INTRODUCTION: The optimal management of the urethra in patients planned for radical cystectomy (RC) remains unclear. We sought to evaluate the impact of urethrectomy on perioperative and oncological outcomes in patients treated with RC for non-metastatic urothelial carcinoma of the bladder (UCB). MATERIALS AND METHODS: We assessed the retrospective data from patients treated with RC for UCB of five European University Hospitals. Associations of urethrectomy with progression-free (PFS), cancer-free (CSS), and overall (OS) survivals were assessed in univariable and multivariable Cox regression models. We performed a subgroup analysis in patients at high risk for urethral recurrence (UR) (urethral invasion and/or bladder neck invasion and/or multifocality and/or prostatic urethra involvement). RESULTS: A total of 887 non-metastatic UCB patients were included. Among them, 146 patients underwent urethrectomy at the time of RC. Urethrectomy was performed more often in patients with urethral invasion, T3/4 tumor stage, CIS, positive frozen section analysis of the urethra, and those who received neoadjuvant chemotherapy, underwent robotic RC, and/or received an ileal conduit urinary diversion (all p < 0.001). Estimated blood loss and the postoperative complication rate were comparable between patients who received an urethrectomy and those who did not. Urethrectomy during RC was not associated with PFS (HR 0.83, p = 0.17), CSS (HR 0.93, p = 0.67), or OS (HR 1.08, p = 0.58). In the subgroup of 276 patients at high risk for UR, urethrectomy at the time of RC decreased the risk of progression (HR 0.58, p = 0.04). CONCLUSION: In our study, urethrectomy at the time of RC seems to benefit only patients at high risk for UR. Adequate risk assessment of UCB patients' history may allow for better clinical decision-making and patient counseling.

• Klíčová slova
• Bladder cancer, Radical cystectomy, Urethral recurrence, Urethrectomy,
• MeSH
• cystektomie MeSH
• karcinom z přechodných buněk * patologie   chirurgie   MeSH
• lidé MeSH
• močový měchýř chirurgie   MeSH
• nádory močové trubice * patologie   chirurgie   MeSH
• nádory močového měchýře * patologie   chirurgie   MeSH
• retrospektivní studie MeSH
• uretra patologie   chirurgie   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

Primary urethral adenocarcinomas are very rare neoplasms accounting for <10% of all urethral carcinomas. Site of their origin is unclear, but they seem to arise from Skene's paraurethral glands, which is the female homologue of the male prostate. The aim of this article is to report the first case of Skene's gland adenocarcinoma in which a molecular genetic profiling was performed. The patient was a 73-year-old woman with a polypoid lesion sized 3 × 2 cm located at the interface between the bladder neck and the proximal urethra. Transurethral resection was performed and small tissue fragments with positive margins were obtained. Histology revealed an epithelial neoplasm consisting of cribriform structures located in the subepithelial connective tissue of the bladder wall and proximal urethra. The lesion showed positive immunohistochemical staining with prostate specific antigen, prostatic acid phosphatase, NKX3.1, and alpha-methylacyl-CoA racemase. Using the Illumina TruSight Tumor 170 next-generation sequencing assay, a mutation and loss of heterozygosity of the phosphatase and tensin homologue (PTEN) gene was detected. No fusion in any of the examined genes was found using this assay as well as FusionPlex Solid Tumor Kit and FusionPlex Sarcoma kit assays from ArcherDX. Given the rarity of Skene's gland adenocarcinoma, it is uncertain whether the same grading and prognostic criteria that are currently used for prostatic cancer apply here as well. It is also unclear what treatment strategy should be applied, but according to the available literature, it seems that local excision or wide surgical resection could represent sufficient therapeutic modalities.

• Klíčová slova
• PTEN gene, Skene’s gland adenocarcinoma, molecular genetics, next-generation sequencing, paraurethral glands,
• MeSH
• adenokarcinom diagnóza   genetika   patologie   MeSH
• fosfohydroláza PTEN genetika   MeSH
• lidé MeSH
• mutace MeSH
• nádorové biomarkery genetika   MeSH
• nádory močové trubice diagnóza   genetika   patologie   MeSH
• senioři MeSH
• uretra patologie   MeSH
• ztráta heterozygozity MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Názvy látek
• fosfohydroláza PTEN MeSH
• nádorové biomarkery MeSH
• PTEN protein, human MeSH Prohlížeč

PURPOSE OF REVIEW: The clinical significance of ureteral and urethral recurrence in patients treated with radical cystectomy for bladder cancer is scarce and heterogeneous. The aim of the current review is to summarize the recent literature on incidence, diagnosis and oncologic outcomes of ureteral and urethral recurrences after radical cystectomy. RECENT FINDINGS: Frozen section analysis (FSA) of ureteral margin had a sensitivity and specificity of 69-77 and 83-96%, respectively. Considering the ureteral margin, the reported sensitivity and specificity were 33-93 and 99-100%, respectively. Transurethral biopsy of the prostatic urethra might help in counseling patients' treatment, although its accuracy and prognostic role is highly questionable. In patients treated with radical cystectomy, recurrence of the urethra or ureteral are rare, occurring approximately in 5% of patients. During the follow-up, urinary cytology and cross-sectional imaging improve the early detection of recurrence in asymptomatic patients, although the majority are diagnosed for symptomatic presentation. Their use should be tailored to the patient's risk of ureteral and/or urethral recurrence. Urethrectomy is indicated in case of singular urethral recurrence, whereas no clear data exists regarding the best management of ureteral recurrence, except surgical removal. SUMMARY: Intraoperative FSA of ureters and urethra share good specificity but poor sensitivity. Recurrence at urethra and upper tract are rare and discordant data exists regarding survival outcomes. Oncologic surveillance after radical cystectomy with the aim to detect these recurrences should be tailored to the individualized patient's risk.

• MeSH
• cystektomie * MeSH
• karcinom z přechodných buněk chirurgie   MeSH
• lidé MeSH
• lokální recidiva nádoru MeSH
• nádory močové trubice chirurgie   MeSH
• nádory močového měchýře chirurgie   MeSH
• ureter patologie   MeSH
• uretra patologie   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• systematický přehled MeSH

INTRODUCTION AND HYPOTHESIS: To estimate distances from the mid-urethra to the obturator foramina and to explore correlations between pelvic dimensions and body height. METHODS: This is a secondary analysis of a parent case-control study on the mechanisms of stress urinary incontinence. We measured pelvic dimensions on magnetic resonance images of women with (cases, n = 50) and without (controls, n = 50) stress urinary incontinence. RESULTS: The mean distance from mid-urethra to the obturator membrane among cases is 31.8 mm (left) and 32.1 mm (right), with a range from 25.9 to 42.0 mm. There were no significant differences in these distances when comparing left with right, or cases with controls. Weak correlation was found between the urethra-to-obturator foramina distances and heights only in the case subjects. CONCLUSION: There is high variability in the distance from mid-urethra to the obturator foramina. Height should not be used as a predictor of dimensions in the lesser pelvis.

• MeSH
• design vybavení MeSH
• index tělesné hmotnosti MeSH
• kyčel anatomie a histologie   patologie   MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• pánevní dno anatomie a histologie   patologie   MeSH
• pánevní kosti anatomie a histologie   patologie   MeSH
• stresová inkontinence moči patologie   MeSH
• studie případů a kontrol MeSH
• suburetrální pásky MeSH
• tělesná výška MeSH
• uretra anatomie a histologie   patologie   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Research Support, N.I.H., Extramural MeSH

The investigators report a series of prostatic-type lesions occurring in the lower female genital tract. The cases included a 4.5-cm mass representing hyperplasia of the glandular and stromal tissue of paraurethral Skene gland, a small ectopic prostatic lesion in the vulva, and 4 tubulosquamous vaginal polyps. All lesions were immunopositive for prostate-specific antigen and/or prostatic acid phosphatase. A brief discussion of the earlier published material is included.

• MeSH
• choristom * MeSH
• hyperplazie MeSH
• kyselá fosfatasa MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádorové biomarkery metabolismus   MeSH
• nádory komplexní a smíšené metabolismus   patologie   chirurgie   MeSH
• nádory vaginy metabolismus   patologie   chirurgie   MeSH
• nemoci vulvy patologie   MeSH
• polypy metabolismus   patologie   chirurgie   MeSH
• prostata patologie   MeSH
• prostatický specifický antigen metabolismus   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• tyrosinfosfatasy metabolismus   MeSH
• uretra patologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Názvy látek
• kyselá fosfatasa MeSH
• nádorové biomarkery MeSH
• prostatic acid phosphatase MeSH Prohlížeč
• prostatický specifický antigen MeSH
• tyrosinfosfatasy MeSH

OBJECTIVE: To evaluate a new system for the ultrasound evaluation of urethral mobility. STUDY DESIGN: We studied the structure of interpubic disc and found landmarks that can be used to align different images and set up an universal system of coordinates. The method for capturing and post-processing of the introital ultrasound examination is described. The urethra in its entire course is evaluated. Ten patients were examined and some important points at the interpubic disc and the urethra were traced to assess the reproducibility of the method. RESULTS: The mean intra-observer difference for x and y coordinates were 1.88 mm (S.D. 1.53) and 2.00 mm (S.D. 1.54), respectively. The inter-observer difference was 2.30 mm (S.D. 1.64) and 2.50 mm (S.D. 1.79), respectively for x and y coordinates. CONCLUSION: The method shows good inter- and intra-observer correlation and presents data that can be further used for biomechanical analysis.

• MeSH
• biomechanika MeSH
• inkontinence moči diagnostické zobrazování   patologie   patofyziologie   MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• odchylka pozorovatele MeSH
• os pubis MeSH
• reprodukovatelnost výsledků MeSH
• ultrasonografie metody   MeSH
• uretra diagnostické zobrazování   patologie   patofyziologie   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

In the group of stress incontinent women (n = 54) the values of cough leak point pressure (CLPP) and Valsalva leak point pressure (VLPP) were studied together with urethral stress profiles. So as to evaluate the function of the pelvic floor during stress manoeuvers the electromyographic potentials were simultaneously recorded. It was verified, that the values of CLPP were significantly increased in comparison with VLPP (p < 0.01), while electromyographic potentials obtained by CLPP test were more powerful than those recorded by VLPP (p < 0.01-p < 0.005) in different subgroups. According to the results mentioned above it can be concluded, that the reaction of the pelvic floor differs significantly due to various stress manoeuvers, like coughing, Valsalva etc. These findings should be considered in evaluation of the type of dysfunction and of the appropriate surgical treatment.

• MeSH
• dospělí MeSH
• elektromyografie * MeSH
• kašel patofyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• pánevní dno patofyziologie   MeSH
• stresová inkontinence moči diagnóza   patofyziologie   MeSH
• uretra patologie   patofyziologie   MeSH
• urodynamika * MeSH
• Valsalvův manévr MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

OBJECTIVE: The aim of the article is the presentation of a new, mini-invasive method for the treatment of urethral incompetence in women--TVT (tension-free vaginal tape). DESIGN AND SETTING: The design was a prospective comparison of the first 10 patients at the Department of Obstetrics and Gynaecology of the 1st Medical Faculty and General Faculty Hospital in Prague where urethral incompetence = genuine stress incontinence regardless of their history was diagnosed consecutively. METHODS: We present the technique of the operation, examination procedure including the application of dynamic magnetic resonance before and after operation at rest and under Valsalva, the subjective and objective outcome in the analyzed group. We compare also the parameters of urethrovesical junction mobility in the MR image and discuss their importance for the new continence mechanism in the TVT method. RESULTS: All patients are 10-18 months after the operation continent. The functional morphology of the lower urinary tract and of the pelvic floor on the MR image after TVT did not reveal any relevant changes in bladder neck dynamic mobility. CONCLUSION: The experience of other authors concerning possible complications, postoperative care and results are evaluated; they are without exception positive.

• MeSH
• ambulantní chirurgické výkony * MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• miniinvazivní chirurgické výkony MeSH
• prospektivní studie MeSH
• stresová inkontinence moči diagnóza   chirurgie   MeSH
• uretra patologie   chirurgie   MeSH
• urologické chirurgické výkony metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• práce podpořená grantem MeSH

• MeSH
• lidé středního věku MeSH
• lidé MeSH
• pooperační komplikace * MeSH
• stresová inkontinence moči diagnostické zobrazování   chirurgie   MeSH
• ultrasonografie MeSH
• uretra diagnostické zobrazování   patologie   MeSH
• vagina chirurgie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Herein is reported a case of angioleiomyoma, i.e. a benign tumour arising predominantly from smooth muscle cells of the vessel wall, in a yet unreported locality, the urethra. The closest to the tumour presented by us are leiomyomas of the urethra, so far described only in females. The angioleiomyoma of our case manifested itself as a stricture of the male urethra and resection operation showed to be the best approach with elimination of the patient's complaints.

• MeSH
• angiomyom diagnóza   epidemiologie   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory močové trubice diagnóza   epidemiologie   chirurgie   MeSH
• radiografie MeSH
• uretra diagnostické zobrazování   patologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH