Optimizing erectile function evaluation pattern in postoperative pelvic fracture-urethral injury patients: introducing PFUI pEF PROM.

PURPOSE: To establish a psychometric validated pelvic fracture-urethral injury postoperative erectile function patient reported outcome measure (PFUI pEF PROM). We also aim to explore PFUI patients' potential classification and suitable postoperative erectile function assessment pattern. METHODS: A total of 93 PFUI patients who treated by excision and primary anastomotic (EPA) urethroplasty from January 2020 to August 2022 were enrolled to this study. Patients who had intercourse completed the IIEF-5, those who had sexual stimulation other than intercourse finished PFUI pEF PROM, and those who performed both completed the IIEF-5, and PFUI pEF PROM. Erection Hardness Score (EHS) was completed by all patients. This PROM was performed psychometric validation and used to find PFUI patients potential classification through latent class analysis. Then, we determined the cut-off value though receiver-operating characteristic (ROC) curve and performed univariate analysis subgroups feature. RESULTS: The PFUI pEF PROM demonstrated high reliability and validity with a Cronbach's alpha of 0.928. It correlated significantly with IIEF-5 (r = 0.550, p < 0.001) and EHS (r = 0.909, p < 0.001). The latent class analysis identified three patient subgroups, with 14.5 as the subgroup cut-off value. Urethral stricture length, IIEF-5, and EHS score were identified as influence factors for maximal erection potential. An assessment pattern combining IIEF-5, EHS, and the PFUI pEF PROM covered 92.5% of patients. CONCLUSION: This PROM effectively addresses the current limitation in assessing erectile function in PFUI patients. This study provides a promising tool for stratified assessment, prediction erection recovery, and treatment guidance in the PFUI Erectile dysfunction field.

Urethral-sparing laparoscopic simple prostatectomy for the treatment of benign prostatic hyperplasia with asymptomatic urethral stricture after urethral stricture surgery.

OBJECTIVE: To evaluate the efficacy of urethral-sparing laparoscopic simple prostatectomy (US-LSP) for the treatment of large-volume (>80 ml) benign prostatic hyperplasia (BPH) with asymptomatic urethral stricture (urethral lumen > 16 Fr) after urethral stricture surgery. METHODS: We retrospectively analyzed clinical data of 39 large-volume BPH patients with asymptomatic urethral stricture after urethral stricture surgery who underwent US-LSP from January 2016 to October 2021. Postoperative follow-ups were scheduled at 1, 3, and 6 months. RESULTS: All patients affected by significant BPH-related lower urinary tract symptoms (LUTS) including 22 cases with asymptomatic anterior urethral stricture and 17 cases with asymptomatic posterior urethral stricture. Median operative time was 118 min (interquartile range [IQR]100-145). Median estimated blood loss was 224 ml (IQR: 190-255). 33 patients(84.6%) avoided continuous bladder irrigation. Postoperative complications occurred in 5 patients (12.8%), including 4 cases with Clavien-Dindo grade 1 and grade 2 and 1 case with grade 3a. During follow-up, US-LSP presented statistically significant improvements in LUTS compared to baseline (P < 0.05). A total of 25 patients had normal ejaculation preoperatively and 3 patients (12%) complained retrograde ejaculation postoperatively. Two patients (5.1%) reported stress urinary incontinence (SUI) and no patient reported aggravated urethral stricture during follow-up. CONCLUSIONS: US-LSP was safe and effective in treating large-volume BPH with asymptomatic urethral stricture after urethral stricture surgery. Meanwhile, US-LSP could reduce the risk of SUI in patients with asymptomatic posterior urethral stricture and maintain ejaculatory function in a high percentage of patients.

Super-resolution imaging of urethral vasculature in healthy pre- and post-menopausal females.

Previous studies have postulated that the urethral vasculature (UV) might play an important role in urinary continence for women. The goal of this research was to compare the UV in pre- and post-menopausal women using a super-resolution ultrasound imaging method called Super Ultrasound for Greater Accuracy and Resolution (SUGAR). We found that post-menopausal women exhibited decreased UV parameters such as fractal dimension, vessel proportion, and mean blood vessel diameter than pre-menopausal women. We also discriminated the vascular pattern in several layers of the urethra and its surrounding in vivo, including the urethral mucosa and submucosa, urethral muscle, and anterior vaginal wall. Besides, the statistical analysis of the vasculature pattern showed that most of the UV parameters peaked at mid-urethra. Ultimately, the UV parameters exhibited a tendency of first increasing, then reducing, and finally decreasing with age.

Modified Y-V plasty based on MRU evaluation for iatrogenic bladder outlet obliteration: a multicentre experience in China.

PURPOSE: To compare the diagnostic ability of traditional radiographic urethrography and magnetic resonance urethrography (MRU) for iatrogenic bladder outlet obliteration (BOO), and explore the efficacy and complications of laparoscopic modified Y-V plasty for patients selected based on MRU evaluation. METHODS: 31 patients with obliteration segments ≤ 2 cm and no false passages or diverticula based on MRU evaluation from eight centers in China were included. Obliteration segments were measured preoperatively by MRU and conventional RUG/VCUG and compared with intra-operative measurements. Surgical effects were evaluated by uroflow rates, urethrography, or cystoscopy at 1, 3, 6, and 12 months post-operation and then every 12 months. Postoperative urinary continence was assessed by 24-h urine leakage (g/day). RESULTS: The results showed that MRU measured the length of obliteration more accurately than RUG/VCUG (MRU 0.91 ± 0.23 cm, RUG/VCUG 1.72 ± 1.08 cm, Actual length 0.96 ± 0.36 cm, p < 0.001), and clearly detected false passages and diverticula. Laparoscopic Y-V plasty was modified by incisions at 5 and 7 o'clock positions and double-layer suture with barbed sutures. All operations were successfully completed within a median time of 75 (62-192) minutes and without any complications. Urethral patency and urinary continence rates were 90.3% (28/31) and 87.1% (27/31), respectively. Three recurrences were cured by direct visual internal urethrotomy. Four patients had stress urinary incontinence after catheter removal 14 days post-operation, with urine leakage of 80-120 g/day, not relieved during follow-up. CONCLUSIONS: Laparoscopic modified Y-V plasty based on MRU evaluation is a promising approach for iatrogenic BOO, with a high patency rate and a low incontinence rate.

Biodegradable nano black phosphorus based SDF1-α delivery system ameliorates Erectile Dysfunction in a cavernous nerve injury rat model by recruiting endogenous stem/progenitor cells.

Stem cell (SC) therapy has been shown high prospects in erectile dysfunction (ED) treatment. Without ethical issues and risks of immune rejection and tumorigenesis of exogenous SC therapy, endogenous stem/progenitor cells (S/PCs) have a better potential for ED management, and their homing and redistribution are controlled by SDF1-α/CXCR4 axis. Considering black phosphorus nanosheet (BPNS) has emerged as an efficient and safe drug vehicle due to its large surface area, biodegradability, and the ability to retain and slowly release its loaded drugs, BPNS is utilized to load SDF1-α, a chemokine for S/PCs, to construct the BP@SDF1-α complex to efficiently recruit stem cells (SCs) by injury-site injection and thus ameliorate ED within the bilateral cavernous nerve injury (BCNI) rat models. We find that BP@SDF1-α can efficiently recruit exogenous SCs and endogenous S/PCs to corpus cavernosum and main pelvic ganglion (MPG) by local administration. Of note, ascribing to endogenous S/PCs recruitment, it also successfully alleviates ED in BCNI rat models by enhancing the protein expression levels of α-SMA, CD31, and nNOs, and eliciting less collagen deposition in the penis after its combined injection at corpus cavernosum and MPG. Thus, this study provides a new insight into the treatment of ED with endogenous S/PCs. BIODEGRADABLE NANO BLACK PHOSPHORUS BASED SDF1-α DELIVERY SYSTEM AMELIORATES ERECTILE DYSFUNCTION IN A CAVERNOUS NERVE INJURY RAT MODEL BY RECRUITING ENDOGENOUS STEM/PROGENITOR CELLS.

The surgical techniques of transperineal anastomotic urethroplasty for complex posterior urethral stenosis in boys and the long-term follow up outcomes.

Objective: To explored the curative effects of various surgical methods used to treat complicated posterior urethral strictures in boys and the long-term complication. Methods: We retrospectively studied 28 boys under 14 years of age with complicated posterior urethral strictures treated at our hospital from January 2015 to December 2020. Urethral angiography revealed posterior urethral strictures. Twelve had previously failed urethral surgery; four had urethral fistulae. All underwent end-to-end urethral anastomoses via a transperineal, inferior pubic approach. We freed the distal end of the urethra, split the penile cavernous septum, partially resected the lower edge of the pubic symphysis, and rerouted the urethra under a corpus cavernosum to reduce the tension of the urethral anastomosis. Results: All boys were 2-14 years of age at the time of surgery (mean 6.3 years). The urethral strictures were 3-5.5 cm in length (mean 4.2 cm). Catheters were removed 4 weeks postoperatively. The postoperative follow-up time was 4-72 months (mean 36.8 months). Twenty-four patients exhibited unobstructed urination after a single operation. The maximum urinary flow rate was 15-22 ml/s (average 17.8 ml/s); the success rate was 85.7%. Two patients required second urethral end-to-end anastomoses; urination became normal postoperatively. Two continued to exhibit cystostomies, and two evidenced mild incontinence. Of the six children who have attained puberty, two report erectile dysfunction. Conclusion: End-to-end urethral anastomosis via a transperineal inferior pubic approach is an ideal treatment for posterior urethral strictures in boys. The complications include incontinence and erectile dysfunction, and require long-term follow-up.

Factors to Consider in Augmentation Urethroplasty with Oral Mucosa Graft or Penile Skin Flap for Anterior Urethral Stricture: A Systematic Review and Meta-analysis.

Context: Oral mucosa graft (OMG) and penile skin flap (PSF) are common substitutions in urethroplasty; however, the recommended substitution for anterior urethral strictures remains uncertain. Objective: To compare the efficacy of OMG and PSF in anterior urethral strictures in terms of success rate and prevalence of postvoid dribbling based on current studies. Evidence acquisition: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and registered at PROSPERO (ID: CRD42022313879). All publications until March 1, 2022, were searched in the PubMed, EMBASE, and Cochrane Library databases without any restriction. Studies that focused on patients with anterior urethral strictures undergoing single-stage augmentation urethroplasty with OMG and PSF, and reported comparable success rates between the two substitutions were included. Evidence synthesis: Thirteen studies involving a total of 1216 patients were included in the screening procedures, and 12 studies were eventually included in the meta-analysis. No significant difference in success rates was identified between OMG and PSF (odds ratio [OR]: 1.41, 95% confidence interval [CI]: 0.96-2.07, p = 0.08). No significant difference was observed in the comparison of success rates in penile urethral strictures (OR: 0.95, 95% CI: 0.53-1.70, p = 0.86) and in the comparison of postvoid dribbling (OR: 0.59, 95% CI: 0.31-1.11, p = 0.10). However, a subgroup analysis suggested that OMG had a higher success rate than PSF in studies with the top 50% sample size (six studies, OR: 1.678, 95% CI: 1.055-2.668, p = 0.029) and the top 50% follow-up period (five studies, OR: 2.279, 95% CI: 1.193-4.352, p = 0.013). Conclusions: OMG provides the same success rate and postvoid dribbling as PSF. However, based on the existing evidence, OMG is more likely to perform better in a cohort with long-term follow-up and a relatively large sample size. More studies on the two substitutions are necessary to evaluate the factors of urethroplasty success rate, performance of substitutions in penile urethral strictures, and indicators of quality of life. Patient summary: In this research, we compared the outcomes of oral mucosa graft (OMG) and penile skin flap for urethroplasty in anterior urethral stricture patients in 13 studies. We found that these were similar in terms of success rate and postvoid dribbling. However, OMG could probably provide a higher success rate when the studies had more patients or a longer follow-up period.

Construction of a three-dimensional urothelium on-chip with barrier function based on urinary flow microenvironment.

The urothelium covers the inner surface of the urinary tract, forming a urinary tract barrier. Impairment of the integrity and dysfunction of the urinary tract barrier is associated with the occurrence and development of various diseases. The development of a three-dimensional model of the urothelium is critical for pathophysiological studies of this site, especially under physiological fluid shear stress stimulated by the urinary flow. In this study, a urothelium on-chip is fabricated with micromilling and replica molding techniques, which contains a microfluidic chip for cell culture and a pump-based fluid perfusion system. The mechanical properties of the human urinary tract are simulated by adjusting the concentration and degree of amino substitution of the gelatin methacrylate hydrogel. The matrix stiffness is similar to the natural urinary tract. Pulsatile flow and periodic flow are provided to simulate the fluid environment of the upper and lower urinary tracts, respectively. The results show that the physiological fluid shear stress could promote the differentiation and maturation of urothelial cells. The model could simulate the three-dimensional structure of urothelium and urinary flow microenvironment, showing morphological structure close to the natural urothelium, specific differentiation and maturation markers (uroplakin 2, cytokeratin 20), and urothelial barrier function.

Application of microfluidic chips in the simulation of the urinary system microenvironment.

The urinary system, comprising the kidneys, ureters, bladder, and urethra, has a unique mechanical and fluid microenvironment, which is essential to the urinary system growth and development. Microfluidic models, based on micromachining and tissue engineering technology, can integrate pathophysiological characteristics, maintain cell-cell and cell-extracellular matrix interactions, and accurately simulate the vital characteristics of human tissue microenvironments. Additionally, these models facilitate improved visualization and integration and meet the requirements of the laminar flow environment of the urinary system. However, several challenges continue to impede the development of a tissue microenvironment with controllable conditions closely resemble physiological conditions. In this review, we describe the biochemical and physical microenvironment of the urinary system and explore the feasibility of microfluidic technology in simulating the urinary microenvironment and pathophysiological characteristics in vitro. Moreover, we summarize the current research progress on adapting microfluidic chips for constructing the urinary microenvironment. Finally, we discuss the current challenges and suggest directions for future development and application of microfluidic technology in constructing the urinary microenvironment in vitro.

Chiroptical Elastomer Film Constructed by Chiral Helical Substituted Polyacetylene and Polydimethylsiloxane: Multiple Stimuli Responsivity and Chiral Amplification.

Chiral and circularly polarized luminescence (CPL) materials with multiple stimuli responses have become a focus of attention. Meanwhile, elastomers have found substantial applications in a wide variety of fields. However, how to design and construct chiral elastomers, in particular CPL-active elastomers, still remains an academic challenge. In the present study, chiral helical substituted polyacetylene is chemically bonded with polydimethylsiloxane (PDMS) by hydrosilylation to form a chiroptically active elastomer. A CPL-active film was further fabricated by adding achiral fluorophores. Compared with the corresponding chiral helical polymer, the chiral films show much enhanced thermal stability in terms of chiroptical properties. The films also demonstrate reversible tunability in optical activity and CPL property when being subjected to a stretching-restoring process and exposed to a solvent like toluene. Further, noticeable chiral amplification is observed when the chiral PDMS film is superimposed with a pure PDMS film. This interesting finding is proposed to be due to the photoreflectivity of PDMS. This study provides an alternative strategy to exploit novel CPL-active elastomer materials with multiple stimuli responsivity and tunability, which may open up new opportunities for developing novel chiroptical devices.

Pelvic Injury Discriminative Model Based on Data Mining Algorithm.

OBJECTIVES: To reduce the dimension of characteristic information extracted from pelvic CT images by using principal component analysis (PCA) and partial least squares (PLS) methods. To establish a support vector machine (SVM) classification and identification model to identify if there is pelvic injury by the reduced dimension data and evaluate the feasibility of its application. METHODS: Eighty percent of 146 normal and injured pelvic CT images were randomly selected as training set for model fitting, and the remaining 20% was used as testing set to verify the accuracy of the test, respectively. Through CT image input, preprocessing, feature extraction, feature information dimension reduction, feature selection, parameter selection, model establishment and model comparison, a discriminative model of pelvic injury was established. RESULTS: The PLS dimension reduction method was better than the PCA method and the SVM model was better than the naive Bayesian classifier (NBC) model. The accuracy of the modeling set, leave-one-out cross validation and testing set of the SVM classification model based on 12 PLS factors was 100%, 100% and 93.33%, respectively. CONCLUSIONS: In the evaluation of pelvic injury, the pelvic injury data mining model based on CT images reaches high accuracy, which lays a foundation for automatic and rapid identification of pelvic injuries.

Anterior substitutional urethroplasty using a biomimetic poly-l-lactide nanofiber membrane: Preclinical and clinical outcomes.

The aim of this study is to investigate the feasibility and efficacy of a novel biomimetic poly-l-lactide (PLLA) nanofiber membrane in repairing anterior urethral strictures from both preclinic and clinic. Biomimetic PLLA membrane was fabricated layer by layer according to the structure of human extracellular matrix. Microstructure, tensile strength, and suture retention strength were fully assessed. Before the clinical application, the safety and toxicology test of the biomimetic PLLA membrane was performed in vitro and in experimental animals. The patients underwent urethroplasty used dorsal onlay or lateral onlay technique. Then, they were followed up for 1 month, 3 months, 6 months, and then annually after the surgery. The mechanical experiments showed well property for application. Biomimetic PLLA membrane was safe according to the in vitro and animal studies. Then, a total of 25 patients (mean age 48.96 years) were included in the study from September 2016 to December 2018. After a mean follow-up of 33.56 months, 20 patients successfully treated with biomimetic PLLA membrane. Five patients (2 bulbar and 3 penile) suffered postoperational urethral stricture recurrence. None of infection or urinary fistula or any other adverse events related to the use of biomimetic PLLA membrane were observed during the follow-up period for all patients. The preliminary result confirmed the feasibility and efficacy of the biomimetic PLLA membrane as a novel material for anterior urethral repair. The long-term effects with more patients should be investigated in further studies.

The treatment practices for anterior urethral strictures in China: A case-based survey.

Objective: To investigate the treatment concept of Chinese urologists for anterior urethral strictures based on actual cases. Methods: A self-designed case-based questionnaire was distributed to the members of Official WeChat account of Learning Union from March 19, 2020, to April 10, 2020. Questionnaires requested respondents' demographic information and responses to five cases of anterior urethral stricture: short obliterative bulbar urethral stricture caused by straddle injury (Case 1), idiopathic bulbar urethral stricture after failure of multiple endoscopic therapy (Case 2), iatrogenic long penile urethral stricture (Case 3), lichen sclerosis-related urethral stricture (Case 4), and anterior urethral stricture in indwelling catheter after multiple failure of endoscopic surgery (Case 5). Data was described by frequency and percentage. Results: A total of 1,267 valid anonymous questionnaires were received. Urethroplasty was recommended more frequently than endoscopic surgery (Case 1: 47.8% vs. 32.8%,Case 2: 42.5% vs. 33.8%, Case 3: 36.1% vs. 26.7%). Referrals patients to other urologists engaged in urethral repair and reconstruction account for a high portion of the treatment (Case 1:18.4%, Case 2:23.1%, Case 3:36.5%, Case 4:27.7%,Case 5:9.3%). Excision and primary anastomosis urethroplasty (EPA) was preferred for treatment of Case 1 (42.5%). For Case 2, the most popular choice was EPA (30.6%). Although the patient has a history of failure in endoscopic surgery, 33.8% of urologists continue to choose endoscopic surgery. For Case 3, 20.0% of urologists would perform oral mucosal urethroplasty. Surprisingly, 5.9% chose EPA. For Case 4, 37.3% of urologists selected meatotomy, 30.4% suggested that glans and urethral biopsies should be performed. 21.0% chose to use steroid ointment after surgery. For Case 5, 26.3% of the respondents believed that urethrography should be performed after removing catheter more than one week, if the urine is obstructed during the period, performing cystostomy firstly. Conclusions: In China, the concept of urethroplasty is more widely accepted than endoscopic surgery for the treatment of anterior urethral strictures. The concept of referral has been widely formed among Chinese urologists. Better understanding of the comprehensive treatment of lichen sclerosis related anterior urethral stricture and the principle of urethral rest should be strengthened.

Novel strategy using a spiral embedded flap for meatal stenosis after post-penile cancer amputation surgery: a single-center experience.

This study aimed to investigate the curative effect of spiral embedded flap urethroplasty for the treatment of meatal stenosis after penile carcinoma surgery. From January 2015 to January 2021, we used our technique to treat strictures of the external urethral orifice in seven patients, including four cases of meatal stenosis after partial penile resection and three cases of meatal stenosis after perineal stoma. All patients had previously undergone repeat urethral dilatation. The patients underwent spiral embedded flap urethroplasty to enlarge the outer urethral opening. The patients' mean age at the time of surgery was 60 (range: 42-71) years, the mean operative time was 43 min, and the median follow-up period was 18 months. The patients voided well post-operatively, and urinary peak flow rates ranged from 18.3 ml s-1 to 30.4 ml s-1. All patients were successful with absence of urethral meatus stricture. The present study showed that using spiral embedded flap urethroplasty to treat meatal stenosis after penile carcinoma surgery is an effective surgical technique with good long-term outcomes.

The ultrasonographic characteristics of female periurethral solid masses.

INTRODUCTION AND HYPOTHESIS: Studies on the imaging of female periurethral masses are sparse, and most are focused on cystic lesions. In this article, we studied female periurethral solid masses and reported their ultrasonographic features. METHODS: Fifteen women with periurethral solid masses pathologically diagnosed between January 2008 and April 2021 were assessed. RESULTS: Each patient had only one mass. The pathological types included urethral caruncle (5 patients), urethral leiomyoma (3 patients), urethral malignant tumor (MT) (3 patients), periurethral spindle tumor (3 patients) and cartilage necrosis of pubic symphysis (PS) (1 patient). On ultrasound, all urethral caruncles were located at the urethral meatus. They were hypoechoic/isoechoic and rich in blood flow signal. Each leiomyoma presented as a well-defined hypoechoic mass with an oval shape. The urethral MT had inhomogeneous/isoechoic echoes, with medium to abundant blood flow signal. The spindle cell tumors had regular/irregular shapes, moderate/high density echogenicity and little/rich blood flow signals. The articular cartilage necrosis of PS was regular in shape, with mixed echogenicity and no blood flow. CONCLUSIONS: Ultrasound imaging is a convenient and useful method to evaluate the morphological characteristics of female periurethral solid masses.

[Application of patient-reported outcome measures in the diagnosis and treatment of male urethral stricture: An update].

Urethral stricture is a common and recurrent male disease, and its treatment has been shifted from endoscopic management to urethroplasty, which has greatly improved the success rate of treatment. However, patients and doctors often have different evaluations of the sexual function and lower urinary tract symptoms after urethroplasty, which has attracted the attention of researchers. In recent years, specific questionnaires or scales have been used to evaluate the effects of preoperative and postoperative treatment, laying more stress on the subjective feelings of the patients. Such questionnaires or scales are called patient-reported outcome measures (PROM). This article reviews the application of PROM in recent studies of urethral stricture, focusing on sexual function and lower urinary tract symptoms, aiming to provide some reference for the development and application of PROM in the diagnosis and treatment of male urethral stricture.

The effects of primary realignment or suprapubic cystostomy on prostatic displacement in patients with pelvic fracture urethral injury: a clinical study based on MR urethrography.

BACKGROUND: To provide direct evidence of whether primary realignment (PR) or suprapubic cystostomy (SPC) had different effects on the prostatic displacement and prognosis in patients with pelvic fracture urethral injury who needed delay anastomotic urethroplasty based on Magnetic Resonance (MR) urethrography. METHODS: We screened the urethral stenosis database of our single institution from January 2016 to June 2020. Patients who underwent delayed anastomotic urethroplasty with a preoperative MR urethrography and no treatment history of urethra were included. We compared the urethral gap length and prostatic displacement between the PR and SPC group based on MR urethrography. The terminal outcomes such as stenosis-free rate, urinary continence and erectile function were also analyzed between two groups. RESULTS: 66 patients were included in this retrospective study in which 36 were in PR group and 30 in SPC group. Mean follow-up time was 15.1 months (3-38 months). One and two patients experienced recurrence of stenosis after urethroplasty in two groups (p = 1.000). No difference of erectile dysfunction and urinary incontinence was found between two groups. Based on MR urethrography, the urethral gap length was 17.4 mm and 23.3 mm (p = 0.008) which presented a significant decrease in PR group. The superior prostatic displacement was similar in two groups (9.8 mm vs. 13.8 mm, p = 0.081). The numbers and distance of displacement on lateral aspect showed no difference, either. However, PR group had less anterior-posterior prostatic displacement (p = 0.005). Besides, the erectile function was significantly related to the lateral prostatic displacement (p = 0.030/0.047). CONCLUSIONS: Based on MR urethrography, patients in PR group showed shorter urethral gap distance and slighter anterior-posterior prostatic displacement without extra erectile dysfunction or incontinence. Besides, patients' erectile function might be significantly related to the lateral prostatic displacement.

Postoperative Infection of Male Posterior Urethral Stenosis with Pelvic Fracture: A Retrospective Study from a Chinese Tertiary Teferral Center.

OBJECTIVES: To investigate the risk factors for postoperative infection, including systemic inflammatory response syndrome, sepsis and surgical site infection, after posterior urethral anastomosis for the treatment of male posterior urethral stenosis with pelvic fractures. METHODS: We retrospectively analyzed data from patients who underwent transperineal end-to-end anastomotic urethroplasty between January 2016 and December 2018. Descriptive statistics were used to analyze patient characteristics and perioperative features. Univariate analysis was performed to identify prognostic factors associated with postoperative infection. Multivariate analysis was used to identify independent risk factors for postoperative infection. RESULTS: Among 261 patients included in the analysis, 16.48% had SIRS, 3.83% had sepsis, and 8.05% had SSI. The primary results suggested that penile septum separation, inferior pubic resection, operating duration, preoperative urine culture result, preoperative waiting time, urethral stenosis length, and draining method were significant predictors of postoperative infections. Multivariate analysis revealed that more complex surgical procedures, operating duration and positive urine culture results were independent risk factors for SIRS and preoperative positive urine culture result was an independent risk factor for sepsis and SSI. CONCLUSIONS: Positive preoperative urine culture was the main risk factor for postoperative infections. More complex surgical procedures, such as penile septum separation and inferior pubic resection, and longer operating duration were more likely to be associated with postoperative SIRS.

The penis transposed to the perineum with penile-prostatic anastomotic urethroplasty for the treatment of a long segment complex urethral strictures.

BACKGROUND: To present our experience of transposing the penis to the perineum, with penile-prostatic anastomotic urethroplasty, for the treatment of complex bulbo-membranous urethral strictures. METHODS: Between January 2002 and December 2018, 20 patients with long segment urethral strictures (mean 8.6 cm, range 7.5 to 11 cm) and scarred perineoscrotal skin underwent a procedure of transposition of the penis to the perineum and the penile urethra was anastomosed to the prostatic urethra. Before admission 20 patients had unsuccessful repairs (mean 4.5, range 2 to 12); five patients were associated urethrorectal fistula; 16 patients reported severe penile erectile dysfunction (PED) or no penile erectile at any time and four reported partial erections. RESULTS: The mean follow-up period was 45.9 (range 12 to 131) months. Nineteen patients could void normally with a mean Qmax of 22.48 (range 15.6 to 31.4) mL/s. One patient developed postoperative urethral stenosis. After 1 to 10 years of the procedure, nine patients underwent the second procedure. Of the nine patients, four underwent straightening the penis and one-stage anterior urethral reconstruction using a penile circular fasciocutaneous skin flap, and five underwent straightening the penis and staged Johanson urethroplasty. Seven patients could void normally, one developed urethrocutaneous fistula and one developed urethral stenosis. CONCLUSIONS: Transposition of the penis to the perineum with pendulous-prostatic anastomotic urethroplasty may be considered as a salvage option for patients with complex long segment posterior urethral strictures.

Multi-Factorial Analysis of Recurrence and Complications of Lingual Mucosa Graft Urethroplasty for Anterior Urethral Stricture: Experience from a Chinese Referral Center.

OBJECTIVE: To evaluate the risk factors that pertain to stricture recurrence and oral complications. METHODS: Patients with long segmented anterior urethral stricture who visited our hospital from 2009 to 2016 were treated with lingual mucosa graft (LMG) urethroplasty. The incidence of complications in all of 128 patients were evaluated. The data were analyzed using the chi-squared test and Fisher's exact test. A multi-factorial regression analysis was performed to identify the risk factors responsible for the recurrence and complications. RESULTS: For patients having LMG urethroplasty, there were no significant difference in recurrence of urethral stricture according to the studied variables. Binary logistic regression analysis reveals that previous surgery involving the urethra was a significant predictor of urethral stricture recurrence (odds ratio [OR]=5.07; 95% confidence interval [95% CI], 1.06-24.40; P = .043). The length of the substitute was significantly related to oral morbidity (P = .020), even after controlling for the studied variables. Patients with a harvested oral mucosa longer than 7 cm had a higher risk of oral morbidity than those with a harvested oral mucosa shorter than 7 cm (OR=4.35; 95% CI, 1.35-14.06; P = .014). CONCLUSION: Our study shows that LMG urethroplasty is effective for patients with long segmented anterior urethral stricture. Previous urethral surgery was identified as a risk factor to cause recurrence and injury to the tip of the tongue for the oral complications.