OBJECTIVETo explore the possibility of injury to the striated urethral sphincter by incision to the anterior lobe region in transurethral prostatectomy.

METHODSWe incised the anterior lobe region of 60 patients with benign prostatic hyperplasia (BPH) undergoing transurethral prostatectomy. The patients were divided into four groups according to the incision fields: proximate superficial (group 1), proximate deep (group 2), distal superficial (group 3) and distal deep (group 4). The tissues taken from the anterior lobe region were subjected to HE staining, and the smooth and striated muscles were detected by immunohistochemical identification of smooth muscle actin (SMA) and myoglobin (MYO) in the tissues. The prostate volume, age, and PSA level of the patients were analyzed against their positive or negative results. The relative contents of the striated muscle were compared among groups 2, 3 and 4. The independent-sample between-group t-test was used for statistic analysis.

RESULTSThe urethral rhabdosphincter was found in the anterior lobe region, with the smooth muscle intermixed with the striated muscle. The incision injury of the urethral rhabdosphincter was associated with the prostate volume. Increased urethral rhabdosphincter was observed in the anterior lobe region, approaching the apex of the prostate and extending to the urethral lumen.

CONCLUSIONThe anterior lobe region should not be excessively incised in transurethral prostatectomy so as to avoid direct injury of the striated urethral sphincter, which is especially important for prostates of smaller volume or operation near the apex of the prostate.

Aged ; Histological Techniques ; Humans ; Male ; Prostate ; anatomy & histology ; pathology ; Prostatic Hyperplasia ; pathology ; surgery ; Transurethral Resection of Prostate ; Urethra ; anatomy & histology ; pathology

Animals ; Colon ; pathology ; Dogs ; Female ; Graft Survival ; Intestinal Mucosa ; pathology ; transplantation ; Mouth Mucosa ; pathology ; transplantation ; Reconstructive Surgical Procedures ; Urethra ; surgery

PURPOSE: Objective of this study is to determine changes in the levels of type I and III collagen in women with stress urinary incontinence (SUI). MATERIALS AND METHODS: Forty-nine women were enrolled to this study and e divided into two groups. Forty-four patients with SUI and 5 patients with without SUI for control. All the women were underwent a pre-operative evaluation. The presence of collagen type I and III was determined by immunohistochemical technique. Analysis of staining was studied with help of specialist of pathology with Image Pro computerized program. The student t-test was used for statistical analysis. RESULTS: Collagen type I and III was significantly reduced (p<0.05) in patients with SUI in anterior vaginal wall tissue. compared to patients in control. Both collagen type I and III were marked reduced in the patient of severe grade of stress urinary incontinence. However there were no significant relation between quantity of collagen and other etiological factors including age, parity, grade, and menopausal. CONCLUSION: In this study, women with SUI have less collagen type I and III around the urethra regardless of the degree of pelvic relaxation, SUI grade, parity, menopausal, age. It appears that collagen has a significant role in the maintenance of urinary continence.
Collagen Type I ; Collagen* ; Female* ; Humans ; Parity ; Pathology ; Relaxation ; Specialization ; Urethra ; Urinary Incontinence*

BACKGROUNDUrethral reconstruction for both congenital and acquired etiologies remains a challenge for most urologic surgeons. Tissue engineering has been proposed as a strategy for urethral reconstruction. The purpose of this study was to determine whether a naturally derived extracellular matrix substitute developed for urethral reconstruction would be suitable for urethral repair in an animal model.

METHODSA urethral segmental defect was created in 20 male rabbits. The urethral extracellular matrix, obtained and processed from rabbit urethral tissue, was trimmed and transplanted to repair the urethral defect. Then, the regenerated segment was studied histologically by haematoxylin-eosin staining and Van Gieson staining at 10 days, 3 weeks, 6 weeks, and 24 weeks postoperation. Retrograde urethrography was used to evaluate the function of the regenerated urethras of 4 rabbits 10 and 24 weeks after the operation. The urodynamics of 4 rabbits from the experimental group and control group I were assessed and compared. In addition, 4 experimental group rabbits were examined by a urethroscope 24 weeks after the operation.

RESULTSAt 10 days after operation, epithelial cells had migrated from each side, and small vessels were observed in the extracellular matrix. The matrix and adjacent areas of the host tissue were infiltrated with inflammatory cells. The epithelium covered the extracellular matrix fully at 3 weeks postoperation. Well-formed smooth-muscle cells were first confirmed after 6 weeks, at which point the inflammatory cells had disappeared. At 24 weeks postoperation, the regenerated tissue was equivalent to the normal urethra. Urethrography and urodynamic evaluations showed that there was no difference between normal tissue and regenerated tissue.

CONCLUSIONSUrethral extracellular matrix appears to be a useful material for urethral repair in rabbits. The matrix can be processed easily and has good characteristics for tissue handling and urethral function.

Animals ; Extracellular Matrix ; metabolism ; Rabbits ; Tissue Engineering ; methods ; Urethra ; pathology ; surgery

OBJECTIVETo investigate the possibility of urethral reconstruction with a free colonic mucosal graft.

METHODSTen female dogs underwent a procedure in which the urethral mucosa was totally removed and replaced with a free graft of colic mucosa. A urodynamic study was performed before the operation and sacrifice. The dogs were sacrificed 8 to 16 weeks after the operation for histological examination of the urethra.

RESULTSUrethral stricture developed in 1 dog. The results of urody namic studies showed that the difference in maximum urethral pressure between pre-operation and pre-sacrifice in the remaining 9 dogs was not of significance (P > 0.05). Histological examination revealed that the colonic free mucosa survived inside the urethral lumen of the 9 dogs. Plicae surface and unilaminar cylindric epithelium of the colonic mucosa was observed in dogs sacrificed 8 weeks after the operation. Plicae surface and unilaminar cylindric epithelium of the colonic mucosa was not observed and metaplastic transitional epithelium covered a large proportion of the urethral mucosa in dogs sacrificed 12 weeks after the operation.

CONCLUSIONSUrethral mucosa can be replaced by colonic mucosa without damaging the continence mechanism in female dogs. This technique is useful when local or preputial skin and buccal or bladder mucosa are not available.

Animals ; Colon ; transplantation ; Dogs ; Female ; Intestinal Mucosa ; transplantation ; Urethra ; pathology ; surgery ; Urologic Surgical Procedures

OBJECTIVETo study the clinical value and operation skills of nasal endoscopy-assisted bulboprostatic anastomosis in the treatment of posterior urethral stricture.

METHODSBetween January 2012 and November 2014, we performed nasal endoscopy-assisted bulboprostatic anastomosis for 12 male patients with posterior urethral stricture. We recorded the operation time, blood loss, exposure of operation visual field, and success rate of anastomosis and summarized the operation skills.

RESULTSEight of the patients experienced first-stage recovery. Two underwent a urethral dilation at 3 months postoperatively, 1 received 10 urethral dilations within 5 months after surgery, and 1 underwent internal urethrotomy after failure in urethral dilation, but all the 4 cases were cured.

CONCLUSIONNasal endoscopy can significantly improve the operation field exposure, elevate the precision, reduce the difficulty, and enhance the efficiency of bulboprostatic anastomosis in the treatment of posterior urethral stricture.

Anastomosis, Surgical ; Endoscopy ; Humans ; Male ; Operative Time ; Postoperative Period ; Urethra ; pathology ; surgery ; Urethral Stricture ; surgery

AIMTo investigate the feasibility of the autologous fascia graft in urethra defect reconstruction.

METHODSIn 24 adult male rabbits, a standardized defect (17 mm) was created within the midportion of each urethra. Two-cm long fascial tube grafts were interposed between the cut ends of the urethra. Twenty-four rabbits were divided into 12 groups. At 0, 3, 10, 15, 21, 30, 45, 60, 90, 120, 150, and 180 days postoperatively, one group was killed. In the first four groups, rabbits were killed and specimens were obtained for histological examination. After 21 postoperative days, in the subsequent eight groups, retrograde urethrograms were carried out to evaluate urethral patency and caliber, then rabbits were killed and specimens were obtained.

RESULTSIn the histological study, advancement of the urethral transitional epithelium along scaffold provided by the fascial graft was determined. At the 30th day, the new urethra was completely covered with the transitional epithelium. Fistula formation was observed in two of 24 rabbits. In urethrograms, narrowing was determined in three of 16 rabbits.

CONCLUSIONFor segmental urethral reconstruction, fascial graft is a good urethral substitute because of its rapid epithelization capacity, low contraction degree and thinness. We therefore propose the use of fascial grafts for reconstruction of male-urethra defects in humans.

Animals ; Disease Models, Animal ; Fascia ; diagnostic imaging ; pathology ; transplantation ; Male ; Pilot Projects ; Rabbits ; Radiography ; Urethra ; diagnostic imaging ; pathology ; surgery ; Urethral Diseases ; pathology ; surgery ; Urologic Surgical Procedures, Male ; methods

OBJECTIVETo investigate the treatment of cystis vesicular seminalis induced by the obstruction of the distal end of the ejaculatory duct.

METHODSFrom November 2005 to December 2006,12 cases of cystis vesicular seminalis ( [2.3 +/- 1.1] cm) were diagnosed by semen analysis (as on the seminal volume, pH and fructose), transrectal palpation and ultrasonography. All cases were treated by transurethral incision or resection of the obstructive ejaculatory duct till milky semen discharged.

RESULTSThe cysts were significantly reduced ([1.0 +/- 0.8] cm, P < 0.05) in all the 12 cases and no complications were observed during the follow-up 1, 3 and 12 months later.

CONCLUSIONTransurethral electrotomy is a simple and effective method for the treatment of cystis vesicular seminalis induced by the obstruction of the ejaculatory duct.

Adult ; Cysts ; etiology ; surgery ; Ejaculatory Ducts ; pathology ; Follow-Up Studies ; Genital Diseases, Male ; complications ; pathology ; Humans ; Male ; Seminal Vesicles ; pathology ; surgery ; Urethra ; surgery

OBJECTIVETo assess the radioactive damage induced by interstitial 125I seed implantation to the rabbit urethra.

METHODSWe implanted 24 rabbits with 125I seeds 1.0 cm to the urethra at the radiation dose of 14.8 MBq (Group A), 29.6 MBq (Group B) and 44.4 MBq (Group C), while a non-radioactive seed was implanted near the urethra of the controls (Group D). Four weeks later, we detected the radiation-induced pathological and morphological changes in the urethra by H&E, light microscopy and electron microscopy.

RESULTSFour weeks after the implantation, no obvious histopathological and ultrastructural changes were observed in the urethral tissues of the experimental rabbits as compared with the control group. The scores on the radioactive damages to the urethra obtained by light microscopy were (2.20 +/- 0.18), (2.23 +/- 0.15), (2.27 +/- 0.10) and (2.10 +/- 0.17) respectively in Group A, B, C and D, with no significant differences between the first three groups and the control (P > 0.05). And the scores on the FlaMeng semi- quantitative analysis of mitochondria in the experimental groups were (1.23 +/- 0.13), (1.34 +/- 0.25) and (1.41 +/- 0.30) respectively, not significantly different from (1.12 +/- 0.13) the control (P > 0. 05).

CONCLUSIONThe radioactive damage induced by 125I seeds to the urethra increases with the enhanced radiation dose. Intraoperative implantation of 125I seeds at the prescription dose has no obvious adverse effect on the rabbit urethra.

Animals ; Dose-Response Relationship, Radiation ; Iodine Radioisotopes ; adverse effects ; Male ; Microscopy, Electron ; Rabbits ; Radiation Injuries, Experimental ; etiology ; pathology ; Urethra ; pathology ; radiation effects ; ultrastructure

MUCP (Maximal urethral closure pressure) is known to be increased in patients with vaginal wall prolapse due to the mechanical obstruction of the urethra. However, urethral function following reduction has not yet been completely elucidated. Predicting postoperative urethral function may provide patients with important, additional information prior to surgery. Thus, this study was performed to evaluate the relationship between MUCP and functional urethral length (FUL) according to stage and age in anterior vaginal wall prolapse patients. 139 patients diagnosed with anterior vaginal wall prolapse at Yonsei University Medical College (YUMC) from March 1999 to May 2003 who had underwent urethral pressure profilometry following reduction were included in this study. The stage of pelvic organ prolapse (POP) was determined according to the dependent portion of the anterior vaginal wall (Aa, Ba). (By International Continence Society's POP Quantification system) Patients were divided into one of four age groups: patients in their 40s (n=13), 50s (n=53), 60s (n=54), and 70 and over (n=16). No difference in MUCP was found between the age groups. The FUL of patients in their 40s was shorter than that of patient's in their 50s and 60s. Patients were also divided into stages: stage II (n=35), stage III (n=76), and stage IV (n=25). No significant difference in MUCP was found according to stage and FUL. However, a significant difference was noted between stage III and IV as stage IV was longer. Anterior vaginal wall prolapse is known to affect urethral function due to prolapse itself, but according to our study, prolapse itself did not alter urethral function. This suggests that, regardless of age and stage, prolapse corrective surgery does not affect the urethral function.
Adult ; Age Factors ; Aged ; Female ; Humans ; Middle Aged ; Postoperative Complications ; Pressure ; Urethra/*anatomy & histology/*physiology ; Urinary Incontinence, Stress/etiology/physiopathology ; Uterine Prolapse/pathology/*physiopathology/*surgery