Endoscopic Diagnosis and Treatment in Urethral Pathology

Handbook of Endourology

Petrisor Aurelian Geavlete

• Publisher: Academic Press
• Year: 2015
• Print ISBN: 9780128024065
• eBook ISBN: 9780128024553
• Topic: Biological Sciences
• Subtopic: Human Anatomy & Physiology
• Index: Biological Sciences

Handbook of Endourology contains five focused, review-oriented volumes that are ideal for students and clinicians looking for a comprehensive review rather than a whole course. Each volume is easily accessible through eBook format.Topics covered review both the endourological diagnosis and treatment of prostate, urethral, urinary bladder, upper urinary tract, and renal pathology. All chapters describe the most recent techniques, review the latest results, and analyze the most modern technologies. In the past ten years, the field of endourology has expanded beyond the urinary tract to include all urologic minimally invasive surgical procedures. Recent advancements in robotic and laparoscopic bladder surgery make this one of the fastest moving fields in medicine. As current textbooks are too time-consuming for busy urologists or trainees who also need to learn other areas of urology, this collection provides quick references and over 4000 images that are appropriate for fellows as well as those teaching in the field. - Offers review content for urologists in training and "refresher content for experts in endourology - Explores new surgical techniques and technology through review-level content and extensive images of pathologies - Includes over 500 images per volume; images taken from more than 4000 endourologic procedures performed annually at the editor's hospital

Chapter 1

Anatomy of the Urethra

Răzvan Mulţescu

Emanuel Alexandrescu

Bogdan Geavlete

Abstract

The male urethra, like the female one, is divided into several parts, each with distinct anatomical landmarks. Due to its longer length and to the presence of the prostate, these landmarks are much more evident in the male urethra. Another difference between the male and the female urethra is that the former, besides its urinary role, also intervenes in the reproductive function through the passage of semen during ejaculation.

Keywords

urethra

urethral meatus

male

female

anterior

posterior

sphincter

1.1. Male urethra

1.1.1. Descriptive Anatomy

The male urethra, like the female, is divided into several parts, each with distinct anatomical landmarks. Due to its longer length and to the presence of the prostate, these landmarks are much more evident in the male urethra. Another difference between the male and the female urethra is that the former, besides its urinary role, also has a reproductive function in the passage of semen during ejaculation.

The male urethra is 17.5–20 cm long and is divided into two distinct regions: anterior and posterior. The line of demarcation between the two segments is represented by the external striated urethral sphincter or the urogenital diaphragm, passed at this level by the urethra (Moore et al., 2005).

The posterior urethra is divided into the prostatic and the membranous urethra, while the anterior urethra is divided into the penile and the bulbar urethra.

The external urethral meatus (urinary meatus) represents the distal limit of the male urethra; it is shaped as a 6 mm long vertical slot and is one of the narrowest segments. The penile urethra, the longest and the most mobile part of the urethra, is surrounded by the corpus spongiosum, is approximately 15 cm long, and has a homogeneous diameter of 6–7 mm, with the exception of the fossa navicularis. The openings of the periurethral glands (or Littre glands), which are located in the submucosal tissue, are found at the level of the penile urethral mucosa. The mucus secreted by these glands is incorporated into the semen during ejaculation. The Lacunae of Morgagni (the urethral lacunae), where the glands of Littre open, are small depressions or recesses found on the surface of the mucosa of the penile urethra.

The largest of these recesses, which is called the lacuna magna (or the sinus of Guérin), is located on the upper part of the fossa navicularis and is occasionally noticed during endoscopic exams (Dyson, 1995).

The second segment of the anterior part is the bulbar urethra, which has a higher diameter compared with the penile urethra. Some anatomical classifications overlooked this segment of the male urethra, including in the penile part. The bulbar urethra starts at the level of the suspensory ligament of the penis, passes through the bulb, being surrounded by the bulbocavernosus muscle, and ends in the distal part of the external sphincter.

The posterior urethra is located between the urogenital diaphragm and the neck of the bladder.

The membranous urethra is the shortest and the less distensible part of the male urethra. With the exception of the urinary meatus, this is also the segment with the smallest diameter. Like the bulbar urethra, its direction is obliquely downward and forward, being slightly curved with the concavity directed forward and upward. Anterior to the membranous urethra, the dorsal vein of the penis enters the pelvis between the transverse and the arcuate pubic ligaments, while the bulbourethral Cowper glands are located posterior and lateral. The membranous urethra is 12–20 mm long and is surrounded by the fibers of the external striated urethral sphincter.

The prostatic urethra is 25–30 mm long, is the largest and most distensible part of the male urethra, and has an almost vertical position in...

Table of contents

• Cover
• Title page
• Table of Contents
• Copyright
• Contributors
• Preface
• Acknowledgments
• Chapter 1: Anatomy of the Urethra
• Chapter 2: Optical Internal Urethrotomy in Males
• Chapter 3: Urethral Stents
• Chapter 4: Urethral Dilations in Males
• Chapter 5: Endoscopic Treatment of Urethral Strictures in Women
• Chapter 6: Treatment of Urethral Lithiasis and Foreign Bodies
• Chapter 7: Endoscopic Treatment of Urethral Tumors
• Chapter 8: Endoscopic Management of Urethral Trauma
• Chapter 9: Difficult Urethro-Vesical Catheterization
• Chapter 10: Endoscopic Treatment of Urinary Incontinence
• Chapter 11: Endoscopic Management of Urethral Abnormalities
• Chapter 12: Verumontanum
• Index