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Designing for Lower Torso and Leg Anatomy
Published in Karen L. LaBat, Karen S. Ryan, Human Body, 2019
Normal urination occurs when the pelvic diaphragm muscles and the internal urethral sphincter relax, followed by voluntary contraction of the bladder wall muscle. Bladder emptying is prompt with a strong continuous flow (Lukacz et al., 2011, p. 1029). Urine flows from the bladder through the urethra and past the external urethral sphincter to exit the body. A full bladder normally triggers the urge to void. Bladder irritants can also create an urge to empty—including: (a) concentrated urine, (b) some foods and spices, (c) medications, or (d) a bladder infection. Fear or anxiety can also trigger an urge to urinate. When the bladder wall muscle contracts in response to any stimulation, the sphincters normally relax to allow bladder emptying. However, the urinary sphincters, as well as the pelvic diaphragm, can be voluntarily activated to help constrict the urethra to try to stop urine flow.
Robotic-assisted surgery for the treatment of urologic cancers: recent advances
Published in Expert Review of Medical Devices, 2020
Ugo Falagario, Alessandro Veccia, Samuel Weprin, Emanuel V. Albuquerque, William C. Nahas, Giuseppe Carrieri, Vito Pansadoro, Lance J. Hampton, Francesco Porpiglia, Riccardo Autorino
Among the newer technologies developed in recent years, 3D reconstruction of MRI imaging is one of the most promising to allow accurate surgical planning and intraoperative navigation. Robotic surgery offers the unique opportunity to integrate 3D virtual renderings and real-time images from the endoscopic camera in the robotic console (Figure 6). Porpiglia et al. described the first clinical experience with a novel software for augmented-reality robot-assisted radical prostatectomy [45]. Preoperatively, prostate gland, urethra, urethral sphincter, neurovascular bundles (NVBs), and index lesion were segmented on MRI images in order to obtain a 3D reconstruction of the prostate and the surrounding structures. The virtual image of the prostate was then superimposed onto the endoscopic view using the TilePro®. The authors considered prostate deformation due to grasping and traction forces of the robotic arm during the intervention and an elastic 3D model was built allowing better registration of the images. The surgeon performed 20 RARP using 3D elastic-augmented reality models and 20 RARP using only 2D images from MRI. The rate of partial nerve-sparing was 17/20 in the 3D group compared to only 7/20 in the 2D group. Interestingly, this increase in nerve-sparing technique was not associated with an increase in positive surgical margins (p = 0.73). Even though these results should only be considered preliminary, there is an increasing interest in this new-generation of image-guided surgery [46].