ABSTRACT
Objective:To explore the outcomes of urethra around corpora cavernosus anastomotic urethroplasty for the treatment of complex posterior urethral strictures.Methods:Between June 2008 and June 2020, 35 patients with complex posterior urethral strictures were treated using urethra rerouted under one corpora cavernosus anastomotic urethroplasty. The patients’ age was 3-54 years(mean 23.2 years), the urethral stricture or loss length was 4-7 cm(mean 5.2 cm), and 6 patients associated with urethrorectal fistula. The technique involved: ①The anterior urethra is dissected long more than 5 cm, separation of the proximal corporeal bodies, inferior pubectomy and the dissected proximal urethra.②A channel around the left crus of the penis through the inferior pubectomy is separated and urethra rerouted under left corpora cavernosus to allow a tension-free anastomosis to the proximal urethra.Results:Two patients lost follow-up; the remainder 33 patients were followed-up for 3 to 144 months(mean 37 months). Thirty-two patients could void normally(97%), The examination of maximal urinary flow rates(Q max) were taken in 21 patients, of whom Q max was 13.6-35.5 ml/s (mean 17.5 ml/s) in 7 children and 16.3-77.6 ml/s(mean 27.9 ml/s) in 14 adult patients. All 6 patients associated with urethrorectal fistula successful repaired, of these patients 1 had died of hemorrhage of brain 6 years postop. One patient developed urethral stenosis postoperatively. Continence was achieved in 29 patients, the remaining 3 patients had incontinence from mild to moderate. Conclusions:Urethra rerouted under left corpora cavernosus anastomotic urethroplasty is not only an effective surgical salvage option, with low recurrent rate for patients with complex posterior urethral strictures, but also do not cause curve and affect growth of corpora cavernosus.
ABSTRACT
OBJECTIVE: To investigate the clinical features and therapeutic efficacy in children with urolithiasis caused by ingestion of melamine-contaminated powdered formula. METHODS: The clinical presentation, laboratory data, ultrasound findings, and treatment methods used for 619 children with melamine-induced urolithiasis were retrospectively recorded and analyzed. The efficacy of the treatment in these children was summarized and evaluated. RESULTS: A total of 619 children aged 1-88 months were included in the present study (mean age 16.32 months). The male/female ratio was 1.9:1. Of the 619 patients, 577 received conservative treatment and 454 became stone free (78.7%). Of the 151 patients with renal and/or ureteral stones, 1-6 sessions of extracorporeal shock wave lithotripsy were performed in 81 patients (61 successful [35.5%] of 172 sessions) and retrograde ureteral catheterization in 70 patients (56 successfully treated [80.0%]). In centers without expertise in minimally invasive medical techniques, 5 patients with bilateral obstructive renal failure were successfully treated with ureteral lithectomy (n = 4) and percutaneous nephrostomy (n = 1). For the remaining 27 children with refractory renal or ureter stones, 9 were successfully treated with percutaneous nephrolithotomy and 18 children underwent ureteroscopic lithotripsy to become stone free. A total of 22 bladder and/or urethral stones were successfully treated with cystoscopic lithotripsy. CONCLUSIONS: Most children with melamine-induced urolithiasis were treated successfully with an infusion of fluids, urine basification, and diuresis. Extracorporeal shock wave lithotripsy is a safe and effective technique for patients in whom conservative treatment fails. However, for patients who have presented with obstructive renal failure, surgical intervention should be considered as early as possible to relieve the obstruction.
