ABSTRACT
Objective To explore the diagnosis and treatment of children anterior urethral valve combined with urethral diverticulum, and study the causes of lower urethral obstruction caused by the anterior urethral valve combined with urethral diverticulum. Methods The clinical data of 5 cases of anterior urethral valves combined with urethral diverticulum were retrospectively analyzed. Excretory bladder urography showed the formation of anterior urethral valve and diverticulum. All children underwent cystostomy, urethral valves, diverticulectomy and urethroplasty. Results All the 5 children were cured by surgery, and urination was smooth, with no urinary fistula and urethral stricture; the postoperative urodynamics, renal function and urinalysis were normal. Conclusions Anterior urethral valve combined urethral diverticulum is rare in clinic, and excretory bladder urethroplasty is the main diagnosis method of lower urethral obstruction. The effect of early diagnosis and treatment is good. Transurethral resection of valve and diverticulum is the first choice.
ABSTRACT
Objective To investigate the feasibility and efficacy of tunica vaginalis flap cover in treatment of recurrent urethrocutaneous fistula (UCF).Methods We reviewed the clinical datas of 25 cases of UCF after urethroplasty of hypospadias from January 2011 to January 2015.The mean age of the patients was 6.2 years(range 1.6-14.0 years).All patients had undergone previous hypospadias repair and at least one previous failed attempt to close the urethrocutaneous fistulae.There were 5 cases of fistula in the coronary sulcus,6 cases of fistula in the penile body and 14 cases of fistula at the junction of penis and scrotum.The diameter of urethrocutaneous fistulae were 3-10 mm.Single fistula was present in all patients.16 cases had undergone UCF repair for two times, 9 cases had undergone UCF repair for more than two times.After closing the fistula with inverting running stitch, a tunica vaginalis flap was mobilized to cover the repair site through a subcutaneous tunnel and the skin closed.Results The mean follow-up time was 2.1 years(range 0.5-4 years).The overall success rate was 96％ (24/25).Penile cosmesis was excellent.There was no evidence of recurrent fistulas or urethral strictures.All parents reported a straight penis when erected, and one patient in whom there was leak from the fistula site because of local wound infection.No postoperative complication was encountered in the testis.The testis was of normal size and position, and the ultrasound findings were normal.Conclusions Repairment of recurrent urethrocutaneous fistulas with a tunica vaginalis flap could be effective regardless of fistula location.The technique is simple to improve the success rate of the repair of UCF effectively and reduce the occurrence of postoperative complications.