Penile necrosis resulting from post-circumcision microwave diathermy: A report of 9 cases / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the pathogenesis and treatment of penile necrosis resulting from microwave diathermy following circumcision.</p><p><b>METHODS</b>We retrospectively analyzed the clinical data about 9 cases of penile necrosis resulting from postoperative microwave diathermy following circumcision. The 9 males, aged 20 - 39 (mean 26) years, underwent traditional circumcision for redundant prepuce or phimosis in other hospitals, followed by microwave diathermy for 30 - 60 minutes daily, which resulted in penile necrosis. With no response to conservative therapy, the patients were referred to our hospital at 3 -30 days postoperatively. Of the 9 patients, 5 presented with dry gangrene and 4 with moist gangrene. Six of the patients underwent partial penectomy, including 1 that received penis lengthening.3 months later, while the other 3 underwent total penectomy for total penile necrosis followed by penile reconstruction 3 months later, with deep inferior epigastric perforator (DIEP) flaps and by implantation of the 12th costal cartilage in 2 cases and with epigastric groin island flaps and by urethroplasty in the other.</p><p><b>RESULTS</b>The patients were followed up for 2 - 8 years, and all could urinate smoothly in the standing position. Of the 6 men treated by partial penectomy, 1 received penis lengthening and achieved a penile length of 7 cm and 5 had the remaining penile length of 3 -5 cm, 4 with erectile function and the other 2 capable of sexual intercourse. The 3 men treated by total penectomy achieved nearly normal external appearance of the penis, with a finalized length of (11.7 ± 1.3) cm, a circumference of (11.4 ± 2.1) cm, and a normal feel of the skin. Of the 3 cases of penile reconstruction, 2 achieved sufficient erectile hardness of the penis (grade 3) for sexual intercourse, while the other 1 remained impotent.</p><p><b>CONCLUSION</b>Post-circumcision microwave diathermy may result in penile necrosis, for the management of which, early debridement is necessitated and penile lengthening or reconstruction can be performed according to the severity of the lesion and needs of the patient.</p>

Hand-assisted-drawing-needle running suture with a curved needle: an effective technique to create a W-ileal neobladder / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>An important milestone in the area of urinary diversion was the advent of a series of orthotopic bladder substitution (OBS). However, reconstruction of OBS by the traditional hand suture method (THSM) is a time-consuming process. Stapling techniques are considered to be inferior to hand-sewn methods. We report our experience and functional results in patients with W-ileal neobladder by a hand-assisted-drawing-needle running suture (HADNRS).</p><p><b>METHODS</b>Between April 1993 and December 2011, 347 patients (338 men and 9 women) aged 28 - 77 years (median age: 59 years) underwent radical cystectomy, followed by the creation of a modified W-ileal neobladder by HADNRS with a curved needle. A total of 347 (20 patients in 2003) were evaluated by urodynamic tests.</p><p><b>RESULTS</b>The operative time ranged from 110 to 310 minutes (mean 148 minutes), and the mean time of reconstruction by HADNRS, excluding ureterointestinal and ileouretral anastomosis, was (20.2 ± 4.3) minutes. Histopathological analysis of removed specimens showed that 317 patients had transitional cell bladder carcinoma. Of these 317 patients, 19 also had squamous carcinoma and 13 had adenocarcinoma. Glandularis and prostate cancer occurred in 16 and 14 patients, respectively. Three patients (0.8%) had neobladder abdominal fistula. No other early complications or injury to the surgeon's hands occurred due to HADNRS. Of the 20 cases with urodynamic examinations in 2003, two suffered from daytime incontinence and six had nocturnal incontinence. The maximum capacity of the neobladder was (492.9 ± 177.8) ml, and the maximum pressure within the reservoir at the end of filling was (32.1 ± 8.6) cmH2O.</p><p><b>CONCLUSION</b>Reconstruction of W-ileal neobladder by HADNRS is effective and economical.</p>

Protective effect of MEK inhibitor (U0126) on donor testes from ischemia-reperfusion injury after orthotopic testicular transplantation in rats / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To determine the effect of MEK inhibitor (U0126) on donor testes from ischemia-reperfusion injury after orthotopic testicular transplantation in rats.</p><p><b>METHODS</b>The rats were divided into 7 groups, Group 1: normal control; Group 2: cold perfusion control; Group 3: sham operation control; Group 4: transplanted for 30 min; Group 5: transplanted for 1 week; Group 6: transplanted for 30 min with pretreatment of U0126; Group 7: transplanted for 1 week with pretreatment of U0126. The orthotopic testicular transplantation model was established with cuff. The levels of ERK1, ERK2, pERK1 and pERK2 of donor testes were evaluated; the change of histology and gonadal hormones were measured as well.</p><p><b>RESULT</b>Group 1, 2 and 3 had no significant differences in all results (P>0.05). The levels of ERK1, ERK2, pERK1 and pERK2 in Group 4 were significantly increased compared with Group 1 (P<0.05), the levels of ERK1 and ERK2 in Group 6 were not different from those of Group 4 (P >0.05), but the levels of pERK1 and pERK2 in Group 6 were lower than those in Group 4 significantly(P <0.05), the histological changes in Group 6 were similar to Group 1 but milder than that in Group 4. The histological injury was more severe in Group 5 than that in Group 7, and the levels of gonadal hormones in Group 5 were lower than those in Group 7 (P <0.05) which remained at the normal levels.</p><p><b>CONCLUSION</b>U0126 has a protective effect on the donor testes in a short period through inhibiting expression of pERK1/2 activated by testicular transplantation.</p>

Establishment of testis transplantation model and study on mechanism of graft injury in rats / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To establish the testis transplantation model in rats and to study the mechanism of graft injury.</p><p><b>METHODS</b>The testis orthotopic transplantation model was established using three-cuff method. The animals were divided into 6 groups. Serum levels of testosterone (T), luteining hormone (LH) and follicle-stimulating hormone (FSH) were determined by radioimmunoassay (RIA). Morphology and ultrastructure were examined by light and electron microscopy. Expression of Glial cell line-derived neurotrophic factor (GDNF) mRNA was studied by reverse-transcription polymerase chain reaction (RT-PCR) technique.</p><p><b>RESULT</b>On the 7th day postoperatively, the allotransplanted testes showed perivascular massive infiltration of lymphocytes and polymorphonuclear neutrophil (PMN) and reduced number of the sertoli cells under light microscopy. It also showed the broken blood-testis barrier, the atrophy of the sertoli cells and spermatogenic cells arranged in disorder under electron microscopy. The decline of serum T level and the increase of serum LH and FSH levels were similar to those found in bilateral castrates. The levels of GDNFmRNA expression were lower than those in normal controls. On 14th day postoperatively, the spermatogenesis of allotransplanted testes was still not recovered and the expression of GDNFmRNA declined further.</p><p><b>CONCLUSION</b>The atrophy and reduced number of the sertoli cells and the breakage of the close connection probably are the main causes of dysfunction of spermatogenesis. The decline of GDNFmRNA expression is in accordance with the dysfunction of the sertoli cells and the spermatogenesis.</p>

Three-cuff method for establishing an allogeneic testis transplantation model in the rat / 中华男科学杂志

<p><b>OBJECTIVE</b>To establish a model of testis transplantation in the rat using cuff techniques.</p><p><b>METHODS</b>Sixty healthy inbred Wistar rats were included as donors and recipients. The testicular artery with the aortic segment with two cuffs was anastomosed to the recipient's aorta and the testicular vein with a cuff was anastomosed to the left common iliac vein of the recipient. The vas deferens was end-to-end anastomosed.</p><p><b>RESULTS</b>Of the 30 rats undergoing transplantation, 27 survived, 2 died from paralytic intestinal obstruction and 1 died from hemorrhage. Of the 27 survivals, 4, 4 and 5 were vivisected on the 14th, 28th and 56th day after operation, respectively, showing a good blood supply to the graft. Another 14 rats were used in another experiment, which revealed no obvious congestion, necrosis and edema in the left lower limb of the recipients.</p><p><b>CONCLUSION</b>The model of allogeneic rat testis transplantation established with cuff techniques, simple, stable and reliable, can be used as a tool for the study of testis transplantation.</p>