From infection to immunotherapy:the immune response of bladder mucous membrane to host / 中国综合临床

Objective The pathogenesis of urinary tract infection and the preventive effect of Bacillus Calmette Guerin on bladder cancer imply the importance of bladder as a unique mucosal surface research. This article discussed that after bladder infected by bacteria,the way in which the microenvironment produce adaptive immunity. Once in the past, bladder is widely considered to be a sterile environment, the concept has been recently shaken. It is suggested that we should further study the influence of urinary tract pathogen infection or BCG immune response. In this paper, bladder biology has been illustrated, and bladder organ immunity is urgently needed to be explored and defined.

Ventral bladder mucosa onlay graft urethroplasty for the treatment of panurethral stricture / 中华泌尿外科杂志

Objective To investigate the efficacy of ventral bladder mucosa onlay graft urethroplasty for the management of panurethral stricture.Methods From August of 2005 to July of 2013,11 cases of panurethral stricture were treated by ventral bladder mucosa onlay graft urethroplasty.The median age of the patients was 53 years (22-72 year),The median stricture length was 15 cm (12-18 cm).The patient was placed in the lithotomy position,Penile urethra was exposed by circumcoronal incision and degloving of skin,Bulbar urethra was exposed by inverted Y-shaped perineal incision.The strictured urethral segment was then opened ventrally in the midline up to at least 1 cm proximally into the healthy urethra.An appropriate size bladder mucosa graft was harvested,and was quilted to the splited urethra edge,the graft width was 1.5-2.0 cm.Two F10 fenestrated silicone catheters were left as urethral stents,a suprapupic cystostomy tube was left.The urethral stent was removed 4 weeks postoperatively.Follow-up was performed every 3 months for the first year,and annually thereafter.Success was defined as normal voiding with a maximum flow rates ≥ 15 ml/s,and the patients required no further instrumentation,including dilation or urethrotomy.Results The mean follow-up was 18 months (range,9-36 months),the overall success rate was 10/11.One patient developed urethral meatus stenosis 3 months postoperatively,and was managed by meatal dilatation.Conclusion Ventral bladder mucosa onlay graft urethroplasty can be used for the management of panurethral stricture,Bladder mucosa is an alternative substitution for complex urethral reconstruction.

Inlaid labial versus bladder mucosal graft repair for complex urethral skin fistula / 中华男科学杂志

<p><b>Objective</b>To compare the effect of inlaid labial mucosal graft repair (LMGR) with that of bladder mucosal graft repair (BMGR) in the treatment of complex urethral skin fistula after hypospadias repair.</p><p><b>METHODS</b>This study included 55 cases of complex urethral skin fistula following hypospadias repair. We randomly assigned them to receive inlaid LMGR (n=36) or BMGR (n=19). After surgery, we compared the incidence of complications and recurrence rate of urinary fistula between the two groups of patients.</p><p><b>RESULTS</b>The success rates of operation were 91.7% and 84.2% in the LMGR and BMGR groups, respectively, and the penile appearance was desirable in both groups. Postoperative complications included 2 cases of urinary fistula and 1 case of urethral stricture in each group. There were no statistically significant differences between the two groups in the success rate of operation (P>0.05) or the incidence rate of postoperative complications (P>0.05).</p><p><b>CONCLUSIONS</b>Both inlaid LMGR and BMGR yield satisfactory results in the treatment of complex urethral skin fistula. However, LMGR involves less injury in mucosa collection and is easier to perform and therefore deserves more clinical attention.</p>

Clinical significance of multispectral imaging in cystoscopic examination / 中华泌尿外科杂志

Objective To explore the imaging characteristics and clinical value of multispectral cystoscopy.Methods From May 2011 to May 2013,31 male and 4 female patients were included in this study,including benign prostatic hyperplasia in 14 patients,bladder tumor in 16 patients,upper urinary tract disease alone in 5 patients.The mean age in this group was 56 years (range 43 to 84 years).All patients accepted the bladder CT scan for diagnosis.TURBT procedure and pathological examination were performed in those patients with bladder tumor.Under the epidural anesthesia,the 27 F resectoscope was inserted to bladder through the urethra.Then,the conventional light source was replaced by multispectral endoscope light source.The white light,UV-light (401.0 nm),blue light (467.6 nm),green light (534.2nm),red light (660.6 nm),and near-infrared light (763.8 nm) were used,subseqently.Meanwhile,the following data were recorded,such as the visibility of bladder cavity,the color of bladder tumors and bladder mucosa,the density of blood vessels,three-dimensional structure of blood vessels,the mobility between mucosa and submucosa.Results When UV-light and near-infrared light irradiated bladders,there were not any imaging on monitor.However,the bladder mucosa and submucosa blood vessels were showed clearly and constituted the three-dimensional blood vessel network when using green light.The density of blood vessels in mucosal and submucosal layer was increased but less clarity when using blue light.The mucosal surface was covered in red when using red light,which vascular and mucosal can not able to be distinguished.Among 16 patients who were accepted the TURBT procedure,seven cases with T1 stage tumors were resected to the submucosa by TURBT.The superficial muscle layer with integrity structure could be observed under white light.While,blood vessels were not appeared when using green light.In six cases with Ta stage tumors,the clear connection of blood spots between mucous blood vessels and the blood vessel from the tumor could be observed under the green-light conditions.In three patients with Tis stage tumors,the mucosal blood vessels were normal under the white-light after tumor resection.However,structural disorder could be found under the green-light,which should be highly suspected as Tis stage tumors.Conclusions Without any photosensitizer or fluorescent dye,tumor blood vessels and bladder mucosal vascular can be showed under the green light.This technique is useful for identify the minimal tumor and evaluate the carcinoma infiltrated depth.

Reconstruction of failed urethroplasty with different tissues and materials for hypospadias / 中华泌尿外科杂志

Objective To study the efficacy and complications of reconstruction of failed urethro-plasty for hypospadias with pedicle flap , bladder mucosa , buccal mucosa , and biological patch . Methods 23 patients were enrolled from Jul .2005 to Dec.2011.8 patients, with good local skin condition , were performed with pedicle flap urethroplasty .The other 15 patients, with bad local skin condition or with long segment urethral stricture , were performed with free grafts , including 6 bladder mucosa , 7 buccal muco-sal and 2 biological patch. Results Of the 23 cases, 7 cases were cured by one phase operation .There were 16 (16/25) cases had complications.3 (3/16) cases were failed because of serious infection (2 pedi-cle flap, 1 bladder mucosa ) .The failed cases were implemented with urethroplasty 6 months later by the buccal mucosa installments operation .4 (4/16) cases had solitary urethral fistula (1 pedicle flap, 2 bladder mucosa, and 1 buccal mucosal), who were successfully treated with simple fistula repair 3 to 6 months later. 9 ( 9/16) cases had urethral stricture ( 2 pedicle flap , 3 bladder mucosa , 3 buccal mucosal , and 1 biologi-cal patch graft ) , who were treated with urethral sound and got good result .We had reconstructed the urethra using mucosa graft onlay urethroplasty .All of the 23 patients were followed up with an average of 14.5 ( 6-24) months.23 cases were satisfied with the stretched penis , urination and no need to expand the urethra more than 6 months.3 cases were not satisfied with penile appearance .After communication, these patients did not require a further penis orthopedic surgery . Conclusions Pedicle flap, bladder mucosa , buccal mucosa and biological patch can be used in urethral repair and construction of failed urethroplasty for hypos -padias.Urethral sound dilation plays an important role in hypospadias repair .

Bladder Mucosal Graft for Severe Hypospadias Repair / 대한비뇨기과학회지

Bladder mucosa has been reported as an excellent tissue for construction of a neourethra. We used bladder mucosa in 3 cases when there was inadequate foreskin to create a neourethra. Two cases were penoscrotal hypospadias with chordee which were repaired in one stage operation and one case was scrotal hypospadias with severe chordee which was repaired in two stage operation. The. sizes of harvested bladder mucosa were 4x 1.5cm, 10 x 3.5cm and 15 x 3cm respectively. Two minor and one major complications occurred. The minor complications were urethral stricture in one case which was managed with urethral dilation and penile swelling after self-voiding in one case which required urinary diversion for several days. In one case severe problem with entire neourethra stricture necessitated internal urethrotomy and intermittent urethral dilatation. In all cases sufficient graft tissue could be obtained and there were no urethrocutaneous fistulas. Thus, the use of bladder mucosal graft in hypospadias repair is feasible in cases in which previous repairs have railed or in which sufficient foreskin for neourethral reconstruction is lacking.

Two Cases of Hypospadias Repaired by Using the Bladder Mucosal Graft Technique / 대한비뇨기과학회지

In the repair of hypospadia, the use of bladder mucosal grafts in cases in which previous adequate foreskin for urethral reconstruction is lacking or in which previous repairs have failed, is feasible. The bladder mucosal graft offers several theoretical advantages. It is of the same histologic character as the normal urethra, is not hair bearing, tends to re-epithelialize exposed surfaces and has great dispensability. We have experienced two cases of the perineal and penoscrotal hypospadias repaired successfully by the bladder mucosal graft technique.