Effect analysis of simultaneous implantation of artificial cavernous body and sphincter in patients with severe erectile dysfunction and urinary incontinence after traumatic posterior urethral stricture / 中华泌尿外科杂志

Objective:To discuss the effect of simultaneous implantation of artificial cavernous body and urethral sphincter for severe erectile dysfunction and urinary incontinence after traumatic posterior urethral stricture.Methods:A retrospective analysis was performed on 3 patients with traumatic posterior urethral stricture admitted to the Southern Theater General Hospital from January 2021 to December 2022, aged 42, 32, 28 years old, all of whom suffered pelvic fracture and posterior urethral stricture after trauma. Patient 2 were missing left lower limb and patient 3 were missing right lower limb, all of whom had dysuria. Preoperative cystourethrography indicated posterior urethral stricture with a length of 2, 2, 3 cm, respectively. No erectile response and severe erectile dysfunction were reported in penile nocturnal erectile function tests. Posterior urethral stricture was cured by end-to-end anastomosis surgery. After urethral stricture was cured, the nighttime erectile function test indicated severe erectile dysfunction and diagnosed erectile dysfunction and urinary incontinence. After 3 months of continuous administration of sildenafil and/or tadalafil, the erectile dysfunction did not improve, and the score of the international erectile function test was 1, 2, 2 points. Severe erectile dysfunction. The urine could not be controlled, the number of urine pads per day was 6, 6, 8, respectively, and pelvic floor rehabilitation training was adopted for urinary incontinence. 6 months later, urodynamic examination indicated severe stress incontinence, and the urine pad test was 30g, 32g, and 82g per hour. Patients were fully informed of the surgical risks before surgery. Simultaneous implantation of artificial penile cavernous body and artificial urethral sphincter were performed after full preoperative preparation: General anesthesia, supine frog position with transverse incision in upper scrotum, the urethra was separated and the artificial urethral sphincter cuff was easily inserted into the upper scrotum. Then the left and right sides of the penis cavernous sinus were dilated and the length of the cavernous body was measured. Suitable artificial penis cavernous body was implanted, water sacs were placed in the posterior pubic space and the anterior vesical space, and the tubes were connected. The erectile switch was placed under the scrotum, and the incision was closed after repeated testing of urine control and normal erectile function.Results:Three cases were successfully completed. The simultaneous implantation time of artificial cavernous body and artificial urethral sphincter was 270, 260, 240 min, respectively. The catheter was removed 1 week after surgery, and the erection switch was trained 2 weeks after surgery, and full erection was achieved after 1 week. The urine control switch was activated 6 weeks after surgery, and urine control was normal without urine pad. Following up for 12 to 18 months, 2 cases had normal erections and urinary control, 1 case had urethral corrosion 2 months after surgery, the original artificial sphincter was removed completely and a new artificial urethral sphincter was implanted in the same period, the operation was successful, and the follow-up was 1 year, urine control and erectile function returned to normal.Conclusions:For the severe erectile dysfunction and severe urinary incontinence after traumatic posterior urethral stricture, simultaneous implantation of artificial penile cavernous body and artificial urethral sphincter could be alternative choice.

The protective effect of non-transecting urethroplasty on erectile function in patients with posterior urethral stricture / 中华泌尿外科杂志

Objective To explore the erectile function preservational mechanism of Non-transecting urethroplasty(NTU) for posterior urethral stricture.Methods From May 2012 to September 2016,62 patients with posterior urethral stricture,who were treated with NTU,were enrolled in this study.The mean age was 37.5 years old,ranging 18-48 years old.The causes were pelvic fracture urethral injury in 53 cases and iatrogenic injury in 9 cases.Preoperative urethrography and urethroscopy revealed the strictures located in posterior urethra,which was at the distal of verumontanum.The mean length of stricture was 2.1 cm,ranging 0.5-2.5 cm.The average period between trauma and surgery was 6.4 months,ranging 3 months-2 years.All patients had no previous history of urethroplasty.Their sexual hormones were in normal level.Among those patients,the IIEF-5 scores were more than 12 and number of events during NPT test were more than twice.Finally,43 cases were underwent NTU and 19 cases accepted inferior pubectomy (IP)+ NTU.All patients had a general anesthesia.The bulbar urethra was mobilized dorsally from the tunica albuginea of the corpora cavernosa and then extended proximally up toward the perineal membrane.Scar tissue surrounding the urethra was excised and inferior pubectomy (IP) was performed as a supplemental technique to keep the suturing position without tension.The ventral hemi-circumference was then sutured with interrupted 4-0 polyglycolic sutures with tension-free anastomosis.The 18-Fr indwelling catheter was inserted.Result Average follow-up was 20.2 months,ranged from 12 to 36 months.In NTU group,NPT test revealed no significant difference in number of events (2.7 ± 0.7 vs.3.0 ± 1.0,P ＞ 0.05),duration of best episode [(16.4 ± 3.5) min vs.(16.4 ± 3.8) min,P ＞ 0.05)] or tip rigidity [(31.2 ± 4.7) ％ vs.(30.8 ± 3.5) ％,P ＞ 0.05)] between pre-and post-operation,respectively.The IIEF-5 score (19.7 ± 1.9 vs.20.4±2.1,P＜0.05)and Qmax[(8.7 ±4.0)ml/s vs.(25.5 ±4.7)ml/s,P＜0.05)] increased significant pre-and post-operation,respectively.In IP + NTU group,Qmax [(8.4 ± 4.4) ml/s vs.(23.1 ± 3.5)ml/s,P ＜ 0.05)] increased significant pre and post operation.The NPT test revealed slight decrease in number of events(2.3 ± 0.6 vs.1.6 ± 1.0,P ＜ 0.05),duration of best episode [(15.6 ± 2.4) min vs.(14.5±2.4)min,P＜0.05)] or tip rigidity [(29.8±3.0)％ vs.(25.6 ±7.1)％,P＜0.05)] between pre-and post-operation,respectively.However,the IIEF-5 scores (17.3 ± 1.6 vs.16.5 ± 2.1,P ＜ 0.05) didn't show significant difference pre-and post-operation.Stricture recurrence occurred in 3 patients,the success rate was 95.2％ (59/62) during 12 months following.Conclusion NTU is not only a safe and promising procedure for posterior urethral stricture less than 2.5cm,but also a new minimally invasive approach to preserve erectile function.

Bipolar plasma vaporization using plasma-cutting and plasma-loop electrodes versus cold-knife transurethral incision for the treatment of posterior urethral stricture: a prospective, randomized study

OBJECTIVE: Evaluate the efficiency and safety of bipolar plasma vaporization using plasma-cutting and plasma-loop electrodes for the treatment of posterior urethral stricture. Compare the outcomes following bipolar plasma vaporization with conventional cold-knife urethrotomy. METHODS: A randomized trial was performed to compare patient outcomes from the bipolar and cold-knife groups. All patients were assessed at 6 and 12 months postoperatively via urethrography and uroflowmetry. At the end of the first postoperative year, ureteroscopy was performed to evaluate the efficacy of the procedure. The mean follow-up time was 13.9 months (range: 12 to 21 months). If re-stenosis was not identified by both urethrography and ureteroscopy, the procedure was considered “successful”. RESULTS: Fifty-three male patients with posterior urethral strictures were selected and randomly divided into two groups: bipolar group (n=27) or cold-knife group (n=26). Patients in the bipolar group experienced a shorter operative time compared to the cold-knife group (23.45±7.64 hours vs 33.45±5.45 hours, respectively). The 12-month postoperative Qmax was faster in the bipolar group than in the cold-knife group (15.54±2.78 ml/sec vs 18.25±2.12 ml/sec, respectively). In the bipolar group, the recurrence-free rate was 81.5% at a mean follow-up time of 13.9 months. In the cold-knife group, the recurrence-free rate was 53.8%. CONCLUSIONS: The application of bipolar plasma-cutting and plasma-loop electrodes for the management of urethral stricture disease is a safe and reliable method that minimizes the morbidity of urethral stricture resection. The advantages include a lower recurrence rate and shorter operative time compared to the cold-knife technique.

The efficacy of non-transecting spongiosum end to end anastomosis of urethra for treatment of posterior urethral stricture / 中华泌尿外科杂志

Objective To report preliminary experiences with a novel procedure of end-to-end anastomotic repairment of posterior urethral strictures.Methods From January 2011 to December 2014,a total of 26 patients with posterior urethral strictures(2 patients with exist simultaneously anterior urethral stricture)were treated.The mean age was 43 years (rang 13-83 years).The etiology of urethral strictures were trauma in 23 patients and iatrogenic causes in 3 patients.The mean length of urethral stricture was 2 cm (rang 1-3 cm).Suprapubic cystostomies were performed in all 26 patients.All patients accepted the non-transecting spongiosum bulbar-membranous end to end anastomosis.During the operation,the perineal incision was made.The dorsal stricture urethra was incised,extending to the 1.5 cm normal urethra at each side.Then,the interrupted end to end suture was performed with 3-0 absorbable suture.Results The mean surgical time was 55 minutes in 24 patients(45-65 minutes).There was no evidence of wound infection or urethrocutaneous fistula during perioperation period.The mean follow-up time for 26 patients were 16 months (4 mouths-3 years).There was no recurrent stricture on symptomatic assessment or uroflowmetry.The patients voided well with mean peak flows rate 25.4 ml/s (16.8-59.1 ml/s).Urethrography showed that each patient had a patent urethra with adequate lumen.Conclusions Non-transecting spongiosum end to end anastomosis of urethra technique could retain spongiosal blood support.In present preliminary study,it appears to give similar results as those of traditional anastomotic urethroplasty.

Surgical treatment of post-traumatic complex posterior urethral stricture in male patients / 中华创伤杂志

Objective To investigate the therapeutic effect of post-traumatic complex posterior urethral stricture in the male patients.Methods Clinical data of 479 male patients with post-traumatic complex posterior urethral stricture were reviewed.One-stage resection of the stenosis and end-to-end anastomosis was performed in 422 patients and scrotal flap with blood pedicle posterior urethroplasty in 57.Results The mean operation time was 115 minutes(range,90-140 minutes).The mean blood loss was 225 ml(range,100-300 ml).No intraoperative blood transfusion was needed.The mean follow-up time was 15 months(range,12-24 months).Among the 422 patients performed end-to-end anastomosis,386 patients had good voiding and 36 had dysuria because of the formation of anastomotic stoma valve(21 patients)or stricture ring(15 patients).The problem was resolved by transurethral valve/stricture ring resection.Among 57 patients undergone posterior urethroplasty,45 patients had good voiding nine patients were found with anterior urethra-skin tube anastomotic stoma stricture,of which four patients were treated by urethral dilatation and five by endourethrotomy; three patients were found with posterior urethra-skin tube anastomotic stoma stricture,of which one patient was treated by urethral dilation and two by endourethrotomy.Conclusions One-stage resection of the stenosis and end-to-end anastomosis is the main treatment for post-traumatic complex posterior urethral stricture.If the condition of the patients does not allow the end-to-end anastomosis,posterior urethroplasty can be an alternative.

Treatment of complex posterior urethral strictures with urethroplasty via transpubic approach after pelvic fracture / 中华创伤杂志

Objective To evaluate the efficacy and safety of urethroplasty via transpubie ap-proach in treatment of complex posterior urethral strictures after pelyic fracture. Methods Urethroplas-ty via transpubic approach was done on 26 patients (21 males and 5 females, at mean age of 26 years) with complex posterior urethral strictures. Posterior urethral stricture was 2.5-4.0 cm long in 23 patiens and > 4.0 em in three. There were five patients with urethratresia. The perioporative complications and operative effect were evaluated after the broken ends of the urethra was thoroughly resected and treated with end-to-end anastomosis. Results A follow-up for 1-7 years ( mean 4 years) showed successful op-eration in 22 patients (85%), with normal urination and without complications like osteitis pubis, pelvic disassociation, pelvic instability or urinary incontinence. But obstructed urination was found in one (4%) and failed operation in three (11%). Conclusions Urethroplasty via transpubic approach takes advantages of precise and thorough scar excision, less complications and long term curative effect and is clinically feasible and safe for patients with complex posterior urethral stricture.

Diagnosis and treatment of posterior urethral stricture: twenty-year clinical experience / 中华泌尿外科杂志

tionale and effective surgical approach, and technique.

Repair of Complicated Posterior Urethral Stricture Using Inferior Pubectomy and Gracilis Muscle Flap / 대한비뇨기과학회지

PURPOSE: To evaluate the usefulness of an inferior pubectomy and a gracilis muscle flap for the reconstruction of a complicated posterior urethral stricture, where urethroplasty had failed, or due to a long urethral defect. MATERIALS AND METHODS: A total of sixty eight patients with complicated posterior urethral strictures, following a pelvic bone fracture, were managed by a one-stage perineal repair at Pundang CHA hospital between March 1998 and April 2002. End-to-end anastomosis was performed in all cases, with corporeal body separation, or an inferior pubectomy and transposition of the gracilis muscle flap performed in a progressive manner if required. RESULTS: The success rate of all the cases was 95.6%. Additional procedures made no differences to the incidence of impotence, and the incidences of restricture and incontinence were low. CONCLUSIONS: Our results shows that an inferior pubectomy and a gracilis muscle flap can be useful methods in the treatment and prevention of incontinence and restricture in most cases of complicated posterior urethral strictures.

Urethroplasty for posttraumatic posterior urethral stricture: An outcome analysis.

To assess the outcome of urethroplasty for posttraumatic posterior urethral stricture. Materials and Methods : All male patients with posttraumatic posterior urethral stricture who underwent urethroplasty procedures in the urological unit at Siriraj hospital from January 1995-June 1998 were included in the study. The details of initial management by the primary hospitals, prior surgical manipulations carried out elsewhere, techniques of urethroplasty, results and complications, especially incontinence and impotence, were collected and analysed. Results : A total of 27 patients were included in the analysis. The follow-up period ranged from 2 to 34 months (mean 12.8 + 9 months). All patients had initial management for acute urethral disruptions from primary hospitals as follows : 21 patients (77.8%) had suprapubic cystostomy alone and 6 patients (22.2%) had suprapubic cystostomy plus urethral realignment. Fifteen patients (55.6%) had failed urethral surgery for stricture corrections when referred. Three techniques of urethroplasty; perineal urethroplasty; perineal urethroplasty with inferior pubectomy and combined abdomino-perineal transpubic urethroplasty were done in 16 (59%), 8 (30%) and 3 (11%) respectively. The success was not associated with either previous surgery or no previous surgery status. Incontinence occurred in 10 patients (37%), but in seven of these was mild. Impotence existed preoperatively in 19 cases (64%). Three of eight cases (37.5%) who were potent preoperatively developed impotence postoperatively. The potency outcome was not statistically between the suprapubic cystostomy alone group and suprapubic cystostomy plus urethral realignment group. Conclusion : The outcome of urethroplasty for posttraumatic posterior urethral stricture was acceptable. Although the incontinence rate was high, most of them were mild. Postoperative impotence rate was high and should be discussed with patients prior to surgery.

Clinical significance of corporeal body separation and inferior pubectomy in complex posterior urethral strictures / 대한비뇨기과학회지

A total of fifty three patients with posterior urethral strictures followed by pelvic bone fracture were managed by one-stage perineal repair at Pusan National University from Jan. 1985. to Jun 1992. End-to-end anastomosis was performed in all cases, but other procedures were added to accomplish tension-free anastomosis in 34 cases. These techniques, which included distal urethra mobilization, corporeal body separation and inferior pubectomy wore performed in a progressive manner as needed. Excellent results were achieved and success rate was 97.8 % of all cases. And we evaluate complications after such progressive maneuvers and the relationship between type of posterior urethral injury based on urethrography, the types of surgical procedure and the types of pelvic bone fractures. Additional procedure were attributed to severe initial type IV urethral injury, unstable pelvic bone fracture and complex urethral stricture. In spite of performing additional procedures, the incidence of impotence, restrictue and incontinence made no differences. Therefore, separation of corporeal bodies and inferior pubectomy are safe and efficient method to treat nearly almost cases of urethral strictures including complex urethral strictures.

Modified Pull through urethroplasty(Netto procedure) in posterior urethral stricture / 대한비뇨기과학회지

To avoid the ball valving obstruction and the interference with ejaculatory process by intussuscepted urethra in Badenoch`s pull through operation, the modified Badenoch operation(Netto procedure) was used in five patients with the post traumatic posterior urethral stricture. The technique was that bulbous urethra was intussuscepted into prostatic tissue only about 5-10mm and the superficial external layer of the bulbous urethra was sutured to superficial external surface of the prostate with 4-6 interrupted sutures at the point of intussusception. Of the 5 patients, 4 have and had satisfactory results and one with dilation.