On Structure-Function Relationships in the Female Human Urethra: A Finite Element Model Approach

Attari, Ali; DeLancey, John O.L.; Ashton‐Miller, James A.

doi:10.1007/s10439-021-02765-4

Cited by 5 publications

(4 citation statements)

References 30 publications

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“…The muscular layer of the urethra is formed of urethral smooth muscle and striated muscle (external urethral sphincter) [ 11 , 17 , 18 ]. The urethral smooth muscle is divided into two layers [ 19 ].…”

Section: Anatomical Factors Of the Urethra Itselfmentioning

confidence: 99%

“…This kind of unique tissue arrangement is very important for continence in the context of urination. The outer circular smooth muscle fiber contracts with the inner longitudinal smooth muscle as a central filler, producing continuous tension [ 21 ], narrowing the lumen diameter of the urethra and maintaining static urethral tension [ 11 , 17 ] ( Figure 1 ).…”

Section: Anatomical Factors Of the Urethra Itselfmentioning

confidence: 99%

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The Anatomical Pathogenesis of Stress Urinary Incontinence in Women

et al. 2022

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Stress urinary incontinence is a common disease in middle-aged and elderly women, which seriously affects the physical and mental health of the patients. For this reason, researchers have carried out a large number of studies on stress urinary incontinence. At present, it is believed that the pathogenesis of the disease is mainly due to changes related to age, childbirth, obesity, constipation and other risk factors that induce changes in the urinary control anatomy, including the anatomical factors of the urethra itself, the anatomical factors around the urethra and the anatomical factors of the pelvic nerve. The combined actions of a variety of factors lead to the occurrence of stress urinary incontinence. This review aims to summarize the anatomical pathogenesis of stress urinary incontinence from the above three perspectives.

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Section: Anatomical Factors Of the Urethra Itselfmentioning

confidence: 99%

Section: Anatomical Factors Of the Urethra Itselfmentioning

confidence: 99%

The Anatomical Pathogenesis of Stress Urinary Incontinence in Women

et al. 2022

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“…In more recent years, detailed anatomically‐accurate representations of the urethra have been created based on histological and morphometric studies or using magnetic resonance imaging (MRI). For example, experimental and structural studies of the male urethra have been combined with 3‐D finite element models to characterize urethral occlusions using artificial devices to provide urinary continence 29,30 ; in addition, MRI studies of the female urethra have been combined with computationally intensive finite element models to simulate how contraction of striated and smooth muscles contribute to the urethral closure pressure (

{P}_{C}

) 31 . Allometric analyses of LUT function across animals with body mass ranging from 0.03 to 8000kg find urethral length, diameter, bladder capacity, and steady‐state flow rate scale with body mass, but bladder pressure and duration of urination are relatively insensitive to body size 32 .…”

Section: Urethramentioning

confidence: 99%

“…For example, experimental and structural studies of the male urethra have been combined with 3-D finite element models to characterize urethral occlusions using artificial devices to provide urinary continence 29,30 ; in addition, MRI studies of the female urethra have been combined with computationally intensive finite element models to simulate how contraction of striated and smooth muscles contribute to the urethral closure pressure (P C ). 31 Allometric analyses of LUT function across animals with body mass ranging from 0.03 to 8000kg find urethral length, diameter, bladder capacity, and steadystate flow rate scale with body mass, but bladder pressure and duration of urination are relatively insensitive to body size. 32 Moreover, such analyses suggest that small-rodent studies guiding models of the human LUT may need to be adapted to put less attention on viscous and capillary forces and more attention on the role of hydrostatic pressure.…”

Section: Urethramentioning

confidence: 99%

Mathematical modeling of the lower urinary tract: A review

Jaskowak

Núñez

Ramachandran

et al. 2022

Neurourology and Urodynamics

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Aims Understand what progress has been made toward a functionally predictive lower urinary tract (LUT) model, identify knowledge gaps, and develop from them a path forward. Methods We surveyed prominent mathematical models of the basic LUT components (bladder, urethra, and their neural control) and categorized the common modeling strategies and theoretical assumptions associated with each component. Given that LUT function emerges from the interaction of these components, we emphasized attempts to model their connections, and highlighted unmodeled aspects of LUT function. Results There is currently no satisfactory model of the LUT in its entirety that can predict its function in response to disease, treatment, or other perturbations. In particular, there is a lack of physiologically based mathematical descriptions of the neural control of the LUT. Conclusions Based on our survey of the work to date, a potential path to a predictive LUT model is a modular effort in which models are initially built of individual tissue‐level components using methods that are extensible and interoperable, allowing them to be connected and tested in a common framework. A modular approach will allow the larger goal of a comprehensive LUT model to be in sight while keeping individual efforts manageable, ensure new models can straightforwardly build on prior research, respect potential interactions between components, and incentivize efforts to model absent components. Using a modular framework and developing models based on physiological principles, to create a functionally predictive model is a challenge that the field is ready to undertake.

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Do We Need to Re‐Focus on Functional Female Urethral Disorders in Lower Urinary Tract Dysfunction? ICI‐RS 2024

Chermansky,

Ockrim,

Kheir

et al. 2024

Neurourology and Urodynamics

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AimsInsights into the role of the urethra in maintaining continence and in normal voiding have been provided with advances in imaging techniques. Also, functional urethral testing is used to understand which treatments are optimal for women with functional bladder outlet obstruction (BOO), but which testing is better for which treatment? This review aims to describe our current understanding of female urethral function and dysfunction and to provide future research directions for treating functional female urethral disorders.Materials and MethodsThis is a consensus report of the proceedings of a research proposal discussed at the annual International Consultation on Incontinence‐Research Society (ICI‐RS), 6th–8th June 2024 (Bristol, UK): “Do we need to re‐focus on functional female urethral disorders in lower urinary tract dysfunction? ICI‐RS 2024”.ResultsRegarding female urethral nomenclature, it was agreed that the same terminology should be used in the orientation of the female urethra as in the male. Also, functional MRI and computer modeling could aid further understanding of urethral function in women with voiding dysfunction and OAB symptoms. As for functional urethral assessment, options include video‐urodynamics with leak point pressure (LPP) testing, urethral pressure profilometry (UPP), and striated urethral sphincter electromyography (EMG). Future testing may include the use of modalities (borrowed from cardiologic assessment of vascular structures such as resistive measures obtained with ultrasound) for the purpose of assessing urethral closure. UPP testing has limitations in measurement and reproducibility in assessing urethral pressure. Urethral sphincter EMG is difficult to perform and reproduce. LPP also has limitations related to testing and to patient effort, in addition to being influenced by factors such as bladder volume and compliance. When performing urethral surgery, it is imperative to dissect in tissue planes that preserve urethral function. Regarding therapeutic modalities for the treatment of functional female urethral dysfunction, conservative management includes pelvic floor muscle training with or without biofeedback, electrical stimulation, and extracorporeal magnetic stimulation. Furthermore, there was a robust discussion on the use of cognitive‐behavioral therapy to address psychological comorbidities, thereby improving female LUTD. The evidence supporting long‐term pharmacologic treatment of female urethral LUTD remains scarce. As for invasive management options, the evidence supporting the use of botulinum toxin in female LUTD is limited. Finally, the very existence of BNO and the validity of its diagnosis was discussed. Furthermore, bladder neck incision as a treatment of BNO was debated, and the indications for this procedure include a therapeutic decision balancing benefit to complications.ConclusionImproving the treatment of female functional storage and voiding disorders depends on optimal urethral function assessment. Functional MRI to better understand urethral function, expanding the use of UPP testing, LPP testing, and emerging modalities while maintaining urethral function during female urethral surgery, and addressing psychological comorbidities whilst pursuing both conservative and invasive options (for refractory symptoms) are all important considerations in treating functional female urethral disorders.

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On Structure-Function Relationships in the Female Human Urethra: A Finite Element Model Approach

Abstract: Associate Editor Raffaella De Vita oversaw the review of this article.

Cited by 5 publications

References 30 publications

The Anatomical Pathogenesis of Stress Urinary Incontinence in Women

The Anatomical Pathogenesis of Stress Urinary Incontinence in Women

Mathematical modeling of the lower urinary tract: A review

Do We Need to Re‐Focus on Functional Female Urethral Disorders in Lower Urinary Tract Dysfunction? ICI‐RS 2024

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