Female urethral diverticula are urine-filled cysts connected to the urethra via an opening. They have a prevalence of 1-6% in adult females and can cause dysuria, dyspareunia, dribbling, and incontinence. Modern theories suggest they develop from repeated infections obstructing periurethral glands that then herniate and expand. Diagnosis involves cystoscopy, ultrasound, MRI, and positive pressure urethrography. Surgical excision and reconstruction of the urethra is the primary treatment, with the goals of removing the diverticulum sac, achieving a watertight closure, and preserving continence. Complications can include recurrence,
Ureters are retroperitoneal structues which run anterior to psoas muscle and cross lateral to medial.4sites are prone where ureter can be injured and its management
Urinary Tract Fistulas -(VVF) Etiology, Diagnosis, ManagementVikas V
Urinary Tract Fistulas - Etiology, Diagnosis, Management
Surgical and Relevant Anatomy, Classification, eitiology, VVF in Detail, Examination and Diagnosis, Management of VVF - Both Conservative And Surgical Management - Steps of Surgical Management, Post operative Management.
Approah to a child / adult presenting with acute scrotum - testicular pain.
The acute scrotum – definition and causes with differential diagnosis
Management of the acute scrotum
Testicular torsion
Torsion of a testicular or epididymal appendage
Epididymitis or epididymo-orchitis
Idiopathic scrotal oedema
Fat necrosis of the scrotum
Case Discussion
Ureters are retroperitoneal structues which run anterior to psoas muscle and cross lateral to medial.4sites are prone where ureter can be injured and its management
Urinary Tract Fistulas -(VVF) Etiology, Diagnosis, ManagementVikas V
Urinary Tract Fistulas - Etiology, Diagnosis, Management
Surgical and Relevant Anatomy, Classification, eitiology, VVF in Detail, Examination and Diagnosis, Management of VVF - Both Conservative And Surgical Management - Steps of Surgical Management, Post operative Management.
Approah to a child / adult presenting with acute scrotum - testicular pain.
The acute scrotum – definition and causes with differential diagnosis
Management of the acute scrotum
Testicular torsion
Torsion of a testicular or epididymal appendage
Epididymitis or epididymo-orchitis
Idiopathic scrotal oedema
Fat necrosis of the scrotum
Case Discussion
Vesicoureteric reflux , a common condition in children which could be misdiagnosed . Early diagnosis can help prevent renal scarring and other complications
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, we’ll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
Navigating the Health Insurance Market_ Understanding Trends and Options.pdfEnterprise Wired
From navigating policy options to staying informed about industry trends, this comprehensive guide explores everything you need to know about the health insurance market.
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
2. Introduction
• Female Urethral Diverticulum (UD) –
– Urine-filled periurethral cystic structure
– Within the confines of pelvic fascia
– Connected to urethra via an ostium
• 1-6% prevalence in adult females
• Diagnostic & reconstructive challenge
• Modern era of female UD began in 1950’s – Positive
pressure urethrography (PPU) by Davis & Cian
3. Anatomy
• Female Urethra – 4cm musculofascial tube
• Urethropelvic ligament – supports urethra & bladder
neck to lateral pelvic wall (ATFP)
• Two layers of fused pelvic fascia extending bilaterally
– Endopelvic fascia – abdominal side
– Periurethral fascia – vaginal side (extension of pubocervical
fascia)
– Within these two leaves lie the urethra & UD
4.
5.
6.
7.
8. Periurethral Glands
• Periurethral glands – Tubuloalveolar glands
– Within the vascular lamina-propria/submucosa
– exist over entire urethra posterolaterally
– most prominent over distal two thirds
– majority glands draining into distal third urethra
• Skene glands – largest & most distal glands draining
outside lumen,
lateral to urethral meatus
9.
10. Pathogenesis
• Infectious etiology – involving periurethral glands
• Young (1996) – Modern hypothesis of UD pathogenesis
– Repeated infection-obstruction of periurethral glands
– Cavity expansion → disrupt urethral muscles
– Herniation into urethropelvic ligament
– Expansion m/c ventrally → classic anterior vaginal wall
mass
– Cavity ruptures into urethral lumen → Ostia formed
11.
12.
13. Associated Pathology
• 10% case – premalignant & malignant changes
• m/c malignancy – Adenocarcinoma
• Calculi within UD – 4-10% cases
• Multiple UD – 6% cases
• Varying degrees of
sphincteric compromise
15. Presentation
• b/w 3rd & 7th decades of life
• Classic presentation – “three Ds” —dysuria, dyspareunia
& dribbling (postvoid) – 20-25%
• Highly variable presentation – Diagnostic challenge
• 1/3rd cases – Incontinence (UD-1.4% UI cases)
• Upto 20% may be completely Asymptomatic
• Size of UD does not correlate with symptoms
• Waxing & wanimg of symptoms over long durations
16.
17. Cystourethroscopy
Bladder neck compression during urethroscopy
facilitates urethral distension & direct observation
Urethroscope – 15° Lens with inflow at
the same level as lens – facilitates direct
urethral observation and distension
18. • UD ostium – m/c posterolaterally at 4 & 8 o’clock
positions at level of mid-urethra
• Variable success in identifying ostium – 15-90%
• Evaluate other causes of LUTS
• Compression of UD sac –
discharge in urethra
O – UD ostium of a UD
L – Lumen of urethra
19. UDS
• 1/3rd patients present with urinary incontinence
• 50% of women with UD will have SUI on UDS
• Urethral pressure profilometry (UPP) –
– continuous measurement of fluid pressure needed
to just open a closed urethra
– Biphasic pattern – pressure
drop at the level of lesion
21. MCU
• Sensitivity – 44-95%
• Voiding required to visualize (patient may not)
• MCU with no post-void image – non-diagnostic
• Inability to generate adequate flow rate during MCU
– Results in suboptimal filling of UD
– Underestimation of size & complexity
28. Surgical Procedures
• Hey (1805) first described Transvaginal incision with
packing of UD cavity with lint
• Transurethral Procedures –
– Marsupialisation
– Endoscopic unroofing
– Fulguration
– Incision & obliteration with oxidised cellulose /
PTFE
29. • Transvaginal Procedures –
– Spence–Duckett procedure – UD marsupialized into
vagina (very distal UD)
– Excision and Reconstruction
• Current - Excision and Reconstruction
Principles of Transvaginal Urethral Diverticulectomy
• Well-vascularized anterior vaginal wall flaps
• Preservation of periurethral fascia
30. • Identification & excision of neck / ostium
• Removal of entire UD wall or sac (mucosa)
• Watertight urethral closure
• Multilayer, nonoverlapping closure – absorbable
suture
• Closure of dead space
• Preservation or creation of continence
