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Objective To assess the feasibility and efficacy of multi-modality three dimensional imaging reconstructive technology in diagnosing the urethral stricture.Methods Totally,121 male patients,suffered with urethral strictures,were enrolled in this study between January 2012 and June 2017.Their age ranged from 17 to 63 years old.The etiology included pelvic fracture in 71 cases,straddle injury in 16 cases,iatrogenic injury in 25 cases,infection in 9 cases.All patients accepted the routine antegrade and retrograde urethrography.The slim CT scan and 3D image reconstruction were performed in patients with posterior urethral stricture.The 3D ultrasound detection and image reconstruction were used in patients with anterior urethral strictures.The fly-through mode was used in each 3D image in order to simulate the process of endoscopic examination.The length of stricture was compared between that in traditional urethrography and in 3D dimensional image,based on the results from anastomotic procedure and substitution.Result Among patients,71 cases were diagnosed as posterior urethral stricture and 50 cases were diagnosed as anterior urethral stricture.In those patients with posterior urethral stricture,no statistical significant difference of stricture length was noticed between traditional urethrography and 3 D dimensional image [(2.30 ± 1.60)cm vs.(2.18 ± 1.55)cm,P =0.91)].In patients who complained about the urine leakage from anus,higher detective rate of fistula could be seen in the CT 3D image than that in traditional endoscopic examination (87.9％ vs.77.6％).To patients with anterior urethral strictures,no statistical significant difference of stricture length was noticed between traditional urethrography and 3D dimensional image [Penile:(2.13 ±0.34) cm vs.(2.24 ± 0.31) cm,P =0.13;Bulbar:(1.98 ± 0.47) cm vs.(2.13 ± 0.32) cm,P =0.23)].However,the advantage of 3D image could be shown in detecting the lesion of navicular fossa and periurethral pathologic fibrosis.In the fly-through mode,the effect of 3D CT image seems to be superior to that in the 3D ultrasound image,which could show more smooth urethral wall and longer urethral segment.The limitation of those 3D image reconstructive technology was that long time consuming was needed during the 3D image reconstruction.Conclusion Our study showed that the multi-modality three dimensional imaging reconstructive technology can improve the sensitivity and specify in diagnosing the urethral stricture.After some modification,it will become the alternative method in diagnosing the urethral stricture.
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Objective To explore the efficacy of constructing the neourethra using a bladder anterior wall for the treatment of female total urethral stricture or atresia.Methods We retrospectively reviewed 11 female patients with total urethral stricture or oblitalition,who were underwent a procedure of reconstructive neourethra using a bladder anterior wall,from January 2009 to November 2015.Of the 11 patients,urethral stricture was associated with vesicovaginal fistula and a severe hydrocolpos in the proximal vagina because of vaginal anterior strictures or atresia in four girls.The mean age was 16 years (ranging 5-48 years) in all patients.The etiology was posttraumatic urethral injuries after pelvic fracture in 9 patients,radical urethral resection because of urethral cancer in 1 patient and congenital bladder exstrophy with an absent urethra in 1 patient.All patients underwent a procedure of neourethral construction under general anesthesia.The bladder anterior wall,which was about 2.0 to 2.5 cm in width and 4.0 ～4.5cm in length,was separated from bladder neck to middle partion of the anterior bladder wall.The bladder flap was tubularized around a 12-14 French catheter using continuous 4-0 polyglycolic acid sutures for the mucosa and interrupted sutures of 3-0 polyglycolic acid for the muscle.The tubularized flap was then flipped caudally to the site of the original external urethral meatus to form a new urethra.4 patients with severe stenosis or oblitalition of the distal vagina underwent a procedure of vaginoplasty at same time,including island vulvar flaps enlarging vaginoplasty in two girls and reconstructive vaginal orifice using the proximal enlargedvagina wall in other two girls.Results There were no serious complications postoperatively.The catheter was removed 3 ～4 weeks after the operation.7 patients were completely continent with excellent voiding,3 patients had stress incontinence.One patient experienced dysuria.And the urethroscopy in this case showed that the mucosal prolapse was present at the 12 to 3 o'clock position on the neck of the bladder,which caused urinary obstruction.Endoscopic resection of the prolapsed mucosa was performed.The patient could easily void without incontinence after the operation.The patients were followed up a median of 38 months,(ranging 6-72 months).2 patients experienced dysuria 3 and 4 months after operation,separatively.Examination showed that the mucosal prolapse was present at the position on the neck of the bladder in one patient and urethral meatal stenosis in another patient.The two patients were separatively underwent a procedure of endoscopic resection of the prolapsed mucosa and meatal urethroplasty,using vulvar flap.All of them could easily void without incontinence after the operation.Of the 3 patients with stress urinary incontinence,one underwent a procedure of TVT-O one year later,and after which continence was achieved with good voiding;the other two cases were awaiting for reoperation.Four cases of postoperative vaginal fluid disappeared with unobstructed micturition.Conclusions Female neo-urethral reconstruction using the bladder anterior wall flap was a reliable technique for the management of complete urethral stricture or obliteration.
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Objective To explore selection of the procedures in one stage urethroplasty for treatment of the coexistence of urethral strictures in anterior and posterior urethra.Methods Between January 2008 and December 2014, a total of 27 patients with coexist strictures simultaneously in anterior urethra and posterior urethra were treated in our hospital.The mean age was 38 years old (ranging 13-83 years old.Stricture etiology was secondary to lichen sclerosus in 2 patients, iatrogenic in 3 and posttraumatic in 22.The mean length of urethral stricture was 11cm (ranging 6-14cm).Two procedures for treatment of anterior urethral stricture, including augmentation of urethroplasty using penile skin flap was performed in 20 patients and augmentation of urethroplasty using lingual mucosa in 7.Three procedures for treatment of posterior urethral stricture, including non-transecting spongiosum end to end anastomosis of the two urethral ends was performed in 3 patients, end to end anastomosis of the two urethral ends was performed in 17 and substitution urethroplasty using different tissues was performed in reminder 7 patients.Of them, pedicle scrotal skin urethroplasty was performed in 2 patients and lingual mucosal graft urethroplasty in 5 patients.Results The patients were mean followed up 2.6 years (ranging 0.545.0 years) with an overall success rate of 88.9％ (24 of 27 cases).Complications developed in 3 patients (11.1％).Of the 17 patients with end to end anastomosis, urethral stricture developed respectively 4 and 6 months in 2 patients and voiding well after pedicle scrotal skin urethroplasty.Urethral pseudodiverticulum developed 9 months after pedicle penile flap urethroplasty in another patient and voiding well after urethroplasty.Urethrography showed patent urethra with adequate lumen in the remaining patients and mean urinary peak flows was 21.3 ml/s (ranging 14.2-37.9 ml/s).Conclusions Substitution urethroplasty using penile skin or oral mucosa was more good procedure for anterior urethral stricture during the treatment of the coexistence of urethral stricture in the anterior and posterior urethra.The treatment of posterior urethral stricture was based on the length of the stricture, local condition to make a choice between anastomotic urethral reconstruction and substitution urethroplasty using other tissue.
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Objective To explore the procedure selection and outcomes of treatment for the patients with severe panurethral strictures secondary to lichen sclerosus ( LS ) and evaluated the bulbar urethral specimens histologically . Methods Seventy-eight patients with severe panurethral strictures of LS underwent one-stage urethroplasty using different mucosal grafts between January 2003 and December 2014. The mean age was 48 years (range 38-72).The mean stricture length was 14.3 ±2.6 cm (range 11.0-22.0).Midline perineal incisions or circumcoronal and midline perineal incisions were used and two procedures were chosen as follow:①the strictured urethras were dissected from the corpora cavernosa only along the left side and the stricture urethras were opened by a dorsal longitudinal incision which extended about 1.5 cm into the proximal healthy urethras .The strictured urethras were augmented using oral mucosal grafts(1.5 to 2.0 cm in width and an appropriate in length ) ( n=50); ② for the patients whose urethras were very narrow or obliterated , the urethras were reconstructed using colonic mucosal graft ( 3 cm in width and an appropriate in length)after the severe strictured urethras were excised (n=28).Biopsies were taken separately from the urethral meatus and bulbar urethral specimens .Results All of the 78 patients were followed up for 6-110 months (mean of 48.3 months).Sixty-nine patients (88.5%) urinated well, with the mean urinary peak flow rate of 23.4 ml/s ( range 15.2-47.0 ml/s ) , and urethrography showed that each had a patent urethra with adequate lumen .Complications associated with urethra occurred in 9 patients (11.5%) . Three patients developed urinary fistula secondary to infection , which required surgical correction;6 patients developed meatal stenosis 3 -11 months postoperatively , and all voided well after meatoplasty.The incidence of LS-positive biopsies was 100.0%in the glans and 88.5%in the meatus.In the bulbar urethral mucosa , the histological alteration in all biopsies was squamous metaplasia of the hyperplasia , and no histological evidence of typical LS was documented .However , homogenization of the collagen with diffuse lymphocyte infiltration was observed in the bulbar urethral specimens of 2 patients, and squamous metaplasia of the hyperplasia with serious orthokeratosis that was similar to its cutaneous counterpart was found in another 2 patients.Conclusions Our study suggests that urethroplasty with oral mucosal grafts is effective to treat panurethral stricture associated with LS .Urethroplasty with a colonic mucosal graft is suitable for repairing very severe strictured or obliterated urethra .No histological evidence of typical LS is observed in the bulbar urethral specimens .
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Objective To explore the outcome of modified bladder neck reconstruction in treating the urinary incontinence due to the sphincter dysfunction.Methods Between January 2010 and December 2014,a total of 23 patients,including 16 male and 7 female cases,with incontinence due to sphincter dysfunction had undergone a procedure of modified bladder neck reconstruction.The mean age was 36 years (range 17-61 years).Etiology of incontinence was secondary to pelvic fracture and urethral rupture procedure in 19 patients and other failure procedures in 4 cases.The mean duration of incontinence was 2 years (range 1-5 years).Urodynamic examination was performed in all patients and the mean maximum urethral pressure was 34 cmH2O (range 21-43 cmH2O).The modified bladder neck reconstruction was performed in 23 patients.Under the general anesthesia and vertical bladder incision,triangular mucosal strips,from the bladder neck to ureteral office,were denuded and leaving the central urethral plate,which was 2.0-2.5 cm in width.In order to form a neourethra and bladder neck,the multilayer triangular muscles were sutured interruptedly over a 14-16 F catheter using 2-0 or 3-0 polyglactin.And the anterior wall of the bladder was then closed over the new bladder neck using continuous sutured.Results The 23 patients were followed up for 6 months to 3 years,mean 1.4 years.Continence achieved in 5 patients.Of them,2 patients had difficulty in voiding but corrected by indwelling the catheter for another 2 weeks.Social continence was achieved in 7 patients.Incontinence status was improved in 7 cases and failed in 2 cases.Urodynamic examination was performed in 4 patients and the mean maximum urethral pressure was 64 cmH2O (range 52-72 cmH2O).Conclusions Our study suggested that the modified bladder neck reconstruction was a good procedure for the treatment of urinary incontinence due to sphincter dysfunction,particularly for the incontinence secondary to the traumatic urethral stricture or other operation.