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Wu Z, Tang Z, Zheng Z, Tan S. A novel trauma induced urethral stricture in rat model. Sci Rep 2024; 14:6325. [PMID: 38491041 PMCID: PMC10943079 DOI: 10.1038/s41598-024-55408-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/22/2024] [Indexed: 03/18/2024] Open
Abstract
Urethral stricture (US) is a longstanding disease, while there has not existed a suitable animal model to mimic the condition. We aimed to establish a trauma-induced US animal model to simulate this clinical scenario. A total of 30 rats were equally distributed into two groups, sham and US group. All rats were anesthetized with isoflurane and undergone cystostomy. In the US group, a 2 mm incision was made in the urethra and sutured to induce US. The sham group only make a skin incision on the ventral side of the anterior urethra. 4 weeks later, ultrasound and cystourethrography were performed to evaluate the degree of urethral stricture, pathological examinations were carried out to evaluate the degree of fibrosis. Urodynamic evaluation and mechanical tissue testing were performed to evaluate the bladder function and urethral tissue stiffness. The results showed that the urethral mucosa was disrupted and urethral lumen was stenosed in the US group. Additionally, the US group showed elevated bladder pressure, prolonged micturition intervals and increased tissue stiffness. In conclusion, the rat urethral stricture model induced by trauma provides a closer representation of the real clinical scenario. This model will significantly contribute to advancing research on the mechanisms underlying traumatic urethral stricture.
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Affiliation(s)
- Ziqiang Wu
- Department of Urology, Xiangya Hospital of Central South University, Changsha, People's Republic of China
- Provincial Laboratory for Diagnosis and Treatment of Genitourinary System Disease, Changsha, People's Republic of China
| | - Zhengyan Tang
- Department of Urology, Xiangya Hospital of Central South University, Changsha, People's Republic of China
- Provincial Laboratory for Diagnosis and Treatment of Genitourinary System Disease, Changsha, People's Republic of China
| | - Zhihuan Zheng
- Department of Urology, Xiangya Hospital of Central South University, Changsha, People's Republic of China.
- Provincial Laboratory for Diagnosis and Treatment of Genitourinary System Disease, Changsha, People's Republic of China.
| | - Shuo Tan
- Department of Urology, Third Xiangya Hospital of Central South University, Changsha, People's Republic of China.
- Provincial Laboratory for Diagnosis and Treatment of Genitourinary System Disease, Changsha, People's Republic of China.
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Frankiewicz M, Vetterlein MW, Markiet K, Adamowicz J, Campos-Juanatey F, Cocci A, Rosenbaum CM, Verla W, Waterloos M, Mantica G, Matuszewski M. Ultrasound imaging of male urethral stricture disease: a narrative review of the available evidence, focusing on selected prospective studies. World J Urol 2024; 42:32. [PMID: 38217706 PMCID: PMC10787903 DOI: 10.1007/s00345-023-04760-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 12/10/2023] [Indexed: 01/15/2024] Open
Abstract
PURPOSE To synthetize the current scientific knowledge on the use of ultrasound of the male urethra for evaluation of urethral stricture disease. This review aims to provide a detailed description of the technical aspects of ultrasonography, and provides some indications on clinical applications of it, based on the evidence available from the selected prospective studies. Advantages and limitations of the technique are also provided. METHODS A comprehensive literature search was performed using the Medline and Cochrane databases on October 2022. The articles were searched using the keywords "sonourethrography", "urethral ultrasound", "urethral stricture" and "SUG". Only human studies and articles in English were included. Articles were screened by two reviewers (M.F. and K.M.). RESULTS Our literature search reporting on the role of sonourethrography in evaluating urethral strictures resulted in selection of 17 studies, all prospective, even if of limited quality due to the small patients' number (varied from 28 to 113). Nine studies included patients with urethral stricture located in anterior urethra and eight studies included patients regardless of the stricture location. Final analysis was based on selected prospective studies, whose power was limited by the small patients' groups. CONCLUSION Sonourethrography is a cost-effective and safe technique allowing for a dynamic and three-dimensional urethra assessment. Yet, because of its limited value in detecting posterior urethral strictures, the standard urethrography should remain the basic 'road-map' prior to surgery. It is an operator-dependent technique, which can provide detailed information on the length, location, and extent of spongiofibrosis without risks of exposure to ionizing radiation.
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Affiliation(s)
| | - Malte W Vetterlein
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Karolina Markiet
- Department of Urology, Department of Radiology, University Clinical Centre in Gdańsk, Gdańsk, Poland
| | - Jan Adamowicz
- Department of Regenerative Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Felix Campos-Juanatey
- Andrology and Reconstructive Urology Unit, School of Medicine, Marqués de Valdecilla University Hospital, Cantabria University, IDIVAL, Santander, Spain
| | - Andrea Cocci
- Department of Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | | | - Wesley Verla
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Marjan Waterloos
- Department of Urology, Ghent University Hospital, Ghent, Belgium
- Department of Urology, AZ Maria Middelares, Ghent, Belgium
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Li K, Ding K, Zhu Q, Han F, He X, Tan S, Wu Z, Zheng Z, Tang Z, Liu Y. Extracellular matrix stiffness aggravates urethral stricture through Igfbp3/Smad pathway. Sci Rep 2023; 13:14315. [PMID: 37653219 PMCID: PMC10471624 DOI: 10.1038/s41598-023-41584-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/29/2023] [Indexed: 09/02/2023] Open
Abstract
Urethral stricture refers to the narrowing of the urethral lumen. While previous studies have hinted at inflammation as the initial driver of this condition, the reasons and mechanisms behind its progression remain largely unknown. By Atomic force microscope (AFM), researchers measured the matrix stiffness of urethra to be 5.23 ± 0.37 kPa for normal tissue and 41.59 ± 2.48 kPa for stricture urethral scar. Similar results were observed in rat urethral stricture models, where the matrix stiffness of normal urethra was 4.29 ± 0.82 kPa, while 32.94 ± 7.12 kPa for urethral stricture scar. Notably, the matrix stiffness increased in rat models over time. To further investigate, polyacrylamide hydrogels were employed to mimic different levels of stiffness for normal and stricture condition. Interestingly, higher matrix stiffness led to an increased fibroblast-to-myofibroblast transition (FMT) in rat urethral fibroblasts, indicated by enhanced expression of α-SMA and Collagen I, as well as changing in the morphology of fibroblast. RNA-seq analysis suggested that Igfbp3/Smads might regulate the progressive FMT in urethral stricture. In the experiment where the expression of Igfbp3 was inhibited, increasing matrix stiffness lose the potential to stimulate FMT progression and the expression of p-Smad2/3 decreased. On the contrary, overexpression of Igfbp3 promoted the process of FMT in urethral fibroblasts. In conclusion, Igfbp3/Smad pathway appeared to be involved in the progression of urethral fibrosis. This finding suggested that Igfbp3/Smad might be an promising target for future research and treatment in this filed.
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Affiliation(s)
- Kaixuan Li
- Department of Cardiac Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
- Department of Urology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
- Provincial Laboratory for Diagnosis and Treatment of Genitourinary System Disease, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Ke Ding
- Department of Urology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
- Provincial Laboratory for Diagnosis and Treatment of Genitourinary System Disease, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Quan Zhu
- Department of Urology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
- Provincial Laboratory for Diagnosis and Treatment of Genitourinary System Disease, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Feng Han
- Department of Urology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
- Provincial Laboratory for Diagnosis and Treatment of Genitourinary System Disease, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Xi He
- Department of Orthopedics, The First Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, 310003, Zhejiang, China
| | - Shuo Tan
- Provincial Laboratory for Diagnosis and Treatment of Genitourinary System Disease, 87 Xiangya Road, Changsha, 410008, Hunan, China
- Department of Urology, Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China
| | - Ziqiang Wu
- Department of Urology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
- Provincial Laboratory for Diagnosis and Treatment of Genitourinary System Disease, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Zhihuan Zheng
- Department of Urology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
- Provincial Laboratory for Diagnosis and Treatment of Genitourinary System Disease, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Zhengyan Tang
- Department of Urology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China.
- Provincial Laboratory for Diagnosis and Treatment of Genitourinary System Disease, 87 Xiangya Road, Changsha, 410008, Hunan, China.
| | - Yanling Liu
- Department of Urology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China.
- Provincial Laboratory for Diagnosis and Treatment of Genitourinary System Disease, 87 Xiangya Road, Changsha, 410008, Hunan, China.
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Salib A, Halpern E, Eisenbrey J, Chandrasekar T, Chung PH, Forsberg F, Trabulsi EJ. The evolving role of contrast-enhanced ultrasound in urology: a review. World J Urol 2022; 41:673-678. [PMID: 35969244 DOI: 10.1007/s00345-022-04088-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/28/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Ultrasound's versatility and ease of use has expanded its application in many clinical settings. Technological advancements with contrast-enhanced ultrasound (CEUS) have allowed high quality imaging similar to CT or MRI with lower risk of contrast toxicity and radiation exposure. In this review article we examine the development of CEUS and its vast applications in the field of urology. METHODS A PubMed literature search was performed using keywords: contrast enhanced ultrasound, prostate cancer, renal cancer, and multiparametric ultrasound. RESULTS The development of CEUS has improved transrectal ultrasound imaging with increased detection of prostate cancer (PCa). Further enhancements of CEUS such as subharmonic imaging (SHI), flash replenishment imaging (FRI) and contrast ultrasound dispersion imaging (CUDI) allow improved PCa diagnosis. CEUS has also emerged as an important tool in characterizing suspicious renal mass without compromising renal function with contrast imaging. CONCLUSION CEUS has modernized imaging and diagnosis of prostate and renal cancer. Future advancements and utilization of CEUS will allow its expansion into other urological subspecialties.
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Affiliation(s)
- Andrew Salib
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut St. Ste. 1100, Philadelphia, PA, 19107, USA
| | - Ethan Halpern
- Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - John Eisenbrey
- Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Thenappan Chandrasekar
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut St. Ste. 1100, Philadelphia, PA, 19107, USA
| | - Paul H Chung
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut St. Ste. 1100, Philadelphia, PA, 19107, USA
| | - Flemming Forsberg
- Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Edouard J Trabulsi
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut St. Ste. 1100, Philadelphia, PA, 19107, USA.
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Elastography in the Urological Practice: Urinary and Male Genital Tract, Prostate Excluded—Review. Diagnostics (Basel) 2022; 12:diagnostics12071727. [PMID: 35885631 PMCID: PMC9320571 DOI: 10.3390/diagnostics12071727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/08/2022] [Accepted: 07/12/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of this article is to review the utility of elastography in the day-to-day clinical practice of the urologist. An electronic database search was performed on PubMed and Cochrane Library with a date range between January 2000 and December 2021. The search yielded 94 articles that passed the inclusion and exclusion criteria. The articles were reviewed and discussed by organ, pathology and according to the physical principle underlying the elastographic method. Elastography was used in the study of normal organs, tumoral masses, chronic upper and lower urinary tract obstructive diseases, dysfunctions of the lower urinary tract and the male reproductive system, and as a pre- and post-treatment monitoring tool. Elastography has numerous applications in urology, but due to a lack of standardization in the methodology and equipment, further studies are required.
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