Ibrahim M. Kandil

Bio: Ibrahim M. Kandil is an academic researcher from Al-Azhar University. The author has contributed to research in topics: Urethral sphincter & Urethra. The author has an hindex of 6, co-authored 15 publications receiving 61 citations.

Pelvic Floor Dysfunction, the Role of Imaging and Reconstructive Surgery

Abstract: 1. The inherent factor is the tough strong collagen layer constituent of the internal urethral sphincter (IUS), that creates the high wall tension necessary for keeping high urethral pressure (Pura). The IUS is a collagen-muscle tissue cylinder that extends from the bladder neck to the perineal membrane in both sexes. 2 .The acquired factor, which is high alpha-sympathetic tone at the IUS gained from learning and training in early childhood, keeps it contracted and the urethra closes all the time until there is a need or a desire to void as social circumstances allow. Injury to one or both factors leads to urinary incontinence. II. The vagina is a cylinder of collagen-elastic-muscle tissues. The strong tough collagen sheet is responsible for the upright position of the vagina. The main function of the pelvic ligaments is to assign the pelvic organs to their anatomical site and keeps the pelvic organs in situ. Childbirth trauma damages the collagen layer due to overstretching of the vagina and leads to flabby and redundant vaginal walls with subsequent vaginal prolapse. When the pelvic ligaments suffer most of the trauma, the insult will lead to weakness of the pelvic ligaments, leading to vault and uterine prolapse. III. The integrity of both anal sphincters, internal anal sphincter (IAS) and external anal sphincter (EAS) is an essential factor in keeping fecal continence. Fecal continence also depends on strong pelvic floor muscles which keep an angle between the rectum and the anal canal. In addition, it depends on an acquired behavior, gained by learning and training in early childhood of maintaining high alpha-sympathetic tone at the IAS keeping

Imaging the internal urethral sphincter and the vagina in normal women and women suffering from stress urinary incontinence and vaginal prolapse prikaz unutra(njeg sfinktera uretre i vagine u zdravih @ena i oboljelih od stres inkontinencije mokra)e i prolapsa vagine

Abstract: SUMMARY. Introduction. The internal urethral sphincter (IUS) is a cylinder formation that extends from the urinary bladder neck to the urogenital diaphragm. It is composed of a strong collagen sheet with muscle fibers that intermingle with the collagen in the middle of the cylinder’s thickness. The strong collagen sheet gives the IUS the high wall tension necessary to create the high urethral pressure. The muscle fibers, innervated by alpha sympathetic nerves (T10-L2) are responsible for closure and opening the urethra. Urinary continence depends on the presence of an intact and strong IUS and of an acquired behavior, gained by learning and training in early childhood, how to maintain a high alpha sympathetic tone at the IUS keeping it closed until there is a need. Normal vagina is a cylinder of collageno-elastic-muscular tissues. Its strong collagen sheet is responsible for keeping it in its normal upward position. Labors cause redundancy and weakness of the vaginal walls with subsequent prolapse and lacerations of the IUS which is intimately overlying the anterior vaginal wall resulting in stress urinary incontinence (SUI). Objectives. To image by 3D-US and MRI the IUS and the vagina; and to examine their histopathology. Methods. Histopathology as well as 3D-US and MR imaging are done. Results. Images show the IUS as a compact tissue cylinder that extends from the bladder neck to the urogenital diaphragm in continent women; IUS is torn in women with SUI. Conclusion. The anterior vaginal wall and the IUS are torn in patients with SUI and with vaginal prolapse. They are intact in continent women. Izvorni ~lanak Klju~ne rije~i: unutra{nji uretralni sfinkter (IUS), trodimenzionalni ultrazvuk (3D-UZ), magnetska rezonancija (MR), prolaps vagine, stresna inkontinencija mokra}e (SUI)

Ultrasound Assessment of the Internal Anal Sphincter in Women with FecalIncontinence and Posterior Vaginal Wall Prolapse (Rectocele)

Abstract: Rupture of the internal anal sphincter (IAS) causes its weakness and it will not withstand increases of abdominal pressure, and fecalincontinence (FI) will occur. Recently, we put forward a novel concept on the physiology of defecation. Defecation is divided into two stages:First stage before training and second stage starts at the age of about 2 years, when the mother starts to teach her child how to hold uphimself. This is gained by maintaining high alpha-sympathetic tone at the IAS, thus keeping it closed all the time till there is a need to passstool or flatus, and the time and place are convenient. On defecation, six neuromuscular actions take place under the control of the CNS:(1) The person will relax the external anal sphincter, (2) he will lower the gained high alpha-sympathetic tone at the IAS, thus opening theanal canal, (3) he will relax the pelvic floor muscles bringing the rectum and the anal canal into one axis, (4) the abdominal and diaphragmaticmuscles contract to increase the abdominal pressure, (5) the muscles of the distal colon and rectum contract pushing the stool, (6)sequential contractions of the three parts of the external anal sphincter (EAS) that squeeze any residual contents in the anal canal. Thus,the anal canal is closed and empty under normal circumstances. The IAS is a collageno-muscular tissue cylinder that surrounds the analcanal.The IAS is intimately related to the posterior vaginal wall, and the vagina is over stretched in labor, childbirth trauma affects both theposterior vaginal wall and the IAS. Rupture of the collagen sheet of the IAS which causes its weakness is better demonstrated by imagingby 3D US.Normal vagina is a cylinder of collageno-elastic-muscular tissues. Its strong collagen sheet is responsible for keeping it in its normalupward position. Labors cause redundancy and weakness of the vaginal walls with subsequent prolapse; and lacerations of the IAS whichis closely related to the posterior vaginal wall leading to FI.

The Urologic Clinics of North America

Abstract: Recognizing the growth of urology as a specialty, WB Saunders has launched a new publication, the Urologic Clinics of North America. The first issue is a symposium entitled "Neurogenic Bladder," with Jack Lapides, MD, as guest editor. The goal of the Clinics, as Dr. Lapides states in the forward, is "to present up-to-date material of practical value," and this issue appears to have accomplished this aim. A chapter on neuroanatomy and neurophysiology of the detrusor and urethra is included, which provides the necessary scientific background for the following articles on classification, clinical evaluation, and therapy. Included in the symposium are several articles on intermittent catheterization by noted authorities in the treatment of spinal cord injuries. The surgical treatment of various neurological abnormalities is adequately discussed in several of the articles, and there is a separate article on indications and techniques of urinary diversion. For the most part, the various authors

Pelvic Floor Dysfunction, the Role of Imaging and Reconstructive Surgery

Abstract: 1. The inherent factor is the tough strong collagen layer constituent of the internal urethral sphincter (IUS), that creates the high wall tension necessary for keeping high urethral pressure (Pura). The IUS is a collagen-muscle tissue cylinder that extends from the bladder neck to the perineal membrane in both sexes. 2 .The acquired factor, which is high alpha-sympathetic tone at the IUS gained from learning and training in early childhood, keeps it contracted and the urethra closes all the time until there is a need or a desire to void as social circumstances allow. Injury to one or both factors leads to urinary incontinence. II. The vagina is a cylinder of collagen-elastic-muscle tissues. The strong tough collagen sheet is responsible for the upright position of the vagina. The main function of the pelvic ligaments is to assign the pelvic organs to their anatomical site and keeps the pelvic organs in situ. Childbirth trauma damages the collagen layer due to overstretching of the vagina and leads to flabby and redundant vaginal walls with subsequent vaginal prolapse. When the pelvic ligaments suffer most of the trauma, the insult will lead to weakness of the pelvic ligaments, leading to vault and uterine prolapse. III. The integrity of both anal sphincters, internal anal sphincter (IAS) and external anal sphincter (EAS) is an essential factor in keeping fecal continence. Fecal continence also depends on strong pelvic floor muscles which keep an angle between the rectum and the anal canal. In addition, it depends on an acquired behavior, gained by learning and training in early childhood of maintaining high alpha-sympathetic tone at the IAS keeping

Imaging the internal urethral sphincter and the vagina in normal women and women suffering from stress urinary incontinence and vaginal prolapse prikaz unutra(njeg sfinktera uretre i vagine u zdravih @ena i oboljelih od stres inkontinencije mokra)e i prolapsa vagine

Abstract: SUMMARY. Introduction. The internal urethral sphincter (IUS) is a cylinder formation that extends from the urinary bladder neck to the urogenital diaphragm. It is composed of a strong collagen sheet with muscle fibers that intermingle with the collagen in the middle of the cylinder’s thickness. The strong collagen sheet gives the IUS the high wall tension necessary to create the high urethral pressure. The muscle fibers, innervated by alpha sympathetic nerves (T10-L2) are responsible for closure and opening the urethra. Urinary continence depends on the presence of an intact and strong IUS and of an acquired behavior, gained by learning and training in early childhood, how to maintain a high alpha sympathetic tone at the IUS keeping it closed until there is a need. Normal vagina is a cylinder of collageno-elastic-muscular tissues. Its strong collagen sheet is responsible for keeping it in its normal upward position. Labors cause redundancy and weakness of the vaginal walls with subsequent prolapse and lacerations of the IUS which is intimately overlying the anterior vaginal wall resulting in stress urinary incontinence (SUI). Objectives. To image by 3D-US and MRI the IUS and the vagina; and to examine their histopathology. Methods. Histopathology as well as 3D-US and MR imaging are done. Results. Images show the IUS as a compact tissue cylinder that extends from the bladder neck to the urogenital diaphragm in continent women; IUS is torn in women with SUI. Conclusion. The anterior vaginal wall and the IUS are torn in patients with SUI and with vaginal prolapse. They are intact in continent women. Izvorni ~lanak Klju~ne rije~i: unutra{nji uretralni sfinkter (IUS), trodimenzionalni ultrazvuk (3D-UZ), magnetska rezonancija (MR), prolaps vagine, stresna inkontinencija mokra}e (SUI)

Ultrasound Assessment of the Internal Anal Sphincter in Women with FecalIncontinence and Posterior Vaginal Wall Prolapse (Rectocele)

Abstract: Rupture of the internal anal sphincter (IAS) causes its weakness and it will not withstand increases of abdominal pressure, and fecalincontinence (FI) will occur. Recently, we put forward a novel concept on the physiology of defecation. Defecation is divided into two stages:First stage before training and second stage starts at the age of about 2 years, when the mother starts to teach her child how to hold uphimself. This is gained by maintaining high alpha-sympathetic tone at the IAS, thus keeping it closed all the time till there is a need to passstool or flatus, and the time and place are convenient. On defecation, six neuromuscular actions take place under the control of the CNS:(1) The person will relax the external anal sphincter, (2) he will lower the gained high alpha-sympathetic tone at the IAS, thus opening theanal canal, (3) he will relax the pelvic floor muscles bringing the rectum and the anal canal into one axis, (4) the abdominal and diaphragmaticmuscles contract to increase the abdominal pressure, (5) the muscles of the distal colon and rectum contract pushing the stool, (6)sequential contractions of the three parts of the external anal sphincter (EAS) that squeeze any residual contents in the anal canal. Thus,the anal canal is closed and empty under normal circumstances. The IAS is a collageno-muscular tissue cylinder that surrounds the analcanal.The IAS is intimately related to the posterior vaginal wall, and the vagina is over stretched in labor, childbirth trauma affects both theposterior vaginal wall and the IAS. Rupture of the collagen sheet of the IAS which causes its weakness is better demonstrated by imagingby 3D US.Normal vagina is a cylinder of collageno-elastic-muscular tissues. Its strong collagen sheet is responsible for keeping it in its normalupward position. Labors cause redundancy and weakness of the vaginal walls with subsequent prolapse; and lacerations of the IAS whichis closely related to the posterior vaginal wall leading to FI.