Scanning Electron Microscopic Observations on the Epithelium of the Human Spongy Urethra

The human spongy urethras of individuals submitted to emasculation because of glans carcinoma have been studied by means of scanning electron microscopy. The luminal surface of the organ shows longitudinal folds and small glandular openings, surrounded by epithelial elements arranged in form of rosettes. Spermatozoa, partially degenerated, adhere to the epithelium. The slightly prominent apices of the superficial epithelial cells are more or less polygonal in shape and covered with short microvilli among which small granules as possible morphological expression of a secretory activity are detectable. Only seldom microplicae, intermingled with microvilli, can be observed. Additionally, some apices appear swollen and protrude into the lumen. Such a pattern may be escalated so that a cell seems to transform itself into a globular mass and then is expulsed from the epithelial surface. Sometimes an epithelial cell appears empty of its contents: only the crumpled plasmalemma remains. This may represent the morphological expression of an apocrine or holocrine secretory activity of the superficial epithelium. In few cases, the proximal portion of the spongy urethra shows small groups of ciliated elements.     

Functional morphology of the prostate

According to embryological and histological studies, the internal structure of the human prostate is separated into four compartments: (1) the non-glandular stroma, (2) the preprostatic segment, (3) the peripheral zone and (4) the central zone. The central zone surrounds the ejaculatory ducts; it is made up of acini with a relatively simple configuration and is inserted in a wedge-like manner into the peripheral zone. The so-called preprostatic segment is the periurethral portion, which is regarded as the predilection site for the development of benign prostatic hyperplasia (BPH). There seems to be functional heterogeneity within the prostatic duct system, with a concentration of estrogen-sensitive and endocrine cells close to the urethra, and those of the most peripheral tip of the ducts, which mature relatively late in puberty. The secretory and proliferative activity of the prostate is totally androgen-dependent. Recent reports on growth factors present in the prostate are particularly important with regard to both stromal and glandular proliferation. A hormonal imbalance in the system of growth factor production, of androgen and estrogen dependence and general mechanisms of cellular aging must be taken into consideration during pathologic alterations of the prostate, such as BPH and prostate cancer.     

Transrectal ultrasound appearance of transitional cell carcinoma involving the prostate

Prostatic involvement with transitional cell carcinoma of the bladder is common. Surveillance for prostatic invasion consists primarily of cystoscopic examination of the urethra. Unfortunately, transitional cell carcinoma may involve other regions of the prostate that are inaccessible by cystoscopy. A total of 58 men with transitional cell carcinoma of the bladder underwent transrectal ultrasound before cystoprostatectomy or, in some cases, ultrasound-guided prostate biopsies and subsequent cystoprostatectomy. Prostatic involvement was found in 20 patients (34.5%). Of those patients 10 (50%) demonstrated prostatic urethra invasion, 7 (35%) stromal invasion, 4 (20%) ejaculatory duct and seminal vesicle invasion, and 3 (15%) involvement of the periprostatic tissues. Invasion of the prostatic urethra was not detected by transrectal ultrasound but 5 of the 7 stromal lesions exhibited hypoechogenicity. All cancer-laden ejaculatory ducts were hypoechoic on ultrasound examination. All cases of periprostatic involvement were also detectable by corresponding areas of hypoechogenicity. Transrectal ultrasound may enhance the surveillance of men with transitional cell carcinoma.     

Ultrasound anatomy of the prostate: the normal gland and anatomical variations

Knowledge of the normal prostatic anatomy is paramount to understanding the pathological conditions of the gland observed on ultrasound imaging. Through transverse and sagittal histological sections of normal prostates, model ultrasound images of the prostate and periprostatic tissues were constructed. Various shades of gray were assigned to these structures depending upon the histological composition. We found that ultrasonic characteristics of the normal prostate and its surrounding tissues could be predicted accurately by knowledge of the histology of these structures. Histological sections of 100 prostates from patients who underwent transrectal ultrasound and subsequent radical prostatectomy for prostate cancer were examined. The congenital anatomical variations observed in this group are described histologically and sonographically. Caudal formation of the ejaculatory ducts within the central zone occurred in 18% of the cases, abnormal posterior penetration of the ejaculatory ducts at the rectal surface in 12% and abnormally large muscle bundles with the ejaculatory duct sheath in 6%. Concomitant ejaculatory duct and seminal vesicle dilatation was observed in 5% of the patients, whereas dilated ejaculatory ducts alone, dilated seminal vesicles alone and cystic utricles each were seen in 2%.     

The lobes of the human prostate.

A dissection technique for the huamn prostate has been developed on about one hundred male autopsies, which makes it possible to delimit two dorsal, two lateral and two median lobes, each with separate ducts. It was found that both the dorsal lobesand the lateral lobes join dorsally to the ejaculatory ducts. The median lobes are situated below the medial parts of the seminal vesicles, and are closely apposed both ventrally and dorsally of the ejaculatory ducts. The ability to delimit the prostatic lobes in man may offer new opportunities to study the relation of prostatic diseases to different lobes as well as the hormonal dependency of the separate lobes.     

前列腺热疗后医源性射精管梗阻的诊断与治疗(附3例报告)

目的:探讨前列腺热疗后医源性射精管梗阻的诊断及治疗特点。方法:回顾分析3例前列腺热疗后射精管梗阻患者的临床资料。结果:3例患者皆因前列腺炎行经尿道前列腺热疗而导致后尿道狭窄、变形,继发射精管梗阻。经精液分析、经直肠B超检查后确诊。行经尿道射精管电切开术(TURED)后患者梗阻解除,精液恢复正常。结论:经尿道微波热疗、射频和电极导融治疗等方法在用于前列腺炎治疗时应严格掌握适应证,使用不慎可导致继发医源性射精管梗阻。经尿道射精管切开术是其首选治疗方法。     

Intestinal-type mucinous adenocarcinoma arising from the prostatic duct

We present a case of mucinous adenocarcinoma of intestinal type arising from the prostatic duct in a 72-year-old Japanese man. The patient presented with macroscopic hematuria. Cystourethroscopy exhibited a mucus deposit at the 5 o'clock position of the verumontanum portion. A transurethral biopsy specimen revealed mucinous adenocarcinoma. A radical retropubic prostatectomy was performed. In the prostatectomy specimen, the cancer lesion mainly showed intraductal growth in the prostatic ducts with scattered mucin lakes in the prostatic stroma. There were no abnormalities in the urethral epithelium. The cancer cells resembled the intestinal epithelium rather than either the prostatic duct or the acinar epithelium, which showed diffusely positive immunohistochemical staining for carcinoembryonic antigen, but showed negative staining for prostate-specific antigen. Therefore, these findings suggest mucinous adenocarcinoma of intestinal type arising from the prostatic duct. A number of cases with mucinous adenocarcinoma arising from the prostatic urethra resembling the present case have been reported, but this is the first known case of carcinoma arising from the prostatic duct.     

Fibroepithelial polyp of the prostatic urethra in an adolescent

Benign fibroepithelial polyp of the prostatic urethra is a rare congenital lesion most commonly diagnosed in the pediatric population because of diverse urinary symptoms. We report a case of a 16-year-old adolescent boy who presented with urinary retention. Imaging and endoscopic studies confirmed the presence of a polypoid lesion at the bladder base/posterior prostatic urethra. Following transurethral resection of this polypoid mass, the diagnosis of a congenital fibroepithelial polyp of the prostatic urethra was rendered by pathologic evaluation. Although this is considered a benign lesion with no previous reports of recurrence or malignant behavior, it produces dramatic urinary symptoms in the pediatric population with a wide differential diagnosis. Imaging and endoscopic findings may suggest a malignancy and are not sufficient to render a precise diagnosis, which can only be made by pathologic examination.     

Bullous lesion in the prostatic urethra: morphological change caused by putative chlamydial infection

PURPOSE: The cause of benign bullous lesions in the prostatic urethra, which we encountered in 10 patients during the last 18 years and which has not been described in literature, was studied. MATERIALS AND METHODS: Among 1,236 patients who underwent cystourethroscopy for a urological complaint 10 had bullous lesions in the prostatic urethra which were empirically thought to be inflammatory rather than tumorous lesions at initial cystourethroscopy. We retrospectively searched for common clinical characteristics for these 10 patients who had a median age of 33.5 years (range 20 to 47). The reasons for cystourethroscopy were terminal gross hematuria in 3 patients, initial gross hematuria in 1, total gross hematuria in 2, blood stain on underpants without scrotal keratoangioma in 1, hemospermia in 1 and voiding difficulty in 2. RESULTS: Based on the results of urinalysis, expressed prostatic secretion, transrectal examination of the prostate, cystourethroscopy, urethral swab test for Chlamydia trachomatis and punch biopsy of urethral mucosa with or without immunofluorescence staining with fluorescein isothiocyanate labeled monoclonal antibody for C. trachomatis, inflammation of the prostatic urethra was considered the cause of these bullous lesions. CONCLUSIONS: Bullous lesions in the prostatic urethra appear to be due to an inflammatory change. We should consider these lesions when we encounter young patients with asymptomatic gross hematuria. We should also note microscopic pyuria in such patients and subsequently perform C. trachomatis polymerase chain reaction test using urine initially as a noninvasive examination before cystourethroscopy.     

Pathology and natural history of urethral tumors in males. Review of 142 cases

A series of 142 tumors of the male urethra is presented. The natural history of these neoplasms is dependent not only on the cell type, but also on the site of origin. A concept concerning the latter is presented and illustrated. The urethra is divided into three zones: A, B, and C. Zone A includes the meatus, fossa navicularis, and distal pendulous urethra. Here the neoplasms were discovered relatively early, treatment in most instances was efficacious, and results were good. Zone B includes the proximal (fixed) urethra and bulbomembranous junction. Here there was often considerable delay in establishing a correct diagnosis because many of the patients were suspected of having a stricture and were traumatized by dilatations with sounds. Results were bad. Zone C includes the posterior urethra (membranous and prostatic). In addition to urothelial andlor squamous tumors there were other neoplasms in this zone which were from paraprostatic structures, such as the terminals of the prostatic ductules, the meatus of the ejaculatory ducts, and the utricle. Urothelial or squamous cell cancers sometimes invaded the prostate and were erroneously diagnosed in some instances as primary neoplasms, in spite of the absence of microacinar patterns in the histology, nonelevation of the serum acid phosphatase, and osseous metastases which were lytic. Failure to recognize the epithelial character of these lesions and that they are not hormonally dependent led to operative procedures and administration of estrogens which adversely affected the underlying process.     

Modified resectoscope loop for transurethral resection of the ejaculatory duct

We report the design of a modified resectoscope loop for transurethral resectionof the ejaculatory ducts. The loop is a modification of a standard 24 F resectoscope loop. Cutting dimensions are 2.5 mm in width and 3 mm in depth for the modified loop versus 6 mm in width and 5 mm in depth for the conventional loop. This modification allows precise resection of obstructed ejaculatory ducts with minimal trauma to the prostatic fossa, reducing the potential for troublesome bleeding.     

Ductal ("endometrioid") adenocarcinoma of the prostate

Ductal ("endometrioid") adenocarcinoma of the prostate is a rare variant of prostatic carcinoma which may have a different clinical presentation than the more common acinar adenocarcinoma. Ductal adenocarcinoma usually involves the urethra and the large periurethral prostatic ducts with direct spread through the more peripheral ductal system. Centrally located tumours have a much better prognosis than tumours involving the deep prostatic parenchyma. Local recurrence rate is high and five-year survival rate is as low as 24% for adenocarcinomas that have spread to the peripheral prostatic ducts. Although there have been some doubts about the role of hormonal therapy in ductal ("endometrioid") adenocarcinoma of the prostate, it is now agreed that therapeutic regimens should not be different from those offered to patients with conventional acinar adenocarcinoma.     

Ejaculatory Duct Obstruction after Transurethral Resection of the Prostate

Transurethral resection of the prostate is currently the most commonly employed surgical procedure for benign prostatic hyperplasia. Although several complications after the procedure have been well documented, ejaculatory duct obstruction is a rare complication. We describe this unusual complication in a 77-year-old male who presented with severe pain and a feeling of fullness in the lower abdomen and with dry ejaculate on three occasions after undergoing post-transurethral resection of the prostate. The patient’s post-ejaculatory urinalysis demonstrated no sperm. Transrectal ultrasonography also showed no dilatation of the bilateral seminal vesicles or ejaculatory ducts. However, ejaculatory duct obstruction was finally diagnosed on vasovesiculography. The patient was successfully treated with transurethral resection of the ejaculatory duct and remained asymptomatic 6 months postoperatively. Although transrectal ultrasonography is currently widely used to evaluate ejaculatory duct obstruction, we suggest that vasovesiculo-graphy is still a feasible and useful tool that provides detailed anatomic information for the advanced confirmation of ejaculatory duct obstruction in patients with a high suspicion of ejaculatory duct obstruction who have normal transrectal ultrasonography findings.     

Effects of Ethanol on Responses of Isolated Rabbit Urinary Bladder and Urethra

Background Acute ethanol ingestion increases the risk of urinary retention in patients with benign prostatic hyperplasia (BPH). To elucidate the mechanism of this effect, we investigated the in vitro effects of ethanol on lower urinary tract function in rabbits.
Methods The responses to various stimuli of muscle strips isolated from male rabbit bladder and urethra were determined in the presence of 0%, 0.5%, 1.0%, and 3.0% ethanol.
Results Basal tension of tissue strips taken from the bladder and the urethra was reduced by ethanol in a dose-dependent manner, as were bladder contractions induced by field stimulation, bethanechol, and ATP. Ethanol also reduced phenylephrine-induced contractions of the prostatic urethra. A high (3%) concentration of ethanol significantly reduced KCI-induced contraction of both the bladder and urethra, as well as urethral relaxation induced by field stimulation following contraction with 200μol/L phenylephrine.
Conclusion Responsiveness of the rabbit lower urinary tract was significantly reduced by exposure to ethanol. A similar decrease in tonus and contractility of the detrusor and inhibition of relaxation in the prostatic urethra may lead to urinary retention in men following acute ingestion of ethanol.     

The structure and innervation of smooth muscle in the wall of the bladder neck and proximal urethra.

Neurohistochemical and electron microscopic techniques have been employed to compare the structure and autonomic innervation of the bladder detrusor with that of the bladder neck and urethra in male and female cats, rats and guinea-pigs. In all specimens the structure and arrangement of smooth muscle in the detrusor was different from that in the bladder neck and proximal urethra. In male specimens this circular smooth muscle extended into the proximal urethra as far as the entrance of the ejaculatory ducts. A similar muscle coat was less well developed in the female but could be identified along the length of the urethra. Differences in the distribution of autonomic nerves have also been demonstrated. Presumptive cholinergic nerves were frequently encountered amongst the smooth muscle cells of the detrusor whilst noradrenergic nerves were relatively sparse. In contrast, muscle in the bladder neck and urethra was richly innervated by both types of autonomic nerve. In the male these findings are considered to provide support for the concept of a sphincteric mechanism which prevents retrograde ejaculation. In both sexes the possible functional role of the autonomic innervation of the bladder neck and proximal urethra during micturition has also been discussed.     

Carcinoembryonic Antigen Positive Adenocarcinoma of a Female Urethral Diverticulum: Case Report and Review of the literature

Paraurethral glands of the female urethra, which are assumed to be embryologically homologous to the male prostate gland, are possible origins for diverticular cancer of the urethra. A case of primary adenocarcinorna arising in a female urethral diverticulum is presented. Pathology revealed a columnar/mucinous type adenocarcinoma which stained positively for carcinoembryonic antigen (CEA) and negatively for PSA. Normal paraurethral ducts located near the urethra and normal urethral epithelium also stained positively for CEA. These findings suggest that the adenocarcinoma in our case originated from the paraurethral duct near the urethral lumen.     

Ejaculatory profiles and fertility in men after posterior urethroplasty for pelvic fracture-urethral distraction defect injuries

OBJECTIVE

In men who sustain a pelvic fracture‐urethral distraction defect (PFUDD) injury, repairing the urethra involves a complicated urethral anastomosis located posteriorly at the junction of the membranous and prostatic urethra. In this study we performed a post‐ operative semen analysis and questionnaire study to determine the effect of PFUDD injuries and PFUDD repair on ejaculatory function and fertility in these men.

PATIENTS AND METHODS

With institutional review board approval, patients who had PFUDD repairs by one surgeon from 1990 to 2004 were identified from a database. Patients were contacted and given a questionnaire eliciting details about their ejaculatory function and history of fertility. Those interested in future paternity were asked to provide semen for analysis.

RESULTS

In all, 32 men were contacted; all claimed to have antegrade ejaculation, although five reported having a lower ejaculatory volume than before their injury, and one claimed that his ejaculate was delayed. We assessed fertility in 19 men, six of whom had either infertility or abnormal semen analyses.

CONCLUSIONS

All men in the present series who had PFUDD injuries repaired had antegrade ejaculation. Although six of 19 had either infertility or an abnormal semen analysis, it appears that the risk of damage to the ejaculatory ducts from either a PFUDD or the subsequent urethral reconstruction is low. However, other associated injuries at the time of the pelvic fracture might place these men at greater risk of infertility.     

Papillary adenoma of the prostatic urethra

Six patients with papillary adenoma of the prostatic urethra are described. Their ages ranged from 39 to 70 years old. Two of them showed evidence of clinical recurrence 1 year after treatment. The pathological features as well as the immunohistochemical demonstration of prostate specific antigen (PSA) and prostatic acid phosphatase (PAP) are illustrated. A brief review of the literature is discussed with special emphasis on the histogenesis and nature of this lesion.     

海拔2260米地区Madigan前列腺切除术尿道破裂不修补135例临床观察

目的回顾性探讨前列腺增生症（benign prostatic hyperplasia，BPH）的Madigan前列腺切除术尿道破裂不修补的治疗效果。方法采用Madigan前列腺切除术，尿道黏膜破裂不予修补。结果尿道保留完整者81例，尿道破裂者54例。尿管保留6—9d，拔除尿管后自主排尿通畅，测定术后剩余尿量、最大尿流率（Qmax）、国际前列腺症状评分（IPSS）、生活质量评分（QOL）等，未修补尿道与保留尿道完整二者比较差异无统计学意义。结论不修补尿道黏膜破裂的Madigan前列腺切除术是适用于未具备TURP设备条件与技术的基层医院治疗BPH较为有效的开放术式。