Cystitis Cystica Leading to Stricture of the Internal Urethral Orifice.

Cystitis cystica is a relatively common chronic reactive inflammatory disease caused by chronic irritation of the bladder mucosa. It is broadly considered one of the classifications of proliferative cystitis. The predilection site is the bladder trigone area, which may present with symptoms such as frequent urination, hematuria, and lower abdominal discomfort; however, it rarely causes bladder outlet obstruction. We present the case of a 59-year-old male patient suffering from incomplete urinary retention due to internal urethral orifice obstruction resulting from cystitis cystica. Following transurethral resection, the patient's dysuria rapidly improved, and the tumor did not recur.

Penile Carcinoma Secondary to Balanitis Xerotica Obliterans and Its Compounding Resultant Pathologies: A Case Report.

A 57-year-old African-American male presented with urinary retention secondary to a history of balanitis xerotica obliterans (BXO) concurrent with penile carcinoma. BXO, characterized by chronic, sclerosing inflammation of the male external genitalia, presents significant clinical challenges due to its progressive nature and potential for complications. The patient experienced recurrent episodes of urinary retention, leading to multiple hospital visits and disease progression, prompting a comprehensive evaluation and intervention. The patient's medical history revealed a complex array of comorbidities, including penile carcinoma secondary to BXO, urethral strictures, and meatal stenosis. Clinical assessment, including bedside bladder ultrasound and laboratory investigations, confirmed urinary retention secondary to urethral stricture, necessitating urological consultation. Management strategies involved Foley catheter placement, urethral dilation, and pharmacological interventions for pain management. Subsequent follow-up and imaging evaluations identified an increased risk of carcinoma development, highlighting the importance of surveillance and early intervention in patients with BXO. This case report highlights the intricate clinical manifestations and therapeutic considerations encountered in managing BXO and its associated pathologies.

Lower partial pubicectomy for postoperative complicated posterior urethral stricture.

OBJECTIVE: To report the experience of partial inferior pubicectomy in the treatment of complex posterior urethral stricture after trauma. METHODS: A total of 46 patients with post-traumatic posterior urethral stricture admitted to the Department of Urology of our Hospital from January 2013 to September 2021 were selected as the research objects and underwent urethroplasty (including nine patients who had failed previous perineal repair surgery and adopted partial inferior pubicectomy approach). Retrograde urethrograph (RUG) and urine flow measurement were performed at 1, 3, 12 and 18 months after operation, and follow-up was performed when necessary. The clinical data during treatment were statistically analyzed. RESULTS: All 46 patients underwent urethroplasty successfully, of which nine were treated with partial pubicectomy, accounting for 19.57% of the total. The causes of the disease were motor vehicle accident in 4 cases, falling collision injury in 2 cases, and rolling injury of military exercise tank in 3 cases. Among the 9 patients, 2 were children (22.22%), aged 8 and 12 years, and 7 were adults (77.78%), aged 19-44 (28.42 ± 1.56) years. Among the 9 patients, 6 had erectile dysfunction, accounting for 66.67%. The length of posterior urinary tract stenosis was (5.12 ± 0.57) cm. The operation time was (290.34 ± 12.35) min from anesthesia induction to skin closure. Five patients received 2 U blood transfusion during operation and three patients received 3 U blood transfusion after operation. The average hospital stay was 12-16 (14.24 ± 1.25) days, and the follow-up was 12-24 (18.24 ± 1.35) months. After surgery, one patient developed HIP abscess, which was successfully treated conservatively. One patient had dysuria 1 month after operation and was successfully treated by transurethral dilatation. One case had postoperative infection and recovered after intravenous administration of potent antibiotics. Cystourethrography was performed 3 months after operation, and there was no difference between patients with wide, long or short anastomotic stretch defects. All patients met the criteria for surgical success. CONCLUSION: Partial inferior pubicectomy is a good surgical procedure for the repair of complicated posterior urethral stricture after operation. It is safe and reliable, can better display the prostatic apex and surgical field, shorten the length of reconstructed urethra, and has good postoperative effect. It has no direct or long-term effect on the stability of pelvis or bladder. However, further studies in a larger cohort of patients with complex posterior urethral strictures after repair are needed to demonstrate the specific indications for partial pubicectomy.

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.

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.

Concomitant anterior urethral valve, distal urethral diverticulum and posterior urethral valve with five-year follow up; A case report and literature review.

Concomitant anterior urethral valve and diverticulum (AUVD) and posterior urethral valve (PUV) is an extremely uncommon congenital anomaly that causes infra-vesical obstruction. We present our experience with one case of concomitant AUVD and PUV as well as the related literature review. Early diagnosis and successful management of these anomalies can improve renal function and prevents recurrent urinary tract infections and subsequent renal failure.

Simplified posterior urethroplasty utilizing laparoscopic instrumentation.

BACKGROUND: Posterior urethral stricture disease presents challenges for even the most skilled reconstructive urologists. Regardless of the surgical technique used, these are complex operations that occur in hard-to-access locations. We describe the use of a novel combination of laparoscopic instrumentation to simplify posterior urethral reconstruction. METHODS: We retrospectively identified patients undergoing a posterior urethral stricture repair utilizing a combination of the RD-180® suture device and the Securestrap®. These procedures were performed by a single surgeon at our institution. Patients with greater than or equal to 4 months of follow up were included in the analysis. RESULTS: From October 2016 to October 2020, 20 patients underwent posterior urethral stricture repair using these laparoscopic instruments. Median age was 70 years (28-90 years). Median follow up was 12 months (5-50 months). Mean stricture length was 3 cm (1.5-16 cm). Median operative time was 150 minutes (120-180 minutes). No peripheral neuropathies or positional injuries were noted. With failure defined as inability to pass a 16-Fr scope, success rate was 95% (19/20 patients). CONCLUSIONS: The combination of the RD-180® and the Securestrap® has become essential to our posterior urethral stricture repair armamentarium. Further data and longer follow up is needed to confirm these reliable outcomes.

Frequency of Extravasation on Pericatheter Retrograde Urethrogram in Patients Who Undergo Posterior Urethroplasty.

Introduction Urethroplasty is the gold standard treatment for urethral stricture disease resulting from pelvic fractures, urethral manipulation, and straddle injuries. Post-operative morbidity depends on the presence of urethral catheterization with or without a suprapubic catheter (SPC). Urethral healing at the anastomotic site can be easily assessed using retrograde pericatheter urethrography (RPU). Post-operative removal of the catheter is traditionally performed on the 21st day following urethroplasty. However, some controversy still exists regarding the best feasible time of proper urethral healing and its assessment utilizing simple techniques. The duration of anastomotic healing differs depending on the type of procedure performed, but whether there is any significant difference in duration of healing at the anastomotic site according to the etiology of short-segment stricture urethra is still a dilemma. Materials and methods This was a descriptive case-series conducted for a duration of six months from September 2019 to February 2020 at the urology department of a tertiary care hospital in Karachi, Pakistan. A sample population of 135 patients aged 20-50 years with posterior urethral stricture who underwent posterior urethroplasty with disease duration of >12 months was included in the study. All patients were put on the next operation theater (OT) list for urethroplasty. After surgery, the patients were catheterized and were kept in the ward under observation for 48 hours and discharged on the 2nd post-operative day. All patients were followed weekly and RPU was performed on the 21st day following urethroplasty to assess the presence of extravasation and the collected data was entered into the proforma by the investigators. All statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 23.0. Results The mean age of our participants was 32.8±6.02 years. The mean duration of the procedure was 26.3±7.14 months. Extravasation cases were observed in less than one-fifth (n=22 out of 135, 16.3%) of the posterior urethral stricture patients in our study. Conclusions It is to be concluded that extravasation is fairly common in patients who undergo posterior urethroplasty. The prevalence varies depending on the assessment method, likely reflecting the treatment of somatic symptoms.

Long-term growth in children with posterior urethral valves.

BACKGROUND: Posterior urethral valves (PUVs) are one of the leading causes of pediatric chronic kidney disease (CKD). Growth impairment is prevalent in pediatric CKD, and children with PUVs are at high risk for growth retardation. OBJECTIVE: The objective of this study was to describe growth profiles in PUVs and to identify risk factors for stunting, defined as age-specific height standard deviation score (SDS) below -2. PATIENTS AND METHODS: Medical records of 65 patients with PUVs and a minimum follow-up of two years were retrospectively reviewed. Chronic kidney disease stage 1-3 was considered mild CKD, whereas CKD stage 4-5 was considered advanced CKD. Age-specific height, weight, and body mass index (BMI) SDS were determined. Seven potential risk factors for stunting, namely timing of diagnosis, renal dysplasia, timing of surgery, requirement of urinary diversion, nadir serum creatinine after surgery, recurrent febrile urinary tract infection (UTI), and severity of CKD, were analyzed. RESULTS: Median age at diagnosis, at surgery, and at last follow-up was 0.51, 0.75, and 7.53 years, respectively. All patients underwent valve ablation, and 33.8% required urinary diversion. Median nadir serum creatinine after surgery was 0.40 mg/dL and was higher in patients who underwent urinary diversion (P < 0.001). Growth profiles by CKD stage are displayed in Fig. 1. Median height SDS was -0.40 and was lower in patients with advanced CKD (P = 0.03). Stunting was diagnosed in 15.4%. Advanced CKD was an independent risk factor for stunting, with the odds ratio of 12.7. Urinary diversion and nadir creatinine more than 0.80 mg/dL were weakly associated with stunting but not significant. Timing of diagnosis and surgery, unilateral renal dysplasia, and recurrent febrile UTI were not associated with stunting. Median SDS of weight and BMI was -0.64 and -0.19, respectively. Patients who were thin, of normal weight, overweight, and obese comprised 26.2%, 58.5%, 10.8%, and 4.6%, respectively. There was no significant difference of SDS of weight and BMI across CKD stages (Fig. 1). DISCUSSION: Deterioration in height began early in the course of disease and was worsening in relation to the decline of renal function. The impact of timing of diagnosis or surgery on height was controversial. Patients who underwent urinary diversion had high nadir creatinine and were likely to have severe PUVs. Although patients with severe baseline renal dysfunction may require urinary diversion, nadir serum creatinine and urinary diversion are not associated with stunting. Delaying progression of CKD could maximize linear growth potential in PUVs. A substantial proportion of patients were overweight or obese. Sufficient caloric intakes may be maintained in patients with PUVs.

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.

"Horrendoplasty" - A case of total perineal destruction by agricultural implement.

Although posterior urethral injury occurs almost always in association with pelvic fracture, it may result from severe trauma to the perineum with its associated potential lethality and severe morbidity. Early primary endoscopic realignment over a urethral catheter can be attempted, although an immediate suprapubic tube placement remains the standard of care. Definitive treatment consists of elective open posterior anastomotic urethroplasty through a perineal approach. The authors present a 53-year-old man who sustained total, massive perineal destruction resulting from work accident with an agricultural implement. Immediate suprapubic tube placement was performed followed by delayed elective transperineal anastomotic posterior urethroplasty. A major multidisciplinary approach was necessary in the management strategy, including orthopedic, general, plastic, vascular surgeries, and reconstructive urology teams. At a later stage, with the patient stabilized and recovered from major, life-threatening lesions dealt with by a multidisciplinary team, urethral reconstruction can be undertaken with ultimate good functional outcomes.

Histopathological effects of mesenchymal stem cells in rats with bladder and posterior urethral injuries

Background/aim: To evaluate the effects of mesenchymal stem cell (MSC) therapy in an experimental bladder and posterior urethral injury model. Materials and methods: The study subjects consisted of 40 male Wistar albino rats that were divided into four groups: control group (n = 10) (the bladder was only surgically opened and closed), sham group (n = 10) (surgical procedure), IVMSC group (n= 10) (surgical procedure and intravenous MSC treatment), and LMSC group (n = 10) (surgical procedure and local MSC treatment). Histopathological evaluation was performed for the degree of fibrosis and inflammation and the extent and intensity of staining of vascular endothelial growth factor (VEGF) and endoglin (CD105). Results: There were no significant differences between the control and LMSC groups with respect to fibrosis (P = 0.070) or inflammation (P = 0.048). Fibrosis and inflammation were significantly lower in the IVMSC (P = 0.034 for fibrosis, P = 0.080 for inflammation) and LMSC (P = 0.01 for fibrosis, P = 0.013 for inflammation) groups when compared with the sham group. No significant differences regarding fibrosis and inflammation were observed between the IVMSC and LMSC groups (P = 0.198 for fibrosis, P = 0.248 for inflammation). A significant difference was noted between the sham and LMSC groups concerning VEGF staining intensity (P = 0.017). However, no significant difference was found among the groups with regard to the extent or intensity of CD105 staining (P > 0.05). Conclusion: MSC treatment significantly decreased the development of fibrosis in a uroepithelial injury model.

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.

Management for the anterior combined with posterior urethral stricture: a 9-year single centre experience.

OBJECTIVE: Therapy for anterior combined with posterior urethral stricture is difficult and controversial. This study aims to introduce a standard process for managing anterior combined with posterior urethral stricture. PATIENTS AND METHODS: 19 patients with anterior combined with posterior urethral stricture were treated following our standard process. Average (range) age was 52 (21-72) years old. In this standard process, anterior urethral stricture should be treated first. Endoscopic surgery is applied for anterior urethra stricture as a priority as long as obliteration does not occur, and operation for posterior urethral stricture can be conducted in the same stage. Otherwise, an open reconstructive urethroplasty for anterior urethral is needed; while in this condition, the unobliterated posterior urethra can also be treated with endoscopic surgery in the same stage; however, if posterior urethra obliteration exists, then open reconstructive urethroplasty for posterior urethral stricture should be applied 2-3 months later. RESULTS: The median (range) follow-up time was 25.8 (3-56) months. All 19 patients were normal in urethrography after 1 month of the surgery. 4 patients (21.1%) recurred urethral stricture during follow-up, and the locations of recurred stricture were bulbomembranous urethra (2 cases), bulbar urethra (1 case) and bladder neck (1 case). 3 of them restored to health through urethral dilation, yet 1 underwent a second operation. 2 patients (10.5%) complaint of dripping urination. No one had painful erection, stress urinary incontinence or other complications. CONCLUSIONS: The management for anterior combined with posterior urethral stricture following our standard process is effective and safe.

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.

Current concepts in the management of pelvic fracture urethral distraction defects.

OBJECTIVES: Pelvic fracture urethral distraction defect (PFUDD) may be associated with disabling complications, such as recurrent stricture, urinary incontinence, and erectile dysfunction. In this article we review the current concepts in the evaluation and surgical management of PFUDD, including redo urethroplasty. MATERIALS AND METHODS: A PubMed™ search was performed using the keywords "pelvic fracture urethral distraction defect, anastomotic urethroplasty, pelvic fracture urethral stricture, pelvic fracture urethral injuries, and redo-urethroplasty." The search was limited to papers published from 1980 to March 2010 with special focus on those published in the last 15 years. The relevant articles were reviewed with regard to etiology, role of imaging, and the techniques of urethroplasty. RESULTS: Pelvic fracture due to accidents was the most common etiology of PFUDD that usually involved the membranous urethra. Modern cross-sectional imaging, such as sonourethrography and magnetic resonance imaging help assess stricture pathology better, but their precise role in PFUDD management remains undefined. Surgical treatment with perineal anastomotic urethroplasty yields a success rate of more than 90% in most studies. The most important complication of surgical reconstruction is restenosis, occurring in less than 10% cases, most of which can be corrected by a redo anastomotic urethroplasty. The most common complication associated with this condition is erectile dysfunction. Urinary incontinence is a much rarer complication of this surgery in the present day. CONCLUSIONS: Anastomotic urethroplasty remains the cornerstone in the management of PFUDD, even in previously failed repairs. Newer innovations are needed to address the problem of erectile dysfunction associated with this condition.

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.

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.

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.

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.