Anatomy Of Lower Urinary Tract Research Articles

Recurrent Urinary Tract Infection in Women from a Urologist’s Perspective

Urinary tract infection (UTI) referred to microbial invasion of the urinary tract system, typically due to bacteria. UTI is more common in women than men, which is thought to be due to differences in lower urinary tract anatomy. Making a diagnosis of UTI begins with the presence of clinical symptoms consistent with either pyelonephritis and cystitis. When pyelonephritis symptoms are present, it is usually associated with bacterial infection, while the symptoms of clinical cystitis may or may not be caused by infection. As both urologic and non-urologic conditions can produce the clinical symptoms of cystitis, diagnosis of UTI requires both pyuria and bacteriuria on urine examination. Complicated UTI is when the infection is associated with either host or bacterial factors that increase the chance of reinfection and decrease treatment efficacy, such as altered organism virulence, immunocompromise, or urinary tract abnormalities. The urologist’s primary role in UTI management is to evaluate for such urinary tract abnormalities and, if needed, resolve those conditions to prevent recurrent infection. This review will describe the urologists’ evaluation and management of complicated and recurrent UTI and inform physician about the urinary tract abnormalities that can predispose to recurrent UTI.

PD38-04 A COMMUNITY-BASED EDUCATION PROGRAM FOR OVERACTIVE BLADDER IN A PREDOMINANTLY MINORITY OLDER FEMALE POPULATION: A PILOT STUDY

You have accessJournal of UrologyCME1 May 2022PD38-04 A COMMUNITY-BASED EDUCATION PROGRAM FOR OVERACTIVE BLADDER IN A PREDOMINANTLY MINORITY OLDER FEMALE POPULATION: A PILOT STUDY Susana Martinez Diaz, Hudson Pierce, John Lee, Tirsit Asfaw, Andrew Abram, Naeem Bhojani, Dean Elterman, Kevin Zorn, and Bilal Chughtai Susana Martinez DiazSusana Martinez Diaz More articles by this author , Hudson PierceHudson Pierce More articles by this author , John LeeJohn Lee More articles by this author , Tirsit AsfawTirsit Asfaw More articles by this author , Andrew AbramAndrew Abram More articles by this author , Naeem BhojaniNaeem Bhojani More articles by this author , Dean EltermanDean Elterman More articles by this author , Kevin ZornKevin Zorn More articles by this author , and Bilal ChughtaiBilal Chughtai More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002596.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Knowledge gaps in available treatment and social stigmatization are barriers to care in patients with overactive bladder (OAB), especially for minority populations. We assess the feasibility of an OAB education program targeting older, minority community-dwelling females. METHODS: Women over age 55 were recruited from community centers in New York City. Individuals with a previous diagnosis of OAB were excluded to control for baseline knowledge about OAB. Eligible participants underwent an education program consisting of a slide presentation covering the following topics: bladder function, lower urinary tract anatomy, pathophysiology of OAB, effect of OAB on quality of life, pelvic floor exercise training, and bladder training. OAB symptom score and general and condition-specific quality of life scores were measured at baseline and 1 week, 3 months, and 6 months post-intervention using the Overactive Bladder Questionnaire-Short Form and Short Form-12. Change in scores over time was analyzed using a linear mixed-effects model for repeated measures. RESULTS: 37 female patients with OAB symptoms at baseline participated in the study. Most participants were from a Latino/Hispanic or Black/African American ethnic/racial background (Table 1). For our youngest subgroup (≤68 years old) significant improvements were observed at 3 and 6 months compared to 1 week post-intervention for symptom bother (3 months, -22.75, p=0.006; 6 months, -25.76; p=0.001) and condition-specific related quality of life sub-scale scores for concern (3 months, +23.76, p=0.006; 6 months, +22.15, p=0.011) and social interaction (3 months, +21.11, p=0.017; 6 months, +20.51; p=0.021). For all ages, improvements in general quality of life measures for mental health were seen at 3 and 6 months compared to baseline (3 months, +7.57, p=0.02; 6 months, +6.70; p=0.048). CONCLUSIONS: There were statistically significant improvements in symptom bother, condition-specific, and general quality of life measures following an OAB education program in a predominantly minority older female population. Further studies are needed to support efficacy and optimize design to benefit these patients in the long-term. Source of Funding: Weill Cornell Clinical and Translational Science Center grant support (CTSC GRANT UL1 TR000457) © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e646 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Susana Martinez Diaz More articles by this author Hudson Pierce More articles by this author John Lee More articles by this author Tirsit Asfaw More articles by this author Andrew Abram More articles by this author Naeem Bhojani More articles by this author Dean Elterman More articles by this author Kevin Zorn More articles by this author Bilal Chughtai More articles by this author Expand All Advertisement PDF DownloadLoading ...

B6 Mouse Strain: The Best Fit for LPS-Induced Interstitial Cystitis Model.

Interstitial cystitis (IC) is a chronic inflammatory disease characterized by bladder pain and increased urinary frequency. Although the C57BL/6J (B6) and FVB/NJ (FVB) mouse strains are commonly used as animal models for studies involving the urinary system, few reports have compared their lower urinary tract anatomy, despite the importance of such data. Our study aimed to characterize bladder function changes in FVB and B6 mouse strains with lipopolysaccharide (LPS)-induced IC, to understand mouse model-based bladder research. The bladder function parameters were measured by cystometrogram. Histological assay was examined by hematoxylin and eosin stain, Masson’s trichrome stain, and immunofluorescence staining. Results indicated that the two strains in the control group exhibited different bladder structures and functions, with significant anatomical differences, including a larger bladder size in the FVB than in the B6 strain. Furthermore, cystometry tests revealed differences in bladder function pressure. LPS-treated B6 mice presented significant changes in peak pressure, with decreased intercontraction intervals; these results were similar to symptoms of IC in humans. Each strain displayed distinct characteristics, emphasizing the care required in choosing the appropriate strain for bladder-model studies. The results suggested that the B6 mouse strain is more suitable for IC models.

Evaluation of transperineal sonography for lower urinary tract symptoms after pelvic floor reconstruction

Objective: To evaluate transperineal sonography for lower urinary tract symptoms after pelvic floor reconstruction. Methods: Eighty-three patients with severe pelvic organ prolapse received surgeries in Fuzhou General Hospital from September 2014 to September 2015, dividing into two groups: 27 patients were selected to receive transvaginal mesh (TVM) pelvic floor reconstruction surgery with tension-free vaginal tape-Abbrevo (TVT-Abbrevo) incontinence surgery, named TVM+TVT-Abbrevo group; 56 patients were selected to receive TVM pelvic floor reconstruction surgery only, named TVM group. The ultrasonic parameters at rest, on contraction and Valsalva condition respectively were observed and measured, including the bladder neck descent (BND), urethral rotation angle, retrovesical angle, levator urethra gap (LUG), the existence of bladder neck funneling, position of the tape, by using 2D and 3D transperineal ultrasound. Results: The two groups were compared with the ultrasonic parameters before and after operation: two groups of patients with postoperative BND [(2.3±0.5) versus (3.1±0.7) cm, (1.6±0.4) versus (3.6±0.4) cm] were significantly reduced, the difference was statistically significant (P=0.02, P<0.01). The two groups of LUG before and after operation [(3.62±0.45) versus (3.26±0.92) cm, (2.96±0.47) versus (2.72±0.38) cm] both had significant difference by maximum Valsalva (P<0.01, P=0.04). There was statistical significance difference of urethral rotation angle in TVM+TVT-Abbrevo group by maximum Valsalva (P=0.01). Observation of morphology: (1) 2 patients with difficulty in urination in TVM+TVT-Abbrevo group, ultrasound showed when the position of the bladder down the urethra discount; 4 patients with stress urinary incontinence (SUI), ultrasound showed slings off or release. (2) One patient with difficulty in urination in TVM group, but ultrasound showed lower urinary tract anatomy were normal; 5 patients with SUI, ultrasound showed the position of the bladder neck were significantly lower in 3 patients, showing high mobility, and the other 2 patients had a larger urethral diameter, showing a tendency of natural deletion. Conclusion: s Anatomy of lower urinary tract could be clearly showed by transperineal sonography. This could provide imaging support for the diagnosis of lower urinary tract symptoms after pelvic floor reconstruction.

Women's toileting behaviours: an online survey of female advanced practice providers.

An online survey of female advanced practice providers (APPs) in a large urban healthcare system was conducted to describe behaviours they use to manage their personal bladder emptying. The questionnaire contained items on demographics, presence of urinary incontinence (UI), and behaviours used to void in work, public and home settings. One hundred thirteen female APPs responded to the survey and 109 responded to items on UI. Over half (53%) reported experiencing UI at least once a week. In general, the APPs reported being worried about the cleanliness of public toilets and delaying voiding when busy. Incontinent APPs were older and had histories of more pregnancies than continent women. Incontinent APPs also used public toilets more frequently and when there was no or little need to void, and delayed or put off voiding while at work and when busy. Although APPs have specialised knowledge about lower urinary tract anatomy and physiology, many engage in behaviours that may be detrimental to bladder health. More research is needed to explore behaviours women use to manage voiding and the effect of these behaviours on bladder health.

Urodynamic studies in pediatric urology

In any type of lower urinary tract dysfunction it is mandatory to obtain as much information as possible on the function of the urinary tract. By definition of the International Continence Society, any investigation that produces such information is part of urodynamics. Thus, voiding and defecation history, physical examination, voiding frequency charts and defecation diaries are all essential parts of urodynamics. Repeated free uroflowmetry is considered an essential routine investigation by the International Children's Continence Society. Static and dynamic ultrasonography of the lower urinary tract and the pelvic floor can give important information on lower urinary tract anatomy and function, in a noninvasive manner. Invasive urodynamic studies such as voiding cystourethrography and cystometry are reserved for patients for whom the outcome of such studies is expected to change the therapeutic regime. Invasive urodynamic tests are performed primarily for one of two reasons. First, to confirm an expected diagnosis in new patients. Second, to ensure that the storage pressures in the bladder remain safe for normal functioning of the kidneys in children with chronic disease.

Imaging of urinary system in neonates

In neonates the most common indication for an imaging procedure is the follow-up of an abnormality detected during antenatal sonography. With its noninvasiveness, wide availability, and ease of use without the risks associated with ionizing radiation exposure, ultrasound is an excellent imaging modality for initial evaluation of a suspected neonatal abdominal mass. When a mass is present, the sonographic features and the clinical presentation along with the age of the patient can help pursue a focused differential diagnosis in most cases. In some cases, ultrasound may even facilitate a definitive diagnosis without the necessity of additional imaging studies. VCUG, the second most common neonatal urinary tract imaging procedure, is used to evaluate lower urinary tract anatomy. It can be used to distinguish obstructive from nonobstructive hydronephrosis, vesicoureteral reflux, bladder tumors, and ureteroceles.

Findings in cystourethrography that suggest lower urinary tract dysfunction in children with vesicoureteral reflux

Children with lower urinary tract dysfunction and vesicoureteral reflux, at cystography assessment, frequently present alterations in the lower urinary tract anatomy such as dilated posterior urethra, irregularity of the bladder wall and diverticula. However, the significance of these findings is unknown. The objective of this study is to evaluate the incidence of these findings, their time of disappearance and their correlation with the severity of the reflux. 193 children with vesicoureteral reflux, considered simple, in the age group above 5 years at the moment of diagnosis, were analyzed. The recommendation for follow-up of these patients was one voiding cystoureterography (VCUG) each year. Only patients with a minimum of 2 VCUGs performed in a period of at least 6 months were considered. The VCUGs were classified as positive and negative in relation to findings that were characteristic of lower urinary tract dysfunction (LUTD). From the 193 children analyzed, 50 (26%) presented positive VCUG and 143 negative VCUG. From the patients without symptoms of lower urinary tract dysfunction (n = 135), 12 (9%) presented positive VCUG and 123 (91%) a negative VCUG. From the patients with negative VCUG, 68 (48%) presented unilateral reflux and 75 (52%) presented bilateral reflux. From those with positive VCUG, 26 (52%) had unilateral reflux and 24 bilateral reflux (48%). This difference was not statistically significant. A higher incidence of grade II reflux was more evident in patients with negative VCUG and degree III in patients with positive VCUG (p < 0.05). Our study demonstrated that 64% of the patients with LUTD and reflux presented findings in the VCUG that suggest dysfunction.

Is the Rhesus Monkey (Macaca mulatta) Comparable to Humans? Histomorphology of the Sphincteric Musculature of the Lower Urinary Tract Including 3D‐reconstruction

The physiology of the muscle systems of the human lower urinary tract is still not known in detail. To study the functional basics of this complex organ system, experiments are often performed in animal models including rhesus monkeys. To apply the results of animal model studies to the humans, a clear knowledge of the comparative anatomy of both species is necessary. However, detailed comparative studies of the lower urinary tract of the rhesus monkey and the humans are lacking. Accordingly, a detailed study on the sphincteric musculature of the lower urinary tract of the rhesus monkey was performed in order to demonstrate anatomical correspondences and differences between both species. The lower urinary tract anatomy was investigated in 18 male and female rhesus monkeys (Macaca mulatta) by serial sections. Immunohistochemical staining methods were used to differentiate striated and smooth musculature. Three-dimensional reconstructions were performed in order to demonstrate the topographical anatomy of the different muscle systems. In both man and male rhesus monkeys, a urethral sphincter muscle exists independent of the pelvic floor musculature, with a smooth and a striated muscular part. A urinary diaphragm (diaphragma urogenitale) does neither exist in the rhesus monkey nor in the human. In contrast to women, a striated muscle encircles the urethra and vagina together in the female rhesus monkey. A vesical sphincter muscle, found in the human bladder outlet, does not exist in the rhesus monkey.

Effects of antisense oligodeoxynucleotides for targeting tachykinin receptors on the expressions of c-Fos and Zif/268 in the rat spinal dorsal horn

Penetrating injuries are caused by the injury of perineal area with gun or stab wounds, which may cause complex injuries or multiple organ injuries. Infections, bleeding, necrotizing fasciitis, ureterocutaneous fistulas, diverticulum, abscesses, narrowing, and incontinence may arise after urethral injuries. Although there are several case reports of urogenital system traumas in the literature, this case reports a schizophrenic patient who had a multisystem genitourinary and rectal trauma after self-detonation of an explosive in the rectum and managed with reconstructive surgery without any postoperative complications. Lower urinary tract anatomy was preserved and full continence was achieved after the surgical procedure.

DIAGNOSIS OF STRESS URINARY INCONTINENCE

This article represents an overview of the evaluation and diagnosis of stress urinary incontinence. Lower urinary tract anatomy in women is reviewed with particular attention to the salient features contributing to stress incontinence. Also discussed is the relevance of the distinction between anatomic incontinence and intrinsic sphincter deficiency in the classification of stress urinary incontinence. Various diagnostic techniques are described with emphasis on the importance of urodynamic evaluation in complex cases.

Nervous control of micturition

The normal micturition depends on a highly elaborate control system that comprises central and peripheral nerves. The recent research on the nervous control of micturition has been markedly progressing. This paper reviews the latest understanding of 1) the functional anatomy of lower urinary tract, 2) the peripheral nervous system and nuclei in the spinal cord, 3) the neurotransmitters and receptors, 4) nervous reflex mechanism of micturition, 5) pontine micturition center, 6) pontine urine storage center and 7) neural connections between pons, higher centers and lower centers.