Urethral Wall Research Articles

Editorial Comment from Dr Negoro to Propiverine increases urethral wall catecholamine levels and bladder leak point pressure in rats.

Editorial Comment from Dr Negoro to Propiverine increases urethral wall catecholamine levels and bladder leak point pressure in rats.

Morphological analysis of the urethral muscle of the male pig with relevance to urinary continence and micturition.

To investigate whether the pig could be considered a suitable model to study lower urinary tract function and dysfunction, the pelvic urethra of 24 slaughtered male pigs were collected, and the associated muscles were macroscopically, histologically and histochemically analyzed. In cross-sections of the urethra, a muscular complex composed of an inner layer of smooth muscle and an outer layer of striated muscle that are not separated by fascial planes was observed. A tunica muscularis, composed of differently oriented smooth muscle bundles, is only evident in the proximal part of the pelvic urethra while, in the remaining part, it contributes to form the prostatic fibromuscular stroma. The striated urethral muscle surrounds the pelvic urethra in a horseshoe-like configuration with a dorsal longitudinal raphe, extending from the bladder neck to the central tendon of perineum. Proximally to the bladder, it is constituted of slow-twitch and fast-twitch myofibers of very small diameter, and embedded in an abundant collagen and elastic fiber net. Moving caudally it is gradually encircled and then completely substituted by larger and compact myofibers, principally presenting circular orientation and fast-twitch histochemical characteristics. So, like in humans, the cranial tract of the muscular system surrounding the pelvic urethra is principally composed of smooth musculature. The striated component cranially may have a role in blocking retrograde ejaculation, while the middle and caudal tracts may facilitate urine and semen flow, and seem especially concerned with the rapid and forceful urethral closure during active continence. Some differences in the morphology and structure between pigs and humans seem due to the different morphology of the 'secondary' sexual organs that develop from the urethral wall and to the different effect of gravity on the mechanics of the urinary system in quadruped and bipedal mammals.

Propiverine increases urethral wall catecholamine levels and bladder leak point pressure in rats.

To investigate whether propiverine has a noradrenaline re-uptake inhibitor and whether it acts on the lumbosacral cord or the urethral wall. In addition, we aimed to examine the effect of propiverine on leak point pressure in rats. A total of 72 female and 30 male rats were used to examine the following: (i) the change of leak point pressure caused by intravenous agents in rats with vaginal distention; (ii) the change of leak point pressure caused by intrathecal agents in rats with vaginal distention; (iii) the noradrenaline re-uptake inhibitor action of propiverine; and (iv) catecholamine levels in the bladder wall, urethral wall, cerebrospinal fluid and plasma after oral administration of propiverine. Intravenous injection of propiverine, imipramine and duloxetine increased the leak point pressure in rats with vaginal distention. Intrathecal naftopidil decreased the leak point pressure, whereas subsequent intravenous propiverine restored the leak point pressure to the level before intrathecal naftopidil in rats with vaginal distention. Propiverine acted like a noradrenaline re-uptake inhibitor, increasing noradrenaline and/or dopamine levels in the plasma, cerebrospinal fluid, and urethral wall perfusion fluid. Propiverine inhibits noradrenaline re-uptake, as well as having antimuscarinic and Ca-antagonist actions. The inhibition of noradrenaline re-uptake by propiverine mainly occurs at the urethral level and partially in the central nervous system, and might stimulate the smooth muscle of the bladder neck and proximal urethra through α1-adrenergic receptors, as well as stimulating the striated muscle of the urethra and pelvic floor by activation of spinal motoneurons. Therefore, propiverine might be effective for both stress and urge incontinence.

Editorial Comment from Dr Saito and Dr Shimizu to Propiverine increases urethral wall catecholamine levels and bladder leak point pressure in rats.

Editorial Comment from Dr Saito and Dr Shimizu to Propiverine increases urethral wall catecholamine levels and bladder leak point pressure in rats.

The Endoscopic Morphological Features of Congenital Posterior Urethral Obstructions in Boys with Refractory Daytime Urinary Incontinence and Nocturnal Enuresis.

Purpose This study aims to evaluate the endoscopic morphological features of congenital posterior urethral obstructions in boys with refractory daytime urinary incontinence and/or nocturnal enuresis. Patients and Methods A total of 54 consecutive patients underwent endoscopy and were diagnosed with a posterior urethral valve (PUV) (types 1-4). PUV type 1 was classified as severe, moderate, or mild. A transurethral incision (TUI) was mainly performed for anterior wall lesions of the PUV. Voiding cystourethrography and pressure flow studies (PFS) were performed before and 3 to 4 months after TUI. Clinical symptoms were evaluated 6 months after TUI, and outcomes were assessed according to PFS waveform pattern groups (synergic pattern [SP] and dyssynergic pattern [DP]). Results All patients had PUV type 1 and/or 3 (i.e., n = 34 type 1, 7 type 3, and 13 types 1 and 3). There were severe (n = 1), moderate (n = 21), and mild (n = 25) cases of PUV type 1. According to PFS, SP and DP were present in 43 and 11 patients, respectively. TUI was effective in the SP group and symptoms improved in 77.4 and 69.3% of patients with daytime incontinence and nocturnal enuresis, respectively. Almost no effect was observed in the DP group. A significant decrease in the detrusor pressure was observed at maximum flow rate using PFS in the SP group. Conclusions PUV type 1 encompassed lesions with a spectrum of obstructions ranging from severe to mild, with mild types whose main obstructive lesion existed at the anterior wall of urethra occurring most frequently in boys with refractory daytime urinary incontinence and/or nocturnal enuresis.

Practical considerations in the selection of seed strength for prostate implants.

There are advantages in using lower numbers of higher activity seeds for prostate seed implants. This work investigated the use of higher strength seeds for our manually optimized prostate implants. Following a planning study using a range of seeds strengths between 0.4 U and 0.7 U, a series of patients were implanted using seeds of strength ∼0.7U. Twenty consecutive patients were selected for this study; ten patients were implanted with 0.4 U seeds and the next ten patients implanted with 0.7 U seeds. Postimplant dosimetry for the target volume, urethra, and rectal wall was compared between the two groups. Our data showed a small and insignificant decrease in the total theatre time when implanting seeds of higher strength. The mean number of seeds required per implant decreased by over 30% for the 0.7 U implants, and the mean number of needles decreased by eight needles. The mean D90 (%) was marginally lower for the 0.7 U group, and spread over a wider range of values. Doses to the rectal wall were slightly higher for the 0.7 U group. At six years postimplant, the symptom scores for urinary and rectal toxicity and erectile function were similar to those reported before brachytherapy, with little differences between the 0.4 U and 0.7 U groups. Our experiences and practical advice in the selection of seed strength for prostate implants are reported in this paper.PACS number: 87.53.Jw

Significance of urethral fibrosis evaluated by preoperative magnetic resonance imaging as a predictor of continence status after robot-assisted radical prostatectomy.

The objective of this study was to assess the impact of urethral fibrosis on the continence status following robot-assisted radical prostatectomy (RARP). The findings of fibrosis of the urethral wall and periurethral tissue in 185 patients undergoing RARP were each divided into grade 0 to 3 based on preoperative T2-weighted magnetic resonance imaging. Urethral fibrosis was defined as the sum of both grades, and scores ≤ 2 and ≥ 3 were considered as 'no/mild' and 'severe' fibrosis, respectively. The incidences of continence in patients with no/mild fibrosis were significantly higher at 3, 6, and 12 months after RARP than those with severe fibrosis. Furthermore, urethral fibrosis was identified as an independent predictor of the postoperative continence status at 3, 6, and 12 months after RARP. Assessment of urethral fibrosis could be a significant predictor of recovery of the urinary continence status after RARP. Copyright © 2015 John Wiley & Sons, Ltd.

MRI factors to predict urinary incontinence after retropubic/laparoscopic radical prostatectomy.

Prostate cancer can be treated by radical prostatectomy (RP) and provoke a troublesome side effect: urinary incontinence (UI). We propose a verification of the usefulness of MRI and an identification of which structures are involved in UI after RP. Between September 2002 and December 2011, 550 patients underwent RP. We performed MRI to evaluate extraprostatic disease before surgery. To evaluate patient status, we measured the following structures: length (LP), width (WP), height (HP) and volume (PV) of the prostate, membranous urethral length (MUL), urethral wall thickness (UWT), levator ani muscle (LAM) and obturator internus muscle (OIM) thickness, ratio of levator ani muscle/prostate volume (LAM/PV), volume of the urethra (VU). UI was defined according to ICS definition as the complaint of any involuntary leakage of urine and evaluated 1 year after surgery. Analyses were performed by mean comparisons, univariate and multivariate logistic regression with a 1000-resample bootstrapping. Means of measurements were: LP 4.46 cm, WP 5.15 cm, HP 3.9 cm, PV 49.3 cc; LAM 0.51 cm, OIM 1.46 cm; MUL 1.43 cm, UWT 1.38 cm; and LAM/PV 0.013 cm/cc, VU 2.33 cc. One hundred and twenty-two (22.2 %) patients complained of urine leakage. Univariate obtained differences in PV, OIM, MUL, and UWT. After adjusting by confounders, multivariate analysis showed: MUL: [OR 0.134; CI 95 % (0.022-0.493); P 0.006]; PV: [OR 1.016; CI 95 % (1.004-1.029); P 0.005]; UWT: [OR 6.03; CI 95 % (1.068-44.1); P 0.033]. MRI is a useful tool to predict UI after RP. The MUL and PV are well-identified structures that are involved in UI. Our study shows that UWT also influences UI.

Removal of Polypropylene Sling Mesh From the Urethra: An Anatomic Technique

To describe a technique for removal of intraurethral mesh with minimal disruption of the periurethral anatomy. Through a midline transvaginal approach the sling is located lateral to the urethra and divided. The medial portion of the divided sling is carefully dissected back to its entrance laterally into the urethral lumen. A stay suture is placed on the dissected sling. The sling is located on the contralateral side and likewise divided and dissected back to the urethral lumen. The completely dissected sling is pulled through such that the holding stitch is through and through the urethral lumen, allowing easy localization of the urethral defect on lateral walls of the urethra. These defects are closed with an absorbable suture and the vaginal incision is closed. Three patients have undergone a transvaginal removal of their intraurethral mesh using the described technique. At a mean follow-up of 6.0 months, there were no intraoperative or postoperative complications. All patients were obstructed preoperatively and all developed stress urinary incontinence postoperatively requiring 0-1 pads per day. Current approaches to the surgical repair of chronic intraurethral mesh have significant limitations that are minimized by the described technique. This anatomic removal of mesh from the urethra has several advantages including no disruption of the ventral wall of the urethra, complete removal of foreign body from the urethra, and simplified localization of the urethral wall defect to allow for anatomic closure.

V12-13 URETHROLYSIS FOR SYNTHETIC PERI-URETHRAL BULKING AGENT COLLECTION

You have accessJournal of UrologyReconstruction1 Apr 2015V12-13 URETHROLYSIS FOR SYNTHETIC PERI-URETHRAL BULKING AGENT COLLECTION Tony Nimeh, William Kobak, Whitney Halgrimson, and Ervin Kocjancic Tony NimehTony Nimeh More articles by this author , William KobakWilliam Kobak More articles by this author , Whitney HalgrimsonWhitney Halgrimson More articles by this author , and Ervin KocjancicErvin Kocjancic More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2783AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Although urethral bulking therapy (UBT) is a minimally invasive procedure for stress incontinence, it nevertheless carries risks and potential for complications. We present the case of a 63 year old female with a history of hysterectomy and stress incontinence who failed sling placement and a subsequent peri-urethral Durasphere ® injection and presented with incontinence, bladder spasms and sharp, throbbing pain. An MRI 6 months after her UBT revealed a periurethral submucosal soft tissue mass. transvaginal ultrasonography revealed a 1 cm spherical periurethral collection at the bladder neck. Cystoscopy revealed a spherical bulge in the proximal urethral wall and retroflexion revealed a spherical bulge at the bladder neck. We present a video demonstrating the surgical technique utilized to perform a transvaginal urethrolysis and removal of peri-urethral Durasphere ® collection. METHODS A circumferencial incision was made around the urethral meatus. Sharp and blunt dissection was then carried out to mobilize the urethra from the meatus to the bladder neck. The pubo-urethralis muscle was then divided, and circumferential urethrolysis was carried out proximally. The urethro-pelvic ligament was also incised. Urethrolysis was carried out to the bladder neck with care taken not to injure the urethral wall. The peri-urethral collection was dissected and the collection of Durasphere (R) with exudate was identified. The collection sac was then thoroughly examined using the flexible cystoscope and no communications was found with the urethral lumen. Intra-operative flexible cystoscopy was repeated and revelead a resolution of the previously noted spherical bulge at the bladder neck. The urethra was then plicated bilaterally on the lateral walls using 4.0 vicryl interrupted sutures and the the urethra was wrapped with a strip of Interseed mesh to guide the healing process. 4.0 vicryl sutures were used to stabilize the Interseed mesh and to prevent its migration and the peri-meatal incision was closed. RESULTS There were no complications and the patient was discharged home the following day with an indwelling foley catheter which was removed 10 days following the procedure. Two weeks postoperatively the patient had complete resolution of her pain as well as incontinence. CONCLUSIONS Transvaginal urethrolysis can correct complications associated with paraurethral Durasphere ® injections. When combined with a urethral and bladder neck plication, this technique can also lead to resolution of the original incontinence symptoms. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e980-e981 Peer Review Report Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tony Nimeh More articles by this author William Kobak More articles by this author Whitney Halgrimson More articles by this author Ervin Kocjancic More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

V2-06 SKENE'S GLAND CYST EXCISION

You have accessJournal of UrologyFemale Voiding Dysfunction1 Apr 2015V2-06 SKENE'S GLAND CYST EXCISION Philippe Zimmern and Gary Lemack Philippe ZimmernPhilippe Zimmern More articles by this author and Gary LemackGary Lemack More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.331AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To review our experience with the long-term outcome after Skene's gland cyst excision METHODS A surgical database of all procedures performed by two surgeons at one institution was reviewed for Skene's gland cyst excision. Data extracted from an electronic medical record or medical charts were presenting symptoms, pre-operative evaluation, site of excision, peri-operative complications, and clinical outcomes. Technique of surgical excision is presented in the attached movie, and includes cystoscopy, dissection of cyst wall from the floor of the urethra with scissors or bovie on low setting, distal urethroplasty as indicated, complete removal of the cyst wall, and primary vaginal wall closure. Urethral Foley catheter is left indwelling for 3–5 days afterwards and sexual function is resumed after completion of vaginal healing. RESULTS From 2001 to 2013, ten women were studied. Mean age was 45 (range: 29 to 66). Presenting symptoms were: dyspareunia (4), urinary tract infections (4), vaginal mass (1) and voiding dysfunction (1), with half of women having more than one presenting symptoms. Evaluation included an MRI in all women, and a voiding cystourethrogram in 5 to exclude a urethral diverticulum. Skene's gland cyst was observed on the left (5) or right (5) sides, with no cases being bilateral. No peri-operative complications were reported. All procedures were done on an outpatient basis. A distal meatoplasty was done in 2 women, and a urethral dilation in another 2. Mean follow-up was 3.5 years (range 3 to 96 months). One woman died of unrelated cause (stroke). Four women had mild stress urinary incontinence in follow-up years, one requiring pelvic floor therapy, the others simple observation. Two have been treated for occasional urinary tract infections. One underwent a distal urethroplasty 6 years later after a failed urethral dilation. Eight of ten women who were sexually active remained sexually active post-operatively. CONCLUSIONS Excision of Skene's gland cyst is a safe procedure with acceptable long-term functional outcomes. Excision of a Skene's gland cyst is: a. A frequent vaginal procedure due to the large incidence of this condition b. A bloody procedure possibly requiring blood transfusion c. A delicate operation that can lead to distal urethral wall damage and possible meatoplasty (∗) d. Similar to a urethral diverticulum removal and requiring closure of the urethral ostium e. Likely to recur even after complete excision of the gland linings © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e99 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Philippe Zimmern More articles by this author Gary Lemack More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Noninvasive estimation of the pressure profile in the male urethra using ultrasound imaging.

Decreased prostatic compliance as a result of benign prostatic enlargement can result in bladder outlet obstruction. This changes the urethral pressure profile during voiding. In this study, the authors propose noninvasive estimation of this pressure profile. In four soft tissue mimicking models of the urethra with increasing degree of obstruction, the authors measured deformation of the wall during flow, using ultrasound imaging. Combined with estimates of the model compliance, the authors were able to estimate the pressure profile. First, the compliances (Young's moduli) of the four models were derived by applying static luminal pressure and measuring the resulting strain of the tissue using an ultrasound imaging system. Next, continuous flow was applied to the models and the strain in the urethral wall was measured similarly. The luminal pressure profile was estimated from the strain (measured under continuous flow conditions) and the derived compliance (measured under static pressure conditions). The estimated pressures up- and downstream of the obstruction were compared with the corresponding measured pressures. In the obstructed region, the strain gradient was estimated using linear regression. The luminal pressure values estimated from the ultrasound data up- and downstream of the obstruction were not significantly different from the corresponding measured pressures. The general pressure profile showed a decrease along the length of the obstruction followed by a small increase after the obstruction. The strain gradient in the obstructed region reflected the decrease in urethral pressure and increased with flow rate and degree of obstruction. The results from this model study illustrate the feasibility of noninvasive estimation of the urethral pressure profile using ultrasound. This offers the prospect of a noninvasive, ultrasound based diagnostic tool for assessment of bladder outlet obstruction in men with lower urinary tract symptoms.

Transforming Growth Factor-β1 Induced Urethral Fibrosis in a Rat Model

We sought to develop a reproducible TGF-β1 injection technique to induce urethral fibrosis in the rat urethra. A total of 32 male Sprague Dawley® rats weighing 300 to 350 gm were anesthetized with ketamine/xylazine intraperitoneally. Using a 5 mm penoscrotal incision the rat urethra was exposed. In the experimental group varying doses of TGF-β1 (5, 10 and 25 μg) were injected in each side of the urethral wall. Normal saline infiltration was used in the sham treated group. Rats were sacrificed 2 and 4 weeks following TGF-β1 injection. Urethral specimens were stained with hematoxylin and eosin, and Masson trichrome, and Western blot evaluations were performed. Normal and strictured urethral tissues from patients were collected and evaluated in the same fashion. There was no evidence of urethral wall thickening or fibrosis in the sham treated group. Varied histological evidence of fibrosis was noted in all experimental groups. There was a significant increase in collagen type I expression 2 weeks after injection of 5, 10 and 25 μg TGF-β1. Collagen type III expression was significantly increased 2 weeks after injecting 10 and 25 μg of TGF-β1, which persisted to 28 days after injection. TGF-β1 injection can successfully generate a reproducible rat model of urethral spongiofibrosis. This technique is simple, inexpensive and reproducible. Our series is a proof of concept study. Additional studies in larger animals are needed to further confirm our findings.

Urethral defect with suspected corpus spongiosum herniation as a cause of stranguria and urethral haemorrhage in a dog

A male neutered Staffordshire bull terrier presented for evaluation of urethral haemorrhage of three days duration. A urethral mass was identified on contrast radiography, ultrasonography and urethroscopy. An open excisional...

Tissue alterations in urethral and vaginal walls related to multiparity in rabbits.

In rodents, vaginal distention after delivery or experimental manipulation affects innervations as well as the amount of striated/smooth musculature or collagen in both the urethra and vagina. These changes are associated with modifications in excretory and reproductive processes. Although successive and consecutive vaginal deliveries (multiparity) affect the contractile and functional properties of the female lower urogenital tract (LUT), its impact on LUT morphometry, including persistency, has been barely studied. The caudal urethra (CU) and cranial (V1) and caudal (V2) pelvic vaginal regions were excised from young and adult nulliparous (YN and AN, respectively) and multiparous (YM and AM, respectively) rabbits. Tissues were histologically processed and stained with Masson's trichrome. The thickness of the tissue layers and areas covered by tissue components were measured and compared using two-way ANOVA followed by Student-Newmann-Keuls tests to determine statistical differences (P ≤ 0.05). Compared to YN, YM, and AN tissues showed a reduction in the thickness of the epithelium, as well as in areas covered by striated musculature, collagen, and blood vessels of the LUT. In comparison with YM, only some morphometric changes were recovered in the AM group. Our study shows that multiparity and age can be associated with epithelial and muscular atrophy of urethral and vaginal walls. The morphometry of the LUT between young and adult female rabbits varies with multiparity. These findings may help to better understand the effects of multiparity on young and adult females and its correlation with the development of pelvic dysfunctions.

Urodynamic diagnosis of female bladder outlet obstruction

Female bladder outlet obstruction (BOO) remains a controversial topic in terms of definition and diagnosis. It is a condition that is far less common in women than in men and has an estimated incidence of 2.7e8%.1,2 The etiology for organic BOO or anatomic BOO (but not including functional BOO) is more diverse in women because of various anatomical or iatrogenic changes affecting vaginal support, the urethra, and/or the bladder. Some changes such as prolapse are related to aging, whereas other changes are related to urethral pathology or previous surgeries (e.g., sling procedure, urethropexy). Furthermore, the urethral anatomical sites for BOO can be further subcategorized by extrinsic compression, urethral wall conditions (e.g., fibrosis, urethral diverticulum), or luminal factors (e.g., stricture disease).3 Owing to the complexity of etiology and nonspecific voiding symptoms, the diagnosis of female BOO requires a high index of suspicion and recourse to a variety of modalities, and includes a thorough history, questionnaires, noninvasive flow and residual assessment, physical examination, cystoscopy, imaging, and urodynamic or videourodynamic studies.

Macro/Nano-Gel Composite as an Injectable and Bioactive Bulking Material for the Treatment of Urinary Incontinence

Many women around the world are suffering from urinary incontinence, defined as the unintentional leakage of urine by external abnormal pressure. Although various kinds of materials have been utilized to treat this disease, therapies that are more effective are still needed for the treatment of urinary incontinence. Here, we present a macro/nanogel composed of in situ forming gelatin-based macrogels and self-assembled heparin-based nanogels, which can serve as an injectable and bioactive bulking material for the treatment of urinary incontinence. The hybrid hydrogels were prepared via enzymatic reaction in the presence of horseradish peroxidase and hydrogen peroxide. Incorporating a growth factor (GF)-loaded heparin nanogel into a gelatin gel matrix enabled the hybrid gel matrix to release GF continuously up to 28 days. Moreover, we demonstrated that the hydrogel composites stimulated the regeneration of the urethral muscle tissue surrounding the urethral wall and promoted the recovery of their biological function when injected in vivo. Thus, the macro/nanohydrogels may provide an advanced therapeutic technique for the treatment of urinary incontinence as well as an application for regenerative medicine.

Heparanase 2, mutated in urofacial syndrome, mediates peripheral neural development in Xenopus

Urofacial syndrome (UFS; previously Ochoa syndrome) is an autosomal recessive disease characterized by incomplete bladder emptying during micturition. This is associated with a dyssynergia in which the urethral walls contract at the same time as the detrusor smooth muscle in the body of the bladder. UFS is also characterized by an abnormal facial expression upon smiling, and bilateral weakness in the distribution of the facial nerve has been reported. Biallelic mutations in HPSE2 occur in UFS. This gene encodes heparanase 2, a protein which inhibits the activity of heparanase. Here, we demonstrate, for the first time, an in vivo developmental role for heparanase 2. We identified the Xenopus orthologue of heparanase 2 and showed that the protein is localized to the embryonic ventrolateral neural tube where motor neurons arise. Morpholino-induced loss of heparanase 2 caused embryonic skeletal muscle paralysis, and morphant motor neurons had aberrant morphology including less linear paths and less compactly-bundled axons than normal. Biochemical analyses demonstrated that loss of heparanase 2 led to upregulation of fibroblast growth factor 2/phosphorylated extracellular signal-related kinase signalling and to alterations in levels of transcripts encoding neural- and muscle-associated molecules. Thus, a key role of heparanase 2 is to buffer growth factor signalling in motor neuron development. These results shed light on the pathogenic mechanisms underpinning the clinical features of UFS and support the contention that congenital peripheral neuropathy is a key feature of this disorder.

MP1-19 ACCUMULATION OF VERSICAN, AN EXTRACELLULAR MATRIX COMPONENT, IN PELVIC FLOOR TISSUES IN A RAT MODEL OF SIMULATED CHILDBIRTH INJURY

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Basic Research I1 Apr 2014MP1-19 ACCUMULATION OF VERSICAN, AN EXTRACELLULAR MATRIX COMPONENT, IN PELVIC FLOOR TISSUES IN A RAT MODEL OF SIMULATED CHILDBIRTH INJURY Chong Choe, Marika Bogdani, Thomas Wight, and Una Lee Chong ChoeChong Choe More articles by this author , Marika BogdaniMarika Bogdani More articles by this author , Thomas WightThomas Wight More articles by this author , and Una LeeUna Lee More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.117AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Abnormal extracellular matrix (ECM) has been correlated with stress urinary incontinence (SUI). Most ECM studies have focused on alterations in collagen and elastin. However, other ECM components such as proteoglycans (PG) play an important role in the remodeling of collagen and elastin. Versican (VC) is a PG that plays a key regulatory role in maintaining elastic fiber networks. VC, however, has not yet been investigated in SUI. Vaginal distension (VD) is a well accepted rodent model of simulated childbirth injury used to study SUI. The aim was to investigate the effects of VD in rats on the distribution of VC on urethral, para-urethral, and anterior vaginal wall tissues. METHODS Nulliparous Sprague-Dawley female rats underwent VD or sham. Pelvic floor tissues were harvested for immunohistochemical staining for VC at days 1, 4, and 21. Tissues were collected from 6 rats per group at each time point. RESULTS Sham injured rats had low VC staining around the urethra and minimal to no VC staining in the para-urethral and vaginal lamina propria (LP) at all time points (fig 1, left). At day 1, VD rats had increased VC staining in the urethra. By day 4, VD rats had increased staining in the urethra, para-urethral tissues, and vaginal LP (fig 1, right). At day 21, VD rats had similar persistent areas of VC staining as the day 4 VD rats. CONCLUSIONS This study demonstrates a distinct pattern of increased versican accumulation in the urethra, para-urethral tissues, and vaginal lamina propria after vaginal distension. Since extracellular matrix has been shown to be abnormal in SUI, studying the patterns of proteoglycan accumulation may lead to an understanding of why elastic fibers are altered in pelvic floor tissues in patients with SUI. Versican accumulation warrants further study to better understand alterations in tissue support and function for the future development of potential targeted therapies. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e8 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Chong Choe More articles by this author Marika Bogdani More articles by this author Thomas Wight More articles by this author Una Lee More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

English

INTRODUCTION: Paraurethral cyst is an uncommon and may be congenital or acquired. Presenting symptoms include a palpable or visible mass, pain, dyspareunia, dysuria, a distorted voiding stream, and a vaginal discharge. Paraurethral cyst affects 1% to 6% of the female population between 20 and 60 years of age. CASE REPORT: A 23 year old patient came with complaints of dysuria, dyspareunia and swelling in the vaginal region since 6 months, size being gradually increasing in size to the present size of 4x 4 cms giving a picture of paraurethral cyst. Ultrasonography was suggestive of a simple cyst and rest all investigations were in normal limits. During surgery, a unilocular cyst adherent to the urethral wall on the right side was appreciated. DISCUSSION: In this case, it was typically diagnosed upon physical examination, although ultrasound was used to confirm. We conclude that paraurethral cysts in adults are benign lesions that respond well to simple marsupialization, with no recurrence. The major risk factor in the present patients was pregnancy and vaginal delivery, but cysts can occur in nulliparous women.