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Damaser MS, Valentini FA, Clavica F, Giarenis I. Is the time right for a new initiative in mathematical modeling of the lower urinary tract? ICI-RS 2023. Neurourol Urodyn 2024; 43:1303-1310. [PMID: 38149773 DOI: 10.1002/nau.25362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 12/01/2023] [Indexed: 12/28/2023]
Abstract
INTRODUCTION A session at the 2023 International Consultation on Incontinence - Research Society (ICI-RS) held in Bristol, UK, focused on the question: Is the time right for a new initiative in mathematical modeling of the lower urinary tract (LUT)? The LUT is a complex system, comprising various synergetic components (i.e., bladder, urethra, neural control), each with its own dynamic functioning and high interindividual variability. This has led to a variety of different types of models for different purposes, each with advantages and disadvantages. METHODS When addressing the LUT, the modeling approach should be selected and sized according to the specific purpose, the targeted level of detail, and the available computational resources. Four areas were selected as examples to discuss: utility of nomograms in clinical use, value of fluid mechanical modeling, applications of models to simplify urodynamics, and utility of statistical models. RESULTS A brief literature review is provided along with discussion of the merits of different types of models for different applications. Remaining research questions are provided. CONCLUSIONS Inadequacies in current (outdated) models of the LUT as well as recent advances in computing power (e.g., quantum computing) and methods (e.g., artificial intelligence/machine learning), would dictate that the answer is an emphatic "Yes, the time is right for a new initiative in mathematical modeling of the LUT."
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Affiliation(s)
- Margot S Damaser
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Advanced Platform Technology Center, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Françoise A Valentini
- Physical Medicine and Rehabilitation Department, Rothschild Hospital, Sorbonne Université, Paris, France
| | - Francesco Clavica
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ilias Giarenis
- Department of UroGynaecology, Norfolk and Norwich University Hospital, Norwich, UK
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Challita EJ, Rohilla P, Bhamla MS. Fluid Ejections in Nature. Annu Rev Chem Biomol Eng 2024; 15:187-217. [PMID: 38669514 PMCID: PMC11269045 DOI: 10.1146/annurev-chembioeng-100722-113148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
From microscopic fungi to colossal whales, fluid ejections are universal and intricate phenomena in biology, serving vital functions such as animal excretion, venom spraying, prey hunting, spore dispersal, and plant guttation. This review delves into the complex fluid physics of ejections across various scales, exploring both muscle-powered active systems and passive mechanisms driven by gravity or osmosis. It introduces a framework using dimensionless numbers to delineate transitions from dripping to jetting and elucidate the governing forces. Highlighting the understudied area of complex fluid ejections, this review not only rationalizes the biophysics involved but also uncovers potential engineering applications in soft robotics, additive manufacturing, and drug delivery. By bridging biomechanics, the physics of living systems, and fluid dynamics, this review offers valuable insights into the diverse world of fluid ejections and paves the way for future bioinspired research across the spectrum of life.
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Affiliation(s)
- Elio J Challita
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA;
| | - Pankaj Rohilla
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA;
| | - M Saad Bhamla
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA;
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Challita EJ, Rohilla P, Bhamla MS. Fluid ejections in nature. ARXIV 2024:arXiv:2403.02359v1. [PMID: 38495571 PMCID: PMC10942486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
From microscopic fungi to colossal whales, fluidic ejections are a universal and intricate phenomenon in biology, serving vital functions such as animal excretion, venom spraying, prey hunting, spore dispersal, and plant guttation. This review delves into the complex fluid physics of ejections across various scales, exploring both muscle-powered active systems and passive mechanisms driven by gravity or osmosis. We introduce a framework using dimensionless numbers to delineate transitions from dripping to jetting and elucidate the governing forces. Highlighting the understudied area of complex fluid ejections, this work not only rationalizes the biophysics involved but also uncovers potential engineering applications in soft robotics, additive manufacturing, and drug delivery. By bridging biomechanics, the physics of living systems, and fluid dynamics, this review offers valuable insights into the diverse world of fluid ejections and paves the way for future bioinspired research across the spectrum of life.
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Affiliation(s)
- Elio J Challita
- School of Chemical & Biomolecular Engineering, Georgia Institute of Technology, 311 Ferst Drive NW, Atlanta, GA, 30332, USA
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, 801 Ferst Drive NW, Atlanta, GA, 30318, USA
| | - Pankaj Rohilla
- School of Chemical & Biomolecular Engineering, Georgia Institute of Technology, 311 Ferst Drive NW, Atlanta, GA, 30332, USA
| | - M Saad Bhamla
- School of Chemical & Biomolecular Engineering, Georgia Institute of Technology, 311 Ferst Drive NW, Atlanta, GA, 30332, USA
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, 801 Ferst Drive NW, Atlanta, GA, 30318, USA
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Lotti L, Spatafora P, Marzi VL, Nicita G, Paris E, Serni S. A Velocity-Based Approach to Noninvasive Methodology for Urodynamic Analysis. Int Neurourol J 2023; 27:63-69. [PMID: 37015726 PMCID: PMC10072997 DOI: 10.5213/inj.2244274.137] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/08/2023] [Indexed: 04/06/2023] Open
Abstract
PURPOSE To date, invasive urodynamic investigations have been used to define most terms and conditions relating to lower urinary tract symptoms. This invasiveness is almost totally due to the urethral catheter. In order to remove this source of discomfort for patients, the present study investigated a noninvasive methodology able to provide diagnostic information on bladder outlet obstruction or detrusor underactivity without any contact with the human body. METHODS The proposed approach is based on simultaneous measurements of flow rate and jet exit velocity. In particular, the jet exit kinetic energy appears to be strongly related to bladder pressure, providing useful information on the lower urinary tract functionality. We developed a new experimental apparatus to simulate the male lower urinary tract, thus allowing extensive laboratory activities. A large amount of data was collected regarding different functional statuses. RESULTS Experimental results were compared successfully with data in the literature in terms of peak flow rate and jet exit velocity. A new diagram based on the kinetic energy of the exit jet is proposed herein. Using the same notation as a Schäfer diagram, it is possible to perform noninvasive urodynamic studies. CONCLUSION A new noninvasive approach based on the measurement of jet exit kinetic energy has been proposed to replace current invasive urodynamic studies. A preliminary assessment of this approach was carried out in healthy men, with a specificity of 91.5%. An additional comparison using a small sample of available pressure-flow studies also confirmed the validity of the proposed approach.
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Affiliation(s)
- Lorenzo Lotti
- Department of Civil and Environmental Engineering, University of Florence, Florence, Italy
| | - Pietro Spatafora
- Unit of Urological Minimally Invasive Robotic Surgery and Renal Transplantation, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Vincenzo Li Marzi
- Unit of Urological Minimally Invasive Robotic Surgery and Renal Transplantation, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Enio Paris
- Department of Civil and Environmental Engineering, University of Florence, Florence, Italy
| | - Sergio Serni
- Unit of Urological Minimally Invasive Robotic Surgery and Renal Transplantation, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Forrester C, Mahomed A. Design of a novel midstream fluid waste sample collection device for patients. J Med Eng Technol 2021; 45:664-671. [PMID: 34463586 DOI: 10.1080/03091902.2021.1955031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Reducing the contamination rates in mid-stream urine samples is a challenge. A novel design for a mid-stream urine sample collection device, which uses a novel mechanism to separate the mid-stream flow from the fore-stream and end-stream flows based on flow speed, is presented. The device, supplied in two parts, is designed to be clipped to a toilet and used in a seated position, which improves ease of use for disabled patients. As there is no mixing of the flow types during use, it is hypothesised that contamination rates should be lower than many competing designs. The all-polymer design is easy to use by both men and women, due to the addition of a form-fitting funnel and is designed to collect samples directly into containers of the same standard currently issued, allowing easy and hygienic collection. Due to its complex shape, the main body of the device is produced by a non-conventional injection moulding process. The holder can be produced using standard injection moulding technology. The two parts are designed to be assembled together by the user by means of a simple interference fit, which removes the cost of assembly altogether.
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Affiliation(s)
- Christopher Forrester
- Department of Mechanical Engineering, University of Birmingham, Birmingham, United Kingdom
| | - Aziza Mahomed
- Department of Mechanical Engineering, University of Birmingham, Birmingham, United Kingdom
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Zhang B, Liu S, Liu Y, Wu B, Zhang X, Wang X, Liang X, Cao X, Wang D, Wu CL. Novel CFD modeling approaches to assessing urine flow in prostatic urethra after transurethral surgery. Sci Rep 2021; 11:663. [PMID: 33436678 PMCID: PMC7804846 DOI: 10.1038/s41598-020-79505-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 11/30/2020] [Indexed: 11/09/2022] Open
Abstract
Assessment of the pressure and velocity of urine flow for different diameter ratios of prostatic urethra (RPU) after transurethral surgery using computational fluid dynamics (CFD). A standardized and idealized two-dimensional CFD model after transurethral surgery (CATS-1st) was developed for post-surgery mid-voiding. Using CATS-1st, 210 examples were amplified according to an array of size [3][5][14], which contained three groups of longitudinal diameters of prostatic urethra (LD-PU). Each of these groups contained five subgroups of transverse diameters of the bladder neck (TD-BN), each with 14 examples of transverse diameters of PU (TD-PU). The pressure and velocity of urine flow were monitored through flow dynamics simulation, and the relationship among RPU-1 (TD-PU/TD-BN), RPU-2 (RPU-1/LD-PU), the transverse diameter of the vortex, and the midpoint velocity of the external urethral orifice (MV-EUO) was determined. A total of 210 CATS examples, including CATS-1st examples, were analyzed. High (bladder and PU) and medium/low (the rest of the urethra) pressure zones, and low (bladder), medium (PU), and high (the rest of the urethra) velocity zones were determined. The rapid changes in the velocity were concentrated in and around the PU. Laminar flow was present in all the examples. The vortices appeared and then gradually shrank with reducing RPU on both the sides of PU in 182 examples. In the vortex examples, minimum RPU-1 and RPU-2 reached close to the values of 0.79 and 0.02, respectively. MV-EUO increased gradually with decreasing RPU. In comparison to the vortex examples, the non-vortex examples exhibited a significantly higher (p < 0.01) MV-EUO. The developed CFD models (CATS) presented an effective simulation of urine flow behavior within the PU after transurethral surgery for benign prostatic hyperplasia (BPH). These models could prove to be useful for morphological repair in PU after transurethral surgery.
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Affiliation(s)
- Bin Zhang
- Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, 030001, Shanxi, China.,Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Shuang Liu
- Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Yinxia Liu
- Department of Obstetrics and Gynecology, Shanxi Health Vocational College, Shanxi Traditional Chinese Medicine School, Jinzhong, 030600, Shanxi, China
| | - Bo Wu
- Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Xuhui Zhang
- Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Xin Wang
- Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Xuezhi Liang
- Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Xiaoming Cao
- Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Dongwen Wang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 113 Baohe road, Longgang district, Shenzhen, 518116, China. .,First College of Clinical Medicine, Shanxi Medical University, Taiyuan, 030001, Shanxi, China.
| | - Chin-Lee Wu
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.,Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
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Cohen AJ, Patino G, Mirramezani M, Srirangapatanam S, Tresh A, Cheema B, Tai J, Romero D, Enriquez A, Baskin LS, Shadden SC, Breyer BN. Novel measurement tool and model for aberrant urinary stream in 3D printed urethras derived from human tissue. PLoS One 2020; 15:e0241507. [PMID: 33175862 PMCID: PMC7657556 DOI: 10.1371/journal.pone.0241507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 10/16/2020] [Indexed: 02/02/2023] Open
Abstract
Background An estimated 10% of male adults have split or dribbled stream leading to poor hygiene, embarrassment, and inconvenience. There is no current metric that measures male stream deviation. Objective To develop a novel method to measure spray in normal and abnormal anatomical conformations. Design, setting, and participants We developed a novel platform to reliably describe spray. We used cadaveric tissues and 3D Printed models to study the impact of meatal shape on the urinary stream. Cadaveric penile tissue and 3D printed models were affixed to a fluid pump and used to simulate micturition. Dye captured on fabric allowed for spray detection. Outcome measurements and statistical analysis Spray pattern area, deviation from normal location, and flowrates were recorded. Computational fluid dynamic models were created to study fluid vorticity. Results and limitations Obstructions at the penile tip worsened spray dynamics and reduced flow. Ventral meatotomy improved flowrate (p<0.05) and reduced spray (p<0.05) compared to tips obstructed ventrally, dorsally or in the fossa navicularis. 3D models do not fully reproduce parameters of their parent cadaver material. The average flowrate from 3D model was 10ml/sec less than that of the penis from which it was derived (p = 0.03). Nonetheless, as in cadavers, increasing obstruction in 3D models leads to the same pattern of reduced flowrate and worse spray. Dynamic modeling revealed increasing distal obstruction was correlated to higher relative vorticity observed at the urethral tip. Conclusions We developed a robust method to measure urine spray in a research setting. Dynamic 3D printed models hold promise as a methodology to study common pathologies in the urethra and corrective surgeries on the urine stream that would not be feasible in patients. These novel methods require further validation, but offer promise as a research and clinical tool.
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Affiliation(s)
- Andrew J. Cohen
- Brady Urological Institute, Johns Hopkins Bayview Medical Center, Baltimore, MD, United States of America
| | - German Patino
- Hospital Universitario San Ignacio, Bogota, Colombia, United States of America
| | - Mehran Mirramezani
- University of California, Berkeley, Department of Mechanical Engineering, Berkeley, CA, United States of America
| | - Sudarshan Srirangapatanam
- Department of Urology, University of California San Francisco, San Francisco, CA, United States of America
| | - Anas Tresh
- Department of Urology, University of California San Francisco, San Francisco, CA, United States of America
| | - Bhagat Cheema
- Department of Urology, University of California San Francisco, San Francisco, CA, United States of America
| | - Jenny Tai
- Makers Lab Library, University of California San Francisco, San Francisco, CA, United States of America
| | - Dylan Romero
- Makers Lab Library, University of California San Francisco, San Francisco, CA, United States of America
| | - Anthony Enriquez
- Department of Urology, University of California San Francisco, San Francisco, CA, United States of America
| | - Laurence S. Baskin
- Department of Urology, University of California San Francisco, San Francisco, CA, United States of America
| | - Shawn C. Shadden
- University of California, Berkeley, Department of Mechanical Engineering, Berkeley, CA, United States of America
| | - Benjamin N. Breyer
- Department of Urology, University of California San Francisco, San Francisco, CA, United States of America
- Department of Biostatistics and Epidemiology, University of California, San Francisco, CA, United States of America
- * E-mail:
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Özbey H, Arlı OT. "Fossa navicularis" and "septum glandis": A "flow-control chamber" for the male urethra? Med Hypotheses 2020; 140:109642. [PMID: 32131035 DOI: 10.1016/j.mehy.2020.109642] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 02/25/2020] [Indexed: 02/06/2023]
Abstract
A clear understanding of the normal anatomy of the glanular urethra is essential for anatomical reconstruction of the male urethra. In hypospadias surgery, tubularization of the neourethra over a catheter or stent has been the standard method for decades. However, the male urethra is not a tubular structure with uniform configuration and diameter by forming a fossa (navicularis) in the glans penis. We recently investigated the structural anatomy of the glanular urethra using magnetic resonance imaging (MRI). We have shown that the male urethra does not have a uniform tubular structure and not covered by the corpus spongiosum to the end. The glanular urethra that forms the "fossa navicularis" has a wider caliber than the proximal urethra. Its vertical elliptical shape resembles a laterally compressed slit-like passage. The fossa navicularis is covered by a thin layer of fibrous tissue ("septum glandis") which is an extension of tunica albuginea of the corpus cavernosum and the corpus spongiosum. Our hypothesis is based on the results of MRI of the glanular urethra and the basic principles of fluid dynamics. We analyzed the flow dynamics of urine on this particular component of the urethra in terms of shape and structural properties. Because of its wider caliber than the proximal urethra, the glanular urethra (fossa navicularis) should cause an increase in pressure and a decrease in velocity of the urine flow. The navicular shape of the fossa and its elliptical external opening (the meatus) should allow urine to be expelled at higher flow rates and at opposite angles at the upper and lower corners which make the wave-like shape of the urine. It can be said that the changes in the volumetric form, pressure and velocity, as well as the wave-like shape of the urine flow are caused by the "fossa navicularis" covered by the "septum glandis". We propose that the "fossa navicularis" and "septum glandis" play a role as 'flow control chamber" in controlling the flow of the urine exiting the urethra, which must be taken into account for successful functional reconstruction of hypospadias.
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Affiliation(s)
- Hüseyin Özbey
- Department of Pediatric Surgery, Division of Pediatric Urology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Department of Pediatric Surgery, Sechenov First Moscow State Medical University, Moscow, Russian Federation.
| | - Osman Tayyar Arlı
- Department of Biophysics, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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Spyropoulos E, Galanakis I, Deligiannis D, Spyropoulou A, Kotsiris D, Panagopoulos A, Mavrikos S. Flow resistive forces index (QRF): Development and clinical applicability assessment of a novel measure of bladder outlet resistance, aiming to enhance the diagnostic performance of uroflowmetry. Low Urin Tract Symptoms 2020; 12:190-197. [PMID: 31999073 DOI: 10.1111/luts.12301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/12/2019] [Accepted: 01/08/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Currently, the diagnostic ability of uroflowmetry, the most widely used urodynamic test available for initial assessment of patients with lower urinary tract symptoms (LUTS), is considered limited by its inability to accurately discriminate between the underlying mechanisms of this condition. To improve the diagnostic accuracy of uroflow, we developed a mathematical formula that calculates the flow resistive forces index (QRF), a novel measure of bladder outflow/urethral resistance, and assessed its clinical applicability compared to the maximum flow rate (Qmax ). MATERIALS AND METHODS A cross-sectional observational study was conducted in a cohort of 61 adult men presenting with voiding dysfunction symptoms, who all underwent free uroflowmetry followed by pressure flow study. The development of the mathematical formula which contains five key uroflowmetry variables (voided volume, flow time, Qmax , average flow rate, and peak flow time) was based on the assumption that urine volume momentum changes during voiding, the concept of diphasic uroflow pattern (acceleration/deceleration), and the urethral resistance factor (URA) equation. Study subjects were classified either as obstructed or nonobstructed according to established urodynamic criteria (linearized passive urethral resistance relation, LinPURR; Abrams-Griffiths number, AGN [also called bladder outlet obstruction index, BOOI]; and URA). Univariate linear correlations, binary logistic regression model, and receiver operating characteristic (ROC) curve statistical analysis were employed (SPSS-22, MedCalc, GraphPad [P < .05]). RESULTS Outflow obstruction was diagnosed in 50.8% (1 in 2) patients. Univariate analysis, and bivariate linear correlation, binary logistic regression, and ROC curve analyses showed that the QRF was a strong independent predictor of bladder outlet/outflow obstruction (BOO), significantly outperforming Qmax . CONCLUSIONS QRF index accurately predicts BOO, significantly outperforming the currently widely used bladder outlet obstruction estimator Qmax . Despite potential study limitations (mainly small cohort size and lack of control group), we anticipate that with further study and proper clinical validation, QRF could become a valuable complement to uroflowmetry.
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Affiliation(s)
| | - Ioannis Galanakis
- Urology Department, Naval & Veterans Hospital of Athens, Athens, Greece
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Minagawa T, Tezuka M, Ogawa T, Ishizuka O. Vorticity in lower urinary tract can be assessed and associates with urinary tract morphology in men. Neurourol Urodyn 2019; 39:286-294. [PMID: 31692125 DOI: 10.1002/nau.24193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/29/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVES The aim of this study is to develop a method to evaluate the fluid dynamics of urine flow in the lower urinary tract (LUT), especially that of vorticity. MATERIALS AND METHODS This investigation included three sub-studies to demonstrate urine flow in the entire LUT. First, we attempted to observe vorticity generation in the urinary bladder during spontaneous voiding using transabdominal color Doppler ultrasonography (CDUS). Second, we performed transrectal CDUS to evaluate the vorticity of urine flow in the prostatic urethra. Patients with prostate cancer were enrolled before robotic surgery and divided into the vorticity and non-vorticity groups based on CDUS findings for comparisons of longitudinal urethral diameter and prostatic urethral angle. Third, the vorticity of the voided urine stream was observed using a high-speed video-camera. Micturition was done in a standing position while synchronously monitored for urine flow using uroflowmetry. RESULTS Vorticity formation could be dynamically demonstrated in the urinary bladder and prostatic urethra using CDUS. The prostatic urethral angle of the vorticity group was more than that of the non-vorticity group. High-speed video recording could clearly capture vorticity and spiral shape generation in voided urine. The distance from the external urethral orifice to the first twist changed in accordance with urine flow rate. CONCLUSIONS In a series of sub-studies, this investigation proved vorticity generation in the LUT and voided urine. Vorticity was detectable in the LUT and in voided urine using CDUS and a high-speed video-camera. Vorticity generation might be associated with urethral morphology.
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Affiliation(s)
- Tomonori Minagawa
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Masato Tezuka
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Teruyuki Ogawa
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Osamu Ishizuka
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Japan
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Özbey H, Kumbasar A. Glans wings are separated ventrally by the septum glandis and frenulum penis: MRI documentation and surgical implications. Turk J Urol 2017; 43:525-529. [PMID: 29201519 DOI: 10.5152/tud.2017.00334] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 08/23/2017] [Indexed: 11/22/2022]
Abstract
Objective In the normal human penis, the glans wings are in apposition in the midline ventrally, and are separated by the "septum glandis" and "frenulum" of the prepuce. However, most of the hypospadias repair techniques include dissection of the glans wings and their approximation enclosing the neourethra within the glans. Material and methods In order to obtain detailed information about the normal anatomy of glans penis, magnetic resonance imaging (MRI) findings of the penis were studied in three adults. Transverse, and sagittal sections of the penis were performed with a 1.5-T MRI scanner. Results The present MRI study has confirmed that the glans wings do not fuse at the ventral midline and they are seperated by a fibrous tissue (septum glandis). This fibrous tissue is connected to the frenulum, traversing the wings of the glans penis. The glanular urethra forming the fossa navicularis has a wider caliber than the proximal urethra, and its walls are radiologically seen as the extension of that fibrous tissue. Conclusion The male urethra is not a uniform tubular structure and has distinct attachments in glans penis. The glans wings are separated ventrally by the septum glandis and frenulum. In hypospadias, the septum glandis and frenulum are entirely missing structures. Therefore, in hypospadias surgery, the anatomical features of the glanular urethra must be taken into consideration.
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Affiliation(s)
- Hüseyin Özbey
- Department of Pediatric Surgery and Division of Pediatric Urology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
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12
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Özbey H, Etker Ş. Hypospadias repair with the glanular-frenular collar (GFC) technique. J Pediatr Urol 2017; 13:34.e1-34.e6. [PMID: 27847256 DOI: 10.1016/j.jpurol.2016.09.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 09/23/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND In the normal human penis, the glans wings merge in the midline ventrally, but are separated by the 'septum glandis' in conjunction with the frenulum. The frenulum is also included in the formation of the distal (glanular and subcoronal) urethra, which has a special part known as the 'fossa navicularis'. This has inspired a hypospadias repair technique that simulates the development of the glanular and subcoronal urethra, which can be incorporated into the repair of all cases of hypospadias. MATERIAL AND METHOD A total of 121 patients with varying degrees of hypospadias underwent surgery with the described technique: a Y-V plasty was used to dissect the inner foreskin, in a fashion that allowed for its ventral mobilization as a frenular mucosal collar. After tubularization of the proximal urethra, a partial spongioplasty was performed that extended up to the subcoronal level. The glans wings were approximated only at their outermost convexities, with a couple of subepithelial sutures, leaving a slit for the meatus. The cleft-like area between the split wings of the glans penis was filled with the terminal ends of the spongiosum and the dartos of the mucosal collar, which converged to form a septum and a neo-frenulum (glanular-frenular collar, GFC). The midline skin closure of the ventral collar and the circumferential foreskin closure was completed as usual. RESULTS At a mean follow-up of 10 months, two patients developed urethral fistula (2%), six had meatal stenosis (5%), and two had glans dehiscence (2%) that resulted in meatal retraction. Overall, patients had a cosmetically satisfying appearance (Figure). Forty-one received secondary circumcision; the parents of 80 (66%) patients were satisfied with the final foreskin appearance obtained with this method. DISCUSSION The split wings of the glans penis or so-called ventral cleft between the glans wings that accommodate the frenulum is part of normal anatomy. Hence, in hypospadias surgery, the approximated glans wings should allow for ventral support of the glanular and subcoronal urethra through a reconstructed neo-frenulum. Neither glanular surface enhancement nor extensive dissection of the glans wings and their full-length approximation are necessary, and may in fact be counter-productive. CONCLUSIONS The employment of a GFC provided: 1) an anatomical restoration of the distal (glanular and subcoronal) urethra, supported by a frenulum; 2) a protective (undissected) dartos layer over the distal part of the tubularized neourethra; and 3) a space for the re-formation of the fossa navicularis.
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Affiliation(s)
- Hüseyin Özbey
- Department of Pediatric Surgery and Division of Pediatric Urology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Society for Sexual Development and Hypospadias (DSDturk), Istanbul, Turkey.
| | - Şeref Etker
- Society for Sexual Development and Hypospadias (DSDturk), Istanbul, Turkey
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Abstract
Many urological studies rely on models of animals, such as rats and pigs, but their relation to the human urinary system is poorly understood. Here, we elucidate the hydrodynamics of urination across five orders of magnitude in body mass. Using high-speed videography and flow-rate measurement obtained at Zoo Atlanta, we discover that all mammals above 3 kg in weight empty their bladders over nearly constant duration of 21 ± 13 s. This feat is possible, because larger animals have longer urethras and thus, higher gravitational force and higher flow speed. Smaller mammals are challenged during urination by high viscous and capillary forces that limit their urine to single drops. Our findings reveal that the urethra is a flow-enhancing device, enabling the urinary system to be scaled up by a factor of 3,600 in volume without compromising its function. This study may help to diagnose urinary problems in animals as well as inspire the design of scalable hydrodynamic systems based on those in nature.
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