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At least 451 records · Page 25Linked to original sources
PubMed1997

Female bladder exstrophy.

Bladder exstrophy is one of the most challenging congenital urinary tract abnormalities. Apart from the open bladder the patient also has various other abnormalities, including urogenital, musculoskeletal and anorectal defects. The size of the exstrophic bladder varies from patient to patient. In the female the clitoris to bifid and the vagina is anteriorly placed. In this paper various aspects of female bladder exstrophy are reviewed in detail, including incidence, etiology, anatomy and clinical features, together with early, medium-term and long-term surgical management. The aim is to achieve a functional bladder closure, although some patients are better off with a urinary diversion. Considering the complexity of the urogenital problems and the surgical management thereof, all patients require lifelong follow-up.

Abnormalities, Multiple↗
PubMed1991

Identification of nonclassical 21-hydroxylase deficiency in girls with precocious pubarche.

Recent studies have described mild adrenal enzymatic defects in patients presenting with precocious pubarche. In order to identify these defects we have evaluated basal and ACTH- (25 IU iv) stimulated serum adrenal steroid levels in 19 girls, 2- to 8.3-year-old, with precocius pubarche (pubic hair Tanner II-III). Two patients had clitorial enlargement. Bone age was moderatly advanced in 10 patients and 2 to 3.7 yr in four others. Four patients had high basal serum levels of 17-hydroxyprogesterone (17OHP) (525 + 202 ng/dl, mean +SD), compatible with the diagnosis of nonclassical congenital adrenal hyperplasia due to 21-hydroxylase deficiency (NCCAH-21OH), which was confirmed by an increased response of 17OHP to ACTH (3425 +/- 953 ng/dl). Fifteen patients had moderately elevated basal 17OHP levels (56 + 38 ng/dl) but a normal 170HP response (191 +/- 71 ng/dl) to ACTH, compatible with the diagnosis of idiopathic precocious pubarche (IPP). The cortisol response to ACTH was normal in both groups. Basal values of DHEA-S were 651 +/- 256 and 506 + 462 ng/ml and of DHEA 380 +/- 24 ng/dl and 205 +/- 102 ng/dl, in NCCAH-210H and IPP, respectively. We conclude that: i) clinical findings and baseline levels of DHEA-S and DHEA in IPP can be indistinguishable from the late onset 21 hydroxylase deficiency; ii) baseline levels of 17OHP are sufficient for the diagnosis of NCCAH-21OH; iii) the ACTH stimulation test is indicated only when baseline levels of 17OHP are moderately elevated (100-300 ng/dl).

17-alpha-Hydroxyprogesterone↗
PubMed2000

The role of the levator ani muscle in evacuation, sexual performance and pelvic floor disorders.

This paper reviews the role of the levator ani muscle (LAM) in evacuation, sexual performance and pelvic floor disorders. The LAM fixes the vesical neck, anorectal junction and vaginal fornices to the side wall of the pelvis by means of the suspensory sling and hiatal ligament. On contraction it shares in the mechanism of evacuation (urination, defecation). During the sexual act vaginal distension by the erect penis evokes the vaginolevator and vaginopuborectalis reflexes, with a resulting LAM contraction. The LAM also contracts upon stimulation of the clitoris or cervix uteri, an action mediated through clitoromotor and cervicomotor reflexes. LAM contraction leads to upper vagina ballooning, which acts as receptacle for semen collection, to uterine elevation and straightening and to elongation and narrowing of the vagina. These actions enhance the sexual response and prepare the uterus and vagina for the reproductive process. During ejaculation LAM contraction facilitates semen ejection. Levator subluxation and sagging leads to levator dysfunction syndrome, which may present as pudendal canal syndrome.

Female↗
PubMed2005

[Implantation of the AMS 800 artificial sphincter system in a woman via a paraurethral access].

The procedure described demonstrates the feasibility of reliable implantation of an artificial sphincter system in female patients via a paraurethral access between the urethral orifice and the clitoris following radical cystectomy with continent, orthotopic urinary diversion and postoperatively developed urinary stress-incontinence. The technique presented avoids the more invasive transperitoneal or transvaginal approaches which jeopardize the neobladder-neck and increase the risk for infections or fistulas.

Female↗
PubMed2004

Small and intermediate conductance Ca(2+)-activated K+ channels confer distinctive patterns of distribution in human tissues and differential cellular localisation in the colon and corpus cavernosum.

The SK/IK family of small and intermediate conductance calcium-activated potassium channels contains four members, SK1, SK2, SK3 and IK1, and is important for the regulation of a variety of neuronal and non-neuronal functions. In this study we have analysed the distribution of these channels in human tissues and their cellular localisation in samples of colon and corpus cavernosum. SK1 mRNA was detected almost exclusively in neuronal tissues. SK2 mRNA distribution was restricted but more widespread than SK1, and was detected in adrenal gland, brain, prostate, bladder, liver and heart. SK3 mRNA was detected in almost every tissue examined. It was highly expressed in brain and in smooth muscle-rich tissues including the clitoris and the corpus cavernosum, and expression in the corpus cavernosum was upregulated up to 5-fold in patients undergoing sex-change operations. IK1 mRNA was present in surface-rich, secretory and inflammatory cell-rich tissues, highest in the trachea, prostate, placenta and salivary glands. In detailed immunohistochemical studies of the colon and the corpus cavernosum, SK1-like immunoreactivity was observed in the enteric neurons. SK3-like immunoreactivity was observed strongly in smooth muscle and vascular endothelium. IK1-like immunoreactivity was mainly observed in inflammatory cells and enteric neurons of the colon, but absent in corpus cavernosum. These distinctive patterns of distribution suggest that these channels are likely to have different biological functions and could be specifically targeted for a number of human diseases, such as irritable bowel syndrome, hypertension and erectile dysfunction.

Adult↗
PubMed2003

The anti-doping hot-line, a means to capture the abuse of doping agents in the Swedish society and a new service function in clinical pharmacology.

With the support of the Swedish National Institute of Health a national information service was started in 1993 aiming to capture the abuse of doping agents in the general public. It was organized as a telephone service, called the Anti-Doping Hot-Line, from our department and managed by trained nurses co-operating with clinical pharmacologists. Important information collected about all callers (anonymous) was: date of call, its origin, category of caller, doping experience and main question being asked. Abusers were asked about their age, sex, affiliation, abused drug(s), duration of abuse, habit of administration and adverse reactions (ADRs). Between October 1993 and December 2000 25,835 calls were received with a peak during spring and autumn. Most calls (12,400) came from non-abusers, 60% being males. Callers connected with gyms represented the largest group (30%). Most calls about specific drugs concerned anabolic androgenic steroids (AAS). Other drugs or products included ephedrine, clenbuterol and creatine. The most commonly abused anabolic steroids were testosterone, nandrolone-decanoate, methandienone and stanozolol. The ten most commonly reported ADRs of AAS were aggressiveness (835), depression (829), acne (770), gynecomastia (637), anxiousness (637), potency problems (413), testicular atrophy (404), sleep disorders (328), fluid retention (318) and mood disturbances (302). Female side effects included menstruation disturbances, hair growth in the face, lower voice and enlarged clitoris. During the period 1996-200, totally 4339 persons reported about 10,800 side effects. This figure should be compared with the very low number of ADRs (27) reported by prescribers to the Swedish ADR committee during the same period. Abuse of doping agents appears to be a new public health problem that needs detection, medical care and prevention.

Adolescent↗
PubMed2006

Pre- and postnatal imaging of a girl with a cloacal variant.

We describe the prenatal MR findings in a 29-week fetus with a cloacal variant (urogenital sinus and anterior placed anus) in combination with an enlarged clitoris and urethral duplication and correlate them with postnatal imaging. Fetal MR imaging permits the diagnosis and characterization of cloacal and urogenital sinus malformations in utero. This information may guide pre-, peri- and postnatal management.

Adult↗
PubMed1999

Female genital mutilation: A global bug that should not cross the millennium bridge.

Female genital mutilation (FGM) has been practiced worldwide, clothed under the tradocultural term "circumcision." Indications for its practice include ensuring virginity, securing fertility, securing the economic and social future of daughters, preventing the clitoris from growing long like the penis, and purely as a "tradition." Outlawed only in the United Kingdom, Sweden, and Belgium, no law forbids it in most other countries. Classified into four identified types, the current perpetrators are mainly quacks, but trained medical personnel still connive at and encourage FGM. Early complications include hemorrhage, urinary tract infection, septicemia, and tetanus. Late complications include infertility, apareunia, clitoral neuromas, and vesicovaginal fistula. Reasons for the ritual persisting include fear that legislation would force it underground and it will be performed in unsterile conditions, belief that it is racist to speak out against FGM, "tolerance" by health professionals, continued use of the term "female circumcision," lack of awareness of the culture of immigrants by the physicians in areas where FGM is not culturally practiced, and sporadic or uncommitted eradication efforts. We believe there is no reason for the continued practice of FGM. It should incur global abolition, the same way slave trade or Victorian chastity belts have done. We advocate that in medical communications the term "female genital mutilation" be used in place of "female circumcision." World leaders should include unacceptable cultural practices such as FGM in the "world summit" agenda. The year 1999 should be declared the year for global eradication of FGM.

Circumcision, Female↗
PubMed2005

Phosphodiesterase inhibitors in female sexual dysfunction.

Based on the increasing knowledge on both the physiology of penile erection and the pathophysiology of erectile dysfunction, selective phosphodiesterase (PDE) inhibitors have been successfully introduced in the oral treatment of male erectile dysfunction. Because of their central role in smooth muscle tone regulation, PDEs remain an attractive target for drug development in urology. Since the distribution and functional significance of PDE isoenzymes vary in different tissues, selective inhibitors of the isoenzymes have the potential to exert at least partially specific effects on the target tissue. Currently, PDE inhibitors are under investigation with potential uses in urinary stone disease, overactive bladder and the so-called benign prostatic syndrome. The convincing clinical data on the use of the orally active PDE5 inhibitors sildenafil (VIAGRA), vardenafil (LEVITRA) and tadalafil (CIALIS) in the treatment of erectile dysfunction are accompanied by boosting research activities on intracellular signal transduction and PDE characterisation in female genital tissues with the aid of immunohistochemistry and immunocytochemistry and molecular biology. The expression of various PDE isoforms in the human clitoris, vagina and labia minora was shown by means of immunohistochemistry and RT-PCR analyses and it was concluded from functional studies that an increase in cGMP or cAMP might be involved in the regulation of female genital blood flow and the control of genital non-vascular smooth muscle. As a consequence, the efficacy and safety of the PDE5 inhibitor sildenafil in the treatment of symptoms of female sexual dysfunction (FSD), including female sexual arousal disorders (FSAD), have been evaluated. Although the experiences from these early clinical studies have so far not been conclusive, they suggest that, after appropriate evaluation of patients, inhibition of PDE5 might be of benefit for selected individuals with FSAD. Such research efforts will possibly allow the identification of efficacious and diagnostic tools for erectile dysfunction and of even more selective drugs in its therapy.

Female↗
PubMed2005

Lifetime changes in the vulva and vagina.

The morphology and physiology of the vulva and vagina change over a lifetime. The most salient changes are linked to puberty, the menstrual cycle, pregnancy, and menopause. The cutaneous epithelia of the mons pubis, labia, and clitoris originate from the embryonic ectoderm and exhibit a keratinized, stratified structure similar to the skin at other sites. The mucosa of the vulvar vestibule, which originates from the embryonic endoderm, is non-keratinized. The vagina, derived from the embryonic mesoderm, is responsive to estrogen cycling. At birth, the vulva and vagina exhibit the effects of residual maternal estrogens. During puberty, the vulva and vagina acquire mature characteristics in a sequential fashion in response to adrenal and gonadal maturation. A trend to earlier pubertal onset has been observed in Western developed countries. In women of reproductive age, the vaginal mucosa responds to steroid hormone cycling, exhibiting maximal thickness and intracellular glycogen content at mid-cycle. Vulvar skin thickness remains unchanged but menstrual cycle-associated changes in ortho- and parakeratosis occur at the cytological level. The vulva and vagina further adapt to the needs of pregnancy and delivery. After menopause, tissue atrophy ensues. Post-menopausal changes in skin barrier function, skin hydration, and irritant susceptibility have been observed on exposed skin but not on the vulva. Nevertheless, older women with incontinence are at increased risk for developing incontinence dermatitis. A combination of factors, such as tissue atrophy, slower dissipation of excess skin hydration, shear forces associated with limited mobility, and lower tissue regeneration capacity increase the risk of morbidity from incontinence dermatitis in older women.

Aging↗
PubMed1999

Vulvar carcinoma: a retrospective analysis of 80 patients.

We evaluated the files of 80 women who were treated for vulvar carcinoma. In 13 women radiotherapy was used as primary treatment, in 45 cases postoperatively and in 22 women because of local recurrence. Patients older than 60 years had a significantly worse 5-year survival rate (39%) than younger women (57%) (p = 0.02). The 5-year survival rate for patients with negative nodes was 72% versus 46% for the N1- and 47% for the N2-status, respectively (p = 0.027). The 5-year actuarial survival rate for patients with tumor manifestation in the clitoris was 77.9% versus 26.1% for patients with tumors in the labia majora (p = 0.0044). There was no difference in survival in patients who had been treated with radical vulvectomy and bilateral groin dissection plus local radiotherapy when compared with patients who had been irradiated (whole pelvis) after tumor resection alone. The 5-year survival rates and the median survival time were identical in both groups (61%/62 months).

Adenocarcinoma↗
PubMed2006

Enhancement of the bulbocavernosus reflex during intraoperative neurophysiological monitoring through the use of double train stimulation: a pilot study.

OBJECTIVE: Electrophysiological bulbocavernosus reflex (BCR) testing, during surgeries in which the constituent neural components are at risk, might supplement other low sacral (S2-4) stimulation/recording techniques. However, intraoperative BCR is not always reliably implemented. We proposed to analyze BCR signals in five surgical patients monitored with the novel application of double train stimulation (DTS) to determine if the potential could be enhanced. METHODS: We prospectively planned a regime of DTS BCR with a series of intertrain delays in five monitored patients at risk for low sacral neural injury. Patients were maintained with propofol, opiate infusion, and low inhalant anesthesia without muscle relaxant. Cutaneous sensory nerves of the penis (or clitoris) were stimulated using two consecutive pulse trains (DTS). Intertrain delays were 75, 100, 125, 150, 175, 200, and 250 ms. For BCR recording, uncoated paired wires were inserted into the external anal sphincter (EAS) bilaterally. For each trial, waveform amplitude, duration, and turn count measures for the first (single train) and second (double train) response were recorded. Percent increase/decrease of the second train response compared to the first train response was calculated. RESULTS: There was at least a 30% increase in measures of amplitude, turn count, and duration of the second train response in 22/28, 22/28, and 14/28 of the total trials respectively. There was an insufficient number of independent observations to determine statistical significance. CONCLUSIONS: Intraoperative BCR is currently obtained with some difficulty using pulse train stimulation. Our preliminary evidence has identified BCR waveform enhancement using DTS and suggests that the reliability of intraoperative BCR acquisition may be further improved by the addition of this technique. Our data are insufficient to define the best intertrain interval.

Adult↗
PubMed2004

Female sexual dysfunction following vaginal surgery: myth or reality?

This article reviews the mechanisms by which vaginal surgery affects female sexual function and related pathophysiology to potential causes. The anatomy, neurovascular supply of the clitoris and introitus, and intrapelvic nerve supply are discussed as they apply to vaginal surgery. Methods to avoid neurovascular damage during pelvic floor surgery have been corroborated by supporting literature. The incidence of female sexual dysfunction after various transvaginal procedures for indications such as stress urinary incontinence and pelvic organ prolapse, anterior/posterior colporrhaphy, perineoplasty, and vaginal vault prolapse has been discussed. Current literature regarding female sexual dysfunction following other procedures such as vaginal hysterectomy, Martius flap interposition, and vesicovaginal and rectovaginal fistula repair also are reviewed.

Female↗
PubMed1976

Pure gonadal dysgenesis with an XY chromosomal constitution (Swyer's syndrome): Report of two cases.

Two cases of Swyer's syndrome, characterized by rudimentary streaks in association with a 46,XY chromosome karyotype are reported. Both individuals were tall, with sparse axillary and pubic hair, and breasts were undeveloped in one and well developed in the other (she had some estrogen therapy). One had infantile but otherwise normal external genitals, while the other had poor development of labia majora and no clitoris. The vagina in each was normal, with a small cervix and uterus, and vaginal smears of the preadolescent type. Urinary 17-ketosteroids were normal, while gonadotropin levels were elevated. The gonadal streaks were extirpated, and histologic examination revealed the presence of fibrous stroma but no ova or follicles. Scattered clumps of Leydig cells and mesonephris remnants were found in one patient. Both patients responded well to cyclic hormonal therapy, i.e., menstrual withdrawal bleeding and breast development.

Adolescent↗
PubMed1976

Virilizing adrenocortical adenoma studied by selective adrenal venography.

A 15-year-old girl with primary amenorrhea, hirsutism, and enlargement of the clitoris was found to have an increased titer of the urinary neutral 17-ketosteroids which failed to decrease after the administration of dexamethasone and an adrenal tumor was demonstrable on venography. Analysis of the adrenal venous effluent revealed gradients on the side of the tumor for testosterone, androstenedione, estradiol, and dehydroepiandrosterone sulfate. Following removal of the tumor, the hirsutism improved markedly, the menses returned, and sexual maturation progressed.

Adenoma↗
PubMed1988

Combination of surgical excision and carbon dioxide laser vaporization for multifocal vulvar intraepithelial neoplasia.

Ten patients with multifocal grade 3 vulvar intraepithelial neoplasia were treated by a combination of surgical excision and carbon dioxide laser vaporization of selected areas. The lesions treated by the laser were either on the clitoris or distal to the vulva. These areas could be functionally and anatomically deformed if surgically excised. Combining the carbon dioxide laser with surgery, however, resulted in a satisfactory cosmetic outcome and provided an adequate specimen for histopathologic diagnosis.

Adult↗
PubMed1995

The squirrel monkey: an animal model of pelvic relaxation.

OBJECTIVE: Casual observations of pelvic prolapse have previously been made in adult female squirrel monkeys. We objectively observed and described the pelvic findings of the adult females in our colony to evaluate their potential as an animal model for studies of pelvic relaxation. STUDY DESIGN: Subsets of a group of 28 adult female squirrel monkeys were examined on three separate occasions and photographed to document perineal findings. Four areas of loss of support in the vagina were described, including the urethra, anterior segment, cervix, and posterior segment. The degree of loss of support at each specific site was documented. Also, three measurements were obtained from each animal, including the distance from the base of the clitoris to the posterior edge of the perineal body and the length and width of the introitus. The length of the perineal body was calculated. RESULTS: Fifty percent of the animals had at least one site of pelvic prolapse at rest or on straining. With straining 50% had urethral prolapse, 21% had anterior segment prolapse, and 11% had posterior segment prolapse. None of the animals had evidence of cervical prolapse. Of the animals with findings of pelvic relaxation, 43% had combined prolapse at two or more sites. Of the measurements obtained, only the width of the introitus was significantly different between the group of normal animals and those found to have pelvic prolapse (p < 0.0005). CONCLUSION: On the basis of observations of our colony of squirrel monkeys, a significant number of animals demonstrated findings of pelvic support loss with defects similar to those observed in humans. Although limitations to some techniques of evaluation and surgical intervention exist, the squirrel monkey is an animal model that may provide new opportunities for basic investigation of the pathophysiologic features and the management of pelvic relaxation.

Animals↗
PubMed1995

Motoneurons innervating guinea pig perineal muscles are sexually dimorphic in size but not number.

Sexual differentiation occurs prenatally in guinea pigs but extends into the postnatal period in rats. Steroids affect the development of two motoneuron nuclei of the rat lumbar spinal cord that innervate sexually dimorphic perineal muscles. The spinal nucleus of the bulbocavernosus (SNB) innervates the bulbocavernosus (BC) and levator ani (LA) muscles while the dorsolateral nucleus (DLN) innervates the ischiocavernosus (IC). In male rats, perinatal testosterone prevents degeneration of these muscles and results in a sex difference in both motoneuron size and number in adulthood. For comparative purposes, we examined the guinea pig motoneurons innervating these muscles, as well as those innervating the retractor penis (RP) and retractor clitoris (RC), muscles that have no counterpart in rats. Injections of horseradish peroxidase localized the BC/LA and IC motoneurons of guinea pigs to discrete columns in spinal levels L6 and S1, with the BC/LA motoneurons occupying a more medial position. The RP/RC motoneurons were found in L5. Motoneuronal soma area was larger in males in all examined motor pools, as was nuclear area of BC/LA and IC motoneurons. Although raw counts suggested a sex difference in cell number in the motor columns containing BC/LA and IC motoneurons, either of two different correction procedures for split nuclei error eliminated the sex difference in cell number, emphasizing the importance of such corrections when comparing neurons of different size.

Analysis of Variance↗