Penile reconstruction using deep inferior epigastric perforator flap / 中华泌尿外科杂志

Objective To explore a new surgical procedure for phallic reconstruction. Methods Since Dec 2003 to Nov 2006,4 patients with penile loss were reconstructed by transferring a deep in-ferior epigastric perforator(DIEP)flap with implanting the 12th costal cartilage. Results All of the flaDs survived successfully.With the follow-up from 5 months to 3 years,the appearance oi the neope-nis and donor-site scar was satisfactory. No one developed fistula or urethral stenosls, All patients were reported the return of erogenous sensibility of the neopenis leading to orgasm and achmving Pene-tration during sexual intercourse. Conclusions This new procedure may provide an esthetlcaIlY ac-ceDtable and functional neophallus.It might be a new alternative in penile reconstruction.

Diagnosis and treatment of tuberculosis in the male genital system / 中华男科学杂志

<p><b>OBJECTIVE</b>To probe into and improve the diagnosis and treatment of tuberculosis (TB) in the male genital system.</p><p><b>METHODS</b>Fifteen patients with the male genital system TB established by microbiological and pathological examinations were retrospectively reviewed.</p><p><b>RESULTS</b>The male genital system TB was diagnosed by history, physical examination, semen analysis, TB culture and biopsy. Treatment consisted of antituberculous chemotherapy for all the patients before and/or after operation, including 5 cases of epididymectomy and 6 cases of orchi-epididymectomy.</p><p><b>CONCLUSION</b>The male genital system TB tends to be atypical and semen polymerase chain reaction of TB (TB-PCR) may provide a new specific means for diagnosis in case of clinical suspicion. Surgical approaches should be cautiously adopted, especially for young patients.</p>

Diagnosis of seminal duct system diseases by percutaneous vasography (a report of 70 cases) / 中华男科学杂志

<p><b>OBJECTIVE</b>To evaluate the value of percutaneous vasography in the diagnosis of the disorders of the seminal duct system.</p><p><b>METHODS</b>Percutaneous vasography was performed successfully in 63 male patients (24 cases of infertility, and 21 hemospermia, 16 chronic prostatitis, and prostate carcinoma) from November 1974 to December 2003.</p><p><b>RESULTS</b>Vasography revealed abnormal ducts in 28 and disorders in 38 (60.3%), including 8 cases of sterility, 13 seminal vesiculitis, 16 chronic prostatitis 5 seminal vesical cyst, and 2 prostate carcinoma.</p><p><b>CONCLUSION</b>Percutaneous vasography is an effective method to identify diseases of the seminal vesical and ductal system.</p>

Development and clinical application of the Chinese-made inflatable penile prosthesis / 中华男科学杂志

<p><b>OBJECTIVE</b>To study the effect and safety of the Chinese-made inflatable penile prosthesis in the treatment of erectile dysfunction (ED).</p><p><b>METHODS</b>According to the anatomy and physiology of Chinese men, an inflatable penile prosthesis was developed in China, consisting of an innovated pump, a reservoir, and a pair of penile cylinders, which were connected by tubes to form a complete system. It was authorized to be used clinically by State Food and Drug Administration (SFDA). Forty-five cases of organic ED were selected for penile prosthesis implantation. Penoscrotal approach was used to implant the cylinders into the corpus cavernosum, the pump into the scrotum and the reservoir into the prevesical space.</p><p><b>RESULTS</b>Surgical problems and mechanical failures were not found in the subjects. Post-operative complications occurred in 3 cases (6.6%), but did not affect the intercourse. Satisfactory intercourses were achieved 10-12 months later and the intercourse duration averaged about (20 +/- 6) min.</p><p><b>CONCLUSION</b>The Chinese-developed inflatable penile prosthesis was safe and effective for patients with ED, with low rate of mechanical failures. Its long term effect has yet to be further studied.</p>

Diagnosis and treatment of priapism (report of 10 cases) / 中华泌尿外科杂志

Objective To ascertain the causes of priapism and to differentiate between the ischemic low-flow type and nonischemic high-flow type so as to improve the clinicians' ability for emergency treatment of priapism. Methods Ten cases of priapism were included.Their mean age was 41 years (range,22～64 years).The priapism lasted 8 to 212 h with a mean of 21.2 h.Of them 1 case had received prostaglandin E,papaverine and phentolamine injection into cavernous body of penis,which led to ED;1 had priapism when experiencing sexual intercourse after taking sildenafil;1 had primary sarcoma of the penis;1 had transitional cell carcinoma of bladder, which metastasized to the penis;1 had leukemia; 2 had traumatic history;and 3 had unknown causes.The types,causes,treatment and outcomes of priapism were analyzed. Results Of the 10 cases,8 were of ischemic low-flow type and 2 of nonischemic high-flow type. In the 8 cases of ischemic low-flow type priapism, 4 achieved detumescence after receiving metaraminol injection (2～8 mg) at the root of cavernous body,and perfusion of haparinized saline at glans and root of cavernous body of the penis by contrecoup if necessary (1 had ED).One case undergoing glandular-cavernosal shunting achieved detumescence with preservation of erectile function.One case with leukemia was cured after chemotherapy.One case suffered from penile sarcoma and the rest 1 from metastasis of transitional cell carcinoma; the prognoses of both were unfavorable.Of the 2 cases of high-flow type,1 achieved detumescence after selective embolization of internal pudendal artery;the other was discharged after conservative treatment,but experienced ED. Conclusions Blood gas analysis of cavernosal blood,color Doppler ultrasound,and internal pudendal arteriography are useful in differentiating the types of priapism.If conservative treatment fails to achieve detumescence of the penis,surgical treatment should be performed immediately for both types of priapism.

Diagnosis and treatment of female pseudohermaphroditism caused by congenital adrenal hyperplasia (report of 4 cases) / 中华泌尿外科杂志

Objective To report the effect of hormone replacement plus orthopedic surgery for 4 patients with female pseudohermaphroditism caused by congenital adrenal hyperplasia. Methods Four patients with female pseudohermaphroditism caused by congenital adrenal hyperplasia were included.On admission their ages were 11,15,14 and 20 years,respectively.The diagnoses were confirmed by medical histories,ultrasonography,serum levels of hormones and chromosome analysis.They all underwent clitoroplasty and vaginoplasty with perineal skin flap. Results After operation the patients received estrogen and progestogen for a short time to adjust the menstrual cycle and hydrocortisone replacement(10 to 20 mg,twice a day) for their lifetime.Normal menstruation and well-developed breasts were observed in all the patients.No constriction occurred in the reconstructed vaginas. Conclusions This disease can be easily misdiagnosed as hypospadias with bilateral cryptorchidism.Therefore,in addition to careful physical examination,the measurement of serum hormones,ultrasonography of the abdomen,and chromosome analysis are necessary.Proper utilization of the perineal skin flap for reconstruction of the clitoris and vagina as well as careful perioperative managements in combination with hormone replacement therapy can greatly contribute to satisfactory results.

Treatment of urinary incontinence with artificial urinary sphincter (report of 4 cases) / 中华泌尿外科杂志

Objective To explore the efficacy and safety of artificial urinary sphincter in the treatment of real urinary incontinence. Methods The implantation of AMS 800 sphincter prostheses was conducted on 4 patients with urinary incontinence.The voiding diaries were recorded and urodynamic examinations were done before and after the implantation.The adverse reactions were recorded after the procedure. Results In the 4 cases,the sphincter pump was activated 4 to 6 weeks after the implantation.The urinary incontinence was well controlled and automatic urination was recovered.No infection-related complication leading to failure of the artificial urinary sphincter occurred.Follow-up for 17 to 46 months showed no leakage of urine at daytime or at night. The mean score of quality of life was 1.Urodynamic examination showed satisfactory compliance and stability of the bladder.The urethral pressure profiles (UPPs) being 8.2 to 9.4 kPa (1 kPa=10.20 cmH 2O);and the mean was 8.7 kPa.Three cases had no residual urine,while only 1 case had 60 ml of residual urine.Only 1 patient had to change the control pump due to mechanical failure 27 months after the operation. Conclusions Artificial urinary sphincter implantation is an effective and safe therapy for real urinary incontinence.The proper use of AM 800 and improved technique result in good long-term outcomes.

A retrospective study of 20 cases of erectile dysfunction treated by domestic made penile prosthesis implantation / 中华泌尿外科杂志

Objective To evaluate the domestic made penile prosthesis for the management of erectile dysfunction. Methods The domestic made three piece inflatable prosthesis has been implanted to 20 ED patients from 1997 to 2001. Results The overall complication rate was 20% (4/20), nonmechanical in 4 (20%) and there has been no mechanical complication.Infection after operation occurred in 1 case (5%). The penile prosthesis penetrated out in 3(15%). Conclusions The mechanical function and concealment have been significantly improved with the domestic made three piece inflatable penile prosthesis.