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Embryology, Anatomy, and Physiology of the Prostate
Published in Karl H. Pang, Nadir I. Osman, James W.F. Catto, Christopher R. Chapple, Basic Urological Sciences, 2021
External sphincterInnervated by the perineal nerve—a branch of pudendal nerve (S2-4).Male − surrounds the membranous urethra.FemaleDistal end of the bladder neck.Three parts: sphincter urethrae, urethrovaginal muscle, and compressor urethrae.Contraction causes vaginal contraction simultaneously.
Surgical Emergencies
Published in Anthony FT Brown, Michael D Cadogan, Emergency Medicine, 2020
Anthony FT Brown, Michael D Cadogan
This may occur to the membranous or bulbous urethra. Membranous urethra: associated with difficulty voiding urine and urethral bleeding, which mimics extraperitoneal rupture of the bladderrectal examination reveals a high-riding prostate, often with an underlying boggy haematoma.Bulbous urethra: caused by a straddle injury (falling astride an object)results in local perineal bruising, pain and meatal bleeding.
Catheter management
Published in Alexander Trevatt, Richard Boulton, Daren Francis, Nishanthan Mahesan, Take Charge! General Surgery and Urology, 2020
Tom Bracewell, Thomas Maggs, David Manson-Bahr, Sarah Y. W. Tang
Next the bulbar urethra (4) is encountered, which becomes the membranous urethra (3). The membranous urethra is the shortest part of the urethra and is found between the bulb of urethra and apex of the prostate. Finally the catheter enters the prostatic urethra (1), before entering into the bladder.
Advances in stem cell therapy for male stress urinary incontinence
Published in Expert Opinion on Biological Therapy, 2019
Fabrizio Gallo, Gaetano Ninotta, Maurizio Schenone, Pierluigi Cortese, Claudio Giberti
Very few studies are reported in literature using ASCs for the treatment of SUI in human patients (Table 2) [70–78]. Even fewer papers have been published concerning male SUI [71–73,77,78]. The first experience with stem cell therapy was reported by Mitterberger et al. in 2007 in 119 women. One year after the injection of myoblasts and fibroblasts, ultrasound evaluation showed an increase of thickness of the rhabdosphincter and an improvement of its contractility at the urodynamic test [70]. Based on this data, the same group treated, using the same technique, 63 male patients with SUI after radical prostatectomy. A significant postoperative improvement of incontinence and quality of life scores as well as thickness and contractility of the rhabdosphincter with no severe side effects were reassessed at one year of follow up. In particular, 41 patients (65%) were continent and 17 (27%) showed improvement while 5 (8%) did not show any improvement. Preoperative strictures, scars and fibrotic areas in the membranous urethra, prior injection of bulking agents or internal urethrotomy as well as radiation therapy negatively influenced the success rates. These data strongly supported the experimental findings that the ultrasound-guided injection of MDSCs leads to regeneration of the urethral submucosa and the rhabdosphincter and not only to passive obstruction on the lower urinary tract [71].
The measurement of membranous urethral length using transperineal ultrasound prior to radical prostatectomy
Published in Scandinavian Journal of Urology, 2018
Sean F. Mungovan, Henk B. Luiting, Petra L. Graham, Jaspreet S. Sandhu, Oguz Akin, Lewis Chan, Manish I. Patel
Transperineal ultrasound (TPUS) is a well-established non-invasive imaging modality used in outpatient urological clinical practice [4–6], including for the assessment of male pelvic floor muscle function [5–8]. TPUS has the potential to visualise the three anatomical landmarks required for MUL measurement: i) the apex of the prostate, ii) the membranous urethra and iii) the point of entry of the membranous urethra into the penile bulb (BU) [9, 10]. While the quality of an ultrasound examination is operator dependent and can be affected by patient habitus, scanning procedures such as TPUS that allow for different patient positions can be advantageous for image optimisation and subsequent analysis. The clinical application of TPUS to reliably measure MUL and determine the level of agreement with MRI measurements of MUL in different supine positions has not been investigated. We undertook a prospective method comparison and reliability study to determine: i) the agreement between MRI and TPUS measurements of MUL in two supine positions, ii) the test-retest reliability of TPUS measurements over two separate days and iii) the agreement between the TPUS measurements of MUL in two positions in male patients prior to RP.
Safety and efficacy of male urethral slings for management of persistent stress urinary incontinence after holmium laser enucleation of the prostate
Published in Baylor University Medical Center Proceedings, 2020
Colin Kleinguetl, Shohaib Virani, Erin T. Bird, Marawan M. El Tayeb
At our facility, the MUS was a transobturator AdVance® male sling. We used a midline perineal approach and dissected the bulbo-spongiosus muscle off of the bulbar urethra. Dissection was carried both anteriorly and posteriorly to allow for necessary mobilization. A transobturator needle was then used to slide under the superior media aspect of the pubic symphysis to place the mesh in an appropriate position. A cystoscopy was performed to ensure that the urethra and bladder were not injured and to show coaptation of the membranous urethra, and a 14 French Foley catheter was used to ensure that this was not done to excess.