Relationship between the shape of passive urethral resistance relation and prostatic histology in patients with benign prostatic hyperplasia

We assessed the relationship between the type of passive urethral resistance relation (PURR) and prostatic histology in 28 patients with benign prostatic hyperplasia (BPH), who underwent transurethral resection of the prostate. PURR was classified into three types according to pressure-flow plots, and resected specimens were analyzed by quantitative morphometry. Patient age, prostatic volume and the area densities of each histological component did not show significant differences among the three groups. However, there was a trend to correlation between prostates with a high glandular component and urethral compliance. Further studies of larger populations are needed to validate this assumption.     

汉族青年女性口唇形态与面型的相关性研究

目的:测量汉族青年女性唇部软组织正常值,探讨唇部软组织正常值间相关性以及与面型的关系。方法:选择2012~2013级在校女学生(共70名,年龄18~19岁;均为汉族),采用面部软组织直接测量口唇各部高度均值、口列宽度均值、正面三庭均值、面宽均值、形态面高和容貌面高均值、内眦距离均值。结果:面部软组织直接测量获得口唇各部高度均值(唇高:3.45±0.608、上唇高:1.95±0.317、上白唇高:1.29±0.326、上红唇高:0.67±0.201、下唇高:1.55±0.349、下白唇高:0.79±0.336、下红唇高:0.77±0.199、上下红唇高:1.48±0.297)cm、口列宽度均值(4.37±0.341)cm、正面三庭均值(上庭:5.92±0.770、中庭:5.75±0.427、下庭6.07±0.607)cm、面宽均值(14.40±1.174)cm、形态面高(11.85±1.144)cm和容貌面高(18.59±1.234)cm均值、内眦距离均值(3.32±0.339)cm。结论:1建立青年女性口唇形态测量相关指标的正常参考值;2口裂宽与内眦距离(P=0.005)、上唇高(P=0.000)、唇高(P=0.007)有正相关(P0.01),唇形态改变的趋势是越厚越宽,越窄越薄;3上唇高(P=0.043)、下唇高(P=0.004)和唇高(P=0.011)与上庭有正相关;4唇高与唇各部高度(除下红唇高无相关)均呈正相关,且与上唇高和下唇高相关性显著(P=0.000);上唇高与唇各部高度(除下白唇高无相关)均呈正相关,且与上红唇高、上下红唇高、上白唇高及唇高相关性显著(P=0.000),而与下红唇高有相关性(P=0.002),且上红唇高对上唇高影响较上白唇高影响大;下唇高与下白唇高(P=0.000)、唇高(P=0.000)相关性显著,颏唇沟位置对下唇高度影响大;上红唇高与上下红唇高相关性显著(P=0.000);(P0.01);5唇各部高度和宽度与容貌面高、形态面高和面宽无相关性(P0.05)。6以上唇形态正常参考值及相关性对整形外科提供形态学基础。     

Observations on the function of the female urethra: I: relation between maximum urethral closure pressure at rest and urethral hypermobility

AIMS: To study the relation between maximum urethral closure pressure at rest and urethral hypermobility in female patients. PATIENTS AND METHODS: We selected 255 patients aged 20 years and older, with a stable bladder on multichannel urodynamics, without known neurological pathology, and without a history of pelvic or anti-incontinence surgery. A resting urethral pressure profile and the degree of urethral hypermobility were registered. Two-tailed analyses of variance (ANOVA) with Fisher's post-hoc tests were used to detect any statistically significant difference (P < 0.05) in urethral closure pressure between groups with varying degrees of urethral hypermobility. RESULTS: Mean age was 45.6 +/- 12.7 (range 20-77) years. Mean maximum urethral closure pressure for the entire group was 62.7 +/- 29 (range 10-150) cm of water. A statistically significant inverse relationship was found between age and maximum urethral closure pressure (r = 0.489, P < 0.0001) when both analyzed as continuous variables, and with age categorized in 10-year increments (P < 0.0001). When comparing mean urethral closure pressure in each group examined for urethral hypermobility, a statistically significant difference was noted when grades I, II, and III were compared to grade 0 hypermobility. No significant difference was observed when grades I, II, and III were compared to each other. Even if statistically non-significant, there exists an inverse relationship between the degree of urethral hypermobility and the maximum urethral closure pressure: a higher hypermobility is associated with a lesser urethral closure pressure. CONCLUSIONS: Urethral closure pressure falls significantly when urethral hypermobility is present. This decrease is not related to patient's age or parity. Our observations demonstrate an inverse relation between urethral closure pressure and the degree of cysto-urethrocele. As hypermobility increases, closure pressure decreases, even if this decrease does not reach the level of statistical significance.     

Observations on the function of the female urethra: III: An overview with special reference to the relation between urethral hypermobility and urethral incompetence

AIMS: To analyze the relation between urethral hypermobility and urethral incompetence, and to summarize the interdependence between maximum urethral closure pressure (MUCP), urethral hypermobility, and urethral incompetence. PATIENTS AND METHODS: A group of 255 patients was selected from a large bank of cases. Inclusion criteria were age 20 years or above, no neurological disease, stable bladder, and no previous incontinence surgery or hysterectomy. The degree of hypermobility (cysto-urethrocele) and the degree of urethral incompetence (abdominal leak point pressure (ALPP)) were determined. Statistical analyses between urethral hypermobility and incompetence were performed with Spearman's correlation and the Jonckherre-Terpstra test. RESULTS: The Spearman's rank correlation test showed a statistically significant relation between urethral hypermobility and the degree of urethral incompetence (P = 0.0049). CONCLUSIONS: The statistically significant relation between urethral incompetence and hypermobility suggests that urethral incompetence will increase as the degree of urethral hypermobility does. Optimal conditions for urinary continence include a high maximum urethral closure pressure, absence of hypermobility, and a low degree of urethral incompetence. This last factor is assured by a strong support underneath the urethra permitting compression of the latter during straining. Failure of the urethral closure mechanism is highly probable with a diminished maximum closure pressure accompanied by urethral hypermobility often associated with a high degree of urethral incompetence. Clinically significant urinary incontinence may appear in many intermediate circumstances between these two extreme states, but stress urinary incontinence is essentially an activity-related phenomenon.     

Prostate shape, external striated urethral sphincter and radical prostatectomy: the apical dissection

In an anatomical study of 64 gross specimens the external striated urethral sphincter was reconfirmed to extend as a single unit from the proximal penile urethra to the bladder base. The configuration of the external striated urethral sphincter was variable and was related to the shape of the apical prostate. Two basic prostatic shapes were recognized, distinguished by the presence or absence of an anterior apical notch. Whether a notch existed depended upon the degree of lateral lobe development and the position of its anterior commissure. In radical prostatectomy knowledge of the variation in the shape of the prostatic apex can help the surgeon to achieve optimal urethral transection with maximal preservation of the external striated urethral sphincter and other tissues of the continence mechanism.     

Treatment of female incontinence secondary to urethral damage or loss

Damage to the urethra may be functional or anatomic. In the former, to some extent, the urethra functions merely as a tube. Anatomic damage ranges from small urethrovaginal fistulas to total loss of the urethra, vesical neck, and trigone. For functional damage, the goal is compression of the proximal urethra, and the author favors a pubovaginal fascial sling, which is described. In the author's view, the best results in anatomic loss are obtained by performing an appropriate anti-incontinence procedure at the time of urethral reconstruction.     

Pressure/flow studies in elderly men without voiding problems: Estimation of the urethral pressure/flow relation and urethral elasticity

The flow in the urethra is controlled by an elastic constriction, the flow-controlling zone. The distensibility of this zone is described by the pressure/area relation, which gives the static pressure as a function of the cross-sectional area at the flow-controlling zone. The pressure/area relation can be calculated from the pressure/flow relation, which is estimated from the pressure/flow plot obtained at a urodynamic examination. In this study the urethral pressure/flow and pressure/area relations were estimated for 21 randomly selected men (62–75 years old) without voiding problems. Nineteen of 21 persons in this group had pressure/flow relations with a low slope. This corresponds to a low slope in the pressure/area relation indicating high distensibility of the flow-controlling zone, which for 18 persons was estimated to be distended to areas larger than 10 mm² during micturition. Twenty persons had a minimal urethral opening pressure below 55 cm H₂O. The estimated pressure/area relation was linear in 59% of the micturitions, indicating that the flow-controlling zone could have been distended to a larger cross-sectional area, if the bladder had achieved a higher pressure. The 10th–90th percentiles for maximum flow and detrusor pressure at maximum flow were 7.2–24.3 ml/s and 24–76 cm H₂O, respectively. Four persons had low flow and low pressure, indicating diminished detrusor contractility with age. Twenty-four percent of the persons had unstable bladder contractions with a pressure rise < 15cm H₂O and 19% with a pressure rise < 15cm H₂O.     

手术治疗复杂尿道狭窄的技术探讨(附光盘)

尿道狭窄的疗效近年显著提高。对于前尿道狭窄,目前临床上应用口腔黏膜尿道成形术疗效满意,被公认为治疗前尿道狭窄的金标准。但对于长段前尿道狭窄,口腔黏膜移植物选取较长,手术颇为复杂。对于后尿道狭窄(或闭锁)的治疗,狭窄段切除端端吻合术是标准术式,但对于复杂的后尿道狭窄,由于狭窄段长、局部瘢痕较多、术野位置深、局部解剖层次不清而增加手术难度。本文重点阐述相关技术的注意事项和技术要点。     

骨盆骨折尿道损伤后狭窄患者阴茎勃起功能障碍相关性因素的临床研究

目的 研究男性骨盆骨折尿道损伤导致的尿道狭窄与阴茎勃起功能障碍(ED)的相关因素.方法对41例骨盆骨折尿道损伤导致尿道狭窄患者进行IIEF-5量表调查,所有患者接受血管活性药物注射下阴茎血流彩超(PPUD)等检测,并进行统计学分析.结果 所有41例患者在受伤后均发生了ED,所有患者受伤前后的IIEF-5评分差异有统计学意义,P＜0.001.不同年龄段患者受伤前后IIEF-5评分比较,P≤0.001;而不同年龄段患者受伤后IIEF-5评分组间比较,P＞0.05.不同部位损伤患者受伤前后IIEF-5评分比较,P＜ 0.001;而不同部位损伤患者受伤后的IIEF-5评分组间比较,P＞0.05.尿道狭窄段长度不同的患者组间比较,差异具有统计学意义;狭窄段较长的患者比狭窄段较短的患者,发生ED概率更高.根据患者PPUD检查结果,约一半患者的ED属于动脉性,部分患者属于静脉性,其他的可能原因为神经性,心理性,混合性或者原因不明.结论 骨盆骨折尿道损伤导致尿道狭窄可使患者勃起功能明显受损,其勃起功能与尿道狭窄长度密切相关,与年龄,尿道狭窄部位等相关性不强.     

女性尿道内口开放与压力性尿失禁的相关性研究

目的探讨盆底超声检查尿道内口开放与女性压力性尿失禁（SUI）的相关性。 方法以2018年9月至2019年9月在中山三院门诊行经会阴实时三维盆底超声检查的女性为研究对象，其中SUI患者190例，无SUI者742例。观察静息及强力闭呼动作（Valsalva动作）时有无尿道内口开放；对于有尿道内口开放的病例，测量开放的宽度、面积、周长、开放角度、开放长度以及开放长度/尿道长度比值等指标，并分析其与压力性尿失禁的相关性。 结果静息状态下，SUI组及对照组均无尿道内口开放。最大Valsalva动作时，SUI组尿道内口开放的比例明显高于对照组（P<0.05），尿道内口开放的宽度、面积、周长、开放角度、开放长度以及开放长度/尿道长度比值均大于对照组（P<0.05）。回归分析显示，尿道内口开放角度与SUI有相关性（OR=1.017，95%CI：1.003~1.031）。 结论尿道内口开放与SUI有关，其中内口开放的角度与SUI发病相关。     

Comparison of passive urethral resistance relation and urethral resistance factor in analysis of bladder outlet obstruction in patients with benign prostatic enlargement

Analysis of the pressure/flow relation renders objective and detailed information on bladder outlet obstruction. The benefit of pressure/flow analysis for clinical and fundamental research questions, however, cannot be acknowledged without comparison of the different methods that exist. We compared one parameter analysis (URA) with two parameter (PURR) analysis in 99 consecutive patients with benign prostatic enlargement. The normal (instantaneous intrapatient) variability of both the PURR parameter Pvoid_min (minimal pressure during voiding) and the URA is ≈ 10–15 cm H₂O. Within these limits agreement between the two methods of analysis in the quantification of (minimal) outlet obstruction was observed in about 50% of the cases. However, when Qmax is less than 6 ml/s (in 49.5% of the patients) the URA number exceeds the value Pvoid_min in 96% of the cases. Predominantly this is caused by the fact that in the majority of these cases the type of bladder outlet obstruction is more constrictive than the URA curve, based on P_det at Q_max indicated. In patients with a low flow rate and/or a constrictive type of obstruction, the Pvoid_min resulting from PURR analysis indicates a lower minimal pressure during voiding compared to URA. © 1996 Wiley-Liss, Inc.     

Aging and overactive bladder may be associated with loss of urethral sensation in women

AIMS: To compare current perception thresholds (CPT) in the urethra and bladder of women with idiopathic overactive bladder to asymptomatic controls. METHODS: Women with > or =1 urge urinary incontinence (UUI) episode per week on 7-day diary, seeking treatment for UUI underwent CPT testing using a Neurometer(R) CPT device (Neurotron, Inc., Baltimore, MD). Testing was done in the urethra and bladder at three frequencies 2,000, 250, and 5 Hz corresponding to A-beta, A-delta, and C fibers, respectively. CPT values from the women with UUI were compared to CPT values from a group of control women without lower urinary tract symptoms. RESULTS: Forty-eight controls without lower urinary tract symptoms and 13 women with UUI were included in the analysis. Women with UUI were significantly older (mean +/- SD age 62 +/- 14 and 44 +/- 15, P < 0.0005) and more likely to be vaginally parous (P = 0.007) than control women. Urethral CPT at 2,000, 250, and 5 Hz were significantly higher in women with UUI than controls, while bladder CPT were not different between groups. Using logistic regression, to control for age and parity, urethral CPT at 5 Hz remained significantly higher in women with UUI than controls (P = 0.013). CONCLUSION: Urethral sensation is significantly higher in older women, suggesting sensory neuropathy in the lower urinary tract increases with age and may contribute to the increase in overactive bladder seen with aging. These data reinforce the role of the urethra in lower urinary tract function.