Urethral Kinking Research Articles

The female urethral closure mechanism during physical stress.

The closure of the urethra under the condition of stress is the result of a reflex contraction of the urethral rhabdosphincter and pelvic floor muscles. This is likely induced by activity of the abdominal muscles due to a sudden increase in abdominal pressure. This reflex contraction with an increase of urethral pressure occurs a few milliseconds before an increase in intraabdominal pressure. The urethral pressure increase during stress is only possible with fixation of the urethra by the pubourethral ligaments (PUL), facilitating urethral kinking. The highest and most important increase in pressure and resistance occurs in the distal urethra due to this kinking of the urethra.

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.

Ultrasonography and clinical outcomes following anti-incontinence procedures (Solyx™ tape): a 3-year post-operative review.

Our primary objective was to study objective and subjective outcomes of patients with urodynamic stress incontinence (USI) following Solyx™ at 3-year follow-up. Our secondary objective was to evaluate ultrasonographic tape and bladder neck position and mobility. Records of 88 women who received Solyx™ surgery between September 2015 and December 2017 were reviewed. Ultrasonographic sling evaluation was performed at 6months and 3 years postoperatively. Primary outcomes were objective and subjective cure of stress incontinence, defined as no involuntary urine leakage during filling cystometry, 1-h pad test < 2g and negative response to Urogenital Distress Inventory-6 Question 3. Subjective and objective cure rates at 3 years were 85.2% and 87.5%, respectively, with no complications reported. QOL improvements were maintained. Bladder neck position and mobility had no significant change between 6-month and 3-year follow-up. Tape position demonstrated significant shifts in the y-axis at both rest and Valsalva and in the x-axis at Valsalva between 6 months and 3 years; overall mobility was unchanged. Percentile of sling location remained unchanged at 60.1%, as did percentage of urethral kinking (67.9%) achieved. Risk factors for failure were bladder neck hypomobility postoperatively and no urethral kinking postoperatively. There was good sustained objective and subjective cure with improved QOL in women who underwent Solyx™ for USI at 3-year follow-up. Ultrasonographic evaluation showed a tape position shift upwards and backwards with unchanged tape and bladder neck mobility. Percentile of sling location and rates of dynamic kinking were maintained.

Association between overactive bladder and pelvic organ mobility as evaluated by dynamic magnetic resonance imaging

Overactive bladder (OAB) is a prevalent condition, which negatively impacts patients’ quality of life. Pelvic organ prolapse (POP), also prevalent in women, has been recognized as an important etiology of female OAB, although the pathophysiological mechanisms remain controversial. In this study, we reviewed findings of dynamic magnetic resonance imaging (dMRI) in 118 patients with POP and investigated the association between dMRI findings, including positions and mobilities of pelvic organs as well as parameters of pelvic organ support and bladder outlet obstruction (urethral kinking), and OAB in order to elucidate the pathophysiology of OAB in patients with POP. Our results showed that compared with non-OAB patients, OAB patients had a significantly higher body mass index, more severe pelvic floor muscle impairment, and more profound supportive defects in the uterine cervix (apical compartment). On the other hand, dMRI parameters showed hardly any significant difference between patients with mild and moderate to severe OAB. These findings may imply that levator ani impairment and defective supports of the apical compartment could be associated with the presence of OAB and that the severity of OAB could be affected by factors other than those related to pelvic organ mobility and support or urethral kinking.

Is location of urethral kinking a confounder of association between urethral closure pressure and stress urinary incontinence?

Intact urethral support and normal sphincter function are deemed important for urinary continence. We aimed to test whether the location of urethral kinking (as the probable anatomical correlate of maximal pressure transmission) is associated with stress urinary incontinence and/or urodynamic stress incontinence. This was a retrospective study of women seen at a tertiary urogynecological center in 2017. Patients had undergone an interview, multichannel urodynamic testing and four-dimensional translabial ultrasound examination. Those with a history of anti-incontinence surgery, absence of urethral kinking on ultrasound and/or missing or inadequate ultrasound volume data were excluded. Volume data were used to assess urethral mobility using a semi-automated Excel® urethral motion profile program. Mobility vectors were calculated using the formula √((x valsalva - x rest )2 + (y valsalva - y rest )2 ), where x and y are the coordinates of six equidistant points along the length of the urethra from the bladder neck to the external urethral meatus. The location of urethral kinking was identified as a concave contour of the urethra on the vaginal side in the midsagittal plane on maximum Valsalva maneuver. The distance between the center of the kink and the bladder neck was measured and expressed as a centile in relation to the total length of the urethra, using the formula: (distance from bladder neck/total length of urethra) × 100. Univariate and multivariate analyses were performed to test the associations of stress urinary incontinence and urodynamic stress incontinence with age, maximum urethral pressure, urethral mobility vectors and location of urethral kinking. Of 450 women seen during the study period, 61 were excluded owing to previous incontinence surgery and 82 owing to absence of urethral kinking, inadequate volume data or missing data, leaving 307 women included, of whom 227 (74%) complained of stress urinary incontinence and 211 (69%) complained of urgency urinary incontinence. 190 (62%) of the women were diagnosed with urodynamic stress incontinence. On multivariate analysis, maximum urethral pressure (36 vs 50 cmH2 O; P < 0.001), mid-urethral mobility (2.27 vs 2.03 cm; P = 0.003) and location of urethral kinking (63.1st vs 59.7th centile; P = 0.002) were associated significantly with urodynamic stress incontinence. The location of urethral kinking was associated with stress urinary incontinence on univariate analysis (P = 0.026) but not on multivariate analysis (P = 0.21). The location of urethral kinking is associated with urodynamic stress incontinence. The further urethral kinking is from the mid urethra, the more likely is urodynamic stress incontinence. This provides circumstantial evidence for the pressure-transmission theory of stress urinary continence. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Urogynecology

Urogynecology

Cystolitholapaxy and laparoscopic sacrocolpopexy in a case of multiple urinary bladder calculi & vault prolapse

Vesical calculi are more common in men than women. The prevalence in women is less than 2%. Multiple vesical calculi in chronic cases of utero vaginal prolapse or vault prolapse is rare. Urinary stasis, urethral kinking along with chronic infection are the probable predisposing factors for stone formation [2]. We report a case of 65 year old female, with mass per vagina since 10 years, who developed acute urinary retention due to impaction of vesical calculus at the external urethra meatus. Subsequently in a span of 12 h she passed 3 more vesical calculi. KUB X-ray failed to show any calculi but Computed Tomography(CT) Kidney Ureter Bladder (KUB) showed 2 vesical calculi. After cystolitholapaxy she underwent laparoscopic sacrocolpopexy for vault prolapse. In cases of chronic uterovaginal prolapse or vault prolapse X-Ray KUB should not miss the prolapsed part of the cystocele as calculi are present in the most redundant part. Chances of missing radiolucent uric acid calculi is high. In such cases CT KUB is essential.

OC27.04: Does urethral kinking affect the association between urethral closure pressure and SUI?

OC27.04: Does urethral kinking affect the association between urethral closure pressure and SUI?

Changes in urethral mobility and configuration after prolapse repair.

To evaluate changes in urethral mobility and configuration after prolapse repair. This was a retrospective study of 92 patients who were examined between 2005 and 2016 before and after surgery for pelvic organ prolapse (POP) without concomitant anti-incontinence surgery. All patients were assessed with an interview, POP quantification and translabial four-dimensional ultrasound. Urethral mobility was evaluated using semi-automated urethral motion profile software in which x- and y-coordinates of six equidistant points along the length of the urethra were determined both at rest and on Valsalva, relative to the posteroinferior margin of the pubic symphysis. Urethral kinking was measured by placing tangents distal and proximal to any visually identified change in the urethral axis. Imaging data obtained before and after prolapse surgery were compared. Mean age was 58 years and mean follow-up was 5.8 months. Prolapse symptoms had resolved in 85% of patients. Highly significant reductions in urethral mobility and urethral kinking were seen after surgery (all P ≤ 0.001). Similar changes were observed after anterior vaginal repair with or without apical repair, without concomitant posterior repair (n = 23; all P < 0.05). POP surgery was associated significantly with 'straightening' of the urethra and reduction in urethral mobility. The effect seems to be due largely to cystocele repair. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Ultrasonography and clinical outcomes following anti-incontinence procedures (Monarc vs MiniArc): A 3-year post-operative review.

ObjectiveTo compare the ultrasonographic positional changes of mid-urethral sling(MUS) tape in relation to symphysis pubis, and the different clinical outcomes among women who underwent MUS insertion with MiniArcTM or MonarcTM for the treatment of stress urinary incontinence 3 years after.Materials and methodsA retrospective follow-up study on patients with clinically confirmed stress urodynamic incontinence and urodynamic stress incontinence who had undergone MiniArc or Monarc surgery. Data regarding preoperative evaluation, intraoperative complications and post-operative follow-ups were collated. Main outcome is to determine the change in position of the sling through measurement of the x- and y-axis at rest and during Valsalva maneuver using the 3D introital ultrasound.ResultsA total of 138 patients were evaluated, 82 belonged to Monarc and 56 to MiniArc. At 3years, objective and subjective cure rates for MiniArc and Monarc were comparable (88%, 91%; p>0.05; 83%, 89%, p>0.05 respectively). Ultrasonographic changes between MiniArc and Monarc from 6 months to 3 years, showed MiniArc to exhibit significant movement in both x- [3.0 ±0.4 mm vs. 2.2 ±0.3 mm (p = 0.02) at rest; 2.6 ±0.3 mm vs. 1.6 ±0.3 mm (p<0.001) during valsalva] and y-axis [3.5 ±0.5 mm vs. 2.0 ±0.3 mm (p<0.001) at rest; 3.3 ±0.5 mm vs. 2.9 ±0.3 mm (p = 0.037) during Valsalva]. The mobility of MiniArc was significantly more than Monarc from rest to Valsalva (1.1 ±0.4 mm vs. 0.3 ±0.3 mm, p = 0.001). Tightness of the sling assessed from the major and minor axis of the urethral core had no significant difference in both groups at rest and during Valsalva. Urethral kinking percentage and the location of the sling did not yield statistical difference.ConclusionMaintenance of continence rates of mid-urethral slings depends on the compressive effect of the sling on the urethra, urethral kinking, and sling fixation. From 6months to 3 years, MiniArc changed its position in both x- and y-axis over time, which the authors attribute to loosening of the anchoring mechanism since no clinical relevance could be sought.

Effects of Pelvic Organ Prolapse on the Bladder

To assess how pelvic organ prolapse (POP) and treatment affect bladder function. There is significant overlap between POP and bladder symptoms, including urinary incontinence and overactive bladder. POP may result in bladder outlet obstruction (BOO) secondary to urethral kinking, which may result in overactive bladder (OAB), dysfunctional voiding, and occult or de novo stress urinary incontinence (SUI). Improvements in obstructive symptoms and dysfunctional voiding after POP surgery suggest that pelvic floor reconstruction restores pelvic floor anatomic structure and function. Furthermore, correction of anatomic structure also seems to improve OAB symptoms, although a direct causative link has yet to be established. Pelvic floor syndromes should be interpreted as a whole. POP, OAB, urinary incontinence, BOO, and dysfunctional voiding are all part of pelvic floor syndromes, coexisting and interacting to manifest different symptoms before and after POP treatment.

OC20.05: Changes in urethral mobility and kinking after prolapse repair

OC20.05: Changes in urethral mobility and kinking after prolapse repair

MP46-20 DEVELOPMENT OF A NOVEL ARTIFICIAL URINARY SPHINCTER (AUS): THE PRECISION MEDICAL DEVICES (PMD) FLOW CONTROL DEVICE (FCD) FOR MANAGEMENT OF SPHINCTERIC DEFICIENCY USING BLUETOOTH TECHNOLOGY

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence: Therapy1 Apr 2017MP46-20 DEVELOPMENT OF A NOVEL ARTIFICIAL URINARY SPHINCTER (AUS): THE PRECISION MEDICAL DEVICES (PMD) FLOW CONTROL DEVICE (FCD) FOR MANAGEMENT OF SPHINCTERIC DEFICIENCY USING BLUETOOTH TECHNOLOGY Michael Ahdoot, Angelo Gousse, Peter Sayet, and Christopher Gomez Michael AhdootMichael Ahdoot More articles by this author , Angelo GousseAngelo Gousse More articles by this author , Peter SayetPeter Sayet More articles by this author , and Christopher GomezChristopher Gomez More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1459AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES PMD has developed a new Bluetooth controlled AUS designed to improve patient satisfaction and allow for physician telemetry. The FCD fluid-free device is composed of 3 solid components: 1) Control Pack 2) Valve assembly 3)Activator. The control pack consists of a printed circuit board, stepper motor and a nickel-cadmium cell in a titanium casing. The valve assembly consists of a cable link, plunger and urethral cuff. The control pack opens and closes the plunger via a drive assembly which adjusts the closure pressure magnitude, allowing post-implant adjustments (via telemetry) without the need for re-operation. The handheld activator communicates with the implanted control pack via Bluetooth technology. The activator allows for either the physician or patient to communicate with the FCD for daily operation or diagnostics. Daily operations of the device are recorded and remote tele-monitoring is available. METHODS The newest FCD prototype was implanted into 11 female mongrel dogs. The study length began at 12 weeks of observation after implantation for the initial animal and is extended to a 1 year follow-up for the most recent implants. There was no attempt to make the animals incontinent. Evaluations include renal ultrasound for each animal as well as weekly CBC, BMP and UA. Software and device performance was evaluated by telemetrically acquired data. Histology of explanted devices at the end of protocol is performed for each implant. RESULTS The successful surgical implantation of 32 previous devices has allowed the development of the newest Bluetooth controlled AUS. We have currently implanted 11 animals with the newest prototype. Successful telemetry has been established for all implants. No device infections or urethral erosions were seen. There was one cutaneous erosion of the control pack. 3 animals developed urinary retention. Two cases were related to tissue overgrowth in the valve cap resulting in urethral kinking and the remaining case was due to a software malfunction causing elevated closure pressure on the urethra with associated loss of communication with the device. This observation was identified through post hoc analysis of the telemetry data. The implanted devices have undergone over 3,560 activation cycles to date. The device has also generated over 1,100 status reports, allowing the investigator to monitor device function. CONCLUSIONS The successful development of a fluid-free remotely controlled AUS that allows for post-implant adjustable settings and remote tele-monitoring capabilities is possible. Further modifications to the prototype to reduce battery size and the risk of urinary retention are needed prior to human trials. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e627 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Michael Ahdoot More articles by this author Angelo Gousse More articles by this author Peter Sayet More articles by this author Christopher Gomez More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Influence of anterior vaginal mesh with concomitant mid-urethral sling surgery on stress urinary incontinence: clinical and sonographic outcome.

To clinically and sonographically evaluate the influence of anterior vaginal mesh (AVM) surgery with concomitant mid-urethral sling surgery (MUS) for stress urinary incontinence (SUI). Women with severe symptomatic pelvic organ prolapse (POP) stage III or IV with concomitant SUI were divided into two groups: Group I had transobturator tape (TOT) and AVM surgery and Group II underwent TOT without AVM surgery. Clinical outcome was assessed pre-operatively and 1year post-operatively, while ultrasound evaluations were performed after one year. Objective cure was defined as no urinary leakage demonstrable on provocative filling cystometry. Subjective SUI cure was a negative response to Urogenital Distress Inventory Six (UDI-6) (question 3). A total of 97 women were recruited, 57 in Group I and 40 in Group II. Three women had symptomatic prolapse in Group I and 5 in Group II. There were no differences in the ultrasound and clinical outcomes between women who had mid-urethral slings with and without AVM. Successful SUI outcome was reported in 85 women. Urethral kinking was demonstrable in 50% of successful cases, but none with failed outcomes. Subanalysis among those with successful SUI outcome (n=85) and failure (n=12) revealed the tape, bladder neck and mesh mobility was significantly higher (P<0.001) among those with SUI success. Among women who had MUS, there were no differences in the ultrasound and clinical outcome between those who had AVM or otherwise.

Should Prophylactic Anti-Incontinence Procedures Be Performed at the Time of Prolapse Repair? Systematic Review

Urodynamic studies performed prior to prolapse repair in women with high-grade pelvic organ prolapse (POP) have revealed asymptomatic stress urinary incontinence (SUI) in 36% to 80% of these women. The probable explanation for maintenance of continence prior to surgery in these patients may be urethral kinking or compression of the urethra by the genital prolapse. Once the genital prolapse has been repaired, these women are at high risk of postoperative SUI. Although occult SUI and prolapse repair can be corrected during a single surgery, combining both procedures is highly controversial. Some surgeons question the effectiveness of a single surgery to make both repairs and recommend a second surgical procedure after prolapse repair to correct occult incontinence. However, there are risks associated with a new hospitalization and a second surgery. This systematic literature review was conducted to determine whether performing prophylactic anti-incontinence procedures during surgical POP correction in women with severe genital prolapse and no symptoms of incontinence could prevent postoperative SUI. PubMed, EMBASE, Cochrane Library, and Lilacs databases were searched to identify articles published up to January 12, 2014. The search was limited to randomized trials. All participants had severe POP and no symptoms of SUI prior to prolapse surgery. The primary study outcome was the incidence of SUI or the need of treatment for this condition after the surgical procedure. The initial search identified 5618 studies; 66% of these were selected for full text analysis. Only 7 of these trials met the study inclusion and exclusion criteria. Following the systematic review, a meta-analysis was performed with common variables of studies and the same scale of quantification. Performance of any prophylactic anti-incontinence procedure during prolapse repair reduced the incidence of SUI postoperatively; the relative risk was 0.51, with a 95% confidence interval of 0.38 to 0.68. However, the results were different when the types of anti-incontinence procedure used were analyzed separately. The only anti-incontinence procedure that led to a significant reduction in the incidence of UI was retropubic midurethral sling surgery (relative risk, 0.09; 95% confidence interval, 0.02–0.36). These data show that use of the retropubic midurethral sling concomitantly with prolapse repair in women with severe POP is the only prophylactic anti-incontinence procedure that reduces risk of SUI.

Should prophylactic anti-incontinence procedures be performed at the time of prolapse repair? Systematic review.

Women with high-grade pelvic organ prolapse (POP) are considered at risk of developing postoperative stress urinary incontinence (SUI) once the prolapse has been repaired. The probable explanation for patients remaining subjectively continent is that POP can cause urethral kinking or compression. We hypothesized that performing prophylactic anti-incontinence procedures during surgical POP correction in women with no symptoms for urinary incontinence (UI) may prevent SUI postoperatively. A systematic review of randomized trials was performed. Participants were women with severe POP and no symptoms of SUI. The primary outcomes were UI or treatment for this condition after the surgical procedure. Results are presented as relative risk (RR), with 95% confidence interval (95% ). Initially, 5,618 studies were identified by the search strategy, but only seven trials met the inclusion criteria. We performed a meta-analysis with common variables of studies and with the same scale of quantification. We found that performing an anti-incontinence procedure at the same time of prolapse repair reduced the incidence of SUI postoperatively (RR 0.51; 95% CI 0.38-0.68). However, when the types of anti-incontinence procedure were analyzed separately, we found different results. The subgroup of patients who underwent retropubic midurethral sling surgery was the only group that benefited from the anti-incontinence procedure, with a decrease in the incidence of SUI (RR 0.09; 95% 0.02-0.36). Prophylactic treatment of women with severe POP using retropubic midurethral sling was the only procedure that reduced the risk of UI.

Ultrasonography and clinical outcomes following surgical anti-incontinence procedures (Monarc vs Miniarc)

ObjectiveTo evaluate the ultrasound morphology and its clinical outcome among women who had undergone Miniarc™ vs Monarc™ in the treatment of stress urinary incontinence (SUI). Study designThis was a prospective study on 140 patients with USI and undergone either Miniarc or Monarc surgery. From March 2010 to December 2011, patients with clinically SUI and urodynamic stress incontinence (USI) were included in the study. Objective cure of SUI was defined as no urinary leakage on provocative filling cystometry and 1-h pad test of <2g. Subjective cure of SUI was the negative response to UDI-6. Introital ultrasound at one-year explored the sling and bladder neck's position, mobility, sling tension, percentile of urethra where the sling was located and urethral kinking. ResultsPostoperative data was available from 130 women. The ultrasound objective data for successful treatment post-operative follow-up was available from 119 women (46 Monarc, 73 Miniarc), the rest failed to follow-up. A bladder perforation was diagnosed in the Monarc group and 15 cases (7.1% of Monarc and 16.3% of Miniarc, p=0.082) of urinary retention was reported due to over-tensioning of the sling, majority of cases came from the Miniarc group. At rest and during Valsalva, analogous distances of the bladder neck and sling as well as the center of the urethral core were similar for both procedures. In both groups, shortest (Us) and longest diameters (Ul) of the urethral core were comparable at Valsalva which was significantly shorter and longer, respectively, compared to the values at rest. Sling position and percentage of urethral kinking were similar. Statistical analysis failed to detect any significant difference between the two groups with regards to the objective and subjective cure (p>0.05). ConclusionsIn conclusion, a Miniarc and Monarc exhibit similar mechanism of action with comparable subjective and objective clinical outcomes. Majority of urethral impingement was noted in the Miniarc group. A higher maximum urethral closure pressure (MUCP), longer resting Ul, and shorter resting Us suggested these observations. Postoperative ultrasonographic evaluation may give a promising future perspective for the evaluation of sling tension.

MP7-07 MRI IN PATIENTS SUFFERING FROM PELVIC ORGAN PROLAPSE AND STRESS URINARY INCONTINENCE

INTRODUCTION AND OBJECTIVES: The aim of our study was to identify differences in anatomical parameters using MRI in patients suffering from pelvic organ prolapse (POP) according to their continence function. METHODS: This study included 44 women suffering from POP (cystocele grade 2-4 by POP-Q) who underwent transvaginal surgical repair. The study was approved by the local ethics committee, and all patients provided signed informed consent. For evaluation of continence, the UDI-6 questionnaire was used. We found that 14 patients (group 1) had concomitant SUI and prolapse. The remaining patients without complaint of SUI were divided into 2 groups: group 2 (n1⁄416) had a negative cough test after prolapse repositioning, and group 3 (n1⁄414) had occult SUI. Dynamic MRI was performed for every patient on MR tomograph General Electric Signa HDxt 3,0 Tesla (Figure 1). The following parameters were recorded: hypermobility of the urethra, dilatation of the bladder neck, retrovesical angle (more than 140 ), urethral length, urethral kinking, bladder neck and base descent, uterus descent, cervical elongation, urethral rhabdosphincter thickness, levator gap width and pelvic fascia defect. RESULTS: Comparing groups 1 and 2, statistically significant differences were obtained for the dilatation of the bladder neck during Valsalva and for the increase of the retrovesical angle at the Valsalva of more than 140 and at rest was noted (Table 1), which indicates the importance of these factors for continence in patients with pelvic organ prolapse. Statistical analysis did not reveal differences in these parameters between groups 2 and 3. CONCLUSIONS: Patients with POP and SUI have certain anatomical features that should be considered when planning surgical treatment. Further studies on the prognostic significance of these parameters with a large sample are necessary to develop an algorithm of treatment for this category of patients.

Spontaneous Urethral Catheter Kinking or Knotting in Male Dogs: Four Cases

Four dogs were diagnosed with urethral catheter malfunction. The catheter was kinked in three dogs and knotted in one dog. In two dogs, kinking of the catheter was associated with presence of urethroliths in the perineal urethra. Diagnosis was based on the difficulty encountered retrieving the catheter in all dogs and swelling in the scrotal or perineal area in two dogs. Diagnosis of catheter kinking or knotting was confirmed after catheter retrieval. Catheter removal was achieved in two dogs after traction under anesthesia, whereas scrotal or perineal urethrotomy were used in the other two dogs. No complications associated with urination were reported in any of the dogs after 7 to 12 mo.

Urinary Retention After Orthotopic Neobladder Substitution in Females

Urinary retention is a common complication after orthotopic neobladder urinary diversion. We reviewed a case series of women who underwent neobladder creation and discuss anatomical findings, and urinary retention etiology and prevention. We retrospectively reviewed the records of all orthotopic neobladder urinary diversions in female patients performed at our institution from 1999 through 2010. We abstracted baseline clinical and demographic characteristics, operative information, and postoperative clinical, urodynamic, imaging and secondary procedure followup. We defined urinary retention as the need for intermittent catheterization. We identified 21 female patients who underwent neobladder diversion. Median age at cystectomy was 62 years (range 43 to 77). Median followup was 3 years (range 3 to 138 months). Of the patients 14 underwent ileocolic diversion, 6 underwent Studer ileal diversion and 1 underwent preservation of a right colon augmentation. All patients underwent prior or concurrent hysterectomy. In 2 patients with a history of genitourinary tuberculosis neobladder-vaginal fistulas developed postoperatively and they were excluded from analysis. Of the 19 female patients with a neobladder included in analysis 7 (36.8%) experienced urinary retention requiring clean intermittent catheterization. Associated abnormalities included neocystocele formation in 6 cases, anastomotic stricture in 1 and progressive neurological disease in 1. Upon straining the average neobladder descent was approximately 2 cm and the average change in the neocystourethral angle in patients with neocystoceles was 18 degrees. Of the patients 11 (57.9%) had a nonobstructive voiding pattern. Urinary retention in female patients with a neobladder can be functional, anatomical or multifactorial. In our series common anatomical findings associated with urinary retention were neocystocele formation and urethral kinking.