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【Objective】 To explore the impacts of groove negative pressure drainage on the short-term prognosis of patients with transperineal anastomotic urethroplasty. 【Methods】 A retrospective case-control study was conducted to analyze the clinical data of 78 patients who underwent transperineal anastomotic urethroplasty during May 2021 and Apr.2022, including 42 patients in the groove negative pressure drainage group (experimental group) and 38 in the rubber strip drainage group (control group). The postoperative drainage volume, rate of scrotal edema, rate of infection, visual analog scale (VAS) score, and maximum urine flow rate were compared between the two groups. 【Results】 Compared with the control group, the experimental group had a longer length of incision [ (12.9±1.6)cm vs. (12.1±1.5)cm, P=0.041] and larger drainage volume 3 days after surgery [(66.1±51.9)mL vs. (36.0±16.9)mL, P=0.001] , but lower rate of scrotal edema (21.4% vs.47.2%, P=0.016) and lower VAS score (3.2±1.0 vs.3.9±1.1, P=0.008). There were no significant differences in the infection rate 7 days after surgery and the maximum urine flow rate 1 month after surgery (P>0.05). 【Conclusion】 Groove negative pressure drainage can be used to drain the effusion of perineum tissue adequately and decrease wound-specific complications, which is beneficial to the rapid recovery after transperineal anastomotic urethroplasty.
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Objective:To evaluate the efficacy of low-intensity extracorporeal shock wave therapy (LI-ESWT) in patients with traumatic erectile dysfunction.Methods:The present study included 62 patients with traumatic erectile dysfunction, including 30 patients treated with low intensity shock waves and 32 controlled patients. The treatment groups were performed six times (twice per week), each by 3 000 impulses. The follow-up was performed 4, 8 and 12 weeks after LI-ESWT. The International Index of Erectile Function-5 (IIEF-5), nocturnal penile tumescence (NPT) and the Erection Hardness Score (EHS) were used to evaluate the therapeutic efficacy of LI-ESWT.Results:LI-ESWT could significantly improve IIEF-5 (15.67±3.89 vs. 9.41±4.66, P<0.01). 67% of patients in the LI-ESWT group and none of the control group answering 'yes’ to the SEP-Q2 elevated. In the low intensity shock wave treatment group and the control group 67% and 0 of patients, respectively, achieved erection hard enough for vaginal penetration, that is an EHS (Erection Hardness Score) of 3 ( P<0.01). According to changes in the IIEF-5 score treatment was effective in 70% of men who received low intensity shock wave treatment but in none in the control group ( P<0.01). Therapeutic efficacy could last 12 weeks ( P<0.05). No adverse events were reported during and following treatment. Conclusions:These studies suggest that LI-ESWT could improve the IIEF and EHS of traumatic ED patients.
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Objective To analyze the clinical outcome of definitive perineal urethrostomy for the treatment of complex adult anterior urethral strictures.Methods From June 2012 to February 2018,28 patients who underwent the definitive perineal urethrostomy for a complex anterior urethral stricture were retrospectively reviewed.The mean age of the patients was 62.3 (range 34 to 77) years and stricture etiology was lichen sclerosus in 46.4％ (13/28) of the cases,iatrogenic stricture after transurethral resection of the prostate in 35.7％ (10/28),failed hypospadias repair in 10.7％ (3/28),infection 3.6％ (1/28)and idiopathic etiology 3.6％ (1/28).The mean stricture length was 9.6 (range 4.5 to 16.0) cm and the stricture length ＜5 cm in 7.1％ (2/28) of the cases,5-10 cm in 35.7％ (10/28) and ＞ 10 cm in 57.1％ (16/28).0f28 patients 21 (75％) underwent prior urethral dilation,4 (14.3％) underwent direct vision internal urethrotomy (DVIU) and 17 (60.7％) underwent urethroplasty.Among the medical history of interest,hypertension was observed in 17 patients (60.7％),chronic ischemic heart disease in 11 patients (39.3％),diabetes mellitus in 9 patients (32.1％) and chronic obstructive pulmonary disease (COPD) in 9 patients (32.1％).All patients completed the perineal urethrostomy with inverted U-shaped perineal skin flap.The patient was placed in a normal lithotomy position and an inverted U-shaped perineal incision was made.We can get an inverted U-shaped perineal skin flap after dissecting along the bulbospongiosus muscle.The bulbar urethra was opened along the ventral surface and the margins of the spongiosum tissue were closed with perineal skin flap.We analyzed the clinical characteristics of the patients,the outcome of the technique and investigated the satisfaction rates of the patients by outpatient follow-up or telephone interview.Surgical success was defined as functional voiding without the need for further procedures.Results The perioperative complications included 3 cases of urinary tract infection,1 case of bleeding and 1 case of wound dehiscence.Mean follow-up length was 27.2 (range 6.0 to 64.0)months.Of 28 cases 26 (92.9％) were successful and the mean maximum urinary flow rate was 26.5 (range 17.0 to 40.0) ml/s.Postoperatively,2 cases of urethrostomy strictures were found in 2 months and 4 months,respectively.They required periodic outpatient dilation and the younger one was in the waiting list for revision of the perineostomy and the older one refused the revision.Of 28 patients 24 (85.7％) were satisfied with the results obtained with surgery,15 were very satisfied,9 cases satisfied and 4 cases dissatisfied.Conclusions The successful rate of the definitive perineal urethrostomy for the complex adult anterior urethral strictures was high and patients were satisfied with the outcome of the surgery.The definitive perineal urthrostomy is a well-tolerated treatment option for patients with complex anterior urethral strictures,especially for those aged and with extensive comorbidities.
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Objective To summarize the long-term efficacy of oral mucosal urethroplasty.Methods The clinical data of 324 patients with anterior urethral stricture who underwent oral mucosal urethroplasty from January 2013 to May 2018 were retrospectively analyzed.The patients were 27-65 years old with an average age of 47 years.Among them,51 patients had urethral meatal stenosis,174 patients had penile urethral stricture and 99 patients had bulbar urethral stricture.The length of urethral stricture was 2.8-14.0 cm,with an average of 6.4 cm.The preoperative maximal urinary flow rate Qmax was 3.2-8.4 ml/s,with an average of 4.8 ml/s.In the urethral meatal stenosis group (51 patients),15 underwent urethrotomy and 36 underwent meatal urethroplasty.In the penile urethral stricture group (174 patients),ventral sagittal incision was done in 21 patients,subcoronal circumferential incision in 49 patients and midline perineal incision in 104 patients.The perineal incision or verted Y incision were done in all the bulbar urethral strictures.Results The patients were followed-up for 3-75 months,with an average of 35.0 months.The results were satisfied in 290 (89.5％) patients.The post-operative maximal urinary flow rate Qmax was 15.8-32.2ml/s,with an average of 21.5 ml/s.Thirty-four patients (10.5％) developed recurrent urethral stricture,including 7 patients in the urethral meatus,17 patients in the penile urethra and 12 patients in the bulbar urethra.Among the recurrent urethral stricture patients,18 treated with the dilatation and 16 treated with the urethroplasty.Five patients (1.5％) developed fistula,including 2 patients in the ventral sagittal incision,1 patient in the circumferential incision and 2 patient in the perineal incision.Conclusions The long-term effect of oral mucosal urethroplasty is realistic.The rate of urethral stricture recurrence and fistula is low.The recurrence can be treated again by urethroplasty.The surgical approach for oral mucosa urethroplasty depends on the location and length of the anterior urethral stricture.
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Objective To establish a calculation method for the voiding work parameters by using the detrusor power curve and to evaluate its clinic efficacy.Methods From January 2001 to January 2011,132 male patients with benign prostate hyperplasia who underwent urodynamic tests were retrospectively reviewed.The patients' age ranged from 45 to 84 years old (mean 57 years old).All patients had no previous history of neurological disease and no positive findings in neurological examinations.The voiding work of bladder,the voiding power of bladder and voiding energy consumption were calculated by using the detrusor power curve method and the linearized passive urethral resistance relation analysis was conducted.According to the detrusor status,all patients were divided into the decreased detrusor pressure group,the normal detrusor pressure group and the increased detrusor pressure group.Meanwhile,normal urethral resistance group and the increased urethral resistance group were classified according to the urethral resistance status.The detrusor pressure at maximal flow rate (PdetQmax),the maximal flow rate (Qmax),the projected isovolumetric pressure (PIP),the voiding work,the voiding power and the voiding energy consumption were compared among the different groups.Results There were 56 cases,58 cases,18 cases in the decreased,normal and the increased detrusor pressure group respectively.The voiding work were (1.1 ± 0.5)J,(1.7± 0.7)J,(2.1±1.2)J; the voiding power were (15.3±7.3)mW,(31.9±12.6)mW,(42.5±21.1)mW; and the voiding energy consumption were (3.9± 1.2) J/L,(5.2± 1.9) J/L,(6.2±3.2) J/L in those three groups,respectively.With the increasing of detrusor pressure,PdetQ Q PIP,the voiding work,the voiding power and the voiding energy consumption all increased among three groups with significant difference (P＜ 0.05).There were 51 cases,81 cases in the normal and the increased urethral resistance group.The voiding work were (1.5±0.7)J and (1.5±0.8)J;the voiding power were (32.3±13.2)mW and (22.6±16.3)mW and the voiding energy consumption were (3.8±0.7) J/L and (5.4±2.4) J/L in two groups.The increased urethral resistance group had higher PdetQmax and voiding energy consumption (P＜0.05) and lower Qmax and voiding power (P＜0.05) than those in the normal urethral resistance group.However,the differences of PIP (P =0.438) and the voiding work (P =0.546) between the two groups were not determined.Conclusions The detrusor power curve method can be used to calculate the work parameters of voiding.This method can be applied to evaluate the compensatory state of bladder and is conductive to urodynamic analysis in low detrusor pressure status.Both detrusor pressure and urethral resistance had significant impact on the work capacity of bladder.
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@#Objective To explore the effect of extracorporeal shock wave therapy (ESWT) combined with hyperbaric oxygen on nonunion after surgery. Methods 83 patients with nonunion were treated with ESWT combined with hyperbaric oxygen (treatment group), and 32 cases served as control group. ESWT application was conducted using a protocol totaling 3000 shocks per treatment. The treatment group received 3~5 times of treatment, at the same time hyperbaric oxygen therapy was performed. The control group received no treatment and was followed up at least 3 months after treatment. Results The overall success rate was 78.31% in the treatment group, while only 12.50% recovered in the control group (P<0.01). The complications of treatment group were less and negligible. Conclusion Treatment of nonunion by extracorporeal shock wave combined with hyperbaric oxygen is safe and effective.
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Objective To present our experience of dealing with complete penile amputation.Methods Two cases of penile complete amputation were reported.The first case was a 34-year-old man,suffered amputation of the penis approximately 2.5 cm distal from the pubic area with a sharp knife.3.5hours later,the patient was transferred to our hospital.The urethra mucosa and corpus spongiosum were anastomosed.The cavernous body of the penis was reattached by suturing the tunics albuginea of each corpus cavernosum to the corresponding proximal segment.One dorssl artery,two dorsal veins,and dorsal nerve were anastomosed under a 10 × microscope with interrupted 9-0 nylon nonabsorbable sutures.The second case was a 25-year-old man,presented to the emergency room 15 hours after distal penile amputation,which had 2 wounds as a result of self-mutilation caused by psychiatric problems.The urethra mucosa and corpus spongiosum were anastomosed.The cavernous body of the penis was reattached by suturing the tunics albuginea of each corpus cavemosum to the corresponding proximal segment using 4-0 polyglactic acid sutures.Results In the first case,the tourniquet was released after replantation,and the distal penis appeared to revascularize,as noted by the gradual increase in redness and size.An arterial pulse was detected,and the superficial penile veins displayed normal turgor,and no bleeding was found.On postoperative day 3,the penile skin started to necrotize.On day 12,the necrotic skin was superficially debrided,and a fistula was observed in the corresponding urethral segment.Two weeks later,the fistula was sutured with 4-0 interrupted synthetic absorbable suture,and a transposition flap to embed the whole injured penis shaft was created from the proximal scrotal skin.The glans was exposed.Two months after the second operation,the embedded penis was released from the scrotum.After follow-up of two years,the patient had glans re-epithelialization with normal voiding,sensation,and erections.In the second case,the glans was still pink,but the penile skin started to necrotize on postoperative day 3.On day 14,serious infections were noted,the necrotic skin was superficially debrided,and the amputated penis was relieved.Conclusions Prompt diagnosis and early treatment are essential to avoid the potential complications of ischemic necrosis and autoamputation.Venous outflow is a critical factor for success of replantation.Microsurgical reanastomosing of the dorsal penile vein,penile arteries,and dorsal nerves can be identified as the standard method for penile replantation.The bipedicled scrotal flap can provide adequate skin cover for penis defects.
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Objective To study the effect of extracellular matrix(ECM)of xenogenic femoral fascia which is a tissue-engineering material in repair of renal trauma.Methods Twenty-four experiment dogs were divided into 3 groups:group 1(n=10),the kidneys were repaired using ECM of xenogenic femoral fascia;group 2(n=10),the kidneys were repaired using self-omentum;group 3(n=4),xenogenic femoral fascia was used as repair materials.The animals were sacrificed separately at 1,2 weeks and 1,2,4 months after renal repair operations in group 1,2.In group 3,the animals were sacrificed separately at 2 weeks and 2 months after renal repair operations.The examinations of blood routine were performed before and after operations immediately,blood creatinine and serum renin were measured before operations and before death.The creatinine clearances of affected and contralateral normal kidneys were evaluated before death and the local areas of renal repair were studied by light and scan electron microscopy.Results In group 1,bleeding stopped rapidly and completely after the entire patch was sutured,only mild adhesions to surrounding tissues were found in various times after operations.As time passed,the repair patch was replaced by smooth neocapsule just like a normal one.In group 2,the bleeding volume in the operations was larger than the other 2 groups.It was diffieult tO separate the kidneys from the surrounding tissues.The wounds gradually contracted because of the scar forming.In group 3,there were severe immunological reactions in the patchs.Conclusion ECM of xenogenic femoral fascia is an ideal tissue-enginee rjng material for renal repair.
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Objective To discuss the relationship between asymptomatic prostatic inflammation (NIH category Ⅳ prostatitis)and serum prostate specific antigen. Methods In a retrospective study,245 prostate biopsies with benign pathological results from January 1998 to January 2000 were reviewed and the corresponding serum PSA before biopsy were analyzed.All patients were taken 6 or 13 cores prostate biopsy. Results One hundred and twenty-seven NIH-Ⅳ prostatitis and 118 patients with benign prostatic hyperplasia(BPH)were identified.The difference in free-PSA,totalPSA,f/t-PSA levels between BPH and NIH-Ⅳ prostatitis was significant(P＜0.05).In multivariate analysis,free-PSA,total-PSA,f/t-PSA was the significant predictors of histology in NIH-Ⅳ prostatitis(P＜0.05).The best prediction factors were constructed to predict pathology type in NIH-Ⅳ prostatitis:TPSA≥4 ng/ml,fPSA≥0.85 ng/ml and f/t-PSA≤0.16(P＜0.05). Conclusions Asymptomatic inflammation of the prostate was one of the confounding factors in patients with an elevated PSA.In the diagnosis of prostate diseases,it should be taken into account prostatitis might elevate the level of PSA.
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Objective To evaluate the cause of evaluated postage-specific antigen(PSA)in patients performed transrectal uhrasonography(TRUSG)guided prostate biopsy beeause of high PSA levels.Methods In a retrospective study 504 prostate biopsies performed between January 1998 and December 2001 were evaluated and the levels of serum PSA were determined in samples obtained immediately before sextant biopsy was performed.All patients underwent 6 or 13 cote primary prostate needle biopsies.Results 185 prostate cancer,109 NIH-Ⅳ prostatitis and 210 patients with benign prostate hyperplasia(BPH)were identified.The difference in free-PSA,total-PSA,f/t-PSA levels between prostate cancer,BPH and NIH-Ⅳ prostatitis was significant(P＜0.05).No significant difference was found in age,transrectal ultrasonography and digital rectal examination.In multivariate analysis,free-PSA,total-PSA,f/t-PSA was the significant predictors of histology in prostate cancer(P＜0.05).A significant correlation was found between the serum total and free PSA levels and the grade and stage of prostate cancer(P＜0.05).Preoperative variables predictors of histology in BPH were TPSA and FPSA(P＜0.05).In multivariate analysis,TPSA was the only significant predictors of histology in BPH(P＜0.01).The best cutoff value was constructed to differ pathology type in prostate diseases:tPSA≥4 ng/ml,fPSA≥0.85 ng/ml and f/t-PSA≤0.16(P＜0.05).Conclusions High serum PSA levels may correlate with asymptomatic inflammatory prostatitis,prostate cancer and BPH.The factors contributing to elevated serum PSA concentrations include cell proliferating,glandular epithelial disrupt.
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Objective: To study the effect of extracellula matrix of xenogenic femoral fascia in repair of renal trauma. Methods: Twelve adult dogs were used and randomly assigned to 6 groups, and the animals were sacrificed separately in 1 and 2 weeks 1,2,4 and 8 months after renal repair operations. The examinations of blood and urine routine, blood urea nitrogen and creatinine, electrolyte and serum renin were performed before and after operations at various times. The creatinine clearances of affected and contralateral normal kidneys were evaluated before death and the local areas of renal repair were studied by light and electron microscopy. Results: Bleeding was stopped completely after the entire patch was sutured, and only mild adhesions to around tissues were found in various times after operations. As time passed, the repair patch was replaced by smooth neocapsule like normal renal capsule. Conclusion: Extracellula matrix of xenogenic femoral fascia might be an ideal tissue-engineering material for renal repair.
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Objective To summarize the experiences on clinical application of flexible cystoscopy,and evaluate the significance of applying flexible cystoscopy in urologists' daily practice.Methods A total of 379 patients underwent examination with flexible cystoscopy,of them 74 patients were with the aim of therapy or related operation.The operation time was counted and the patients' discomfortableness was recorded according to a visual analog scale(VAS).What's more,a satisfaction questionnaire was made by no doctor presenting to check the patients' response to cystoscopy operation.36 male patients were undergone both rigid and flexible cystoscopy operation.The statistical significance of the differences was analyzed after reading the VAS scores and the results of questionnaires were evaluated.Results 223 patients were found to have relative diseases by the examination of flexible cystoscopy.The mean operation time in using flexible cystoscopy was 7.8?0.27 minutes.The median pain scores of male and female patients were 2.9 and 1.3,respectively.The maximum pain was felt by male patients when the cystoscopy went through the membran of urethra.Satisfactory rate in male patients was 99%,and it was 100% when evaluating the questionnaires answered by female patients.For the 36 male patients undergone both rigid and flexible cystoscopy operation,the median pain score was 2.1(0.5-4.5) for flexible cystoscopy,and was 5.7(1.0-10.0) for rigid cystoscopy.After flexible cystoscopy examination,all the 36 patients were satisfied by the operation.However,only 61.1%(22/36) patients were satisfied by the rigid cystoscopy operation.Statistical analysis showed significant difference(P
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Objective To evaluate the effect of 5? reductase inhibitor on vascularity of benign prostatic hyperplasia (BPH). Methods Sixty male adult rats were randomly divided into 4 groups (15 per group): normal control, BPH control group, the group of 5? reductase inhibitor treatment during hyperplasia and the group of treatment after hyperplasia. Immunohistochemistry combined with computer assisted image analysis system were performed to examine the expression of factor Ⅷ related antigen, PCNA and VEGF in the prostatic tissue for all rats. Results The microvessel density(MVD) and the expressions of PCNA and VEGF were much less in treatment during hyperplasia and treatment after hyperplusia than that in BPH control group( P