Internal Urethral Orifice Research Articles

Risk factors for postpartum stress urinary incontinence: a prospective study

PurposePostpartum stress urinary incontinence (SUI) is a common occurrence in women, and it has a profound effect on women’s health and quality of life. This study aimed to investigate the risk factors for postpartum SUI and the relative importance of each factor, including pelvic floor ultrasound measurement data and clinical data.MethodPregnant women who delivered in our hospital from March 2021 to January 2022 were selected as the study population. The clinical and anatomical Data from women with SUI and those without SUI were collected and analyzed. The clinical and anatomical risk factors associated with postpartum SUI were identified using univariate and multivariate analyses.ResultsA total of 255 participants were recruited. Logistic regression analysis indicated that age (OR:1.215, 95% CI:1.097–1.346, P < 0.001), vaginal delivery (OR:3.05, 95% CI:1.328–7.016, P < 0.009), parity (OR:3.059, 95% CI:1.506–6.216, P < 0.002), bladder neck descent (OR:4.159, 95% CI: 2.010–8.605, P < 0.001), the angle of the internal urethral orifice funnel (OR:1.133, 95% CI:1.091–1.176, P < 0.001) were important independent risk factors for postpartum SUI (all P < 0.05). The AUC was 0.883 (95% CI: 0.839–0.926) in the model.ConclusionsAge, vaginal delivery, parity, bladder neck descent and the angle of the internal urethral orifice funnel are independent risk factors for postpartum SUI. To prevent the occurrence of postpartum SUI, high-risk factors of postpartum SUI should be identified as early as possible during pregnancy and after delivery, and postpartum pelvic floor rehabilitation training should be promoted.

Towards Automated Dosimetric Analysis of the Bladder Trigone: Deep-Learning-Based Joint Segmentation and Landmark Localization

The bladder trigone dosimetry is hypothesized to have a stronger correlation with post-SBRT urinary toxicity than that of the entire bladder. However, the trigone tends to move significantly between simulation and daily treatment. Its small size, large daily motion, and proximity to the target lead to potentially consequential but unaccounted-for dosimetric uncertainties. Manual segmentation of the structure can be inconsistent and time-consuming, even with MR-guided RT. Here, we propose and demonstrate a deep-learning-based framework for joint segmentation and landmark localization to support deformable registration and comprehensive dosimetric analysis. A total of 30 patients were randomly selected for training, and 20 were held out for testing. Each patient had 1 simulation and 5 daily pre-treatment images obtained from a clinical 0.35T MR Linac. The trigone is defined as the triangular bladder section among three landmarks (2 ureteral orifices and the internal urethral orifice). In the manual contouring process, the 3 landmarks were identified first, followed by trigone segmentation. The proposed joint method uses a modified 3D nnU-Net with 2 decoders, one for segmentation and the other for landmark localization. The shared encoder is expected to extract features useful for both tasks. The joint framework was compared with a baseline method using two separate 3D nnU-Nets for landmark localization and trigone segmentation, respectively. Since the trigone is small (∼2% of the bladder volume), we further experimented with a second-stage prediction mimicking the human contouring process. The predicted landmarks from the first stage were used to crop the trigone region, and a second network was trained on cropped images. Evaluation metrics included the Dice score, 95% Hausdorff distance (HD95), and average surface distance (ASD) for segmentation, and Euclidean distance (ED) between the predicted and ground truth landmarks for localization. The quantification metrics are summarized in the table below. The joint approach shows similar Dice performance to the baseline method but markedly better HD95 by 13%. For landmark localization, the proposed method is similar to the baseline, but the integration of the segmentation task stabilizes the training process. The two-stage approach further improves HD95, ASD, and ED by 27%, 24%, and 19%. Combining segmentation and landmark localization exhibits a synergistic effect. The proposed two-stage approach provided additional improvement. Future studies will explore the deformable registration of the trigone based on the segmentation and landmark detection, as well as analyze cumulated dose distribution.

Establishment and validation of a risk prediction model for postpartum stress urinary incontinence based on pelvic floor ultrasound and clinical data

Introduction and hypothesisThis study aimed to establish a risk prediction model for postpartum stress urinary incontinence (SUI) based on pelvic floor ultrasound measurement data and certain clinical data.MethodsSingleton pregnant women aged ≥ 18 years who underwent delivery were selected. All participants were followed up to determine the symptoms of SUI, and pregnancy-related data were collected at the time of registration. Pelvic floor ultrasound was performed at 6–12 weeks postpartum to obtain ultrasonic measurement data. Logistic regression analysis was used to select predictors and establish a nomogram to predict the risk of postpartum SUI. Area under the ROC curve (AUC) values and calibration curves were used for discrimination and calibration, respectively. Finally, external verification of the model was carried out.ResultsA total of 255 participants were included in the analysis, comprising 105 in the postpartum SUI group and 150 in the non-SUI group. Logistic regression analysis identified age, parity, vaginal delivery, bladder neck descent (BND), and angle of internal urethral orifice funnel as risk factors for postpartum SUI (all P < 0.05).ConclusionsWe constructed a prediction model for postpartum SUI based on pelvic floor ultrasound measurement data and certain clinical data. In clinical practice, this convenient and reliable tool can provide a basis for formulation of treatment strategies for patients with postpartum SUI.

Exploring the impact of urogenital organ displacement after abdominoperineal resection on urinary and sexual function

PurposeThis study aimed to establish the functional impact of displacement of urogenital organs after abdominoperineal resection (APR) using validated questionnaires.MethodsPatients who underwent APR for primary or recurrent rectal cancer (2001–2018) with evaluable pre- and postoperative radiological imaging and completed urinary (UDI-6, IIQ-7) and sexual questionnaires (male, IIEF; female, FSFI, FSDS-R) were included from 16 centers. Absolute displacement of the internal urethral orifice, posterior bladder wall, distal end of the prostatic urethra, and cervix were correlated to urogenital function by calculating Spearman’s Rho (ρ). Median function scores were compared between minimal or substantial displacement using median split.ResultsThere were 89 male and 36 female patients included, of whom 45 and 19 were sexually active after surgery. Absolute displacement of the internal urethral orifice and posterior bladder wall was not correlated with UDI-6 in men (ρ = 0.119 and ρ = 0.022) nor in women (ρ = − 0.098 and ρ = − 0.154). In men with minimal and substantial displacement of the internal urethral orifice, median UDI-6 scores were 10 (IQR 0–22) and 17 (IQR 5–21), respectively, with corresponding scores of 25 (IQR 10–46) and 21 (IQR 16–36) in women. Displacement of the cervix and FSDS-R were correlated (ρ = 0.433) in sexually active patients.ConclusionThis first analysis on functional impact of urogenital organ displacement after APR suggests that more displacement of the cervix might be associated with worse sexual function, while the data does not indicate any potential functional impact of bladder displacement. Studies are needed to further explore this underexposed topic.

Urinary bladder duplication in coronal plane in a dog

AbstractAn 8‐year‐old female intact Yorkshire terrier was presented with a 1‐year recurrent urinary tract infection. Abdominal ultrasound, computed tomography, positive contrast retrograde urethrography and cystoscopy were performed, revealing a tubular structure continuous with the ventral wall of the bladder connected with the urethra by an ostium ventral to the internal urethral orifice. Excision of the tubular structure was performed. Histopathological results were consistent with urinary bladder tissue. One year after surgery no clinical signs were reported. To the authors’ knowledge, this is the first report of urinary bladder duplication in the coronal plane with a single urethra in a dog.

Quantifying displacement of urogenital organs after abdominoperineal resection for rectal cancer.

AimThis study aimed to quantify displacement of urogenital organs after abdominoperineal resection (APR), and to explore patient and treatment characteristics associated with displacement.MethodPatients from 16 centres who underwent APR for primary or recurrent rectal cancer (2001–2018) with evaluable preoperative and 6–18 months postoperative radiological imaging were included in the study. Anatomical landmarks on sagittal images were related to a coordinate system based on reference lines between fixed bony structures and absolute displacements were calculated using the Pythagorean theorem. Rotation of landmarks was measured relative to a pubic‐S5 reference line.ResultsThere were 248 patients included of which 171 were men and 77 women. The median displacement of the internal urethral orifice was 25 mm in men (maximum 65), and 17 mm in women (maximum 50). Rotation of the internal urethral orifice was in a caudal direction in 160/170 (94%) of men and 65/73 (89%) of women, with a median of 32 degrees (maximum 85) and 33 degrees (maximum 83), respectively. Displacements of the posterior bladder wall, distal end of prostatic urethra and cervix were significantly correlated with the internal urethral orifice. In linear regression analysis, biological mesh reconstruction of the pelvic floor and visceral interposition were significantly associated with increased displacement of the internal urethral orifice, and female gender and any filling of the presacral space with decreased displacement.ConclusionsSubstantial absolute displacement and rotation of urogenital organs after APR for rectal cancer were observed, but with high variability among both men and women, and being significantly associated with reconstructive interventions.

Факторы риска развития осложнений при пластике пузырно-влагалищных свищей с предоперационным применением аутоплазмы, обогащенной тромбоцитами

Introduction. Vesicovaginal fistula, or VVF, is one of the most urgent and sociomedically significant problems in modern urology. As of today, more than three million women suffer from VVF worldwide. Purpose of the study. To evaluate the risk factors for complications in a group of patients with VVF operated with the preliminary use of platelet-rich plasm, or PRP. Materials and methods. Study included 22 patients who underwent surgical closure of VVF in period from 2011 to 2018 with the preliminary preparation of PRP tissues. A total of 22 patients were divided into two groups: the 1st group included 14 patients who had no complications, while the 2nd group included eight women with developed complications. Results. Statistically significant differences in the assessment of clinical characteristics of patients in the two groups were observed for the following indicators: duration of hospitalization (p&lt;0.01), duration of bladder drainage (p&lt;0.01). Urinary tract infection, or UTI, was identified more often in the group with complications (p&lt;0.05). Presence of hypertension (p&lt;0.05), pain syndrome (p&lt;0.05), macrohematuria (p&lt;0.05). Statistically significant differences in the assessment of characteristics of vesicovaginal fistula of patients in the two groups were observed for four indicators: distance between the fistula and the internal urethral orifice (p&lt;0.05), the largest diameter of the fistula (p&lt;0.05), the stage of сicatrization (p&lt;0.05), the diameter of the fistula before surgical treatment (p&lt;0.01). Conclusion. Results of the study dictate the need for an operating surgeon to carefully select the timing and volume of surgical treatment, taking into account many factors mentioned above. Patients should be made aware in detail of possible complications that might arise following VVF fistuloplasty and the reasons for their development in order to adequately prepare for surgical treatment, compensate for concomitant diseases, optimize tissues and blood vessels for better healing of the postoperative wound.

V14-11 TRANSVESICAL ROBOT ASSISTED RADICAL PROSTATECTOMY

You have accessJournal of UrologyProstate Cancer (V14)1 Apr 2020V14-11 TRANSVESICAL ROBOT ASSISTED RADICAL PROSTATECTOMY Gongxian Wang*, Xiaochen Zhou, Bin Fu, and Cheng Zhang Gongxian Wang*Gongxian Wang* More articles by this author , Xiaochen ZhouXiaochen Zhou More articles by this author , Bin FuBin Fu More articles by this author , and Cheng ZhangCheng Zhang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000982.011AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To introduce the technique and report our initial experience of transvesical robot assisted radical prostatectomy (TvRARP). METHODS: 35 TvRARP for prostate cancer performed by a single surgical team between 2018 April and 2019 April were retrospectively reviewed. Preoperative data of patients [patient age (63.4, [49-73]) years, BMI (28.6 [22.1-35.4]) kg/m2, tPSA (10.8 [4.6-19.5]) ng/ml, biopsy Gleason score 6 (6∼7), prostate volume (30.6 [15.4-61.2]) ml and IIEF-5 score 15 (10∼20)] were collected. Preoperative study revealed 28 cases of cT2a and 7 case of cT2b. All patients were continent preoperatively. Surgical techniques: The surgery was performed with da Vinci Si system via 4 robotic ports and 2 assistant ports as the following: 1) cystotomy, further expended by bilateral suspension stitches. 2) A circumferential incision is made around the internal urethral orifice through the mucosa and muscular layer. 3) Initial dissection of the vas deferens and semi vesicles is carried out through the lower half of the circumferential incision around the internal urethral orifice. 4) Posterior dissection towards the apex of the prostate. 5) Dissection of bilateral NVB. 6) Anterior dissection towards the apex of the prostate. 7) Dissection and transection of the urethra. 8) Urethrovesical anastomosis. 9) 2-layer closure of bladder. RESULTS: All 35 cases were successfully performed robotically without conversion, transfusion or other major intraoperative and postoperative complications. Postoperative pathology confirmed 24 pT2a cases, 9 pT2b cases and 2 pT2c case [Gleason score 6 (6∼8)]. 4 case reported positive surgical margin (12.5%). Operative time was (130 [90-190]) min. Estimated blood loss was (100 [50-250]) ml. Urethral catheter was removed at postoperative 7-day. 32 patients achieved urinary continence (0 pads) immediately after the removal of urinary catheter, while 3 patient returned to full continence in 2 weeks postoperatively. During a mean follow up of 12 months (6∼18 months), no biochemical recurrence was noted (tPSA<0.2ng/ml). At 2-month postoperatively, IIEF-5 score was 15 (10∼19) and not statistically different from preoperative status (p > 0.05). CONCLUSIONS: Transvesical approach is a valid alternative of performing RARP in patients bearing localized low-risk prostate cancer. Tumor control and preservation of erectile function remains to be determined in long term follow up. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1309-e1309 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gongxian Wang* More articles by this author Xiaochen Zhou More articles by this author Bin Fu More articles by this author Cheng Zhang More articles by this author Expand All Advertisement PDF downloadLoading ...

Surgical techniques and short-term outcomes of transvesical robot assisted radical prostatectomy

Objective To introduce the technique and report our initial experience of transvesical robot assisted radical prostatectomy (TvRARP). Methods From April 2018 to August 2018, 10 patients underwent TvRARP performed by a single surgical team were retrospectively reviewed. Preoperative data of patients [aged (58.6±9.4) years, BMI (26.5±3.1) kg/m2, tPSA (19.5±4.1) ng/ml, biopsy Gleason score 6(6-7), prostate volume (33.4±15.8)ml and IIEF-5 score 12(10-16)] were collected. Preoperative study revealed 8 cases of cT1c, 1 case of cT2a and 1 case of cT2b. All patients were continent preoperatively. During the surgical procedure, the bladder was opened, and a circumferential incision was then made around the internal urethral orifice. Initially, posterior dissection of bilateral vas deferens and seminal vesicles was performed, followed by posterior dissection towards apex. Lateral dissection of neurovascular bundles was performed before anterior dissection towards apex. The exposed urethra was transected and specimen was removed. Vesicourethral anastomosis and closure of bladder was performed in a standard way. Results All 10 cases were successfully performed robotically without conversion, transfusion or other major intraoperative or postoperative complications. Postoperative pathology confirmed 6 cases of pT2a , 3 cases of pT2b and 1 case of pT2c [median Gleason score 6(6-7)]. One case was reported positive surgical margin. Operative time was (140.5±35.5) mins. Estimated blood loss was (65.5±35.5) ml. Urethral catheter was removed at 7 days postoperatively. Nine patients achieved urinary continence (0 pads) immediately after the removal of urinary catheter, while 1 patient returned to full continence at 2 weeks postoperatively. During a mean follow-up of 3 months (2-4 months), no biochemical recurrence was detected (tPSA 0.05). Conclusions Transvesical approach is a valid alternative of RARP in patients bearing localized low-risk prostate cancer. Tumor control and preservation of erectile function remains to be determined by long term follow-up. Key words: Radical prostatectomy; Robot; Transvesical approach; Localized prostate cancer

Topographic distribution of serotonin-immunoreactive urethral endocrine cells and their relationship with calcitonin gene-related peptide-immunoreactive nerves in male rats

We investigated the topographic distribution and morphology of serotonin (5-HT)-immunoreactive endocrine cells in the urethra of male rats, and focused on their relationship with peptidergic nerve fibers immunoreactive for calcitonin gene-related peptide (CGRP). Urethral endocrine cells immunoreactive for 5-HT were densely distributed in the epithelial layers of the prostatic part, but were sparsely distributed in the membranous and spongy parts of urethra. Distribution of urethral endocrine cells with 5-HT immunoreactivity in the prostatic part was restricted from the internal urethral orifice to the region of seminal colliculus. 5-HT-immunoreactive endocrine cells were also observed in the ductal epithelial layers of coagulating glands, prostatic glands, and seminal vesicles. 5-HT-immunoreactive endocrine cells were triangular or flask in shape and possessed an apical projection extending toward the urethral lumen, and basal or lateral protrusions intruding between other epithelial cells were also detected in some cells. Double immunolabeling for 5-HT and CGRP revealed that CGRP-immunoreactive nerve fibers attached to urethral endocrine cells with 5-HT immunoreactivity in the prostatic part. These results suggest that urethral endocrine cells may release 5-HT in response to luminal stimuli, and that these cells and CGRP-immunoreactive nerves may regulate each other by an axon reflex mechanism.

Urethral ultrasonography: A novel diagnostic tool for dysuria following bipolar transurethral plasma kinetic prostatectomy.

Urethral ultrasonography is non-invasive and able to indicate the urethral lumen clearly, as well as the surrounding tissues of the posterior urethra, without contrast agent or X-ray irradiation. In this paper, we evaluate the reliability of urethral ultrasonography in the diagnosis of dysuria following bipolar transurethral plasma kinetic prostatectomy (TUPKP). A total of 120 benign prostate hyperplasia (BPH) patients with dysuria undergoing TUPKP were enrolled in this study, with a mean age of 72.8 years. All the patients received urethral ultrasonography, urethroscopy and bladder neck urethra stenosis oulectomy. Among the 120 cases, there were 22 cases of bladder neck closure, 20 bladder orifice stricture, 60 urethral stricture, 10 prostate remnants, 2 calculi in prostatic urethra, 4 dysfunction of bladder detrusor muscle and 2 flap of internal urethral orifice. χ2-test was used for the comparison of ultrasonography and urethral cystoscopy in the diagnosis of dysuria following TRPKP, and no significant difference was found between two diagnostic tools (χ 2 = 0.94, P > 0.05). Urethral ultrasonography is a reliable and minimally invasive diagnostic tool for dysuria following TUPKP and is conducive to early treatment of dysuria following prostatectomy.

Technique of Tubularized Bladder Mucosa Method for Treating Recurrent Vesicoureteral Reflux.

Technique of Tubularized Bladder Mucosa Method for Treating Recurrent Vesicoureteral Reflux.

Muscular Structure at the Male Bladder Outlet Examined With Successive Celloidin-embedded Slices

To re-examine the detailed anatomy of the muscular system at the bladder neck and proximal urethra in the male and to explore its function in urinary continence and micturition further. The pelvic organs, including bladder, prostate, and rectum, were obtained from 20 formalin-fixed adult male cadavers and were removed from the pelvic cavity and embedded in celloidin in their entirety. The embedded block was cut into successive slices with an immersing-alcohol microtome. Circular muscle fibers of the detrusor at the bladder outlet consist of the anterior downward-projected circular muscle fibers of the bladder outlet (ADPC), the bilateral accumulated circular fibers, and the posterior circular fibers of the bladder outlet. Together, these fibers concentrically surround the internal urethral orifice and trigone muscle. The lower part of the ADPC surrounds the ventral surface of the proximal urethra. Longitudinal muscle fibers are radially inserted into the circular muscle around the internal urethral orifice. Numerous fibers from the ventral longitudinal muscle are inserted into the lower part of the ADPC. The upper part of the trigone muscle exists in bladder cavity; the lower part extends into the proximal urethra to surround the posterior and posterolateral surface of the urethra. The ADPC and the upward extension of the rhabdosphincter comprise the anterior fibromuscular stroma. The circular muscle of the bladder outlet may be responsible for closure; the longitudinal muscle of the bladder outlet may be responsible for opening of the internal urethral orifice and proximal urethra.

Congenital urethrovaginal fistula associated with imperforate hymen causing fetal urinary ascites and abdominal cystic lesions: A case report and literature review

Abstract A primipara presented to our hospital due to fetal ascites, bilateral hydronephrosis and hydrometrocolpos. The female baby had two giant abdominal cysts, a single atrium and foot polydactyly. Absence of the vaginal orifice was noticed, and the hymen was broken through; the left cyst collapsed after fluid drainage. The right cyst was punctured and drained, which improved the hydronephrosis. Contrast imaging showed medium pouring into the abdominal cavity via the uterine tube; the right cyst was a 6 × 5 cm closed cavity. Vaginal uroplania persisted even after hospital discharge. At the age of 4 years, cystoscopy showed a fistulous opening on the urethra 5 mm distal from the internal urethral orifice. A catheter inserted via the opening was found in the vagina. In our case, urine poured into the abdominal cavity through the fistula and uterine tube; following obstruction of the uterine tube, giant hydrometrocolpos and hydrosalpinx appeared. Three cases of congenital urethrovaginal fistula (CUVF) with imperforate hymen have been reported. A remnant of communication between the uterovaginal primordium and urogenital sinus may be responsible for CUVF.

Implantation of Autologous Adipose-Derived Cells Reconstructs Functional Urethral Sphincters in Rabbit Cryoinjured Urethra

We investigated the ability of autologous adipose-derived cells injected into cryoinjured rabbit urethras to improve urinary continence and explored the possible mechanisms by which it occurred. Adipose tissue was harvested from the perivesical region of nine 10-week-old female New Zealand White rabbits and cultured for 7 days. Immediately after harvesting the tissue, we injured the internal urethral orifice by spraying liquid nitrogen for 20 s. The cultured cells expressed the mesenchymal cell marker STRO1, but not muscle cell markers myoglobin or smooth muscle actin (SMA). Just before implantation, the adipose-derived cells were labeled with the PKH26 fluorescent cell linker. Autologous 2.0×10(6) adipose-derived cells (five rabbits) or a cell-free control solution (four rabbits) was injected around the cryoinjured urethras at 7 days after injury. Fourteen days later, the leak point pressure (LPP) was measured, and the urethras were harvested for immunohistochemical analyses. At 14 days after implantation, LPP of the cell-implanted group was significantly higher compared with the cell-free control group (p<0.05). In immunohistochemical examination, the reconstructed skeletal and smooth muscle areas in the cell-implanted regions were significantly more developed than those in controls (p<0.01). Implanted PKH26-labeled adipose-derived cells were immunohistochemically positive for myoglobin, SMA, and Pax7 antibodies, which are markers for skeletal muscles, smooth muscles, and myoblast progenitor cells, respectively. In addition, these implanted cells were positive for the nerve cell markers, tubulin β3, S100, and the vascular endothelial cell marker, von Willebrand factor. Furthermore, some of the implanted cells were positive for the transforming growth factor β1, nerve growth factor, and vascular endothelial growth factor. In conclusion, implantation of autologous adipose-derived cells into the cryoinjured rabbit urethras promoted the recovery of urethral function by myogenic differentiation, neuroregeneration, and neoangiogenesis of the implanted cells and/or the surrounding tissues as well as by bulking effects. Thus, treatment of human radical prostatectomy-related stress urinary incontinence by adipose-derived cell implantation could have significant therapeutic effects.

Ultrasound diagnosis in inverted papilloma of the bladder

Objective To explore the ultrasound findings of inverted papilloma of the bladder (IPB).Methods The clinical manifestation,cystoscopy examination,intraoperative observation and ultrasonographic imaging of 24 patients with IPB,which were confirmed by surgery and pathology examination,were analyzed retrospectively.Results 24 patients underwent ultrasound examination and 24 tumors were found.The maximum diameter of tumors were from 1.0 cm to 3.4 cm:1.0-2.0 cm (n =17),2.0-3.4 cm (n =7).Tumors were papillary (n =17) or cauliflower shape (n =7),6 cases had pedicles and none in 18 cases,2 cases swung in the bladder cavity.Tumors were slight hyperecho (n =14) or highlevel echo (n =10),and could be divided into three types:homogenous internal echoes (n =14),inhomogenous internal echoes with punctiform hyperecho in brim or internal part (n =7),inhomogenous internal echoes with peripheral hyperecho and hypoecho in internal part (n =3).Color Doppler flow imaging (CDFI) showed that there were no blood flow signal in 17 cases,punctiform blood flow signal in 4cases,point and strip blood flow signal or strip blood flow signal in 3 cases.Local bladder walls were continuous and there were no attenuation behind the tumors.The onset position were:triangular area (n =6),left posterior wall (n =5),internal urethral orifice (n =4),right lateral wall (n =3),right posterior wall (n =3),posterior wall (n =2),left lateral wall (n =1).5 cases were misdiagnosed as bladder carcinoma,and 17 cases were considered as solid tumors,and only 1 case was diagnosed as papilloma,and 1 case was considered as benign lesion.Conclusions The representative ultrasonographic imaging of IPB are mostly single,pedunculated,papillary or cauliflower shape with smooth surface,neck and trigone of bladder are the most risk position.Color Doppler ultrasonography can be used as the important screening process for IPB. Key words: Ultrasonography; Urinary bladder neoplasms; Papilloma,inverted

The clinical value of sonourethrography after bipolar transurethral plasmakinetic prostatectomy

The aim of this study was to assess the value of transrectal sonourethrography in the diagnosis of dysuria after bipolar transurethral plasmakinetic prostatectomy (TUPKP). Seventy-seven male patients with dysuria after TUPKP underwent transrectal sonourethrography. The clinical data were then compared with the surgical outcomes. The following pathologies were diagnosed: Bladder neck atresia (17/77), bladder orifice strictures (15/77), membranous urethral strictures (21/77), pars cavernosa urethral stricture (12/77), residual prostate gland (5/77), external urethral orifice stricture (2/77), calculi in the prostatic urethra (2/77), flap in the internal urethral orifice (2/77), and postoperative dysfunction of the bladder detrusor muscle (1/77). Transrectal sonourethrography is a reliable diagnostic method for numerous pathologies that occur in patients with dysuria after TUPKP and is a clinically useful tool.

Clinical value of sonourethrography in the diagnosis of dysuria after bipolar transurethral plasmakinetic prostatectomy

Objective To evaluate the value of sonourethrography in the diagnosis of dysuria after bipolar transurethral plasmakinetic prostatectomy. Methods Sixty male patients with dysuria after bipolar transurethral plasmakinetic prostatectomy underwent sonourethrography and re-operation.The clinical data of these patients were reviewed. Results The sonourethrographic findings were similar with the operative findings in 57 cases.In the 60 cases,there were 11 cases with bladder neck closure,10 cases with bladder neck stricture,30 cases with urethral stricture (16 located at membranous urethra,12 located at pars cavernosa urethra and 2 in external orifice of urethra),5 cases with prostate remnant,1 case with calculi in prostatic urethra,2 cases with dysfunction of detrusor of bladder and 1 case with flap of internal urethral orifice,Conclusions Sonourethrography could be a reliable diagnostic method for dysuria after bipolar transurethral plasmakinetic prostatectomy.It may be helpful for clinical treatment. Key words: Hyperplasian of prostate; Bipolar transurethral plasmakinetic prostatectomy; Dysuria; Sonourethrography

Ultrasonography of the urinary tract in 29 female Saanen goats

The left and right kidneys, ureters, urinary bladder and urethra of 29 female clinically healthy Saanen goats were examined via transcutaneous and transrectal ultrasonography. In order to establish reference values the examinations were performed using a 5.0 MHz linear transducer to scan the right caudal costal part of the abdominal wall, right and left dorsal flanks and right and left inguinal regions of standing goats. A 5.0 MHz intracavity probe was used for transrectal ultrasonographic examination of the urinary bladder and urethra. The kidneys were examined in longitudinal and cross section and assessed subjectively. They could usually be seen from the 12th intercostal space on the right side and dorsal right flank. The right kidney was 8.0 ± 0.67 cm long and the left was 8.4 ± 0.64 cm long. The ureters could not be visualized in any of the goats. The length of the urinary bladder was 5.1 ± 1.38 cm, and its largest cross-sectional diameter was 2.6 ± 1.01 cm. The urethra was seen in 23 goats and appeared as echogenic lines with no visible lumen. The transition from the neck of the bladder to the internal urethral orifice extended beyond the brim of the pelvis in only one goat.

Implantation of Autologous Bone-Marrow-Derived Cells Reconstructs Functional Urethral Sphincters in Rabbits

The purpose of this study was to determine if implantation of autologous bone-marrow-derived cells has the potential to treat stress urinary incontinence caused by intrinsic sphincter deficiency. Bone marrow cells harvested from femurs of New Zealand White rabbits were cultured for 10 days. Seven days before implantation, the urethral sphincters located at the internal urethral orifice were cryo-injured by spraying liquid nitrogen for 15 s. The cultured autologous bone-marrow-derived cells were implanted 7 days after cryo-injury. For controls, cell-free solutions were injected. At 7 and 14 days after implantation, leak point pressures were determined and the urethral sphincters were examined by immunohistochemistry. At 7 and 14 days, the cell-implanted regions contained numerous striated and smooth muscle-like cells expressing myoglobin and smooth muscle actin, respectively. The proportions of myoglobin- and smooth muscle actin-expressing areas in both the 7- and 14-day cell-implanted regions were significantly higher than in controls. By 14 days, these differentiated cells formed contacts with similar cells, creating layered muscle structures. At that time, the leak point pressure of the cell-implanted rabbits was significantly higher than that of the controls. In conclusion, autologous bone-marrow-derived cells can reconstruct functional urethral sphincters.