Periurethral Tissue Research Articles

PDE-5 and NOS II mRNA expression in menopausal women: a molecular biology study

Phosphodiesterase (PDE) and nitric oxide synthase (NOS), evaluated in male erectile dysfunction, are currently under study for their role in the female counterpart. We aim to assess PDE-5 and NOS II presence, at messenger Ribonucleic Acid (mRNA) level, in vaginal environment of menopausal women, by using molecular biology techniques. Specimens of vaginal tissue were obtained from 16 menopausal women undergoing surgery for pelvic organ prolapse. The two samples obtained for each patient, one under the urethra (called U) and one on the rest of the vaginal wall (called V), were tested for PDE-5 and NOS II by RT-PCR and by a densitometric semiquantitative analysis. Of the V samples, 81.3% expressed PDE-5 and 100% NOS II. PDE-5 and NOS II expression were revealed in 87.5% of U specimens. A significant difference (P < 0.05) between V and U samples was found in the expression of NOS II (V vs. U: 24.14 vs. 7.25) and PDE-5 (V vs. U: 44.32 vs. 68.57). Our results demonstrated the presence of PDE-5 and NOS II mRNA in periurethral and vaginal tissue of menopausal women. The distribution of PDE-5 and NOD II may indicate a physiologic role in the regulatory function of human vagina.

Cadaveric Assessment of Synthetic Mid-Urethral Sling Placement

Study Objective: To prove that mid-urethral synthetic slings are visually the same against the urethra at the end of a procedure regardless of the fact that they may be placed or tensioned differently, or anchored to different muscles. To evaluate which sling placement was tensioned most correctly and was most likely at the mid-urethra.Design: We placed an obturator, retropubic, and a single incision sling in three different fresh cadavers. Afterwards, 30 physicians were allowed to visually inspect the cadavers without being aware of how the slings were placed. Each physician completed a questionnaire asking what type of sling was placed, if the sling was the right tension, and if it was located at the mid-urethra.Setting: N/APatients: N/AIntervention: Each cadaver had all possible skin incisions made. The tension for the obturator and retropubic slings were set using a 12 Hagar dilator as a spacer. The tension of the single incision sling was set so that the sling lay against the urethra such that pillowing of the periurethral tissues were observed through the pores of the sling.Measurements and Main Results: The physicians were composed of 5 urologists, 7 urogynecologist, and 18 general gynecologists. The average number of slings performed per year by each physician was 53. The findings are summarized in the table below:Tabled 1Cadaveric Mid-Urethral Sling Placement ResultsRetropubic SlingObturator SlingSingle Incision Sling% Who correctly identified sling40%43%23%% Who thought tension was just right33%47%73%% Who thought sling was at mid-urethra50%67%83% Open table in a new tab Physicians were least likely to be able to identify a single incision sling placement. The single incision sling whose tension was not set with a spacer was felt to have the most appropriate tension and was felt to most likely represent a mid-urethral placement.Conclusion: This study showed that after placement of a mid-urethral synthetic sling it is hard to tell how the sling was placed. This study also showed that most physicians felt that the sling that was tensioned the best and most likely at the mid-urethra was the single incision sling. Study Objective: To prove that mid-urethral synthetic slings are visually the same against the urethra at the end of a procedure regardless of the fact that they may be placed or tensioned differently, or anchored to different muscles. To evaluate which sling placement was tensioned most correctly and was most likely at the mid-urethra. Design: We placed an obturator, retropubic, and a single incision sling in three different fresh cadavers. Afterwards, 30 physicians were allowed to visually inspect the cadavers without being aware of how the slings were placed. Each physician completed a questionnaire asking what type of sling was placed, if the sling was the right tension, and if it was located at the mid-urethra. Setting: N/A Patients: N/A Intervention: Each cadaver had all possible skin incisions made. The tension for the obturator and retropubic slings were set using a 12 Hagar dilator as a spacer. The tension of the single incision sling was set so that the sling lay against the urethra such that pillowing of the periurethral tissues were observed through the pores of the sling. Measurements and Main Results: The physicians were composed of 5 urologists, 7 urogynecologist, and 18 general gynecologists. The average number of slings performed per year by each physician was 53. The findings are summarized in the table below: Physicians were least likely to be able to identify a single incision sling placement. The single incision sling whose tension was not set with a spacer was felt to have the most appropriate tension and was felt to most likely represent a mid-urethral placement. Conclusion: This study showed that after placement of a mid-urethral synthetic sling it is hard to tell how the sling was placed. This study also showed that most physicians felt that the sling that was tensioned the best and most likely at the mid-urethra was the single incision sling.

Bulking Agents: Anesthesia Techniques

Bulking therapy for the minimally invasive treatment of stress urinary incontinence (SUI) may be offered to women with urodynamic SUI, wishing to avoid the complications associated with more invasive surgery, on the basis of low operative morbidity and low long-term success rates. These bulking agents may be injected by a retrograde or antegrade technique in the periurethral tissue around the bladder neck and proximal urethra. This therapy is strongly dependent on the anesthetic technique of choice; moreover its application as an outpatient procedure implies the potential for a cost-effective treatment for selected patients with SUI. In the present paper all factors affecting the choice of different types of anesthetic techniques are discussed.

Tuberculous urethral fistula.

Three cases of tuberculous urethral fistula are presented with clinical details and 2 postmortem specimens of genito-urinary tuberculosis were studied in detail. The active fistulous ulcer in 2 of the clinical cases was strikingly different from the typical urinary fistula which cornplicates post-gonococcal stricture, and resembles the skin lesion occasionally seen about other mucous orifices in cases of virulent internal tuberculosis. From analysis of the pathology of the post-mortem cases, the probable mechanisms of infection are postulated. In the presence of a pre-existing urethral stricture, urine stasis and local mucosal abnormalities enhance the possibility of colonisation, while in miliary tuberculosis infection probably arises in the periurethral tissues and will produce local symptoms only if complications ensue.

Benign masses of the female periurethral tissues and anterior vaginal wall

Due to their rarity, benign masses of the periurethral tissues and anterior vaginal wall are poorly understood. Arriving at the proper evaluation and treatment is challenging because many of these masses have similar presenting signs and symptoms, as well as overlapping differential diagnoses. The literature regarding these lesions mainly consists of level III evidence, mostly involving case reports and series. Clinical management has traditionally been based on established surgical principles and expert opinion. This review presents the pertinent embryologic and anatomic background for these benign masses, as well as other pertinent etiological processes. Furthermore, the most current evidence is reviewed regarding the differential diagnosis, evaluation, and treatment for each mass.

Sulfated glycosaminoglycans of periurethral tissue in pre- and postmenopausal women

Objective The objective was to determine the sulfated glycosaminoglycans (GAGs) of the extracellular matrix (ECM) in pre- and postmenopausal women. Study design Periurethral tissue was obtained from 44 consecutive women who underwent surgery for urinary incontinence, for pelvic organ prolapse, or for other gynecologic benign conditions. Biopsy specimens were assessed by biochemical methods to characterize and quantify sulfated GAG. Measurements were made of total GAG, chondroitin sulfate, dermatan sulfate and of heparan sulfate. Data were compared using the t-test. Results Patients were divided into two groups (pre- and postmenopausal groups) and dermatan sulfate was the most predominant glycosaminoglycan. Postmenopausal women had significantly less total sulfated glycosaminoglycans ( p < 0.01), dermatan sulfate ( p < 0.01) and chondroitin sulfate ( p < 0.05) than premenopausal women. We did not observe any differences in heparan sulfate. Conclusions Postmenopausal women showed quantitative differences in the biochemical characteristics of the ECM in periurethral tissue by analysis of sulfated GAG.

A microbiological and immunohistochemical analysis of periurethral and vaginal tissue in women with de novo urge symptoms after mid-urethral sling procedures—a prospective case-controlled study

The aims were to determine whether bacteria-infection-elicited immune response after mid-urethral sling (MUS) may cause de novo urge symptoms (DNUS) and to evaluate the efficacy of suburethral sling excision for relieving the urgency. In a period of 40 months, 360 consecutive subjects with urodynamic stress incontinence had undergone one of three different MUS. Sixty-eight women with DNUS were included after exclusion. The suburethral sling of 24 of the 68 women needed to be excised because of refractory urgency. The excised vagina, or periurethral tissue, included sling of the study and control groups were sent for microbiological and immunohistochemical analyses. Statistically significant differences in the cell density percentage of CD68, CD25, CD4+CD25 and positive rate of Gram (+) bacteria were noted between two groups (p=0.024, p=0.053 and 0.016, respectively, p<0.001). The success rate of sling excision was 80.2%. In conclusion, bacteria-infection-related immune hyperreactivity might explain the pathologic basis of DNUS after MUS.

Avaliação dos glicosaminoglicanos do tecido periuretral de pacientes com e sem prolapso genital

To characterize and quantify periurethral tissue sulphated glycosaminoglycans (GAGs) in women with and without pelvic organ prolapse. Periurethral tissue was obtained from 35 women who underwent surgery for pelvic organ prolapse, for stress urinary incontinence, or for other gynecological benign conditions. Patients were submitted to a clinical history, physical and urodynamic examination and were divided in two groups according to genital prolapse. The standard biopsy with 1.0 x 1.0 cm was taken from periurethral tissue during surgery and assessed by biochemical methods. The GAGs were obtained by proteolysis and precipitated by trichloroacetic acid. The relative concentration of sulfated GAGs was determined by densitometry of toluidine blue stained gel using a spectrophotometer with a 525 nm wavelength. Data were compared using analysis of variance (ANOVA). In the two groups dermatan sulphate (DS) was the predominant glycosaminoglycan (85%), followed by chondroitin sulphate (CS) and heparan sulphate (HS). Women with pelvic organ prolapse had significantly more total GAGs, DS and HS. Differences in CS were not observed. This study showed altered biochemical characteristics in the extracellular matrix of periurethral tissue and also accumulation of GAGs, DS and CS, in women with pelvic organ prolapse.

The normal post-surgical anatomy of the male pelvis following radical prostatectomy as assessed by magnetic resonance imaging

The magnetic resonance imaging (MRI) appearances of recurrent prostate cancer following radical prostatectomy have been documented in the radiology literature; however little has been written on the range of normal post-operative appearances. Common routes of surgical access for radical prostatectomy include retropubic and transperineal, although newer minimally invasive methods are gaining increasing acceptance. Specifically the range of appearances of the anastomotic site, the prostatic bed, the position of the bladder base, periurethral tissue, levator sling, rectum and residual seminal vesicles (if present) are demonstrated. A non-enhancing low signal nodule is frequently seen at the vesicourethral anastomosis or within the seminal vesicle remnant and usually represents fibrosis. Appearances following different surgical accesses do not differ tremendously, although the retropubic fat pad is reduced or absent following a retropubic approach. Anterior rectal-wall scarring may be present following a transperineal approach. Other post-surgical findings that may mimic disease include a lymphocoele and injected bladder-neck bulking agent. Many patients referred for MRI following radical prostatectomy will have a pathological study showing disease recurrence, although in non-pathological studies the radiological features can differ significantly. It is important for the radiologist to be aware of the spectrum of normal post-surgical appearances so not to confuse these with locally recurrent disease.

Treatment of Postprostatectomy Stress Urinary Incontinence Using a Minimally Invasive Adjustable Continence Balloon Device, ProACT: Results of a Preliminary, Multicenter, Pilot Study

To evaluate the safety and efficacy of a new minimally invasive device, Adjustable Continence Therapy (ProACT) for patients with postprostatectomy stress urinary incontinence (SUI). Sixty-two patients with urodynamic SUI after prostate surgery were evaluated according to daily pad count and a specific validated evaluation for persons with urinary incontinence. All patients were successfully implanted in a single procedure using general or spinal anaesthesia. Procedural time was 37 minutes (range, 18 to 80 minutes). Daily pad usage decreased from 4.6 pads per day to 1.06 pads per day at 12 months. Mean quality-of-life index score increased from 48 to 67 at 12 months.Fifty-nine percent of patients without adjuvant radiation were improved (greater than 50% reduction in pad use), and 30% were cured (no pads), whereas 83% of postirradiated patients failed intervention. Fifty-five patients (88%) required percutaneous balloon adjustments. The mean optimal volume after adjustments for all 45 improved patients was 3.8 mL per balloon. Complications necessitating removal occurred in 19 patients and included erosion, infection, migration, and failure to respond. Of these, 4 were successfully reimplanted. All complications occurred in the first postoperative month. Implantation of postoperatively adjustable balloons in postprostatecomy men is technically feasible, with an improvement in continence particularly in patients with nonirradiated periurethral tissues. Optimal urethral resistance is achieved, with easy postoperative adjustment. Implantation of ProACT balloons may represent a promising development in the treatment of postprostatectomy SUI.

Effects of Mesenchymal Stem Cells on Stress Incontinence in a Rat Model

Purpose: Several study trials have used stem cells to treat stress incontinence in an animal model. In this study, we compared injecting either periurethral mesenchymal stem cells (MSC) or normal saline (C) to increase the leak point pressure (LPP) and closing pressure (CP) in a rat model of stress urinary incontinence. Materials and Methods: Sprague Dawley rats (250g each, 12 weeks old) were divided into the MSC group (n=5) and group C (n=5). They were anesthetized and the pudendal nerve was transected bilaterally via a ventral incision in order to denervate the external urethral sphincter. The MSCs were obtained from both femurs of Sprague Dawley rats (150g each, 6 weeks, n=10). After 1 week, the MSCs were stained by 4'-6-diamidino2-phenylindole (DAPI), which was injected into both sites of the proximal external urethra (n=1.5x10). At 3 weeks after injection, cystometry was performed and this was followed by cord transection at the T9-10 level with the rat under anesthesia. Visually identified LPP and CP measurements were evaluated with using a vertical tilt/intravesical pressure clamp. The urethral tissues of the rats were harvested for histology. Results: Both the LPP and CP measurements were significantly higher in the MSC group when compared with that of the C group (p<0.05). The mean LPP of the MSC group and group C was 42.3±2.1cmH2O and 25.8± 1.7cmH2O, respectively. The mean CP of the MSC group and group C was 31.7±2.5cmH2O and 21.3±1.1cmH2O, respectively. The existence of DAPI-stained MSCs in the injected periurethral tissue was verified by histology after the completion of the study. Conclusions: Injection of MSCs into the periurethal tissue after transection of the bilateral pudendal nerve in rats led to an increase in the LPP and CP. This finding suggests that MSCs can be used as one of the potentially effective cell therapies for stress urinary incontinence. (Korean J Urol 2008;49:432-438) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Role of proteoglycans in the organization of periurethral connective tissue in women with stress urinary incontinence

Objectives Connective tissue consists of fibroblasts and extracellular matrix (ECM) with collagen and elastic fibers, glycoproteins and proteoglycans (PGs) and it is considered an important factor of the supportive structures of the genitourinary region. Since PGs are essential for the organization of the collagen fibrils in the ECM, we investigated the presence of two PGs, fibromodulin and lumican, and of collagen type I in the periurethral connective tissue from women with stress urinary incontinence (SUI), compared to asymptomatic controls. Methods Thirty-two patients participated in the study and they were divided into four groups: premenopausal incontinents, premenopausal controls, postmenopausal incontinents and postmenopausal controls. All patients underwent gynaecologic surgical procedures and punch biopsies from the periurethral tissue were obtained. Immunohistochemistry for collagen type I, fibromodulin and lumican was performed on the histological slides. Results In premenopausal incontinents the immunoreactivity for collagen type I was weaker with an irregular distribution compared to premenopausal controls; while for fibromodulin, the staining was stronger in premenopausal incontinents than in premenopausal controls. Between the two postmenopausal groups there was not a significant difference in the intensity of collagen type I and fibromodulin staining that instead were less strong than in premenopausal groups. Lumican staining had the same distribution in the four groups. Conclusions Our results suggest an altered remodelling of connective tissue in the periurethral region of premenopausal patients with SUI, with a significant decrease of collagen content and an irregular organization and distribution of the collagen fibrils, compared to premenopausal controls. In the SUI patients this abnormal ECM remodelling, mainly related to the observed change in PGs expression, might affect significantly the tensile strength of the connective tissue and consequently the support that is provided by the urogenital suspensory apparatus to urethra and bladder base. Moreover, the significant decrease in collagen type I content in postmenopausal patients respect to premenopausal patients, suggests that age and hormonal factors could contribute to the pathological modifications of the supportive genitourinary connective tissues in the SUI patients.

Comparison of the precision of transurethral endoscopic versus ultrasound‐guided application of injectables

To compare the precision of transurethral endoscopic- vs ultrasound (US)-guided injections, as transurethral application of various injectables under endoscopic view are widely used to treat urinary incontinence. Bovine collagen was injected into the lower urinary tract in 20 dead female pigs. In each pig five depots of collagen were injected and there were five pigs in each group. In group I collagen was injected into the urethral wall under endoscopic control. In group II collagen depots were injected periurethrally under endosocopic guidance. In group III collagen was injected into the urethral wall under US control. In group IV collagen depots were injected periurethrally under US guidance. A transurethral US probe (6 F, 15 MHz) and injection device were used for transurethral US-guided injections. In all pigs the urethra and the periurethral tissue were removed after injection and investigated using anatomical preparations and histological sections. In group I only two collagen depots were actually located in the urethral wall in two pigs (two of 25 depots, 8%). In group II five depots in two pigs were located in the urethral wall (five of 25 depots, 20%). The periurethral collagen depots were found to spread out in the loose connective and fat tissue around the urethra. In group III all US-guided injections of collagen were situated in the urethral wall and in group IV they were all located periurethrally. The present study shows that endoscopic application of injectables is an inaccurate technique, while US-guided injections are precise. US-guided injection enables excellent control of the therapeutic procedure.

Local advanced transitional cell cancer and squamous cell cancer of the urethra treated with neoadjuvant chemotherapy followed by radical surgery

Background: Primary urethral cancer is rare, accounting for less than 1% of all malignancies. The management of the urethral cancer depends on several factors which includes the clinical stage and the location of the lesion. Local surgical excision is the treatment of choice for the distal and low stage tumor while proximal tumors need more radical surgery. Aim: To report a case of a young African man who presented with locally advanced squamous cell cancer of the periurethral tissues and underlying isolated transitional cell cancer of the urethra. Case report: A 51-year-old man presented with a locally advanced squamous cell cancer of the periurethral tissues as well as an underlying isolated transitional cell cancer of the urethra. Chemotherapy with Gemcitabin and Cisplatinum together with local radiation to the pelvis and the perineum was given. There was remarkable regression of the tumour was identified by clinical examination and computed tomography scan after the treatment. The patient subsequently underwent cystoprostatectomy, radical penectomy, excision of the scrotum and ileal conduit. He recovered well postoperatively. Conclusion: Multimodal therapy combining chemotherapy and surgical resection should be used in locally advanced cases to improve the patient\'s survival chance. Port Harcourt Medical Journal Vol. 1 (3) 2007: pp. 208-211

Synthetic sling options for stress urinary incontinence

Various materials have been used in the treatment of stress urinary incontinence. Autologous materials such as muscle and fascia were first used to provide additional anatomic support to the periurethral and pelvic tissues; however, attempts to minimize the invasiveness of the procedures have led to the use of synthetic materials. We review the literature and describe different synthetic materials used for slings. We performed a comprehensive review of the literature on synthetic grafts used in slings using MEDLINE and resources cited in those peer-reviewed papers. Of all synthetic materials, the type I macroporous polypropylene meshes have demonstrated superiority in terms of efficacy and lower complication rates than other mesh types due to their structure and composition. The success of the graft appears to be independent of the placement technique. The ideal graft provides structural integrity and durability with minimal adverse reaction by the host tissue. Certain synthetic grafts used in pubovaginal slings can provide durability with minimal complications.

Is There an Impact of Postoperative Urethral and Periurethral Anatomical Features in Post-Radical Retropubic Prostatectomy Incontinence?

Objectives: To determine the anatomical changes in urethral and periurethral tissues after radical retropubic prostatectomy (RRP) by magnetic resonance imaging (MRI) and correlate these changes to continence. Materials and Methods: 14 patients with grade 2–5 incontinence and 16 continent (grade 1) patients who had undergone non-nerve-sparing RRP for clinically localized prostatic carcinoma were evaluated. The sphincteric urethral length, transverse and craniocaudal diameters of both levator ani muscles and the volume of periurethral fibrosis were determined by abdominopelvic MRI. Continent (group 1) and incontinent (group 2) groups were compared in terms of sphincteric urethral length, transverse and craniocaudal diameters of levator ani muscles, volume of periurethral fibrosis, prostate volume, age and pathological stage. Results: Among all the evaluated parameters, a statistically significant correlation was found only between the volume of periurethral fibrosis and the number of postoperative operations for urethral strictures in the incontinent group (p = 0.013, r = 0.859). Conclusions: Our results suggest that the postoperative sphincteric urethral length is not the sole factor in regaining continence after RRP as mentioned in the literature.

Effects of Injection Therapy using Muscle Derived Stem Cell/ Chitosan/ Hydroapatite Composite Gel in a Rat Model of Urinary Incontinence

Purpose: We investigated whether periurethral injections of musclederived stem cells (MDSC) and chitosan/hydroapatite after denervation of rat's pudendal nerve could increase the leak point pressure over a long time period in a rat model of urinary incontinence. Materials and Methods: Muscle-derived stem cells isolated from the gastrocnemius muscle of normal female rats were purified to obtain a myogenic population by using the preplate technique. The N group was the normal female rats, the D Group was the pudendal nerve transected group and the M Group was the MDSC/chitosan/hydroapatite composite gel injected group after pudendal nerve transection. The MDSC/chitosan/hydroapatite composite gel was injected into the proximal periurethral area. At 2 and 4 weeks, visually identified leak point pressure measurement was done with using the vertical tilt/intravesical pressure clamp model of urinary incontinence. The rats were then sacrificed and the periurethral tissues harvested for histological examination. Results: The leak point pressure was significantly lower in the D group at each time compared with the N group, and the leak point pressure in the N and M groups were significantly higher than those in the D group at both 2 and 4 weeks. The persistence of MDSC over the period of study was verified by histological examination. Conclusions: MDSC/chitosan/hydroapatite injection into the denervated external urethral sphincter in female rats increased the leak point pressure at 2 and 4 weeks. This MDSC/chitosan/hydroapatite composite gel can be an alternative injection method for treating urinary incontinence in the future. (Korean J Urol 2007;48:627-632) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Fascial patch technique for repair of complicated urethrovaginal fistula

Introduction The operative repair of urethrovaginal fistula due to tension-free vaginal tape (TVT) erosion is a challenging task, and coexisting stress urinary incontinence may complicate the situation even further. We present our technique for the repair of recurrent urethrovaginal fistula combined with stress urinary incontinence, occurring after previous removal of an eroded TVT and failed repair of the fistula. Technical Considerations With the patient in the dorsal lithotomy position, an inverted U-shaped incision was cut in the anterior vaginal wall, and a vaginal flap was developed. The Martius flap from the previous repair was identified and separated from the urethra, thereby disclosing a large fistula hole on the left side of the mid-urethra. Because the periurethral tissues were very friable and attenuated, only one-layer closure of the fistula hole with these tissues was feasible. Therefore, we opted to combine a pubovaginal fascial sling with a fascial patch graft, used to reinforce the fistula site. Through a low transverse abdominal incision, a 15 × 2-cm strip of rectus fascia was harvested. A 2 × 2-cm patch of fascia was excised from the strip and transfixed to the periurethral tissues, covering the sutured fistula site. The Martius flap was repositioned over the flap, and a pubovaginal sling procedure was done. The postoperative course was uneventful, the fistula has healed, and the patient regained full continence. Conclusions This technique can be used in complicated urethrovaginal fistula repair when the surrounding periurethral tissues have been devastated and can be combined with pubovaginal fascial sling placement.

Changes in the extracellular matrix in periurethral tissue of women with stress urinary incontinence

Changes in structural support of the urethra and bladder neck have been proposed as important factors in the pathogenesis of stress urinary incontinence (SUI). In this context, we undertook an ultrastructural study on the periurethral connective tissue with an emphasis on incontinent women with normotonic and hypotonic urethras. Small specimens of periurethral connective tissue were obtained by dissection during a tension-free vaginal tape-implantation procedure in 34 stress urinary incontinent postmenopausal women with a normotonic urethra and 9 stress urinary incontinent postmenopausal women with a hypotonic urethra. In the samples taken from stress-incontinent women with a normotonic urethra, intact elastic fibers were closely connected with collagen fibers, smooth muscle cells and fibrocytes. In the samples taken from stress-incontinent women with a hypotonic urethra, we detected irregular fragmented distribution of the elastin within the tissue. We assume that these structural changes lead to functional consequences, such as diminished tissue extensibility and loss of stability surrounding the female urethra. These altered connective tissue properties may affect the mechanism of urethral closure under stress (e.g., coughing) and therefore contribute to the occurrence of SUI with a hypotonic urethra.

3228: Positive pressure transvaginal ultrasonography of female urethral diverticulum

Objectives: The purpose of this study was to explore the role of compression of urethral diverticulum during transvaginal ultrasonography for women with urethral symptoms and suspected urethral diverticulum. Methods: Four women with urethral symptoms underwent transvaginal ultrasonography. Sonograms of diverticula were evaluated for the diameter before and after compression, echogenicity, shape, and vascularity on Doppler sonography. Results: On sonography the diverticula ranged in diameter from 2.3 cm to 3.8 cm (mean; 2.6 cm). Three of four cases showed decrease in size after compression of diverticula and the change of diameter ranged from 0.2 cm to 0.3 cm (mean; 0.27 cm). Thee diverticula were anechoic and one was hypoechoic. Three of four diverticula wrapped around more than 76% of urethral circumference and one was between 26% to 50%. Three diverticula were complex in shape and one was simple. Blood flow was seen around the periphery of sac and periurethral tissues in three of four cases. Conclusions: Compression of urethral diverticulum during transvaginal ultrasonography is useful in identifying communication between diverticula and urethra.