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【Objective】 To investigate the penile appearance, sexual function, psychological status and related influencing factors of adult patients who underwent hypospadias repair surgery in their minors, so as to provide reference for the diagnosis, treatment and prognosis of hypospadias. 【Methods】 This study included 50 adult hypospadias patients who underwent urethroplasty in our hospital during May 2005 and Aug. 2018. The present appearance, sexual function and psychological status were evaluated. The correlation and consistency between hypospadias objective scoring evaluation (HOSE) and pediatric penile perception score (PPPS) were analyzed. Factors affecting the results were determined with univariate and multivariate regression analysis. 【Results】 The satisfaction rate of HOSE was significantly correlated with the urethral length and complications (P=0.024, P=0.033). The satisfaction rate of PPPS was significantly correlated with the number of urethral operations and postoperative complications (P=0.041, P=0.023). There was a weak correlation between HOSE and PPPS (r=0.291, P=0.040), but almost no consistency (Kappa=0.2, P=0.107). Sixty percent of the patients paid attention to the ventral appearance of penis, whose dissatisfaction rate of PPPS was higher than those who did not pay attention to the ventral appearance of the penis (19/30 vs. 6/20, P=0.021). Patients with multiple operations (>1), postoperative complications or unsatisfactory penile appearance were more likely to have inferiority complex (52.6% vs. 22.6%, P=0.029; 59.1% vs.14.3%, P=0.001;61.5% vs. 24.3%, P=0.015). Multivariate regression analysis showed that dissatisfaction with the appearance of the penis was an independent risk factor for patients’ perception of their own physical defects. Among the patients who believed that they had physical defects, the percentage of patients with grade IV penile erectile hardness was significantly lower than that of those who denied they had physical defects (9/17 vs. 27/33, P=0.047). 【Conclusion】 The undesirable postoperative penis appearance is likely to have a negative impact on patients’ long-term psychological state, which might further damage the sexual function in adulthood. Surgeons should pay attention to the penile appearance during the conduction of hypospadias repair.
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Objective@#To assess the reliability and validity of the Urinary Tract Dilation (UTD) classification system as a new grading system for fetal hydronephrosis, and analyze the risk factors for prognosis of fetal hydronephrosis.@*Methods@#The data of patients who presented with fetal hydronephrosis from January to July 2016 at Sichuan Aca-demy of Medical Sciences & Sichuan Provincial People′s Hospital were retrospectively reviewed.The outcome of the patients who were treated with surgery or without surgical treatment was recorded if they were older than 2 years old.All renal nephrons were regraded if UTD classification system had been used for antenatal hydronephrosis assessment reliability previously.Univariate and multivariate analysis was performed to analyze the risk factors for prognosis of fetal hydronephrosis.@*Results@#A total of 94 patients (136 renal nephrons) were eligible for enrollment.During the observation period, 43 kidneys received surgery which had clinical indications for surgery, and the remaining 93 kidneys without surgery were stable until the end of the observation period.Ultrasound finding of fetal hydronephrosis in the second trimester were graded according to UTD grading system.Among the 51 kidneys with UTD A1, 7 kidneys (13.73%) received surgery during the observation period, and 35 kidneys (47.30%) received surgery during the observation period among 74 kidneys with UTD A2-3.In the third trimester of pregnancy, among 54 kidneys with UTD A1, 3 kidneys (5.56%) were operated during the observation period, and among 82 kidneys with UTD A2-3, 40 kidneys (48.78%) were operated during the observation period.Multivariate analysis revealed that parenchymal thickness before 32 weeks and UTD classification system during the third trimester of pregnancy were risk factors for fetal hydronephrosis which required surgical treatment after birth.@*Conclusions@#The UTD classification system is reliable for the evaluation of fetal hydronephrosis and is valid in predicting surgical intervention.Parenchymal thickness before 32 weeks and grading UTD A2-3 after 32 weeks is a risk factor for postnatal surgery.Analysis of fetal hydronephrosis data based on UTD grading system and standardized follow-up are helpful to control the risk of fetal hydronephrosis effectively.
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Objective To compare the postoperative effects of Onlay transverse island preputial flap and Onlay transverse free island preputial graft for midshaft hypospadias repair.Methods Retrospective analysis of clinical data of 59 patients with midshaft hypospadias who underwent hypospadias repair from January 2013 to December 2018.Among them,49 children were repaired with Onlay transverse island preputial flap,aged from 14 months to 81 months,with the median age of 28 months.Ten children were repaired with Onlay transverse free island preputial graft.The age at surgery was from 15 months to 51 months,with the median age of 30 months.There was no significant difference in term of the age at surgery between the two groups (Z =-0.384,P =0.701).There were 9 cases of Donnahoo Ⅱ and 40 cases of Donnahoo Ⅲ in the traditional Onaly group,and 3 cases of Donnahoo Ⅱ and 7 cases of Donnahoo Ⅲ in the free graft Onlay group,respectively.There was no significant difference in the type of chordee between the two groups(x2 =0.161,P =0.688).The classification of hypospadias,the length of the urethroplasty and surgical complications were compared.The maximum urinary flow rate of some patients was summarized and analyzed after operation.Results Follow-up ranged from 3 to 72 months,with a median period of 38 months.In the children who underwent Onlay transverse island preputial flap,there were 2 cases of distal shaft,5 cases of middle shaft,and 42 cases of proximal shaft.The neourethra was 1.3-3.5 cm,with a median of 2.3 cm.There were 11 cases of fistula,1 case of glan dehiscence,and 1 case of diverticulum.Ten children were treated with Onlay transverse free island preputial graft.There were 1 case of distal shaft,2 cases of middle shaft and 7 cases of proximal shaft.The neourethra was 1.2-2.5 cm,with a median of 2.0 cm.Two cases of fistula occurred after operation.There was no significant difference in hypospadias classification between the two groups(x2 =1.313,P =0.519).There was no significant difference in the length of the urethra between the two groups (Z =-1.732,P =0.083).There was no significant difference in the incidence of postoperative complications between the two surgical methods (x2 =0.001,P =0.973).The patients' parents were satisfied with the appearance of genital organ after operation.Fourteen patients finished the uroflowmetry 3 months after surgery.Twelve patients in the traditional Onlay group had a urine volume of 60.2-147.8 ml,with an average of 98.8 ml.The maximum urinary flow rate was 3.5-13.6 ml/s,with an average of 8.1 ml/s.In the free graft Onlay group,the urine volume was 101.3-165.4 ml,with an average of 133.5 ml,and the maximum urinary flow rate was 9.6-15.7 ml/s,with an average of 12.7 ml/s.Conclusions Onlay transverse free island preputial graft has the same complication incidence with Onlay transverse island preputial flap,but could get a good maximum urinary flow rate and cosmetic result,which could achieve a good choice for midshaft hypospadias repair.
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Objective To evaluate the role of multiple dorsal midline plication (MDMP) procedure in correction of Donnahoo type Ⅲ chordee in postpubertal patient.Methods From September 2010 to July 2013,33 postpubertal patients with Donnahoo type Ⅲ chordee (＞ 20°) were treated with MDMP procedure.The age ranged from 18 to 37 years with an average of 29 years.Primary surgery was indicated in 18 patients including type Ⅲ chordee in 11 and type Ⅲ/Ⅳ in 7,with associated hypospadias in 12.Redo surgery was warranted in 15 patients including type Ⅲ chordee in 13 and type Ⅲ/Ⅳ in 2,with associated urethral defects necessitating repair in 12.Intraoperative artificial erection was induced to confirm the degree and length of chordee.Longitudinal plication sutures,4 dots each,were applied close to the midline in a parallel fashion on each apex of curvature,to achieve satisfactory orthoplasty with 16-dot to 64-dot plication according to the chordee status,and the urethral repair indicated was achieved simultaneously.Results Satisfactory orthoplasty was achieved with 16-dot plication in 16 patients,24-dot in 10,32-dot in 6,and 64-dot in 1 patient whose penile curvature was severe and long.Followup was obtained from 35 to 69 months with an average of 46 months.Three patients lost of followup.Urethroplasty-related complications were noted in 5 patients including urethrocutaneous fistula in 2,urethral dehiscence in 1,urethral diverticulum in 1,and urethral stricture in 1.Mild cicatrical curvature (less than 15 degree) was noted in 2 patients.No postoperative priapism,erectile dysfunction,and paraesthesia was noted,nor chordee recurrence.Conclusions When applied appropriately,MDMP is an effective procedure in correction of Donnahoo type Ⅲ chordee in postpubertal patient with good and long-standing orthoplasty.
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Hypospadias repair is highly challenging especially for those severe or cripple variants.Correction via single stage or staged repair is controvercial whereas the controversies are with different content with advancement of hypospadiology.Here the authors introduce the contemporary concepts of staged repair for hypospadias.
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OBJECTIVE: To explore the surgical outcome of Duckett urethroplasty-urethrotomy for staged hypospadias repair. METHODS: Fifty-three patients with hypospadias were treated by 2 stages between August 2013 and September 2014. The age ranged from 10 months to 24 years and 3 months (median, 1 year and 10 months). There were 5 cases of proximal penile type, 2 cases of penoscrotal type, 36 cases of scrotal type, and 10 cases of perineal type. Urethroplasty was performed with tubed transverse preputial island flap only in 27 cases or combined with urethral plate in the other 26 cases, thus a urethrocutaneous fistula was intentionally created; stage II fistula repair was carried out at 1 year after stage I repair. RESULTS: The length of the new urethra ranged from 2 to 8 cm with an average of 3.6 cm. The patients were followed up 5-17 months with an average of 8 months after stage II repair. After stage I repair, urethral fistula was noted at other site in 3 cases, skin necrosis in 1 case, glandular stricture in 2 cases, cicatric curvature in 1 case, and position and morphology of urethral orifice not ideal in 4 cases. After stage II repair, urethral fistula was noted in 2 cases, mild urethral diverticulum in 2 cases, and stricture at temporary repair site in 1 case. HOSE score was 12-16 at 3 months after stage II repair (mean, 14.5). At 3-14 months after stage II repair, the maximum flow rate ranged from 3.9 to 22.7 mL/s with an average of 8.6 mL/s. CONCLUSIONS: Duckett urethroplasty-urethrotomy can be used as staged repair for primary treatment of hypospadias because of high safety, low complication incidence, and satisfactory appearance.
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It was reported that pancreatic arteries constricted during the early phase of bile salt-induced acute pancreatitis (AP), leading to pancreatic microcirculatory disturbance. We conducted this experiment to verify whether the above-mentioned finding was true. AP was induced with intraductal injection of taurodeoxyholate. Small pancreatic artery pressure in dogs was recorded. Functional capillaries were counted and calibrated by multiplying wet weight of pancreas. Pancreatic perfusion was measured with Laser Doppler flowmeter. Pancreatic arterioles of rats dilated during the initial 20 min of AP, and pancreatic arterial pressure declined during the early phase of AP in dogs (from 104.5 +/- 4.8 mmHg to 54.6 +/- 5.6 mmHg). The hematocrit of blood from inferior vena cava was significantly lower than that of portal vein at 5 min after pancreatitis induction. The "true" pancreatic functional capillary density increased. The early pancreatic microcirculatory disturbance coincided with a marked increase of portal vein pressure (PVP) as high as 9.18 +/- 0.78 mmHg. Reduction of PVP to baseline level was followed by a marked increase of pancreatic perfusion (by 1.4-fold). Arterial dilatation, but not constriction, occurred during the early phase of bile salt-induced AP. The pancreatic microcirculatory disturbance was due to a marked rise in PVP that greatly reduced the pressure difference in the pancreatic blood vessels and increased plasma extravasation which led. to local hemoconcentration.
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Animals , Male , Rats , Bile Acids and Salts , Hypertension, Portal , Microcirculation , Physiology , Pancreas , Pancreatitis , Portal Pressure , Portal Vein , Rats, Sprague-DawleyABSTRACT
Objective To analyze the clinical,endocrinal and genetic features of 46,XX male syndrome. Methods Retrospectively collect and analyze the clinical data of 4 cases of 46,XX male sex reversal syndrome. Results Four patients were all sociopsychologically males.Among them,2 cases had cryptorchidism,3 hypospadia and 1 severe chordee with short urethra.Neither ovary nor uterus was detected through B ultrasonography or surgical exploration.Assessment of serum sex hormone suggested hypergonadotropic hypogonadism.Genetic detection indicated 46,XX karyotype as normal female's type. Conclusions 46,XX male has nearly normal male phenotype otherwise with testes dysgenesis and most are infertile.The target of treatment is to correct the urinogenital malformation and to compensate hormone defect with androgen.