Urethral Orifice Research Articles

Towards Automated Dosimetric Analysis of the Bladder Trigone: Deep-Learning-Based Joint Segmentation and Landmark Localization

The bladder trigone dosimetry is hypothesized to have a stronger correlation with post-SBRT urinary toxicity than that of the entire bladder. However, the trigone tends to move significantly between simulation and daily treatment. Its small size, large daily motion, and proximity to the target lead to potentially consequential but unaccounted-for dosimetric uncertainties. Manual segmentation of the structure can be inconsistent and time-consuming, even with MR-guided RT. Here, we propose and demonstrate a deep-learning-based framework for joint segmentation and landmark localization to support deformable registration and comprehensive dosimetric analysis. A total of 30 patients were randomly selected for training, and 20 were held out for testing. Each patient had 1 simulation and 5 daily pre-treatment images obtained from a clinical 0.35T MR Linac. The trigone is defined as the triangular bladder section among three landmarks (2 ureteral orifices and the internal urethral orifice). In the manual contouring process, the 3 landmarks were identified first, followed by trigone segmentation. The proposed joint method uses a modified 3D nnU-Net with 2 decoders, one for segmentation and the other for landmark localization. The shared encoder is expected to extract features useful for both tasks. The joint framework was compared with a baseline method using two separate 3D nnU-Nets for landmark localization and trigone segmentation, respectively. Since the trigone is small (∼2% of the bladder volume), we further experimented with a second-stage prediction mimicking the human contouring process. The predicted landmarks from the first stage were used to crop the trigone region, and a second network was trained on cropped images. Evaluation metrics included the Dice score, 95% Hausdorff distance (HD95), and average surface distance (ASD) for segmentation, and Euclidean distance (ED) between the predicted and ground truth landmarks for localization. The quantification metrics are summarized in the table below. The joint approach shows similar Dice performance to the baseline method but markedly better HD95 by 13%. For landmark localization, the proposed method is similar to the baseline, but the integration of the segmentation task stabilizes the training process. The two-stage approach further improves HD95, ASD, and ED by 27%, 24%, and 19%. Combining segmentation and landmark localization exhibits a synergistic effect. The proposed two-stage approach provided additional improvement. Future studies will explore the deformable registration of the trigone based on the segmentation and landmark detection, as well as analyze cumulated dose distribution.

Recurrent urethral obstruction secondary to large vulval inclusion cyst: a remote complication of female genital mutilation: a case report

BackgroundFemale genital mutilation/cutting (FGM/C) is a major public health problem, particularly in developing countries.Case presentationThe authors reported a case of 48-year old multiparous woman presented to Kassala Hospital, east Sudan, with recurrent urine retention resulting from urethral obstruction, which was caused by large vulval inclusion cyst. A traditional birth attendant circumcised her when she was 5 year old. Five years before her presentation the patient observed a painless swelling in her vulva, which was gradually increasing in size. She presented to the hospital with urine retention seeking medical care. Local examination showed a large cystic swelling originating in the circumcision line and covering the introitus. A diagnosis of inclusion cyst at the site of circumcision was made. The cyst was large enough causing bladder outlet obstruction and when the patient advised to tilt it away from the urethral orifice she passed urine without difficulties. The cyst was surgically removed by dissection along the lines of cleavage, which measured 10 × 9.2 cm and weighed 1.2 kg.ConclusionThis case report indicates that FGM is a serious public health problem and there should an urgent intervention such as planned health education campaigns to end FGM practice.

Long term results of video-assisted anal fistula treatment for complex anal fistula: another shattered dream?

Complex anal fistula represents a burden for patients, and its management is a challenge for surgeons. Video-assisted anal fistula treatment (VAAFT) is one sphincter-sparing technique. However, data on its long-term effectiveness are scant. We aimed to explore the outcomes of VAAFT in a retrospective cohort of patients referred to a tertiary centre. Consecutive adult patients with a minimum of 2 years' follow-up after VAAFT were reviewed. Patients were followed up to 5 years postoperatively. Failure was defined as incomplete healing of the external orifice(s) during the first 6 months. Recurrence was defined as new radiologically and/or clinically confirmed onset of the fistula after primary healing. A generalized linear model was fitted to evaluate the association between failure and sociodemographic characteristics. Predictors of recurrence were determined in a subgroup analysis of patients found to be free from disease at 6 months postoperatively. Overall, 106 patients (70% male; mean age 41 years) were reviewed. Of these 86% had a previous seton placement. Fistulas were either high trans-sphincteric (74%), suprasphincteric (12%) or extrasphincteric (13%). Eight (7%) patients experienced postoperative complications, none of which required reintervention. Mean follow-up was 53 ± 13.2 months. VAAFT failed in 14 (13%) patients. The overall recurrence rate ranged from 29% at 1 year to 63% at 5 years. Multiple external orifices, suprasphincteric fistula, younger age, previous surgery and higher complexity of the fistulous tract were independent risk factors for recurrence. VAAFT is a safe sphincter-sparing technique. The initially high success rate decreases over time and relates to a higher degree of complexity.

Urethral catheterization of small female cats and dogs weighing less than ten kilograms: the two-catheter technique.

To provide a video tutorial on how to perform an alternate method for urethral catheterization, the 2-catheter technique. Small female cats and dogs that are too small for concurrent digital palpation (generally < 10 kg). A larger red rubber catheter (18 Fr in dogs, and 10 Fr in cats) is gently fed into the vaginal canal and reflected dorsally, then a smaller urethral catheter can be introduced ventrally, angling downwards at a 45° angle, into the urethral orifice for urinary catheterization. The 2-catheter method is a useful alternative in petite female cats and dogs to improve rates of successful catheterization. The inability to perform concurrent digital palpation in petite female dogs and cats can make urinary catheterization more challenging due to the inability to palpate locoregional anatomic landmarks and without the added manipulation of the catheter tip during placement. Using a second, larger catheter to occlude the vaginal canal similarly to how a finger would during digital palpation can aid in successful catheterization in this challenging subset of veterinary patients.

Mysterious death of student in hostel: A case report and its medico -legal aspect

Smothering is a form of asphyxia, caused by either closing or blocking the external respiratory orifices i.e. mouth and nose. Deaths from smothering may or may not be accompanied by physical signs of evidence during autopsy depending upon the manner or circumstances making the autopsy surgeon’s task a daunting challenge. A strangulation is a form of violent asphyxia death caused by constriction of air passage at the neck by means of ligature or by any means other than suspension of the body. Suicide by strangulation is rare. In the absence of signs of violence and marks of a struggle, the task becomes more difficult. Here we report one such case of a student staying in a hostel who died in a mysterious circumstance, whose dead body was found lying in a car outside the hostel premises and the manner concluded after studying the injuries tediously in summation with the detailed history of the case and FSL report of visceral chemical analysis, ligature material report and report of the scene of incidence.

Synovial sarcoma of female urethra: a case report and review of the literature

Synovial sarcoma (SS) is a rare malignant soft tissue sarcoma that originates from primitive mesenchymal cells with epithelial differentiation potential. It is most commonly found in the limbs and trunk. In the urinary system, it is mostly found in the kidneys. However, synovial sarcomas originating from the external urethra are extremely rare. Only one case of synovial sarcoma arising from the vulvar urethral orifice has been reported previously, and we report a second case of synovial sarcoma of the urethral orifice. In addition, a total of 16 vulvar synovial sarcomas were identified and the literature are analyzed in this report reviews from 1966 to the present.

Analysis of the distal urinary tract in larval and adult zebrafish reveals homology to the human system.

Little is known about the distal excretory component of the urinary tract in Danio rerio (zebrafish). This component is affected by many human diseases and disorders of development. Here, we have undertaken multi-level analyses to determine the structure and composition of the distal urinary tract in the zebrafish. In silico searches identified uroplakin 1a (ukp1a), uroplakin 2 (upk2) and uroplakin 3b (upk3b) genes in the zebrafish genome (orthologues to genes that encode urothelium-specific proteins in humans). In situ hybridization demonstrated ukp1a expression in the zebrafish pronephros and cloaca from 96 h post-fertilization. Haematoxylin and Eosin staining of adult zebrafish demonstrated two mesonephric ducts uniting into a urinary bladder that leads to a distinct urethral opening. Immunohistochemistry identified Uroplakin 1a, Uroplakin 2 and GATA3 expression in zebrafish urinary bladder cell layers that match human urothelial expression. Fluorescent dye injections demonstrated zebrafish urinary bladder function, including urine storage and intermittent micturition, and a urethral orifice separate from the larger anal canal and rectum. Our findings reveal homology between the urinary tracts of zebrafish and humans, and offer the former as a model system to study disease.

Two-finger digital rectal examination for the diagnosis of anal fistula: protocol for a randomized controlled trial.

Anal fistula is an anorectal infectious disease caused by a perianal abscess or perianal disease. Accurate anorectal examinations are of great significance. The two-finger digital rectal examination (TF-DRE) has been used in clinical practice, with a lack of comprehensive research on the value of the TF-DRE in the diagnosis of anal fistula. This study will compare the difference in the diagnostic value of the TF-DRE, traditional digital rectal examination (DRE), and anorectal ultrasonography in the diagnosis of anal fistula. For patients who meet the inclusion criteria, a TF-DRE will be performed to explore the number and location of the external and internal orifices, the number of fistulas, and the relationship between the fistula and the perianal sphincter. A DRE and anorectal ultrasonography will also be performed, and the same data will be recorded. To make a comparison, the final diagnosis results of the clinicians during the operation will be taken as the gold standard, the accuracy of the TF-DRE in diagnosing anal fistula will be calculated, and the significance of the TF-DRE in the preoperative diagnosis of anal fistula will be studied and analyzed. All the statistical results will be analyzed using SPSS22.0 (IBM, USA), and a P value <0.05 will be considered statistically significant. The research protocol details the advantages of the TF-DRE compared to the DRE and anorectal ultrasonography in the diagnosis of anal fistula. This study will provide clinical evidence of the diagnostic value of the TF-DRE in the diagnosis of anal fistula. Currently, there is a lack of high-quality research using scientific methods on this innovative anorectal examination method. This study will provide rigorously designed clinical evidence on the TF-DRE. Chinese Clinical Trials Registry ChiCTR2100045450.

Improving Foley Catheter Insertion Procedure by Developing Foley Introducer: A 100-Year Overdue Innovation.

Foley catheter (FC) insertion is very basic yet one of the most widely performed procedures all across the fields of medicine. Since FC was first introduced in 19020's, no significant improvement has been made in view of methodology, despite the inconvenience associated with cumbersome preparation, procedure, and the patients' discomfort with having to have their genitalia exposed. We developed a new, easy-to-use FC insertion device, Quick Foley, that provides an innovative approach to introducing FC while simplifying and minimizing time spent without compromising the sterility. We developed an all-in-one disposable FC introducer contains all the necessary components in a single-device-kit. Minimal plastic components are necessary to keep accuracy and consistency, but the rest are made of the paper to minimize plastic waste. The preparation is done by connecting to the drainage bag, spurring the lubricant gel through gel insert, separating the tract, and connecting with the ballooning syringe. For the insertion, after sterilizing the urethral orifice, rotate the control knob to feed FC to the end of the urethra. After ballooning, dissembling of the device is done only by opening and removing the module, then only the FC remains. As the device is all-in-one, there is no need to prearrange the FC tray, simplifies the FC preparation and catheterization procedure. This device not only makes it convenient for the practitioner, but ultimately, it will reduce the psychological discomfort experienced by patient by truncating perineal exposure time. We have successfully developed a novel device that reduces the cost and burden of using FC for practitioners while maintaining an aseptic technique. Furthermore, this all-in-one device allows the entire procedure to be completed much more quickly compared to the current method, so this minimizes perineal exposure time. Both practitioners and patients can benefit by this new device.

A Giant Urethral Stone With Urethrocutaneous Fistula: A Case Report

Urethral stones are commonly associated with urinary tract calculi and underlying diverticulum or stricture urethra. Urethral calculus represent less then 1% of all urinary stones diseases. Giant urethral calculi frequently may occur in male and rarely in female. This purpose of reporting this case is to describe a way to diagnose urethral stone cases and so that patients can be treated by urologists. CASE PRESENTATION: A 48-year-old man patient with a giant urethral stone with urethrocutaneous fistula for the past 1 year and a diventral penile meatotomy was performed. With physical examination found on the penis palpable stone +/- 4cm anterior to the penis, the tip of the stone can be seen from Eksternum Urethra Orifice. There was also a urethrocutaneous fistula on the ventral penis, about a stone, measuring +/- 0.1 cm so a diventral penis meatotomy was performed, a stone measuring 4x1 cm was found, with unhealthy tissue in the urethra along the stone. DISCUSSION: The incidence of penile urethral stones is increasing which may due to various factors especially climate change and genetic factors. The gradual formation of this long penile urethral stone could take approximately around 5-10 years which indicates the patient’s persistent ignorance of pain and discomfort in the urinary tract. In our case, 3 months after the first operation, urethrocutaneous fistula repair was performed. Evaluation after 2 months after fistula repair, Urination is smooth, no pain, good wound, no fistula, was performed in our report. CONCLUSION: From our experience some predisposing factors of urethral stone with a Urethrocutaneous fistula. The complications seriously affect the quality of life and even cause more serious consequences, so physicians and patients should be aware. Keywords: giant urethral stone, urethrocutaneous fistula, meatotomi ventral penis

Canine Cutaneous Extragenital Venereal Granuloma (CCEVG): Clinical and Pathological Features, Diagnostic Approach, and Treatment Strategies

Transmissible venereal tumor (TVT) is a contagious neoplasm affecting canines that is primarily transmitted through the transfer of malignant cells during coitus. TVT is a rare example of a naturally occurring allograft cancer, and studies have suggested that it may have originated from an individual dog or wolf that lived approximately 11,000 years ago (Murchison et al., 2014). The tumor is characterized by its predominantly extra-genital manifestations, which may develop from the implantation of neoplastic cells on exposed mucosae, as well as its unique genetic features. For instance, TVT has an unusual karyotype that is believed to have arisen from a rearrangement of the normal canine chromosomes, resulting in the maintenance of a stable tumor genome across the population of TVT cells (Bongiovanni et al., 2016). Young dogs, stray dogs and sexually active dogs are most regularly affected by this tumour (Nak et al., 2005). It is classified into two groups, genital TVT and extragenital TVT, depending upon the sites of the tumour mass is present (Das and Das, 2000). The most common site of TVT is the caudal penile region in male dogs and the posterior vagina region in female dogs, with the tumor frequently surrounding the urethral orifice and protruding from the vulva if located within the vagina. In rare cases, TVT may develop at extra-genital sites. Macroscopically, TVT lesions are often friable, with a low cohesion between the neoplastic cells, resulting in their propensity to hemorrhage. This tendency towards bleeding, in conjunction with the formation of nodular, granulomatous, or necrotic masses, typically forms the first clinical sign observed in affected animals. Diagnosis of TVT often involves a combination of clinical presentation, cytology, histopathology, and immunohistochemistry to differentiate it from other neoplasms. While TVT can cause significant morbidity, several chemotherapeutic agents have shown to be highly effective in treating it. Hence, this report describes canine cutaneous extragenital venereal granuloma (CCEVG) in three dogs: its clinical and pathological features, diagnostic approach, and treatment strategies.

MP15-03 MONKEYPOX AND THE PENIS: AN EMPIRICAL CARE PATHWAY

You have accessJournal of UrologyCME1 Apr 2023MP15-03 MONKEYPOX AND THE PENIS: AN EMPIRICAL CARE PATHWAY Piotr Sluzar, Alex Murray, Anna Daunt, Aatish Patel, Achyuta Nori, Geraldine O'Hara, and Tet Yap Piotr SluzarPiotr Sluzar More articles by this author , Alex MurrayAlex Murray More articles by this author , Anna DauntAnna Daunt More articles by this author , Aatish PatelAatish Patel More articles by this author , Achyuta NoriAchyuta Nori More articles by this author , Geraldine O'HaraGeraldine O'Hara More articles by this author , and Tet YapTet Yap More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003235.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Monkeypox is a viral illness affecting predominantly gay, bisexual and other men having sex with men. The rapid progression of the recent outbreak meant genital manifestations preceded any guidelines for cases with urological symptoms. This study aims to develop an empirical care pathway for patients presenting with penile and scrotal symptoms secondary to monkeypox. METHODS: From May to September 2022, 198 patients with monkeypox who presented to a tertiary referral hospital were assessed for genital involvement by the infectious disease team, with the involvement of a urologist. Of these, 19 patients (10%) were admitted with genital lesions and were treated in an isolation ward with full personal protection equipment (PPE) in use. Symptoms requiring urological input were present in 8 individuals (4%). The mean time from the onset of symptoms to resolution was 25.3 (range 9-63) days. Based on the management of these patients, an empirical care pathway for genital monkeypox was developed. RESULTS: Four stages of genital monkeypox were observed (Figure 1). Limited penile oedema and discrete lesions should be managed conservatively with analgesia, cold compresses and elevation for swelling control. Patients with moderate oedema, paraphimosis and large coalescing ulcers should be considered for a topical 1% hydrocortisone cream to reduce the inflammation. In severe oedema with necrotic ulcers glyceryl trinitrate (GTN) patches are crucial to improve the vascularization of the necrotic ulcers on the penis. Cases of widespread necrosis and oedema may require imaging to assess the need for surgical debridement. GTN patches require daily changes for tissue salvage. Catheterization should be guided by the extent of oedema, the presence of paraphimosis and lesions close to the external urethral orifice. CONCLUSIONS: Monkeypox cases presenting through lesions on the penis and scrotum often require urological management to reduce penile oedema and prevent catheterisation. All admitted patients require isolation with full PPE. The initial stages of the infection should be managed conservatively with cold compresses, elevation and analgesia. Patients with advanced genital symptoms can benefit from the early use of topical steroid creams and GTN patches applied over the necrotic areas to reduce swelling and aid perfusion. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e192 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Piotr Sluzar More articles by this author Alex Murray More articles by this author Anna Daunt More articles by this author Aatish Patel More articles by this author Achyuta Nori More articles by this author Geraldine O'Hara More articles by this author Tet Yap More articles by this author Expand All Advertisement PDF downloadLoading ...

MP02-08 CATHETER ASSOCIATED MUCOSAL PRESSURE INJURIES (CAMPI): A NOVEL STUDY DEFINING THE IMPACT OF LONG TERM URETHRAL CATHETERS

You have accessJournal of UrologyCME1 Apr 2023MP02-08 CATHETER ASSOCIATED MUCOSAL PRESSURE INJURIES (CAMPI): A NOVEL STUDY DEFINING THE IMPACT OF LONG TERM URETHRAL CATHETERS Kandice Keogh, Devang Desai, and Hannah Flynn Kandice KeoghKandice Keogh More articles by this author , Devang DesaiDevang Desai More articles by this author , and Hannah FlynnHannah Flynn More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003213.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Indwelling urethral catheters (IDC) are common in surgical practice. Given their widespread use, it is tempting to dismiss IDCs as benign drainage tubes. However, a significant complication is erosion of the urethra and surrounding soft tissues resulting in a pressure injury. We coined the term Catheter-Associated Mucosal Pressure Injury (CAMPI) for this form of iatrogenic hypospadias. Active treatment for CAMPI can be invasive with significant side effect profiles, emphasizing the importance of prevention in these patients. To date, there has been little research into CAMPI. Existing publications are either isolated case reportsor small case series. This study explored the prevalence and risk factors of CAMPI in adults with long-term IDCs in regional Australia. METHODS: A multi-centre cross-sectional study was undertaken at two large regional hospitals. The cohort was comprised of 200 adults with an IDC in-situ for >4 weeks between January 2019 to June 2021. Data was collected via a voluntary questionnaire and review of medical records. A novel grading system based on existing hypospadias classification was developed (Image 1). RESULTS: Overall prevalence of CAMPI was 9% (17/200). The mean IDC duration in patients with CAMPI was 39 weeks (9.7 months). The shortest time between IDC insertion and CAMPI detection was only 2 weeks. Prevalence was higher in males (16/169, 10%) compared to females (1/31, 3%). In males, the grades of CAMPI were meatal (7/17, 41%), glanular (3/17, 18%), coronal (4/17, 23%), subcoronal (1/17, 6%), distal penile shaft (1/17, 6%) and mid-penile shaft (1/17, 6%). The female case involved erosion of the urethral orifice during a long hospital admission. Over two-thirds of adults with a CAMPI had an IDC >16Fr (13/18, 72%). Latex IDCs were more common than silicone IDCs in both groups (78% non-CAMPI vs 67% CAMPI, p=0.49). Poor mobility (36% non-CAMPI vs 72% CAMPI, p=0.01), community managed IDCs (26% non-CAMPI vs 50% CAMPI, p=0.03), and congestive cardiac failure (9% non-CAMPI vs 28% CAMPI, p=0.02) were associated with CAMPI formation. CONCLUSIONS: CAMPI is a prevalent complication of long-term IDCs and prevention is key. Catheter securement, hygiene and care must be prioritised by all clinicians who insert, manage and change IDCs. Source of Funding: Nil Funding © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e13 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kandice Keogh More articles by this author Devang Desai More articles by this author Hannah Flynn More articles by this author Expand All Advertisement PDF downloadLoading ...

Imaging study of anatomical parameters related to pterygoid canal neurotomy

Objective:Measuring the important anatomic parameters related to vidian neurectomy to locate the vidian nerve accurately and prevent the surgical complications. Methods:High resolution CT（HRCT） was used to measure the distance parameters between the important anatomic landmarks in 50 patients （100 sides） with chronic rhinosinusitis, sinus cyst or allergic rhinitis et al. The distance from the posterior opening of the palatovaginal canal to the upper edge of the sphenoidal process of palatine bone, the upper edge of the sphenoidal process of palatine bone to the external opening of the vidian canal, the external opening of the vidian canal to the greater palatine canal, and the external opening of the vidian canal to the foramen rotundus were measured. Results:The posterior opening of the palatovaginal canal, the upper edge of the sphenoidal process of palatine bone, the external opening of the vidian canal, the greater palatine canal, and the foramen rotundum are of great value in locating vidain nerve and preventing surgical complications. The distance from the posterior opening of the palatovaginal canal to the upper edge of the sphenoidal process of palatine bone, the upper edge of the sphenoidal process of palatine bone to the external opening of the vidian canal, the external opening of the vidian canal to the greater palatine canal, and the external opening of the vidian canal to the foramen rotundus were（12.46±1.19） mm, （3.23±0.36） mm, （6.09±0.75） mm and（7.6±1.16） mm respectively. Conclusion:HRCT can be used as a powerful tool for preoperative localization of the external pterygoid nerve orifice and its related important anatomical landmarks, and the preoperative distance parameters obtained are valuable for intraoperative localization of the pterygoid nerve to prevent the occurrence of complications.

Study on the Influencing Factors of the Response Characteristics of the Slide Valve-Type Direct-Acting Relief Valve with External Orifice

The slide valve-type direct-acting relief valve with external orifice (SVTDARVWEO) is widely used in hydraulic systems, and its response characteristics are influenced by key factors. It is of great significance to carry out research on the influencing factors of the response characteristics of the SVTDARVWEO. The working principle of the SVTDARVWEO is analyzed in the present study. The simulation model of the SVTDARVWEO is established using AMESim. The influence of the orifice diameter, viscosity coefficient, valve element mass, spring stiffness, oil seal length, and valve element diameter on the response characteristics of the SVTDARVWEO is studied. The results show that: (1) The smaller the orifice diameter is, the smaller the oscillation frequency, amplitude and maximum overshoot of pressure, flowrate, displacement and velocity are. (2) When the viscosity coefficient is 50 N/(m/s), 55 N/(m/s) and 60 N/(m/s), the pressure, flowrate, displacement and velocity oscillate periodically, but the amplitude of the oscillation decreases gradually, and the oscillation frequency is 250 Hz. When the viscosity coefficient is 60 N/(m/s), the pressure, flowrate, displacement and velocity will reach their respective stable values earlier. (3) When the valve element mass is 0.01 kg, 0.015 kg and 0.02 kg, the pressure, flowrate, displacement and velocity oscillate periodically, but the amplitude of oscillation decreases gradually. When the valve element mass is 0.01 kg, the pressure, flowrate, displacement and velocity will reach the stable value earlier. (4) The smaller the spring stiffness is, the greater the maximum overshoot of pressure, flowrate, displacement and velocity is, and the higher the number of oscillations to reach the stable value are, in addition to more time being required. (5) With the increase in oil seal length, the maximum overshoot of pressure and velocity, stability value of displacement also increase correspondingly. (6) With the increase in the valve element diameter, the stable value of pressure decreases, and the oscillation frequency of pressure, flowrate, displacement and velocity increase, but the oscillation amplitude decreases.

Application of a free preputial tube graft coupled with urethral plate urethroplasty combined with a Buck's fascia integral covering for the single-stage repair of severe hypospadias.

To assess the outcome of a free preputial tube graft coupled with urethral plate urethroplasty combined with a Buck's fascia integral covering (BFIC) for the single-stage repair of severe hypospadias in children. A retrospective study was performed on 40 children with hypospadias who were treated in our hospital from December 2017 to February 2022. The inclusion criteria were as follows: (1) the patient had proximal hypospadias, or penile curvature over 30° after degloving the penis; and (2) the patient underwent surgery for hypospadias for the first time. A free preputial tube graft coupled with urethral plate urethroplasty combined with a Buck's fascia integral covering was performed, and all patients were followed up for more than 6 months. After degloving the foreskin, the urethral orifice was retracted to the perineum and scrotum in 20 cases, penoscrotal in 8 cases, and penile in 12 cases. Single-stage repair was achieved without complications in 34 (85%) patients. The remaining six patients experienced postoperative complications: urethrocutaneous fistula occurred in five cases and glans dehiscence with urethrocutaneous fistula in one case. No urethral diverticulum occurred in any case. A neomeatus with a vertically oriented slit-like appearance was achieved at the tip of the glans in all cases, with one exception. The single-stage operation with a free preputial tube graft coupled with urethral plate urethroplasty combined with a Buck's fascia integral covering in the treatment of severe hypospadias achieves favorable functional and cosmetic outcomes.

Comparison of urethral length and orifice diameter in cats undergoing transpelvic or subpubic urethrostomy for perineal urethrostomy revision (cadaveric study).

Stenosis is a postoperative complication reported in 12-17% of male cats that undergo perineal urethrostomy (PU). This study compared two different revision techniques for failed perineal urethrostomies. The first objective was to evaluate the feasibility of performing a transpelvic urethrostomy (TPU) after a previous, correctly performed PU in male cats. The second objective was to determine the residual urethral length, orifice diameter, and the position of the orifice relative to the pubic brim and anus after PU, TPU and subpubic urethrostomy (SPU). Twenty male cat cadavers were randomly divided into two groups: TPU and SPU. In group TPU, PU was followed by TPU; in group SPU, PU was followed by SPU. After each procedure, the urethral orifice cross-section size was estimated by inserting the largest possible urinary catheter without resistance. Residual urethral length was measured both on contrast radiographs and after anatomical dissection. In all cats, TPU could be performed following a technically correct PU. The TPU resulted in a 1.5-times longer residual urethral length than SPU, based on contrast radiographs (P = 0.001) and confirmed by anatomical dissection (P <0.001). Relative to the initial urethral length, PU, TPU and SPU resulted in a reduction of 24%, 36% and 56%, respectively. The urethral orifice diameter after TPU did not differ from SPU (P = 1.000), and it was not statistically significantly different between TPU and PU (P = 0.317) or between SPU and PU (P = 0.655). The urethral orifice was located further away from the pubis (P <0.001) and closer to the anus (P <0.001) after TPU than after SPU. Both TPU and SPU are possible revision surgeries following PU. As TPU preserves a significantly longer urethral length and requires less tissue dissection, the risk of urinary tract infections, urinary dermatitis and urinary incontinence might be less following TPU than SPU.

Acupoint Definition and Clinical Study Analysis for Internal and External Orifices of Intervertebral Foramen Procedures

Acupoint Definition and Clinical Study Analysis for Internal and External Orifices of Intervertebral Foramen Procedures

Anatomical background of the sensory function in the urethra: involvement of endocrine paraneurons and afferent nerves in divergent urogenital functions. A review.

The urethra is ontogenetically derived from the cloaca together with distal parts of the large intestine, and serotonin cells are predominant among dispersed endocrine/paracrine cells in the epithelia of both tissues. Analysis of urethral endocrine cells thus helps us to understand the functions of gut endocrine cells and their communication with the nervous system, due to the fact that the urethra is a simple tubular organ, where only urine without microflora rapidly passes through. A certain number of urethral endocrine cells display unique, complicated shapes with dendritic processes, reminiscent of neurons. Characteristically, urethral endocrine cells-often called paraneurons-have direct contact with sensory nerves within the epithelium, unlike gut endocrine cells lacking in direct contact with nerves. These traits encourage us to focus on the urethral paraneurons as ideal endocrine/paracrine cells. A topographical complex of urethral paraneurons and afferent nerve fibers is sensitive to the passage of urine or the distention of the urethral lumen. The urethra-bladder excitatory reflex facilitates micturition via the release of serotonin from the paraneurons, ultimately ensuring complete voiding of the bladder. This reflex may also influence sexual behaviors such as ejaculation or the female orgasm. Urethral brush cells as well as paraneurons are responsible for continuous monitoring of the mucosal surface, especially for pathogens entering via the external urethral orifice.

Experience of using acitretin in genital form of scleroatrophic lichen with urethral lesion in men

The defeat of the genitals in scleroatrophic lichen is often accompanied by the involvement of the urethra in the process, which threatens serious complications and, first of all, the development of stricture. Therapy of such cases is difficult and ineffective in the case of topical corticosteroids. The article describes the positive experience of using acitretin at a dose of 25 mg per day for the treatment of scleroatrophic lichen, which occurs with damage to the external orifice and anterior segment of the urethra.