Experience for post-adolescent postoperative urethral stricture of hypospadias in a single center (a report of 71 cases) / 中华泌尿外科杂志

Objective:To explore management experience for post-adolescent postoperative urethral stricture of hypospadias in a single center.Methods:The clinical data of 71 cases of postoperative urethral stricture of post-adolescent hypospadias from January 2015 to December 2019 were retrospectively analyzed. The average age was 27.7(12-65) years. The mean duration of urethral stricture was 33.4(1-240) months. The number of prior surgeries was 2.5(1-9). There were 32 cases of ectopic urethral orifice, including 22 on penile, 8 on scrotum and 2 on perineum. There were 17 cases of urethral stricture with penile curvature, 11 with urethra-cutaneous fistula, 9 with urethral diverticulum, 11 with urethral calculus and 25 with urethral infection. Ten patients kept suprapubic tubes; 61 patients were able to urinate on their own, but suffered from dysuria and weak steam. The average maximum uroflow rate of 71 cases was 4.7(0-11.2) ml/s. The primary urethral reconstruction procedures were performed on 33 cases, included 11 penile or scrotal septum flap urethroplasty, 2 urethral diverticulum wall flap urethroplasty, 12 oral mucosal urethroplasty and 8 urethrotomy. Thirty-three cases underwent two-staged surgery. For patients with penile curvature greater than 30 degrees, the penis was straightened with a urethrotomy in first stage. Besides, the dorsal skin of penis or oral mucosal graft were transferred to the ventral side of the penis to the preset urethral plate. In second-stage, Denis Brown urethroplasty was performed on 23 patients, tubularized incised plate (Snodgrass) urethroplasty on 6, and oral mucosa inlay urethral plate (Snodgraft) urethroplasty on 4. In 5 cases, preplacing of oral mucosa was done in the second stage with a third-staged urethroplasty. Penile curvature was relieved by ventral scar resection with the folding the dorsal tunica albuginea of corpus cavernosum when necessary.Results:The mean follow-up time was 30.5(4-59) months. Sixty-one patients got satisfying postoperative urination, with an average maximum uroflow rate of 22.7 ml/s (15.8-37.2 ml/s). Restenosis occurred in 10 cases, and urethral fistula in 7 cases. Re-stricture patients underwent urethrotomy in 5 cases, augmented urethroplasty with flap in 4 cases, and urethroplasty with oral mucosal graft in 1 case. Among the 7 patients with urethral fistula, 5 were cured by one fistula repair, and 1 cured by second repair; the rest one was left untreated. 2 patients still had penile curvature after operation.Conclusions:It is difficult to manage post-adolescent postoperative urethral stricture of hypospadias, especially for patients with residual penile curvature greater than 30 degrees and lack of penile skin. Performing correction of the curvature and reconstruction of the urethral plate in first stage and Denis Brown urethroplasty or Snodgrass urethroplasty in second or third stage could achieve good results.

Laparoscopic modified Y-V plasty for recurrent bladder outlet obstruction induced by operation of benign prostatic hyperplasia / 中华泌尿外科杂志

Objective To investigate the clinical effect of laparoscopic modified bladder neck Y-V plasty in the treatment of recurrent bladder outlet obstruction after surgery for prostatic hyperplasia.Methods Seventeen patients with recurrent bladder outlet obstruction after prostatic hyperplasia operation from May 2017 to January 2019 was treated by laparoscopic bladder neck Y-V plasty,with the median age of 71 years old (65-81 years).All had a history of repeated urination obstruction and urinary tract infection,and experienced at least 2 times transurethral stenosis incision,resection or repeated urethral dilatation,with 12 cases of bladder neck stenosis (type Ⅰ) and 5 cases of middle prostate stenosis (type Ⅱ).Three-port laparoscopy surgery was performed with outer-peritoneal route into the Retzius Gap.After revealing the bladder and prostate junction,the "Y" incision of the bladder and stenosis of the prostate urethra was firstly performed,and inverted symmetrical "V" shape suture was performed with two 3-0 Stratifix suture for two layers,including the 1th layer suture of mucosal and inner muscle layer,and the 2nd layer suture of the outer muscle and the serous layer.F22 silicone catheter was indwelled for 2 weeks postoperatively.Urinary flow rate and bladder urethral examination were perfrmed to evaluate the effect of surgery 2 weeks and 3 months after the operation respectively.Results Seventeen operations were completed successfully,with the median operation time of 100 minutes (30-100 minutes),the median operation blood loss of 50 ml (20-100 ml),and the median hospital stay of 5 days (1-7 days).The patient had unobstructed voiding after removing the urinary catheter 2 weeks postoperatively,and had no urinary incontinence.Postoperative median follow-up was 7 months (3-17 months) and no stenosis of the urethra was detected.Conclusions Laparoscopic modified bladder neck Y-V Plasty has the advantages of high success rate,low recurrence rate and minimally invasiveness in the treatment of recurrent bladder outlet obstruction after prostatic hyperplasia surgery,which is worthy of clinical application.

Surgical selection and outcome for treating the post-traumatic posterior urethral strictures via transperineal approach / 中华泌尿外科杂志

Objective To evaluate the outcome of various operative selection for treating posterior urethral stricture via transperineal approach.Methods The clinical data of 5 000 patients with posterior urethral stricture or obstruction from January 1990 to January 2017 were analyzed retrospectively.All patients were male.The age of those patients ranged from 18 months to 77 years old,mean 36.6 years old.Pelvic crush inju.ry caused by car accident occurred in 2010 cases.Falling injury occurred in 1680 cases.Pelvic compressed injury occurred in 1 310 cases.Accompanied visceral damage occurred in 2 590 cases,including the liver and spleen rupture in 920 cases,lower limb fracture in 1 200 cases.2 200 cases accepted urethral realignment under emergency.2 800 cases were treated with pubic cystostomy.All patients were undergone a retrograde and voiding urethrogram.562 patients accepted urethral ultrasongraphy,and 2 448 patients accepted urethroscopy.204 patients accepted MRI examination.The mean stricture length was 4.3 cm,ranged from 1.8 to 8.6 cm.Posterior urethral stricture was found in 810(16.2％)cases.The complete olstruction of posterior urethra was found in 4 190 (83.8％) cases,of which the length of the distraction defects≤3 cm was found in 2 650(53.0％) cases and the length of the distraction defects ＞ 3 cm was found in 1 540 (30.8％) cases.Bladder calculi was found in 2 300 cases.The perineal fistula or abscess was noticed in 290 cases.False passage was found in 460 cases.Urethra rectum fistula was found in 160 cases.Bladder neck open was noticed in 89 cases.Repairing was performed via a simple anastomosis after urethral mobilization in 1 700 patients,via separation of the corporeal bodies in 1 302 patients,via separation of the corporeal bodies and inferior pubectomy in 1 910 patients and via scrotal skin flap urethroplasty in 68 patients.Pull-through operation was performed in 20 patients.Results Postoperative follow-up were conducted from 6 to 72 months with average duration of 23 months.The overall successive results after operation was 92.2％(4 608/5 000),which the Q was more than 15 ml/s.The successive rate of urethroplasty were 97％(1 649/1 700) in simple anastomosis;93％ (1 211/1 302) in separation of the corporeal bodies;88％ (1 680/1 910) in separation of the corporeal bodies and inferior puberctomy;78％ (53/68) in scrotal skin flap urethroplasty and 83％ (15/18) in pull-through operation.The successive rate were 96％ (778/810) in posterior urethral stricture;95％ (2 517/2 650)in distraction with the length of obstruction less than 3 cm and 86％ (1 324/1 540) in distraction with the length of obstruction more than 3 cm.Conclusions The transperineal end to end anastomotic urethroplasty has become the first-line therapy for posterior urethral atresia.The length of the strictures or distraction defect which is lower than 3 cm is much more successfully corrected.

Analysis of therapeutic methods of surgical treatment for urethrocutaneous fistulas after urethroplasty / 中华泌尿外科杂志

Objective To discuss the curative effect of different operative methods for the treatment of urethrocutaneous fistula (UCF) after urethroplasty.Methods Clinical data of 54 cases of UCF from January 2003 to July 2011 were collected.Simple suture,advancement skin flap,pedicle penile skin flap urethroplasty,tongue/buccal mucosa urethroplasty were performed according to the size,location,number and whether there was urethral stricture of UCF.The treatment effect was recored and analyzed.Results The success rate of UCF repair was 85％ (46/54).There were 4 patients cured after second surgery.The success rates of repair of UCF with simple suture,advancement skin flap,pedicle penile skin flap urethroplasty,tongue/buccal mucosa urethroplasty were 95％,76％,82％,and 83％,respectively.Postoperative recurrence was observed in 5 patients in 6 months after the surgery and 4 of them received the re-operation.Conclusion According to the principle and the individual circumstance,taking personalized operative methods may improve the success rate of the repair of all kinds of UCF.

Value of direct vision internal urethrotomy in treatment of urethral stricture-twenty-year clinical experience / 中华泌尿外科杂志

Objective To summarize the experience and evaluate the efficacy of treatment of urethral stricture using direct visual internal urethrotomy (DVIU).Methods The clinical data of 361 patients (age range 16 -72 years, mean age 38 years) with urethral stricture who underwent urethrotomy from 1990 to 2010 was retrospectively analyzed.The disease course ranged from three months to 78 months with a mean of 16 months.The stricture length ranged from 0.2 to 2.0 cm (mean 1.1 cm).Stricture length was split into four main groups:stricture length≤0.5 cm in 63 (group 1 ), stricture length ranging between 0.6 and 1.0 cm in 175 ( group 2), stricture length ranging between 1.0 and 1.5 cm in 85 ( group 3 ) , and stricture length ranging between 1.6 and 2.0 cm in 38 ( Group 4).Of the 238 patients with length less than 1.0 cm there were 148 who's scar thickness were less than 1.0 cm, and 90 who's scar thickness were greater than 1.0 cm.Of the 123 patients with length less than 2.0 cm there were 69 who's scar thickness was less than 1.0 cm, and 54 who's scar thickness was greater than 1.0 cm.Results Three patients with DVIU failed because of long occlusion and false passage.Three hundred and twenty patients were followed-up from 12 to 120 months (mean:42).Re-openiag procedures were performed on 174 patients (54.4%) due to recurrence.The re-openiag procedure rate was 3.3%, 49.7%, 83.3% and 97.1% in Group1, Group2,Group3 and Group4, respectively.On the basis of scar thickness, of the 207 patients with stricture length less than 1.0 cm, 38 of 136 patients (27.9%) with scar thickness less than 1.0 cm underwent opening operation, and 43 of 71 patients (60.6%) with scar thickness more than 1.0 cm underwent opening operation.One hundred and thirteen patients with stricture length more than 1.0 cm, 33 of 42 patients (78.6%) with scar thickness less than 1.0 cm underwent opening operation, and 60 of 71 patients (84.5%) with scar thickness more than 1.0 cm underwent opening operation.Conclusions Good efficacy can be achieved in patients whose urethral stricture length is less than 0.5cm or whose stricture length and scar thickness is less than 1.0 cm using DVIU.

Serous-lined tunnel technique in urinary reconstruction / 中华泌尿外科杂志

Objective To examine the feasibility of using the serous-lined tunnel technique for orthotopic neobladder, continent cutaneous diversion and ureteral replacement by the intestinal segment. Methods In 31 patients of orthotopic ileal neobladder, the serous-lined tunnel techniques were used for antirefluxing ureteral implantation: In 13 patients of continent ileal pouch, the techniques were adopted for continent-valve construction and for uretersl implantation: In 3 patients (with lower ureteric cancer), the same techniques were applied for constructing the ileal ureters with a proximal antirefluxing mechanism. Results With a mean follow-up of 27 mon( 12-132 mon), 88 ureters implanted into ileal neobladders or continent pouches functioned well with neither obstruction nor reflux: 12 in 13 continent valves functioned well with no incontinence. 3 patients with ileal ureters showed no ileo-ureteric reflux and had reduced hydronephrosis comparing to that of before surgery.Conclusions Ureteral reimplantation and continent valve formation achieved by adopting the serouslined tunnel technique provide satisfactory results. The versatility of the technique is obvious in the present experience and the creative application of the serous-lined tunnel technique should be possible in urinary reconstruction.

Diagnosis and treatment of posterior urethral stricture: twenty-year clinical experience / 中华泌尿外科杂志

tionale and effective surgical approach, and technique.

Selection of operative approaches for the treatment of complicated urethral strictures / 中华泌尿外科杂志

Objective This study was to discuss various operative approaches for the repair complicated posterior urethral strictures. Methods 34 patients with posterior urethral strictures and associated ure-throrectal fistulas (URFs) were reviewed. The etiology of urethral strictures and fistula was due to pelvic fracture in 26 patients, iatrogenic in 6 cases and fall injury in the remaining 2 cases. The patients were treated by using a simple perineal approach (4 patients), a transperineal inferior pubectomy approach (21 patients) and combined abdominal transpubic perineal approach (9 patients) and URF repair and anastomotic urethroplasty were performed simultaneously in all cases. Results One-stage repair was successful in four patients (100%) using a simple perineal approach, in 19 of 21 (90. 48%) using the transperineal-inferior pubectomy approach and 7 of 9 (77. 78%) using the transpubic-perineal approach. Of the 34 patients, recurrent urethral strictures developed in two cases, recurrent URFs developd in two patients. Conclusions Surgical approaches for the special complex urethral strictures should be based on the location of the URF, its etiology and length of the urethral strictures, as well as a history of previous repairs. The transperineal-inferior pubic approach may be appropriate as a first-line procedure.

Trauspubic access using pedicle labial skin flap urethroplasty for the treatment of female urethral stric-tures associated with urethrovaginal fistulas / 中华泌尿外科杂志

Objective To evaluate the efficacy of transpubie access using pedicle tabularized la-bial urethroplasty for urethral reconstruction in female patients with urethral strictures associated with urethrovaginal fistulas.Methods Eight cases of urethral strictures were treated using pedicle labial skin flaps for urethral reconstructions.All cases were the mid-urethral strictures associated with ure-throvaginal fistulas.A single face pedicle flap was obtained from the labia minus or majus in 5 women,and double face pedicle labial flaps were used in 3 patients.Results There were no serious complica-tions.Two patients complained of dysuria symptoms for 2 weeks and one patient experienced stress incontinence which resolved after 4 weeks.The patients were followed up for 6 to 130 months (mean 52) postoperatively.All patients had normal micturition following catheter removal with urinary peak flow greater than 15 ml/s(17.4-42.0 ml/s).Conclusion Pedicle labial urethroplasty might be a reliable technique for the management of complex urethral strictures associated with urethrovaginal fis-tulas.

Testicular breeding sperm function and p63 expression in androgen receptor knockout mice / 中华泌尿外科杂志

Objective To study the testicular breeding function and p63 expression in seminiferous tubules in androgen receptor(AR)knockout mice.Methods Eight AR knockout mice selected by Cre-lox and 8 Wistar male mice were studied.Testicular breeding function was determined by Makler score and p63 was detected by immunohistochemistry. Results Seminiferous tubules inner diameter deflated in AR knockout group than in Wistar group(60.0±1.5 μm vs 92.05±2.0μm,P＜0.01),peri-tube membrane thickened(4.0±0.7 μm vs 2.85=0.9 μm,P＜0.01),the number of cell layer decreased(2.0±0.3 vs 4.0±0.2,P＜0.01),generative eell maturation arrested(3.0±1.2 score vs 5.05±0.5 score,P＜0.01),Makler score was lower(8.0±0.3 vs 16.0±0.5,P＜0.01).p63 expression was lower in AR knockout group than in Wistar group and the expression was located at the stage of spermatogenous cell and spermatocyte.Conclusion Testicular breeding sperm function is damaged in AR knockout mice,lower expression of p63 mainly affects early differentiation in generative cells.

Primary urethroplasty with the use of two pedunculated flaps of lip of pudenda for female urethral oblite ration (report of 2 cases) / 中华泌尿外科杂志

Objective To improve the urethroplasty efficacy for female urethral obliteration by the use of 2 pedunculated flaps of the lip of pudenda. Methods 2 cases of female urethral obliteration were treated with the use of 2 pedunculated flaps of lip of pudenda to repair the urethral obliteration. Results Both the patients could pass urine freely and needed no dilation of the urethra during the 15 and 36 months of follow up.The maximum flow rate were 18.2 ml/s、17.7 ml/s,the average flow rate were 9.0 ml/s、 10.9 ml/s and the voiding volume were 206 ml、247 ml. Conclusions Urethroplasty with the use of pedunculated flaps of lip of pudenda is a safe and effective procedure.