Pubic Bone Research Articles

Acetabular index and acetabular depth ratio in newborns and infants aged 6 months or less with the healthy development of hips: A retrospective cross-sectional study.

Radiographic assessment of the hip may render critical in the diagnosis of developmental dysplasia of the hip (DDH) in newborns and infants aged ≤6 months. There is no complete dataset on the acetabular index (AI) and acetabular depth ratio (ADR) values in this age group. The objective of this study was to assess the AI and ADR values in newborns and infants aged ≤6 months with healthy development. A retrospective analysis was performed on pelvic radiographs of newborns and infants (≤6 months) between August 2020 and September 2021. There were 3000 children with pelvic radiographic imaging. Normal sonographic findings and radiographs without any structural deformity of the hip were inclusion criteria. A total of 1132 newborns and infants (2264 hips) were analyzed. Measurements of AI and ADR (ischium and pubic bone as landmarks for acetabular depth ratio A [ADR-A] and acetabular depth ratio B [ADR-B]) were performed. Correlation and intraclass correlation coefficient (ICC) values were calculated. Left-sided AI values were significantly higher than the right-sided AI values, except in infants aged 4 to ≤5 months (P < .05). ADR-B values differed significantly between male and female newborns and infants both in terms of the side of the hip measured and age (P < .05). AI values were fairly correlated with age (r = -0.286 for left and r = -0.254 for right) in the negative direction and with ADR-A (r = 0.449 and r = 0.469 for left and right) and ADR-B (r = 0.545 and r = 0.592 for left and right) in the positive direction. Inter-observer ICC was 0.845 to 0.989 (excellent) for AI, 0.534 and 0.904 (moderate to excellent) for ADR-A, and -0.014 and 0.774 (slightly good to good) for ADR-B. Intra-observer ICC was 0.811 to 0.996 (excellent) for AI, 0.575 to 0.98 (moderate to excellent) for ADR-A, and 0.023 to 0.954 (slightly good to excellent) for ADR-B. This study features the first complete data set of AI and ADR measurements, which are essential for pelvic radiographic imaging of hip dysplasia, in newborns and infants aged ≤6 months.

Genitourinary vascularized composite allotransplantation for gender affirmation in trans men: An anatomical feasibility study

Gender affirmation in trans men requires multiple staged procedures. The final masculinizing step involves phalloplasty or metoidioplasty and further incorporation of penile and testicular prostheses. However, these are functionally suboptimal and associated with high complication rates. Therefore, we sought to investigate the anatomical feasibility of one-stage genitourinary vascularized composite allotransplantation (GUVCA) for such gender-affirming surgeries. Twenty fresh cadaveric dissections were performed to delineate the neurovascular anatomy of the proposed GUVCA. Specifically, in donors (n=14), besides the penis and scrotum, the GUVCA included an inferior bladder patch with the urinary sphincter, prostate, seminal vesicles, as well as a strip of the pubic bone. In trans men recipients, osteotomies of the pubic bone to match that of the donor GUVCA were required. Five cadaveric GUVCA transplants were then performed to simulate one-stage gender affirmation surgery. The GUVCA required (1) vascular anastomoses between the recipient's deep inferior epigastric, external pudendal, and superficial circumflex iliac (or superficial inferior epigastric) vessels to the donor's internal pudendal, external pudendal and genitofemoral vessels respectively; (2) neurosynthesis between the recipient pudendal and dorsal clitoral nerves to the donor pudendal and genitofemoral nerves; and (3) urinary bladder anastomosis at the bladder neck, upstream of the urinary sphincter. Average donor measurements (length (cm), diameter (mm)) were: external pudendal artery (2.5, 2.0) and vein (2.0, 3.5), internal pudendal artery (15.0, 4.0), pudendal (15.0, 3.0) and genitofemoral nerves (8.0, 2.0). We have described the anatomical basis for a one-stage GUVCA in trans masculine genitourinary reconstruction.

From a Single Penile Suspensory Ligament to a Penile Suspensory Apparatus: Application to the Buried Penis Surgery

Abstract Goals/Purpose The ligamentous system supporting the penis is widely called « penile suspensory ligament ». It supports and attaches the penis to the abdominal wall and the pubic bone. However, the complexity of the anatomy of the penile suspensory system was underestimated. The aim of this anatomical study was to describe the different ligamentous (features, insertion sites, path) and their functions. Methods/Technique The first step consisted in a description of the different components of the penile suspensory apparatus on two cadavers embalmed by the Thiel method. The second part was an evaluation of the function of each ligament on freshly dead cadavers. In the third stage, we applied those findings to an exploratory cohort of patients undergoing a penile lengthening surgery for buried penis. Results/Complications The penile suspensory apparatus consisted in four ligaments from anterior to posterior : the fundiform ligament, the suspensory ligament, dense vertical ligament and the arcuate ligament. The first two were loose, non-stabilizing and the two posterior ones were dense and stabilizing. In our cohort, 12 patients were included. The mean BMI was 38. The mean pre-operative flaccid length was 4.1 cm [2.2 cm – 7 cm] and at 6 months 8.2 cm [5.2 cm - 11.5 cm] which represents a mean augmentation of 100%. The mean pre-operative circumference at a flaccid state was 8.2 cm [2 cm – 11.5 cm] and at 6 months post-operative was 12.6 cm [8.3 cm - 16 cm] which represents a mean augmentation of 85.7%. The most common complication was a phimosis. Conclusion We have described the detailed anatomy of the penile suspensory apparatus. It is the first time that the dense vertical ligament was brought to light. To avoid instability in penile lengthening, the posterior part of the dense vertical ligament and the arcuate ligament must be spared.

The AIUM Practice Parameter for the Performance of the Musculoskeletal Ultrasound Examination.

The AIUM Practice Parameter for the Performance of the Musculoskeletal Ultrasound Examination.

Rare Case of an Unresectable Giant Cell Tumor of Pubic Bone

Giant cell tumor (GCT) of bone, a benign but locally aggressive invasive tumor. It commonly affects long bones, has a low incidence in pelvis (1.5-6.1%). It is most commonly treated with a surgical approach. However, here we present a rare case of GCT of pubic bone, which was rendered unresectable due to its location and extensive nature. Thereby, treated with radical radiation therapy and injection denosumab.

A serious consequence of pelvic organ prolapse: Hydroureteronephrosis.

We aimed to determine the association between pelvic organ prolapse (POP) and hydroureteronephrosis (HUN), risk factors for developing HUN and resolution of HUN after surgery. A retrospective study was conducted on 528 patients diagnosed with uterine prolapse. All patients with or without HUN were compared in terms of risk factors. The 528 patients were divided into five groups according to the POP-Q classification. A significant relationship was found between POP stage and HUN. The other risk factors for developing HUN were age, rural life, parity, vaginal delivery, smoking, body mass index and increased comorbidity. The prevalence of POP was 12.2% and the prevalence of HUN was 65.3%. All patients with HUN underwent surgery. After surgery, HUN resolved in 292 (84.6%) patients. POP is a multifactorial herniation of pelvic organs out of the urogenital hiatus due to pelvic floor dysfunction. The main etiological factors in POP are older age, grand multiparity, vaginal delivery and obesity. The most important problem in patients with severe POP is HUN due to urethral kinking or urethral obstruction, which is a result of the cystocele squeezing the urethra under the pubic bone. In low-income countries, the main aim is to prevent the development of POP, which is the most common cause of HUN. It is important to increase the level of knowledge about contraception methods and to increase screening and training to reduce other risk factors. Women should be made aware of the importance of gynecological examination in the menopausal period.

V04-12 SINGLE PENILE INCISION FOR CONCOMITANT CIRCUMCISION AND INGUINAL SURGERY

You have accessJournal of UrologyCME1 Apr 2023V04-12 SINGLE PENILE INCISION FOR CONCOMITANT CIRCUMCISION AND INGUINAL SURGERY Andrew Carey, Arighnno Das, Madison Wi, Fardod O'kelly, Shannon Cannon, Vinaya Bhatia, and Walid Farhat Andrew CareyAndrew Carey More articles by this author , Arighnno DasArighnno Das More articles by this author , Madison WiMadison Wi More articles by this author , Fardod O'kellyFardod O'kelly More articles by this author , Shannon CannonShannon Cannon More articles by this author , Vinaya BhatiaVinaya Bhatia More articles by this author , and Walid FarhatWalid Farhat More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003252.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients undergoing circumcisions with concomitant inguinal pathologies currently require both a penile and inguinal incision. We have previously described performing inguinal procedures through a penile incision. Herein we extend on this minimally invasive approach by performing a hydrocelectomy through a circumcision incision. METHODS: Once the preputial skin is excised, the penopubic junction is bluntly dissected. An S-shaped retractor is placed on the pubic bone and retracted towards the ipsilateral shoulder. With the pubic bone as a key landmark, the cord structures are carefully identified and the hydrocele sac is dissected off. The circumcision is then completed in the usual fashion. RESULTS: To date, we have offered this approach to all children undergoing circumcision and who also have undescended testis (UDT), hydroceles, or hernias. We have found that this approach is best for children who are under 5 years of age. Notably, this approach does not affect the appearance of the circumcision in any way. CONCLUSIONS: Children with inguinal pathologies, such as UDT, hernias or hydroceles, who are also undergoing circumcision or any penile procedure are currently offered this approach. A single penile incision for circumcision and correction of inguinal pathology is feasible, safe, and provides similar surgical outcomes with shorter overall operative time. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e341 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrew Carey More articles by this author Arighnno Das More articles by this author Madison Wi More articles by this author Fardod O'kelly More articles by this author Shannon Cannon More articles by this author Vinaya Bhatia More articles by this author Walid Farhat More articles by this author Expand All Advertisement PDF downloadLoading ...

V09-07 HOW TO USE A MESH SLING SAFELY AFTER THE POST-VESICOVAGINAL FISTULA REPAIR REPAIR PATIENT WITH STRESS URINARY INCONTINENCE

You have accessJournal of UrologyCME1 Apr 2023V09-07 HOW TO USE A MESH SLING SAFELY AFTER THE POST-VESICOVAGINAL FISTULA REPAIR REPAIR PATIENT WITH STRESS URINARY INCONTINENCE Micheal Breen Tamatave, Madagascar, Ly Hoang Roberts, and Larry Sirls Micheal Breen Tamatave, MadagascarMicheal Breen Tamatave, Madagascar More articles by this author , Ly Hoang RobertsLy Hoang Roberts More articles by this author , and Larry SirlsLarry Sirls More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003317.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with complicated obstetric fistulas may have stress urinary incontinence (SUI) after vesicovaginal fistula repair (VVF), especially if the urethra in involved. Various techniques to treat post-VVF SUI have low success rates or is technically challenging due to thin and scarred peri-urethral tissue. We describe a technique to place a midurethral mesh sling outside of the pre-existing vaginal mucosa. METHODS: With the patient in dorsal lithotomy under spinal anesthesia, a foley catheter is placed into the bladder and the labial majora is retracted for adequate exposure. A rectangular area of the same size as the mesh sling (3x1cm) at the midurethra is marked. A number 15 scalpel is used to incise the vaginal mucosa at the marked lines, and Metzenbaum scissors are used to dissect and mobilize the edges. The dissection is then carried out laterally to be behind the inferior pubic bone. This is done on both sides. The island of vaginal mucosa is then superficially scored using low power bovie cauterization to allow for mesh adhesion and tissue ingrowth. The mesh is sutured to the island of skin using a 3-0 Chromic or vicryl suture at the mesh edges in 4 areas. 0- prolen sutures are then placed on each lateral edge of the mesh in a running stitch. The Metzenbaum scissors are then used to enter into the endopelvic fascia behind the pubic bone to develop the retropubic space. Next, a suprapubic incision is made 1cm cranial to the pubic bone down to the rectus fascia. The Stamey needle is passed in a top-down approach approximately 2cm from midline and end delivered into the vaginal incision. To check for bladder perforation, a metal catheter is placed into the bladder and swept laterally to evaluate for any metallic noise indicative of contact. The prolene suture is passed up to the suprapubic incision and the same is done contralaterally. Bladder is backfilled with sterile saline with methylene blue by gravity and foley removed. Sutures are tied together midline with the sling tension adjusted while patient performs a Valsalva. Suprapubic incision is then closed in multiple layers. The vaginal incision is closed with mobilization of the proximal vaginal mucosa and reapproximation to the distal edge. For larger incisions, a Singapore flap can be done for adequate coverage. RESULTS: Successful managment of SUI. CONCLUSIONS: For challenging cases of SUI after a post-VVF repair, this technique can be an option. Further investigation is needed for clinical outcomes. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e839 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Micheal Breen Tamatave, Madagascar More articles by this author Ly Hoang Roberts More articles by this author Larry Sirls More articles by this author Expand All Advertisement PDF downloadLoading ...

The Effect of Breathing Relaxation Techniques and Body Exercises on The Decrease of Pregnant Women’s Discomforts in The Third Trimester

Pregnancy is the most challenging and the happiest phase in every woman’s life in which a mother through physical and psychological changes. These physical changes will lead to discomforts to pregnant women. These discomforts can occur in their third trimester of pregnancy, such as backache, leg cramps, pain in pubic bones, false contraction, insomnia, breathing soreness, and fatigue. Exercise that can be done during pregnancy is practicing breathing techniques and body exercises (Prenatal Yoga). This is because the body stretches the muscles more relaxed, so that blood circulation works properly and the body produces endorphins. This study aimed to find out the effect of breathing relaxation techniques and body exercises on the discomfort decrease in the third trimester of pregnant women. Type of study was Quasi Experiment with Non-Equivalent Control Group approach by examining the pregnant women’s discomforts in the third trimester before (pre-test) and after (post- test) practicing breathing techniques and body exercises (Prenatal Yoga). The population were all the third trimester pregnant women who practiced breathing techniques and body exercises at Kasih Ibu Mother and Child Hospital. The sampling technique used was quota sampling. This study carried out from October to November 2020. The Wilcoxon test results obtained p value = 0.000, then p = 0.000&gt; = 0.05, it can be concluded that there was significant difference between of third trimester pregnant women before and after doing breathing relaxation techniques and exercise body. There is an effect of Prenatal Yoga practice on discomfort in third trimester pregnant women. Key words: Discomforts, Breathing Relaxation Techniques and Body Exercises (Prenatal Yoga)

The Detection of Prostate Cancer with Magnetic Resonance Imaging-targeted Prostate Biopsies is Superior With the Transperineal vs the Transrectal Approach. A European Association of Urology-Young Academic Urologists Prostate Cancer Working Group Multi-institutional Study. Reply.

The Detection of Prostate Cancer with Magnetic Resonance Imaging-targeted Prostate Biopsies is Superior With the Transperineal vs the Transrectal Approach. A European Association of Urology-Young Academic Urologists Prostate Cancer Working Group Multi-institutional Study. Reply.

V10-01 A COMPREHENSIVE REVIEW OF NEUROANATOMY, PROSTATE ANATOMY AND PERI-PROSTATIC STRUCTURES

You have accessJournal of UrologyCME1 Apr 2023V10-01 A COMPREHENSIVE REVIEW OF NEUROANATOMY, PROSTATE ANATOMY AND PERI-PROSTATIC STRUCTURES Sneha Parekh and Ashutosh Tewari Sneha ParekhSneha Parekh More articles by this author and Ashutosh TewariAshutosh Tewari More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003328.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We aim to present the most revised anatomy of prostate, surrounding structures and its neuroanatomy in the form a 3D animated video. METHODS: We searched the PubMed database to identify original and review articles that addressed the anatomy of the prostate and relevant surrounding structures, with an emphasis on work published from July 2002 to January 2022. Understanding the findings in literature, we applied this knowledge and created a 3D animation video. RESULTS: Laterally the prostate is surrounded by the Endopelvic fascia, which has Parietal and medially has prostatic fascia. Ventrally prostatic capsule attached to Anterior Fibromuscular Stroma (AFMS), reaches postero-lateral prostate embracing Neurovascular bundle (NVB) medially and becomes pararectal fascia covering the rectum. The detrusor apron is an extension of anterior wall of bladder towards posterior area of pubic bone and contributes to AFMS. The urethral sphincter complex consists of external rhabdosphincter, inner lissosphincter and membranous urethra. Seminal Vesicles(SV) and Vas Deferens (VD) are extra peritoneal tubular structures, located at base of prostate, surrounded by major nerves posterolaterally, associations with Proximal neurovascular plate (PNP). Prostate with surrounding structures is supplied by autonomic and somatic branches originating from lower (T11-L2) and (S2-S4). Nerve fibers from centers coalesce to form pelvic plexus, aka PNP.The autonomic fibers from PNP are distributed into NVB and ANP (Accessory Neural Pathway) in a spray like pattern, with 60% of fibers on postero-lateral and 40% on antero-lateral prostate.DVC is composed of nerve fibers, dorsal veins and prostatic arteries. The puboprostatic ligamentous complex comprises of puboprostatic ligaments, arcus tendineus, and puboperinealis muscle. The puboprostatic ligaments are dense pyramid-shaped medial portions of distal endopelvic fascia. The puboperinealis is a paired muscle that originates from pubis, flanks prostatic-urethral junction, terminates at perineal body. CONCLUSIONS: Prostate is a dense fibromuscular gland, situated in the true pelvis surrounded by a compact multi-layered fascia with intermingling nerves and vessels.The nerves from the lumbar and sacral roots along with somatic supply form the pelvic plexus, further giving the prostatic neural hammock. This forms the basis of nerve sparing and its grades. Puboprostatic ligamentous complex along with peri-prostatic fascia and detrusor apron support the prostate and has a role in erectile and continence. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e926 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sneha Parekh More articles by this author Ashutosh Tewari More articles by this author Expand All Advertisement PDF downloadLoading ...

MP42-14 BIOLOGIC MESH BUTTRESS WITH VERTICAL RECTUS ABDOMINIS MUSCLE FLAP TO REESTABLISH PELVIC INTEGRITY DURING CYSTECTOMY FOR ANTERIOR URINARY FISTULA

You have accessJournal of UrologyCME1 Apr 2023MP42-14 BIOLOGIC MESH BUTTRESS WITH VERTICAL RECTUS ABDOMINIS MUSCLE FLAP TO REESTABLISH PELVIC INTEGRITY DURING CYSTECTOMY FOR ANTERIOR URINARY FISTULA Syed M. Alam, Jordan Stiverson, and Hadley Wyre Syed M. AlamSyed M. Alam More articles by this author , Jordan StiversonJordan Stiverson More articles by this author , and Hadley WyreHadley Wyre More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003280.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Post-radiation puboprostatic and pubourethral fistulae are devastating conditions, and surgical intervention remains highly morbid. Here, we describe a novel technique using a mesh buttress and vertical rectus abdominis muscle flap (VRAM) to restore pelvic integrity during cystectomy for anterior urinary fistulae. METHODS: Patients having undergone cystectomy with ileal conduit were identified in a prospectively maintained database. Those having undergone VRAM harvest with placement of a mesh buttress for anterior urinary fistula were selected for analysis. Following supratrigonal cystectomy, all patients underwent a left-sided VRAM harvest. After the bladder plate was fulgurated, a biologic mesh was tailored to the pelvic defect and sutured to the posterior trigone. It was then incorporated circumferentially around the levator muscles and anteriorly to the pubic bone and underside of rectus fascia. Prior to circumferential closure of the underlying space, a VRAM flap was secured in the pelvis. The remainder of the mesh was then secured, creating a tunnel for the flap pedicle. Surgical metrics and post-operative outcomes were evaluated using descriptive statistics. RESULTS: Between 2019-2021, eleven patients underwent this technique, of which five carried a diagnosis of post-radiation anterior urinary fistula with pubic osteomyelitis. The median age was 73 years, and all patients were male. Three patients previously underwent radical prostatectomy, all of whom underwent subsequent endoscopic intervention for vesicourethral anastomotic stenosis. One patient underwent transurethral resection of the prostate after radiation. One patient had no prior surgical history. Median operative time was 387 minutes and median blood loss was 500cc. Average length of stay was five days. No patients developed an immediate post-operative complication. All patients had positive intra-operative bone cultures. No patients reported persistent pubic, groin, or thigh pain after surgery. No fistula recurrence occurred at a median follow-up of 264 days. CONCLUSIONS: The use of a mesh buttress in conjunction with pelvic VRAM flap is a novel technique designed to restore pelvic integrity for patients undergoing cystectomy for an anterior urinary fistula. Source of Funding: N/a © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e573 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Syed M. Alam More articles by this author Jordan Stiverson More articles by this author Hadley Wyre More articles by this author Expand All Advertisement PDF downloadLoading ...

MP73-13 MRI ANALYSIS OF PROSTATE MORPHOMETRY AND PERIPROSTATIC ANATOMICAL RELATIONSHIPS BEFORE AND AFTER PARTIAL HIGH-INTENSITY FOCUSED ULTRASOUND TREATMENT OF LOCALIZED PROSTATE CANCER.

You have accessJournal of UrologyCME1 Apr 2023MP73-13 MRI ANALYSIS OF PROSTATE MORPHOMETRY AND PERIPROSTATIC ANATOMICAL RELATIONSHIPS BEFORE AND AFTER PARTIAL HIGH-INTENSITY FOCUSED ULTRASOUND TREATMENT OF LOCALIZED PROSTATE CANCER. Denis Seguier, Srinath Kotarmarti, Zoe Michael, Rajan Gupta, Cary Robertson, Thomas Polascik, Jonathan Olivier, and Arnauld Villers Denis SeguierDenis Seguier More articles by this author , Srinath KotarmartiSrinath Kotarmarti More articles by this author , Zoe MichaelZoe Michael More articles by this author , Rajan GuptaRajan Gupta More articles by this author , Cary RobertsonCary Robertson More articles by this author , Thomas PolascikThomas Polascik More articles by this author , Jonathan OlivierJonathan Olivier More articles by this author , and Arnauld VillersArnauld Villers More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003341.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Little is known regarding anatomical changes to peri-prostatic tissues after focal high intensity focused ultrasound (fHIFU) for localized prostate cancer. We sought to provide a novel approach to assess prostato-pelvic anatomical morphometric magnetic resonance imaging (MRI) changes post- fHIFU. METHODS: 38 patients (Pts) over two institutions (Lille University Hospital and Duke University Hospital) undergoing fHIFU with pre-and post-treatment (Pre-/Post-Tx) (≥6 months) MRI were included. Pre- and post-TX. MRIs were assessed for prostate and treated region volume. Distances to pubic bone and rectum were measured to account for the post-Tx periprostatic changes. Two subgroups were also identified, those with recurrence (positive biopsy and/or subsequent whole gland Tx) and those recurrence-free. Specific MRI features were also described within those two groups. RESULTS: The median treated-lobe volume was of 16.8 ml (IQR 10.6-21.5) on pre-Tx MRI and of 10.2 ml on post-Tx MRI (IQR 7.2-14.8). Comparison on pre-Tx MRI vs. post-Tx MRI showed a significant difference (p<0.01). The median percentage reduction of treated lobe volume for the entire cohort was 28.5% (IQR: 17-47). No significant difference was identified between the non-recurring group and the recurring group for prostate volume and treated lobe-volume both at pre- and post-Tx. Analysis of prostato-rectal measurements was conducted in 17 Pts. The mean value of the median prostato-rectal distance was 2 mm (SD 1) in pre-Tx and 1.97 mm (SD 1.1) in post-Tx. We noted no significant difference in either the pre-Tx or post-Tx configuration (p=0.78 and p=0.1 respectively) between the groups of recurring vs. non-recurring Pts. 13 Pts were qualitatively classified as presenting an aspect of loss of symmetry in the prostato-rectal space on post-Tx MRI. No significative difference existed between the recurring and non-recurring group for this parameter. CONCLUSIONS: With this study, we described a novel standardized method of morphometric alteration post-fHIFU. This preliminary work incite further studies to assess the clinical significance and implications of these results in a larger prospective cohort. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1040 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Denis Seguier More articles by this author Srinath Kotarmarti More articles by this author Zoe Michael More articles by this author Rajan Gupta More articles by this author Cary Robertson More articles by this author Thomas Polascik More articles by this author Jonathan Olivier More articles by this author Arnauld Villers More articles by this author Expand All Advertisement PDF downloadLoading ...

Is Groin Hernia Associated with Pubic Edema Severity in Footballers?

Objective: The groin area, with its complex anatomical structure, can have different athletic problems simultaneously. In this study, it was aimed to investigate whether groin hernia had a relationship with pubic bone marrow edema (BME) severity in footballers. &#x0D; &#x0D; Method: Among the athletes with painful groin from different sports, only male footballers who had pubic BME in pelvic MRI report were included in the study. The included athletes underwent a second archive scan for groin hernia (hernia symptoms, previous hernia surgery, sonography report). Then, the MRI sections of hernia-related cases were re-evaluated. For this purpose, right and left pubic BME signal intensities (SI) were quantitatively measured using "region of interest (ROI)" program module on T2 fat-suppressed images.&#x0D; &#x0D; Results: A total of 93 footballers with pubic BME were found. Eleven of them (11.8%) had a concurrent hernia, while five (5.4%) had a repaired hernia prior to study. ROI measurements of these sixteen athletes revealed that the pubic bones on the side of concurrent and repaired hernia had a significantly greater mean BME intensity than opposite pubic bones (1049 SI versus 796 SI, p

Minimally Invasive Two-passage Electrical Genital Nerve Stimulation: A Human Cadaver Study of a New Technique

To present and evaluate the feasibility of a new technique of lead-electrode stimulation to the genital nerves using a 2-step, double-passage retropubic/retrograde approach. Prospective observational study. The procedure was initiated in the retropubic passage by placing the electrode from below through a paravulvar/testicular small incision toward the urogenital diaphragm, guided through the retropubic space along the backside of the pubic bone. Through a second passage along the frontside of the pubic bone, the lead-electrode was placed finally at the genital nerves. Department of Anatomy, University Bern, Bern, Switzerland PARTICIPANTS: The study was performed in 5 cadavers (bilaterally) and tested by 10 obstetrics and gynecology surgeons. Positions and courses of the lead electrode in relation to the dorsal nerve of the clitoris/penis were evaluated by dissection of the genitals and showed an optimal parallel course of the lead electrodes to the dorsal nerve from the perforation of the urogenital diaphragm to the crura of the clitoris, with area of the dorsal nerve of the clitoris/penis to the electrode never exceeding 2 mm. Participant surgeons self-evaluated reproducibility and difficulty of the procedure by using a score from 1 to 10 (1, easy/safe; 10, extremely difficult/dangerous). Both reproducibility and difficulty achieved a score of 1 by all participants. The double-passage genital nerve stimulation procedure is a new peripheral nerve stimulation technique that had a high self-evaluated rate of ease and reproducibility for surgeon participants.

PERFORMA KUALITATIF DAN KUANTITATIF AYAM KAMPUNG (Gallus Gallus Domesticus) DI PETERNAKAN PEMBIBITAN THE MOTHER

This study aims to identify the quantitative and qualitative performance of native chickens in The Mother breeding farm. This study used 50 male native chickens and 50 female native chickens aged 7 months. Variables observed included body hair pattern color, comb shape, comb color, shank color, eye color, beak color, body weight, chest circumference, shank length, shank circumference, body length, pubic bone length to chest, pubic bone distance and length wing span. Data were analyzed using descriptive analysis. The results of this study indicate that the body color of the male is Columbian (100%), while the female is solid black (62%), columbian (22%) and speckled or dotted (16%). The male cockscomb is pea (86%) and single (14%), while the female is pea (70%), walnut (20%) and single (10%). The color of the male comb is red (100%), while the female is red (98%) and black (2%). The shank color of males is yellow (74%), black (14%) and white (12%), females are black (74%), white (16%) and yellow (10%). Male eye color is orange (76%) and yellow (24%), while females are orange (66%), yellow (20%) and brown (14%). The color of the male's beak is yellow (54%), black and yellow (38%) and white (8%), while the female's beak is black and yellow (82%), yellow (10%) and white (8%). The results of the quantitative characteristics of the study showed that the male body weight was 2.22 ± 2.02 kg and the female was 1.71 ± 0.25 kg, the male chest circumference was 33.9 ± 3.68 cm and the female was 30.67 ± 2.08 cm, the length male shank 9.61 ± 0.89 cm and female 27 ± 0.59 cm, male shank circumference 5.52 ± 0.65 cm and female 4.4 ± 0.5 cm, male body length 20.27 ± 1.17 cm and female 20.40 ± 2.27 cm, the length of the pubic bone to the chest of the female is 7.87 ± 1.06 cm, the distance between the pubic bones is 2.8 ± 0.49 cm, the length of the male wing span is 23.28 ±2.18 cm and females 16.61±2.44 cm. The conclusion of this study is that the quantitative and qualitative characteristics of free-range chickens on The Mother farm are diverse and selection can be made. Keywords: Domestication chicken, Selection, Quality breeds, Lampung Province

Principal component analysis of body biometric traits in Marathwadi buffaloes

The identification of livestock breed is a necessity for its long-term maintenance and utilisation. Principal component analysis of morphometric traits has proved successful for reduction in the number of features needed for morphological evaluation in livestock species, which keeps costs down and saves time and efforts. Eighteen body biometric traits, viz. Height at withers, Leg length, Neck length, Neck circumference, Body length, Chest girth, Abdominal girth, Face length, Face width, Ear length, Horn length, Horn base circumference, Distance between horns, Hip-bone distance, Pin-bone distance, Distance between hip and Pubis bone, Rump length and Tail length of 103 Marathwadi buffaloes were analysed by using Promax rotated PCA with Kaiser Normalization to explain body conformation. Highest correlation was observed between HW × LEG (0.77), KMO Measure of Sampling Adequacy was 0.794 while Bartlett’s test of Sphericity was significant with chi-square value of 640.494. PCA revealed five components which explained about 61.91% of the total variation. First component explained 31.05% describing general body conformation with highest loadings for BH, CG, LEG and HB. The communality ranged from 0.43 (HC) to 0.78 (FW). Total variance explained by second, third, fourth and fifth component was 10.83%, 7.34%, 6.75% and 5.92% respectively. The rotated pattern matrix showed higher loadings of NC, PG, FL for Marathwadi buffaloes. Traits having high loadings in pattern matrix had high correlation with the components under structure matrix. Present study suggested that PCA can successfully reduce the dimensionality and first PC can be used in the evaluation and comparison of body conformation in Marathwadi buffaloes.

Left Pubic Tuberculosis Was Misdiagnosed as Synovitis of the Left Hip

A 51-year-old male patient was admitted to hospital with “1 week of restricted movement in left hip pain.” The patient denied trauma and had no other specific discomfort. Slightly reduced weight and physical strength, normal diet. No previous history of tuberculosis or exposure. Admission examination: no obvious abnormalities in the appearance of the spine, no tenderness and percussion pain. Left groin tenderness (+), left hip and buttock percussion pain (+), left 4-word experiment (+). Admission to complete relevant investigations: consider infectious lesions of the left pubic bone. After admission to the hospital and standardized treatment of tuberculosis, the patient's left pubic pain was significantly improved.

Contribution of Retzius-sparing robot-assisted radical prostatectomy to the mechanism of urinary continence as demonstrated by dynamic MRI

Retzius-sparing robot-assisted radical prostatectomy (RARP) has been reported to exhibit better postoperative urinary continence, but the reasons behind this are unknown. This study included 254 cases who underwent RARP and underwent postoperative dynamic MRI. We measured the urine loss ratio (ULR) immediately after postoperative urethral catheter removal and investigated its affecting factors and the mechanisms. Nerve-sparing (NS) techniques was performed in 175 (69%) unilateral and 34 (13%) bilateral cases, whereas Retzius-sparing in 58 (23%) cases. The median ULR early after indwelling catheter removal in all patients was 4.0%. The multivariate analysis was performed on factors that reduce ULR and found that the following factors were associated with ULR: younger age, NS and Retzius-sparing, which were significant. Additionally, dynamic MRI findings showed that membranous urethral length and the anterior rectal wall movement toward the pubic bone during abdominal pressure were significant factors. The movement observed on the dynamic MRI during abdominal pressure was thought to reflect an effective urethral sphincter closure mechanism. Long membranous urethral length and an effective urethral sphincter closure mechanism during abdominal pressure were considered effective for favorable urinary continence after RARP. NS and Retzius-sparing were clearly shown to have an additive effect in preventing urinary incontinence.

The 'Pelvic exenteration lexicon': Creating a common language for complex pelvic cancer surgery.

Pelvic exenteration surgery is an umbrella term for a multitude of operative techniques for locally advanced and recurrent pelvic malignancy. Currently, there is heterogeneity in the operative description that limits the interpretation of patient outcome and collaboration between units through standardized data collection. Our study aims to develop a consensus lexicon to describe the operative components of extended and exenteration pelvic surgery. This study adopted a mixed-methods approach using semi-structured interviews, questionnaires, focus groups and validation exercises involving pelvic exenteration experts from centres in the UK. Qualitative data were collected, and descriptive statistics are presented. We identified eight headings with 32 subheadings that encompass all components of the extent of the potential surgery. The lexicon was validated by 15 UK specialists. A 'high-complexity pelvic exenteration' was defined as encompassing 'conventional pelvic exenteration' with the extension of surgery to remove bony structures or the structures in the pelvic sidewall. Pelvic sidewall structures include major vessels, sciatic nerves and/or bone. Bony structures include the sacrum and/or pubic bones. This pelvic exenteration lexicon will permit classification of the surgical approach used that will improve data synthesis, allow more accurate activity recording for audit and ultimately improved outcomes for patients.