No confusion on the nomenclature of female urethra

No confusion on the nomenclature of female urethra:

(For UroacademyPankaj Joshi, Sanjay B Kulkarni. Kulkarni Reconstructive Urology Center,Pune, India.

In a four legged animal like a dog the face is the anterior surface and tail is posterior. The back surface instead of superior is conventionally called dorsal surface, so the abdomen becomes ventral surface. 

The anatomical position of a human being is defined in standing position. The back is posterior or dorsal surface and front becomes anterior or ventral surface.

The position of penis is considered in a functionally erect posture. 

The male urethra is divided into anterior portion of penile and bulbar, the posterior portion of membranous and prostatic urethra. The anterior urethra facing the corpora is called dorsal and not posterior to avoid confusion with membranous and prostatic urethra. The urethra facing the surgeon operating in the perineum is called ventral surface.

Posterior urethra makes a turn so the dorsal wall of bulbar urethra becomes the anterior wall of membranous urethra and prostate. Similarly ventral wall of bulbar urethra continues as the posterior wall of membranous and prostatic urethra.

Female urethra is akin to male membranous urethra and it is sphincter active in its whole length. The female urethra has pubic surface called ventral or anterior and vaginal side called posterior or dorsal surface.

When it comes to female urethra, most of the oldliterature has quoted pubic side as dorsal and vaginal side as ventral.

This is anatomically wrong nomenclature and has led to confusion amongst the urologists and gynecologists.

 

Let us explain why this is wrong: 

 

Consider the true nomenclature as per the anatomical standing position.

The nomenclature does not change even if the patient’s position is changed.

In female patient undergoing a trans pubicurethroplasty for pelvic fracture urethral injury, the anterior bladder wall continues as anterior/ ventral/ pubic side of a female urethra. Otherwise, the literature has labelled the anterior wall as dorsal wall which is wrong.

Consider female in a lithotomy position for cystocele repair. Cystocele is on the posterior wall of the bladder,it continues as the posterior/ dorsal or vaginal side of the urethra.

Otherwise, the literature has labelled the posterior wallas ventral wall which is wrong.

 

 

The truth about nomenclature in female urethra is 

Pubic side or anterior wall of urethra is the ventral wall

And vaginal side or posterior wall of urethra is the dorsal wall.

The truth is eternal.

 

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Comments(7)

  • Venugopal P
    Venugopal P
    19 Dec 2020 09:56:18 AM

    Dear All,

    We must thank Pankaj and Sanjay for clarifying the confusion as regards Orientation of Female Urethra. If one were to peruse the literature in terms of description of the procedures, There is considerable confusion as to Ventral and dorsal aspects of Female Urethra. The description regarding this varies from authors. Pankaj has given us the facts governing what is Ventral and what is Dorsal as regards Female Urethra and have urged us to use the terminologies suggested when describing the procedures used.

    This write up of Pankaj originated from my request after perusing a letter to the Editor of European Urology on ‘Female Urethra: Is Ventral the True Dorsal?’ (PDF provided).

    I am sure henceforth the suggestions of Pankaj and Sanjay will be used by all of us.

    With warm regards,

    Venu

     

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  • Dr Sarika Pandya
    Dr Sarika Pandya
    19 Dec 2020 04:11:05 PM

    as well female urethra is resembelling posterior urethra of male. so in membranous & prostatic urethra pubic side is anterior & opposite wall is posterior.so same way pubic side in female urethra should be anterior & vaginal side is posterior urethra.

  • Venugopal P
    Venugopal P
    20 Dec 2020 10:47:20 AM

    Dear All,

    Though we accept what is provided by  Pankaj and Sanjay as what is Ventral and what is dorsal as regards Female urethra and as mentioned by Sarika ‘labeling anterior part of urethra as facing pubic side & posterior urethra, facing vaginal side’. The analogy of Posterior Urethra in the male as Anterior and posterior its closeness to pubic bone is easily understandable.

    My doubt is as regards male Anterior Urethra. Penis remains in a flaccid state most often.

    When it is in flaccid state, the anterior aspect of flaccid penis is what we consider ‘Dorsal’ and the posterior aspect of the penis is what we consider ‘Ventral’. I wonder how it can be labelled as this. In the erect penis, yes, the usage of dorsal and ventral is legitimate but not in flaccid state.

    I would like our experts to comment on this ambiguity.

    Venu

     

  • PANKAJ JOSHI
    PANKAJ JOSHI
    20 Dec 2020 11:09:14 AM

    The Female urethra in our latest publication has been addressed as Anterior and Posterior.

    Joshi PM, Kulkarni SB. A new technique of double-face buccal graft urethroplasty for female urethral strictures. Turk J Urol 2019; DOI: 10.5152/tud.2019.19228

    The terms dorsal and ventral were designated in erect state of penis.As per the norms, the nomenclature does not change with the change in body position ,so the terms dorsal and ventral continue irrespective of the flaccid state of penis.

  • Venugopal P
    Venugopal P
    20 Dec 2020 05:35:30 PM

    Dear All,

    I am providing the link for the article mentioned by Pankaj on ‘double faced buccal graft urethroplasty for your reading.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7053988/pdf/tju-46-2-165.pdf

    With warm Regards,

    Venu

     

  • PANKAJ JOSHI
    PANKAJ JOSHI
    20 Dec 2020 09:08:17 PM

    The Female urethra in our latest publication has been addressed as Anterior and Posterior.

    Joshi PM, Kulkarni SB. A new technique of double-face buccal graft urethroplasty for female urethral strictures. Turk J Urol 2019; DOI: 10.5152/tud.2019.19228

    The terms dorsal and ventral were designated in erect state of penis.As per the norms, the nomenclature does not change with the change in body position ,so the terms dorsal and ventral continue irrespective of the flaccid state of penis.

  • Dr. Roy Chally
    Dr. Roy Chally
    21 Dec 2020 02:19:47 PM

    s there a possibility of confusion with the present terminology for surfaces of male urethra?

         In the male, the fixed part of the male urethra are the post and bulbar part. The penile urethra in the flaccid position is perpendicular ( median plane)  to the body. In this position the cavernosal surface is actually the ventral surface or anterior surface. In the erect position penis assumes a position,  right angle to the body. In this position logically urethra has no  anterior or post surface. So for correct terminology of surface of urethra, this should be in relation to a fixed anatomical surface. Cavernosal surface of urethra and skin surface. This will avoid confusion. 

        The bulbar urethra similarly is at right right to the post urethra. The urethra does not take a U  turn. The curve is similar to the male metal dilator which has a curvature close to 90 degree in the tip. The post urethra has an anterior and posterior surfaces but for the bulbar urethra which is lying in a transverse plane it is not logical to assign an anterior or posterior surface. Here also the  correct terminology should be the cavernosal surface and skin surface. 

        

         

        

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