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PubMed1998

Characterization, localization and distribution of alpha1 adrenoceptor subtype in male rabbit urethra.

PURPOSE: The subtype specificity, localization and distribution of urethral alpha1-adrenoceptors were studied in the male rabbit urethra. MATERIALS AND METHODS: The properties of the urethral alpha1-adrenoceptors were investigated using radioligand receptor binding and light microscopic autoradiography with [125I]iodo-2-[b-(4-hydroxyphenyl)-ethylaminomethyl]tetralone (HEAT), and immunohistochemistry with monoclonal anti-alpha smooth muscle actin and anti-alpha sarcomeric actin antibodies. RESULTS: Saturation experiments with [125I]HEAT demonstrated the presence of significant amounts of a single high affinity binding site for alpha1 adrenoceptors in the male rabbit urethra. The pharmacological profile of the alpha1 adrenoceptors in rabbit urethra, determined by inhibition experiments with subtype selective alpha1 adrenoceptor antagonists, was characterized by the following rank order of potency of inhibition constants (Ki values): prazosin < or = WB 4101 < spiperone < 5-methylurapidil < BMY 7378. The pKi values for the rabbit urethra were correlated with the pKi values for rat spleen, submaxillary glands, and vas deferens and for those reported for cloned alpha1d receptors with correlation coefficients of 0.68, 0.929, 0.909, and 0.523, respectively. CONCLUSIONS: The pharmacological characterization demonstrates the predominance of alpha1A or alpha1A + alpha1B adrenoceptor subtype(s) in male rabbit urethral smooth muscle. Furthermore, the autoradiographic and immunohistochemical studies show a heterogeneous distribution of alpha1 adrenoceptors along the longitudinal axis of the urethra, within the smooth muscle fibers, with the receptors being localized more densely in the proximal than in the distal urethra.

Adrenergic alpha-1 Receptor Antagonists↗
PubMed2001

Urethra-sparing cystectomy and orthotopic urinary diversion in women with malignant pelvic tumors.

BACKGROUND: To the authors' knowledge, few data exist regarding the functional and oncologic outcome of pelvic tumors in women with urethra-sparing cystectomy and orthotopic urinary diversion to the urethra. PATIENTS AND METHODS: The combined data of 102 women age 28-79 (mean, 59 yrs) years who underwent a urethra-sparing cystectomy and orthotopic urinary diversion for either primary bladder cancer (96 patients), carcinoma of the uterine cervix (2 patients), carcinoma of the vagina (1 patient), primary fallopian tube carcinoma (1 patient), uterine sarcoma (1 patient), or rectal carcinoma (1 patient) were reviewed. The histology of the 96 primary bladder tumors was 81 transitional cell carcinomas (TCC), 8 adenocarcinomas, 5 squamous cell carcinomas, 1 small cell carcinoma, and 1 unclassified. Follow-up ranged from 1.5-100 months (mean, 26 mos; median, 24 mos). In all patients, the bladder neck and up to 1 cm in length of the adjacent urethra were removed with the bladder. An ileal orthotopic neobladder procedure was performed if staging biopsies of the bladder neck and intraoperative frozen section of the urethral margin revealed no tumor. RESULTS: There was no perioperative mortality, and an early and late complication rate requiring secondary intervention in 5 (5%) and 12 (12%) patients. With 88 of 102 patients alive and 83 of 102 patients disease free, a disease-specific survival of 74% and a disease-free survival of 63% was estimated at 5 years. No pelvic recurrence was seen in 81 patients with TCC. Three pelvic recurrences occurred, two tumors of the inner genitalia and one adenocarcinoma of the bladder, none of them in the area of the urethra or its supplying autonomic nerves. Daytime continence was 82%; nocturnal continence was 72%. Twelve (12%) patients were unable to empty their bladders completely and needed some form of catheterization. CONCLUSIONS: The functional and oncologic outcome of female patients with an orthotopic urinary diversion to a remnant urethra was found to be comparable to that found in large studies on males. An orthotopic neobladder proved to be an oncologically safe option for women with pelvic tumors and was found to provide quality of life when there was adherence to previously defined selection criteria.

Adult↗
PubMed2000

[Versatility of axial penile skin fasciocutaneous flap in reconstruction of pendulous urethra].

PURPOSE: We describe three cases, with different features, of anterior urethral strictures that were treated with the same technique: a circular axial penile fasciocutaneous flap. MATERIAL AND METHODS: We report three cases of patients with urethral strictures that affected the whole glandar and penile urethra. In one case the stricture affected the bulbar urethra. No patient has the preputial skin disposable, because of a previous circumcision, and all has been treated with different techniques. In one patient, a first step urethroplastia was performed previously, open all the penile urethra. All the cases were successfully treated with a circular axial fasciocutaneous penile flap in one stage. In case number one the reconstruction was combined with a scrotal flap. In case number three, the glandar urethra was reconstructed. CONCLUSIONS: The circular axial fasciocutaneous penile flap is a versatile technique that can be use to correct various type of strictures of the whole glandar and penile urethra alone or associated with strictures of the bulbar urethra.

Aged↗
PubMed1999

The flow regimes and the pressure-flow relationship in the canine urethra.

Classical fluid dynamics predicts that the pressure difference Deltap between any two points along a fully developed, viscous flow stream is linearly proportional to the flow rate Q (the Poiseuille relation). However, the passive urethral resistance relationship (PURR) widely used in modern urodynamics describes the pressure difference Deltap between two points along the urethra as linearly proportional to the flow rate squared (Q(2)). It is our hypothesis that this functional dependence may have its origins in the developing flow field within the urethra. That is, rather than being fully developed hydrodynamically, urethral flow is more likely representative of flow within the entry length of a rigid conduit. In our study, we used a canine model of the lower urinary tract to investigate the possibility of entrance effects. Although the most rigorous model of urethral fluid mechanics would include the elastic properties of the urethra into its configuration, the solutions from such a model would be unnecessarily complex and not readily lend themselves to the analysis of clinical data. Therefore, we chose to model the canine urethra at each instant in time as a rigid tube, and characterized its instantaneous flow using viscous flow theory for a rigid tube. All urodynamic analyses were performed on a surgically exposed urinary tract. Solid state pressure transducers were used to measure the intravesical and distal urethral pressures, whereas an ultrasonic flowmeter was used to obtain a simultaneous measure of the urinary flow rate. Detrusor contractions were induced using bilateral electrical stimulation of the pelvic nerves. Varying degrees of outlet obstruction were created using an inflatable sphincter cuff secured around the bladder outlet. The experimental data were evaluated using the well-known laminar entry length model of Atkinson and Goldstein. The peak Reynolds numbers under nonobstructed R(p)(e non-obs) and obstructed R(p)(e obs) outlet conditions ranged between 500 < R(p)(e non-obs) < 1,500 and 300 < R(p)(e obs) < 1,700, respectively. Under non-obstructed outlet conditions, the urethral diameters D and total lengths l(T) ranged between 1.5 mm < D < 2.5 mm and 75 mm < l(T) < 95 mm, respectively, whereas the peak entrance lengths L(p)(e non-obs) ranged between 55 mm < L(p)(e non-obs) < 215 mm. These data suggest that flow in the canine urethra under both non-obstructed and obstructed outlet conditions is typically laminar. The data further support the hypothesis that non-obstructed flows are predominantly entry length in nature. Entry length flows are fluid dynamically described by a quadratic pressure-flow relationship, thus suggesting a physiological basis for Schäfer's quadratic pressure-flow relationship, and therefore, for the PURR. Neurourol. Urodynam. 18:521-541, 1999.

Animals↗
PubMed1991

Human papillomavirus infection of the male diagnosed by Southern-blot hybridization and polymerase chain reaction: comparison between urethra samples and penile biopsy samples.

A group of 108 healthy men aged 18 to 23 years underwent penoscopy after application of acetic acid. In 39 (37%) aceto-white lesions were found and a biopsy was taken. From 105 patients a urethra sample was collected with a brush. The prevalence of HPV-DNA by dot-blot and Southern-blot hybridizations (DBH/SBH) and polymerase chain reaction (PCR) as well as the correlation between results from urethra samples and penile aceto-white epithelium were examined. In urethra, HPV-DNA was detected in four of the 66 patients (6%) with normal epithelium and in three of the 39 (8%) with aceto-white epithelium by using DBH/SBH. By PCR the corresponding findings were eight (12%) and 10 (26%) HPV-DNA-positive patients, respectively. Out of the 39 biopsy samples HPV-DNA was detected in six (15%) by DBH/SBH and in 17 (44%) by PCR. Twenty-two (56%) of the patients with aceto-white lesions were by PCR positive in either the urethra sample or biopsy. All samples positive by DBH/SBH were also positive by PCR except for one biopsy with HPV 35, a type not tested for by PCR. HPV 11 was the most common finding in urethra and HPV 6 and 16 in aceto-white epithelium.

Adolescent↗
PubMed1996

Sling transection of urethra: a rare complication.

Common postoperative complications associated with suburethral sling procedures include voiding disorders and urinary retention, de novo development of detrusor instability, sling graft rejection and, rarely, erosion of the graft into the urethra. The authors present a case of a late postoperative complication of polytetrafluoroethylene graft erosion and partial transection of the urethra, with resultant acute urinary retention. A 50-year-old patient presented with acute urethral outflow obstruction due to sling graft erosion into the urethra nearly 2 years after she underwent a curative sling procedure for recurrent genuine stress incontinence. After relieving the acute urinary retention by inserting a suprapubic catheter under ultrasound guidance, the sling graft was accessed and removed. The urethral defect was repaired successfully. At follow-up 5 months later, the patient was continent subjectively and by urodynamic criteria, with no voiding abnormalities. Although erosion of the sling graft into the urethra and transection of this structure is a rare complication after a sling procedure, it should be considered in the patient who experiences progressive voiding difficulties, has transvaginal urinary leakage, and/or cannot be catheterized transurethrally. Expedient relief of the urinary retention and outflow obstruction is necessary, as well as careful surgical reconstruction of the urethra. To minimize the development of this complication we recommend plication of paraurethral connective tissue in the midline beneath the sling graft, and placement of minimal tension on the sling.

Female↗
PubMed1997

Magnetic resonance imaging of the female pelvic floor and urethra: body coil versus endovaginal coil.

The anatomy of the female pelvic floor and urethra is complex. With the introduction of MRI, the discussion about the normal anatomy of this area has not diminished. The use of a body coil may be contributary to this. In the present study images obtained with an endovaginal coil are compared with those of a quadrature body coil series to study the possible advantage of endovaginal imaging. Axial and radial T2-w TSE images at a 1.0-T machine were obtained in seven healthy volunteers. The pelvic floor structures as well as the levator ani muscle and the urogenital diaphragm are excellently demonstrated with the endovaginal coil. Also, the urethrovaginal sphincter could be recognized in six volunteers, but only in three with the body coil. In six volunteers a new ligamentous structure, the urethropelvic sling, connecting the urethra to the levator ani muscle and contributing to the supporting mechanism of the urethra is shown with the endovaginal coil. The zonal anatomy of the urethra is excellently shown with the endovaginal coil. The urethral length could only be accurately measured with this coil and ranged from 3.1 to 3.6 cm. Compared with the body coil, endovaginal MRI is excellent in demonstrating the anatomy of the pelvic floor and urethra.

Adult↗
PubMed1992

Imaging the urethra in men and women.

This review describes and illustrates the radiologic techniques, normal anatomy, and common congenital and acquired lesions of the urethra in men and women. Voiding cystourethrography and retrograde urethrography are the most common imaging modalities employed in the diagnosis of anatomic lesions of the urethra. The appearance of the urethra may then dictate the need for further functional evaluation with urodynamic studies. Congenital lesions in men include posterior and anterior urethral valves and duplicated urethra. In women, ectopic insertion of the ureter into the urethra is the usual congenital lesion. Acquired urethral lesions include benign prostatic hypertrophy in men and strictures and diverticula in both men and women.

Adult↗
PubMed1994

Differential distribution of nitric oxide synthase in neural pathways to the urogenital organs (urethra, penis, urinary bladder) of the rat.

Axonal tracing techniques were used in combination with histochemical methods (NADPH-diaphorase activity and nitric oxide synthase immunoreactivity) to examine the distribution of nitric oxide synthase (NOS) in the neural pathways to the urogenital organs of the male rat. The major goal of this study was to compare the histochemical properties of the efferent and afferent neurons innervating the urethra with the properties of neurons innervating the penis and bladder. In the major pelvic ganglion (MPG) large percentages of postganglionic neurons innervating the urethra (44%) and the penis (97%) exhibited NADPH-diaphorase (NADPH-d) staining whereas only a small percentage (3.5%) of neurons innervating the bladder were N-d positive. Urethral neurons stained for N-d were on average smaller (33.3 microns diameter) than unstained neurons (54.5 microns diameter). The histochemical difference between the three types of neurons was also reflected in NOS-immunoreactivity (IR); however, the absolute percentage of neurons exhibiting NOS-IR was low: penis (21%), urethra (11%) and bladder (0%). Axonal varicosities staining for N-d or NOS-IR were noted in the MPG in close proximity to unidentified neurons and neurons innervating the urogenital organs. A considerable number of afferent neurons in the lumbosacral dorsal root ganglia (DRG) stained for N-d (64 cells/L6, 35 cells/S1 section); however, only small numbers of neurons (average 1 cell/section) exhibited NOS-IR. N-d activity was detected in a large percentage of urethral (55%) and bladder (80%) afferent neurons in the L6-S1 dorsal root ganglia (DRG) but in relatively few (12%) penile afferent neurons in the L6 ganglia. These results suggest that the contribution of nitric oxide (NO) to neurotransmission varies considerably in different urogenital organs. NO could have a significant role in postganglionic efferent pathways to the urethra and penis but very likely has no role in the efferent pathways to the bladder. Similarly, the prominence of N-d staining in some DRG neurons (e.g. urethra and bladder) but not others (penile) also raises the possibility of a varying role of NO in afferent pathways. However, in these neurons N-d staining was not paralleled by NOS-IR, which was present in only a small percentage of neurons. Thus, N-d staining may not reflect the presence of NO in afferent pathways to the pelvic viscera.

Afferent Pathways↗
PubMed1984

Alpha 1- and alpha 2-adrenoceptors in the smooth muscle of isolated rabbit urinary bladder and urethra.

The present experiment was undertaken to determine the existence of alpha 1- and alpha 2-adrenoceptors in the smooth muscle of the rabbit bladder dome, trigone and proximal urethra. In the dome pretreated with propranolol (10(-6) M), phenylephrine (10(-5) M-10(-3) M) and norepinephrine (10(-7) M-10(-5) M) caused only a small contraction but norepinephrine, only at high concentrations (10(-4) M-10(-3) M), produced a small relaxation. Clonidine, however, had no effect on the dome. In both trigone and urethra, phenylephrine, clonidine and norepinephrine caused dose-dependent contractions. The contractile response to phenylephrine or norepinephrine was significantly greater than that to clonidine in the trigone but no such difference was observed in the urethra. Prazosin (10(-8) M-10(-6) M, alpha 1-adrenoceptor antagonist) produced a rightward shift of the phenylephrine and clonidine dose-response curve in both the trigone and urethra. Yohimbine (10(-8) M-10(-6) M, alpha 2-adrenoceptor antagonist) inhibited the response to clonidine without significantly affecting the responses to phenylephrine. These studies indicated that alpha 1- and alpha 2-adrenoceptors are present in both the trigone and proximal urethra. In the dome, only alpha 1-adrenoceptors are sparsely distributed.

Adrenergic alpha-Agonists↗
PubMed1985

Objective assessment of resistance of female urethra to stress. A scale to establish degree of urethral incompetence.

During urethral pressure profile (UPP) studies under gradually increasing stress, the maximum urethral closure pressure decreases. This observation led to a simple urodynamic test which allows the estimation of the maximum stress (intensity of cough) tolerated by the urethra before leakage begins. The determination of this critical pressure forms the basis of the urethral incompetence scale. The urethra of a female patient can be characterized by the amplitude of this maximum stress (in cm H2O) the urethra can handle and still remain continent. The cough intensity scale has been divided into 5 segments, defining 5 degrees of urethral incompetence. The critical pressure, which determines the degree of urethral incompetence is a constant value for a given patient, provided the bladder volume is kept constant and the position of the patient during the examination is unchanged. This method establishes the functional status of the female urethra as far as its sphincteric capabilities are concerned under different stress conditions. It represents the degree of pressure transmission from the abdominal cavity to the proximal urethra during stress. It evaluates objectively the functional results of different surgical or medical therapeutic modalities to cure genuine stress incontinence. It allows a better selection of patients with unstable bladder and genuine stress incontinence who will more likely benefit from a retropubic cystourethropexy.

Female↗
PubMedDate not supplied

Immuno-electron microscopic study of tyrosine hydroxylase in the cat urinary bladder and proximal urethra.

The distribution and density of tyrosine hydroxylase (TH)-immunoreactive nerves in the cat urinary bladder and proximal urethra were similar to those of glyoxylic acid fluorescent nerves. Both TH-immunoreactive and fluorescent nerve fibres markedly decreased after 6-hydroxydopamine treatment. Hence, immuno-electron histochemistry of TH was employed to investigate adrenergic termination to the muscle layers of the cat urinary bladder and proximal urethra. A total number of 3728 TH-immunoreactive axon terminals in the lower bladder body, lateral bladder base, trigone, bladder neck and proximal urethra were examined. In the bladder base (the lateral bladder base, trigone and bladder neck) and proximal urethra, most of the TH-immunoreactive axon terminals (57.1-89.2%) lay outside smooth muscle cell fascicles, while most (69.7%) in the bladder body were inside muscle cell fascicles. The proportions of TH-immunoreactive axon terminals accompanying non-TH-immunoreactive axon terminals in the five regions were almost the same (about 70%). The present study demonstrated that the mode of adrenergic termination in the bladder base and proximal urethra notably differed from that in the bladder body, and that approximately 70% of adrenergic axon terminals were associated with non-adrenergic or cholinergic axon terminals in each region.

Animals↗
PubMed2004

The effect of tamsulosin on the resting tone and the contractile behaviour of the female urethra: a functional urodynamic study in healthy women.

AIMS: The aim of this functional urodynamic experiment was to study the effect of the selective alpha1(A)-blocker tamsulosin on the urethral pressure in healthy human females and assessed first the resting urethral pressure and second the urethral contractility in response to magnetic stimulation of the sacral roots. METHODS: 11 healthy female subjects gave their written informed consent and were included. A microtip pressure transducer catheter was inserted into the bladder and three baseline urethral pressure profiles were obtained. Another three urethral pressure profiles were recorded while magnetic single pulse stimulation of the sacral roots was performed above the motor threshold of the pelvic floor to evoke reproducible urethral contractions. Then the subjects received 0.4 mg of tamsulosin and the entire protocol was repeated 6 hours after drug administration. Cardiovascular monitoring was obtained during the baseline and follow-up measurements. Mean and maximal urethral pressure values calculated over the entire urethra, mean pressure values calculated over the proximal, middle and distal third of the urethra and the pressure amplitudes to magnetic stimulation at baseline were statistically compared to the follow-up measurements with tamsulosin. RESULTS: The oral administration of tamsulosin did not change the systemic blood pressure, but did significantly reduce the mean and maximal urethral pressure acquired over the entire urethra. When the proximal, middle and distal third of the urethra were analysed separately, there was a significant pressure reduction in all three segments. Amplitudes of the urethral contractions evoked by sacral magnetic stimulation remained unchanged after tamsulosin. CONCLUSIONS: These data show a significant relaxing effect of tamsulosin on the resting urethral tone in healthy females in vivo. These results may suggest tamsulosin as a new pharmacological approach to treat urinary retention due to overactive or non-relaxing urethra in women.

Adrenergic alpha-Antagonists↗
PubMed2006

Turbulent urinary flow in the urethra could be a causal factor for benign prostatic hyperplasia.

Benign prostatic hyperplasia (BPH) is the most common form of prostate disease in middle-aged and elderly men, and leads to severe impairment later in life. Despite its significant impact on public health, the underlying cause of BPH is yet to be determined. This hypothesis proposes a new causal factor for BPH. Applying concepts of dynamics of fluids to the process of urination it could be stated that a turbulent urinary flow through the passage of the urethra. The turbulent urinary flow in the urethra applies pressure and stretch forces to the surrounding tissue. This stimulus repeated over time and coupled with age-related changes of the urethral tissue could contribute to the development of BPH. In support of this hypothesis, several mechanotransduction studies have shown that vibration and pressure forces applied to different cell tissues can provoke cellular and molecular changes. Another supportive data is the presence of the hyperplasic reaction surrounding the urethra specifically located in the transition zone, the only zone where BPH develops. It is crucial to identify causal factors to understanding the disease and to determine effective primary prevention strategies. Future studies of the dynamics of fluids in the urethra are warranted. The finding of significant forces transmitted to the periurethral tissue from a turbulent urinary flow could give us the clue to the underlying cause of BPH. If this hypothesis proves to be valid there are several primary prevention measures that could be implemented to impede the development of BPH. Educational intervention measures in younger populations to avoid frequent urinary retention and active urination (process of forcing the urine through the urethra at a high velocity) could be considered. Studies of the impact of turbulence in the standing vs. sitting position during urination in men should also be considered.

Aged↗
PubMed2003

The axial location of structural regions in the urethra: a magnetic resonance study in nulliparous women.

OBJECTIVE: To define and quantify the appearance and location of distinct regions of the bladder neck and urethra by using axial magnetic resonance images from healthy, continent, nulliparous women. METHODS: Seventy-eight asymptomatic, healthy, nulliparous women (mean age 29.2 +/- 5.4 years) volunteered for this study. All women were proven continent on urodynamic examination. Axial proton density magnetic resonance images of the pelvic floor were analyzed at 5-mm intervals. A geometric origin was established at the internal urethral meatus. The presence or absence of each of six structural regions--the bladder base, bladder neck, striated urethral sphincter, compressor urethrae and urethrovaginal sphincter, perineal membrane, and distal urethra--was then noted in each more distal image. The proportion of women in whom a structural region was seen at each 5-mm interval was recorded. RESULTS: The striated urogenital sphincter was observed at 5-25 mm distal to the bladder base. It was observed 10 and 15 mm below the bladder base in 91% (95% confidence interval [CI] 85%, 98%) and 99% (95% CI 97%, 100%), respectively, of all women. The perineal membrane, marking the distal end of the muscular urethra, was located 20-35 mm distal to the bladder base. The length of the muscular region of the urethra ranged from 20 to 35 mm (mean 24 mm, 95% CI 24, 25 mm). CONCLUSION: Magnetic resonance images allow the normal appearance and location of urethral and bladder neck structures to be quantified in healthy, continent, nulliparous women.

Adult↗
PubMed2006

Interstitial temperature mapping during Prolieve transurethral microwave treatment: imaging reveals thermotherapy temperatures resulting in tissue necrosis and patent prostatic urethra.

OBJECTIVES: Temperature mapping of the prostate during transurethral microwave thermotherapy and imaging of the resultant zones of tissue necrosis have been previously performed using several commercial systems. This study was performed using the Prolieve Thermodilatation System, which simultaneously compresses the prostate with a 46F balloon circulating heated fluid and delivering microwave energy into the prostate. METHODS: Interstitial temperature mapping during Prolieve treatment was performed on 10 patients with benign prostatic hyperplasia using 24 temperature sensors arrayed throughout the prostate. Voiding cystourethrograms were performed on 3 additional patients treated without temperature mapping to document the patency of the prostatic urethra 1 hour after treatment. Gadolinium-enhanced magnetic resonance imaging studies were performed on all patients 1 week after treatment to determine the extent and pattern of tissue necrosis resulting from transurethral microwave thermotherapy. RESULTS: Interstitial temperature mapping found that the heating pattern generated by the Prolieve system created average peak temperatures of 51.8 degrees C an average of 7 mm away from the prostatic urethra. These temperatures were greater near the bladder neck and mid-gland than toward the prostatic apex. Subtherapeutic temperatures were seen adjacent to the urethra, consistent with the viable tissue seen on gadolinium-enhanced magnetic resonance imaging sequences. Magnetic resonance imaging also revealed necrotic zones that were consistent with sustained temperatures greater than 45 degrees C. Voiding cystourethrograms showed widely patent prostatic urethras 1 hour after treatment. CONCLUSIONS: Transurethral microwave thermotherapy with the Prolieve Thermodilatation System produced sustained therapeutic temperatures that resulted in tissue necrosis while maintaining viable tissue surrounding a temporarily dilated prostatic urethra.

Body Temperature↗
PubMed2003

Glycosaminoglycan profile in bladder and urethra of castrated rats treated with estrogen, progestogen, and raloxifene.

OBJECTIVE: This study was undertaken to evaluate the action of conjugated equine estrogens alone, medroxyprogesterone, the combination of these estrogens with progestogens, and of raloxifene on the glycosaminoglycan profile in the bladder and urethra of adult oophorectomized rats in comparison with noncastrated rats. STUDY DESIGN: Sixty adult rats, of which 50 were submitted to bilateral oophorectomy, were studied. After 4 days, the latter were assigned to five groups of 10 animals each. For 30 consecutive days the following treatments were given: group 1, conjugated equine estrogens; group 2, conjugated equine estrogens combined with medroxyprogesterone acetate; group 3, medroxyprogesterone; group 4, raloxifene; and group 5, placebo. Thereafter the bladders and urethras of the animals were removed, processed to yield a dry powder of which the sulfated glycosaminoglycan content was determined by densitometry after agarose gel electrophoresis and that of hyaluronic acid by a fluorimetric assay. RESULTS: Glycosaminoglycans found in the bladder and urethra were dermatan sulfate, heparan sulfate, and hyaluronic acid. In the bladder, hypoestrogenism or replacement with estrogens led to a lower sulfated glycosaminoglycan content. Replacement with estrogens and/or medroxyprogesterone reverted this effect. Hypoestrogenism decreased the dermatan sulfate/heparan sulfate ratio and reduced hyaluronic acid content. Estrogen therapy reverted this alteration and medroxyprogesterone addition annulled the estrogenic effect. In the urethra, castration did not alter hyaluronic acid content and sulfated glycosaminoglycan content, but raloxifene decreased the latter. CONCLUSION: Castrated rats had a decrease in sulfated glycosaminoglycans and hyaluronic acid content in the bladder. Hormonal replacement altered the quantity and quality of glycosaminoglycans. In the urethra, raloxifene reduced sulfated glycosaminoglycans.

Analysis of Variance↗
PubMed1998

Anatomical relationship between urethra and clitoris.

PURPOSE: We investigated the anatomical relationship between the urethra and the surrounding erectile tissue, and reviewed the appropriateness of the current nomenclature used to describe this anatomy. MATERIALS AND METHODS: A detailed dissection was performed on 2 fresh and 8 fixed human female adult cadavers (age range 22 to 88 years). The relationship of the urethra to the surrounding erectile tissue was ascertained in each specimen, and the erectile tissue arrangement was determined and compared to standard anatomical descriptions. Nerves supplying the erectile tissue were carefully preserved and their relationship to the soft tissues and bony pelvis was noted. RESULTS: The female urethra, distal vaginal wall and erectile tissue are packed into the perineum caudal (superficial) to the pubic arch, which is bounded laterally by the ischiopubic rami, and superficially by the labia minora and majora. This complex is not flat against the rami as is commonly depicted but projects from the bony landmarks for 3 to 6 cm. The perineal urethra is embedded in the anterior vaginal wall and is surrounded by erectile tissue in all directions except posteriorly where it relates to the vaginal wall. The bulbs of the vestibule are inappropriately named as they directly relate to the other clitoral components and the urethra. Their association with the vestibule is inconsistent and, thus, we recommend that these structures be renamed the bulbs of the clitoris. CONCLUSIONS: A series of detailed dissections suggest that current anatomical descriptions of female human urethral and genital anatomy are inaccurate.

Adult↗