With respect to five established principles in conventional anatomy or physiology of the urinary bladder and urethra, the following revisions were proposed from the viewpoint of physics and ultrasound: (1)Throughout urinary storing and micturition, only involving action from the motor neurons into the bladder may be an on-off switching between two steps of bladder property as a material. (2)The weight of the bladder (thickness of the bladder wall) varies quickly and dynamically with the change in the stress necessary for contraction (urethral resistance). (3)The main function of the urethra may not be the closure during storing but rather opening during micturition, and this opening function may control the overall micturition behavior. (4)The male urethra is surrounded by a long-ranged muscle unit throughout the prostate. The so-called “external sphincter muscle” described in current anatomy is no more than the caudal end of that muscle unit. (5)The bladder may absorb a considerable amount of water from the urine inside it, at least while sleeping.

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The role of ultrasonography in the diagnosis of female lower urinary tract symptoms (FLUTS) includes exclusion of diseases unrelated to FLUTS, detection of morphological abnormalities associated with FLUTS, and measurement of residual urine volume. Though it is hard to say that transperineal and transvaginal ultrasonography are frequently used in daily clinical practice, they are useful for observing the morphology of the lower urinary tract, particularly that of the bladder neck, urethra, and pelvic floor, which are hard to observe with transabdominal ultrasonography.

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Ultrasonography is not a common modality for observing the female urethra in a clinical setting. However, it can yield useful information on urethral function, especially in female patients with stress urinary incontinence. The morphology of the female urethra, dynamic findings under high abdominal pressure, and the vascularity of the urethra are important information for understanding the pathology of female stress urinary incontinence. Nowadays, a new urethral function, not only a closer but also an opener, was reported using ultrasonography of urinary micturition. In addition, sonourethrography of the female urethra is presented, and the role of ultrasonography of the female urethra is described.

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Ultrasonography is the most suitable imaging modality for visualizing polypropylene tapes and meshes. We describe ultrasonographic evaluation for tension-free vaginal tape (TVT) procedure for surgical treatment of female stress urinary incontinence, transvaginal mesh (TVM) surgery, and laparoscopic sacrocolpopexy (LSC) for surgical treatment of pelvic organ prolapse. We use a transabdominal convex probe for evaluating TVT surgery. An implanted tape is shown as a high echoic linear structure. When the tape is correctly implanted, it is located in the mid-urethra, parallel to the urethra in the sagittal section, and it surrounds the dorsal urethra in the coronal section. We use a transabdominal convex probe, a transvaginal probe, and a linear probe for evaluating TVM surgery. An implanted mesh is shown as a high echoic linear structure. When the mesh is correctly implanted, it is located in the pubocervical layer, with the anterior mesh extending from the bladder neck to the cervical neck, and the posterior mesh extending from the vaginal entrance to the cervical neck. We use a transabdominal convex probe, a transvaginal probe and a linear probe for evaluating LSC after supracervical hysterectomy. The implanted mesh is shown as a high echoic linear structure. When the mesh is correctly implanted, it is located in the pubocervical layer, with the anterior mesh extending from the bladder neck to the remaining cervical neck, and the posterior mesh extending from the vaginal entrance to the remaining cervical neck. As female pelvic floor surgery is being practiced more frequently, ultrasonography is becoming more and more important as a diagnostic tool.

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Purpose: This study was conducted to investigate the correlation between Sonazoid^® contrast-enhanced ultrasound (CEUS) characteristics and histopathological disease parameters including biomarker expression, subtypes, nuclear grade, and Ki67 index of breast cancer. Subjects and Methods: Histopathological results from 45 patients with breast cancer who had undergone surgery after CEUS between October 2013 and November 2015 were analyzed. In terms of CEUS characteristics after bolus infusion of Sonazoid^®, enhancement size compared with the original tumor size measured by plain B-mode imaging was classified as extended, equal, and smaller size, and enhancement intensity relative to surrounding normal breast tissue was classified as high-, iso-, and hypoenhancement. The correlation between CEUS classifications and histopathological findings including estrogen receptor (ER), progesterone receptor (PgR), human epidermal growth factor receptor type 2 (HER2) expression; subtypes; nuclear grade; and Ki67 index was analyzed. Histology in the extended enhancement region in lesions with extended enhancement and that of the boundary between imaging in lesions with equal or smaller enhancement were also examined. Results and Discussion: Compared with equal or smaller enhancement, extended enhancement was significantly associated with higher nuclear grade (Chi-square test, p=0.0111) and higher Ki67 index (Chi-square test, p=0.0042). There was no significant correlation between enhancement size and ER, PgR, and HER2 expression. No histopathological finding was significantly associated with enhancement intensity. Examination of histopathological images showed that the invasion of cancer cells to peripheral adipose tissue matched the region of extended enhancement for the most part in all lesions with extended enhancement. Conclusion: Enhancement pattern in CEUS exceeding the margin of a breast cancer lesion measured by B-mode imaging reflects the invasion of cancer cells to peripheral tissue incapable of being visualized by B-mode imaging only and may suggest high grade and high proliferating potential.

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A 56-year-old female was admitted to our hospital with a history of cough, chest discomfort, and palpitation for 2 weeks. Diastolic murmur (Levine 3/6) and hypoxemia were found. Chest X-ray showed pulmonary congestion and pleural effusion. Transthoracic echocardiography and transesophageal echocardiography demonstrated bicuspid aortic valve and severe aortic regurgitation, with a mobile fibrous band adhering to the valve leaflet. Infective endocarditis was excluded by negative blood culture and afebrile condition. Emergent aortic valve replacement was performed because of uncontrollable heart failure. A ruptured fibrous strand (raphal cord) was found during the operation. Major causes of acute aortic regurgitation are infective endocarditis and aortic dissection. Acute aortic regurgitation due to ruptured raphal cord is rare. Transthoracic echocardiography and transesophageal echocardiography were useful for differential diagnosis of acute aortic regurgitation.

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A 63-year-old man presented to our hospital with a 3-day history of lower right abdominal pain. Examination revealed tenderness and rebound tenderness in the lower right quadrant. Laboratory tests showed a white blood cell count of 8,800/μl, and C-reactive protein level of 14.89 mg/dl. Abdominal contrast-enhanced computed tomography confirmed enlargement of the appendix with increased surrounding fat density of the appendix, suggesting acute appendicitis. Abdominal ultrasonography confirmed enlargement and the normal laminar wall structure of the appendix. There was a projecting hypoechoic mass at the distal portion from the center of the appendix, and significant thickening located in the fat tissue around the hypoechoic mass. Our final diagnosis was appendiceal diverticulitis. The histopathological diagnosis was true appendiceal diverticulitis. Abdominal ultrasonography was very useful for preoperative diagnosis in this case of appendiceal diverticulitis.

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