Anatomy of Cowper’s gland in humans suggesting a secretion and emission mechanism facilitated by cooperation of striated and smooth muscles

This study presents the detailed anatomy of the Cowper’s gland in humans. Elucidating the mechanism of secretion and emission of the Cowper’s gland requires analysis of the muscles around the Cowper’s gland. We hypothesized that the Cowper’s gland involves not only smooth muscle but also the striated muscles of the pelvic floor. Here, we provide comprehensive and three-dimensional anatomy of the Cowper’s gland and its surrounding structures, which overcomes the current local and planar understanding. In this study, seven male corpses of body donors were used to conduct macroscopic anatomy, histology, and three-dimensional reconstruction. The Cowper’s gland was surrounded laterally and posterosuperiorly by striated and smooth muscles, respectively. The striated muscle bundle was connected from the superficial transverse perineal muscle, levator ani, and external anal sphincter to the external urethral sphincter (rhabdosphincter). The smooth muscle was part of the deep transverse perineal muscle and entered between the bilateral Cowper’s glands and lobules. Our findings indicate that the secretion and emission of the Cowper’s gland in humans are carried out through the cooperation of striated and smooth muscles.

Postpartum perineal muscle sonogram in Madura beef cow

Background and Aim: Ultrasonography (USG) is useful for non-invasively identifying changes that occur in soft tissue architecture. The objective of this research was to demonstrate postpartum (PP) uterine involution through the changes of perineal muscle intensity and thickness in Madura beef cow by ultrasonography. Materials and Methods: Madura's breed cows used in the research consist of eight non-pregnant (NP) cows and three PP cow. The transrectal and transperineal USG imaging of NP cows was performed on days 1, 33, and 65. USG imaging of PP cows was performed every day starting from day 1 (24 h after parturition) until day 21 PP. Transrectal USG of the reproductive tract was performed for the cervix, corpus uteri, and cornua uteri. USG was performed transcutaneously over the perineal area for coccygeus and levator ani muscles at the longitudinal and transverse angles. Reproductive tract diameter and perineal muscle intensity and thickness were measured with ultrasound imaging. Results: The analysis of the sonogram of PP cows showed that the diameter of the cervix, corpus uteri, and cornua uteri decreased within 21 days PP. The transverse view of the coccygeus muscle of PP cows showed decreased muscle intensity and thickness. On the other hand, the longitudinal view showed increased coccygeus muscle intensity and thickness. The transverse view of the coccygeus muscle of NP cows showed increased muscle intensity, while muscle thickness was reduced. Sonogram analysis of the levator ani muscle of PP cows showed decreased muscle intensity with increasing muscle thickness. However, imaging of the levator ani muscle of NP cows showed a decrease in both intensity and muscle thickness. There was a significant difference in the mean value intensity of the scanning view analysis results of the levator ani muscle of the PP cow (523.6 AU increased to 672.1 AU) and the NP cow (515.9 AU decreased to 465.4 AU). Furthermore, there was a significant difference (p<0.05) in the mean value thickness of both scanning view analyses of the coccygeus and levator ani muscles of PP cows (5.8 mm increased to 6.5 mm and 3.8 mm increased to 4.8 mm, respectively) and NP cows (8.8 mm increased to 9.1 mm and 5.9 mm decreased to 4.9 mm, respectively). Conclusion: We found that the perineal muscles, namely, the levator ani muscle and coccygeus muscle, change in size, and intensity during uterine involution as demonstrated on Madura beef cow.

Urine Incontinence Before and After Delivery in Primipara

Introduction: Urinary incontinence is a common condition in pregnancy and postpartum period. It causes discomfort, embarrassment, loss of confidence and self esteem. This study aimed to determine the occurrence of urinary incontinence in pregnant attending antenatal clinic in a tertiary hospital. Methods: A descriptive observational study was conducted to find out occurrence of urinary incontinence in primiparous attending department of obstetrics and gynecology from August 2014 to August 2015 at B.P. Koirala Institute of Health Sciences. Results: The total of 100 primigravida were enrolled in the study. Out of which six had urinary incontinence with mean age of 23 years. Most of them were in the period of gestation group 38–40 weeks. 22% of total were obese with mean BMI of 26.69 kg/m2. Seventy nine patients had vaginal delivery, four had vacuum assisted vaginal delivery and 17 had cesarean section. Age and Body Mass Index (BMI) was not found to be associated with urinary incontinence. Oxford grading for assessment of perineal muscle after delivery showed decline in pelvic muscle tone which was significantly associated with urinary incontinence. However, the mode of delivery, and birth weight of baby was not found to be significant. Conclusion: The study finding suggested that pregnancy acts a risk factor for development of UI although no preference could be drawn regarding the mode of delivery. Our study also concluded antepartum UI as a risk factor for postpartum UI.

Efektifitas Massage Perineum untuk Percepatan Persalinan Kala II pada Ibu Bersalin

Background: Stiff perineum is caused by the nerves of the perineal muscle contain pyruvic acidwhich enters the mitochondria which are converted into lactic acid. Lactic acid causes metabolicproblems and shrinks between the perineal muscle cells, so the perineum becomes stiff. Theimpact of a stiff perineum can inhibit the second stage of labor which increases the risk of death tothe fetus and causes damage to the birth canal or laceration. Research Objectives: to accelerate thesecond stage of labor. Research Method: The design of this study uses the case study method. Thesampling method used was non probability sampling through a purposive sampling approach of 3patients. Patients used as participants were maternity patients in Cilacap District Hospital. Datawas collected from January 2 to January 25, 2019. After tabulation with data that has beenanalyzed using analysis of explanation and time series. Results: The study showed there was agreat impact of the Perineum Massage Midwifery Care for the Acceleration of Second Stage ofLabor in Maternity Women. With the results of the first participant the process of acceleratinglabor took place within 15 minutes. In the second participant, the process of labor accelerationtook place within 10 minutes. And in the third participant the process of accelerating labor tookplace within 20 minutes. Conclusion: Thus, that Perineum Massage Care for the Acceleration ofSecond Stage of Labor is really effective.