ABSTRACT
Objective:To explore the clinical features and treatment strategy of congenital anterior urethrocutaneous fistula.Methods:A total of 7 cases with congenital anterior urethrocutaneous fistula were repaired by surgery between January 2006 and February 2019 in Affiliated Children’s Hospital of Xi’an Jiaotong University. The median age was 30 (18-92) months. All of cases had a intact prepucs and a normal external urethal meatus located at the tip of glans. Fistula located at subcoronal culus in 2 cases, midshaft in 3 cases, penioscrotal region in 1 case, scrotum in 1 case, respectively.Defect longitudinal diameter was 0.5-1.5cm. Associated anomalies including division of scrotum in 3 cases, penile chordee in 2 cases, urethral meatus stenosis in 1 case, right hydrocele in 1 case. Six cases had underwent one-stage fistula repair incluing Duplay procedure in 4 cases(case 1, 2, 4 and 6), Onlay preputial flap in 1 case(case 3), TIP repair with dorsal plication for straightening and urethrotomy in 1 case(case 5). Case 7 had underwent a two-stage repair, which received Duckett flap repair with urethrostomy simultaneously at the base of the penis, and the defect was closed in second procedure. All of neourethras were reinforced by soft tissues from different places.Results:Of 6 cases with one-stage repair, the catheter was removed 10-14 days after surgery in 5 cases. Removal of the catheter was delayed until 3 weeks in case 3 because of poor wound healing. Case 7 received Duckett flap repair with urethrostomy in the initial surgery, who recovered uneventfully and was resolved during the second operation. No recurrence, urethral stricture or chordee occurence were noted in all after a 1-8 years followup period.Conclusions:Congenital anterior urethrocutaneous fistula have a high overall success rate.Duplay could be applied to cases without penile curvature, and well-developed urethral plate. Onlay or TIP is more suitable for cases with narrow urethral plate. The principle of hypospadias repair should be followed for those cases with severe penile curvature.
ABSTRACT
Objective To investigate the feasibility and efficacy of the first stage anastomosis using perineal ring-shaped flap in the treatment of anterior urethral defect after bladder-preserving urinary continence anterior urethral resection in female patients with early urethra carcinoma. Methods Tweenty-nine female patients with early urethra malignant tumor diagnosed in Changhai Hospital, Second Military Medical University from Jan. 2013 to Jan. 2016 were enrolled in this study. The average age of the patients was (61.4±14.4) years old, the clinical stages were type and the lesions were limited to half of the urethra. All patients underwent bladder-preserving urinary continence anterior urethral resection. After the resection of tumor, a free 30-40 mm long ring-shaped flap from the perineal vestibule was anastomosed inline to the end of the urethra. The clinical feasibility and safety of the operation were evaluated. Results The operation time was 0.45-1.50 h, with an average of (0.51±0.30) h. The postoperative urethral orifice shape of patients was close to the physiological shape with unobstructed urination, and the maximum urination rate was 12.8-33.0 mL/s, with an average of (19.3±8.7) mL/s. The success rate of one-stage operation was 100%, without any urethral stricture or urinary incontinence. All patients were followed up for 12-48 months with an average of (32.6±3.5) months. During follow-up, 1 case (1/6) with squamous cell carcinoma had a positive left inguinal lymph node metastasis in the first 2 years after surgery, and died of extensive lung metastasis 3 years after surgery; 1 case diagnosed with metastatic squamous cell carcinoma by postoperative pathological report developed regional swollen lymph nodes in the groin 13 months after surgery, and then ilioinguinal lymphadenectomy was perform to dissect the lymph nodes. No other recurrence was found during follow-up. Conclusion The first stage anastomosis surgury using perineal ring-shaped flap is safe and effective in the treatment of anterior urethral defect after bladder-preserving urinary continence anterior urethral resection in female patients with early urethra carcinoma.
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Objectives:To determine the feasibility of routinely performing internal urethrotomy for anterior urethral stricture under intracorpus spongiosum anesthesia in an outpatient setting.Methods:In a consecutive series of 18 patients with anterior urethral stricture,a dosage of 2~3 ml of 1%~2% lidocaine was slowly injected into the glans penis.Next,optical urethrotomy was performed immediately with a cold-cutting knife.According to pain scale,the effect of this anesthetic technique was assessed by questionnaire.Results:Internal urethrotomy was successfully completed in all the patients.All patients had no pain or discomfort.All the minor procedures varying from 15 to 45 minutes in duration were successfully completed under the new local anesthesia without any additional IV sedation.The anesthesia was very satisfactory without any complications.Conclusions:Under intracorpus spongiosum anesthesia,optical urethrotomy can be routinely performed in an outpatient setting.With this new local anesthesia,internal urethrotomy is a safe,effective,simple,and inexpensive procedure for treatment of anterior urethral stricture.
ABSTRACT
Carcinoma of the male urethra is an uncommon malignancy that accounts for less than 1 percent or all urologic malignancies. Adenocarcinoma of male urethra is usually found in posterior urethra. We experienced a case of anterior urethral adenocarcinoma, which was confused with inverted papilloma.