Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Urethral stenosis is still a challenge for urological surgeons even though there are several corrective techniques in humans. In veterinary medicine there are few alternatives, especially in dogs affected by extensive intra-pelvic lesions and the usual treatment in the clinical routine is prepubic urethrostomy, a procedure related to several complications. Before research aimed at describe an innovative surgical technique of prepubic urethral transposition to restore urinary flow interrupted by stenosis of extensive segments of the membranous urethra in adult male dogs. This study was developed in two stages that occurred concomitantly. In one of the stages, 18 adult male dogs from Hospital de Clínicas Veterinaria of the Universidade Federal de Pelotas (HCV/UFPel) were used. The surgical technique consisted initially of orchiectomy, followed by celiotomy, transverse section of the penis in the pre-scrotal region and transposition into the abdominal cavity making anastomosis to the prostatic urethra. In this stage, the feasibility of the technique, surgical time, description of the anatomical planes discussed, pre and postoperative length of the urethra were evaluated, and then submitted to retrograde contrast-enhanced urethrocystography for evaluation of anastomosis effusion, urethral diameter and constriction in the anastomosis. In the other stage, the same surgical technique was applied to six male dogs treated at the HCV/UFPel, which were affected by extensive stenosis of the intra-pelvic urethra, with prepubic urethral transposition as an alternative to prepubic urethrostomy and genitalia ablation external. These six dogs were evaluated clinically and by urethrocystographies with intervals between seven and 48 XX months post-procedure, none of which presented voiding or stenosis images. It is concluded that the prepubic urethral transposition is a feasible technique in dogs, effective in maintaining the diameter and sealing of the anastomosis, giving a new urethral pathway to restore the urinary flow. / A estenose uretral ainda é um desafio para os cirurgiões urológicos ainda que existam diversas técnicas corretivas em humanos. Na medicina veterinária há poucas alternativas, principalmente em cães acometidos por lesões intrapélvicas extensas e o tratamento usual na rotina clínica é a uretrostomia pré-púbica, procedimento relacionado a diversas complicações. Diante disso, o objetivo deste trabalho é propor e descrever uma técnica cirúrgica inovadora de transposição uretral pré-púbica para restituir o fluxo urinário interrompido por estenose de segmentos extensos da uretra membranosa em cães machos adultos. Este estudo foi desenvolvido em duas etapas que ocorreram de forma concomitante. Em uma das etapas, utilizou-se 18 cadáveres de cães machos adultos oriundos do Hospital de Clínicas Veterinária da Universidade Federal de Pelotas (HCV/UFPel), cuja técnica cirúrgica consistiu inicialmente pela orquiectomia, seguida de celiotomia retroumbilical, secção transversa do pênis na região pré-escrotal e transposição deste em direção à cavidade abdominal fazendo-se anastomose à uretra prostática. Nesta etapa avaliou-se a exequibilidade da técnica, tempo cirúrgico, descrição das estruturas anatômicas abordadas, comprimento pré e pós-operatório da uretra, a seguir, foram submetidos a uretrocistografia retrógrada com contraste positivo para avaliação de derrame na anastomose, diâmetro uretral e constrição na anastomose. Na outra etapa, a mesma técnica cirúrgica foi aplicada em seis cães machos atendidos no HCV/UFPel acometidos por estenose extensa da uretra intrapélvica, fazendo-se a transposição uretral pré-púbica como alternativa à uretrostomia pré-púbica e ablação da genitália externa. Os cães foram avaliados clinicamente e por uretrocistografias com intervalos entre sete e 48 meses após o procedimento, sendo que nenhum apresentou alteração do jato miccional ou imagens de estenose. Conclui-se que a transposição uretral pré-púbica é uma técnica exequível em cães, eficaz na manutenção diâmetro e no selamento da anastomose, conferindo um novo trajeto uretral para restituir o fluxo urinário.

Orientadores: Carlos Arturo Levi D'Ancona, Cássio Luíz Zanettini Riccetto / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-26T23:13:06Z (GMT). No. of bitstreams: 1 Kos_RodolfoSilva_M.pdf: 2065885 bytes, checksum: 76b4bdc123fa42204d321a899cd184f6 (MD5) Previous issue date: 2015 / Resumo: Mielomeningocele (MMC) é a principal causa de bexiga neurogênica na infância, descrita por disfunção na inervação vésico-esfincteriana e da musculatura perineal, interferindo no funcionamento correto do trato urinário inferior e alterando o processo de micção normal. O tratamento urológico conservador é orientado com base nos resultados de todos os exames relacionados à função vesical e deve-se levar em consideração os sintomas apresentados pelo paciente. A disfunção vesical sem o adequado tratamento pode inibir o indivíduo socialmente e contribuir para influências negativas sobre a qualidade de vida de seus portadores, definida por sensação subjetiva de felicidade e satisfação pessoal do indivíduo. Pela imaturidade da criança com MMC as responsabilidades relacionadas ao tratamento urológico são atribuídas ao cuidador, sendo possível observar aumento da sobrecarga global neste. O objetivo deste trabalho foi avaliar a influência do tratamento urológico conservador na qualidade de vida de crianças com MMC e na sobrecarga de seus cuidadores. Foram estudadas 24 crianças com MMC, divididos em grupos de acordo o tratamento urológico em que a criança estava atualmente de cateterismo intermitente limpo ou uso contínuo de fraldas. Os procedimentos da avaliação contaram com ficha para caracterização da amostra, Teste do Absorvente, Diário Miccional, além dos questionários Burden Interview feito com o cuidador, e AUQUEI e Qualiveen, feitos com a criança. Os resultados obtidos demonstraram que não houve diferença significativa com relação à qualidade de vida da criança quando comparadas entre os grupos de tratamentos urológicos diferentes, entretanto, os cuidadores do grupo que realizava o cateterismo intermitente limpo apresentaram maior sobrecarga global, sendo afetados pelo tratamento urológico com mais ênfase que as próprias crianças / Abstract: Myelomeningocele (MMC) is the leading cause of neurogenic bladder in children, described by dysfunction in vesical-sphincter innervation and the perineal muscles, interfering in the proper function of the lower urinary tract and altering the normal urination process. The conservative urological treatment is targeted based on the results of all tests related to bladder function and should take into account the symptoms presented by the patient. A bladder dysfunction without proper treatment can inhibit the individual socially and contribute to adverse effects on the quality of life of their patients, defined by subjective feeling of happiness and satisfaction of the individual. Because of the immaturity of the children with MMC, the responsibilities related to urological treatment are assigned to the caregiver and are recording increasing global burden on them. The objective of this study was to evaluate the influence of conservative urological treatment on quality of life of children with MMC and overload on their caregivers. 24 children with MMC were studied, divided into groups according to the current urological treatment of clean intermittent catheterization or continuous use of diapers. The evaluation procedures relied on file for sample characterization, Pad Test, Voiding Diary, and the questionnaires Burden Interview done with the caregiver, and AUQUEI and Qualiveen, made with the child. The results showed no significant difference with regard to the quality of a child's life when compared between different urological treatment groups, however, the group of caregivers who performed clean intermittent catheterization showed higher overall burden, being affected by the distinct urological treatment with more emphasis that children themselves / Mestrado / Fisiopatologia Cirúrgica / Mestre em Ciências

Introduction: Treatment methods of anterior urethral strictures in adults have undergone considerable changes in the recent past. Our goal was to determine national practice patterns among German urologists and to compare results with the results of prior international surveys. Methods: We conducted a survey on the management of urethral strictures among German urologists. Results: Eight hundred forty-five urologists, representing about 14.6% of German urologists, answered the survey. Most common procedures were direct vision internal urethrotomy (DVIU; 87.2%), blind internal urethrotomy (57.5%), dilatation (56.3%), ventral buccal mucosa graft urethroplasty (31.6%) and excision and primary anastomosis (28.9%). In case of a 3.5-cm bulbar stricture and in the case of a 1-cm bulbar stricture after 2 failed DVIUs, a consecutive urethroplasty was significantly more often favoured compared to transurethral treatment options (44.9 vs. 21.3% and 59.4 vs. 8.3%, both p < 0.001). Conclusion: Open urethral reconstruction reveals to be a more common method in practice nowadays. Adherence to recommended treatment algorithms improved in comparison to prior surveys.

Orientador: Marla Andréia Garcia de Avila / Resumo: Trata-se do levantamento de vídeos sobre o cateterismo intermitente limpo no YouTube e avaliação dos acessos de conteúdos voltados do website Cateterismo Digital nas redes sociais. Estudo metodológico dividido em duas etapas com abordagem quantitativa e descritiva para avaliar os conteúdos existentes no YouTube que abordam o cateterismo intermitente limpo e na segunda etapa avaliar os acessos de tecnologias educativas disponibilizadas em redes sociais acerca da temática. Na primeira etapa a amostra constituiu-se por 07 vídeos que descreviam a técnica do cateterismo intermitente limpo com disponibilização gratuita no YouTube. O material foi avaliado por enfermeiros baseado nas recomendações da Sociedade Brasileira de Urologia. A segunda etapa constituiu-se pela avaliação dos acessos das redes sociais Cateterismo Digital, sendo o YouTube a rede social com maior média de visitas ao perfil e impressão de conteúdos. De acordo a avaliação dos acessos das redes sociais Cateterismo Digital pode concluir que os perfis responderam positivamente às expectativas de divulgação dos conteúdos do website aos usuários. Nesse contexto, é importante considerar o potencial que as redes sociais desenvolvidas por profissionais de saúde apresentam como ferramentas tecnológicas educativas, podem ser utilizadas tanto pelos usuários quanto por demais profissionais para nortear a busca por informações seguras online colaborando com a promoção da saúde. / Abstract: This involves surveying videos about clean intermittent catheterization on YouTube and evaluating access to content on the Cateterismo Digital website on social networks. Methodological study divided into two stages with a quantitative and descriptive approach to evaluate the existing content on YouTube that address clean intermittent catheterization and in the second stage to assess the access of educational technologies available on social networks on the subject. In the first stage, the sample consisted of 07 videos that described the technique of clean intermittent catheterization with free availability on YouTube. The material was evaluated by nurses based on the recommendations of the Brazilian Society of Urology. The second stage consisted of assessing the accesses of the social networks Cateterismo Digital, with YouTube being the social network with the highest average number of visits to the profile and content printing. According to the evaluation of the accesses of the social networks Cateterismo Digital can conclude that the profiles responded positively to the expectations of disclosing the contents of the website to users. In this context, it is important to consider the potential that social networks developed by health professionals present as educational technological tools, which can be used by both users and other professionals to guide the search for safe information online, collaborating with health promotion. / Mestre

Background: Primary urethral carcinoma is a very rare condition, and no large-scale experience with such cases has been published. Treatment will therefore have to follow rules established for the treatment of similar conditions. Patients: Six cases of primary urethral carcinoma (5 male, 1 female) who had been treated at our institution between 1995 and 1999 were retrospectively analyzed. In 3 male cases, a primary urothelial carcinoma of the distal urethra was treated by distal urethrectomy only. In 3 other cases with locally advanced tumors and/or lymph node metastases surgical treatment was followed by adjuvant cisplatinum-containing chemotherapy. Results: In the 3 cases with distal urethral carcinoma, partial urethrectomy with preservation of the penis resulted in cure, with a follow-up of 12–71 months. In the cases with advanced disease, adjuvant chemotherapy after surgery has resulted in complete remissions in all 3 cases, with a follow-up of 4–47 months at present. Conclusions: In localized, noninvasive carcinoma of the distal male urethra, partial urethrectomy seems adequate and the avoidance of penile amputation justified. In advanced cases, after local excision and lymphadenectomy adjuvant chemotherapy which by necessity must follow the guidelines established for the treatment of other urothelial or squamous cell malignancies seems to be beneficial. / Hintergrund: Das primäre Harnröhrenkarzinom ist eine sehr seltene Erkrankung, und in der Literatur gibt es keine prospektiven Serien mit größeren Fallzahlen. Die Behandlung wird sich daher an Erfahrungen orientieren müssen, die bei der Behandlung ähnlicher Krankheitsbilder gewonnen wurden. Patienten: Sechs Fälle von primärem Urethralkarzinom (5 Männer, 1 Frau), die zwischen 1995 und 1999 in unserer Klinik behandelt wurden, wurden retrospektiv analysiert. Bei 3 der männlichen Patienten lag ein primäres Urothelkarzinom der distalen Harnröhre vor, und es wurde eine Urethrateilresektion ohne adjuvante Therapie durchgeführt. In den 3 anderen Fällen mit lokal fortgeschrittenen Tumoren und/oder Lymphknotenbefall wurde nach operativer Behandlung eine adjuvante Cisplatin-haltige Chemotherapie durchgeführt. Ergebnisse: In allen 3 Fällen nach Urethrateilresektion wurde eine komplette Heilung bei einer Nachbeobachtung von 12–71 Monaten erzielt. Bei den fortgeschrittenen Fällen mit lymphogener Metastasierung wurde nach adjuvanter Chemotherapie in allen 3 Fällen eine komplette Remission bei einer Nachbeobachtung von bislang 4–47 Monaten erzielt. Schlußfolgerungen: Beim lokalisierten, nichtinvasiven distalen Urethralkarzinom des Mannes ist eine organerhaltende Strategie gerechtfertigt. In lokal fortgeschrittenen und/oder lymphogen metastasierten Fällen ist nach lokaler Exzision und Lymphadenektomie eine adjuvante Chemotherapie, die sich an den Erfahrungen der Behandlung von anderen Plattenepithel- und Urothelkarzinomen orientieren muß, sinnvoll und erfolgversprechend. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Orientador: Priscylla Tatiana Chalfun Guimarães Okamoto / Resumo: A doença do trato urinário inferior em felinos (DTUIF) apresenta diversos fatores etiológicos, sendo a forma obstrutiva a mais grave. As proteínas de fase aguda (PFAs) são biomarcadores utilizados para avaliar processos inflamatórios sistêmicos. A Alfa-1 Glicoproteína Ácida e o Amilóide A Sérico são PFAs positivas e major, o fibrinogênio é PFA minor e a albumina é negativa em gatos. O objetivo deste estudo é determinar as concentrações séricas das proteínas de fase aguda, Amilóide A sérico, Alfa-1 Glicoproteína Ácida, fibrinogênio e albumina e utilizá-las como biomarcadores de inflamação no monitoramento do processo inflamatório de gatos com doença do trato urinário inferior obstrutiva. Foram avaliados 25 gatos, machos, sem predileção de raça e idade, divididos em dois grupos experimentais, GC - grupo controle com oito gatos hígidos e GO - grupo obstruído com 17 gatos diagnosticados com DTUIF obstrutiva. Foram coletadas amostras para determinação das PFAs, bioquímica sérica, urinálise e UP/C nos M0, M12, M24 e M48 no GO e no GC somente no primeiro momento. As determinações das PFAs foram realizadas com os kits de ELISA para SAA, Kit Cat Serum Amyloid A Elisa (LIFE-SAA-8) e AGP, Kit Cat Alpha-1-Acid Glycoprotein Elisa (LIFE-AGP-8), ambos marca: Life Diagnostics®. No M0 houve correlações positivas de SAA, AGP e fibrinogênio com ureia e creatinina e correlação negativa de albumina com hematúria, SAA e potássio. No M48, houve correlações positivas entre SAA e AGP, AGP e ureia, fi... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The Feline Lower Urinary Tract Disease (FLUTD) presents several etiologic factors, with the obstructive form representing the most severe. The acute phase proteins (APPs) are biomarkers used to evaluate systemic inflammatory processes. In cats, Alpha-1-Acid Glycoprotein and Serum Amyloid A are major positive APPs, fibrinogen is a minor APP and albumin is a negative APP. This study aims at determining the serum concentrations of acute phase proteins Serum Amyloid A, Alpha-1-Acid Glycoprotein, fibrinogen and albumin, in addition of using them as biomarkers of inflammation during the monitoring of the inflammatory processes of cats with obstructive feline lower urinary tract disease. A total of 25 male cats were recruited for the study irrespective of breed and age, and were divided into two experimental groups: the control group (CG), comprised of eight healthy cats; and the obstruction group (OG), comprised of 17 cats diagnosed with obstructive FLUTD. Samples were collected for APP analysis, serum biochemical assay, urinalysis and UP/C determination at M0, M12, M24 and M48 in the OG, and at M0 in the CG. The concentrations of the APPs were determined using commercially-available ELISA kits for SAA (Kit Cat Serum Amyloid A Elisa, LIFE-SAA-8) and AGP (Kit Cat Alpha-1-Acid Glycoprotein Elisa, LIFE-AGP-8) (Life Diagnostics®). At M0, there were positive correlations of SAA, AGP and fibrinogen with urea and creatinine, as well as negative correlations between albumin and hematuria, ... (Complete abstract click electronic access below) / Mestre

Introduction: Intrinsic and extrinsic urethral factors play a significant role in urinary continence mechanism in women. Urethral wall structure including inervation, perfusion of submucosal layer etc. is not clinically assessed despite its important role in urethral closure function. The association of incontinence and pelvic floor reconstructive surgery is well known. Every postoperative healing process is associated with factors of ischemia and neovascularisation. According those facts we would expect that the healing and scaring should involve intrinsic urethral mechanism. After reconstructive surgery Implants further increase scaring process. Methods: In our study we included patients with anterior compartment defect. We randomized patients into three interventional arms according the surgical approach and use of implants. Before and 3-5 month after the surgery we performed urodynamic studies and pelvic floor ultrasound examination, including Doppler for urethral perfusion assessment. Another early ultrasound scan was added forth day after surgery. We correlated ultrasound and urodynamic parameters. Results: We randomized 87 patients. We couldn't find any correlation between the morphologic changes and severity of incontinence. Methods for urethral perfusion assessment showed high inaccuracy...

Die Belastungsinkontinenz des Mannes ist eine häufige Komplikation der radikalen Prostatovesikulektomie. Abgewandelte Operationstechniken und Rekonstruktions-verfahren führen zu verbesserten postoperativen Kontinenzraten und weisen auf die Bedeutung einzelner Komponenten am urethralen Verschlussmechanismus hin. Im Vergleich zum weiblichen ist der männliche Harnkontinenzmechanismus nur ansatzweise verstanden. In der vorliegenden Arbeit werden die am urethralen Verschluss beteiligten Komponenten und ihre Verbindungen zu angrenzenden Strukturen makroskopisch und mikroskopisch analysiert und auf ihre funktionelle Bedeutung untersucht. Zehn konservierte Leichname wurden für Untersuchungen des männlichen Urogenitaltraktes genutzt, aus drei Becken wurden Organpakete für die Erstellung von mikroskopischen Schnittpräparaten entnommen. Die histologischen Untersuchungen konnten zeigen, dass die Form des Musculus sphincter urethrae externus im Transversalschnitt von der Schnitthöhe abhängig ist. Seine Fasern strahlen in die Faszie des Musculus levator ani ein. Auch die Fasern des Corpus perineale inserieren in die Faszie dieses Muskels. Anhand dieser Ergebnisse wird die zentrale Rolle des Musculus levator ani im männlichen Harnkontinenzapparat deutlich. Der eigentliche Verschlussdruck wird demnach durch den Musculus levator ani aufgebaut und durch das Corpus perineale von dorsal auf die Urethra übertragen. Die Aufgabe des Musculus sphincter urethrae externus wird nicht als primär aktiv, sondern als dynamisches Widerlager für die membranöse Urethra beschrieben. Außerdem geht die Arbeit auf die noch wenig erforschte Mediatorfunktion der glatten Muskulatur im männlichen Urogenitaltrakt ein. Diese Ergebnisse präzisieren die Vorstellung des Kontinenzmechanismus des Mannes als Zusammenspiel von unterschiedlichen Komponenten und geben Anlass, aktuelle Standardtechniken der Beckenchirurgie zu überdenken und den Fokus auf schonende bzw. rekonstruktive Operationsverfahren zu richten.:Inhaltsverzeichnis Seite Bibliographische Beschreibung……………………………….………........…………… 3 Inhaltsverzeichnis………………………………………………………….........………….. 4 Verzeichnis der Abkürzungen…………………………………….…….......…………… 7 Verzeichnis der Abbildungen……………………………………….…….......…………. 8 Verzeichnis der Tabellen…………………………………………….…………........……. 9 1 Einleitung……………………………………………………….………...........………. 10 1.1 Epidemiologie der Harninkontinenz………………………….…...…………… 10 1.2 Stellenwert der radikalen Prostatektomie im Spektrum der operativen Therapieverfahren zur Behandlung des Prostatakarzinoms…............... 11 1.3 Protektion und Rekonstruktion von Kontinenzstrukturen....…..... 13 1.4 Zielstellung der Arbeit……………………………………………………....…...... 15 2 Material und Methoden……………………………………………………........…. 16 2.1 Instrumentarium und Reagenzien…………………………………………….. 16 2.2 Körperspender…………………………………………………………….......…....... 16 2.3 Konservierung…………………………………………………………....….......…... 16 2.4 Makroskopische Darstellung………………………………………………....…... 17 2.5 Gewebeentnahme…………………………….................................…..... 19 2.6 Fixation und Einbettung…...................................………………….... 20 2.7 Färbung………………………………………………………….…………...........……. 21 2.8 Histologische Auswertung…………………………………....…………………... 22 3 Ergebnisse……………………………………………............………………………… 23 3.1 Makroskopie………………………………………………………..........…………….. 23 3.1.1 Musculus sphincter urethrae externus – ein fächerförmiger Muskel mit ausgeprägter Vaskularisierung......................................... 23 3.1.2 Corpus perineale…...........................................…………....... 26 3.1.3 Musculus levator ani – Bestandteil der ventralen Suspension des Harnkontinenzorgans………………………………………...............…………… 26 3.2 Mikroskopie……………………………………………………….........…………....... 28 3.2.1 Musculus sphincter urethrae externus und Corpus perineale inserieren im Musculus levator ani und lateralen Venenplexus…...….… 28 3.2.2 Form und Verlauf des Musculus sphincter urethrae externus........………........................................................................... 32 3.2.3 Glatte Muskulatur als dynamische Verankerung des Harnkontinenzorgans......................................................... 34 4 Diskussion…………………………………………...........………………………….... 37 4.1 Struktur und Form des Musculus sphincter urethrae externus…. 37 4.2 Verankerung des Musculus sphincter urethrae externus …......... 39 4.3 Kontroverse Ansichten zum Corpus perineale und seiner Verankerung….................................................................................. 41 4.4 Glattmuskuläre Komponenten im männlichen Kontinenzsystem.43 4.5 Vorstellungen zum männlichen Harnkontinenzmechanismus…… 44 4.7 Experimentelle Arbeiten zum Harnkontinenzorgan im Vergleich..48 4.8 Auswirkungen der Ergebnisse auf die Praxis…………………......……… 53 5 Zusammenfassung……………………………………………………........…….… 55 Anhang…………………………………………………………………............……………….. 59 Erklärung über die eigenständige Abfassung der Arbeit……….......………. 64 Lebenslauf…………………………………………………………………………...........….... 65 Danksagung………………………………………………………………...........……………. 66 Literaturverzeichnis………………………………………………........………………...... 67

The placement of an indwelling urinary catheter (IUC) is a commonly performed clinical procedure which may become challenging for the clinician and painful for the patient. In response to urologic complications attributed to repeated failed IUC insertion attempts by nurses, a difficult urinary catheter (DUC) team program was launched in October 2012. The purpose of the doctoral project was to conduct a quality improvement evaluation of the effectiveness of the DUC team program using retrospective data from May 1, 2013 through May 31, 2017. Benner's novice to expert model was chosen as the theoretical framework to guide the additional training, critical thinking, problem-solving, and skill acquisition necessary for team member inclusion. The practice-focused question for the project answered whether DUC team nurses, through advanced training and demonstrated procedural competence, have been effective with DUC insertions. Sources of evidence included primary and secondary articles in peer-reviewed journals, as well as clinical evidence collected from internal sources. During the project time-line, 463 DUC team consultations were recorded with an insertion success rate of 89.6%. Based on the DUC team concept, additional didactic content and simulation training may be developed for other cognitive and skill-based clinical procedures. The implications for positive social change include improved patient safety and comfort, as well as cost savings for the organization and overall healthcare system.

Background: Pelvic floor muscle (PFM) training is recommended as first line conservative management for stress urinary incontinence (SUI). The fundamental issue of how to optimally contract the PFM has not previously been investigated. An effective voluntary PFM contraction is known to positively influence the bladder neck and urethra which are urethrovesical (UV) structures associated with continence. The PFM may be globally or selectively contracted according to cue to instruction. The main research question was to investigate which cue to instruction for a PFM contraction has the potential to optimise position of UVSs following a brief period of practice in continent nulliparous pre-menopausal women (aiming to provide normative data) and parous menopausal women with previously unreported SUI. Hypotheses: Posterior or combined cues for instruction of PFM contraction are more influential in optimising UV position (UVP) during PFMC following brief practice than an anterior cue. Posterior or combined cues are equally influential in altering UVP. Aims: Preliminary aim was to investigate the reliability and suitability of 2-DRTUS and angle of urethral inclination (AUI) for imaging of selective contraction of the PFM and ease of reading images by a non diagnostic imaging researcher. Principal aim was to investigate if there is an optimal cue to instruction for a PFM contraction in two groups of women. Study 1: pre menopausal nulliparous continent women (to provide normative data) and Study 2: post menopausal parous stress incontinent women. Secondary aims were investigation of posture; ability to selectively contract the PFM contraction; and cue preference. Method: Study 1: Twenty women who were able to effectively and selectively contract were taught the following cues: anterior; posterior; anterior and posterior combined. Following 4 weeks of practice, perineal 2-D RTUS images of three PFMC for each cue were captured in supine and standing twice (for repeatability analysis) five minutes apart. Two raters measured AUI. Data analysis was undertaken using a Customized General Linear Model (GLM) ANOVA with Bonferroni correction for interactions between all variables; subject, cue, posture and test. Seventeen data sets were available for analysis. Study 2: Methodology was based on Study 1. Twenty-one women were taught the study cues, followed the practice protocol and underwent data collection in the supine position. Twenty-one sets of data were available for analysis. Results: Reliability: ICC [1,3] for intra rater reliability was 0.957 [CI 95%: 0.946 to 0.967 p=0.000], inter rater reliability [2,1] 0.820 [CI 95%: 0.768 to 0.861] and for repeatability [1,3] 0.781 [CI 95%: 0.690 to 0.849 p=0.000] (continent) and 0.954 [CI 95%:0.931 to 0.971 p=0.000] (incontinent). Principal results Study 1: anterior vs posterior cues (difference) 3.979˚ (CI 95%: [0.503 to 7.455 p=0.021]); anterior vs combined 3.777˚ (CI 95%: [-0.099 to 6.853 p= 0.059]) posterior vs combined cues -0.602˚ (CI 95%: [-2.874- 4.078 p=1.00]). Aggregated data from tests 1 and 2: anterior vs posterior 4.240° (CI 95%: [1.213 to 7.267 p=0.003]); anterior vs posterior 3.756° (95%CI: [0.729 to 6.783 p=0.009]); posterior vs combined-6.48° (95% CI: [-3.511 to 2.542 p=1.000]). Principal results Study 2: anterior vs posterior 3.936˚ (95%CI: [0.863 to 7.008p=0.008]; 4.946˚ anterior vs combined (95%CI: [1.873 to 8.018 p=0.001]); posterior vs combined 1.010° (95%CI: -[2.062 to 4.082 p=1.000]). Aggregated analysis was anterior vs posterior 3.703˚ (95%CI: [1.639 to 5.761 p=0.000]); anterior vs combined 5.089˚ (95%CI: [3.0287 to 7.1503 p=0.000]) and posterior and combined 1.389° (95%CI: [-0.672 to 3.450 p=0.309]). Secondary results: 2-D RTUS and the AUI were found to be suitable for investigating selective PFM contraction. Posture: supine vs standing (difference) 9.496˚ (p=0.000); (posture did not affect absolute AUI). Three continent (13%) and 2 incontinent (7%) subjects were unable to selectively contract the PFM. Cue preference in both studies was posterior or combined. Conclusions: AUI was significantly narrower/optimal when instruction for PFM contraction included a posterior cue, in both continent and stress incontinent women. This is proposed to be due to optimal recruitment of puborectalis. Puborectalis may be more important in urinary continence than widely recognized. This study has provided seminal information with respect to optimal cue to contraction for a PFM contraction and will change practice. Investigation of the potential impact of these findings clinically is required. It is proposed that further understanding will lead to standardisation of PFM instruction, ease of comparability between PFM research studies, and will clarify PFM instructions for the media and lay public.