Penile fracture and its treatment: is retrograde urethrograghy necessary for management of penile fracture? / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>Penile fracture, being defined as rupture of the tunica albuginea of the corpus cavernosum, is uncommon. Here, we analyze findings on our patients during a 10-year period and evaluate the role of retrograde urethrography.</p><p><b>METHODS</b>From February 2002 to April 2012, 116 patients were admitted with penile fracture at Ghaem Medical Center. Patient history and physical examination were taken at their admittance to detect probable urethral injury. Before surgery, retrograde urethrography was performed in all patients. The size and site of the tunical rupture were recorded. Then the rupture of tunica albuginea was sutured with nonabsorbable (3-0 nylon) sutures and the ties were placed on the internal surface (continuous method). All patients were followed up for 12 months.</p><p><b>RESULTS</b>Patients' mean age was (32.78 ± 10.61) years and ranged (16-62) years. The mechanism of trauma was sexual intercourse in 103 patients (89%) and masturbation in 13 patients (11%). The most common site of injury found after exploration was right (55%) and lateral (74%) of the corpus cavernosum. The size of the tunical rupture was from 0.5 to 3.0 cm (mean 1.88 ± 0.72). Three of the patients had Marphan's syndrome. Urethral injury was detected by retrograde urethrography in 4 patients (3%) who had macroscopic hematuria and urethrorrhagia. During 12 months follow-up, no complication was seen.</p><p><b>CONCLUSION</b>There is no need to perform retrograde urethrography unless the patients have gross hematuria or urethrorrhagia. The key to success in treatment of penile fracture is to achieve a rapid diagnosis based on history and a physical examination, avoid unnecessary imaging tests and perform immediate surgery to reconstruct the site of injury.</p>

Percutaneous treatment of bladder calculi in children: 5 years experience

We sought to evaluate the safety and efficacy of percutaneous cystolithotripsy in children. Thirty children [27 boys and 3 girls; mean age, 6.06 +/- 2.64 years; range, 1.5 to 12 years] with bladder calculi underwent percutaneous stone removal. The mean size of the largest diameters of the calculi was 24.8 +/- 8.47 mm [range, 13 mm to 50 mm]. Under general anesthesia, a 1-cm incision was made 1 to 2 cm above the pubic symphysis. A 26-F nephroscope was introduced into the bladder following tract dilation, and the calculi were removed. If the calculi were larger than 1 cm, fragmentation was performed. The procedure was done without fluoroscopy. Finally, a urethral catheter was placed for 48 hours. All patients became stone free. The mean operative time was 23.13 +/- 8.38 minutes [range, 12 to 40 minutes]. All patients were discharged 24 hours after operation, except 1, who was hospitalized 2 more days for suprapubic pain and severe irritating symptoms. No significant intraoperative or postoperative complications were seen. Percutaneous suprapubic cystolithotripsy is an efficient and safe technique for treating bladder calculi in children. We recommend this technique for treating large bladder calculi [larger than 1 cm] in children