Females and males differ significantly in gross anatomy and physiology of the lower urinary tract, and these differences are commonly discussed in the medical and scientific literature. However, less attention is dedicated to investigating the varied development, function, and biology between females and males on a cellular level. Recognizing that cell biology is not uniform, especially in the lower urinary tract of females and males, is crucial for providing context and relevance for diverse fields of biomedical investigation. This review serves to characterize the current understanding of biological sex differences between female and male lower urinary tracts, while identifying areas for future research. First, the differences in overall cell populations are discussed in the detrusor smooth muscle, urothelium, and trigone. Second, the urethra is discussed, including anatomic discussions of the female and male urethra followed by discussions of cellular differences in the urothelial and muscular layers. The pelvic floor is then reviewed, followed by an examination of the sex differences in hormonal regulation, the urinary tract microbiome, and the reticuloendothelial system. Understanding the complex and dynamic development, anatomy, and physiology of the lower urinary tract should be contextualized by the sex differences described in this review.

https://cdr.lib.unc.edu/downloads/gt54kq242

Sex differences in lower urinary tract biology and physiology.

.............................................................................................................................. ix Dedication ............................................................................................................................ xi Acknowledgements ............................................................................................................ xiii Funding ...................................................................................................................................... xiv Abbreviations ..................................................................................................................... xv Conventions ...............................................................................................................................xvii Chapter 1: Background literature ...........................................................................................

Urogenital Fistula :studies on epidemiology and treatment outcomes in high-income and low-and middle-income countries

Normal and Abnormal Prepuce

Urogynecological surgical mesh implants: New trends in materials, manufacturing and therapeutic approaches.

Lower urinary tract symptoms affect 2.3 billion individuals worldwide and pose a substantial burden on the quality of life. An important step in a LUTS investigation is the exclusion of a urinary tract infection with the help of nationally recommended urine tests. These tests include the routine midstream urine culture, which is regarded as the UK’s gold standard for detecting infection. Microbial confirmation of UTI stems from criteria that were originally proposed in the 1950s, following a study that examined patients with acute pyelonephritis. Whilst the clinical diagnosis of UTI is considered to be straightforward in patients that describe hallmark symptoms, notably acute frequency and dysuria, the presentation of less well-recognised LUTS may not be as straightforward to diagnose and treat. This thesis consists of original work from three specific studies. Firstly, a retrospective observational study was conducted to compare the clinical characteristics of patients describing LUTS with a suspected UTI, on the basis of their routine MSU culture findings. This study revealed the striking clinical similarities between patients with a culture result of doubtful significance that consists of multiple organisms and patients with a positive culture that represents significant bacteriuria. Secondly, an evaluation of the UK’s MSU culture was performed by comparing the microbial yield achieved with three different culture techniques. Additionally, the urinary bacterial community, represented by the cultured spun urinary cell sediment was characterised in three different cohorts. These were (i) first-visit symptomatic patients suspected to have a UTI, (ii) chronic patients with recurrent or unresolved LUTS from a previous symptomatic episode and (iii) asymptomatic individuals. Species-level microbial identification was achieved with matrix-assisted laser desorption ionisation time-of-flight mass spectrometry. The criteria used to determine significant bacteriuria and the technique employed to perform the MSU culture were identified as factors with the potential to limit the microbiological detection of UTI. Finally, following the disproved assumption of the healthy urinary tract as a sterile environment, molecular characterisation of LUTS patient and asymptomatic control urinary tract bacterial communities was achieved using 16S rRNA gene sequencing. The core bacterial taxa shared by both patient and healthy communities were determined, with Enterobacteriaceae identified as the most abundant bacterial group in patients and Streptococcus noted as the most abundant taxa in controls. Analysing unspun urine combined with concentrated urinary cell sediment significantly discriminated between the species richness of both communities. The presented original work establishes the potential significance of mixed growth urine cultures, prompting the question of their dismissal without further investigation. In addition to identifying the limitations of the UK’s MSU culture, the complex bacterial communities of asymptomatic and LUTS patients have been characterised mostly at the genus level and established as a foundation for subsequent functional characterisation to help elucidate the mechanisms involved in LUTS and UTI development.

Characterisation of the urinary microbial community and its association with lower urinary tract symptoms

Until now, anatomy of the lower urinary tract still persists for controversial discussion. Especially, the basis of the continence mechanism is still obscure. On the basis of our own exten...

Anatomy of the Lower Urinary Tract

New operating procedures that spare the important neural structures of the urogenital tract have led to improved functional results in terms of bladder function, urinary continence and erectile potency. Well-described examples are nerve-sparing radical prostatectomy [1–3] and cystectomy (continence, potency) [3, 4], ureteric antireflux surgery (bladder function) [5], extended radical hysterectomy with total mesometrial resection (bladder function) [6] and rectal resection (continence, bladder function, potency) [7].

Urinary Bladder and Prostate

Whilst the patient is supine, following induction of anaesthesia, a urinary catheter is inserted. The patient is now rotated to the lateral position and the urinary bag is placed either at the top or bottom end of the bed for access by the anaesthetist. The legs are separated and protected with either pillows or a specially designed foam or rubber device between them as seen in the inset, in order to relieve any weight on pressure points, while the legs are slightly flexed at the knees. All other bony points, including shoulders and hips, are protected by the rubber or foam mat that is positioned on the operating table. The head and neck are supported with either pillows or a rubber head ring in order to maintain them in a neutral position. Depending on the softness of the table mattress, an axillary rubber roll may be required (not illustrated in these images) to prevent brachial plexus injury.

Jens Mondry

Papers

Anatomy of the Lower Urinary Tract

Urinary Bladder and Prostate

Upper Urinary Tract (Kidney, Ureter and Adrenal Gland)