Urethral Diameter Research Articles

Association of bi-parametric MRI measures with continence after robot-assisted radical prostatectomy.

To investigate the association between pre- and postoperative magnetic resonance imaging (MRI) measurements of the membranous urethra and the prostate volume and continence following robot-assisted radical prostatectomy (RARP). From December 2018 to June 2022, 100 continent patients undergoing unilateral nerve-sparing or non-nerve-sparing RARP were included in this cohort study. Bi-parametric MRI scans were performed before and 12 months after RARP and measurements included the membranous urethral length (MUL) measured in cm (mMUL) and in the number of image slices (sMUL; 3 mm/slice), the membranous urethral diameter (MUD), and the prostate volume. Urinary function was evaluated by the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) and continence, defined as the use of zero pads and the answer 'never' to the ICIQ-UI SF question regarding incontinence frequency or <8 g urine-loss per 24 h. Regression with robust variance estimates was used to analyse the association between measurements and outcomes. At 12 months, continence and MRI data were available for 82 patients. The continence rate was 63% and the median (interquartile range) ICIQ-UI SF score was 4 (0-9). Both preoperative MUL measurements were associated with continence at 12 months. Every extra 5 mm of MUL increased the likelihood of being continent by 13 percentage points (P = 0.03) and every additional slice of sMUL increased it by 6 percentage points (P = 0.05). Both postoperative MUL measurements were associated with better continence and lower ICIQ-UI SF scores (P < 0.01). A larger prostate volume was associated with urinary incontinence at 12 months, with a small effect size. The MUD was not associated with continence. Preoperative mMUL and sMUL are associated with continence at 12 months after RARP. The sMUL may be a useful measurement when only the axial plane is available, and the slice gap is known. Postoperative MUL measurements are strongly associated with continence, while MUD and prostate volume hold minimal prognostic value.

Enhanced Non-Invasive Diagnosis of Female Urinary Incontinence Using Static and Functional Transperineal Ultrasonography.

Background/Objectives: To investigate the utility of transperineal ultrasound in detecting stress urinary incontinence (SUI) and identify optimal anatomical and functional parameters. Methods: Thirty-four women presenting with SUI with or without pelvic organ prolapse between 2012 and 2016 were studied. The control group included patients without SUI who underwent surgery for mild gynecologic disorders or pelvic organ prolapse. The relationship between selected ultrasound parameters and SUI was determined. Results: Among the 20 variables measured in ultrasonography using 4 angles and the bladder-symphysis distance (BSD) values, we found that the difference in the BSD obtained at rest and during the Valsalva maneuver (odds ratio [OR]: 1.15, 95% confidence interval [CI]: 1.05-1.27, p = 0.004), the mean urethral diameter (UD; OR: 4.29, 95% CI: 2.07-8.83, p = 0.0001), and the occurrence of the funneling sign during the Valsalva maneuver (OR: 21; 95% CI: 6.1-71.9, p < 0.0001) were associated with urinary incontinence in the logistic regression analysis. The optimal cut-off point for BSD was >8 mm (area under the curve (AUC), 0.71; sensitivity, 91.2%; specificity, 56.8%; p = 0.001) and that for UD was >6 mm (AUC, 0.84; sensitivity, 82.1%; specificity, 73%; p < 0.001). Conclusions: Transperineal ultrasonography is a useful tool for detecting SUI. Our findings highlighted the utility of several sonographic parameters, mainly the urethral diameter, in the diagnosis of urinary incontinence.

Relationship between parameters of the urethrovesical segment and quality of life in women with stress urinary incontinence

Aim of the study. To determine the relationship between ultrasound parameters of the urethro-vesical segment and the quality of life of women with stress urinary incontinence before and after surgical treatment. Materials and methods. We studied the quality of life and the severity of symptoms according to the UDI-6, I-Qol, IIQ-7, ICIQ-SF questionnaires, as well as ultrasound examination of the urethro-vesical segment in 40 women with stress urinary incontinence before and after surgery for the period 2023-2024. Correlation analysis among the listed indicators was performed. The mean age in the analyzed group was 49.7±9.7 years. Results and discussion. There was a significant improvement in postoperative quality of life scores for all the questionnaires used. There was a direct correlation between UDI-6 and urethral diameter in the Valsalva test, between IIQ-7 and the distance between the pubic symphysis and the bladder neck in the Valsalva test, the severity of symptoms according to the ICIQ-SF scale and the size of the posterior urethro-vesical angle at rest before surgery. After surgery, an inverse correlation was found between the distance from the pubic symphysis to the bladder neck in the Valsalva test and the data of the I-Qol questionnaire, as well as I-Qol and the values of the posterior urethro-vesical (β) angle in the Valsalva test. A direct correlation was found between the distance from the pubic symphysis to the bladder neck in the Valsalva test and the results of the IIQ-7 questionnaire, as well as between the β-angle value and the severity of symptoms according to the ICIQ-SF questionnaire. Conclusions. The results of the analysis confirmed the researchers' hypothesis that ultrasound parameters of the urethro-vesical segment correlate with the severity of symptoms and the level of quality of life in patients with stress urinary incontinence before and after surgical treatment.

Heterogeneous porous hypoxia-mimicking scaffolds propel urethral reconstruction by promoting angiogenesis and regulating inflammation

The nasty urine microenvironment (UME) impedes neourethral regeneration by inhibiting angiogenesis and inducing an excessive inflammatory response. Cellular adaptation to hypoxia improves regeneration in numerous tissues. In this study, heterogeneous porous hypoxia-mimicking scaffolds were fabricated for urethral reconstruction via promoting angiogenesis and modulating the inflammatory response based on sustained release of dimethyloxalylglycine (DMOG) to promote HIF-1α stabilization. Such scaffolds exhibit a two-layered structure: a dense layer composed of electrospun poly (l-lactic acid) (PLLA) nanofibrous mats and a loose layer composed of a porous gelatin matrix incorporated with DMOG-loaded mesoporous silica nanoparticles (DMSNs) and coated with poly(glycerol sebacate) (PGS). The modification of PGS could significantly increase rupture elongation, making the composite scaffolds more suitable for urethral tissue regeneration. Additionally, sustained release of DMOG from the scaffold facilitates proliferation, migration, tube formation, and angiogenetic gene expression in human umbilical vein endothelial cells (HUVECs), as well as stimulates M2 macrophage polarization and its regulation of HUVECs migration and smooth muscle cell (SMCs) contractile phenotype. These effects were downstream of the stabilization of HIF-1α in HUVECs and macrophages under hypoxia-mimicking conditions. Furthermore, the scaffold achieved better urethral reconstruction in a rabbit urethral stricture model, including an unobstructed urethra with a larger urethral diameter, increased regeneration of urothelial cells, SMCs, and neovascularization. Our results indicate that heterogeneous porous hypoxia-mimicking scaffolds could promote urethral reconstruction via facilitating angiogenesis and modulating inflammatory response.

Comparison of firocoxib and meloxicam for pain mitigation in goats undergoing surgical castration

Castration is a common husbandry practice in food animal management. Castration reduces aggression, prevents indis­criminate breeding, and improves carcass quality. For male goats intended to be kept as pets, castration is recommended close to sexual maturity (6-8 m) to allow for increased urethral diameter. A larger urethral diameter lowers the chances of ure­teral obstruction occurring. There are currently no approved analgesic drugs for surgical castration in goats. Veterinarians must extrapolate analgesic data from other livestock species to try to mitigate pain in goats. Sheep and cattle are commonly used, but there is little research supporting best practices of pain mitigation in goats. This study sought to examine the ef­fects of firocoxib and meloxicam after surgical castration in crossbred goats.

Biocompatibility and efficacy of prostatic urethral lift in benign prostate hyperplasia: an in vivo and in vitro study

The study aimed to assess the biocompatibility and efficacy of a prostatic urethral lift (PUL) for benign prostatic hyperplasia (BPH). Human BPH-1 cells were co-cultured with implant anchors and sutures, and cytotoxicity was measured. Scanning electron microscopy (SEM) was used to observe adhesion and growth of cells and to evaluate implant biocompatibility. Fifteen male beagle dogs were randomly assigned to the surgical (n = 9) or sham-operated (n = 6) groups. The surgical group underwent cystotomy, and PUL was used to insert two implants in each lobe of the prostate to compress the enlarged prostate and dilate the urethra; the sham group underwent cystotomy without implant insertion. Compared with the control group, no significant difference in cell viability among the groups with different co-culture times of implant anchors and sutures (P > 0.05) was observed. SEM revealed good adhesion and growth of prostate cells on the implants. Improvements in urine flow rates remained stable at 7, 28, and 180 days after surgery, and the urethral diameter in the prostate region was significantly increased compared with that before surgery. PUL is a biocompatible and effective treatment for BPH, improving the urine flow rate without causing inflammation, tissue damage, or cytotoxic effects. Here, the basis for further PUL application was provided.

Influence of transurethral catheters on urine pressure-flow relationships in males: A computational fluid-dynamics study

Background and ObjectiveIn the field of urology, the pressure-flow study (PFS) is an essential urodynamics practise which requires the patient's transurethral catheterization during the voiding phase of micturition to evaluate the functionality of the lower urinary tract (LUT) and reveal the pathophysiology of its dysfunctionality. However, the literature evidences confusion regarding the interference of the catheterization on the urethral pressure-flow behaviour. MethodsThe present research study represents the first Computational Fluid-Dynamics (CFD) approach to this urodynamics issue, analysing the influence of a catheter in the male LUT through case studies which included the inter-individual and intra-individual dependence. A set of four three dimensional (3D) models of the male LUT, different in urethral diameters, and a set of three 3D models of the transurethral catheter, diverse in calibre, were developed leading to 16 CFD non-catheterized either catheterized configurations, to describe the typical micturition scenario considering both urethra and catheter characteristics. ResultsThe developed CFD simulations showed that the urine flow field during micturition was influenced by the urethral cross-sectional area and each catheter determined a specific decrease in flow rate if compared to the relative free uroflow. ConclusionsIn-silico methods allow to analyse relevant urodynamics aspects, which could not be investigated in vivo, and may support the clinical PFS to reduce uncertainty on urodynamic diagnosis.

Urethral Stricture Induction Followed by Buccal Mucosa Graft Urethroplasty in a Rat Model.

Urethral reconstruction is an important area of expertise for urologists. The buccal mucosa is considered the best option when urethral grafting is necessary, although in some cases, it is inappropriate or needs to be optimized to repair a given stricture. Therefore, developing innovative procedures and evaluating their putative success in experimental models is crucial to fit the clinical need. With this goal, this study describes a protocol in which urethral stricture was induced by electrocautery in Wistar rats. Urethral reconstruction was performed 1 week later with a buccal mucosa graft, harvested from the lower lip, and placed in a ventral onlay fashion. A retrograde urethrogram showed a significant improvement in urethral diameter after urethroplasty compared to the respective value after stricture induction. Additionally, the graft placement was assessed by blood perfusion analysis using laser Doppler. As expected, a dark blue area corresponded to the non-vascularized buccal mucosa graft. This procedure can successfully simulate the normal pathophysiological process of urethral injury and tissue modulation, as well as urethral reconstruction using a buccal mucosa graft in a reproducible manner, and serve as the basis for future research based on tissue engineering or urethral grafts.

Overactive bladder (OAB): a failed concept needing revision to accommodate an external anatomical control system.

In 45years, the definitions and practice of the urodynamically based overactive bladder (OAB)/detrusor overactivity (DO) system have failed to adequately address pathogenesis and cure of urinary urge incontinence, frequency and nocturia. We analysed the OAB syndrome with reference to the Integral Theory paradigm's (ITS) binary feedback system, where OAB in the female is viewed as a prematurely activated, but otherwise normal micturition caused mainly, but not entirely, by ligament damage/laxity. The ITS Clinical Assessment Pathway which details the relationships between structural damage (prolapse), ligaments and dysfunction (symptoms) is introduced. The ITS was able to "better explain" OAB pathophysiology in anatomical terms with reference to the binary model. The phasic patterns diagnostic of "detrusor overactivity" are explained as a struggle for control by the closure and micturition reflexes. The exponentially determined relationship between urethral diameter and flow explains why obstructive patterns occur, why they do not and why urine may leak with no recorded pressure. Mechanically supporting ligaments ("simulated operations") during urodynamic testing can improve low urethral pressure, negative pressure during coughing with SUI and diminish urge sensation or even DO patterns, transforming urodynamics from non-predictive test to accurate predictor of continence surgery results. High cure rates for OAB by daycare repair of damaged ligaments is a definitive test of the binary system's validity. Conceptual progression of OAB to the Integral Theory paradigms's prematurely activated micturition validates OAB component symptoms as a syndrome, explains pathogenesis, and unlocks a new way of understanding, diagnosing, treating and researching OAB.

Correlation of Urethral Ratio and Bladder Wall Thickness with Cystoscopic Findings in Posterior Urethral Valve Patients to Assess Residual Valves.

Introduction:Posterior urethral valve (PUV) is life threatening congenital anomaly of urinary tract. Aim of the study was to correlate urethral ratio (UR) and bladder wall thickness (BWT) with cystoscopic findings in PUV patients to assess residual valves and to validate UR as a diagnostic tool for residual valves. It also aimed to assess the utility of bladder wall thickness in diagnosis of residual valves.Materials and Methods:A total of 31 patients were included in the prospective study done from 2017 to 2019. Calculation of UR was done in oblique VCUG films by dividing maximum posterior and anterior urethral diameter without the catheter insitu. Measurement of BWT was done at dome and bladder neck at full distension with feeding tube insitu and was done at same volume in follow up. The procedure was repeated at 3 months follow up. The findings were compared with cystoscopic findings for the status of residual valves as gold standard. Each patient served as control for self in the study.Results:Median age of presentation was 1 years with range of 1day to 10 years. The most common complains at the time of presentation in our study was straining (35.48%) followed by antenatally diagnosed patients (25.81%) and recurrent UTI (19.36%). Pre fulguration median UR was 2.45. Post Fulguration median UR was 1.20. It showed a statistically significant reduction (p < 0.001) after fulguration. Pre fulguration median BWT was 4 mm. Post fulguration median BWT was 2.5 mm. BWT showed a statistically significant reduction (p < 0.001) after fulguration as well. ROC curve was plotted for UR and BWT. BWT more than 1.95 mm (sensitivity-80%) and UR more than 1.2 (sensitivity-70%) indicates residual valves.Conclusion:A step ladder approach including BWT, UR and check cystoscopy can serve as a new diagnostic algorithm for the assessment of residual valves thereby avoiding extra radiation and general anesthesia exposure.

Application of acellular dermal matrix loaded collagen binding domain-vascular endothelial growth factor patch in urethral wound repair in beagles

Objective: To investigate the application value of acellular dermal matrix (ADM) loaded collagen binding domain-vascular endothelial growth factor (CBD-VEGF) patch in the repair of urethral wound in beagles. Methods: Twenty-one healthy adult beagles were selected to establish urethral wound model and randomly divided into 3 groups, which were treated with different repair methods. CBD-VEGF patch was prepared and instantaneous implantation was performed as the models were successfully built. The blank control group was treated without any repair materials;the ADM group was treated with collagen patch for repair and the ADM loaded with CBD-VEGF group was treated with collagen patch loaded with VEGF for repair. The safety and effectiveness of the three groups of materials implanted into the urethral wound model at 6 months after surgery were compared. Urodynamic examination, urethral angiography and pathological examination were used to evaluate the recovery of urethral tissue in the three groups. Result: Compared with blank control group and ADM patch group, there was no complications or other adverse conditions in the ADM-loaded CBD-VEGF patch group. Urethrography was performed to measure the diameter of the urethra in the experimental segment, the mean urethral diameter of blank control group [(3.07±0.43) mm] was significantly smaller than that of ADM patch group [(3.73±0.11) mm] and ADM loaded CBD-VEGF patch group [(3.64±0.32) mm], with statistical difference (P<0.05). Pathological examination with HE and Masson staining showed more proliferative blood vessels in the ADM loaded CBD-VEGF patch group. HE staining indicated that there were more proliferative vessels in the group of CBD-VEGF patch loaded with ADM. Masson staining showed that the positive area percentage of collagen tissue in the three groups was 34.27%±7.40%, 29.08%±3.79% and 28.02%±2.39%, respectively, with no statistical difference between the three groups(all P>0.05). There was no excessive deposition of collagen tissue in the two groups using collagen patch. The percentage of positive staining per unit area in the three groups were 1.4%±0.1%,1.8%±0.1%3.1%±0.2%, respectively, and the difference was statistically significant among three groups and between every two groups (all P<0.01), indicating the vascular density of CBD-VEGF group loaded with ADM was the highest. Conclusion: ADM loaded CBD-VEGF patch is a good biological support material for covering the wound after urethral surgery, and it provides an alternative direction for promoting the healing of the urethral wound.

Narrative review of penile distal urethroplasties and suggestions for optimizing outcomes.

Distal urethral strictures can be a challenging entity for urologists. Endoscopic maneuvers such as optical internal urethrotomies or dilations are even less successful than in other urethral locations and the repeated trauma will increase the scarring which advocates for a urethroplasty as primary option for patient management. Success rates of distal urethroplasties have been lower than those for other urethral strictures due to the anatomy of the distal urethra with a very thin corpus spongiosum associated with decreased mucosal blood supply. Also, the high prevalence of lichen sclerosus in this population with circumferential scarring is often a complicating factor. However, in the past two decades several surgical techniques have been described and further developed which has led to significant improvement in stricture recurrence rates. Meatoplasties are indicated for strictures limited to the meatus and involve opening of the stenotic meatus with subsequent reconstruction of it to minimize spraying of urine. Often, however, distal urethral strictures involve the fossa navicularis and may even extend further proximally. These strictures can be addressed with dorsal or ventral inlay procedures using buccal mucosa graft. In addition or alternatively, skin flaps can be mobilized to increase the urethral diameter. Lastly, multi-stage urethroplasty with buccal mucosa are a very successful approach yet given the high success rates of above mentioned procedures are usually reserved for revision surgery or most severe distal urethral strictures. In the following report, we are describing a variety of surgical techniques and their indication which should allow the practicing urologist to successfully address all encountered distal urethral strictures.

Ultrasound‐guided transurethral urinary bladder biopsy using an endoscopic biopsy forceps in dogs: 27 cases (2016–2019)

To describe an ultrasound-guided transurethral bladder biopsy technique using endoscopic forceps and its results in dogs of different sizes with different lesion locations. Medical records of dogs that underwent ultrasound-guided transurethral bladder biopsy with endoscopic forceps were retrospectively reviewed. Patient signalment, lesion location, use of urinary catheter as a guide, outcome of the procedure and histopathology results were retrieved. Twenty-seven dogs underwent this procedure. Biopsy samples were successfully obtained in 23 dogs. Insertion of the endoscopic forceps without a urinary catheter allowed the procedure to be performed in patients with a small urethral diameter without complication. The procedure was unsuccessful in dogs with a urethral diameter smaller than the outer diameter of the biopsy forceps (i.e. 1.8 mm), either due to small patient size or obstructive urethral lesion. All biopsy samples allowed histopathological diagnosis. No complications were reported after the procedure. This non-invasive biopsy technique should be considered in patients with bladder lesions in which histopathological diagnosis is needed, especially when endoscopic examination is not feasible. By use of the Doppler mode, biopsy retrieval was safe also when the lesion ​was highly vascularised.

Hyaluronic Acid Reduces Fibrosis in a Rabbit Model of Urethral Anastomosis.

IntroductionUrethral stricture caused by fibrosis is a common medical condition, but top-line therapy for this pathology has a high recurrence rate. This study aimed to determine the efficacy of hyaluronic acid (HA) treatment in preventing the development of fibrosis in a rabbit model of urethral anastomosis.Materials and MethodsThis experimental study involved 20 rabbits. HA (0.5 mL, 25 μg/mL) was applied in the experimental group (n = 10) during an experimental urethral anastomosis, and sterile saline (0.9%) solution was applied in the control group (n = 10). Animals underwent reoperation 12 weeks later for urethral resection. Fibrosis, inflammation, and urethral diameter were measured by two blinded pathologists at the site of the anastomosis.ResultsThe amount of inflammatory infiltrate was similar in both groups. The thicknesses of the collagen fiber band were 275.9 ± 62.3 and 373.4 ± 44.3 μm in the study and control groups (p = 0.001), respectively, and the urethral lumen diameters at the anastomosis site at follow-up were 2575 ± 167 and 2382 ± 214 μm, respectively (p = 0.04).ConclusionHA treatment reduced fibrosis at the anastomosis site during this experiment; we suggest further research to corroborate its efficacy in the treatment of urethral stricture.

Urethral Diameter at the Time of Birth and Its Implication on Urinary Incontinence

Background: Throughout life, many women develop urinary incontinence (UI), and vaginal birth has been implicated as one of the causes of this pathology, once it may cause damages to the pelvic floor and to the continence mechanism. The aim was to compare urethral diameter between primiparous women after vaginal birth and women after elective cesarean section, without previous vaginal birth, correlating these measurements with factors related to pregnancy and childbirth and with presence of UI within 6 months of childbirth. Methods: Urethral diameter was measured in the immediate postpartum period (up to 2 days) by transperineal ultrasound at the level of the bladder neck and mid urethra. The data were collected on pregnancy and birth. Six months after childbirth, the participants were assessed for the presence of UI. Results: Of 151 women, 73 delivered vaginally (group 1) and 78 had a cesarean section (group 2). Urethral diameter at the level of the bladder neck was significantly smaller in group 2 (P ≤ 0.0001). There was no significant difference between the two groups in urethral diameter at the mid urethra (P = 0.505). Only urethral diameter at the mid urethra was inversely correlated with UI at 6 months (P = 0.014). There was a positive correlation between presence of UI during pregnancy and at 6 months after childbirth (r s = 0.214, P = 0.016). Conclusions: A significant difference was observed in the urethral diameter at the bladder neck according to the mode of birth. A positive correlation was also found between presence of UI during pregnancy and at 6 months postpartum. J Clin Gynecol Obstet. 2020;9(4):102-107 doi: https://doi.org/10.14740/jcgo705

The urethra of healthy female dogs can be normally narrowed due to the urethral flexure in retrograde CT urethrography.

Quantitative analysis of urethral size in male dogs by retrograde CT urethrography using a power injector is a recently reported technique. The aim of the current, prospective, analytical study was to apply the same method to six, healthy, intact female Beagle dogs. The proximal (P<.0001) and middle (P=.0010) urethral volumes significantly differed between the empty and distended bladder states, although no significant difference was observed in the distal volume (P=.0971). Unlike male dogs, female dogs showed two patterns of the urethral course: a straight urethra and urethral flexure. The urethral flexure was always related to intrapelvic position of the urinary bladder, and the more caudal the location of the vesicourethral junction beyond the pecten of the pubic bone, the more marked the appearance of the urethral flexure. Analysis of the urethral diameter at five sites (adopted from the previous radiographic study) was performed, and the urethral diameter showed a significant difference between the empty and the distended bladder states at sites 1 (vesicourethral junction, P<.0001), 2 (P<.0001), and 3 (P=.0244). However, there were no significant differences at sites 4 (P=.2516) and 5 (inflatable retention bulb, P=.1260). The urinary bladder may be in part intrapelvically located in clinically healthy female dogs, and urethral flexure and urethral narrowing can result from the intrapelvic location of the bladder. Narrowing of the urethra should be interpreted with caution when the pelvic bladder is identified.

Коррекция стенозов уретры после оперативных вмешательств по поводу проксимальных форм гипоспадии у детей

Aim Urethral stenosis is one of the serious complications after proximal hypospadias repair. A variety of techniques has been suggested for its correction, such as urethral dilation using bougies, endoscopic incisions and one- or two-staged urethroplasty with buccal mucosa. The aim of our study was to improve results of urethral stenosis correction in children after multiple proximal hypospadias repairs. Materials and methods A total of 24 patients with urethral stenosis after proximal hypospadias repairs underwent treatment in the Department of Uroandrology of the Russian Childrens Clinical Hospital from 2015 to 2019. The age of the patients was from 3-17 years (average - 4.2) with penoscrotal form of hypospadias in 12, scrotal in 8, and perineal in 4 patients. All children previously underwent 2-8 hypospadias repairs. Patients were divided into 2 groups. In group I, 16 patients had urethral stenosis from the glans of the penis to the penoscrotal area, urethral diameter of 3-4 Ch and ventral penile curvature of 45-60o. These patients were treated with a two-staged urethroplasty, similar to Brackas technique. In group II, 8 patients with urethral stenosis in the penile shaft area, urethral diameter of 6 Ch, without penile curvature were included. They underwent to a one-stage urethroplasty with buccal mucosa graft, which was sutured on the dorsolateral aspect of the urethra, with a formation of the age-appropriate urethra (Dorsolateral Inlay). Results All patients in both groups had successful results with flow rate of 8-12 ml/sec. Conclusions The correction of urethral stenosis in children after proximal hypospadias repairs can be performed using buccal mucosa. In cases of long urethral stenosis, urethral diameter of 3-4 Ch, penile curvature, and scarring of the penile skin, a two-staged urethroplasty is recommended. In patients with stenosis of the penile shaft, urethral diameter of 6 Ch and lack of penile curvature, a one-stage urethroplasty with buccal mucosa fixation on the dorsolateral aspect of the urethra (Dorsolateral Inlay) allows to achieve successful results.

An extracellular matrix-mimicking, bilayered, heterogeneous, porous, nanofibrous scaffold for anterior urethroplasty in a rabbit model

Anterior urethral reconstruction is still a challenging clinical task, and tissue engineering technology offers new options for anterior urethroplasty. In this work, we evaluated an extracellular matrix (ECM) mimicking scaffold for anterior urethral reconstruction in a New Zealand white rabbit model. After the creation of a urethral defect, the ECM-mimicking scaffold was applied in six rabbits, and small intestinal submucosa (SIS) was used in three rabbits. The outcomes of urethrography and histological analysis were evaluated six months postoperatively. A larger urethral diameter was observed in the ECM-mimicking scaffolds (3.01 ± 0.12 mm) than in the SIS grafts (0.95 ± 0.07 mm). Urethral fistulae and stenosis were observed in the SIS grafts. Urothelial and smooth muscle cells were observed in all rabbits, but the ECM-mimicking scaffold showed better performance. The ECM-mimicking scaffold may be an effective clinical treatment option for congenital and acquired urethral pathologies.

Retrograde CT urethrography using a power injector quantitatively reveals effects of bladder distension on urethral size in healthy male Beagle dogs.

Quantitative analysis of the normal retrograde urethrogram is well reported in radiography, but studies on CT urethrography are lacking. Recently, a method of retrograde CT urethrography using a power injector was described. The purpose of the current, prospective, analytical study was to quantify the urethral size of five, healthy, intact, male Beagle dogs using retrograde CT urethrography and a power injector. With the injection rate of the power injector set at 0.3mL/s, 1mL/kg of diluted contrast medium (15mg I/mL) was injected, and a CT examination was performed. The state of the initial urethrogram taken was defined as "empty bladder." The same procedures were repeated with the injection of an additional 1mL/kg of diluted contrast medium until the ureteral reflux was seen (distended bladder). There was a significant difference in volumes between the empty and distended bladder, but the membranous urethra showed the least difference (P=.0044) among the three regions (P<.0001 for the prostatic and penile urethra). Urethral diameters at six sites were measured from sagittal images, and the sites of measurements were adopted from the earlier radiographic studies. The most significant difference in the urethral diameters between the empty and distended bladder occurred at the cranial and middle prostatic urethra (P<.0001). The results of this study can be useful for interpreting the results of retrograde CT urethrography. Care must be taken when narrowing is suspected at the prostatic urethra, and if necessary, further distension of the urinary bladder should be tried.

Evaluation of transperineal ultrasound in diagnosis and grading of female genuine urinary stress incontinence

Stress urinary incontinence (SUI) has an observed prevalence of between 4%and 35%. Purpose: To determine the role of transperineal ultrasound in diagnosing stress incontinence, its degree and the possible cause by: Measuring the BN descent, urethral hypermobility, funneling of BN or proximal urethra, urethral diameter, posterior urethra vesical angle, associated cystocele Using color Doppler to detect escape of urine through the urethra. Methods: 52 female patients diagnosed to have genuine stress incontinence using 3 day voiding diary, simple questionnaire and confirmed by standard urodynamics. Classification of stress incontinence into mild, moderate and severe using Valsalva leak point pressure during urodynamic study. Transperineal ultrasound for evaluation of the anterior pelvic compartment regarding: bladder neck descent, urethralhy permobility, Funneling of the BN, posterior urethrovesical angle ,urethral diameter, associatedcystocele, and finally the Doppler detection of urinary escape both at rest and with Valsalva maneuvers. Results: 28/52 cases (53.8%) of SUI didn’t show clinical evidence of cystocele; 11 cases (21.2%) showed grade 1 cystocele and 13cases (25%) showed grade 2 cystocele. The presence or absence of cystocele and also the grade of cystocele did not show a statistically significant relation to the degree of SUI; p=0.089 and 0.086 respectively Conclusion: We came to conclusion that transperineal ultrasound can be used in accurate diagnosis and grading of female urinary stress incontinence with our given cutoff values for bladder displacement, α angle, β angle and urethral diameters and from this grading by transperineal ultrasound comes the novelity of our research.