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Data generated from flexible ureteroscope with real-time intrarenal pressure (IRP) sensing. Key data include procedure time of 13.5 min, mean IRP of 12 mmHg, peak IRP of 103 mmHg, and 65 s spent at IRP >30 mmHg.
Published Online: 08 August 2025
Fig. 1. Data generated from flexible ureteroscope with real-time intrarenal pressure (IRP) sensing. Key data include procedure time of 13.5 min, mean IRP of 12 mmHg, peak IRP of 103 mmHg, and 65 s spent at IRP >30 mmHg. More about this image found in Data generated from flexible ureteroscope with real-time intrarenal pressur...
Forest plot of complication risk comparing patients with higher vs. lower mean IRP during PCNL. Patients with higher mean IRP had four times higher odds of a perioperative complication than those with lower IRP (p < 0.001).
Published Online: 08 August 2025
Fig. 2. Forest plot of complication risk comparing patients with higher vs. lower mean IRP during PCNL. Patients with higher mean IRP had four times higher odds of a perioperative complication than those with lower IRP ( p < 0.001). More about this image found in Forest plot of complication risk comparing patients with higher vs. lower m...
Journal Articles
“Simulated operation” relieves pain and urge by supporting USL. Left: 3D view of the PUL and USL attachments to the pelvic brim. A gently inserted speculum mechanically supports lax USLs and pelvic visceral nerve plexuses (VP). The test, if successful, decreases afferent pain and urge impulses; the patient reports lessening pain in multiple sites, for example, “B,” “R,” and “M” (right image). Co-occurring urge is also often relieved by speculum support of urothelial stretch receptors “N.” Right: 3D view of pelvic organs. The VP comprises sympathetic plexus (SP) and parasympathetic plexus (PS). The yellow lines represent visceral nerves to and from the end organs. M, muscles; V, vagina/vulva; B, bladder; R, rectum; G, force of gravity acting on “VPs” (left figure); PCM, pubococcygeus muscle; PUL, pubourethral ligament; ATFP, arcus tendineus fascia pelvis; USL, uterosacral ligament; CL, cardinal ligament; LP, levator plate; LMA, conjoint longitudinal muscle of the anus; L, USL laxity.
Published Online: 04 August 2025
Fig. 1. “Simulated operation” relieves pain and urge by supporting USL. Left: 3D view of the PUL and USL attachments to the pelvic brim. A gently inserted speculum mechanically supports lax USLs and pelvic visceral nerve plexuses (VP). The test, if successful, decreases afferent pain and urge i... More about this image found in “Simulated operation” relieves pain and urge by supporting USL. Left: 3D vi...
Binary model for bladder control by 2 opposing reflexes, either closure or micturition. Schematic 3D sagittal view, system in normal closed mode. PCM, pubococcygeus muscle; LP, levator plate; LMA, conjoint longitudinal muscle of the anus; PUL, pubourethral ligament; USL, uterosacral ligament; N, urothelial stretch receptors; CX, cervix; CL, cardinal ligament; ATFP, arcus tendineus fascia pelvis; small green arrows, afferent and efferent nerves; white arrows, cortical suppression. Control of SUI: PCM closes the distal urethra from behind; LP/LMA stretches the proximal urethra around PUL to close the bladder neck. Control of urge: afferent impulses “X” from stretch receptors “N” signal bladder fullness reflexly suppressed cortically (white arrows) or peripherally by a musculo‐elastic mechanism, vaginal stretching by 3 striated pelvic muscles contracting against PUL and USL. Micturition: the closure reflex is shut down and the micturition reflex is activated. PCM relaxes. LP and LMA open out the posterior wall of the urethra (white broken lines below the urethra). Dysfunction: any lesion in the circuit can cause retention or loss of urge control: cortex; collagen loss in PUL, USL weakens pelvic muscle contractile strength; excitation of “N” by inflammation, tumour; MS in afferent nerves (retention), MS in efferent nerves (leakage).
Published Online: 04 August 2025
Fig. 2. Binary model for bladder control by 2 opposing reflexes, either closure or micturition. Schematic 3D sagittal view, system in normal closed mode. PCM, pubococcygeus muscle; LP, levator plate; LMA, conjoint longitudinal muscle of the anus; PUL, pubourethral ligament; USL, uterosacral lig... More about this image found in Binary model for bladder control by 2 opposing reflexes, either closure or ...
How ligament laxity diminishes striated muscle force? Upper image: Anatomy. If USLs are overstretched by length “E,” the uterus prolapses, LP and LMA lengthen by “E.” The wavy shape of LP and LMA indicate diminution of contractile strength. Lower image: Sarcomere (striated muscle fibres). A striated muscle contracts optimally of a short length only (L). Elongation of the muscle to “E” diminishes contractile force. USL, uterosacral ligament; LP, levator plate; LMA, conjoint longitudinal muscle of the anus.
Published Online: 04 August 2025
Fig. 3. How ligament laxity diminishes striated muscle force? Upper image: Anatomy. If USLs are overstretched by length “E,” the uterus prolapses, LP and LMA lengthen by “E.” The wavy shape of LP and LMA indicate diminution of contractile strength. Lower image: Sarcomere (striated muscle fibres... More about this image found in How ligament laxity diminishes striated muscle force? Upper image: Anatomy....
The anatomy of nocturia pelvic muscles (large arrows) is relaxed. As the bladder (broken outline) fills, it is distended downwards by gravity “G.” If the uterosacral ligaments (USLs) are weak, they continue to descend until the stretch receptors “N” are stimulated, activating the micturition reflex “O” once the cortical closure reflex “C” has been overcome. PCM, pubococcygeus muscle; LP, levator plate; LMA, conjoint longitudinal muscle of the anus.
Published Online: 04 August 2025
Fig. 4. The anatomy of nocturia pelvic muscles (large arrows) is relaxed. As the bladder (broken outline) fills, it is distended downwards by gravity “G.” If the uterosacral ligaments (USLs) are weak, they continue to descend until the stretch receptors “N” are stimulated, activating the mictur... More about this image found in The anatomy of nocturia pelvic muscles (large arrows) is relaxed. As the bl...
Pictorial diagnostic algorithm. Symptoms indicate which ligaments are damaged. Tick every box where a symptom occurs, and the diagnosis of ligament and damage-associated prolapse appears. The rectangle indicates the symptoms associated with USL laxity. The height of the bar indicates the probability of association of a symptom with a particular zone. The connective tissue structures causing prolapse and pelvic symptoms fall naturally into 3 zones. Anterior zone: external meatus to bladder neck. Middle zone: bladder neck to anterior cervical ring. Posterior zone: posterior cervical ring to PB. CPP and nocturia are uniquely caused by USL laxity, stress urinary incontinence by PUL, pubourethral ligament; hammock, suburethral vagina. EUL, external urethral ligament; CL, cardinal ligament; PCF, pubocervical fascia; ATFP, arcus tendinous fascia pelvis; PB, perineal body; RVF, rectovaginal fascia; USL, uterosacral ligament.
Published Online: 04 August 2025
Fig. 5. Pictorial diagnostic algorithm. Symptoms indicate which ligaments are damaged. Tick every box where a symptom occurs, and the diagnosis of ligament and damage-associated prolapse appears. The rectangle indicates the symptoms associated with USL laxity. The height of the bar indicates th... More about this image found in Pictorial diagnostic algorithm. Symptoms indicate which ligaments are damag...
Journal Articles
Venn diagram showing the relation of diagnostic findings before RNU. Only a small proportion of patients had more than one characteristic indicating high-risk UTUC (overlapping areas). Positive urine cytology was defined as SHGUC or HGUC in the bladder according to the Paris System for reporting urinary cytology. SHGUC, suspicious for high-grade urothelial carcinoma; HGUC, high-grade urothelial carcinoma.
Published Online: 31 July 2025
Fig. 1. Venn diagram showing the relation of diagnostic findings before RNU. Only a small proportion of patients had more than one characteristic indicating high-risk UTUC (overlapping areas). Positive urine cytology was defined as SHGUC or HGUC in the bladder according to the Paris System for ... More about this image found in Venn diagram showing the relation of diagnostic findings before RNU. Only a...
Prognostic impact of ureterorenoscopic biopsy before RNU. Kaplan-Meier curves for intravesical RFS (a), OS (b), and CSS (c). Log-rank tests showed no significant difference between patients who underwent URS biopsy before RNU and those who did not. ap = 0.8. bp = 0.8. cp = 0.3.
Published Online: 31 July 2025
Fig. 2. Prognostic impact of ureterorenoscopic biopsy before RNU. Kaplan-Meier curves for intravesical RFS ( a ), OS ( b ), and CSS ( c ). Log-rank tests showed no significant difference between patients who underwent URS biopsy before RNU and those who did not. a p = 0.8. b p = 0.8. c ... More about this image found in Prognostic impact of ureterorenoscopic biopsy before RNU. Kaplan-Meier curv...
Journal Articles