Is there a urodynamic equivalence to anterior urethra in the male?

World Journal of Urology, 2019

Purpose Urethroplasty is the most effective treatment method for anterior urethral strictures, which constitute an important health concern for males. This study aims to investigate factors that may predict treatment failure following urethroplasty for anterior urethral strictures and evaluate outcomes of different urethroplasty techniques. Methods This retrospective study utilized univariate and multivariate analyses to identify factors affecting treatment success following different urethroplasty techniques performed by a single surgeon on male patients with anterior urethral strictures. Surgical outcomes of different urethroplasty techniques were evaluated individually. Results Urethroplasty procedures performed on 244 patients with a mean age of 54 years and a mean stricture length of 4.7 cm produced a success rate of 79.1%. Multivariate analyses identified stricture length and number of previous internal urethrotomy procedures as factors predicting urethroplasty success (HR 1.265, 95% CI 1.129-1.416, p < 0.001 and HR 1.188, 95% CI 1.038-1.361, p = 0.013, respectively). The eight surgical techniques used by the surgeon produced success rates that varied between 50% and 86.2%. Conclusion Urethroplasty can offer satisfactory outcomes for anterior urethral strictures. Accordingly, a longer stricture length and greater number of previous internal urethrotomy procedures were associated with greater risk for urethroplasty failure. Moreover, urethroplasty techniques must be selected based on multifactorial evaluation and performed at experienced centers.

Medical & Biological Engineering & Computing, 1989

Neurourology and Urodynamics, 1987

Canine experiments were conducted in order to determine potential sources of error in measurement of total and static urethral pressures during urodynamic studies. Transmural urethral cannulas were inserted at various urethral sites, downstream and upstream of an elastic constriction, and attempts were made to study 1) the effect of increasing rates of urethral perfusion, 2) the differences in static and total urethral pressures at a urethral site, and 3) the differences between the static pressures recorded through the transmural cannulas and the intraurethral catheter. More than 300 pressure measurements were made in 14 dogs (both male and female). The results suggested that 1) static pressure increases with increasing rates of infusion, 2) when constrictions are applied in the midurethra, the increase of pressure is greater in the proximal (upstream) than the distal (downstream) urethral segments, 3) the total urethral pressures were (4 to 10%) higher than the static pressures, and 4) although statistically not significant, the static pressures recorded through the urethral catheter were lower than those recorded through the extraluminal transmural cannula.

Aims: The aim of this study was to investigate the anatomical origins and clinical signi¢cance of cough pressure transmission ratio (CTR) by using virtual-operation (VO) techniques. Methods: Thirty-four patients underwent perineal ultrasound examination, standard urethral pressure cough testing both with and without unilateral midurethral anchoring (VO), all tests being performed without urethral elevation. In eight patients where there was no change in CTR, a one-sided fold of suburethral vagina (VO) was taken (pinch test) and the CTR repeated. Results: After midurethral anchoring, maximal urethral pressure increased from a mean of 33.25 cm H 2 O to a mean of 58.06 cm H 2 O (P < 0.0001) and restoration of anatomy was noted in all 11 patients who had obvious funneling on straining. Conversion of a <100% CTR to >100% CTR in the proximal urethra was observed in 14 of 22 patients (P < 0.005), with no signi¢cant change noted in the distal urethra. Further conversion of CTR was noted in six of the remaining eight patients with unilateral plication of suburethral vagina (pinch test). Conclusions: A musculoelastic closure mechanism most likely activates urethral closure. CTR is most likely an index of changed intraurethral area, not necessarily closure, and may be a more sensitive objective test than perineal ultrasound for diagnosing urethral narrowing, especially when used with virtual-operation techniques. Neurourol. Urodynam. 22: 1911 97,

Neurourology and Urodynamics, 1991

Pressurciflow studies were performed in 28 men with benign prostatic hypertrophy. Twcnty-three of the men were also studied postoperatively. Urethral function during micturition was quantified by the urethral pressureiflow relation, pder = p,,,, + L,, Qm, where pdr, is detrusor pressure, p, , is minimal opcning prcssure, Q is flow rate, and m and L, are parameters. Using this method to quantify urethral function, three urodynamically different types of obstruction can he defined. In the first of these, pm0 is elevated corresponding to Schafer's compressive obstruction. The second is a constrictive type of ohstruction in which m ? 413 and L, is elevated and the third is a low-compliant type of obstruction in which m 5 I and L,,, is elevated. The two latter types of obstruction may be combined with a compressive obstruction.

International Journal of Endorsing Health Science Research

Background: Male urethral stricture has remained the major problem in urologic practice. Patients presenting with urethral stricture disease are commonly managed by dilatation, DVIU, and urethroplasty. Methodology: This is a descriptive study of male patients who underwent anterior urethroplasty at our setup from 5th August 2021 to 25th February 2022. We analyzed the age, duration, type, length, and location of the stricture and the surgical treatment outcome after urethroplasty. The post-operative catheter was removed after 3 weeks, and UFM is advised. Qmax (max flow rate) &gt; 15 ml/sec was measured on UFM (uroflowmetry) on the 1st week, 6 weeks, and followed on 3 months. Final outcome in terms of success was assessed by uroflowmetry. A maximum urine flow greater than 15mL/s after 3 months’ treatment assessed by uroflowmetry was considered as success. Results: In our study, the blood loss in group A and group B patients, those patients who had DVIU or dilation in the past, had mor...

Neurourology and Urodynamics, 2018

Background and Objectives: The pathophysiology of female stress urinary incontinence (SUI) is far from unraveled. Capturing all aspects of this bothersome condition in one theory remains challenging. The well-known Hammock and Integral theories, both from the early 90's, were successful in explaining a large proportion of the observations made in clinical practice. Nevertheless, some (pre)clinical observations cannot be explained by the current understanding. One of the issues concerns the pressure transmission. Is this process really a passive mechanical action, or is an additional active mechanism responsible for urethral closure? The finding that an increase in urethral pressure sometimes precedes and exceeds the increase in intravesical pressure suggests the latter. This concept has never been incorporated in one of the existing theories describing SUI. This is remarkable as a lot of evidence has been generated in recent years that proves involvement of active components. This review aims to provide an additional theory in which an active reflex closure mechanism of the urethra is incorporated. Methods: Recent as well as older publications from clinical and animal studies are included to support the hypothesis. Results: The smooth muscles of the urethra, the vascular bed, and the estrogeninfluenced urethral mucosa, combined with striated muscle tone, contribute to the intra-urethral pressure. A passive transmission of force to the urethra exists only in the abdominal proximal third of the urethra. In the distal two thirds of the urethra an active closure mechanism is present, dependent on sufficient urethral support in the proper anatomical position. This active closure mechanism is generated by reflex contraction of striated muscles of the urethra and the pelvic floor. Conclusion: Continence is a result of passive as well as active urethral closure mechanisms. The most important factor in female continence seems to be the proper functioning of an active reflex urethral closing mechanism.

Urology, 2005

Objectives. To evaluate the etiology and characteristics of symptomatic anterior urethral strictures in a large series of men presenting for urologic treatment in an effort to determine the common themes that may influence possible prevention or treatment strategies. Many questions about the origin and features of contemporary anterior urethral stricture disease remain unanswered. Methods. The records of 175 men with symptomatic anterior urethral strictures were reviewed. Data were entered both prospectively by careful patient questioning and retrospectively from detailed chart review. The stricture length, location, and cause were recorded from urologic presentation, before definitive treatment. Posterior strictures from pelvic fracture urethral disruption defects were excluded from this review. Results. A total of 194 strictures were identified in 175 men. Most strictures were idiopathic (65 of 194, 34%) or iatrogenic (63 of 194, 32%); fewer were inflammatory (38 of 194, 20%) or traumatic (28 of 194, 14%). Most involved the bulbar urethra (n ϭ 100, 52%). Pendulous strictures (mean 6.1 cm) were longer on average than those in the fossa navicularis (mean 2.6 cm) or bulb (mean 3.1 cm). Prolonged catheterization (n ϭ 26) and transurethral surgery (n ϭ 25) were common causes of iatrogenic strictures.

The Journal of urology, 1985

A physical phenomenon known as elastic jump occurs downstream of an elastic constriction applied to a collapsible tube. This flow anomaly is analogous to the hydraulic jump that occurs in surface flows. Some investigators have predicted that an elastic jump could occur in the male urethra (during voiding) in the cavernous segment between constrictions at the membranous and meatal regions. To identify and understand this flow anomaly, and to obtain clinical correlations in human male subjects we have attempted several radiological and urodynamic studies in normal and abnormal subjects. The studies were retrograde urethrography, voiding cystourethrography, static pressure recordings during voiding and uroflowmetry. Retrograde urethrography was believed to delineate accurately the anatomy of the bulbous urethra. Voiding cystourethrography showed the geometry of the functional bulb. Our observations in 43 male subjects suggest that the site and degree of elastic jump depend on the sever...

Neurourology and Urodynamics, 1995

The aim of' the study was to determine the contribution of intra-abdominal pressure transmission to urinary continence in the leniale. Five patients with genuine str (GSI) were studied. Pressure transinission was measured in equivalent pos outside the urethra and bladder during thc Intravaginal Slingplasty procedure. a surgical operation used lor treatinent ol. urinary incontinence. and pcrlorincd under I c ~a l anaesthesia. A 6 iiiin diameter channel was created alongside the urethra. Two separate niicrotransduccr catheters appropriately marked for length were inserted. one inside the urethra, and the other inside the described channel. With the vaginal hammock intact. an average of 10 simultaneous pressure nieasurements were made intraoperatively in response to coughing and \training in equivalent positions inside the urethra. and directly outside. Significantly higher pressure readings were lound inside the urethra ( P = 0.0()2.5), indicating that an active component within the urethra may have created this pressure rise. After opening out two suburethral vaginal llaps. large quantities crt urine were iost o n coughing in all patients Continence was achieved o n tightening the suburethral vagina. indicating that an adequately tight vaginal hammock is a critical element in the continence process. The findings of this study question intraahdominal pressure as a niechanisin contributing to continence, hut support an alternative mechanism, inusculovaginal closure of the urethra.