Bulbar Urethral Necrosis
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Bulbar Urethral Necrosis
Bulbar urethral necrosis is a problem that can occur after a pelvic fracture associated urethral distraction defect (PFUDD). Description A pelvic fracture can cause the urethra to separate, leading to a variable length of scar that can severely hamper the ability to urinate normally. The urethra is a tubular conduit that transports urine out of the bladder. The bulbar urethra is a segment of the male urethra that is in between the penile urethra and the membrano-prostatic urethra that typically has a robust blood supply. This blood supply includes antegrade flow from the paired bulbar arteries and circumflex arteries, and retrograde flow from the paired dorsal arteries of the penis. PFUDD treatment The treatment for PFUDDs is scar excision and primary anastomosis, which means reconnecting the two ends of the urethra that were severed during the pelvic injury. Most patients do well with this but occasionally, stricture of the repair recurs and the patients may require redo surge ...
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Pelvic Fracture
A pelvic fracture is a break of the bony structure of the pelvis. This includes any break of the sacrum, hip bones (ischium, pubis, ilium), or tailbone. Symptoms include pain, particularly with movement. Complications may include internal bleeding, injury to the bladder, or vaginal trauma. Common causes include falls, motor vehicle collisions, a vehicle hitting a pedestrian, or a direct crush injury. In younger people significant trauma is typically required while in older people less significant trauma can result in a fracture. They are divided into two types: stable and unstable. Unstable fractures are further divided into anterior posterior compression, lateral compression, vertical shear, and combined mechanism fractures. Diagnosis is suspected based on symptoms and examination with confirmation by X-rays or CT scan. If a person is fully awake and has no pain of the pelvis medical imaging is not needed. Emergency treatment generally follows advanced trauma life sup ...
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Urethra
The urethra (from Greek οὐρήθρα – ''ourḗthrā'') is a tube that connects the urinary bladder to the urinary meatus for the removal of urine from the body of both females and males. In human females and other primates, the urethra connects to the urinary meatus above the vagina, whereas in marsupials, the female's urethra empties into the urogenital sinus. Females use their urethra only for urinating, but males use their urethra for both urination and ejaculation. The external urethral sphincter is a striated muscle that allows voluntary control over urination. The internal sphincter, formed by the involuntary smooth muscles lining the bladder neck and urethra, receives its nerve supply by the sympathetic division of the autonomic nervous system. The internal sphincter is present both in males and females. Structure The urethra is a fibrous and muscular tube which connects the urinary bladder to the external urethral meatus. Its length differs between the sexes, ...
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Bulbar Urethra
The spongy urethra (cavernous portion of urethra, penile urethra) is the longest part of the male urethra, and is contained in the corpus spongiosum of the penis. It is about 15 cm long, and extends from the termination of the membranous portion to the external urethral orifice. Commencing below the inferior fascia of the urogenital diaphragm it passes forward and upward to the front of the pubic symphysis; and then, in the flaccid condition of the penis, it bends downward and forward. It is narrow, and of uniform size in the body of the penis, measuring about 6 mm in diameter; it is dilated behind, within the bulb, and again anteriorly within the glans penis, where it forms the fossa navicularis urethrae. The spongy urethra runs along the length of the penis on its ventral (underneath) surface. It is about 15–16 cm in length, and travels through the corpus spongiosum. The ducts from the urethral gland (gland of Littre) enter here. The openings of the bulbouret ...
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Penile Urethra
The spongy urethra (cavernous portion of urethra, penile urethra) is the longest part of the male urethra, and is contained in the corpus spongiosum of the penis. It is about 15 cm long, and extends from the termination of the membranous portion to the external urethral orifice. Commencing below the inferior fascia of the urogenital diaphragm it passes forward and upward to the front of the pubic symphysis; and then, in the flaccid condition of the penis, it bends downward and forward. It is narrow, and of uniform size in the body of the penis, measuring about 6 mm in diameter; it is dilated behind, within the bulb, and again anteriorly within the glans penis, where it forms the fossa navicularis urethrae. The spongy urethra runs along the length of the penis on its ventral (underneath) surface. It is about 15–16 cm in length, and travels through the corpus spongiosum. The ducts from the urethral gland (gland of Littre) enter here. The openings of the bulbouret ...
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Dorsal Artery Of The Penis
The dorsal artery of the penis is an artery on the top surface of the penis. It is a branch of the internal pudendal artery. It runs forward on the dorsum of the penis to the glans, where it divides into two branches to the glans penis and the foreskin (prepuce). The dorsal artery of the penis supplies the integument and fibrous sheath of the corpus cavernosum penis, the glans penis, the foreskin, and the skin of the distal shaft. It also branches with circumflex arteries that supply the corpus spongiosum. Its role in erectile function is unknown. The dorsal artery of the penis may be damaged in traumatic amputation of the penis and repairing the dorsal artery surgically prevents skin loss, but it is not essential for sexual and urinary function. Its hemodynamics and blood pressure can be assessed to test for sexual impairment. Structure The dorsal artery of the penis is a branch of the internal pudendal artery. It ascends between the crus penis and the pubic symphysis ...
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Penis
A penis (plural ''penises'' or ''penes'' () is the primary sexual organ that male animals use to inseminate females (or hermaphrodites) during copulation. Such organs occur in many animals, both vertebrate and invertebrate, but males do not bear a penis in every animal species, and in those species in which the male does bear a so-called penis, the penises in the various species are not necessarily homologous. The term ''penis'' applies to many intromittent organs, but not to all. As an example, the intromittent organ of most cephalopoda is the hectocotylus, a specialized arm, and male spiders use their pedipalps. Even within the Vertebrata there are morphological variants with specific terminology, such as Hemipenis, hemipenes. In most species of animals in which there is an organ that might reasonably be described as a penis, it has no major function other than intromission, or at least conveying the sperm to the female, but in the Eutheria, placental mammals the peni ...
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Anastomosis
An anastomosis (, plural anastomoses) is a connection or opening between two things (especially cavities or passages) that are normally diverging or branching, such as between blood vessels, leaf#Veins, leaf veins, or streams. Such a connection may be normal (such as the foramen ovale (heart), foramen ovale in a fetus's heart) or abnormal (such as the atrial septal defect#Patent foramen ovale, patent foramen ovale in an adult's heart); it may be acquired (such as an arteriovenous fistula) or innate (such as the arteriovenous shunt of a metarteriole); and it may be natural (such as the aforementioned examples) or artificial (such as a surgical anastomosis). The reestablishment of an anastomosis that had become blocked is called a reanastomosis. Anastomoses that are abnormal, whether congenital disorder, congenital or acquired, are often called fistulas. The term is used in medicine, biology, mycology, geology, and geography. Etymology Anastomosis: medical or Modern Latin, from Gre ...
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Anus
The anus (Latin, 'ring' or 'circle') is an opening at the opposite end of an animal's digestive tract from the mouth. Its function is to control the expulsion of feces, the residual semi-solid waste that remains after food digestion, which, depending on the type of animal, includes: matter which the animal cannot digest, such as bones; Summary at food material after the nutrients have been extracted, for example cellulose or lignin; ingested matter which would be toxic if it remained in the digestive tract; and dead or excess gut bacteria and other endosymbionts. Amphibians, reptiles, and birds use the same orifice (known as the cloaca) for excreting liquid and solid wastes, for copulation and egg-laying. Monotreme mammals also have a cloaca, which is thought to be a feature inherited from the earliest amniotes via the therapsids. Marsupials have a single orifice for excreting both solids and liquids and, in females, a separate vagina for reproduction. Female placental mamm ...
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Scrotum
The scrotum or scrotal sac is an anatomical male reproductive structure located at the base of the penis that consists of a suspended dual-chambered sac of skin and smooth muscle. It is present in most terrestrial male mammals. The scrotum contains the external spermatic fascia, testes, epididymis, and ductus deferens. It is a distention of the perineum and carries some abdominal tissues into its cavity including the testicular artery, testicular vein, and pampiniform plexus. The perineal raphe is a small, vertical, slightly raised ridge of scrotal skin under which is found the scrotal septum. It appears as a thin longitudinal line that runs front to back over the entire scrotum. In humans and some other mammals the scrotum becomes covered with pubic hair at puberty. The scrotum will usually tighten during penile erection and when exposed to cold temperatures. One testis is typically lower than the other to avoid compression in the event of an impact. The scrotum is biologicall ...
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Erectile Dysfunction
Erectile dysfunction (ED), also called impotence, is the type of sexual dysfunction in which the penis fails to become or stay erect during sexual activity. It is the most common sexual problem in men.Cunningham GR, Rosen RC. Overview of male sexual dysfunction. In: UpToDate, Martin KA (Ed), UpToDate, Waltham, MA, 2018. Through its connection to self-image and to problems in sexual relationships, erectile dysfunction can cause psychological harm. In about 80% of cases, physical causes can be identified. These include cardiovascular disease; diabetes mellitus; neurological problems, such as those following prostatectomy; hypogonadism; and drug side effects. About 10% of cases are psychological impotence, caused by thoughts or feelings; here, there is a strong response to placebo treatment. The term ''erectile dysfunction'' is not used for other disorders of erection, such as priapism. Treatment involves addressing the underlying causes, lifestyle modifications, and addres ...
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Urethroplasty
Urethroplasty is the surgical repair of an injury or defect within the walls of the urethra. Trauma, iatrogenic injury and infections are the most common causes of urethral injury/defect requiring repair. Urethroplasty is regarded as the gold standard treatment for urethral strictures and offers better outcomes in terms of recurrence rates than dilatations and urethrotomies. It is probably the only useful modality of treatment for long and complex strictures though recurrence rates are higher for this difficult treatment group. There are four commonly used types of urethroplasty performed; anastomotic, buccal mucosal onlay graft, scrotal or penile island flap, and Johansen's urethroplasty. With an average operating room time of between three and eight hours, urethroplasty is not considered a minor operation. Patients who undergo a shorter duration procedure may have the convenience of returning home that same day (between 20% and 30% in total of urethroplasty patients). Hospita ...
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Sigmoid Colon
The sigmoid colon (or pelvic colon) is the part of the large intestine that is closest to the rectum and anus. It forms a loop that averages about in length. The loop is typically shaped like a Greek letter sigma (ς) or Latin letter S (thus ''sigma'' + ''-oid''). This part of the colon normally lies within the pelvis, but due to its freedom of movement it is liable to be displaced into the abdominal cavity. Structure The sigmoid colon begins at the superior aperture of the lesser pelvis, where it is continuous with the iliac colon, and passes transversely across the front of the sacrum to the right side of the pelvis. It then curves on itself and turns toward the left to reach the middle line at the level of the third piece of the sacrum, where it bends downward and ends in the rectum. Its function is to expel solid and gaseous waste from the gastrointestinal tract. The curving path it takes toward the anus allows it to store gas in the superior arched portion, enabling the co ...
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