Urethral Research Articles

Androgenic induction of penile features in postnatal female mouse external genitalia from birth to adulthood: Is the female sexual phenotype ever irreversibly determined?

Female mice were treated for 35 days from birth to 60 days postnatal (P0, [birth], P5, P10, P20 and adult [∼P60]) with dihydrotestosterone (DHT). Such treatment elicited profound masculinization the female external genitalia and development of penile features (penile spines, male urogenital mating protuberance (MUMP) cartilage, corpus cavernosum glandis, corporal body, MUMP-corpora cavernosa, a large preputial space, internal preputial space, os penis). Time course studies demonstrated that DHT elicited canalization of the U-shaped clitoral lamina to create a U-shaped preputial space, preputial lining epithelium and penile epithelium adorned with spines. The effect of DHT was likely due to signaling through androgen receptors normally present postnatally in the clitoral lamina and associated mesenchyme. This study highlights a remarkable male/female difference in specification and determination of urogenital organ identity. Urogenital organ identity in male mice is irreversibly specified and determined prenatally (prostate, penis, and seminal vesicle), whereas many aspects of the female urogenital organogenesis are not irreversibly determined at birth and in the case of external genitalia are not irreversibly determined even into adulthood, the exception being positioning of the female urethra, which is determined prenatally.

The female urethra: urethral function throughout a woman's lifetime.

The objective of this narrative review is to describe changes in urethral function that occur during a woman's lifetime. Evaluation of urethral function includes measurements of urethral closure pressure, at rest and during stress, leak point pressure, and the detailed study of anatomical and histological changes of the urethral sphincteric mechanism. A literature search in MEDLINE, PubMed, and relevant journals from 1960 until 2020 was performed for articles dealing with urethral function and the impact of aging, pregnancy, and childbirth, female hormones, and menopausal transition on the urethral sphincteric mechanism. Longitudinal and cross-sectional epidemiological surveys, studies on histological changes in urethral anatomy during aging, and urodynamic data obtained at different points in a woman's lifetime, during pregnancy, after childbirth, as well as the effects of female hormones on urethral sphincter function are reviewed. Relevant studies presenting objective data are analyzed and briefly summarized. The findings lead one to conclude that a constitutional or genetic predisposition, aging, and senescence are the most prominent etiological factors in the development of urinary incontinence and other pelvic floor disorders. Vaginal childbirth dilates and may damage the compressed pelvic supportive tissues and is invariably associated with a decline in urethral sphincter function. Pregnancy, hormonal alterations, menopausal transition, weight gain, and obesity are at best of secondary influence on the pathology of lower urinary tract dysfunction. The decline of circulating estrogens during menopausal transition may play a role in the transition of fibroblasts to cellular senescence.

Female urethroplasty with a flap of the oral mucosa in a patient with in idiopathic urethral stricture. Clinical case

This article presents a clinical case of a rare pathology in urological practice – idiopathic stricture of the female urethra, considers the tactics of patient management and the method of surgical correction.

STUDY OF BACTERIURIA AMONG PREGNANT WOMEN ATTENDING A TERTIARY CARE HOSPITAL IN PANIPAT DISTRICT, INDIA

Most common population at risk for both symptomatic urinary tract infection (UTI) and asymptomatic bacteriuria, however, is sexually active women. Although asymptomatic infection in this group does not clearly produce serious medical problems, it may be a predictor of future symptomatic infection. Women are more susceptible to infection than men because of the shorter length of the female urethra. Perineal bacterial microbiota that originate in the gastrointestinal tract are the usual pathogens, especially if the bacteria possess factors that facilitate their binding to the uroepithelium. Sexual intercourse facilitates entry of the bacteria into the female urethra. Pregnant women are extra at risk of expand UTIs due to physiological adjustments withinside the urinary tract. UTI constitute severe threats to human health worldwide and hundreds of thousands of the humans affected every year. The aim of this study was to know the prevalence and antimicrobial susceptibility pattern of isolates in pregnant female patients. A total two hundred pregnant and non-pregnant females patients had been included on this study after obtaining the consent. Under strict aseptic precautions midstream urine samples had been taken from all sufferers. All the samples had been processed with the aid of using the usage of standard bacteriological methods i.e. wet mount, inoculation on blood agar and MacConkey's agar after which diagnosed with the aid of using standard biochemical tests, antibiotic sensitivity trying out changed into completed with the aid of using Kirby Bauer's disc diffusion method. In this study 80 out of 200 females patient i.e. 40% were showed UTI of which a most of 20 to 30 years age group had a considerably better occurrence of UTI i.e. 56.25%, while the age group of 60 years and above suggests the lowest contamination rate i.e 2.5% as compared to others. Females belonging to lower socioeconomic status had been extra liable to UTI then others. Pregnant females were more prone to UTI then non-pregnant females i.e. 52.73% and 35.17% respectively. Amongst pregnant females, primigravida and those in the first and second trimesters had been at higher risk. All isolates had been sensitivity to ampicillin+sulbactam, sparfloxacin, and gatifloxacin. Our study mentioned that the prevalence of UTIs was 40%; the pregnant female patients were more prone to UTI than non-pregnant females. The most isolated microorganism had been Escherichia coli which was maximum accountable for UTIs. The sexually active age group 26-30 years was highly at risk of UTI. Females belonging to lower socioeconomic status had been extra liable to contamination. Pregnancy was one in each of the predisposing elements for UTI. All isolates had been confirmed sensitivity to ampicillin+sulbactam, sparfloxacin, and gatifloxacin.

A study on etiology of incontinence in double knockout mouse model

Stress urinary incontinence is of concern in both pediatric and adult population. Double mutant GLI family zinc finger Gli2+/-; Gli3Δ699/+ murine model of stress incontinence has been recently developed as a reliable model which does not require surgical manipulation to create incontinence and is shown to survive to adulthood. The aim of this study was to establish the etiology of incontinence in the double mutant Gli2+/-; Gli3Δ699/+ mice. We used 13 cluster of differentiation 1 (CD-1) mice (7-9 weeks) for demonstration of histology of the bladder and urethra. There were 3 Wild Gli2+/- females, 2 Wild Gli2+/- males, 4 Gli2+/-;Gli3Δ699/+ females and 4 Gli2+/-;Gli3Δ699/+ males. The Wild Gli2+/- mice served as the control group and Gli2+/-;Gli3Δ699/+ mice served as the test group. Additionally, eight 16.5 days mice (2 each of Wild Gli2+/- females, Wild Gli2+/- males, double knockout (DKO) Gli2+/-;Gli3Δ699/+ females and Gli2+/-;Gli3Δ699/+ males) were used to assess the histology of the spinal cord. The gross appearance of bladder and urethra was studied using ink injection assays. Immunohistochemistry was done for smooth muscle actin and cytokeratin. Gross and histologic appearance confirmed the previously reported widening of bladder outlet and hypoplasia of smooth muscles in female urethra and also established them in the male urethra of Gli2+/-;Gli3Δ699/+ mice compared to Gli2+/- mice. The double knockout mice were smaller than the Gli2 mice (5.2 vs 6.1cm, p=0.002). Immunohistochemistry demonstrated epithelial hyperplasia and smooth muscle hypoplasia. Additionally, there was prostatic hypoplasia in the Gli2+/-;Gli3Δ699/+ male mice. The spinal cord length for body size appeared comparable between the Gli2+/- and Gli2+/-;Gli3Δ699/+ mice but histological evaluation revealed abnormal development of the caudal end of the vertebral body with premature termination of the spinal cord (Figure). The histological changes in the bladder neck and urethra were consistent to those previously reported. While previous report described the findings in female mice only, we confirmed that these findings are also present in males as well as prostatic hypoplasia, a possible additional factor leading to stress incontinence. The most important finding in the present study however, was the detection of premature termination of spinal cord in the DKO Gli2+/-; Gli3Δ699/+ mice which has not been reported previously and is likely a major contributor to incontinence in this model. The incontinence in male as well as female Gli2+/-; Gli3Δ699/+ mice is due to both myogenic and neurogenic involvement. These double knockout mice are a valuable model of stress incontinence related to neurogenic bladder due to low outlet resistance.

An assessment of urethral radiation exposure in the treatment of endometrial and rectal cancers.

Female survivors of endometrial and rectal cancers have increased risk of urinary incontinence. Survivors with prior radiation therapy are counseled against mesh incontinence surgery. We hypothesize that urethral radiation dose varies based on modality which may influence surgical risks. We aimed to demonstrate urethral radiation dose differences between vaginal brachytherapy (VBT) and external beam radiation therapy (EBRT). This is a retrospective cohort study of women exposed to VBT for endometrial cancer and EBRT for rectal cancer. The urethra was contoured on CT imaging to calculate radiation doses in centigray (cGy). The primary outcome was the percent of treatment radiation dose estimated to be received by the urethra based on the volume dose to 0.2cc of urethra. Secondary outcomes were point doses to the bladder neck, mid-urethra, and total mean urethral dose. Descriptive statistics described demographic characteristics. Bivariate analyses compared urethral radiation dose based on radiation modality. Between 2014-2017, 32 women treated were included: 18 with VBT and 14 with EBRT. Mean ± SD urethral volume doses were lower in VBT (1266cGy ± 533, 42.2% of prescribed treatment dose) compared to EBRT (5051cGy ± 192, 100.2% of prescribed treatment dose), p < 0.0001. VBT also had significantly lower mean total urethral dose and point doses to bladder neck and mid- urethra compared to EBRT (p < 0.0001). The female urethra is exposed to significantly less radiation in VBT compared to EBRT. These data highlight that modality of pelvic radiation should be considered in treatment counseling on urinary incontinence in women.

Is Urine Egress into the Female Urethra a Risk Factor for UTI?

In 50% of typical (nonneurogenic) women, at least one urinary tract infection (UTI) will occur, with cystitis being the most common UTI, with about 25% of patients experiencing recurrence. A factor not currently included in UTI risk models is egress of urine from the bladder into the urethra during bladder filling and activities of daily living. Urinary egress, if it occurs, would shorten the distance that bacteria need to travel to gain access to the bladder. Video urodynamics with contrast medium can demonstrate urinary egress; however, the observations can be difficult to conduct. Egress can be expected to be more likely in women with lower urinary tract conditions such as urge and stress incontinence. Treatment of the incontinence also reduces UTI rates and the reduction could, in part, be due to reduced urine egress. If UTI risk remains after incontinence management, then further treatment with pelvic floor exercises and pessaries could be considered to reduce the risk from potential residual urine egress. In summary, urine egress as a risk factor for UTI needs further research and clinical consideration.

Therapeutic effects of silodosin and urapidil on underactive bladder associated with diabetic cystopathy.

Pharmacological treatment options for underactive bladder (UAB) syndrome are limited. Urapidil is the only alpha1 -adrenoceptor (AR) antagonist that can be used for urinary disorders in women in some countries. However, no studies have directly verified the effects of alpha1 -AR antagonists on the female urethra and UAB-like dysfunctions. We investigated the effects of silodosin (alpha1A -AR antagonist) and urapidil (nonselective alpha1 -AR antagonist) on the voiding function in female rats with diabetes mellitus (DM). Changes in intraurethral pressure (IUP) induced by midodrine (alpha1 -AR agonist) and mean blood pressure (MBP) were continuously measured in normal female rats to verify the pharmacological profiles of the drugs. To establish a DM model, rats were administered streptozotocin (STZ; 50 mg/kg, intravenous). Eight weeks after STZ administration, drugs were subcutaneously delivered through an osmotic pump. Four weeks after drug administration, emptied bladder blood flow (BBF), intravesical pressure, and the micturition volume were measured. Both silodosin and urapidil inhibited the midodrine-induced increase in IUP and decreased MBP in a dose-dependent manner. Silodosin had a more substantial effect on the lower urinary tract than on MBP. Twelve weeks after STZ administration, DM rats exhibited UAB-like dysfunction (increased bladder capacity/bladder weight and residual volume and decreased bladder voided efficiency) and decreased BBF. Both drug treatments controlled this dysfunction. Alpha1 -AR antagonists induced dose-dependent urethral relaxation in female rats. These drugs ameliorated UAB-like dysfunction in STZ-induced DM rats. In addition, alpha1A -AR antagonists such as silodosin, which have limited effects on blood pressure, appear to be useful for treating UAB.

Paraurethral leiomyoma in a 22-year-old woman: A case report

Leiomyoma is a benign fibromuscular neoplasm originating from smooth muscle cells. Paraurethral leiomyoma is an extremely rare, benign, hormone-dependent​ growth from the mesenchymal cells in paraurethral space of female urethra. They usually appear in the reproductive age group women, mean age of presentation being approximately 41 years. A 22-year-old woman presented with palpable mass at vagina and weak urinary stream. She underwent clinical examination and MRI imaging followed by transvaginal excision of the mass. Histopathological examination confirmed paraurethral leiomyoma. Paraurethral leiomyoma make up approximately five percent of urethral tumors. This case depicts the presentation and treatment of a paraurethral leiomyoma in one of the youngest women reported in the literature.

Enhanced visualization of female squirting.

Squirting is the involuntary expulsion of fluid from the female urethra following stimulation of the anterior vaginal wall before or during orgasm. The mechanism underlying squirting has not been established. To elucidate the mechanism of squirting. The subjects in the current study were women who were able to squirt. They were not sex workers. A urethral catheter was inserted before sexual stimulation and the bladder was emptied. Then, a mixture of indigo carmine (10 ml) and saline (40 ml) was injected into the bladder. Sexual stimulation was provided tofacilitate squirting, which was videotaped and verified. The secretions were collected in sterile cups, and prostate specific antigen (PSA) and glucose levels were measured. Five women (2 in the 30s, 2 in the 40s, and 1 in the 50s) participated in this study. All women were able to squirt; three squirted only with manual sexual stimulation and two with penetrative sexual stimulation. The discharged fluid was blue in all cases, confirming the bladder as the source. The fluid was PSA-positive in four patients. The main component of squirt fluid is urine, but may also contain fluid from Skene's glands (female prostate). This is the first report in which visualization of squirting was enhanced.

Primary Malignant Melanoma of the Female Urethra, A Rare Histologic Pathology Subtype and Poor Prognosis: Case Report

Introduction: Primary malignant melanoma of the genitourinary tract is extremely rare. The recommendations for management of this cancer still undefined due to paucity of literature. We report a case of primary malignant urethral melanoma developed in an elderly female patient. Presentation of case: 72 years old Thai female presented with palpable urethral mass with contact bleeding. On physical examination, there were no suspicious lesions on her skin. On external genital examination, a lesion at urethral meatus was observed and biopsied by rural doctor. The pathological diagnosis was malignant melanoma of urethra. Discussion: Despite major surgery, radiotherapy or immunotherapy malignant melanoma usually has a poor prognosis. We performed distal urethrectomy and followed up her clinical closely but unfortunately tumor recurrence in 15 months of the follow up. Conclusion: Primary malignant melanoma of female urethra is an extremely rare and poor prognosis. The histological and immunohistochemical findings can be helpful in making an accurate diagnosis.

Macro-microscopic features of the structure of lymphoid nodules in the wall of the female urethra

The aim of the investigation was to study the macro-microscopic features of the structure and quantitative indicators of the lymphoid nodules of the female urethra in postnatal ontogenesis.Material and methods. The topography, number and size of lymphoid nodules in the urethral wall from corpses of 63 women of different age groups were studied by macro-microscopy using binocular stereomicroscope MBS-9 after elective staining with Harris hematoxylin. The material was fixed in a 10% formalin solution. The preparations were photographed and the area of lymphoid nodules was measured in the ImageJ program. For statistical data processing, parametric statistics methods based on the Statistica 6.0 program were used. Statistical data processing included the calculation of arithmetic averages, their errors, and the analysis of the amplitude of the variation series of each indicator.Results. The maximum number of lymphoid nodules in the urethra in early childhood corresponds to the idea of the largest total number of lymphoid cells, the severity of lymphoid tissue in the first years of life. The density of lymphoid nodules is maximum in the 1st period of childhood (9,5–10,5 nodules), and then decreases sequentially. In senile age, compared with the 1st period of childhood, the density of localization of lymphoid nodules decreases in the walls of the upper third of the urethra by 1.7 times (p&lt; 0.05), the middle and lower thirds of the organ - by 1.2 times (p&lt;0.05) and the urethra as a whole – by 1.3 times (p&lt;0.05). The amplitude of the variation series (differences between individual maximum and minimum) of the density of the location of lymphoid nodules, according to our data, does not change significantly during postnatal ontogenesis. The size of the lymphoid nodule during postnatal ontogenesis is maximal in the 1st period of childhood. Further, the value of this indicator decreases and reaches a minimum in old age and in centenarians.Conclusion. The study showed that lymphoid tissue in the urethral wall is at different stages of morphogenetic maturity, lymphoid nodules are found, which, as is known, are considered to be a more functionally mature stage of lymphoid tissue development. The values of the density of the location of lymphoid nodules throughout the female urethra in postnatal ontogenesis change slightly, the minimum number of them is observed in old age and the period of longevity, the maximum does not actually change.

A Comparative Study of Urinary Complication Rates before and after the Incorporation of a Urethral Lengthening Technique during Masculinizing Genital Gender Affirmation Surgery.

Objectives Masculinizing genital gender affirmation surgery (MgGAS) consists of operative procedures designed to help the transition of transmen in their journey toward male gender role. Phalloplasty and urethral lengthening remain the most challenging of these surgeries, as the female urethra (4 cm long) must be lengthened to male dimensions (15–29 cm) with anastomosis at two sites, the native urethra/pars fixa urethra and the pars fixa urethra-penile urethra. As a result, there is a high incidence of urinary complications such as strictures and fistulae. Authors incorporated a urethral lengthening technique to reduce urinary complications in MgGAS. They compare the rates of urinary complications rates in cohorts before and after the introduction of this technique. Materials and Methods Authors have been performing phalloplasty since past 27 years, utilizing mainly free radial artery forearm flap (fRAFFp 431 cases) and pedicled anterolateral thigh flap (pALTp 120 cases). A retrospective review and comparison of urinary complications were performed before and after the introduction of their new technique since March 2017. Results There was a statistically significant reduction in the incidence of stricture with and without fistulae (25.94% with conventional and 4.17% with urethral lengthening technique p = 0.001) and fistulae alone (12.81% with conventional and 2.78% with urethral lengthening technique p = 0.011) in fRAFFp cases. In pALTp cases, the respective reductions were 43.08 to 17.07%, p = 0.006 (significant), and 13.85 to 4.88%, p = 0.197 (not statistically significant). Conclusion Over years, the rates of urinary complications in MgGAS have remained constant, varying from 25 to 58% for strictures and 17 to 75% for fistulae as noted by many authors. Authors noted that in most of their cases, strictures occurred at distal pars fixa urethra (DPFU)-penile urethra anastomosis and incorporated a urethral lengthening technique, which lengthens the DPFU by 3 to 5 cm at this anastomotic site, thus significantly reducing the anastomotic tension and the rate of urinary complications.

Macro-microscopic anatomy of the lymphoid nodules of the urinary organs in people of different age

The aim of the investigation was to study the quantitative morphometric characteristics of the lymphoid follicles in the walls of the urinary tract using the method of macro-microscopy.Material and methods. The topography, number and size of lymphoid nodules in the walls of the ureters, bladder and urethra obtained from the corpses of 142 people of different ages were studied by macro-microscopy using a binocular stereomicroscope MBS-9 after elective staining with Harris's hematoxylin. The material was taken from persons whose death was due to injuries and asphyxia, and autopsy showed no signs of pathology of the urinary organs. For statistical data processing, parametric statistics methods based on the Statistica 6.0 program were used. Statistical data processing included the calculation of arithmetic mean indicators, their errors, analysis of the amplitude of the variation series of each indicator.Results. Lymphoid nodules are permanent structures in the walls of the ureters, bladder, and urethra. The number of lymphoid structures is maximum in the 1st period of childhood. In subsequent age periods, regardless of organ affiliation, the number of lymphoid nodules decreases with age, reaching a minimum in old age. In the 1st period of childhood, the maximum values are also reached by the size indicators of lymphoid nodules, increasing in the walls of the right ureter by 5.06 times, the left ureter – by 5.22 times, the bladder – by 4.60 times, the male urethra – by 4.60 times, female urethra – 4.65 times compared with the neonatal period (p&lt;0.05). In the future, a decrease in size is observed, which is most pronounced in old age in the walls of the female urethra. Regional (organ) differences are in a smaller number of lymphoid nodules and their size in the walls of the ureters and the maximum value of these parameters in the walls of the urethra.

Primary Non-Hodgkin’s Lymphoma of the Female Urethra Presenting as Carunculous of Urethra: A Very Rare Case Report

Background: Female urethral carcinoma occurred &lt; 1% of all female malignancies. With a small prevalence of Malignant Urethral Lymphoma, there is lack of data about quality of the therapy.&#x0D; Case Report: A 41-year-old woman came to Division of Urology, Department of Surgery Dr. Kariadi Hospital Semarang with chief complaint a recurrence mass on her urethra. Her general condition was fine, and has a normal vital signs. On the physical examination of urogenital region, there was mass on the orifice of urethra external that can easily bleed. She is already performed excision of urethral caruncle with immunohistochemistry examination and found CD-20 positive which indicated a diffuse B-cell Lymphoma. Then she had 6 cycle chemotherapy procedures in Division of Hematooncology, Internal Medicine Department. Until now, she routinely check-up to urology and internal medicine departments to monitor her disease progression.&#x0D; Conclusion: Female urethral carcinoma is very rare, although surgery alone has been established as effective for treating low-stage urethral cancer, neither surgery nor radiation therapy alone provide good results. Delay in diagnose and treatment can decrease patient survival.&#x0D; Keyword: non-Hodgkin’s lymphoma, immunohistochemistry, Urethral carcinoma, urethral caruncle, chemotherapy

Stress urinary incontinence is caused predominantly by urethral support failure

Whales are mammals that can dive to depths of > 1000 m without the high water pressure pushing open their mouth or anus. The same is true for the female urethra. The meatus externus and internus are seals that cannot be pushed open by high water pressures. Recent evidence suggests that the female meatus internus is pushed open when the bladder pressure exceeds the urethral pressure. For a relaxed detrusor, this opening is not possible for at least three reasons: the law of elastic collision, Pascal’s law of hydrostatics and the Hagen-Poiseuille law. The three laws do not support that urethral function failure is the predominant cause of stress urinary incontinence (SUI); however, they do support that urethral support failure is. Influential urogynecologists claim the opposite. TVT surgery, according to the integral theory of SUI (IT), has high failure rates because it does not principally prevent the urethra from hanging on a less mobile bladder neck. In the case of a long urethra, the tape is set too distally, and in hypomobile SUI, the use of a tension-free suburethral tape is unwarranted/ineffective, because the proximal urethra is not elevated above its resting position. A successful operation corrects urethral support failure and not urethral function failure.

Advancing our understanding of the neural control of the female human urethra.

Advancing our understanding of the neural control of the female human urethra.

An impacted urethral stone: a rare cause of acute urinary retention in women\u2014case report

BackgroundUrethral calculi are rare, representing 1–2% of all calculi affecting the urinary tract. Impacted urethra calculi are commoner in males due to anatomical differences between the male and female urethra. The treatment approach is determined by the size and location of the stone, associated anomalies and available facilities.Case presentationWe present the case of 35-year-old woman who presented with acute urinary retention secondary to an impacted urethral stone. The calculus could not be removed through the external urethral meatus due to the size of the stone. She had cystolithotomy after retrograde manipulation to the bladder. She did well postoperatively. This line of management was based on the size of the stone, and the available facilities which are typical of many hospitals in developing countries.ConclusionsUrethral calculi are extremely rare in women. The treatment should be individualized.

MP04-08 BLUNT TRAUMATIC FEMALE URETHRAL AND BLADDER NECK INJURIES: A 15 YEAR SINGLE-INSTITUTION EXPERIENCE

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) I (MP04)1 Sep 2021MP04-08 BLUNT TRAUMATIC FEMALE URETHRAL AND BLADDER NECK INJURIES: A 15 YEAR SINGLE-INSTITUTION EXPERIENCE Catalina K. Hwang, Stanley Moore, Ziho Lee, and Judith C. Hagedorn Catalina K. HwangCatalina K. Hwang More articles by this author , Stanley MooreStanley Moore More articles by this author , Ziho LeeZiho Lee More articles by this author , and Judith C. HagedornJudith C. Hagedorn More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001971.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Injury of the female urethra and bladder neck (BN) from blunt trauma is rare. Our understanding of its management and outcomes is based on case reports predominantly in the pediatric population, which describe high complication rates related to delayed management. We present our 15-year experience of this injury in an adult population. METHODS: We retrospectively reviewed records of all female patients admitted to our Level 1 trauma center from 2005 to 2019 with a urethral or BN injury. All inpatient and outpatient records were reviewed. RESULTS: Ten patients were identified with a median age of 36.5 (range 17-48) years. All patients had concomitant pelvic fractures. Six injuries involved the BN, 3 the proximal urethra, and 1 the distal urethra. All injuries were confirmed operatively. Median time to diagnosis was 1 (range 0-4) day after presentation. Gross hematuria was seen in all patients. Of 6 patients with preoperative CT cystogram, 50% had a scan that demonstrated the injury. Of 8 patients with pre-operative pelvic examination, 50% had an identifiable injury on that exam. Cystoscopy in the operating room was performed in 4 patients. Visual inspection of the urethra through cystotomy was performed in 5 patients. There were no delayed or missed diagnoses. Two patients were lost to follow-up. One patient was not eligible for early repair of urethral injury due to clinical instability and underwent urethrovaginal fistula repairs at 3 months, and at 18 months after presentation. Of the 7 remaining patients who underwent early management of their injury within 7 days, 2 (29%) had a major surgical complication (Clavien grade >2) including pyelonephritis and suprapubic wound abscess. One patient had a urethrovaginal fistula that was seen on voiding cystourethrogram with spontaneous resolution of pneumaturia. On median follow-up of 15.2 (range 3-19.5) months, none of these patients who underwent early management reported long-term Urologic concerns related to urethral injury, including stricture and incontinence. CONCLUSIONS: Our experience suggests that intraoperative evaluation is the only reliable diagnostic modality for urethral and BN injury in adult females. Although some patients had early surgical complications, none of those who underwent prompt management within 7 days of injury had long-term complications of their urethral injury. Our excellent outcomes reinforce the importance of an aggressive diagnostic strategy and surgical repair for female urethral and BN injury. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e70-e70 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Catalina K. Hwang More articles by this author Stanley Moore More articles by this author Ziho Lee More articles by this author Judith C. Hagedorn More articles by this author Expand All Advertisement PDF downloadLoading ...

Mapping afferent and pelvic postganglionic neurons of the urethra from female rats: The L6 DRG is the major primary afferent supplier.

To map sensory and pelvic postganglionic neurons from three different regions of the female rat urethra. The neuronal tracer True Blue (TB) was injected into the pre-pelvic, pelvic, and clitoral regions of the urethra from female Wistar rats. Seven days after TB injection, TB+ cells from the dorsal root ganglia (DRGs) and the major pelvic ganglion (MPG) were examined. The number and morphometry of TB+ cells were determined. TB+ cells were mainly distributed in lumbar 1 (L1), lumbar 2 (L2), lumbar 6 (L6), and sacral 1 (S1) DRGs, and in the MPG. The mean number of sensory neurons was 1200 ± 143. TB injection in pre-pelvic and pelvic urethra labeled neurons in L1, L2, L6, and S1 DRGs. TB injection in clitoral urethra labeled neurons in L6 and S1 DRGs. L6 DRG contained >50% of the total urethral TB+ neurons, and ~80% of the clitoral region. The mean value of the total number of MPG TB+ neurons was 1217 ± 72. DRG and MPG neurons projecting to the urethra presented a somatotopic distribution. The results demonstrated that L6 DRG is the major supplier of afferent innervation to the urethra, and that the distal urethral region is exclusively innervated by lower lumbosacral DRGs. Considering that electrical stimulation of sensory pudendal nerve improves overactive bladder, and that most of the sensory neurons in the distal urethra are from L6 DRG, electrical stimulation of this ganglion may be an innovative and effective neuromodulation therapy for neurogenic urinary dysfunctions.