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Objective:To compare the efficacy of pneumovesicoscopic Cohen and Politano-Leadbetter procedures in the treatment of vesicoureteral junction obstruction (VUJO) in children.Methods:The data of 48 children with VUJO who underwent operations in the Department of Urology, Anhui Provincial Children′s Hospital from January 2017 to December 2021 were retrospectively analyzed.According to the operation time, the patients were divided into the pneumovesicoscopic Cohen group(group C) (28 cases) and pneumovesicoscopic Politano-Leadbetter group(group P) (20 cases). The operation time, postoperative urinary catheterization duration, hematuria duration, hospitalization time, and the improvement of hydronephrosis, ureteral dilatation, and renal function after surgery were compared between the 2 groups.The enumeration data were compared by the χ2 test or Fisher′ s exact probability method.The measurement data were compared by the t-test. Results:All the 48 children were successfully operated on by the same surgeon, without conversion to open surgery.Six cases in the group C had a megaureter and underwent ureter tailoring.Two cases in the group P had calyceal and ureteral calculi, which were all removed after operation.There was a statistically significant difference in the operation time between group C and group P[(136.5±35.4) min vs.(165.8±33.2) min, t=-3.154, P=0.002]. The patients were followed up for (10.3±2.6) months after operation.There were 8 cases and 6 cases of urinary tract infection in group C and group P within 2 months after the operation, respectively.They all improved after conservative anti-infection treatment, and the infection was well controlled after removal of the D-J tube.Besides, their intravenous pyelography 6 months after operation showed that the ureter was unobstructed.In group C, 6 months after the operation, the anterior and posterior diameters of the renal pelvis [(1.62±0.54) cm vs.(2.55±1.24) cm, t=-5.027, P=0.001] and the largest diameter of the ureter [(0.95±0.27) cm vs.(1.51±0.52) cm, t=-8.495, P<0.001] were significantly decreased, compared with those before operation.However, the renal cortex thickness was increased significantly [(1.47±0.25) cm vs.(0.86±0.46) cm, t=2.028, P=0.004], and the renal function (as indicated by the diuretic nephrogram) was notably improved [(46.27±2.16)% vs.(41.83±3.04)%, t=1.647, P=0.030]. In group P, 6 months after operation, the anterior and posterior diameters of the renal pelvis[(1.48±0.82) cm vs.(2.68±1.41) cm, t=-2.740, P=0.003] and the maximum diameter of the ureter [(1.05±0.46) cm vs.(1.36±0.27) cm, t=-1.635, P=0.040] were significantly smaller than those before operation.However, the renal cortical thickness was increased [(1.38±0.33) cm vs.(0.74±0.39) cm, t=9.073, P<0.001], and the renal function (as indicated by the diuretic nephrogram) was significantly improved [(45.18±3.35)% vs.(39.55±2.49)%, t=1.277, P=0.030]. Politano-Leadbetter surgery outperformed Cohen surgery in promoting the recovery of the anterior and posterior diameters of the renal pelvis [(1.48±0.82) cm vs.(1.62±0.54) cm, t=-1.748, P=0.030]. Conclusions:Pneumovesicoscopic Politano-Leadbetter operation can establish a longer submucosal tunnel without changing the ureteral shape and opening position, having good effects in treating VUJO combined with calyceal and ureteral calculi.Pneumovesicoscopic Politano-Leadbetter operation can also better improve postoperative recovery from hydronephrosis than Cohen operation.However, the pneumovesicoscopic Politano-Leadbetter operation is more difficult and requires longer time.The surgeon should choose a reasonable operation based on his/her own experience.
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Objective To investigate the clinical effect of urethral plate combined with unilateral crescent flap in the treatment of hypospadias in children.Methods The clinical data of 14 cases of hypospadias treated from March 2017 to March 2018 were retrospectively analyzed,with average age of (3.3 ± 2.1) years.The external urethral orifice was located in the middle and distal part of the ventral side of the penis,with mild and moderate bends of the penis.The prepuce was piling up on the penile dorsal side,the ventral skin was deficient,and there was no concomitant disease such as penis scrotum transposition or cryptorchidism.All children were primarily treated with urethroplasty with urethral plate and one crescent flap.One side of the free urethral plate had a crescent superficial fascia,which was used as the new urethral material together with the urethral plate.By design,the urethra sutured deviating from the midline.The external urethral orifice was formed by trimming the anterior opening of urethra in the form of shallow "V" shape,and the new urethra was covered with the dorsal fleshy vascular pedicle.The pterygoid flap of the penis was sutured to form the penile head,and the foreskin was cut to cover the body of the penis.The specimens were taken for HE staining.Results The operation was successfully completed in 14 children.The length of the penis was measured before it is stretched out.The penile length was(3.5 ±0.5)cm,the penile diameter was(1.2 ±0.3) cm at the coronal sulcus,and the diameter of the tortoise head was (1.5 ± 0.3) cm at the pterygoid.The width of urethral plate was (0.6 ± 0.1) cm.Remeasurement was performed after complete correction of penile bending deformity.The length of the penis was (3.5 ± 0.5) cm,and the urethral defect was (1.7 ± 0.7)cm.According to Barcat method,there were 2 cases of coronal sulcus type,7 cases of anterior penile type and 5 cases of middle penile type.The results of HE staining showed that the number of blood vessels in the dorsal prepuce and fascia was (8.5 ± 2.1),dorsal foreskin plate was (5.1 ± 1.6),ventral prepuce internal plates was (7.6 ± 1.8),and ventral outer prepuce plates was (4.8 ±1.6).The number of superficial fascia vessels and deep fascia vessels were (10.3 ± 1.4) and (4.2 ± 1.7).The analysis of variance showed that there was significant difference in the mean number among groups(P =0.036),which was compared with each other by SNK-q test.The number of fasciae in dorsal prepuce was the most abundant,there was significant difference between dorsal and outer prepuce(P =0.033),and there was also significant difference with ventral prepuce(P =0.047).But there was no significant difference between the two groups(P =0.326).There was no significant difference in the number of blood vessels between the dorsal and ventral prepuce (P =0.682).The number of superficial fascia vessels near the skin was significantly more than that of deep fascia(P =0.037).On the transverse plane,there are more branches of the superficial fascia to the urethral plate at the junction of the ventral external plate and the urethral plate.All 14 cases were followed up for 3 to 9 months with an average of(5.4 ± 2.1) months.The penis was straight and satisfactory,urethral orifice was not cracked,urination was laborious and not forked,and there was no fistula.One patient with middle penile type developed postoperative infection and was controlled after antiinfective treatment.One patient with anterior penile type had slight urination after operation,but had no difficulty in urination.F6 metal urethral dilator was used to dilate for 2 months,and the urination was normal.Conclusion Urethral plate combined with crescent flap urethroplasty for hypospadias has a satisfactory appearance and fewer complications.It provides an optional operative method for the children who need no transection of urethra plate to straighten the penis,especially for the poor development of the penis and the insufficiency of the new urethral materials.The superficial fascia tissue on both sides of the urethral plate is an ideal material for the new urethra because of its abundant blood supply adjacent to the urethral plate and direct vascular connection.
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Objective By analyzing the cases of cryptorchidism owing to dysplasia in children to explore how to apply orchidectomy in the treatment of children with cryptorchidism. Methods Two hundred and seven cryptorchi-dism patients with dysplasia who underwent surgical treatment were collected in the Department of Urology,Anhui Province Children′s Hospital Affiliated to Anhui Medical University from July 2005 to May 2016. All the patients were true cryptorchidism,aged from 0. 6 to 11. 4 years [(4. 7 ± 1. 2)years]. There were 78 cases of left cryptorchidism,104 cases of right cryptorchidism and 25 cases of bilateral cryptorchidism. All cases underwent ultrasound examination be-fore surgery,showing that there were no testis in 53 cases,testicular atrophy or dysplasia in 154 cases. All cases under-went surgical treatment,including 149 cases of inguinal incision alone,groin incision combined with laparoscopic explo-ration in 47 cases and simple laparoscopic surgery in 11 cases. Communication with the parents of all the children was conducted during operation. One hundred and sixty - seven cases of mild and moderate testicular dysplasia underwent testicular descending fixation. Forty cases of severe dysplasia or testicular atrophy,including 16 cases of intrahepatic unilateral cryptorchidism and 22 cases of unilateral cryptorchidism outside the abdomen which underwent testicular resection,while 2 cases of bilateral cryptorchidism with severe dysplasia underwent bilateral testicular descent fixation after communication with the parents of the children during operation. All the specimens were sent for pathological examination after the operation. One hundred eighty - six cases were followed up from 1 to 128 months [(53 ± 8) months],and 21 cases were lost. Ultrasound examination was performed from 3 to 6 months after the operation to observe the development of bilateral testis and whether testicular dysplasia or testicular atrophy existed. Results All the children successfully underwent the operation and discharged from hospital. The group who underwent testicular had confirmed slim blood vessels in spermatic cord and poor testicular development through operation,while another group in postoperative follow up ultrasound showed that there was no obvious testicular - like structure in 6 cases,complete atrophy in 12 cases and partial atrophy in 48 cases and no atrophy in 93 cases. No patients had testicular resection again and no canceration after the operation. The healthy sides of the testicular resection in another group all had normal development. Conclusions Mild and moderate testicular dysplasia in children can choose testicular descending fixation,while severe dysplasia or testicular atrophy should select a reasonable surgical approach after communication with families.