of the short-time scans; 2) the directly averaged image of the short-time scans (without motion correction); and 3) the single image of the corresponding long-time scan. Six experts were asked to blindly score these images in terms of two important aspects: 1) the definition of the bladder wall and 2) the overall expression on the image quality. Statistical analysis on the scores suggested that the best result in both the aspects is achieved by the presented motion-corrected average. Furthermore, the superiority of the motion-corrected average over the other two is statistically significant by the measure of a linear mixed-effect model with p -values < 0.05. Our findings may facilitate the detection of bladder abnormality in MR cystography by mitigating the motion challenge. The effectiveness of this approach depends on the noise level of acquired short-time scans and the robustness of image registration, and future effort on these two aspects is needed.

Bladder health across the life course

Influences on bladder health begin during infancy and continue throughout the lifespan. Bladder anatomy and physiology change as individuals age, and the risk and propensity for bladder conditions, including lower urinary tract symptoms, throughout life are related to factors specific to age, sex, and life events. Bladder habits and dysfunctions at one stage of life may affect bladder health in subsequent stages. However, bladder problems are neither a normal part of aging nor inevitable at any stage of life. Many of the factors that negatively impact bladder health at all ages may be modifiable, and healthy bladder habits may prevent or reverse bladder dysfunctions that can occur naturally or in response to life events. There are opportunities to further define and promote healthy bladder habits through focused research and heightened public awareness of the importance of bladder health, which may lead to improvements in overall health and quality of life. It is our hope that this paper will inform and encourage public health initiatives and research programs aimed at this goal.

The Therapeutic Effects of Repeated Detrusor Injections Between 200 or 300 Units of OnabotulinumtoxinA in Chronic Spinal Cord Injured Patients

To investigate the therapeutic effects of repeated detrusor onabotulinumtoxinA injections on treatment outcomes, quality of life (QoL), and glomerular filtration rate (GFR) in chronic spinal cord injured (SCI) patients with neurogenic lower urinary tract dysfunction and urinary incontinence. Patients with SCI who failed antimuscarinic treatment were enrolled. All patients had urodynamic detrusor overactivity (DO) or increased detrusor tonicity without anatomical bladder outlet obstruction or intrinsic sphincter deficiency. They were randomly assigned to receive 200-U or 300-U onabotulinumtoxinA detrusor injections every 6 months. The primary endpoint was 6 months after the second injection. The urodynamic parameters, QoL measures, and 99mTc renal scans were evaluated at baseline and every 3 months and compared between dosages. A total of 72 patients were enrolled, including 43 men and 29 women and mean injury duration of 8.7 years. Among them, 38 patients received 200-U and 34 received 300-U onabotulinumtoxinA injections. At the end-point, the urodynamic parameters and incontinence severity improved significantly, without a significant difference between the two groups. QoL also improved in both groups, without differences between groups. Uninhibited DO improved more in 300-U group compared to 200-U group at end-point (P = 0.01). The GFR did not change significantly in either group. The most common complication was urinary tract infection, which occurred in one third of patients. Either 200-U or 300-U repeated detrusor onabotulinumtoxinA injections improved incontinence, urodynamic parameters, and QoL in SCI patients with neurogenic DO. Renal function was maintained in patients receiving both dosage of repeated injections.

Okołooperacyjna ocena anatomii pęcherza moczowego i cewki moczowej w badaniu ultrasonograficznym u pacjentek operowanych z powodu wysiłkowego nietrzymania moczu

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Brzeziński M, Żurawik-Pietrzak A, Ostrowski D, Żurawik T, Wielgoś M. Perioperative evaluation of anatomy of urinary bladder and urethra in ultrasound examination of female patients operated due to urinary stress incontinence. Menopause Review/Przegląd Menopauzalny. 2013;12(3):235-239. doi:10.5114/pm.2013.36590. APA Brzeziński, M., Żurawik-Pietrzak, A., Ostrowski, D., Żurawik, T., & Wielgoś, M. (2013). Perioperative evaluation of anatomy of urinary bladder and urethra in ultrasound examination of female patients operated due to urinary stress incontinence. Menopause Review/Przegląd Menopauzalny, 12(3), 235-239. https://doi.org/10.5114/pm.2013.36590 Chicago Brzeziński, Marek, Anna Żurawik-Pietrzak, Dariusz Ostrowski, Tadeusz Żurawik, and Mirosław Wielgoś. 2013. "Perioperative evaluation of anatomy of urinary bladder and urethra in ultrasound examination of female patients operated due to urinary stress incontinence". Menopause Review/Przegląd Menopauzalny 12 (3): 235-239. doi:10.5114/pm.2013.36590. Harvard Brzeziński, M., Żurawik-Pietrzak, A., Ostrowski, D., Żurawik, T., and Wielgoś, M. (2013). Perioperative evaluation of anatomy of urinary bladder and urethra in ultrasound examination of female patients operated due to urinary stress incontinence. Menopause Review/Przegląd Menopauzalny, 12(3), pp.235-239. https://doi.org/10.5114/pm.2013.36590 MLA Brzeziński, Marek et al. "Perioperative evaluation of anatomy of urinary bladder and urethra in ultrasound examination of female patients operated due to urinary stress incontinence." Menopause Review/Przegląd Menopauzalny, vol. 12, no. 3, 2013, pp. 235-239. doi:10.5114/pm.2013.36590. Vancouver Brzeziński M, Żurawik-Pietrzak A, Ostrowski D, Żurawik T, Wielgoś M. Perioperative evaluation of anatomy of urinary bladder and urethra in ultrasound examination of female patients operated due to urinary stress incontinence. Menopause Review/Przegląd Menopauzalny. 2013;12(3):235-239. doi:10.5114/pm.2013.36590.

Comparison of Urodynamic Findings in Women With Anatomical Versus Functional Bladder Outlet Obstruction

To characterize the symptoms and urodynamic findings of anatomical bladder outlet obstruction (AO) and functional bladder outlet obstruction (FO) in women and to determine if future endeavors at defining bladder outlet obstruction in women can group these entities together. Retrospective review of all videourodynamic studies was performed on women from March 2003 to July 2009. Women with diagnosis of obstruction were categorized based on the cause of obstruction into 2 groups: AO and FO. Demographic data, symptoms, and urodynamic findings were compared between the 2 groups. One hundred fifty-seven women were identified of which 86 (54.8%) were classified as having AO and 71 (45.2%) were classified as having FO. There were no differences in symptoms between the 2 groups. There was no difference (P=0.5789) in the mean detrusor pressure at maximum flow rate Qmax between AO (38.9 cm H20) and FO (41.0 cm H20). There was a difference in the Qmax between AO and FO (10.6 [0-41.7] and 7.4 [0-35.7] mL/s, respectively; P=0.0044), but there was considerable overlap between the values in these 2 groups. Anatomical bladder outlet obstruction and FO have similar urodynamic voiding pressure findings, but Qmax was statistically significantly lower in AO. However, there is a large overlap in the Qmax values between the 2 groups. Therefore, future studies that attempt to characterize bladder outlet obstruction in women need not exclude either group.

Bladder exstrophy: Comparison of anatomical bladder neck repair with innervation preserving sphincteroplasty versus Young-Dees-Leadbetter bladder neck reconstruction

Aim:To evaluate the outcome of innervation preserving sphincteroplasty along with anatomical bladder neck reconstruction (IPS-ABNR) compared to classic Young-Dees-Leadbetter (YDL) bladder neck reconstruction in exstrophy with insufficient bladder capacity requiring detubularized-ileocystoplasty.Materials and Methods:Sixteen male patients of exstrophy bladder who required ileocystoplasty from 2004 to 2010 were randomized into group A (n = 7) and group B (n = 9). After detubularized-ileocystoplasty with Mitrofanoff stoma and ureteric reimplantation in all, group A received YDL bladder neck repair while group B received IPS-ABNR repair through a midline scrotoperineal approach. Outcome measurement included operative and postoperative problems, continence, and upper tract status.Results:In group A, two had incompetent bladder neck with gross incontinence, while four had a dry interval of more than 3 h without the ability of voiding per urethra. In group B, seven patients had dry interval of more than 3 h with an ability of urethral voiding and midstream holding in five.Conclusions:Exstrophy patients requiring augmentation cystoplasty and repaired with IPS-ABNR can achieve dynamic bladder outlet resistance with adequate leak point pressure and ability to void voluntarily with midstream holding capability. The children had the satisfaction of voiding per urethra with ability to stop in midstream similar to that in normal children.

Cause of Residual Urine in Bladder Outlet Obstruction: An Experimental Study in the Rat

We explored the role of bladder mechanoreceptors in post-void residual urine in rats with bladder outlet obstruction. Partial bladder outlet obstruction was induced by a urethral ligature in 11 adult female Sprague-Dawley® rats. Nine sham operated rats served as controls. The outcome was evaluated in acute experiments using α-chloralose anesthesia 6 weeks later. Bladders were catheterized for infusion, pressure recording and intravesical electrical stimulation. Bladder efferent activity was recorded from a thin pelvic nerve branch close to the bladder. Micturition contractions were triggered at different bladder volumes by a brief train of electrical stimulation of bladder afferents while monitoring post-stimulus efferent activity and reflex bladder contractions. The degree of obstruction was assessed by bladder wet weight at the end of the experiment. Bladder weight, micturition threshold volume, anatomical bladder capacity and peak contraction force were significantly increased in obstructed rats. In sham operated controls a triggered micturition reflex was sustained by afferent feedback from the bladder until the bladder was empty. In contrast, reflex discharges failed with substantial volume remaining in the bladder in obstructed rats. The minimal micturition reflex volume correlated positively with bladder weight, micturition threshold volume and maximal bladder capacity (r ≥0.74). In rats with partial bladder outlet obstruction the micturition reflex failed before the bladder was empty due to a decreased afferent drive from bladder mechanoreceptors. Similar changes may contribute to post-void residual urine in humans with bladder outlet obstruction.

Bedside ultrasound diagnosis of atraumatic bladder rupture in an alcohol-intoxicated patient: a case report

Most commonly, patients who present to the emergency department with a history and physical examination suggestive of urinary bladder rupture report a preceding traumatic event. Spontaneous atraumatic bladder rupture is relatively uncommon, but can occur in the context of a recent alcohol binge. The alcohol-intoxicated patient presents diagnostic and therapeutic challenges to the emergency physician (EP) that take on additional urgency given the high mortality of unrecognized bladder rupture. This case report reviews bladder anatomy, the unique physiological changes in the alcohol-intoxicated patient, and the high mortality rate of a ruptured urinary bladder. We review the historical diagnostic imaging options followed by a discussion of how bedside ultrasound could expedite diagnosis and management. We present the case of a patient with spontaneous atraumatic rupture of the urinary bladder after a recent alcohol binge. Bedside ultrasound was utilized by the EP to determine the need for emergent surgical consultation and intervention. We recommend that EPs consider bladder rupture in their initial evaluation of patients presenting with nonspecific abdominal pain in the context of recent alcohol intoxication. When using bedside ultrasound to evaluate the pelvis, the presence of anterior or posterior vesicular fluid collections, the loss of normal pelvic landmarks, or irregularities in the bladder wall may increase the EPs suspicion for this disease entity and expedite time-sensitive management.

Bladder anatomy physiology and pathophysiology: Elements that suit near infrared spectroscopic evaluation of voiding dysfunction

Bladder studies are the most recent biomedical application of NIRS in urology. Transcutaneous monitoring of the detrusor muscle in the bladder wall as the organ fills and empties offers new parameters for evaluation of normal and dysfunc- tional voiding. While established as a research entity clinical adoption requires comprehensive understanding of the attributes and limitations of the technique. We review key anatomic and physiologic elements that suit the bladder to study using NIRS. These include the depth and consistent relationship of the anterior wall below the abdominal skin which allow transcutaneous monitoring; the unique vas- cular anatomy which is central to normal organ function and maintenance of perfusion during the spatial changes that occur during bladder expansion and contraction; and the known association of various pathologies with adverse effects on the micro- circulation and compromise of the contractile properties of the detrusor muscle. Such pathologies cause symptoms of voiding dysfunction which in many patients are due to disordered detrusor hemody- namics and/or an imbalance in oxygen supply and demand. Yet current clinical methodology for evaluating the underlying cause of voiding dysfunction only measures pressure and flow, and provides no information related to bladder hemodynamics or oxygenation. Monitoring data from prior studies that illustrate how NIRS of the bladder can contribute novel information related to the physiology of the bladder in health and disease are summarized.

Surgical management of vesicoureteral reflux in children

Vesicoureteral reflux (VUR) is the most common uropathy affecting children. Compared to children without VUR, those with VUR have a higher rate of pyelonephritis and renal scarring following urinary tract infection (UTI). Options for treatment include observation with or without antibiotic prophylaxis and surgical repair. Surgical intervention may be necessary in patients with persistent reflux, renal scarring, and recurrent or breakthrough febrile UTI. Both open and endoscopic approaches to reflux correction are successful and reduce the occurrence of febrile UTI. Estimated success rates of open and endoscopic reflux correction are 98.1% (95% CI 95.1, 99.1) and 83.0% (95% CI 69.1, 91.4), respectively. Factors that affect the success of endoscopic injection include pre-operative reflux grade and presence of functional or anatomic bladder abnormalities including voiding dysfunction and duplicated collecting systems. Few studies have evaluated the long-term outcomes of endoscopic injection, and with variable results. In patients treated endoscopically, recurrent febrile UTI occurred in 0–21%, new renal damage in 9–12%, and recurrent reflux in 17–47.6% of treated ureters with at least 1 year follow-up. These studies highlight the need for standardized outcome reporting and longer follow-up after endoscopic treatment.

Mutations in HPSE2 Cause Urofacial Syndrome

Urinary voiding dysfunction in childhood, manifesting as incontinence, dysuria, and urinary frequency, is a common condition. Urofacial syndrome (UFS) is a rare autosomal recessive disease characterized by facial grimacing when attempting to smile and failure of the urinary bladder to void completely despite a lack of anatomical bladder outflow obstruction or overt neurological damage. UFS individuals often have reflux of infected urine from the bladder to the upper renal tract, with a risk of kidney damage and renal failure. Whole-genome SNP mapping in one affected individual defined an autozygous region of 16 Mb on chromosome 10q23-q24, within which a 10 kb deletion encompassing exons 8 and 9 of HPSE2 was identified. Homozygous exonic deletions, nonsense mutations, and frameshift mutations in five further unrelated families confirmed HPSE2 as the causative gene for UFS. Mutations were not identified in four additional UFS patients, indicating genetic heterogeneity. We show that HPSE2 is expressed in the fetal and adult central nervous system, where it might be implicated in controlling facial expression and urinary voiding, and also in bladder smooth muscle, consistent with a role in renal tract morphology and function. Our findings have broader implications for understanding the genetic basis of lower renal tract malformations and voiding dysfunction.

Laparoscopic Diverticulocystoplasty

Secondary diverticula initially serve as a pop-off mechanism in high-pressure voiding. Large diverticula, however, have been implicated in bladder-neck and ureteral obstruction and frequently demand definitive treatment, which, so far, has usually meant excision. We present this first report on using the diverticulum for laparoscopic urothelialized bladder augmentation as a novel procedure. We performed laparoscopic freehand sutured diverticulocystoplasty in 3 adult male patients suffering from low-capacity, low-compliance bladders accompanied by hydroureteronephrosis. All 3 patients had a dominant large diverticulum with very poor drainage by voiding and catheterization. The technique is described in detail. Patients were followed for upper tract changes and bladder anatomy by cystogram, sonography antegrade pyelography (per case), and laboratory studies. The procedures lasted 114-152 minutes. Patients were discharged uneventfully on postoperative day 3. At the 9-month follow-up, mean functional bladder capacity had increased by 266% (range, 195-351), and mean maximum detrusor pressure had dropped by 190% (range, 167-234). At 15-32 months, upper tract dilation has improved in all 3 patients. All patients remain on intermittent catheterization, though with far less frequency than before surgery. When there is a dominant bladder diverticulum with poor evacuation, and the bladder is noncompliant, laparoscopic bladder augmentation by the diverticulum (instead of standard diverticulectomy) can afford functional improvement with minimal morbidity.

On Occasion of 800th Anniversary of Birth of Ibn al-Nafis - Discoverer of Cardiac and Pulmonary Circulation

With Ibn Sina great Canon came the "golden age of Arabic medicine", almost to its peak. Since the beginning of XI century, when Ibn Sina died, until the middle of XIII century, when creative was Ibn al-Nafis, medical science continues to develop and progress, and had its brilliant minds. For that time characteristic is the fact that neither the strong authority as Avicenna was could paralyze the progress of medical science. Three hundred years before Paracelsus, in Cairo appears a medical scientist who dares to touch the authority of Ibn Sina-Avicenna in the infallibility of Canon-"Medical Bible". The scholar was called Alauddin Ibn al-Nafis (1210-1288). He, 250 years ago Servet, (Michael Servetus, XVI century) reveals the truly describes the small or pulmonary circulation, but also gives a description of the great forerunner of the bloodstream. In his separate work on the anatomy, Ibn al-Nafis in five places contested arguments of Galen's teachings, which also Ibn Sina was accepted. He very persuasively argues that the blood does not oxidize ("does not mix with air "), passing through some hypothetical pores in the partition between the right half of the heart, in which blood is collected and left half, in which, supposedly is the air, but that this happen when the blood is going from the right ventricle through the pulmonary artery into the lungs, where it is mixed with air and thus "converted" murmurs through the pulmonary vein into the left half of the heart. On occasion of the 800th anniversary of Ibn al-Nafis birth, one of the largest Arab and world doctors of all times we publish this article so that readers get something closer image his creative work, especially the one which relates to his contribution to the discovery of cardiac and pulmonary circulation, revolutionary discoveries in the world of medicine. In the year 1924 a heated debate started regarding the discovery of the pulmonary circulation. This discovery was attributed only to European scholars. It stemmed back to the sixteenth century. When Michael Servetus (1511-1553), Anderea Vesalius (?1514-1654), Nicolai Massa (1485-1569), Realdo Colombo (1520-1654), Valverde De Hamusco (1508-1565), Andera Cesalpino (1519-1603), Fabrici d'Aquapendent (1533-1619) and William Harvey (1578-1657) developed the concept. However, Muhyi-d-din At-Tatawi (1896-1945) presented his thesis "Der Lungenkreislauf nach El-Korachi. Dissert, z.eil. d. Doktorwrde, Freiburg im Brisgau 1924" of the blood circulation according to al Qurashi relaying on his discovery of his description of pulmonary circulation in one of ancient manuscripts, He proposed that the real credit for the discovery of the pulmonary circulation belongs this eminent physician of the thirteenth century: Ibn al-Nafis. Later another doctor Abdul Kareem Chihade (1922- ) presented another dissertation in Paris 1951 entitled" decouverte de la circulatio pulmonaire chez Ibn an-Nafis". Published by Institut Francais De Damas 1955. Other prominent professors like: Paul Galiounji and Salman Qatayyah researched extensively in his manuscripts and produced very important monographs. The general consensus is that Ibn al-Nafis' work exerted great influence on the development of medical science, both in the Islamic world and Europe. A closer look on Ibn al-Nafis contribution would indicate that he also described the coronary circulation, the cranial nerves the gall bladder anatomy and many new aspect of ophthalmology. He advocated as well therapy through nutrition. His work integrated the medical knowledge with great clarity and emphasized precision.