Application of modified koyanagi technique with coverage by tunica vaginalis of testis in severe hypospadias / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical effect of modified Koyanagi technique with coverage by tunica vaginalis of testis in severe hypospadias.</p><p><b>METHODS</b>49 cases with severe hypospadias treated from Jan. 2009 to Sep. 2011 were retrospectively studied. 25 patients underwent Koyanagi technique with coverage by tunica vaginalis of testis. 24 cases underwent one-stage Duplay + Duckett technique in the same term. The patients were followed up for 7-24 months.</p><p><b>RESULTS</b>Among the 25 children treated with Koyanagi procedure, 20 cases were cured, 5 patients had postoperative complications, including urethral fistula in 3 cases,urethral stenosis in 2 cases. At the same time, in the Duplay + Duckett group, 17 cases were cured, 7 children had postoperative complications, including urethral fistula in 4 cases, and urethral stenosis in 3 cases. All the patients with urethral fistula were repaired successfully 6 months after the first surgery; The urethral stenosis were cured by dilatation within 1 to 3 months. The successful rate in the 2 groups had no significant difference(P >0.05).</p><p><b>CONCLUSIONS</b>Koyanagi technique with coverage by tunica vaginalis of testis is relatively simple with similar effect as Duplay + Duckett technique for severe hypospadias.</p>

The clinical outcome of urethroplasty using acellular dermal matrix patch for the treatment of anterior urethral stricture caused by lichen sclerosus / 中国医师进修杂志

Objective To summarize the clinical effect of urethroplasty using acellular dermal matrix patch for the treatment of anterior urethral stricture caused by lichen sclerosus.Methods The clinical data was analyzed retrospectively from 15 patients with anterior urethral stricture caused by lichen sclerosus treated with aeellular dermal matrix patch.Results The patients were followed up for 8-40 months.The urethral silicone stent was removed 4 weeks after operation in 15 cases and all the patients voided well 2 months after operation.The urinary peak flow rates ranged from 17.6 to 41.7 ml/s(mean,28.6ml/s).Urethral stricture occurred in 2 patients 3 months after operation undergoing discontinuous dilatation within 3 to 6 months,the patients voided very well.Conclusion It is feasible,safe and relatively simple to use acellular dermal matrix patch for anterior urethral stricture caused by lichen sclerosus.

Reconstruction of failed urethroplasty with different tissues and materials for hypospadias / 中华泌尿外科杂志

Objective To study the efficacy and complications of reconstruction of failed urethro-plasty for hypospadias with pedicle flap , bladder mucosa , buccal mucosa , and biological patch . Methods 23 patients were enrolled from Jul .2005 to Dec.2011.8 patients, with good local skin condition , were performed with pedicle flap urethroplasty .The other 15 patients, with bad local skin condition or with long segment urethral stricture , were performed with free grafts , including 6 bladder mucosa , 7 buccal muco-sal and 2 biological patch. Results Of the 23 cases, 7 cases were cured by one phase operation .There were 16 (16/25) cases had complications.3 (3/16) cases were failed because of serious infection (2 pedi-cle flap, 1 bladder mucosa ) .The failed cases were implemented with urethroplasty 6 months later by the buccal mucosa installments operation .4 (4/16) cases had solitary urethral fistula (1 pedicle flap, 2 bladder mucosa, and 1 buccal mucosal), who were successfully treated with simple fistula repair 3 to 6 months later. 9 ( 9/16) cases had urethral stricture ( 2 pedicle flap , 3 bladder mucosa , 3 buccal mucosal , and 1 biologi-cal patch graft ) , who were treated with urethral sound and got good result .We had reconstructed the urethra using mucosa graft onlay urethroplasty .All of the 23 patients were followed up with an average of 14.5 ( 6-24) months.23 cases were satisfied with the stretched penis , urination and no need to expand the urethra more than 6 months.3 cases were not satisfied with penile appearance .After communication, these patients did not require a further penis orthopedic surgery . Conclusions Pedicle flap, bladder mucosa , buccal mucosa and biological patch can be used in urethral repair and construction of failed urethroplasty for hypos -padias.Urethral sound dilation plays an important role in hypospadias repair .

Laparoscopy in the Diagnosis and Treatment of Non-palpable Undescended Testes / 中国医师杂志

Objective To evaluate applicative value of laparoscopy in children for the diagnosis and treatment of non-palpable testes.Method We evaluated retrospectively the laparoscopic approach used in 16 boys for the diagnosis and treatment of 21 non-palpable testes. All of them were diagnosed by non-palpable testis before operation.Results 7 cases (11 testis) in the internal ring were mobilized laparoscopically, and the operation was completed by open orchidopexy. Agenesis or atrophy of the 6 testis in the inguinal region was found. 2 high intra-abdominal testis (left) were found. The testis had no found in the intra-abdomen in two cases.Conclusions Miniinvasive laparoscopy is considered at present the standard method for the localization and treatment of non-palpable testes. No serious complications were recorded during or after operation. It should be the preferred method for the non-palpable testes.