1
|
Abosena W, Almetaher HA, El Attar AA, Nofal AH, Elhalaby EA. Outcomes of one-stage feminizing genitoplasty in children with congenital adrenal hyperplasia and severe virilization. Pediatr Surg Int 2024; 40:72. [PMID: 38446278 PMCID: PMC10917856 DOI: 10.1007/s00383-024-05638-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2024] [Indexed: 03/07/2024]
Abstract
PURPOSE To present our surgical experience and outcomes in congenital adrenal hyperplasia (CAH) patients with severe virilization using a combined technique of total urogenital mobilization (TUM) and a modified pull-through vaginoplasty to perform a safe and effective one-stage feminizing genital reconstruction for these children. METHODS Fourteen CAH patients with severe virilization, defined by a Prader IV and V rating of the external genitalia, underwent TUM followed by a limited vaginal pull-through procedure from June 2016 to December 2020. Postoperative anatomical and cosmetic outcomes, and urinary continence, were evaluated. RESULTS Out of the 14 cases in this study, 8 were classified as prader IV and 6 as Prader V. The median age at surgery was 11 months (range 6-36 months), and the mean urethral length was 1.4 cm (range 1.2-1.8 cm). The median follow-up period was 4 years. Our cosmetic outcomes were good in 11 (78.5%), satisfactory in 2, and poor in one case. All patients achieved age-appropriate toilet training without urinary incontinence. CONCLUSION Adopting our surgical approach of TUM with modified pull-through vaginoplasty has simplified feminizing surgical reconstruction in CAH cases with severe genital atypia and a very high vaginal confluence with short urethral length, yielding adequate introitus with good anatomical and cosmetic appearance and adequate urinary continence outcomes.
Collapse
Affiliation(s)
- Wael Abosena
- Pediatric Surgery Department, Faculty of Medicine, Tanta University Hospital, Tanta, 31527, Egypt.
| | | | - Ashraf Ahmed El Attar
- Pediatric Surgery Department, Faculty of Medicine, Tanta University Hospital, Tanta, 31527, Egypt
| | - Ahmed Hassan Nofal
- Pediatric Surgery Department, Faculty of Medicine, Tanta University Hospital, Tanta, 31527, Egypt
| | - Essam Abdelaziz Elhalaby
- Pediatric Surgery Department, Faculty of Medicine, Tanta University Hospital, Tanta, 31527, Egypt
| |
Collapse
|
2
|
Grant A, Carpenter CP, Li B, Kim SJ. Hydrometrocolpos: a Contemporary Review of the Last 5 Years. Curr Urol Rep 2023; 24:601-610. [PMID: 38038828 DOI: 10.1007/s11934-023-01191-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2023] [Indexed: 12/02/2023]
Abstract
PURPOSE OF REVIEW The goal of this review is to provide a comprehensive overview of hydrometrocolpos, covering disease etiology, pathophysiology, clinical presentation, and diagnostic and management techniques, and known outcomes. RECENT FINDINGS This narrative review presents the literature on hydrometrocolpos in the pediatric population from the past 5 years. We highlight the 69 reported cases of hydrometrocolpos and classify them based on type of obstruction or associated anomaly, discuss new diagnostic algorithms based on imaging, and present novel and underutilized surgical techniques for definitive management. Hydrometrocolpos, a condition characterized by retained fluid causing a distended vagina and uterus in the setting of a distal vaginal outflow obstruction, has a wide range of presentation severity based on the type of obstruction. Whether hydrometrocolpos is due to an isolated condition like imperforate hymen, a complex abnormality like cloacal malformation, or a part of a large congenital syndrome, the mainstay of treatment is decompression of the dilated vagina and surgical correction of the outflow obstruction. Imaging-based diagnostic algorithms and new treatment techniques reported in the literature, as well as longitudinal and patient-reported outcome research, can improve the lives of children affected by this condition.
Collapse
Affiliation(s)
- Allison Grant
- Department of Pediatric Urology, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA
| | - Christina P Carpenter
- Department of Pediatric Urology, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA
| | - Belinda Li
- Department of Pediatric Urology, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA
| | - Soo Jeong Kim
- Department of Pediatric Urology, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA.
| |
Collapse
|
3
|
Shibui Y, Obata S, Hirose R, Nakano R, Setoue T, Miyazaki T, Matsuoka H, Sato T. A case of sacrococcygeal teratoma associated with antenatally acquired urethrovaginal fistula and hydrocolpos. Surg Case Rep 2023; 9:191. [PMID: 37903968 PMCID: PMC10616020 DOI: 10.1186/s40792-023-01772-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 10/22/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Sacrococcygeal teratomas (SCTs) are known to cause urological complications, but urethrovaginal (UV) fistula as a complication of SCT is rare. We herein report a case of SCT with UV fistula and hydrocolpos. CASE PRESENTATION A 1-day-old female neonate presented to our department with prominent swelling in the sacrococcygeal region. She was born at 37 gestational weeks via spontaneous vaginal delivery from a 39-year-old woman. The weight of the baby was 2965 g, and her Apgar scores were 4/10 (at 1 and 5 min). An MRI examination confirmed an 11 × 11 cm Altman classification typeII SCT associated with hydrocolpos, a dilated urinary bladder, and bilateral hydronephrosis. When she was 5 days, the SCT was excised totally and a coccygectomy was performed. After the operation, as her urinary output appeared unstable, a cystoscopic examination was performed on the third postoperative day. This revealed that the UV fistula was located approximately 1 cm from the urethral opening. In addition, the proximal urethra was unobstructed and connected to the bladder. The cystoscope allowed for the passage of a urinary catheter through the urethra. After 1 month of catheter placement, she was discharged from the hospital at 57 days of age. Follow-up was uneventful, with neither urinary infection nor retention. CONCLUSIONS SCTs are associated with not only trouble with rectal function and lower extremity movement but also urinary complications. The pathogenesis of this UV fistula is thought to be the rapid growth of the SCT that developed in the fetal period, resulting in obstruction of the urethra by the tumor and the pubic bone, which in turn caused urinary retention and the formation of a fistula as an escape route for the pressure. Because SCTs can cause a variety of complications depending on the course of the disease, careful examination and follow-up are necessary.
Collapse
Affiliation(s)
- Yuichi Shibui
- Department of General Thoracic, Breast, and Pediatric Surgery, Fukuoka University, 7-45-1, Nanakuma Jonan-Ku, Fukuoka, Fukuoka, 814-0180, Japan.
- Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Satoshi Obata
- Department of General Thoracic, Breast, and Pediatric Surgery, Fukuoka University, 7-45-1, Nanakuma Jonan-Ku, Fukuoka, Fukuoka, 814-0180, Japan
| | - Ryuichiro Hirose
- Department of General Thoracic, Breast, and Pediatric Surgery, Fukuoka University, 7-45-1, Nanakuma Jonan-Ku, Fukuoka, Fukuoka, 814-0180, Japan
| | - Ryo Nakano
- Division of Neonatology, Center for Maternal, Fetal and Neonatal Medicine, Fukuoka University Hospital, 7-45-1, Nanakuma Jonan-Ku, Fukuoka, Fukuoka, 814-0180, Japan
| | - Takashi Setoue
- Division of Neonatology, Center for Maternal, Fetal and Neonatal Medicine, Fukuoka University Hospital, 7-45-1, Nanakuma Jonan-Ku, Fukuoka, Fukuoka, 814-0180, Japan
| | - Takeshi Miyazaki
- Department of Urology, Faculty of Medicine, Fukuoka University, 7-45-1, Nanakuma Jonan-Ku, Fukuoka, Fukuoka, 814-0180, Japan
| | - Hirofumi Matsuoka
- Department of Urology, Faculty of Medicine, Fukuoka University, 7-45-1, Nanakuma Jonan-Ku, Fukuoka, Fukuoka, 814-0180, Japan
| | - Toshihiko Sato
- Department of General Thoracic, Breast, and Pediatric Surgery, Fukuoka University, 7-45-1, Nanakuma Jonan-Ku, Fukuoka, Fukuoka, 814-0180, Japan
| |
Collapse
|
4
|
Singh P, Lanman NA, Kendall HLR, Wilson L, Long R, Franco OE, Buskin A, Miles CG, Hayward SW, Heer R, Robson CN. Human prostate organoid generation and the identification of prostate development drivers using inductive rodent tissues. Development 2023; 150:dev201328. [PMID: 37376888 PMCID: PMC10357030 DOI: 10.1242/dev.201328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 06/20/2023] [Indexed: 06/29/2023]
Abstract
The reactivation of developmental genes and pathways during adulthood may contribute to pathogenesis of diseases such as prostate cancer. Analysis of the mechanistic links between development and disease could be exploited to identify signalling pathways leading to disease in the prostate. However, the mechanisms underpinning prostate development require further characterisation to interrogate fully the link between development and disease. Previously, our group developed methods to produce prostate organoids using induced pluripotent stem cells (iPSCs). Here, we show that human iPSCs can be differentiated into prostate organoids using neonatal rat seminal vesicle mesenchyme in vitro. The organoids can be used to study prostate development or modified to study prostate cancer. We also elucidated molecular drivers of prostate induction through RNA-sequencing analyses of the rat urogenital sinus and neonatal seminal vesicles. We identified candidate drivers of prostate development evident in the inductive mesenchyme and epithelium involved with prostate specification. Our top candidates included Spx, Trib3, Snai1, Snai2, Nrg2 and Lrp4. This work lays the foundations for further interrogation of the reactivation of developmental genes in adulthood, leading to prostate disease.
Collapse
Affiliation(s)
- Parmveer Singh
- Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, NE2 4AD, UK
| | - Nadia A. Lanman
- Department of Comparative Pathobiology, Purdue University, West Lafayette, IN 47907, USA
- Purdue University Center for Cancer Research, Purdue University, West Lafayette, IN 47907, USA
| | - Hannah L. R. Kendall
- Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, NE2 4AD, UK
| | - Laura Wilson
- Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, NE2 4AD, UK
| | - Ryan Long
- Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, NE2 4AD, UK
| | - Omar E. Franco
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL 60201, USA
- University of Chicago Pritzker School of Medicine, Chicago, IL 60637, USA
| | - Adriana Buskin
- Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, NE2 4AD, UK
| | - Colin G. Miles
- Translational and Clinical Research Institute, Newcastle University, Central Parkway, Newcastle upon Tyne, NE1 3BZ, UK
| | - Simon W. Hayward
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL 60201, USA
- University of Chicago Pritzker School of Medicine, Chicago, IL 60637, USA
| | - Rakesh Heer
- Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, NE2 4AD, UK
- Department of Urology, Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
| | - Craig N. Robson
- Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, NE2 4AD, UK
| |
Collapse
|
5
|
Uno W, Ofuji K, Wymeersch FJ, Takasato M. In vitro induction of prostate buds from murine urogenital epithelium in the absence of mesenchymal cells. Dev Biol 2023; 498:49-60. [PMID: 36963625 DOI: 10.1016/j.ydbio.2023.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 03/08/2023] [Accepted: 03/21/2023] [Indexed: 03/26/2023]
Abstract
The prostate is a male reproductive gland which secretes prostatic fluid that enhances male fertility. During development and instigated by fetal testosterone, prostate cells arise caudal to the bladder at the urogenital sinus (UGS), when the urogenital mesenchyme (UGM) secretes signals to the urogenital epithelium (UGE). These initial mesenchymal signals induce prostate-specific gene expression in the UGE, after which epithelial progenitor cells form prostatic buds. Although many important factors for prostate development have been described using UGS organ cultures, those necessary and sufficient for prostate budding have not been clearly identified. This has been in part due to the difficulty to dissect the intricate signaling and feedback between epithelial and mesenchymal UGS cells. In this study, we separated the UGM from the UGE and tested candidate growth factors to show that when FGF10 is present, testosterone is not required for initiating prostate budding from the UGE. Moreover, in the presence of low levels of FGF10, canonical WNT signaling enhances the expression of several prostate progenitor markers in the UGE before budding of the prostate occurs. At the later budding stage, higher levels of FGF10 are required to increase budding and retinoic acid is indispensable for the upregulation of prostate-specific genes. Lastly, we show that under optimized conditions, female UGE can be instructed towards a prostatic fate, and in vitro generated prostate buds from male UGE can differentiate into a mature prostate epithelium after in vivo transplantation. Taken together, our results clarify the signals that can induce fetal prostate buds in the urogenital epithelium in the absence of the surrounding, instructive mesenchyme.
Collapse
Affiliation(s)
- Wataru Uno
- Laboratory for Human Organogenesis, RIKEN Center for Biosystems Dynamics Research, Kobe, 650-0047, Japan; Laboratory of Molecular Cell Biology and Development, Department of Animal Development and Physiology, Graduate School of Biostudies, Kyoto University, Kyoto, 606-8501, Japan
| | - Kazuhiro Ofuji
- Laboratory for Human Organogenesis, RIKEN Center for Biosystems Dynamics Research, Kobe, 650-0047, Japan
| | - Filip J Wymeersch
- Laboratory for Human Organogenesis, RIKEN Center for Biosystems Dynamics Research, Kobe, 650-0047, Japan
| | - Minoru Takasato
- Laboratory for Human Organogenesis, RIKEN Center for Biosystems Dynamics Research, Kobe, 650-0047, Japan; Laboratory of Molecular Cell Biology and Development, Department of Animal Development and Physiology, Graduate School of Biostudies, Kyoto University, Kyoto, 606-8501, Japan.
| |
Collapse
|
6
|
Pathak M, Saxena AK. Laparoscopic management of common cloaca: Current status. J Pediatr Urol 2022; 18:142-149. [PMID: 35101384 DOI: 10.1016/j.jpurol.2021.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 12/15/2021] [Accepted: 12/28/2021] [Indexed: 11/18/2022]
Abstract
AIM This study reviewed the literature on the laparoscopic management of cloaca. METHODS A Medline and Embase search was performed for "laparoscopy" and "cloaca." Articles for which full-text in English was not available, duplicate articles, and review articles were excluded. Demographic characteristics, duration of follow-up, length of common channel, postoperative complications, and functional outcomes were analyzed. RESULTS The database search retrieved 81 articles after excluding unrelated articles and identified new articles through cross-referencing 14 articles (72 patients) for this review. The rectal pouch was situated below the pubococcygeal (PC) line in three patients. In all other patients, the rectum was located above the PC line. Only the rectal component of the malformation was repaired laparoscopically in 80% (58/72). Fourteen patients underwent laparoscopic mobilization of the rectum and urogenital component. The length of the common channel was more than 3 cm in all these fourteen patients. The most common complication was rectal prolapse (n = 11). Functional evaluation by Krickenbeck scoring system was reported in 32 patients, of which 6/32 (18.75%) had fecal soiling > Grade 2. DISCUSSION Until recently, laparoscopy for the common cloaca was almost exclusively used in patients with low urogenital sinus with high rectal pouch. Moreover, only the rectal component was repaired laparoscopically. Recently, laparoscopic rectal mobilization and urogenital separation was described for patients with common channel length ≥3 cm. It has been reported that laparoscopic vaginal mobilization is easy and more complete by this technique and may avoid vaginal replacement in most of these patients with the long common channel. However, only two studies have reported this technique, and its reproducibility and long-term results are still awaited. Another interesting observation was the increasing use of urethral length along with common channel length in determining the appropriate procedure for the patients with common cloaca. Recent studies propose that the urogenital separation technique be preferred over urogenital mobilization in patients with the short urethra. Nonetheless, we still don't have long-term comparative data to demonstrate that the functional outcomes are better with this new algorithm. We conclude that the persistent cloaca needs an individualized approach, and laparoscopy can be utilized to mobilize the high rectum and is also helpful for the urogenital separation in patients with common channel length >3 cm. However, at present, there is no conclusive evidence to support that laparoscopic repair has a better functional outcome than the open approach.
Collapse
Affiliation(s)
- Manish Pathak
- Department of Pediatric Surgery, All India Institute of Medical Sciences Jodhpur, Jodhpur, India.
| | - Amulya K Saxena
- Department of Pediatric Surgery, Chelsea Children's Hospital, Chelsea and Westminster Hospital NHS Fdn Trust, Imperial College London, London, United Kingdom
| |
Collapse
|
7
|
Bayne AP, Austin JC, Seideman CA. Robotic assisted retrovesical approach to prostatic utricle excision and other complex pelvic pathology in children is safe and feasible. J Pediatr Urol 2021; 17:710-715. [PMID: 34511376 DOI: 10.1016/j.jpurol.2021.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/29/2021] [Accepted: 08/06/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Excision of the prostatic utricle has been a challenging surgical problem due to the location deep in the pelvis between the rectum and bladder. Robotic-assisted laparoscopic surgery allows minimally invasive access to this location. OBJECTIVE To describe the robotic surgical outcomes and important techniques associated with robotic excision of the prostatic utricle and explain how these techniques apply to similar pediatric pelvic pathology. STUDY DESIGN Retrospective chart evaluation of patients treated at a single institution with robotic excision of a prostatic utricle as well as two other patients in which the similar approach was employed. RESULTS 4 patients underwent robotic excision of a prostatic utricle. A fifth patient underwent excision of urethral diverticulum that was the remnant of an ectopic ureter. The sixth patient had a high urogenital sinus that required laparoscopic assisted vaginoplasty approached in a similar manner to the above listed cases. Mean age at surgery was 35.5 months for the utricle patients. Mean follow-up duration for the utricle patients was 30.75 months. Average hospital stay for the utricle patients was one day. In the utricle patients one patient developed transient urinary retention and one had a postoperative urinary tract infection. Concomitant cystoscopy used in the two non-utricle patients was a key step in defining the proper location of dissection. DISCUSSION Robotic-assisted laparoscopic retrovesical excision of the prostatic utricle is a safe operation that requires a skill set that can be readily applied to other complex pelvic pathology such as the ectopic ureter, urethral diverticulum, and urogenital sinus. Concomitant cystoscopy can aid significantly in defining the location and limits of dissection.
Collapse
Affiliation(s)
- Aaron P Bayne
- Oregon Health and Science University, Portland, OR, USA.
| | | | | |
Collapse
|
8
|
Cunha GR, Cao M, Derpinghaus A, Baskin LS. Human urogenital sinus mesenchyme is an inducer of prostatic epithelial development. Am J Clin Exp Urol 2021; 9:329-336. [PMID: 34541031 PMCID: PMC8446767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 08/17/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To determine whether human fetal urogenital sinus mesenchyme (UGM) can induce prostatic development in a responsive mouse epithelium. METHOD Male and female human fetal UGM was combined with mouse urinary bladder epithelium (BLE), and the resultant human UGM + mouse BLE tissue recombinants were grown under renal capsules of male athymic mice. Human male and female UGM was derived from reproductive tracts 9 and 14 weeks of gestation obtained following elective termination of pregnancy. At these ages prostatic ducts had already emerged from the urogenital sinus epithelium, and the human UGM remained contaminated with human prostatic epithelium. This unavoidable problem was tolerated because the induced mouse prostatic epithelium could be distinguished from contaminating human prostatic epithelium. RESULTS The simple columnar epithelium induced from mouse bladder epithelium by human male and female UGM resembled mouse prostatic epithelium by: (a) histology, (b) the pattern of basal cell distribution, (c) Hoechst dye nuclear staining, (d) expression of NKX3.1, (e) the pattern of androgen receptor expression and (f) the expression of probasin, a mouse prostatic secretory protein. Summary/Interpretation: These findings provide validation for mouse as a model of human prostatic development as the molecular dialogue involved in mesenchymal-epithelial interactions are sufficiently conserved that human UGM can induce mouse bladder epithelium to undergo prostatic development.
Collapse
Affiliation(s)
- Gerald R Cunha
- Department of Urology, University of California 400 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Mei Cao
- Department of Urology, University of California 400 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Amber Derpinghaus
- Department of Urology, University of California 400 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Laurence S Baskin
- Department of Urology, University of California 400 Parnassus Avenue, San Francisco, CA 94143, USA
| |
Collapse
|
9
|
AbouZeid AA, Mohammad SA, Shokry SS, El-Naggar O. Posterior cloaca: A urogenital rather than anorectal anomaly. J Pediatr Urol 2021; 17:410.e1-410.e7. [PMID: 33549475 DOI: 10.1016/j.jpurol.2021.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/04/2021] [Accepted: 01/14/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND 'Persistent Cloaca' refers to one of the major groups of anorectal anomalies in the female when a single perineal orifice is located at the normal site of the urethra draining both urogenital and alimentary tracts. However, 'posterior cloaca' is a new term developed by Pena to describe a unique defect in females in which a common urogenital sinus is deviated posteriorly to open into normally located anorectum (type A) or in the perineum slightly anterior to the anus (type B). METHODS The study included seven girls diagnosed as posterior cloaca. Their age at presentation ranged from 1 to 108 months (median 12 months). The main presentation was abnormal external genitalia, while two cases underwent colostomy (±vaginostomy) at birth. Surgical reconstruction varied according to the degree of deviation from normal anatomy. Partial urogenital sinus mobilization (PUM) was used to correct minor forms; while at the other end of the spectrum (absent urinary bladder), continent urinary diversion was performed. Due to the high incidence of renal and urological anomalies, regular follow up at paediatric nephrology/urology clinics was advised for affected cases. RESULTS All seven cases had a common urogenital confluence characteristically deviated posteriorly. The degree of backward deviation of the common urogenital orifice was variable ranging from mild to severe posterior displacement. In six cases (85%), the common urogenital orifice was shifted backwards in the perineum approaching the anal verge (type B). In one case, the common urogenital orifice opened internally into the anorectum (type A). Major urinary tract anomalies were quite common (5 of 7 cases; 71%): absent urinary bladder (2 cases); single kidney (2 cases); crossed ectopic kidney (1 case); hydroureteronephrosis (2 cases). CONCLUSION Posterior cloaca is a rare anomaly in the female essentially affecting the lower urogenital tract with a high incidence of associated renal anomalies. Management should be tailored according to the degree of developmental defect.
Collapse
Affiliation(s)
| | | | - Shady S Shokry
- Pediatric Surgery Department, Faculty of Medicine, Ain Shams University, Egypt
| | - Osama El-Naggar
- Pediatric Surgery Department, Faculty of Medicine, Ain Shams University, Egypt
| |
Collapse
|
10
|
Abstract
BACKGROUND Ciliated cyst of the vulva is a variety of ciliated cutaneous cyst, which itself is a rare presentation and a very few cases has been reported. CASE This case report shows the presentation of this cyst in a 12-year-old girl with early onset of puberty. The histopathology supports estrogen receptor and progesterone receptor positivity of the cyst lining, which supports the theory of Müllerian heterotopy during embryogenesis. This is the most popular theory on the development of this cyst. Its an uncommon presentation in children but a curable benign cyst.
Collapse
Affiliation(s)
- Montila Ghosh
- Speciality Doctor, Obstetrics and Gynaecology, St Mary's Hospital, Manchester University Foundation Trust, Manchester, United Kingdom.
| | - Stefania Bitetti
- Consultant Paediatric and Perinatal Histopathologist, Department of Paediatric Histopathology, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Gail Busby
- Consultant ,Gynaecology, St Mary's Hospital, Manchester University Foundation Trust, Manchester, United Kingdom
| |
Collapse
|
11
|
Abstract
BACKGROUND Primary vaginal calculus is rare and often misdiagnosed due to its low incidence. The formation of primary vaginal calculus is mainly due to the pooling and stasis of urine within the vagina, and associated with urogenital tract abnormalities. CASE PRESENTATION We present a case of a 23-year-old woman with urogenital sinus anomaly who presented with a vaginal calculus. The patient was not suspected of a calculus in the vagina until the patient suffered amenorrhea and dyspareunia. Pelvic computed tomography (CT) and magnetic resonance imaging (MRI) confirmed the patient had urogenital sinus anomaly with vaginal calculus. For the reason, the calculus was removed by surgery, and the reconstruction of vagina and urethra was performed. The postoperative recovery and follow-up were uneventful. CONCLUSIONS Although vaginal calculus and urogenital sinus anomaly are extremely rare in literature, the radiologist should be familiar with the imaging appearance of urogenital sinus anomaly, and be aware of the possibility of vaginal calculus.
Collapse
Affiliation(s)
- Qiong Xu
- Department of Radiology, Women's Hospital School of Medicine Zhejiang University, Hangzhou, 310006, Zhejiang province, China
| | - Yu Zou
- Department of Radiology, Women's Hospital School of Medicine Zhejiang University, Hangzhou, 310006, Zhejiang province, China.
| |
Collapse
|
12
|
Ranawaka RS, Goyal A, Shabani A, Hennayake S, Dickson AP, Cervellione RM. Novel approach to vaginal calculus in a girl with urogenital sinus anomaly. J Pediatr Surg 2020; 55:e4-e5. [PMID: 25783409 DOI: 10.1016/j.jpedsurg.2012.07.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 06/28/2012] [Accepted: 07/08/2012] [Indexed: 10/24/2022]
Abstract
Isolated urogenital sinus can cause distended bladder and/or vagina and may present with an abdominal mass and sepsis during infancy. Older children may present with recurrent urinary tract infections and hematocolpos. We describe a 3-year-old girl with recurrent urinary tract infections thought to be secondary to vesicoureteric reflux. On further investigation, an isolated urogenital sinus anomaly with a calculus inside one of the hemivaginae was noted. She was managed expectantly with a plan to intervene at puberty. At puberty, during removal of the stone, the hemivaginal introitus was found to be stenotic. Gradually increasing sizes of Amplatz type graduated renal dilators were introduced from the introitus of the urogenital sinus into the hemivaginal stone until a size 22F Amplatz sheath could be passed easily. Size 10F cystoscope was passed through this channel, and the stone was fragmented using electrohydraulic lithotripsy. At a later date, she underwent staged anterior sagittal transvulval mobilization of the urogenital sinus.
Collapse
Affiliation(s)
- Ravibindu Sujeewa Ranawaka
- Department of Paediatric Urology, Royal Manchester Children's Hospital, Manchester M13 9WL, United Kingdom
| | - Anju Goyal
- Department of Paediatric Urology, Royal Manchester Children's Hospital, Manchester M13 9WL, United Kingdom
| | - Abdusamea Shabani
- Department of Paediatric Radiology, Royal Manchester Children's Hospital, Manchester M13 9WL, United Kingdom
| | - Supul Hennayake
- Department of Paediatric Urology, Royal Manchester Children's Hospital, Manchester M13 9WL, United Kingdom
| | - Alan P Dickson
- Department of Paediatric Urology, Royal Manchester Children's Hospital, Manchester M13 9WL, United Kingdom
| | - Raimondo M Cervellione
- Department of Paediatric Urology, Royal Manchester Children's Hospital, Manchester M13 9WL, United Kingdom.
| |
Collapse
|
13
|
Bavadiya G, shah C, Sarkar KK, Ghoshal P, Pathak H, Sarkar K. Unusual presentation of female bladder outlet obstruction- female hypospadias with urethral stenosis. Urol Case Rep 2020; 32:101243. [PMID: 32455118 PMCID: PMC7235932 DOI: 10.1016/j.eucr.2020.101243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 11/23/2022] Open
Abstract
Hypospadias is a rare birth deformity characterised by shortening of urethra with dorsal ectopia of the urethral meatus. The occurrence of hypospadias in female patients is extremely rare. We present a young female complaining of recurrent urinary tract infection and voiding difficulty caused by hypospadias.
Collapse
|
14
|
Uemura KI, Hayashi T, Hiroshige T, Ueda K, Ohta K, Kanazawa T, Hirashima S, Nakiri M, Igawa T, Nakamura KI. Ectopic subcutaneous transplantation of fetal rat urogenital sinus and seminal vesicle promotes the organ growth and formation. Acta Histochem 2020; 122:151569. [PMID: 32622420 DOI: 10.1016/j.acthis.2020.151569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE The fate of subcutaneously transplanted urogenital sinus (UGS) and seminal vesicle (SV) was investigated in the present study. MATERIALS AND METHODS Fetal UGS and SV extracted from 20-embryonic-day-old male normal and GFP transgenic rats were subcutaneously transplanted into 7-week-old male immunologically inhibited rats. The transplants were then examined at 2, 4, 8, and 16 weeks after transplantation. We analyzed the survival ratio, weight, and histopathology as well as the immunohistochemical characteristics of the transplanted tissues. For control experiments, 2-, 4-, 8-, and 16-week-old normal male rats were used. RESULTS Almost all of the transplanted tissues survived under the skin, and the tissue weights increased over time after transplantation. The histopathological characteristics and immunohistochemical staining pattern with certain antibodies of the transplanted tissues were similar to those of normal adult rat prostate and seminal vesicle. The transplanted GFP transgenic tissues demonstrated spontaneous growth and organ formation under the skin, showing distribution and movement of transplanted cells and tissues. CONCLUSION Subcutaneously transplanted fetal UGS and SV were able to develop into mature adult organs.
Collapse
Affiliation(s)
- Kei-Ichiro Uemura
- Division of Microscopic and Developmental Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan; Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
| | - Tokumasa Hayashi
- Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Tasuku Hiroshige
- Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Kosuke Ueda
- Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Keisuke Ohta
- Division of Microscopic and Developmental Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Tomonoshin Kanazawa
- Division of Microscopic and Developmental Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Shingo Hirashima
- Division of Microscopic and Developmental Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Makoto Nakiri
- Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Tsukasa Igawa
- Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Kei-Ichiro Nakamura
- Division of Microscopic and Developmental Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| |
Collapse
|
15
|
Hoshino S, Obara K, Hoshii T, Kuroki H, Watanabe K, Tomita Y. Virilization of a female infant genitalia caused by a maternal androgen-producing adrenocortical tumor: A case report. Urol Case Rep 2020; 32:101253. [PMID: 32477877 PMCID: PMC7248416 DOI: 10.1016/j.eucr.2020.101253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/07/2020] [Accepted: 05/11/2020] [Indexed: 11/30/2022] Open
Abstract
A 4-month-old girl presented us with genital ambiguity. The patient had a persistent urogenital sinus, posterior labial fusion with clitoromegaly. MRI reveals ovary-like mass in left inguinal region and right abdominal cavity. Uterus and vagina was also identified. Her mother was diagnosed with a right androgen-producing adrenocortical tumor 14 months after the birth of a virilized infant.
Collapse
Affiliation(s)
- Sayaka Hoshino
- Division of Urology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Kenji Obara
- Division of Urology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Tatsuhiko Hoshii
- Division of Urology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hiroo Kuroki
- Division of Urology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Kazuhiro Watanabe
- Division of Urology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yoshihiko Tomita
- Division of Urology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| |
Collapse
|
16
|
Weidler EM, Grimsby G, Garvey EM, Zwayne N, Chawla R, Hernandez J, Schaub T, Rink R, van Leeuwen K. Evolving indications for surgical intervention in patients with differences/disorders of sex development: Implications of deferred reconstruction. Semin Pediatr Surg 2020; 29:150929. [PMID: 32571514 PMCID: PMC7322933 DOI: 10.1016/j.sempedsurg.2020.150929] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Rare medical conditions are difficult to study due to the lack of patient volume and limited research resources, and as a result of these challenges, progress in the care of patients with these conditions is slow. Individuals born with differences of sex development (DSD) fall into this category of rare conditions and have additional social barriers due to the intimate nature of the conditions. There is also a lack of general knowledge in the medical community about this group of diverse diagnoses. Despite these limitations, progress has been made in the study of effective ways to care for patients who are born with chromosomal or anatomical differences of their internal reproductive organs or external genitalia. Advocacy groups have placed a spotlight on these topics and asked for a thoughtful approach to educate parents of newborns, medical providers, and the adolescents and young adults themselves as they mature.1 There is growing interest in the approaches to surgical reconstruction of the genitalia and the management of internal gonads, specifically the timing of procedures and the indications for those procedures.2 Advocates suggest deferring surgical procedures until the affected individual can participate in the decision-making process. This approach requires a roadmap for addressing the long-term implications of delayed surgical management. Presented here is a review of the specific issues regarding the complex management of the various categories of DSD.
Collapse
Affiliation(s)
- Erica M Weidler
- Division of Pediatric Surgery, Phoenix Children‟s Hospital, Phoenix, AZ
| | - Gwen Grimsby
- Division of Pediatric Urology, Phoenix Children‟s Hospital, Phoenix, AZ
| | - Erin M Garvey
- Division of Pediatric Surgery, Phoenix Children‟s Hospital, Phoenix, AZ
| | - Noor Zwayne
- Division of Pediatric and Adolescent Gynecology, Phoenix Children‟s Hospital, Phoenix, AZ
| | - Reeti Chawla
- Division of Pediatric Endocrinology, Phoenix Children‟s Hospital, Phoenix, AZ
| | - Janett Hernandez
- Division of Pediatric Surgery, Phoenix Children‟s Hospital, Phoenix, AZ
| | - Timothy Schaub
- Division of Plastic Surgery, Phoenix Children‟s Hospital, Phoenix, AZ
| | - Richard Rink
- Division of Pediatric Urology, Riley Hospital for Children, Indianapolis, IN
| | - Kathleen van Leeuwen
- Division of Pediatric Surgery, Phoenix Children's Hospital, Phoenix, AZ, 85006, United States.
| |
Collapse
|
17
|
AbouZeid AA, Mohammad SA. Transformation of the female genitalia in congenital adrenal hyperplasia: MRI study. J Pediatr Surg 2020; 55:977-984. [PMID: 32037221 DOI: 10.1016/j.jpedsurg.2020.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/11/2019] [Accepted: 01/16/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE In this report, we aim to define the different degrees of structural abnormality affecting the female genitalia in cases of CAH by using the multiplanar capabilities and high soft tissue resolution of MRI. PATIENTS AND METHODS The study included cases of CAH who were referred to our pediatric surgical facility for genital reconstruction during the period 2016 through 2019. We studied the pelvic MRI anatomy in cases of CAH while referring to clinical and operative findings. To set up a grading scale for the degree of virilization in cases of CAH, we included another two control groups of normal boys and girls representing the two ends of the spectrum. RESULTS The study included 23 cases of CAH who underwent preoperative pelvic MRI examination. All cases had normal chromosomal analysis (46 XX). Their age ranged from 1 to 156 months at time of MRI examination (mean 42.4; median 25). The level of the lower end of the vagina was identified in midsagittal T2WI and confirmed in sequential axial cuts. Based on the level of the lower end of the vagina in relation to the pubic symphysis, we classified cases of CAH into either low or high types. Moreover, we could observe a correlation between the degree of vaginal descent and structural transformation of erectile tissue between both genders. CONCLUSION MRI can have an important role in the evaluation of cases of CAH by displaying the severity of internal anomaly which is crucial for proper preoperative counseling. TYPE OF STUDY Case control study. LEVEL OF EVIDENCE Level III.
Collapse
|
18
|
Hougen HY, Seideman CA, Adam MP, Amies Oelschlager AM, Fechner PY, Ramsell L, Shnorhavorian M, Squire A, Austin JC. Congenital virilization of female infants recognized after pregnancies with retained levonorgestrel intrauterine devices. J Pediatr Urol 2020; 16:241-243. [PMID: 32265103 DOI: 10.1016/j.jpurol.2020.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 03/12/2020] [Indexed: 11/25/2022]
Abstract
The Mirena intrauterine device (IUD) is a hormone-secreting contraceptive device. Pregnancy with the Mirena is rare and effects to the fetus are unknown. Here we present four females with genital virilization after pregnancy with persistent Mirena IUD. All patients had a 46, XX karyotype and normal hormone evaluation. All underwent exam under anesthesia, demonstrating posterior labial fusion and short urogenital sinus with normal bladder, urethra, vagina, and cervix. Three of four patients underwent flap vaginoplasty without complications and good cosmetic outcomes. This series suggests that persistent levonorgestrel-secreting IUD during pregnancy is associated with genital virilization in female fetuses.
Collapse
Affiliation(s)
- Helen Y Hougen
- Department of Urology, Oregon Health and Sciences University, 3303 SW Bond Ave. CH10U. Portland, OR, 97239, USA.
| | - Casey A Seideman
- Division of Pediatric Urology, Department of Urology, Oregon Health and Sciences University, 3181 SW Sam Jackson Park Rd. Portland, OR, 97239, USA.
| | - Margaret P Adam
- Division of Genetic Medicine, Department of Pediatrics, University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, WA, 98105, USA; Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
| | - Anne-Marie Amies Oelschlager
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA, 98195, USA.
| | - Patricia Y Fechner
- Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA; Division of Endocrinology, Department of Pediatrics, University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Linda Ramsell
- Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Margarett Shnorhavorian
- Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA; Division of Pediatric Urology, Department of Urology, University of Washington School of Medicine, 4800 Sandpoint Way NE, Seattle, WA, 98105, USA.
| | - Audrey Squire
- Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - J Christopher Austin
- Division of Pediatric Urology, Department of Urology, Oregon Health and Sciences University, 3181 SW Sam Jackson Park Rd. Portland, OR, 97239, USA.
| |
Collapse
|
19
|
Chow JS, Paltiel HJ, Padua HM, McNamara E, Dickie BH. Case series: Comparison of contrast-enhanced genitosonography (ceGS) to fluoroscopy and cone-beam computed tomography in patients with urogenital sinus and the cloacal malformation. Clin Imaging 2019; 60:204-208. [PMID: 31927495 DOI: 10.1016/j.clinimag.2019.11.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/15/2019] [Accepted: 11/21/2019] [Indexed: 11/26/2022]
Abstract
In this case series, contrast enhanced genitosonography is compared to genitography performed using fluoroscopy and cone-beam computed tomography in patients with urogenital sinus and the cloacal malformation. The method of contrast enhanced genitosonography is described, including contrast preparation, contrast administration, ultrasound imaging approaches, as well as the benefits and potential pitfalls of this technique compared to fluoroscopy and computed tomography.
Collapse
Affiliation(s)
- Jeanne S Chow
- Boston Children's Hospital, 300 Longwood Avenue, Department of Radiology, Boston, MA 02115, United States of America.
| | | | | | | | | |
Collapse
|
20
|
Uchtmann KS, Taylor JA, Timms BG, Stahlhut RW, Ricke EA, Ellersieck MR, Vom Saal FS, Ricke WA. Fetal bisphenol A and ethinylestradiol exposure alters male rat urogenital tract morphology at birth: Confirmation of prior low-dose findings in CLARITY-BPA. Reprod Toxicol 2019; 91:131-141. [PMID: 31756437 DOI: 10.1016/j.reprotox.2019.11.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 11/08/2019] [Accepted: 11/18/2019] [Indexed: 02/06/2023]
Abstract
Bisphenol A (BPA) is a contaminant in virtually all Americans. To examine BPA's adverse effects, the FDA-NCTR, NIEHS, and 14 groups of academic scientists formed a consortium: CLARITY-BPA. The purpose of our study was to investigate the effects of a wide range of doses of BPA on fetal development of the NCTR CD-SD male rat urogenital sinus (UGS). Pregnant rats were administered BPA or positive control ethinylestradiol (EE2) daily, via oral gavage, from gestational day 6 through parturition. Tissues were collected on postnatal day 1 and the UGS was analyzed using computer-assisted 3-D reconstruction. Importantly, only low doses of BPA, as well as EE2, significantly changed birth weight and UGS morphology, including an increased size of the colliculus and decreased size of the urethra, consistent with prior reported BPA and EE2 effects. Our findings provide further evidence that BPA mediates nonmonotonic developmental effects on the fetal urogenital sinus.
Collapse
Affiliation(s)
- Kristen S Uchtmann
- Department of Urology, University of Wisconsin, Madison, WI 53705 USA; George M. O'Brien Center of Research Excellence, University of Wisconsin, Madison, WI 53705 USA
| | - Julia A Taylor
- Division of Biological Sciences, University of Missouri, Columbia, MO 65211 USA
| | - Barry G Timms
- Division of Basic Biological Sciences, University of South Dakota, Vermillion, SD 57069 USA
| | - Richard W Stahlhut
- Division of Biological Sciences, University of Missouri, Columbia, MO 65211 USA
| | - Emily A Ricke
- Department of Urology, University of Wisconsin, Madison, WI 53705 USA; George M. O'Brien Center of Research Excellence, University of Wisconsin, Madison, WI 53705 USA
| | - Mark R Ellersieck
- Department of Statistics, University of Missouri, Columbia, MO 65211 USA
| | | | - William A Ricke
- Department of Urology, University of Wisconsin, Madison, WI 53705 USA; University of Wisconsin Carbone Cancer Center, University of Wisconsin, Madison, WI 53705 USA; Molecular & Environmental Toxicology Center, University of Wisconsin, Madison, WI 53705 USA; George M. O'Brien Center of Research Excellence, University of Wisconsin, Madison, WI 53705 USA.
| |
Collapse
|
21
|
AbouZeid AA, Mohammad SA. The cloacal anomalies: Anatomical insights through a complex spectrum. J Pediatr Surg 2019; 54:2004-11. [PMID: 31072675 DOI: 10.1016/j.jpedsurg.2019.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 02/25/2019] [Accepted: 04/08/2019] [Indexed: 11/21/2022]
Abstract
PURPOSE To study the detailed anatomy of cloacal anomalies using the multiplanar capabilities of MRI in addition to other available modalities. PATIENTS AND METHODS The study was conducted on 27 cases of cloaca that were managed at our unit during the last 12 years. Preoperative assessment included conventional investigations and MRI studies. Endoscopic and operative findings were important for confirmation and completion of the whole picture. For better perception of the degree of deviation from the norm, we included another control group of girls who underwent pelvic MRI studies for causes other than anorectal anomalies. RESULTS For practical reasons, we dissociated the cloacal complex into its two basic components to be described separately namely the anorectal anomaly and persistent urogenital sinus. The anorectal anomaly may be best described regarding two parameters: the position of the rectum and type of rectal communication with the urogenital tract. Persistent urogenital sinus anomalies were stratified based on referring the level of the urogenital confluence to the back of pubic symphysis. Three types could be identified (low, intermediate, and high) in which the mean length of the common channel was 6.4, 14.6, and 24 mm respectively with a significant statistical difference (Kruskal-Wallis chi-squared test). CONCLUSION Applying MRI in the preoperative assessment of cases of cloaca has the advantage of demonstrating the real anatomy of the anomaly in multiple planes. This can improve our perception of the degree of deviation from the norm in these cases, which may be important during planning for surgical reconstruction. LEVEL OF EVIDENCE This is a case control study (level III evidence).
Collapse
|
22
|
Wegner KA, Mehta V, Johansson JA, Mueller BR, Keil KP, Abler LL, Marker PC, Taketo MM, Headon DJ, Vezina CM. Edar is a downstream target of beta-catenin and drives collagen accumulation in the mouse prostate. Biol Open 2019; 8:bio.037945. [PMID: 30745437 PMCID: PMC6451354 DOI: 10.1242/bio.037945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Beta-catenin (CTNNB1) directs ectodermal appendage spacing by activating ectodysplasin A receptor (EDAR) transcription, but whether CTNNB1 acts by a similar mechanism in the prostate, an endoderm-derived tissue, is unclear. Here we examined the expression, function, and CTNNB1 dependence of the EDAR pathway during prostate development. In situ hybridization studies reveal EDAR pathway components including Wnt10b in the developing prostate and localize these factors to prostatic bud epithelium where CTNNB1 target genes are co-expressed. We used a genetic approach to ectopically activate CTNNB1 in developing mouse prostate and observed focal increases in Edar and Wnt10b mRNAs. We also used a genetic approach to test the prostatic consequences of activating or inhibiting Edar expression. Edar overexpression does not visibly alter prostatic bud formation or branching morphogenesis, and Edar expression is not necessary for either of these events. However, Edar overexpression is associated with an abnormally thick and collagen-rich stroma in adult mouse prostates. These results support CTNNB1 as a transcriptional activator of Edar and Wnt10b in the developing prostate and demonstrate Edar is not only important for ectodermal appendage patterning but also influences collagen organization in adult prostates. This article has an associated First Person interview with the first author of the paper. Summary: This study provides a rare connection between beta catenin and ectodysplasin A receptor in an endoderm derived tissue and presents a potential mechanism for collagen accumulation in the prostate.
Collapse
Affiliation(s)
- Kyle A Wegner
- Molecular and Environmental Toxicology Center University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Vatsal Mehta
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Jeanette A Johansson
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh EH25 9RG, United Kingdom.,MRC Human Genetics Unit, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XR, United Kingdom
| | - Brett R Mueller
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Kimberly P Keil
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Lisa L Abler
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Paul C Marker
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - M Mark Taketo
- Division of Experimental Therapeutics, Graduate School of Medicine, Kyoto University Yoshida-Konoé-cho, Sakyo, Kyoto 606-8501, Japan
| | - Denis J Headon
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh EH25 9RG, United Kingdom
| | - Chad M Vezina
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, WI 53706, USA
| |
Collapse
|
23
|
Dannull KA, Browne LP, Meyers MZ. The spectrum of cloacal malformations: how to differentiate each entity prenatally with fetal MRI. Pediatr Radiol 2019; 49:387-398. [PMID: 30547222 DOI: 10.1007/s00247-018-4302-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 09/21/2018] [Accepted: 10/31/2018] [Indexed: 01/13/2023]
Abstract
The term cloacal malformation is commonly used to describe the classic cloacal malformation where there is a single common urogenital and intestinal channel located at the expected site of the urethra. There is, however, a spectrum of cloacal abnormalities that differ from this classic type and are less well discussed in the radiologic and surgical literature. The aim of this pictorial essay is to familiarize radiologists with the anatomy, appropriate terminology and key prenatal imaging findings that differentiate the six entities that constitute the spectrum of cloacal abnormalities.
Collapse
Affiliation(s)
- Kimberly A Dannull
- Department of Diagnostic Radiology, Division of Pediatric Radiology,, Children's Hospital Colorado,, 13123 East 16th Ave., Mailbox B-463,, Aurora, CO, 80045, USA.
- Department of Radiology,, University of Colorado School of Medicine,, Anschutz Medical Campus, Aurora, CO, USA.
| | - Lorna P Browne
- Department of Diagnostic Radiology, Division of Pediatric Radiology,, Children's Hospital Colorado,, 13123 East 16th Ave., Mailbox B-463,, Aurora, CO, 80045, USA
- Department of Radiology,, University of Colorado School of Medicine,, Anschutz Medical Campus, Aurora, CO, USA
| | - Mariana Z Meyers
- Department of Diagnostic Radiology, Division of Pediatric Radiology,, Children's Hospital Colorado,, 13123 East 16th Ave., Mailbox B-463,, Aurora, CO, 80045, USA
- Department of Radiology,, University of Colorado School of Medicine,, Anschutz Medical Campus, Aurora, CO, USA
| |
Collapse
|
24
|
Halleran DR, Ahmad H, Ching C, Gorra A, McCracken K, Wood RJ, Levitt MA. Acquired Urethrovaginal Fistula and Urethral Atresia in a Patient with a Sacrococcygeal Teratoma. J Pediatr Surg 2019; 54:612-5. [PMID: 30297116 DOI: 10.1016/j.jpedsurg.2018.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 09/17/2018] [Indexed: 11/22/2022]
Abstract
Acquired urethrovaginal fistulae and urethral atresia are rare findings in pediatric patients, but have been described in adult patients related to trauma or iatrogenic injury. Little exists in the published literature to guide management of such conditions in children, but lessons learned from congenital causes can help. Herein we discuss the preoperative evaluation and management of a child with an acquired urethrovaginal fistula and urethral atresia likely related to in utero compression from an intrapelvic sacrococcygeal teratoma and provide several images detailing the complex anatomy.
Collapse
|
25
|
Halleran DR, Thompson B, Fuchs M, Vilanova-Sanchez A, Rentea RM, Bates DG, McCracken K, Hewitt G, Ching C, DaJusta D, Levitt MA, Wood RJ. Urethral length in female infants and its relevance in the repair of cloaca. J Pediatr Surg 2019; 54:303-6. [PMID: 30503195 DOI: 10.1016/j.jpedsurg.2018.10.094] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 10/30/2018] [Indexed: 11/21/2022]
Abstract
AIM OF THE STUDY The goals of urinary reconstruction in urogenital sinus and cloacal repair include: (1) positioning of the bladder neck above the urogenital diaphragm to maximize future urinary continence, and (2) creating a visible urethra that can be catheterized if needed. A recent algorithm in cloacal reconstruction proposed a urethral length of 1.5 cm as the key determinant in deciding whether to perform a total urogenital mobilization or a urogenital separation, the hypothesis being that a 1.5 cm length urethra is needed for the patient to remain dry. We wondered if the normal female urethral length correlated with this empiric technical determinant. METHODS We reviewed voiding cystourethrograms of healthy female patients between ages 6 and 36 months and measured the patient's urethral length. RESULTS Ninety-one children were included. The mean urethral length for patients age 6-12 months was 2.50 cm, age 12-24 months was 2.31 cm, and age 24-36 months was 2.59 cm. There was no difference between the urethral length in the three groups (p = 0.38). Of 91 patients, 87 (96%) had a urethral length >1.5 cm. CONCLUSION A urethra of at least 1.5 cm was present in the majority of normal control patients. We believe therefore that for urogenital sinus and cloacal repair, surgeons can extrapolate that patients need a 1.5 cm urethra at the end of the reconstruction. Additional follow-up is needed to determine if this urethral length as an independent factor maintains dryness in the long term after cloacal repair. TYPE OF STUDY Case Series. LEVEL OF EVIDENCE III.
Collapse
|
26
|
Chiaramonte C, Vestri E, Tripi F, Giannone AG, Cimador M, Cataliotti F. Bladder Mucosal Graft Vaginoplasty: A Case Report. J Pediatr Adolesc Gynecol 2018; 31:528-532. [PMID: 29929017 DOI: 10.1016/j.jpag.2018.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 06/08/2018] [Accepted: 06/11/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Female vaginoplasty reconstruction, by choice, is usually performed with adjacent tissue. However in some clinical conditions such as high urogenital confluence sinus, cloacal malformation with extreme vaginal hypoplasia, local tissue may not be available. When vaginal replacement is performed in pediatric patients intestinal segments is preferred to non-operative procedures that require continuative dilations. However mucus production, malignant transformation risk and diversion colitis are important side effects. TECHNIQUE We present a nouvel technique for vaginoplasty in a female child presenting with an isolated urogenital sinus malformation without virilization. The patient at 20 months underwent vaginoplasty using tubularized bladder mucosal graft. RESULTS Surgical procedure was devoid of complications. Pubertal development occurred at age of 15. She underwent regular follow up until 18 years of age. At this age we performed clinical evaluation: absence of vaginal introitus stenosis and good cosmetic results were observed. Then she underwent vaginoscopy with multiple biopsies. Pathology examination of the bladder mucosal graft evidenced a normal structure of the mucosa, with a stratified squamous epithelium. DISCUSSION Different techniques are taken into account for vaginal reconstruction according to the severity and to the type of malformation. We describe the use of bladder mucosal graft with favorable results after long term follow-up.
Collapse
Affiliation(s)
| | - Elettra Vestri
- Department of Mother and Child Health, University of Palermo, Italy
| | - Flavia Tripi
- Department of Mother and Child Health, University of Palermo, Italy
| | | | - Marcello Cimador
- Department of Mother and Child Health, University of Palermo, Italy
| | | |
Collapse
|
27
|
Cunha GR, Robboy SJ, Kurita T, Isaacson D, Shen J, Cao M, Baskin LS. Development of the human female reproductive tract. Differentiation 2018; 103:46-65. [PMID: 30236463 PMCID: PMC6234064 DOI: 10.1016/j.diff.2018.09.001] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 08/31/2018] [Accepted: 09/03/2018] [Indexed: 12/12/2022]
Abstract
Development of the human female reproductive tract is reviewed from the ambisexual stage to advanced development of the uterine tube, uterine corpus, uterine cervix and vagina at 22 weeks. Historically this topic has been under-represented in the literature, and for the most part is based upon hematoxylin and eosin stained sections. Recent immunohistochemical studies for PAX2 (reactive with Müllerian epithelium) and FOXA1 (reactive with urogenital sinus epithelium and its known pelvic derivatives) shed light on an age-old debate on the derivation of vaginal epithelium supporting the idea that human vaginal epithelium derives solely from urogenital sinus epithelium. Aside for the vagina, most of the female reproductive tract is derived from the Müllerian ducts, which fuse in the midline to form the uterovaginal canal, the precursor of uterine corpus and uterine cervix an important player in vaginal development as well. Epithelial and mesenchymal differentiation markers are described during human female reproductive tract development (keratins, homeobox proteins (HOXA11 and ISL1), steroid receptors (estrogen receptor alpha and progesterone receptor), transcription factors and signaling molecules (TP63 and RUNX1), which are expressed in a temporally and spatially dynamic fashion. The utility of xenografts and epithelial-mesenchymal tissue recombination studies are reviewed.
Collapse
Affiliation(s)
- Gerald R Cunha
- Department of Urology, University of California, 400 Parnassus Avenue, San Francisco, CA 94143, USA.
| | - Stanley J Robboy
- Department of Pathology, Duke University Medical Center, DUMC 3712, Durham, NC 27710, USA
| | - Takeshi Kurita
- Department of Cancer Biology and Genetics, College of Medicine, Comprehensive Cancer Center, Ohio State University, 812 Biomedical Research Tower, 460 W. 12th Avenue, Columbus, OH 43210, USA
| | - Dylan Isaacson
- Department of Urology, University of California, 400 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Joel Shen
- Department of Urology, University of California, 400 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Mei Cao
- Department of Urology, University of California, 400 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Laurence S Baskin
- Department of Urology, University of California, 400 Parnassus Avenue, San Francisco, CA 94143, USA
| |
Collapse
|
28
|
Silveira LTR, de Mello Santos T, Camora LF, Pinho CF, Anselmo-Franci JA, Domeniconi RF, Justulin LA, Barbisan LF, Scarano WR. Protective effect of resveratrol on urogenital sinus and prostate development in rats exposed in utero to TCDD (2,3,7,8-tetrachlorodibenzo-p-dioxin). Reprod Toxicol 2018; 83:82-92. [PMID: 29935225 DOI: 10.1016/j.reprotox.2018.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 06/07/2018] [Accepted: 06/19/2018] [Indexed: 12/21/2022]
Abstract
This study evaluated the protective effects of resveratrol on the prostate development of rats exposed to TCDD. Pregnant rats received TCDD (1 μg/kg) at GD15 and/or RES (20 mg/kg/day) from GD10 to PND21. Newborn and adult males from Control, TCDD, TCDD + RES and RES groups were euthanized and the prostate was excised. On PND1, there was a reduction in the number of prostatic buds, AR-positive mesenchymal cells and proliferation index in epithelial and mesenchymal cells in TCDD group, but restored by RES. AhR immunoreactivity was greater in TCDD group than the other groups. On PND90, there was higher frequency of functional hyperplasia in the distal area of the prostate acini in TCDD group, but restored by RES. AhRR expression was higher in the TCDD while NRF2 was higher in the TCDD + RES compared to the other groups. Resveratrol was able to reduce the adverse effects of TCDD on prostate development and its long-term repercussions.
Collapse
Affiliation(s)
| | | | - Lucas Fredini Camora
- Department of Morphology, São Paulo State University - UNESP, Institute of Biosciences, Brazil
| | | | | | | | - Luis Antonio Justulin
- Department of Morphology, São Paulo State University - UNESP, Institute of Biosciences, Brazil
| | - Luis Fernando Barbisan
- Department of Morphology, São Paulo State University - UNESP, Institute of Biosciences, Brazil
| | | |
Collapse
|
29
|
Jesus VM, Buriti F, Lessa R, Toralles MB, Oliveira LB, Barroso U Jr. Total urogenital sinus mobilization for ambiguous genitalia. J Pediatr Surg 2018; 53:808-12. [PMID: 28917585 DOI: 10.1016/j.jpedsurg.2017.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 08/11/2017] [Accepted: 08/11/2017] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Genital ambiguity is a very common phenomenon in disorders of sex development (DSD). According to the Chicago Consensus 2006, feminizing genitoplasty, when indicated, should be performed in the most virilized cases (Prader III to V). Advances in the knowledge of genital anatomy in DSD have enabled the development and improvement of various surgical techniques. Mobilization of the urogenital sinus (MUS), first described by Peña, has become incorporated by most surgeons. However, the proximity of the urethral sphincter prompts concern over urinary incontinence, especially for full mobilization of the urogenital sinus. OBJECTIVE To retrospectively evaluate the short-term surgical results of feminizing genitoplasty with total mobilization of the urogenital sinus in patients with DSD. METHODS Review of medical records of all patients undergoing feminizing genitoplasty with mobilization of the urogenital sinus. We evaluated the rates of complications from surgery and of urinary incontinence, as well as cosmetic results, according to the opinion of the surgeon and the family. RESULTS A total of 8 patients were included in the study. The mean age at surgery was 51months. Congenital adrenal hyperplasia (CAH) was diagnosed in six patients, and gonadal dysgenesis in the other two. The vagina was separated from the urethra, with suitable distance in all cases. No patient had urinary incontinence after surgery. The mean follow-up of patients was. 20months (3-56months). In all cases, surgeons recorded being satisfied with the aesthetic result of post-surgical genitalia. The family was recorded as satisfied with the aesthetic result of the genitalia after surgery. In every case, there was no need for a second surgical procedure. CONCLUSION The total mobilization of the urogenital sinus is a feasible and safe technique. The technique permits good cosmetic results, and urinary incontinence is absent. TYPE OF STUDY Therapeutic study. LEVEL OF EVIDENCE Level III.
Collapse
|
30
|
Abstract
Hydrometrocolpos is a rare condition in which the uterus and the vagina are grossly distended with a retained fluid other than pus or blood. It may present during the neonatal period or later at puberty. Most cases reported earlier were stillbirths and were diagnosed only on autopsy. Antenatal diagnosis is now possible with the advent of ultrasound. An early diagnosis and speedy management is the key to survival. Many previous case reports have focused on the varied clinical presentations, multiple causes, associated syndromes and/or the radiological diagnosis of this condition. However, management options for different types of hydrometrocolpos have not yet been concisely discussed. We have reviewed the literature and tried to summarize the management options applicable to most case scenarios of hydrometrocolpos.
Collapse
Affiliation(s)
- Kashish Khanna
- Department of Pediatric Surgery, All India Institute of Medical Sciences, R. No 4002, 4th floor, Ansari Nagar, New Delhi, 110029, India
| | - Shilpa Sharma
- Department of Pediatric Surgery, All India Institute of Medical Sciences, R. No 4002, 4th floor, Ansari Nagar, New Delhi, 110029, India
| | - D K Gupta
- Department of Pediatric Surgery, All India Institute of Medical Sciences, R. No 4002, 4th floor, Ansari Nagar, New Delhi, 110029, India.
| |
Collapse
|
31
|
Mallmann MR, Reutter H, Mack-Detlefsen B, Gottschalk I, Geipel A, Berg C, Boemers TM, Gembruch U. Prenatal Diagnosis of Hydro(metro)colpos: A Series of 20 Cases. Fetal Diagn Ther 2018; 45:62-68. [PMID: 29478043 DOI: 10.1159/000486781] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 12/29/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hydrocolpos and hydrometrocolpos are rare malformations caused by accumulation of secretion due to congenital obstruction of the vagina. Hydro(metro)colpos may be isolated or can be combined with other malformations as part of a syndromic disorder. We report on a series of 20 cases with hydro(metro)colpos diagnosed prenatally, delineate the differential diagnoses, and illustrate the spectrum of associated malformations. SUBJECTS AND METHODS This was a retrospective study involving 20 fetuses with hydro(metro)colpos at two large tertiary referral centers in Germany over an 18-year period (2000-2017). RESULTS The median diagnosis was made at 30+4 weeks of gestation, the earliest at 20+6 weeks, the latest at 37+2 weeks. All 20 fetuses presented with the typical cystic structure behind the fetal bladder. Additional malformations included urogenital malformations, hexadactyly, and heart defects. Postnatal follow-up revealed that hydro(metro)colpos was associated with anorectal malformation in 11/20 fetuses, McKusick-Kaufman syndrome or Bardet-Biedl syndrome in 4/20 fe tuses, Mayer-Rokitansky-Küster-Hauser syndrome in 3/20 fetuses, and Herlyn-Werner-Wunderlich syndrome in 1/20. In 1 fetus pressure from an intraabdominal teratoma resulted in prenatal hydro(metro)colpos. CONCLUSION Hydro(me tro)colpos is a rare prenatal sonographic feature. Multidisciplinary prenatal counseling should include all potential syndromes that can present with hydro(metro)colpos in the prenatal setting.
Collapse
Affiliation(s)
- Michael R Mallmann
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, .,Department of Obstetrics and Gynecology, University of Cologne, Cologne,
| | - Heiko Reutter
- Department of Neonatology and Pediatric Intensive Care, University of Bonn, Bonn, Germany.,Institute of Human Genetics, University of Bonn, Bonn, Germany
| | - Birte Mack-Detlefsen
- Department of Pediatric Surgery and Pediatric Urology, Children's Hospital of Cologne, Cologne, Germany
| | - Ingo Gottschalk
- Department of Obstetrics and Gynecology, University of Cologne, Cologne, Germany
| | - Annegret Geipel
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - Christoph Berg
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany.,Department of Obstetrics and Gynecology, University of Cologne, Cologne, Germany
| | - Thomas M Boemers
- Department of Pediatric Surgery and Pediatric Urology, Children's Hospital of Cologne, Cologne, Germany
| | - Ulrich Gembruch
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| |
Collapse
|
32
|
Ashour K, Shehata S, Osheba A. Cystourethroscopy versus contrast studies in urogenital sinus and cloacal anomalies in children. J Pediatr Surg 2018; 53:313-315. [PMID: 29223670 DOI: 10.1016/j.jpedsurg.2017.11.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 11/08/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cloacal malformation is a spectrum of diseases affecting females, resulting in abnormal confluence of the urinary system, genital system, and/or gastrointestinal system. Proper reconstruction depends mainly on accurate preoperative illustration of the abnormal anatomy. Among the various modalities to delineate the urogenital sinus and the distances to confluence, lies the radiological contrast study, as well as the preoperative diagnostic cystourethroscopy. AIM OF THE STUDY The aim of this study was to compare the accuracy of the contrast study and diagnostic cystourethroscopy in the demonstration of the exact changes in anatomy resulting from urogenital sinus / cloacal abnormalities. METHODS Sixteen girls with median age 21 (11-27) months were studied. They included 4 girls with complete cloacal anomalies and 12 girls with persistent urogenital sinus secondary to congenital adrenal hyperplasia (CAH). Contrast studies and diagnostic cystourethroscopy were applied to all cases. Accuracy of both methods in delineating the abnormal anatomy was evaluated by comparison against intraoperative findings. Data are presented as median (range) or %. RESULTS Contrast studies accurately delineated the abnormal anatomy in 12 (75%), cases with 50% and 85% accuracy in cases of cloacal anomalies and persistent urogenital sinus, respectively. Cystourethroscopy was overall accurate in 15 cases (94%), with accuracy of 75% in cloacal anomalies and 100% in persistent urogenital sinus. CONCLUSION Although the presented series is small, it suggests that cystourethroscopy is superior to contrast studies in preoperative illustration of the abnormal anatomy in cases of cloacal malformations. These findings warrant confirmation in larger series. TYPE OF STUDY Diagnostic study. LEVEL OF EVIDENCE II.
Collapse
Affiliation(s)
| | | | - Ahmed Osheba
- Alexandria University Hospital, Alexandria, Egypt
| |
Collapse
|
33
|
Wood RJ, Reck-Burneo CA, Dajusta D, Ching C, Jayanthi R, Bates DG, Fuchs ME, McCracken K, Hewitt G, Levitt MA. Cloaca reconstruction: a new algorithm which considers the role of urethral length in determining surgical planning. J Pediatr Surg 2017; 53:S0022-3468(17)30644-9. [PMID: 29132797 DOI: 10.1016/j.jpedsurg.2017.10.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 10/05/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cloacal malformations represent a uniquely complex challenge for surgeons. The surgical approach to date has been based on the common channel (CC) length with two patient groups considered: less than or greater than 3cm, which we believe is an oversimplification. We reviewed 19 patients, referred after surgery done elsewhere. Eight had postoperative urinary complications, 3 had constant urinary leakage and had been left after surgery with a urethra <1cm, .5 with an original 3 to 5cm common channel, who had undergone total urogenital mobilization (TUM), experienced peri-operative urethral loss needing a vesicostomy, and later, a Mitrofanoff. These patients together with a review of the cloacal and urological literature led us to design a new algorithm where urethral length is a key determinant for care. METHODS We prospectively collected data on 31 consecutive cloaca patients referred to our team (2014 to 2016) and managed according to this new protocol. The CC length, urethral length, surgical technique employed, and initial outcomes were recorded. RESULTS Of 31 primary cases, CC length was 1 to 3cm in 20, 3 to 5cm in 9, and greater than 5cm in 2. In the 1 to 3cm and the 3 to 5cm groups, a urethra less than 1.5cm led us to perform an urogenital separation. We only performed a TUM if the urethra was greater than 1.5cm. Using this protocol, we performed a urogenital separation in 1 of 20 in the 1 to 3cm CC group, 6 of 9 in the 3 to 5cm CC group, and 2 of 2 in the greater than 5cm CC group. Seven patients underwent separation, who with the previous approach, would have had a TUM. Thus far, no urinary leakage or urethral loss has occurred in any patient, but follow-up is less than 3years. CONCLUSION Urethral length appears to be a vitally important component in cloacal reconstruction. A short urethra left after repair can lead to urinary leakage. A TUM done under the wrong circumstances can lead to urethral loss. We describe a new technical approach to cloacal repair which considers urethral length but recognize that long term urological outcomes will need to be carefully documented. TYPE OF STUDY Clinical cohort study with no comparative group. LEVEL OF EVIDENCE Level 4.
Collapse
Affiliation(s)
- Richard J Wood
- The Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
| | - Carlos A Reck-Burneo
- The Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Daniel Dajusta
- The Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Christina Ching
- The Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Rama Jayanthi
- The Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - D Gregory Bates
- Department of Radiology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Molly E Fuchs
- The Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Katherine McCracken
- The Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Geri Hewitt
- The Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Marc A Levitt
- The Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| |
Collapse
|
34
|
Robboy SJ, Kurita T, Baskin L, Cunha GR. New insights into human female reproductive tract development. Differentiation 2017; 97:9-22. [PMID: 28918284 DOI: 10.1016/j.diff.2017.08.002] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 07/31/2017] [Accepted: 08/01/2017] [Indexed: 01/01/2023]
Abstract
We present a detailed review of the embryonic and fetal development of the human female reproductive tract utilizing specimens from the 5th through the 22nd gestational week. Hematoxylin and eosin (H&E) as well as immunohistochemical stains were used to study the development of the human uterine tube, endometrium, myometrium, uterine cervix and vagina. Our study revisits and updates the classical reports of Koff (1933) and Bulmer (1957) and presents new data on development of human vaginal epithelium. Koff proposed that the upper 4/5ths of the vagina is derived from Müllerian epithelium and the lower 1/5th derived from urogenital sinus epithelium, while Bulmer proposed that vaginal epithelium derives solely from urogenital sinus epithelium. These conclusions were based entirely upon H&E stained sections. A central player in human vaginal epithelial development is the solid vaginal plate, which arises from the uterovaginal canal (fused Müllerian ducts) cranially and squamous epithelium of urogenital sinus caudally. Since Müllerian and urogenital sinus epithelium cannot be unequivocally identified in H&E stained sections, we used immunostaining for PAX2 (reactive with Müllerian epithelium) and FOXA1 (reactive with urogenital sinus epithelium). By this technique, the PAX2/FOXA1 boundary was located at the extreme caudal aspect of the vaginal plate at 12 weeks. During the ensuing weeks, the PAX2/FOXA1 boundary progressively extended cranially such that by 21 weeks the entire vaginal epithelium was FOXA1-reactive and PAX2-negative. This observation supports Bulmer's proposal that human vaginal epithelium derives solely from urogenital sinus epithelium. Clearly, the development of the human vagina is far more complex than previously envisioned and appears to be distinctly different in many respects from mouse vaginal development.
Collapse
Affiliation(s)
- Stanley J Robboy
- Department of Pathology, Duke University, Davison Building, Box 3712, Durham, NC 27710, United States.
| | - Takeshi Kurita
- Department of Cancer Biology and Genetics, The Comprehensive Cancer Center, Ohio State University, 460 W. 12th Avenue, 812 Biomedical Research Tower, Columbus, OH 43210, United States
| | - Laurence Baskin
- Department of Urology, University of California, 400 Parnassus Avenue, San Francisco, CA 94143, United States
| | - Gerald R Cunha
- Department of Urology, University of California, 400 Parnassus Avenue, San Francisco, CA 94143, United States
| |
Collapse
|
35
|
Abstract
Female patients with congenital adrenal hyperplasia (CAH) have varying degrees of atypical genitalia secondary to prenatal and postnatal androgen exposure. Surgical treatment is focused on restoring normal genitalia anatomy by bringing the vagina to the normal position on the perineum, separating the distal vagina from the urethra, forming a normal introitus and preserving sexual function of the clitoris by accepting moderate degrees of hypertrophy as normal and strategically reducing clitoral size only in the most severely virilized patients. There remains a need for continued monitoring of patients as they go through puberty with the possibility of additional surgery for vaginal stenosis. Anatomically based surgery and refinement in surgical techniques with acceptance of moderate degrees of clitoral hypertrophy as normal should improve long-term outcomes.
Collapse
Affiliation(s)
- Laurence S Baskin
- UCSF Benioff Children's Hospital, 1825 Fourth St, 5th Floor, San Francisco, CA 94143.
| |
Collapse
|
36
|
Park HJ, Bolton EC. RET-mediated glial cell line-derived neurotrophic factor signaling inhibits mouse prostate development. Development 2017; 144:2282-2293. [PMID: 28506996 DOI: 10.1242/dev.145086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 05/10/2017] [Indexed: 01/15/2023]
Abstract
In humans and rodents, the prostate gland develops from the embryonic urogenital sinus (UGS). The androgen receptor (AR) is thought to control the expression of morphogenetic genes in inductive UGS mesenchyme, which promotes proliferation and cytodifferentiation of the prostatic epithelium. However, the nature of the AR-regulated morphogenetic genes and the mechanisms whereby AR controls prostate development are not understood. Glial cell line-derived neurotrophic factor (GDNF) binds GDNF family receptor α1 (GFRα1) and signals through activation of RET tyrosine kinase. Gene disruption studies in mice have revealed essential roles for GDNF signaling in development; however, its role in prostate development is unexplored. Here, we establish novel roles of GDNF signaling in mouse prostate development. Using an organ culture system for prostate development and Ret mutant mice, we demonstrate that RET-mediated GDNF signaling in UGS increases proliferation of mesenchyme cells and suppresses androgen-induced proliferation and differentiation of prostate epithelial cells, inhibiting prostate development. We also identify Ar as a GDNF-repressed gene and Gdnf and Gfrα1 as androgen-repressed genes in UGS, thus establishing reciprocal regulatory crosstalk between AR and GDNF signaling in prostate development.
Collapse
Affiliation(s)
- Hyun-Jung Park
- Department of Molecular and Integrative Physiology, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Eric C Bolton
- Department of Molecular and Integrative Physiology, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| |
Collapse
|
37
|
Jin ZW, Abe H, Hinata N, Li XW, Murakami G, Rodríguez-Vázquez JF. Descent of mesonephric duct to the final position of the vas deferens in human embryo and fetus. Anat Cell Biol 2016; 49:231-240. [PMID: 28127497 PMCID: PMC5266102 DOI: 10.5115/acb.2016.49.4.231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 09/28/2016] [Accepted: 12/08/2016] [Indexed: 11/27/2022] Open
Abstract
Because the ureter arises from the mesonephric or Wolffian duct (WD), the WD opening should migrate inferiorly along the urogenital sinus or future urethra. However, this process of descent has not been evaluated morphometrically in previous studies and we know little about intermediate morphologies for the descent. In the present work, serial sagittal sections of 15 specimens at gestational age 6-12 weeks and serial horizontal sections of 20 specimens at 6-10 weeks were analyzed. Monitoring of horizontal sections showed that, until 9 weeks, a heart-, lozenge- or oval-shape of the initial urogenital sinus remained in the bladder and urethra. Thus, the future bladder and urethra could not be distinguished by the transverse section or plane. The maximum width of the urogenital sinus or bladder at 6-10 weeks was 0.8 mm, although its supero-inferior length reached 5 mm at 10 weeks. During earlier stages, however, the medial shift of the WD was rather evident. Depending on the extent of upward growth of the bladder smooth muscle, the descent of the vas deferens became evident at 10-12 weeks. Development of the urethral rhabdosphincter likely resulted in the differentiation of urogenital sinus into the urethra and bladder before formation of the bladder neck with 3-layered smooth muscles. Development of the prostate followed these morphological changes, later accelerating the further descent of the WD opening. Because of their close topographical relationships, slight anomalies or accidents of the umbilical cord at 10-12 weeks may have a significant effect on normal anatomy.
Collapse
Affiliation(s)
- Zhe Wu Jin
- Department of Anatomy, Histology and Embryology, Yanbian University Medical College, Yanji, China
| | - Hiroshi Abe
- Department of Anatomy, Akita University School of Medicine, Akita, Japan
| | - Nobuyuki Hinata
- Department of Urology, Kobe University School of Medicine, Kobe, Japan
| | - Xiang Wu Li
- Department of Anatomy, Histology and Embryology, Yanbian University Medical College, Yanji, China
| | - Gen Murakami
- Division of Internal Medicine, Iwamizawa Asuka Hospital, Iwamizawa, Japan
| | | |
Collapse
|
38
|
Lindert J, Hiort O, Tüshaus L, Tafazzoli-Lari K, Wünsch L. Perineal ultrasound offers useful information in girls with congenital adrenal hyperplasia. J Pediatr Urol 2016; 12:427.e1-427.e6. [PMID: 27751833 DOI: 10.1016/j.jpurol.2016.08.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 08/22/2016] [Indexed: 10/21/2022]
Abstract
A variable spectrum of urogenital malformations exists in girls with congenital adrenal hyperplasia (CAH). The vagina may enter the urethra at a variable level, and relations to the sphincter complex vary accordingly. Furthermore, an enlarged clitoris and variations in the bladder sphincter anatomy can be found. Endoscopy, genitography or magnetic resonance imaging (MRI) are commonly used for the assessment of these anomalies, and to provide information for counselling and treatment. When surgery is planned, introitoplasty cosmetical reduction of the clitoris and labioplasty are discussed with the families; introitoplasty is the most demanding aspect. In order to plan the most appropriate surgical approach, the entrance level of the vagina into the urethra and its relation to the bladder sphincter must be known. Thus, imaging has an important role in CAH. The imaging techniques mentioned above require sedation, anaesthesia or involve ionizing radiation of the gonads and, thus, are relatively invasive. It would therefore be highly desirable to have a minimally invasive and accurate technique that provides images of the individual anatomic situation. The present paper describes experience with perineal ultrasound in the initial imaging evaluation of girls with CAH. Ultrasound findings were compared to the results of endoscopy that was performed before surgery. From 2006 to 2012, 11 girls had perineal ultrasound and endoscopy. Measurements of clinical relevance for introitoplasty were: the length of the urogenital sinus, the distance to the vaginal opening into the urogenital sinus, and the length of the bladder neck. This retrospective analysis showed that the entrance point of the vagina into the urogenital sinus could be identified in 10 of 11 girls. In some cases, the correlation of endoscopic and ultrasound data showed a correlation between endoscopic and sonographic findings. The length of the bladder neck and the length of the urogenital sinus could be measured by ultrasound in 10 of 11 girls, and were subsequently confirmed by endoscopy. This showed, for the first time, that perineal ultrasound could provide the information required for surgical correction of the urogenital sinus anomaly in CAH. Advantages of these techniques are the minimal invasiveness and wide availability. Because long-term problems are not uncommon, perineal ultrasound may also be of value during follow-up. Widespread use of this technique has the potential to reduce costs and morbidity associated with endoscopy and genitography.
Collapse
Affiliation(s)
- J Lindert
- Department of Paediatric Surgery, University of Lübeck, Ratzeburger Alle 160, 23538 Lübeck, Germany.
| | - O Hiort
- Division of Paediatric Endocrinology and Diabetes, University of Lübeck, Ratzeburger Alle 160, 23538 Lübeck, Germany
| | - L Tüshaus
- Department of Paediatric Surgery, University of Lübeck, Ratzeburger Alle 160, 23538 Lübeck, Germany
| | - K Tafazzoli-Lari
- Department of Paediatric Surgery, University of Lübeck, Ratzeburger Alle 160, 23538 Lübeck, Germany
| | - L Wünsch
- Department of Paediatric Surgery, University of Lübeck, Ratzeburger Alle 160, 23538 Lübeck, Germany
| |
Collapse
|
39
|
Marei MM, Fares AE, Abdelsattar AH, Abdullateef KS, Seif H, Hassan MM, Elkotby M, Eltagy G, Elbarbary MM. Anatomical measurements of the urogenital sinus in virilized female children due to congenital adrenal hyperplasia. J Pediatr Urol 2016; 12:282.e1-8. [PMID: 26994589 DOI: 10.1016/j.jpurol.2016.02.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 02/06/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Virilized females due to congenital adrenal hyperplasia represent the most common form of female disorders of sexual development. The anomaly therein is an external virilization to resemble male genitalia and a persistent urogenital sinus. OBJECTIVES To study the anatomical details of the virilized female cases operated upon between 2011 and 2015. This anatomical description is presented to support the current surgical strategy of partial urogenital mobilization to correct this anomaly. METHODS Thirty cases (presenting to a single tertiary center) were prospectively studied by genitography, cysto-urethroscopy, and operated upon via a single-stage feminizing genitoplasty. A single surgical team operated upon all cases. External virilization was assessed by the Prader classification. The internal anatomy was studied by measuring the length of the urethra proximal to the confluence, and the vertical depth of the vaginal-urethral confluence from the perineum. The correlation coefficients between the external virilization and the internal anatomical measurements were derived. RESULTS The median age at surgery was 19 months (range 6-42 months). External virilization did not obviously correlate with the length of the proximal (prejunctional) urethra (r = -0.03, P = 0.5), or strongly with the depth of the vaginal-urethral confluence (r = 0.2, P = 0.2). The mean length of the proximal urethra was 22 mm (range 10-32 mm), and the mean vertical depth of the vaginal-urethral confluence from the perineum was 16 mm (range 8-31 mm). DISCUSSION Due to limitations of the radiological and endoscopic evaluation, the accurate anatomical assessment of this condition may be challenging. In order to assess or compare the anatomy of these cases, there are two important points to address: (1) the length of the urethra proximal to the urogenital sinus, as this will impact the urinary outcome; and (2) the depth (level) of vaginal entry into the urogenital sinus, as this will affect the mobilization required to exteriorize the vagina. CONCLUSION The degree of external virilization does not totally correlate with the internal anatomy. The depth of the vaginal-urethral confluence from the perineum is an indicator of the required mobilization for the current perineal approach. In 90% of cases in this age group (1-3 years old), this depth is ≤20 mm. This supports the current understanding that partial urogenital mobilization could be suitable for most cases Figure (Summary).
Collapse
|
40
|
Abstract
This is a summary of the milestones in the history of the treatment of cloacal malformations. It is based in a comprehensive literature review of the subject, from the early times, followed by a description of the evolution of the surgical maneuvers that were created, to be able to deal with the different anatomical variants of this complex congenital malformation.
Collapse
Affiliation(s)
- Alberto Peña
- International Center for Colorectal Care, Children's Hospital Colorado, 13123 East 16th Avenue, Box 323, Anschutz Medical Campus, Aurora, CO 80045.
| |
Collapse
|
41
|
Uemura KI, Ohta K, Kanazawa T, Hayashi T, Tanoue R, Yoshitomi M, Hirashima S, Suekane S, Matsuoka K, Igawa T, Nakamura KI. Subcutaneous transplantation promotes organ formation of the fetal rat urogenital sinus. Acta Histochem 2015; 117:512-20. [PMID: 25858530 DOI: 10.1016/j.acthis.2015.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 03/07/2015] [Accepted: 03/09/2015] [Indexed: 11/19/2022]
Abstract
The aim of this study is to develop a novel experimental model of the subcutaneous transplantation of fetal urogenital sinus (UGS) into normal and castrated adult male rats for the pathophysiological investigation of the normal and developing prostate. Fetal UGS obtained from 20-day-old male rat embryos was subcutaneously transplanted into 7-week-old normal and castrated male rats. We observed the growth pattern, histopathological characteristics and immunohistochemical localization of cytokeratin 5 (CK 5), cytokeratin 8 (CK 8) and androgen receptor (AR) in the transplanted tissues. Almost all of the transplanted UGS organs gradually increased in weight over time in the non-castrated recipient animals, and the histopathological observations and immunohistochemical analysis of CK 5 and CK 8 revealed that the morphological changes in the tissues were in accordance with the features of normal prostate development. The histological characteristics included glandular epithelial dominant and stromal dominant area, with an increase in the glandular epithelial dominant areas over time and resemblance among a portion of the transplanted tissues within a certain period during the developmental course to the histopathology of human benign prostatic hyperplasia (BPH). The effects of androgens and resemblance in the immunohistochemical localization pattern changes in AR to that observed in the normal differentiating rat prostate were also noted. We conclude that the subcutaneous space provides an adequate microenvironment for UGS growth.
Collapse
Affiliation(s)
- Kei-ichiro Uemura
- Division of Microscopic and Developmental Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan; Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
| | - Keisuke Ohta
- Division of Microscopic and Developmental Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Tomonoshin Kanazawa
- Division of Microscopic and Developmental Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Tokumasa Hayashi
- Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Ryuichiro Tanoue
- Division of Microscopic and Developmental Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Munetake Yoshitomi
- Division of Microscopic and Developmental Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Shingo Hirashima
- Division of Microscopic and Developmental Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Shigetaka Suekane
- Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Kei Matsuoka
- Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Tsukasa Igawa
- Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Kei-ichiro Nakamura
- Division of Microscopic and Developmental Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| |
Collapse
|
42
|
Georgas KM, Armstrong J, Keast JR, Larkins CE, McHugh KM, Southard-Smith EM, Cohn MJ, Batourina E, Dan H, Schneider K, Buehler DP, Wiese CB, Brennan J, Davies JA, Harding SD, Baldock RA, Little MH, Vezina CM, Mendelsohn C. An illustrated anatomical ontology of the developing mouse lower urogenital tract. Development 2015; 142:1893-908. [PMID: 25968320 DOI: 10.1242/dev.117903] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 04/01/2015] [Indexed: 01/10/2023]
Abstract
Malformation of the urogenital tract represents a considerable paediatric burden, with many defects affecting the lower urinary tract (LUT), genital tubercle and associated structures. Understanding the molecular basis of such defects frequently draws on murine models. However, human anatomical terms do not always superimpose on the mouse, and the lack of accurate and standardised nomenclature is hampering the utility of such animal models. We previously developed an anatomical ontology for the murine urogenital system. Here, we present a comprehensive update of this ontology pertaining to mouse LUT, genital tubercle and associated reproductive structures (E10.5 to adult). Ontology changes were based on recently published insights into the cellular and gross anatomy of these structures, and on new analyses of epithelial cell types present in the pelvic urethra and regions of the bladder. Ontology changes include new structures, tissue layers and cell types within the LUT, external genitalia and lower reproductive structures. Representative illustrations, detailed text descriptions and molecular markers that selectively label muscle, nerves/ganglia and epithelia of the lower urogenital system are also presented. The revised ontology will be an important tool for researchers studying urogenital development/malformation in mouse models and will improve our capacity to appropriately interpret these with respect to the human situation.
Collapse
Affiliation(s)
- Kylie M Georgas
- Institute for Molecular Bioscience, The University of Queensland, St Lucia, Queensland 4072, Australia
| | - Jane Armstrong
- Center for Integrative Physiology, University of Edinburgh, Edinburgh EH8 9XD, UK
| | - Janet R Keast
- Department of Anatomy and Neuroscience, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Christine E Larkins
- Department of Molecular Genetics and Microbiology, University of Florida, Gainesville, FL 32610, USA
| | - Kirk M McHugh
- Centre for Molecular and Human Genetics, The Research Institute at Nationwide Children's Hospital and Division of Anatomy, The Ohio State University, Columbus, OH 43205/10, USA
| | - E Michelle Southard-Smith
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Martin J Cohn
- Department of Molecular Genetics and Microbiology, University of Florida, Gainesville, FL 32610, USA Department of Biology, Genetics Institute, University of Florida, Gainesville, FL 32610, USA Howard Hughes Medical Institute, University of Florida, Gainesville, FL 32610, USA
| | | | - Hanbin Dan
- Columbia University, Department of Urology, New York, NY 10032, USA
| | - Kerry Schneider
- Columbia University, Department of Urology, New York, NY 10032, USA
| | - Dennis P Buehler
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Carrie B Wiese
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Jane Brennan
- Center for Integrative Physiology, University of Edinburgh, Edinburgh EH8 9XD, UK
| | - Jamie A Davies
- Center for Integrative Physiology, University of Edinburgh, Edinburgh EH8 9XD, UK
| | - Simon D Harding
- MRC Human Genetics Unit, MRC IGMM, Western General Hospital, Edinburgh EH4 2XU, UK
| | - Richard A Baldock
- MRC Human Genetics Unit, MRC IGMM, Western General Hospital, Edinburgh EH4 2XU, UK
| | - Melissa H Little
- Institute for Molecular Bioscience, The University of Queensland, St Lucia, Queensland 4072, Australia
| | - Chad M Vezina
- University of Wisconsin-Madison, School of Veterinary Medicine, Madison, WI 53706, USA
| | - Cathy Mendelsohn
- Columbia University, Department of Urology, New York, NY 10032, USA
| |
Collapse
|
43
|
Cunha GR, Risbridger G, Wang H, Place NJ, Grumbach M, Cunha TJ, Weldele M, Conley AJ, Barcellos D, Agarwal S, Bhargava A, Drea C, Hammond GL, Siiteri P, Coscia EM, McPhaul MJ, Baskin LS, Glickman SE. Development of the external genitalia: perspectives from the spotted hyena (Crocuta crocuta). Differentiation 2014; 87:4-22. [PMID: 24582573 DOI: 10.1016/j.diff.2013.12.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Revised: 11/14/2013] [Accepted: 12/06/2013] [Indexed: 11/23/2022]
Abstract
This review/research paper summarizes data on development of the external genitalia of the spotted hyena, a fascinating mammal noted for extreme masculinization of the female external genitalia. The female spotted hyena is the only extant mammal that mates and gives birth through a pendulous penis-like clitoris. Our studies indicate that early formation of the phallus in both males and females is independent of androgens; indeed the phallus forms before the fetal testes or ovaries are capable of synthesizing androgens. Likewise, pre- and postnatal growth in length of the penis and clitoris is minimally affected by "androgen status". Nonetheless, several internal morphologies, as well as external surface features of the phallus, are androgen-dependent and thus account for dimorphism between the penis and clitoris. Finally, estrogens play a critical role in penile and clitoral development, specifying the position of the urethral orifice, determining elasticity of the urethral meatus, and facilitating epithelial-epithelial fusion events required for proper formation of the distal urethra/urogenital sinus and prepuce. Accordingly, prenatal inhibition of estrogen synthesis via administration of letrozole (an aromatase inhibitor) leads to malformations of the glans as well as the prepuce (hypospadias). The effects of prenatal androgens, anti-androgens and impaired estrogen synthesis correlated with the tissue expression of androgen and estrogen receptors.
Collapse
|
44
|
Keil KP, Abler LL, Mehta V, Altmann HM, Laporta J, Plisch EH, Suresh M, Hernandez LL, Vezina CM. DNA methylation of E-cadherin is a priming mechanism for prostate development. Dev Biol 2014; 387:142-53. [PMID: 24503032 DOI: 10.1016/j.ydbio.2014.01.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 12/20/2013] [Accepted: 01/23/2014] [Indexed: 12/31/2022]
Abstract
In prostate and other epithelial cancers, E-cadherin (CDH1) is downregulated inappropriately by DNA methylation to promote an invasive phenotype. Though cancer frequently involves a reawakening of developmental signaling pathways, whether DNA methylation of Cdh1 occurs during organogenesis has not been determined. Here we show that DNA methylation of Cdh1 mediates outgrowth of developing prostate ducts. During the three-day gestational window leading up to and including prostate ductal initiation, Cdh1 promoter methylation increases and its mRNA and protein abundance decreases in epithelium giving rise to prostatic buds. DNA methylation is required for prostate specification, ductal outgrowth, and branching morphogenesis. All three endpoints are impaired by a DNA methylation inhibitor, which also decreases Cdh1 promoter methylation and increases Cdh1 mRNA and protein abundance. A CDH1 function-blocking antibody restores prostatic identity, bud outgrowth, and potentiates epithelial differentiation in the presence of the DNA methylation inhibitor. This is the first study to mechanistically link acquired changes in DNA methylation to the normal process of prostate organogenesis. We propose a novel mechanism whereby Cdh1 promoter methylation restricts Cdh1 abundance in developing prostate epithelium to create a permissive environment for prostatic bud outgrowth. Thus, DNA methylation primes the prostate primordium to respond to developmental cues mediating outgrowth, differentiation and maturation of the ductal network.
Collapse
Affiliation(s)
- Kimberly P Keil
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, 1656 Linden Drive, Madison, WI 53706, USA
| | - Lisa L Abler
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, 1656 Linden Drive, Madison, WI 53706, USA
| | - Vatsal Mehta
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, 1656 Linden Drive, Madison, WI 53706, USA
| | - Helene M Altmann
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, 1656 Linden Drive, Madison, WI 53706, USA
| | - Jimena Laporta
- Department of Dairy Science, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Erin H Plisch
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - M Suresh
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Laura L Hernandez
- Department of Dairy Science, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Chad M Vezina
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, 1656 Linden Drive, Madison, WI 53706, USA.
| |
Collapse
|
45
|
Capito C, Belarbi N, Paye Jaouen A, Leger J, Carel JC, Oury JF, Sebag G, El-Ghoneimi A. Prenatal pelvic MRI: additional clues for assessment of urogenital obstructive anomalies. J Pediatr Urol 2014; 10:162-6. [PMID: 24054781 DOI: 10.1016/j.jpurol.2013.07.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 07/23/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Ultrasound prenatal evaluation of pelvic cystic mass can be challenging. After having ruled out a cloaca anterior to a large hydrocolpos, it is important to differentiate between combined urogenital anomalies such as urogenital sinus and isolated genital anomalies. PATIENTS AND METHODS We reviewed the charts of 13 women referred for a third trimester pelvic MRI for cystic pelvic mass discovered in second trimester ultrasound. We evaluated MRI compared with postnatal surgical findings in order to determine clues for improving prenatal diagnoses. RESULTS MRI excluded the diagnosis of cloacal malformation in nine cases with no false negative. Once a cloaca is ruled out, a different signal between the bladder and the hydrocolpos on T2 sequences is in favor of an isolated genital obstruction. In contrast, in case of urogenital sinus, the vagina is filled with a mixture of genital secretions and urine, which gives it an MRI signal similar to the bladder on T2 sequences. CONCLUSION Third trimester fetal MRI is an essential exam for characterization of pelvic cystic mass diagnosed by ultrasound. This exam appears valuable for invalidating the diagnosis of cloacal malformation and for differentiating between isolated genital obstruction and urogenital sinus.
Collapse
Affiliation(s)
- Carmen Capito
- AP-HP, Hôpital Robert Debré, Service de Chirurgie Viscérale et d'Urologie Pédiatriques, centre de référence de maladies endocriniennes Rares de la Croissance, F-75019 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, F-75019 Paris, France.
| | - Nadia Belarbi
- AP-HP, Hôpital Robert Debré, Service de Radiologie Pédiatrique, Paris, France.
| | - Annabel Paye Jaouen
- AP-HP, Hôpital Robert Debré, Service de Chirurgie Viscérale et d'Urologie Pédiatriques, centre de référence de maladies endocriniennes Rares de la Croissance, F-75019 Paris, France.
| | - Juliane Leger
- Université Paris Diderot, Sorbonne Paris Cité, F-75019 Paris, France; AP-HP, Hôpital Robert Debré, Service d'Endocrinologie Diabétologie Pédiatrique et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, F-75019 Paris, France; Institut National de la Santé et de la Recherche Médicale Unité UMR 676, F-75019 Paris, France.
| | - Jean-Claude Carel
- Université Paris Diderot, Sorbonne Paris Cité, F-75019 Paris, France; AP-HP, Hôpital Robert Debré, Service d'Endocrinologie Diabétologie Pédiatrique et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, F-75019 Paris, France; Institut National de la Santé et de la Recherche Médicale Unité UMR 676, F-75019 Paris, France.
| | - Jean-François Oury
- Université Paris Diderot, Sorbonne Paris Cité, F-75019 Paris, France; AP-HP, Hôpital Robert Debré, Service de Gynécologie, Obstétrique et Diagnostic Prénatal, F-75019 Paris, France.
| | - Guy Sebag
- AP-HP, Hôpital Robert Debré, Service de Radiologie Pédiatrique, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, F-75019 Paris, France.
| | - Alaa El-Ghoneimi
- AP-HP, Hôpital Robert Debré, Service de Chirurgie Viscérale et d'Urologie Pédiatriques, centre de référence de maladies endocriniennes Rares de la Croissance, F-75019 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, F-75019 Paris, France.
| |
Collapse
|
46
|
Chan BK, Turnock RR, McAndrew HF. Urinary incontinence - an unusual indication for early vaginoplasty in late presenting congenital adrenal hyperplasia. J Pediatr Adolesc Gynecol 2013; 26:e103-4. [PMID: 23602038 DOI: 10.1016/j.jpag.2013.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 12/08/2012] [Accepted: 02/05/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Congenital adrenal hyperplasia (CAH) is an autosomal recessive condition leading to deficient cortisol with an incidence of 1/16,000. Patients with CAH typically present early with ambiguous genitalia or as an emergency with adrenal crisis. CASE We report an atypical late presentation of a 4-year-old girl with pubertal-like symptoms and urinary incontinence, due to a persistent urogenital sinus (UGS). An early vaginoplasty was successfully performed allowing the patient to achieve continence. CONCLUSION Literature describing the symptoms of CAH with UGS is scarce. The case is unusual in demonstrating pubertal-like symptoms and urinary incontinence due to the late presentation of a persistent UGS, highlighting the need for an open mind in assessment of children with urinary incontinence. Timing of surgery is controversial, and cases need to be considered on an individual basis.
Collapse
|
47
|
Keil KP, Altmann HM, Mehta V, Abler LL, Elton EA, Vezina CM. Catalog of mRNA expression patterns for DNA methylating and demethylating genes in developing mouse lower urinary tract. Gene Expr Patterns 2013; 13:413-24. [PMID: 23920106 DOI: 10.1016/j.gep.2013.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 06/07/2013] [Accepted: 07/25/2013] [Indexed: 10/26/2022]
Abstract
The mouse prostate develops from a component of the lower urinary tract (LUT) known as the urogenital sinus (UGS). This process requires androgens and signaling between mesenchyme and epithelium. Little is known about DNA methylation during prostate development, including which factors are expressed, whether their expression changes over time, and if DNA methylation contributes to androgen signaling or influences signaling between mesenchyme and epithelium. We used in situ hybridization to evaluate the spatial and temporal expression pattern of mRNAs which encode proteins responsible for establishing, maintaining or remodeling DNA methylation. These include DNA methyltransferases, DNA deaminases, DNA glycosylases, base excision repair and mismatch repair pathway members. The mRNA expression patterns were compared between male and female LUT prior to prostatic bud formation (14.5 days post coitus (dpc)), during prostatic bud formation (17.5 dpc) and during prostatic branching morphogenesis (postnatal day (P) 5). We found dramatic changes in the patterns of these mRNAs over the course of prostate development and identified examples of sexually dimorphic mRNA expression. Future investigation into how DNA methylation patterns are established, maintained and remodeled during the course of embryonic prostatic bud formation may provide insight into prostate morphogenesis and disease.
Collapse
Affiliation(s)
- Kimberly P Keil
- Department of Comparative Biosciences, University of Wisconsin-Madison, 1656 Linden Dr., Madison, WI 53706, USA
| | | | | | | | | | | |
Collapse
|
48
|
Abstract
Objectives To provide a review and summary of recent advances in the diagnosis and management of disorder(s) of sexual differentiation (DSD), an area that has developed over recent years with implications for the management of children with DSD; and to assess the refinements in the surgical techniques used for genital reconstruction. Methods Recent publications (in the previous 10 years) were identified using PubMed, as were relevant previous studies, using following keywords; ‘diagnosis and management’, ‘ambiguous genitalia’, ‘intersex’, ‘disorders of sexual differentiation’, ‘genitogram’, ‘endocrine assessment’, ‘gender assignment’, ‘genitoplasty’, and ‘urogenital sinus’. The findings were reviewed. Results Arbitrary criteria have been developed to select patients likely to have DSD. Unnecessary tests, especially those that require anaesthesia or are associated with radiation exposure, should be limited to situations where a specific question needs to be answered. Laparoscopy is an important diagnostic tool in selected patients. The routine use of multidisciplinary diagnostic and expert surgical teams has become standard. Full disclosure of different therapeutic approaches and their timing is recommended. Conclusions Diagnostic tests should be tailored according to the available information. Parents and/or patients should be made aware of the paucity of well-designed studies, as these conditions are rare. Unnecessary irreversible surgery should be postponed until a multidisciplinary experienced team, with the parents’ and or patients’ approval, can make a well-judged decision.
Collapse
|
49
|
Sahinoglu Z, Cerrah Celayir A, Resit Asoglu M, Özcan N. Type IV Sacrococcygeal Teratoma Associated with Urogenital Sinus: Difficulties in the Prenatal Differential Diagnosis. J Neonatal Surg 2013; 2:9. [PMID: 26023429 PMCID: PMC4420355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Accepted: 08/27/2012] [Indexed: 11/10/2022] Open
Abstract
Sacrococcygeal teratoma (SCT) is being more often detected due to availability of prenatal ultrasonography. Type IV SCT could be misdiagnosed as cloacal abnormalities due to the pelvic midline cystic mass associated with renal malformations and obstructive uropathy during the pregnancy. We discuss difficulties in the prenatal differential diagnosis of SCT and urogenital sinus in a 26-year-old pregnant woman, admitted to our prenatal diagnosis centre for a detailed US for a pre-sacral mass.
Collapse
Affiliation(s)
- Zeki Sahinoglu
- Department of Obstetrics and Gynecology, Zeynep Kamil Women and Child Diseases Education and Research Hospital Istanbul, Turkey.
| | - Aysenur Cerrah Celayir
- Department of Pediatric Surgery, Zeynep Kamil Women and Child Diseases Education and Research Hospital Istanbul, Turkey.
| | - Mehmet Resit Asoglu
- Department of Obstetrics and Gynecology, Zeynep Kamil Women and Child Diseases Education and Research Hospital Istanbul, Turkey.
| | - Nahit Özcan
- Sonomed Medical Imaging Center, Istanbul, Turkey.
| |
Collapse
|
50
|
Masumoto H, Takenaka A, Rodríguez-Vázquez JF, Murakami G, Matsubara A. Reappraisal of intergender differences in the urethral striated sphincter explains why a completely circular arrangement is difficult in females: a histological study using human fetuses. Anat Cell Biol 2012; 45:79-85. [PMID: 22822461 PMCID: PMC3398178 DOI: 10.5115/acb.2012.45.2.79] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 05/01/2012] [Accepted: 05/02/2012] [Indexed: 11/29/2022] Open
Abstract
To investigate why the development of a completely circular striated sphincter is so rare, we examined histological sections of 11 female and 11 male mid-term human fetuses. In male fetuses, the striated muscle initially extended in the frontal, rather than in the horizontal plane. However, a knee-like portion was absent in the female fetal urethra because, on the inferior side of the vaginal end, a wide groove for the future vestibule opened inferiorly. Accordingly, it was difficult for the developing striated muscle to surround the groove, even though there was not a great difference in width or thickness between the female vestibule and the male urethra. The development of a completely circular striated sphincter seems to be impossible in females because of interruption of the frontal plane by the groove-like vestibule. However, we cannot rule out the possibility that before descent of the vagina, the urethral striated muscle extends posteriorly.
Collapse
Affiliation(s)
- Hiroshi Masumoto
- Department of Urology, National Hospital Organization Higashi-Hiroshima Medical Center, Higashi-Hiroshima, Japan
| | | | | | | | | |
Collapse
|