This document provides an overview of the anatomy of the male urethra. It discusses the embryology, parts including the prostatic, membranous, bulbar, and penile urethra. It describes the gross structure, relations, blood supply, innervation and clinical correlations like injuries and strictures. Additionally, it briefly covers the anatomy of the female urethra. The document is intended as an educational guide for medical students and residents in the department of urology.
location, length, and relation of right an left ureter, raletion of male an female ureter, n physiological site of ureteric constriction, bloo supply an inerve supply of ureter, clinical sinificance of ureter with hysteriectpomy
Anatomy of urinary bladder. surfaces, border of urinary bladder its relation , ligament support, peritoneal relation in male and females, pouches, blood supply of bladder, nerve supply of bladder, true and false ligament of urinary bladder,
location, length, and relation of right an left ureter, raletion of male an female ureter, n physiological site of ureteric constriction, bloo supply an inerve supply of ureter, clinical sinificance of ureter with hysteriectpomy
Anatomy of urinary bladder. surfaces, border of urinary bladder its relation , ligament support, peritoneal relation in male and females, pouches, blood supply of bladder, nerve supply of bladder, true and false ligament of urinary bladder,
Dr. Prabin Kumar Bam, MBBS
Anatomy of urinary bladder, introduction, gross features, histology, relations, interior of the bladder, trigone of bladder, uvula vesicae, ligaments of urinary bladder, histology of urinary bladder,
Prabin Kumar Bam
Development of urethra with male and female developmental difference .
The development of male & female urethra is different . The female urethra is short
&
its development is very simple .but male urethra is long
&
its development is complicated
The epithelium of entire female urethra
&
most of the male urethra is derived from urogenital sinus
Urogenital sinus is developed from cloaca
Cloaca : part of hindgut caudal to attachment of allantois, which is common chamber for hindgut & urinary system
Dr. Prabin Kumar Bam, MBBS
Anatomy of urinary bladder, introduction, gross features, histology, relations, interior of the bladder, trigone of bladder, uvula vesicae, ligaments of urinary bladder, histology of urinary bladder,
Prabin Kumar Bam
Development of urethra with male and female developmental difference .
The development of male & female urethra is different . The female urethra is short
&
its development is very simple .but male urethra is long
&
its development is complicated
The epithelium of entire female urethra
&
most of the male urethra is derived from urogenital sinus
Urogenital sinus is developed from cloaca
Cloaca : part of hindgut caudal to attachment of allantois, which is common chamber for hindgut & urinary system
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdf
Urethra anatomy 1
1. ANATOMY OF URETHRA
Dept of Urology
Govt Royapettah Hospital and Kilpauk Medical College
Chennai
1
2. Moderators:
Professors:
• Prof. Dr. G. Sivasankar, M.S., M.Ch.,
• Prof. Dr. A. Senthilvel, M.S., M.Ch.,
Asst Professors:
• Dr. J. Sivabalan, M.S., M.Ch.,
• Dr. R. Bhargavi, M.S., M.Ch.,
• Dr. S. Raju, M.S., M.Ch.,
• Dr. K. Muthurathinam, M.S., M.Ch.,
• Dr. D. Tamilselvan, M.S., M.Ch.,
• Dr. K. Senthilkumar, M.S., M.Ch.
Dept Of Urology, KMC and GRH, Chennai 2
4. • Prostatic Urethra .Prox.-mesonephric duct
Distal –urogenital sinus
• Membranous U. & prox. Penile U - urogenital sinus
• Distal penile U.-ingrowth of ectodermal cells of glans.
Dept Of Urology, KMC and GRH, Chennai 4
5. • epithelialized tube for the passage of urine and semen
• “anterior” urethra extends from the meatus to the proximal
bulbar urethra
• “posterior” urethra extends from the bladder neck to the
distal membranous urethra
Dept Of Urology, KMC and GRH, Chennai 5
6. Male urethra
• 18–20 cm long
• from internal orifice in the urinary bladder to the meatus
THE ANTERIOR URETHRA ( 16 cm long)
proximally - lies within the perineum
distally - within the penis , surrounded by the corpus-
- spongiosum.
THE POSTERIOR URETHRA ( 4 cm long)
lies in the pelvis proximal to the corpus spongiosum
where it is acted upon by the urogenital sphincter mechanism
Dept Of Urology, KMC and GRH, Chennai 6
7. Parts of urethra
Parts of anetrior urethra
• Fossa navicularis: lined with stratified squamous epithelium
• Pendulous urethra: at the centre of c.spongiosum and lined by lined simple
squamous epithelium
• Bulbous urethra: closer to dorsal aspect of the c.spongiosum, lined distally
with squamous epithelium & transitional epithelium .
Dept Of Urology, KMC and GRH, Chennai 7
8. Parts of distal urethra
• Membranous urethra :traverses the perineal pouch and surrounded
by external urethral sphincter
• Prostatic urethra :proximal to the membranous urethra and is mostly
surrounded by the prostate
• Bladder neck is the location of the bladder neck musculature,
surrounded by intravesical protrusion of the prostate
Dept Of Urology, KMC and GRH, Chennai 8
11. Pre-prostatic urethra
• 1-1.5cm in length
• Circular smooth M.is thickened to form invol.int.sphincter
• Small periurethral glands, extend between smooth M.to be enclosed
by preprostatic sphincter. They form <1% secretary element &
contribute significant prostatic volume in old age
• Smooth M. of this part prevents retrograde ejaculation.
Dept Of Urology, KMC and GRH, Chennai 11
12. Prostatic urethra
• 3–4 cm in length
• closer to the anterior than the posterior surface of the gland.
• It is continuous above with the preprostatic part and emerges from the
prostate slightly anterior to its apex
• Throughout its length the posterior wall possesses a midline ridge, THE
URETHRAL CREST.
• On each side of the crest there is a shallow depression, the PROSTATIC
SINUS, the floor of which is perforated by the orifices of 15–20
PROSTATIC DUCTS.
Dept Of Urology, KMC and GRH, Chennai 12
13. Prostatic urethra …CONTD
• Verumontanum(seminal colliculus), is seen at about the middle of the
length of the urethral crest: surgical landmark for the
urethral sphincter during TURP
• At this point the urethra turns anteriorly by 35° and contains the slit-like
orifice of the PROSTATIC UTRICLE.
•
• Utricle ,a 6mm mullerian remnant, a sac project into prostate. Forms
diverticulam in ambiguous genitalia pt
• Both sides of, or just within, this orifice are the two small openings of
the ejaculatory ducts.
.
• The lowermost part of the prostatic urethra is fixed by the puboprostatic
ligaments and is therefore immobile.
Dept Of Urology, KMC and GRH, Chennai 13
15. Membranous urethra
• Within the urogenital diaphragm
• From apex of prostate to perineal membrane
• Thickly invested by Smooth & striated Muscle
• M. form an incomplete ring at post.midline resembling omega letter
• Its action is more of compressive than spincteric.
Dept Of Urology, KMC and GRH, Chennai 15
17. • Urinary continence
• located along the urethra from
the bladder neck to the distal
membranous urethra
• Continence after anastomotic
urethroplasty for post-traumatic
posterior urethral stenosis is
maintained solely by the
proximal urethral continence
mechanism
Dept Of Urology, KMC and GRH, Chennai 17
18. • Urinary continence
• Five “sphincters” are recognized
Dept Of Urology, KMC and GRH, Chennai 18
20. Urinary continence at the level of the
membranous urethra is mediated by
• radial folds of urethral mucosa-lumen occlude
• submucosal connective tissue-urethral sealing intrinsic urethral smooth
muscle,
• striated muscle fibres pubourethral component of levatorani.
Dept Of Urology, KMC and GRH, Chennai 20
22. Bulbar urethra
• Enveloped by penile bulb,bulbospongious Muscle
• Sup. -suspensory ligament
• Inf. -penoscortal junction
• Bifurcation of urethral crest extents from prostatic apex to penile bulb
• Bulbourethral glands drain into proximal bulbar.U
• Intra bulbar part –dilated
Dept Of Urology, KMC and GRH, Chennai 22
23. Bulbar urethra
• RELATIONS :
- dorsal vein complex………>anteriorly,
- levatorani…………………………….>laterally
- perineal body & rectourethralis ………>posteriorly,
• suspended from the pubis by fibrous tissue that extends from its
anterior and lateral parts to the puboprostatic liagaments
posteriorly and to the suspensory ligament of the penis anteriorly.
• The bulbourethral glands are invested in sphincteric muscle and drain
into the membranous urethra during sexual excitement.
Dept Of Urology, KMC and GRH, Chennai 23
26. Penile urethra
• Within the corpus spongiosum
• Extents from Inf. fascia of Urogenital diaphragm to ext.urethral meatus
• Transversely slit like lumen,during micturation it expands to 6 mm
• Navicullar fossa-dilated part
• External urethral meatus-narrowest part
Dept Of Urology, KMC and GRH, Chennai 26
27. Narrowings
3 narrow areas:
at the membraneous part
at the junction of glans with corpous spongiosum
at external urethral meatus
Dept Of Urology, KMC and GRH, Chennai 27
29. Urethral curvatures
• Reverse S shaped
• 1. Penoscortal angle
• 2.Bulbar urethra raises up behind symphysis. Overcome by lowering
the instrument.
• 3.large endovesical median lobe: compensated by lowering eye
piece of instrument, pain in unanethetized pt.
Forceful advancement may perforate median lobe.
Dept Of Urology, KMC and GRH, Chennai 29
30. • intramural part- varies in length & caliber –depends on bladder
capacity
• Prostatic U.-widest & most dilatable
• Memb. U. least dilatable = tone of urethral sphincter & rigid
perineal membrane
• Penile U. Most dependent part. Common site for ch. Inflammation &
strictures
Dept Of Urology, KMC and GRH, Chennai 30
31. Glands & recesses
• Bulbourethral glands(cowper’s )
-on the floor of memb.urethra
• Submucosal urethral glands(littre’s)
-on the roof of penile urethra
• Lacuna magna
-large recesses in the roof of F. navicularis
Dept Of Urology, KMC and GRH, Chennai 31
32. Posterior wall of male urethra
Dept Of Urology, KMC and GRH, Chennai 32
33. Urethral epithelium
• Prostatic - transitional
• Membraneous –stratified columnar
• Penile -pseudostratified columnar
• Fossa naviculoris-stratified squmous
Dept Of Urology, KMC and GRH, Chennai 33
34. Devlopmental anamoly of urethra
• Posterior urethral valve
• Congenital Urethral Fistula
• Congenital Urethral stricture
• Congenital Urethral polyp
• Urethral Duplication
• megalourethra
Dept Of Urology, KMC and GRH, Chennai 34
35. Arterial Supply of the Urethra
• Dual artrial supply
• Proximal urethra in an antegrade fashion, and the distal urethra in a
retrograde fashion.
• The internal pudendal artery branches into the perineal artery and
posterior scrotal artery
Dept Of Urology, KMC and GRH, Chennai 35
36. Arterial supply
• Prostatic - inf. Vesical, mid.rectal A.
• Membranous - artery of bulb (int.pudendal A.)
• Penile -urethral,bulbar, penile A.
• Blood supply through C. Spongiosum is plenty
• Urethra can be divided without compromising its vascularity
Dept Of Urology, KMC and GRH, Chennai 36
37. Arterial supply
• Prostatic - inf. Vesical,mid.rectal A.
• Memb. - art. Of bulb (int.pudendal A.)
• Penile -urethral,bulbar, penile A.
•
• Blood supply through C. Spongiosum is plenty
• Urethra can be divided without compromising
• - its vascularity
Dept Of Urology, KMC and GRH, Chennai 37
38. • After division of the bulbar
arteries, blood supply of the
proximal bulbar urethra
depends on the retrograde
blood supply along its spongy
tissue.
Dept Of Urology, KMC and GRH, Chennai 38
39. VENOUS SUPPLY
Anterior urethra drains into the dorsal veins of the penis & internal
pudendal veins, which drain to the prostatic plexus.
• Posterior urethra drains into the prostatic plexuses, which drain into
the internal iliac veins and vesical venous plexus
Dept Of Urology, KMC and GRH, Chennai 39
41. LYMPHATIC DRAINAGE
• Vessels from the posterior urethra pass mainly to the internal iliac
nodes
• Vessels from the membranous urethra accompany the internal
pudendal artery.
• Vessels from the anterior urethra accompany those of the glans penis,
ending in the deep inguinal nodes.
Dept Of Urology, KMC and GRH, Chennai 41
42. NERVE INNERVATION
• prostatic plexus supplies the smooth muscle of the prostate & prostatic
urethra.
• On each side it is derived from the pelvic plexus and lies on the
posterolateral aspect of the seminal vesicle and prostate
• Lesser cavernous nerves pierce the bulb of the corpus spongiosum
proximally to supply the penile urethra.
• Greater cavernous nerves carry the sympathetic supply which causes
contraction of the preprostatic sphincter during ejaculation and prevents
reflux of ejaculate into the bladder.
• parasympathetic preganglionic fibres are axons from neurones in the
second to fourth sacral spinal segments.
Dept Of Urology, KMC and GRH, Chennai 42
43. • The nerve supply of the external urethral sphincter is controversial.
It is believed to be supplied by neurones in Onuf's nucleus& by perineal
branches of the pudendal nerve lying on the perineal aspect of the
pelvic floor
• Fibres from Onuf's nucleus (somatic) travel with the pelvic plexus on
each side until they branch off and run on the pelvic aspect of the pelvic
floor to enter the membranous urethra.
Dept Of Urology, KMC and GRH, Chennai 43
45. Ant. Urethral injuries
• Extravasation depends upon which fascial covering is involved.
• When buck’s fascia remains intact, hematoma extends into base of
penis
• When it is violated,butterfly like hematoma is seen over perineum,
contained by dortus F. which extend along abd.wall to colles & scarpa
F.
• Contusion,complete & incomplete injuries
Dept Of Urology, KMC and GRH, Chennai 45
47. Posterior urethral injury
• Prostato-membraneous part lies between 2 fixed points
• 1)memb. U-to ischiopubic rami by UGD
2)Prostatic U-to pubis by puboprostatic lig.
Almost all are ass. With pelvic #
sphincter mechanism defect
difficulty in accessability
Dept Of Urology, KMC and GRH, Chennai 47
50. Urethral strictures
• Scarring induced by local tissue injury
• Trauma- pelvic #,iatrogenic
• Inflamatory-gonococal
• Malignancy
• *Reconstruction is better with traumatic stricture.
Dept Of Urology, KMC and GRH, Chennai 50
51. Female urethra
• From the bladder neck to the meatus
length :3 to 5 cm. Diameter: 6mm.
Can be dilated upto 1cm.
Open into vestibule 2.5 cm below clitoris
At the side of ext.meatus paraurethral glands open
Fibromuscular tube -composed of
-mucosa
-submucosa
-muscle
Dept Of Urology, KMC and GRH, Chennai 51
53. Female urethra
• More distensible –elastic tissue,smooth M.
• Commonly infected-short, open through vestibule.
• In contrast to male prox.U., No circular smooth M. sphincter.
• Sus. lig. Of clitoris (ant. Urethral lig.) pubourethral lig. (post.
Urethral lig.) form a sling that support urethra beneath pubis.
Dept Of Urology, KMC and GRH, Chennai 53
54. • Except during the passage of urine, the anterior and posterior walls of
the urethra are in apposition
• The epithelium is thrown into longitudinal folds, one of which, on the
posterior wall of the canal, is termed the urethral crest.
• Many small mucous urethral glands and minute pit-like recesses or
lacunae open into the urethra and may give rise to urethral diverticula.
• On each side, near the lower end of the urethra, a number of these
glands, Skene's glands (female prostate), are grouped together and
open into the para-urethral duct.
Dept Of Urology, KMC and GRH, Chennai 54
55. VASCULAR SUPPLY AND LYMPHATIC DRAINAGE
• URETHRAL ARTERY
supplied principally by the vaginal artery, but also receives a supply
from the inferior vesical artery.
• VEINS
The venous plexus around the urethra drains into the vesical venous
plexus around the bladder neck then into the internal pudendal veins.
An erectile plexus of veins along the length of the urethra is continuous
with the erectile tissue of the vestibular bulb.
• LYMPHATIC DRAINAGE
internal and external iliac nodes.
Dept Of Urology, KMC and GRH, Chennai 55
56. • Like male, striated urethral sphincter receives dual somatic
innervation,from pudendal &pelvic.
• Somatic &autonomic N. travel along lat. Wall of vagina,near urethra.
• During transvaginal incontinence surgery,ant.vag. Wall should be
incised laterally –to prevent incontinence
Dept Of Urology, KMC and GRH, Chennai 56
57. MICROSTRUCTURE
• The mucosa consists of a stratified epithelium and a supporting lamina
propriaof loose fibroelastic connective tissue.
• The lamina propria contains a fine nerve plexus, believed to be derived
from sensory branches of the pudendal nerves.
• The proximal part of the urethra is lined by urothelium, identical in
appearance to that of the bladder neck.
• Distally the epithelium changes into a non-keratinizing stratified
squamoustype which lines the major portion of the female urethra.
• keratinized at the external urethral meatuscontinuous with the skin of
the vestibule.
Dept Of Urology, KMC and GRH, Chennai 57
59. Mucosa &submucosa
• Mucosa:
prox- transitional cell
distal –nonkeratinised stratified squmous
• Submucosa:
long&circular elastic fibers with prominent venous system
Act as washer producing a seal that contribute to urethral closer
pressuree
In hypoestrogenic state>thinning of tissue>incontinence
Dept Of Urology, KMC and GRH, Chennai 59
60. Muscle layer
• Thick seat of long.fibers &thin outer circular F.
• Distal 2/3-circular layer of striated smooth M
• Rhabdosphincter-
type 1 & 3 muscles fiber
• Proximally,the M. forms ring(sphincter urethra)
• Distally,the M. fans out laterally along inf.border of pubic
rami(compressor urethra)
Dept Of Urology, KMC and GRH, Chennai 60
61. Internal sphincter
• Located at UV JUNCTION.
• Formed by trigonal ring, 2 U –shaped loops from detrusor muscle
• Innervated by autonomic fibers
• Pudendal N.dysfunction-
- birth injury
-prior anti incontinence procedure
- myelodysplasia
• Lead to incontinence even the anatomic support is normal
Dept Of Urology, KMC and GRH, Chennai 61
63. EXTERNAL SPHINCTER
• Proximal portion:
sphincter urethrae muscle
• Distal portion
1.compressor urethrae M.
2. urethrovaginal M.
located above perineal membrane in the deep compartment of
urogenital triangle
As a unit they contract voluntarily&prevent incontinence if urine gets
passed in a marginally functioning int.sphincter
Dept Of Urology, KMC and GRH, Chennai 63
64. MUSCLES OF EXT SPHINCTER
Dept Of Urology, KMC and GRH, Chennai 64
65. Mucosal coaptation
• -> increase the urethral resting pressure
• AV complex located between smooth muscle coat &epithelial lining
• Filling of this vasculature with blood,improves mucosal coaptation by
causing urethral walls to seal
• Preventing involuntary urine loss
• They are estrogen sensitive
Dept Of Urology, KMC and GRH, Chennai 65
66. Pubocervical fascia
• Located on the vagina, underneath bladder.
• Ant. Vaginal fascia providing sling for urethra & bladder.
• Prox. -attaches to cervix
• Distal –travels beneath urethra,fuses with perineal membrane.
• Laterally-connected to pelvic wall at fascial white line (F. of levator
ani)
increased abd. Pressure ,lower urinary tract is forced
inferiorly,&compressed against pubocervical F. >>
this UV junction trapping promotes continence.
Dept Of Urology, KMC and GRH, Chennai 66
67. Muscles of pelvic floor
• Levator ani M. –pubococcygeus
• iliococcygeus
• Perineal surface- br.of pudendal N.
• Pelvic surface- motor eff. From S2—S4
• Unlike other striated M., pelvic floor muscles,are in constant state of
contraction>> efficient positioning of UV junction
Dept Of Urology, KMC and GRH, Chennai 67
69. Female continence mechanism
involuntary int.sphincter-vesical neck
Voluntary ext.sphincter-guarding reflex
Mucosal coaptation-urethral submucosal vascular plexus.
• Hammock hypothesis”—abdominal pressure transmitted through
the proximal urethra presses the anterior wall against the posterior
wall
Support of UB &UV junction: pubocevical fascia which is attached to
levator ani ,pelvic floor muscles
Dept Of Urology, KMC and GRH, Chennai 69