Urethra and Penis
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
The female urethra is around 2-3 cm long, extending from the bladder neck to the external urethral meatus. Continence is maintained by the external striated urethral sphincter, which in women extends for almost the whole length of the urethra. There is extra support from the surrounding pelvic floor musculature. In contrast to men, the female bladder neck has little role in the maintenance of continence. Abnormalities of the female urethra include:prolapse;stricture;Fowler’s syndrome (dysfunction of the striated urethral sphincter);diverticulum;caruncle;papillomata acuminata;
Complications of Urethral Stricture Surgery
Kevin R. Loughlin in Complications of Urologic Surgery and Practice, 2007
Surgery for urethral stricture can be accomplished, in most cases, with minimal morbidity and complication. The most common complication of surgery for urethral stricture is recurrence of stricture. One must certainly also consider the potential complications of hematoma and/or infection. As many of these surgeries require tissue transfer, donor site issues must be considered. In many cases, surgery for urethral stricture can be accomplished with the patient in a supine or frog-leg/split-leg supine position. However, much of the surgery also requires lithotomy position. The distribution of complications with regard to the lithotomy position varies in accordance with the degree of lithotomy. These issues along with others will comprise the body of this Chapter.
Miscellaneous conditions affecting the genitalia
Shiv Shanker Pareek in The Pictorial Atlas of Common Genito-Urinary Medicine, 2018
Epispadias (Fig. 24.5.1) is a very rare congenital defect of the urethral meatus position that occurs in males and females, although it is more frequent in males. In males the urethra generally opens on the dorsal (upper) surface of the penis, on the side of the penis, or occasionally over the entire length of the penis rather than the tip. In females the urethral opening may be in the belly area with the urethra split along its length dorsally.
Dynamic magnetic resonance imaging of the behavior of the mid-urethra in healthy and stress incontinent women
Published in Acta Obstetricia et Gynecologica Scandinavica, 2010
Kirsi Marja Rinne, Sakari Kainulainen, Sinikka Aukee, Seppo Heinonen, Carl Gustaf Nilsson
Objectives. Support of the mid-urethra is thought to be an essential element of urinary continence in the female. Our aim was to image the behavior of the mid-urethra in healthy volunteers and in stress urinary incontinence (SUI) patients by dynamic magnetic resonance imaging (MRI). Design. Prospective study. Setting. Gynecology outpatient clinic association with Department of Radiology in University Hospital of Kuopio, Finland. Sample and methods. Fifteen healthy volunteers and 40 SUI women underwent dynamic MRI at rest, during pelvic floor muscle contraction, coughing and voiding with a bladder volume of 200 ml. Our aim was to determine the precise location and movement of the mid-urethra during these activities. Main outcome measure. The co-ordinate location and movement of the mid-urethra. Results. Continent volunteers can elevate their mid-urethra significantly higher than incontinent women. Moreover, the mid-urethra of incontinent women rotated significantly more dorsocaudally during straining and coughing than in continent women. Conclusions. Elevation of the mid-urethra was more marked in continent compared to urinary incontinent women on pelvic floor muscle contraction suggesting sufficient support of the urethra. Downward movement of the mid-urethra was more significant in stress incontinent women than in continent volunteers.
Prospective study of transitional cell carcinoma in the prostatic urethra and prostate in the cystoprostatectomy specimen
Published in Scandinavian Journal of Urology and Nephrology, 2007
Fredrik Liedberg, Harald Anderson, Mats Bläckberg, Gunilla Chebil, Thomas Davidsson, Sigurdur Gudjonsson, Staffan Jahnson, Hans Olsson, Wiking Månsson
Objectives. To prospectively evaluate the incidence of transitional cell carcinoma (TCC) in the prostatic urethra and prostate in the cystoprostatectomy specimen, investigate characteristics of bladder tumours in relation to the risk of involvement of the prostatic urethra and prostate and examine the sensitivity of preoperative loop biopsies from the prostatic urethra. Material and methods. Preoperatively, patients were investigated with cold cup biopsies from the bladder and transurethral loop biopsies from the bladder neck to the verumontanum. The prostate and bladder neck were submitted to sagittal whole-mount pathological analysis. Results. The incidence of TCC in the prostatic urethra and prostate in the cystoprostatectomy specimen was 29% (50/175 patients). Age, previous bacillus Calmette–Guérin treatment, carcinoma in situ (Cis) in the cold cup mapping biopsies and tumour grade were not associated with the risk of TCC in the prostatic urethra/prostate. Cis, multifocal Cis (≥2 locations) and tumour location in the trigone were significantly more common in cystectomy specimens with TCC in the prostatic urethra and prostate: 21/50 (42%) vs 32/125 (26%), p=0.045; 20/50 (40%) vs 27/125 (22%), p=0.023; and 20/50 (40%) vs 26/125 (21%), p=0.01, respectively. Preoperative resectional biopsies from the prostatic urethra in the 154 patients analysed identified 31/47 (66%) of patients with TCC in the prostatic urethra/prostate, with a specificity of 89%. The detection of stromal-invasive and non-stromal involvement was similar: 66% and 65%, respectively. Conclusions. The incidence of TCC in the prostatic urethra and prostate was 29% (50/175) in the cystoprostatectomy specimen. Preoperative biopsies from the prostatic urethra identified 66% of patients with such tumour growth. Our findings suggest that preoperative cold cup mapping biopsies of the bladder for detection of Cis add little extra information with regard to the risk of TCC in the prostatic urethra and prostate.
MECHANISM OF EJECTION DURING EJACULATION: IDENTIFICATION OF A URETHROCAVERNOSUS REFLEX
Published in Archives of Andrology, 2000
The ejaculatory mechanism involves 2 reflexes: the "glans-vasal", which seems to bring the semen to the posterior urethra (emission phase of ejaculation), and the "urethromuscular" which ejects it to the exterior (ejection phase). This study investigated the mechanism of bulbocavernosus muscle (BCM) contraction, once the seminal fluid reaches the bulbous urethra. The study included 14 healthy male volunteers (mean age 37 +/- 10.2 SD years). To test the response of the BCM to urethral distension, a 10F balloon-tipped catheter was introduced into the prostatic urethra and filled with saline in increments of 0.25 mL; a needle electrode recorded the response. The balloon was then withdrawn to lie in the membranous, bulbous, and pendulous urethra and the test was repeated at each site. The latency of the muscle response was calculated. The BCM response to each of the anesthetized bulbous urethra and anesthetized BCM was recorded. Distension of the prostatic, membraneous, or pendulous urethra effected no BCM EMG response. Bulbous urethral distension with 0.25 mL of saline also produced no muscle response, whereas distension with 0.5 mL and up to 1.5 mL caused increased EMG activity of the BCM. The muscle response augmented with the increase of the distending volume. The mean latency was 10 +/- 1.3 ms and showed no significant change (p >. 05) with the different distending volumes. Neither the anesthetized bulbous urethra nor the anesthetized BCM responded to bulbous urethral distension. The BCM contraction upon distension of the bulbous urethra is probably reflex and mediated through the urethrocavernosus reflex. Small-volume distension did not effect BCM contraction. The latter presumably propels the semen from the posterior to the pendulous urethra. It is suggested that the urethrocavernosus reflex be included in current andrologic investigations for patients with ejaculatory disorders.
Related Knowledge Centers
- Ejaculation
- Urinary System
- Kidney
- Semen
- Anatomy
- Urine
- Urinary Bladder