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Indian Journal of Plastic Surgery :... Apr 2022A penile prosthesis can be successfully implanted after phalloplasty in transgender men to permit sexual intercourse. A prosthesis can be categorized as malleable or... (Review)
Review
A penile prosthesis can be successfully implanted after phalloplasty in transgender men to permit sexual intercourse. A prosthesis can be categorized as malleable or inflatable. The most common penile prosthesis implanted after masculinizing genital surgery is the inflatable prosthesis but this can be a challenging operation with high complication rates. Penile prosthesis in transgender patients differs from cis-patients in many respects but one critical difference is the absence of the tough, protective tunica of the corporal body to contain the prosthesis. This causes greater mobility of the prosthesis under the skin and increases the risk of migration and erosion of the device through the skin. In addition, to overcome the absence of a corpora cavernosa, the proximal portion of the prosthesis must be anchored to bone. Complications include injury to the urethra, vascular injury, skin breakdown, infection, device migration, device failure, extrusion, and erosion. There is no robust data on the use of penile prosthesis in transgender men with only multiple reports of small numbers of patients. While successful implantation can improve patients' quality of life, surgeons should counsel patients about the relatively high risk of the need for revision surgery.
PubMed: 36017401
DOI: 10.1055/s-0041-1740523 -
International Journal of Surgery Case... Aug 2021Primary tumors of the female urethra are exceedingly rare and account for <0.02% of the malignant disease occurring in women. This disease usually presents late and,...
INTRODUCTION
Primary tumors of the female urethra are exceedingly rare and account for <0.02% of the malignant disease occurring in women. This disease usually presents late and, hence, has a poor outcome. Early diagnosis is necessary to prevent further metastasis and prevent urinary catheter-dependant. Tumors arising from the distal urethra tend to be early stage and cure rates are high, however lack of knowledge about this disease is notorious, the transmission of knowledge is made only by case reports.
CASE PRESENTATION
A 76-years-old woman presented with the chief complaint of lower pelvic pain. The complaintas also accompanied by a burning sensation in the urethra and stranguria, urinary retention, and hematuria. Macroscopic observation revealed the lesion was whitish with vegetative aspect at the urethral meatus, involving the entire urethra. The fragile mass was palpable in distal urethra and external meatus urethra per vaginally and easily bleedings. Laboratory examination of blood chemistry results within normal limit. Urinalysis showed pyuria and hematuria. Urethrocystoscopy findings were whitish lesion with vegetative aspect also fragile mass along the urethra, abnormal bladder neck, and bladder mucous was hyperemis. The histopathological result showed metaplasia squamous cell carcinoma, clear cell carcinoma. She is planned on getting cystouretherectomy (anterior exenteration) later.
CLINICAL DISCUSSION
The female urethral carcinoma is a disease with low prevalence with urothelial carcinoma (transitional cell) is the most common histological type (Leão et al., 2016; Adolfsson et al., 2012). Symptoms of urethral carcinoma are varied. The carcinoma spreads initially by local invasion into the periurethral tissue, vagina, and vulva and proximally spread to the bladder neck (Leão et al., 2016; Mittal et al., 2020). Distant metastasis is uncommon (Mittal et al., 2020). The most suitable method for collecting material for biopsy is the urethrocystoscopy. MRI is commonly used for staging. For post-surgical staging, the best investigation is the excretory urography (Gourtsoyianni et al., 2011; Picozzi et al., 2012). The management in vogue are surgical such as tumor excision, radical nephro-ureterectomy or anterior pelvic exenteration with radiotherapy or chemotherapy complementary. This cancer is associated with poor outcomes. Therefore, prognostic factors are important to be known.
CONCLUSION
Although female urethral carcinoma is a rare disease entity, clinicians should have strong suspicion of malignancies in patients to make an exact diagnosis. Early radical surgery can achieve better outcomes, although the standard therapy remains controversial.
PubMed: 34311342
DOI: 10.1016/j.ijscr.2021.106100 -
TheScientificWorldJournal Jun 2010Knowledge of penile embryology and anatomy is essential to any pediatric urologist in order to fully understand and treat congenital anomalies. Sex differentiation of... (Review)
Review
Knowledge of penile embryology and anatomy is essential to any pediatric urologist in order to fully understand and treat congenital anomalies. Sex differentiation of the external genitalia occurs between the 7th and 17th weeks of gestation. The Y chromosome initiates male differentiation through the SRY gene, which triggers testicular development. Under the influence of androgens produced by the testes, external genitalia then develop into the penis and scrotum. Dorsal nerves supply penile skin sensation and lie within Buck's fascia. These nerves are notably absent at the 12 o'clock position. Perineal nerves supply skin sensation to the ventral shaft skin and frenulum. Cavernosal nerves lie within the corpora cavernosa and are responsible for sexual function. Paired cavernosal, dorsal, and bulbourethral arteries have extensive anastomotic connections. During erection, the cavernosal artery causes engorgement of the cavernosa, while the deep dorsal artery leads to glans enlargement. The majority of venous drainage occurs through a single, deep dorsal vein into which multiple emissary veins from the corpora and circumflex veins from the spongiosum drain. The corpora cavernosa and spongiosum are all made of spongy erectile tissue. Buck's fascia circumferentially envelops all three structures, splitting into two leaves ventrally at the spongiosum. The male urethra is composed of six parts: bladder neck, prostatic, membranous, bulbous, penile, and fossa navicularis. The urethra receives its blood supply from both proximal and distal directions.
Topics: Humans; Male; Penis
PubMed: 20602076
DOI: 10.1100/tsw.2010.112 -
Anatomical Record (Hoboken, N.J. : 2007) Feb 2019The aim of this study was to characterize the number, type and distribution of immunochemically identified nerves in epithelium and lamina propria of the female rat...
The aim of this study was to characterize the number, type and distribution of immunochemically identified nerves in epithelium and lamina propria of the female rat urethra. Urethras from female Sprague-Dawley rats (n = 12) were fixed, frozen and sectioned (8 μm). Standard immunohistochemical techniques were used to identify putative nerves using the following antibodies: calcitonin gene related peptide (cgrp), neuronal nitric oxide synthase (nNos), tyrosine hydroxylase (TH) and vesicular acetylcholine transporter (vacht). The number, distribution and characteristics of all immunoreactive (IR) structures adjacent to the urethral epithelium and in the lamina propria was assessed. In the bladder, few cgrp-IR and vacht-IR fibers were associated with the urothelium or suburothelium of the lateral wall. In contrast, large numbers of vacht-IR, nNos-IR and cgrp-IR fibers were found close to the epithelium and subepithelium of the bladder neck and throughout the urethra. The number of cgrp-IR fibers was significantly higher in the urethra in comparison with the bladder neck. A population of undescribed cgrp-IR cells associated with the bladder neck and proximal urethra has been characterized. Each of these cells appears to be associated with a nerve fiber. In the distal urethra, the number of peptidergic fibers penetrating the epithelium was significantly higher than the rest of the urethra. Clearly, this study has revealed a highly complex and heterogeneous network of putative afferent nerves fibers along the length of the urethra. These structural specializations need to be taken into account when probing the different functions of the urethra. Anat Rec, 302:201-214, 2019. © 2018 Wiley Periodicals, Inc.
Topics: Animals; Antibodies, Monoclonal; Biomarkers; Calcitonin Gene-Related Peptide; Epithelium; Female; Mucous Membrane; Nitric Oxide Synthase Type I; Rats; Rats, Sprague-Dawley; Tyrosine 3-Monooxygenase; Urethra; Vesicular Acetylcholine Transport Proteins
PubMed: 30290399
DOI: 10.1002/ar.23937 -
Differentiation; Research in Biological... 2020Development of the human prepuce was studied over the course of 9-17 weeks of gestation in 30 specimens. Scanning electron microscopy revealed subtle surface features...
Development of the human prepuce was studied over the course of 9-17 weeks of gestation in 30 specimens. Scanning electron microscopy revealed subtle surface features that were associated with preputial development, namely the appearance of epidermal aggregates that appeared to be associated with formation of the preputial fold. Transverse and sagittal sections revealed that the epidermis of the glans is considerably thicker than that of the penile shaft. We described a novel morphogenetic mechanism of formation of the preputial lamina, namely the splitting of the thick epidermis of the glans into the preputial lamina and the epidermis via the intrusion of mesenchyme containing red blood cells and CD31-positive blood vessels. This process begins at 10-11 weeks of gestation in the proximal aspect of the glans and extends distally. The process is likely to be androgen-dependent and mediated via androgen receptors strategically localized to the morphogenetic process, but signaling through estrogen receptor may play a role. Estrogen receptor alpha (ESR1) has a very limited expression in the developing human glans and prepuce, while estrogen receptor beta (ESR2) is expressed more broadly in the developing preputial lamina, epidermis and urethra. Examination of the ontogeny of innervation of the glans penis and prepuce reveals the presence of the dorsal nerve of the penis as early as 9 weeks of gestation. Nerve fibers enter the glans penis proximally and extend distally over several weeks to eventually reach the distal aspect of the glans and prepuce by 14-16 weeks of gestation.
Topics: Humans; Male; Microscopy, Electron, Scanning; Morphogenesis; Penis; Receptors, Androgen; Receptors, Estrogen; Urethra
PubMed: 31654825
DOI: 10.1016/j.diff.2019.10.002 -
Current Urology Reports Feb 2016Urothelial carcinoma is a highly heterogeneous disease that can arise throughout the entire urothelial lining from the renal pelvis to the proximal urethra. Upper tract... (Review)
Review
Urothelial carcinoma is a highly heterogeneous disease that can arise throughout the entire urothelial lining from the renal pelvis to the proximal urethra. Upper tract urothelial carcinoma (UTUC) is rare, and while it shares many similarities with urothelial carcinoma of bladder (UCB), there are also significant differences between UTUC and UCB regarding clinical management and outcomes. No major advances have been made recently in the development of new systemic therapies for urothelial carcinoma, partly due to the lack of understanding of underlying molecular pathogenetic mechanisms. In the past decade, the emergence of next-generation sequencing has greatly enabled genomic characterization of tumor samples. Researchers are currently exploring a personalized approach to augment traditional clinical decision-making based on genetic alterations. In the present review, we summarize current genomic advances in UTUC and discuss the potential implications of these developments for developing prognostic and predictive biomarkers.
Topics: Animals; Epigenesis, Genetic; Gene Expression Regulation, Neoplastic; Humans; Microsatellite Instability; Polymorphism, Single Nucleotide; Prognosis; Urinary Bladder Neoplasms
PubMed: 26757906
DOI: 10.1007/s11934-015-0566-y -
International Urogynecology Journal Dec 2020The objective was to describe the behaviour of the bladder neck and proximal urethra during urine leaking in the cough stress test (CST) in supine and standing positions...
Real-time assessment of the behaviour of the bladder neck and proximal urethra during urine leaking in the cough stress test (CST) in supine and standing positions using transperineal ultrasound.
INTRODUCTION AND HYPOTHESIS
The objective was to describe the behaviour of the bladder neck and proximal urethra during urine leaking in the cough stress test (CST) in supine and standing positions using transperineal ultrasound (TPUS).
METHOD
We carried out prospective data collection and a retrospective data analysis of 102 women with stress urinary incontinence (SUI) who had a positive CST with TPUS in the supine and/or standing position. On TPUS, the behaviour of the bladder neck and proximal urethra was described by the urethral length, urethral funnelling, bladder neck descent (BND), retrovesical angle (RVA) and urethral rotation angle (URA). Differences between the ultrasound findings in the two positions were evaluated.
RESULTS
In the 102 women, the mean age was 48 years and mean BMI was 23.8 kg/m. On TPUS, urine leakage was detected in the supine or standing position in 102 women and in both positions in 81. Between the two positions, significant differences were found in the URA and RVA. In the standing position, the median RVA of 166° was significantly larger than that of 133° in the supine position (p < 0.001), and the median URA of 35° was significantly smaller than that of 64° in the supine position (p < 0.001).
CONCLUSIONS
TPUS in both positions can be used to detect the real-time behaviour of the bladder neck and urethra in the CST. In the standing position, less rotation and more straightening of the bladder neck and proximal urethra occurred during urine leakage.
Topics: Cough; Exercise Test; Female; Humans; Male; Middle Aged; Prospective Studies; Retrospective Studies; Standing Position; Ultrasonography; Urethra; Urinary Bladder; Urinary Incontinence, Stress
PubMed: 32291473
DOI: 10.1007/s00192-020-04273-w -
Ultrasonography (Seoul, Korea) Jan 2022The aim of this study was to explore differences in the bladder neck configuration and segmental urethral mobility during the cough stress test (CST) in the supine and...
PURPOSE
The aim of this study was to explore differences in the bladder neck configuration and segmental urethral mobility during the cough stress test (CST) in the supine and standing positions between women with and without stress urinary incontinence (SUI).
METHODS
This prospective study included 100 control women and 100 incontinent women who had a CST with transperineal ultrasonography. The bladder neck configuration and urethral mobility were described in terms of urethral funneling, bladder neck descent (BND), retrovesical angle (RVA), urethral rotation angle, and urethral mobility at six points along the urethra (vectors 1 to 6). The two groups' ultrasound findings in the two positions were compared.
RESULTS
Valid data were collected from 78 control women and 90 women with SUI. Significant differences were found in age and body mass index between the two groups (P<0.01). Urethral funneling was found in 33 women (36.7%) with SUI and five continent women (6.4%) and altered little in the standing position. In the standing position, the mean RVA significantly increased (160° to 179°, P<0.001) in the SUI group; The mean vector of points 1 to 6 significantly increased in the control group (all P<0.001). The RVA, BND, and vectors 1 to 4 were significantly greater (all P≤0.01) in women with SUI than without, in both positions.
CONCLUSION
Urethral funneling was an intrinsic anatomical characteristic relative to SUI. Weak upper- and mid-urethral support and an unstable connection between the trigone and proximal urethra were the anatomical signs of SUI.
PubMed: 34399041
DOI: 10.14366/usg.21058 -
Journal of Visualized Experiments : JoVE Oct 2022In addition to forming a high-resistance barrier, the urothelium lining the renal pelvis, ureters, bladder, and proximal urethra is hypothesized to sense and transmit...
In addition to forming a high-resistance barrier, the urothelium lining the renal pelvis, ureters, bladder, and proximal urethra is hypothesized to sense and transmit information about its environment to the underlying tissues, promoting voiding function and behavior. Disruption of the urothelial barrier, or its sensory/transducer function, can lead to disease. Studying these complex events is hampered by lack of simple strategies to alter gene and protein expression in the urothelium. Methods are described here that allow investigators to generate large amounts of high-titer adenovirus, which can then be used to transduce rodent urothelium with high efficiency, and in a relatively straightforward manner. Both cDNAs and small interfering RNAs can be expressed using adenoviral transduction, and the impact of transgene expression on urothelial function can be assessed 12 h to several days later. These methods have broad applicability to studies of normal and abnormal urothelial biology using mouse or rat animal models.
Topics: Rats; Mice; Animals; Urothelium; Urinary Bladder; Adenoviridae; Muscle, Smooth; Transgenes
PubMed: 36282713
DOI: 10.3791/64584 -
Differentiation; Research in Biological... 2020The goal of this paper is to explore the ability of the human female urogenital sinus immediately below the bladder (proximal urethra) to undergo prostatic development...
The goal of this paper is to explore the ability of the human female urogenital sinus immediately below the bladder (proximal urethra) to undergo prostatic development in response to dihydrotestosterone (DHT). To establish this idea, xenografts of human fetal female proximal urethra were grown in castrated nude mouse hosts receiving a subcutaneous DHT pellet. To verify the prostatic nature of the resultant glands, DHT-treated human fetal female urethral xenografts were compared with human fetal prostatic xenografts (derived from male specimens) grown in untreated and DHT-treated castrated mouse hosts and human fetal female proximal urethral xenografts grown in untreated castrated hosts. The resultant glands observed in DHT-treated human fetal female proximal urethral xenografts expressed 3 prostate-specific markers, NKX3.1, prostate specific antigen and prostatic acid phosphatase as well as the androgen receptor. Glands induced by DHT exhibited a protein expression profile of additional immunohistochemical markers (seven keratins, RUNX1, ESR2, TP63 and FOXA1) consistent with the unique spatial pattern of these proteins in prostatic ducts. Xenografts of human fetal female proximal urethra grown in DHT-treated hosts also expressed one of the salient features of prostatic development, namely androgen responsiveness. The experimental induction of prostatic differentiation from human fetal female proximal urethra makes possible future in-depth analysis of the molecular pathways directly involved in initiation of human prostatic development and subsequent epithelial differentiation, and more important whether the molecular pathways involved in human prostatic development are similar/identical versus different from that in murine prostatic development.
Topics: Animals; Cell Differentiation; Core Binding Factor Alpha 2 Subunit; Dihydrotestosterone; Estrogen Receptor beta; Fetus; Hepatocyte Nuclear Factor 3-alpha; Homeodomain Proteins; Humans; Male; Mice; Organogenesis; Prostate; Prostate-Specific Antigen; Prostatic Neoplasms; Receptors, Androgen; Transcription Factors; Tumor Suppressor Proteins; Urethra
PubMed: 32861072
DOI: 10.1016/j.diff.2020.06.001