Search

To evaluate the efficacy and safety of solifenacin in the treatment of bladder spasms after urethroplasty. Patients underwent urethroplasty were randomly assigned to the study group ( n = 165) and the control group ( n = 150). Patients in the study group were treated with solifenacin for 7 days. Patients in the control group were placebo. Each group was further divided into four subgroups: paracentetic suprapubic cystostomy subgroup, traditional suprapubic cystostomy subgroup, former suprapubic cystostomy subgroup, and urethral catheter subgroup. A visual analogue scale (VAS) was used to measure the severity of bladder spasms. The mean duration of spasms, the frequency of spasms, and the incidences of urine extravasation and radiating pain were recorded each day. There were no significant differences in the VAS scores and mean duration of bladder spasms between the study and control groups . However, there was a significantly lower VAS score in the patients taking solifenacin in the paracentetic suprapubic cystostomy subgroup ( p < .05). A similar tendency was noted in the mean duration of bladder spasms in this subgroup. In a comparison of the daily and nightly frequency of spasms within the four subgroups, a significant improvement was noted in the control group within 5 days. A similar difference was not noted within 6 days in the study group. The short-term therapy with solifenacin is an effective and safe method for decreasing the frequency of bladder spasms after urethroplasty. Patients undergoing paracentetic suprapubic cystostomy might be the only subset to benefit from this treatment.

This study was designed to evaluate the clinical utility of CT voiding urethrography (2D/3D reformatted CT images and virtual cystourethroscopy) in terms of its ability to detect urethral stricture associated with fistula.In the study period, 80 patients were found to have signs or symptoms of urine leakage, as detected by voiding CT scanning. 2D/3D reformatted CT images and the virtual cystourethroscopic view were generated by the software. Conventional urethrography and traditional cystourethroscopy were also used prior to operation. The accuracy of these techniques was compared to the actual findings during the operation.For 58 male patients suffering from urethral strictures associated with fistulas, the detection rate of the fistulas by 2D/3D reformatted CT images was superior to conventional urethrography for characterizing the site of the fistula and the length of the urethral stricture (P 0.05). The detection rate of the fistula by 3D virtual cystourethroscopy was similar to that by traditional cystourethroscopy (P 0.05). The duration of the examination was shorter for 3D virtual cystourethroscopy than for traditional cystourethroscopy (P 0.05). The same results were observed in 22 cases that featured a urethrovaginal fistula.CT voiding urethrography is a useful technique for the diagnosis of urethral disease, especially in male patients suffering from urethral stricture associated with fistula.

Purpose: To investigate the etiology and management of male iatrogenic urethral stricture in China. Methods: The data of 172 patients with iatrogenic urethral stricture who underwent treatment at a high volume reference center in China from January 2008 to February 2014 were analyzed retrospectively. Databases were analyzed to understand the impact of different types of iatrogenic injury on stricture location, length and treatment of urethral strictures, as well as success rates. Results: The most common type of iatrogenic stricture was urethral instrumentations in 80 patients (46.51%). Mean stricture length was 3.3 ± 2.54 cm and the longest strictures were those caused by intravesical instillation. Substitution urethroplasty was the most common intervention and was performed in 60.47% (104/172) of patients. The overall success rate was 85.00% (136/160). Univariable analyses revealed that the type of iatrogenic injury was significantly related to restenosis (p = 0.036), and it is more apt to postoperative restenosis in the type of intravesical instillation than others. Conclusion: Our results showed that urethral instrumentation is the most common etiology of iatrogenic urethral stricture, and most iatrogenic urethral strictures involve the anterior urethra. The different etiologies are closely associated with stricture location, length and the overall prognosis of urethral strictures.

Most patients with failed hypospadias have complicated clinical manifestations, including urethral strictures, chordee, multiple fistulas, and diverticula. The treatment for failed hypospadias repair is one of the most challenging procedures for the reconstructive urologist, as its success requires both a functional urethra and a cosmetically acceptable glans appearance. In this reporter, we introduced a tactics of procedure selection of the treatments for failed hypospadias repair include a variety of surgical techniques using different types of tissues for substitution, such as local skin flaps, free mucosal grafts. In cases with penile skin scar, scarred urethral plate or fistulas that lacked an available original urethra or had a shortage of the local foreskin, lingual mucosa graft (LMG) substitution urethroplasty was the only choice for surgical procedures. In our experience, the modifier TIP technique (tubularized incised plate technique and an LMG inlay urethroplasty) was also a suitable and effective technique for patients with no penile skin scar or scarred urethral plate, providing a satisfactory success rate. One-stage onlay or inlay urethroplasty with LMG may be an effective option to treat the patients with less available skin after failed hypospadias repairs; LMG harvesting is easy and safe, irrespective of the patient’s age. A vascularized fascia needs to be transplanted to cover the neourethra or to be inserted between the neourethra and sutured skin if possible. If there is no suitable fascia in the penile shaft, the fascia can be harvested alternatively from the scrotum.

Introduction Various urethroplasty techniques have been used to treat urethral stricture. Whether the patient erectile function is affected by this open surgery is still controversial. Aim The aim of this study is to determine the relationship between erectile function and open urethroplasty. Methods A systematic review of the literature was performed using Medline, Embase, the Web of Science, and the Cochrane Library databases through October 2012 to identify articles published in any language that examined the effect of open urethroplasty on the risk of erectile dysfunction (ED). This meta-analysis was conducted according to the guidelines for the meta-analysis of observational studies in epidemiology. Main Outcome Measures The incidence of ED after urethroplasty. Results This meta-analysis consisted of 23 cohort studies, which included 1,729 cases. No significant difference was noticed in patients with anterior urethral stricture before or after intervention (odds ratio [OR] = 0.86; 95% confidence interval [CI]: 0.52–1.40; P = 0.53). While statistical difference in the incidence of ED was revealed in patients before and after intervention for a posterior urethral (OR = 2.51; 95% CI: 1.82–3.45; P P = 0.04). For the posterior urethroplasty, previous operative history did not show a strong relationship with ED. No statistically significant difference in the risk of ED was demonstrated comparing the posterior urethral reconstructive techniques included in this analysis. Conclusion The adverse effect of urethroplasty itself on erectile function is limited, as more patients recover erectile function after urethral reconstruction. For anterior urethroplasty, bulbar anastomosis might cause a slightly higher incidence of ED than other operations. For posterior urethroplasty, trauma might be the main cause of ED. Feng C, Xu Y-M, Barbagli G, Lazzeri M, Tang C-y, Fu Q, and Sa Y-L. The relationship between erectile dysfunction and open urethroplasty: A systematic review and meta-analysis. J Sex Med 2013;10:2060-2068.

Aims To better understand the effects of the selective 5-HT7 receptor agonist 4-[2-(Methylthio)phenyl]-N-(1,2,3,4-tetrahydro-1-naphthalenyl)-1-piperazinehexanamide hydrochloride (LP44) on micturition in spinal cord injury (SCI) rats. Methods Female Sprague-Dawley rats weighing 200–275 g were used. SCI was produced in 8 of the 16 rats by transection at the T10 level; cystometric study occurred 8–12 weeks post-transection. Intravesical pressure was monitored in urethane-anesthetized animals via a transvesical catheter. The selective 5-HT7 antagonist (R)-3-[2-[2-(4-Methylpiperidin-1-yl)ethyl]pyrrolidine-1-sulfonyl] phenol hydrochloride (SB-269970) was administered after each LP44 dose–response curve (all drugs were administered intravenously, i.v). Results Compared to controls, SCI rats had a higher bladder capacity and residual volume, and a lower voiding efficiency. In SCI rats, LP44 (0.003–0.3 mg/kg, i.v) induced significant dose-dependent increases in micturition volume, significant dose-dependent decreases in residual volume, resulting in significant increases in voiding efficiency. CMG measurements showed a dose-dependent increase of the high-frequency oscillation (HFO) activity, including the number of small oscillation per voiding. This was correlated with the improved voiding efficiency. SB-269970 (0.1 mg/kg, i.v) partially or completely reversed all LP44-induced changes. Conclusions HFOs seems to be correlated with external urethral sphincter (EUS) bursting activity during voiding. Both the bladder voiding efficiency and the periodic EUS activity were decreased in SCI rats. 5-HT7 receptor agonist can enhance HFO activity, thereby improving voiding efficiency. Whether or not these results may have implications for the future treatment of voiding dysfunction in SCI patients remains to be studied. Neurourol. Urodynam. 33:1165–1170, 2014. © 2013 Wiley Periodicals, Inc.

To evaluate the value of three-dimensional spiral computed tomography/cysto-urethrography (CTCUG) in diagnosing posterior urethral strictures associated with urethrorectal fistulas (URF). Between June 2008 and March 2012, 38 patients with posterior urethral strictures associated with URFs were examined by CTCUG, retrograde urethrography (RUG) and cysto-urethrography (CUG). Urethral reconstruction was undertaken and URFs were surgically repaired in all patients. The length of the urethral defect, location and size of URFs were recorded. Data from radiological examinations were compared with surgical findings. No statistically significant difference was found in the length of stricture measured using CTCUG (4.31 ± 2.28 cm) or conventional urethrography (4.02 ± 3.12 cm; p > 0.05), However, the accuracy in determining the location of the stricture was higher with CTCUG (93.12%) than with conventional urethrography (70.59%; p < 0.05). CTCUG identified URFs in all 38 patients (100%), whereas URFs were only observed in 27 patients (71%) using conventional urethrography. In conclusion, CTCUG was more accurate, safer and provided more details of URFs and urethral defects than conventional urethrography in patients with posterior urethral strictures associated with URFs.

Bladder exstrophy is a rare lower urinary tract malformation that occurs less frequently in women than in men. We report 2 cases of bladder exstrophy occurring in women. One patient was an adult with congenital bladder exstrophy; the patient's bladder wall flap was used to reconstruct the neourethra after the bladder was closed using a conventional procedure. The other patient experienced lower abdominal trauma that led to widespread loss of skin and subcutaneous tissue, exposing the bladder in the lower abdominal wall. In this patient, a pedicled gracilis muscle flap was used to close the abdominal wall after the closure of the bladder. To our knowledge, the first is the fifth reported case of bladder exstrophy in an adult woman and the latter is the first reported case of bladder exstrophy caused by trauma. Both patients showed good outcomes after undergoing surgical treatment.

Objective: To describe the value of flexible cystoscopy versus conventional urethrography (retrograde urethrography and cystourethrography) in diagnosing pelvic fracture urethral distraction defects (PFUDDs). Patients and Methods: Between May 2010 and June 2011, 120 male patients with PFUDDs were evaluated. In this study, all patients underwent conventional urethrography after admission. Flexible cystoscopy was also used for comparison, followed by conventional urethrography. The flexible cystoscope was introduced into the posterior urethra and the area was evaluated for the length of the proximal urethra and any possible fistulas, false passages, calculi or displacement of the posterior urethra. Results: Severe allergic reaction or obvious discomfort did not occur in any patients after conventional urethrography or flexible cystoscopy. By comparing the data obtained from flexible cystoscopy to those from conventional urethrography, no statistical difference was found in the measured length of the proximal posterior urethra (4.31 ± 2.28 vs. 4.02 ± 3.12, p > 0.05). However, the rate of detection in other abnormalities was higher in flexible cystoscopy than in conventional urethrography (48.3 vs. 10.8%, p < 0.05). Seventeen (14.2%), 9 (7.5%) and 32 (26.7%) patients were detected with fistula, false passage and calculus, respectively, according to flexible cystoscopy. In comparison, fistula, false passage and calculus were only observed in 2 (1.7%), 7 (5.8%) and 4 (3.3%) patients, respectively, through conventional urethrography imaging. Conclusions: Flexible cystoscopy is a valuable procedure in the evaluation of the posterior urethra and bladder neck, and in patients with urethral distraction defects before surgery. More details about fistulas, false passages, calculi and urethral defects could be obtained through this method.

Objective: To develop a modified rat varicocele model. Methods: 300 male Sprague-Dawley rats were selected. In 82 rats (classic group, CG), this was achieved by dissecting the left renal vein and ligating it using a 0.8-mm metal clip and 3–0 silk suture proximal to the inferior vena cava, followed by removal of the bar. In 118 rats (modified group, MG), in addition to the partial ligation of the left renal vein, the communicating branch was fully ligated. In 100 rats (sham operation group, SG), the left renal vein and communicating branches were dissected, but not ligated. The seminal fluid was aspirated and the diameters of the left spermatic veins were analyzed. Three months later, the examination was performed again. Results: The diameters were 0.16 ± 0.1 mm and 1.88 ± 0.1 mm before and after operation, respectively, in the CG (p < 0.01), and 0.15 ± 0.05 mm and 2.0 ± 0.1 mm in the MG (p < 0.01). Postsurgical diameters in the CG and MG were 1.88 ± 0.1 mm and 2.0 ± 0.1 mm (p > 0.5), and 0.16 ± 0.1 mm and 0.16 ± 0.11 mm in the SG (p > 0.5). Semen parameters in the CG had significant differences before and after the operation (p < 0.01), were significantly lower in the MG (p < 0.01), and had no significant differences in the SG (p > 0.5). Conclusion: Simple partial ligation of the renal vein combined with ligation of the communicating branch leads to acceptable models for varicocele.

We critically reviewed recent reports of lingual mucosal grafts (LMGs) for substitution urethroplasty, to determine the efficacy and complications of this approach. Only a few centres have published the short or interim outcome of LMG urethroplasty. These studies dealt mainly with surgical techniques and harvesting LMGs, emphasizing the comparison of different intra-oral donor sites. The preliminary results seem to be encouraging for the safety and efficacy of LMG urethroplasty. When compared with other substitute materials, LMG give equally good results with much easier harvesting and minimal donor site morbidity. Thus, lingual mucosa is most likely to become an alternative to oral mucosa for substitution urethroplasty and longer term results of its use are awaited with interest.

We investigated the long-term outcome of urethral reconstruction using colonic mucosa grafts for long segment, complex urethral strictures. Another aim was to identify clinical factors impacting long-term outcomes.We retrospectively reviewed the records of 36 consecutive patients with a mean age of 39.8 years (range 17 to 70) who underwent colonic mucosal graft urethroplasty for long segment, complex urethral stricture from October 2000 to November 2006. Patients were evaluated postoperatively at scheduled office visits at our institution and/or by telephone interview. Successful repair was defined as normal voiding without any postoperative procedure such as dilation.Urethral reconstruction with done with colonic mucosa grafts 10 to 20 cm long (mean 15.1). One patient was lost to followup. Mean followup in the remaining cases was 53.6 months (range 26 to 94). Outcomes were successful in 30 of 35 patients (85.7%). Complications, specifically meatal stenosis, bulbar or bulbomembranous urethral stenosis and proximal anastomotic site stricture, developed in 5 patients (13.3%).Colonic mucosa graft urethroplasty is a feasible procedure for complex urethral strictures. The most common complications are meatal stenosis and stenosis at the anastomosis.

Background Female urethral injury is rare, and there is no accepted standard approach for the repair of urethral strictures. Objective To evaluate the efficacy of transpubic access using pedicle tubularized labial urethroplasty for urethral reconstruction in female patients with urethral obliterative strictures and urethrovaginal fistulas. Design, setting, and participants Between January 1996 and December 2006, eight cases of female urethral strictures associated with urethrovaginal fistulas were treated using pedicle labial skin flaps. Interventions A flap of approximately 3×3.5×3cm of the labia minora or majora with its vascular pedicle was tubularized over an 18–22 Fr fenestrated silicone stent to create a neourethra. This technique was used in five women. Two flaps, approximately 1.5–3.5cm, were taken from bilateral labia minora or majora and were pieced together to create a neourethra. This technique was used in three patients. Measurements We performed voiding cystourethrography and uroflowmetry to assess postoperative results. Results and limitations The patients were followed up for 10–118 mo (mean 48.25 mo) after the procedure. There were no postoperative complications. Two patients complained of dysuria, which resolved spontaneously after 2 wk. One patient experienced stress incontinence that resolved after 4 wk. At 3-mo follow-up, one patient complained of difficulty voiding; the urinary peak flow was 13ml/s, and the patient was treated successfully with urethral dilation. All other patients had normal micturition following catheter removal. Conclusions Pedicle labial urethroplasty is a reliable technique for the repair of extensive urethral damage, and a transpubic surgical approach provides wide and excellent exposure for the management of complex obliterative urethral strictures and urethrovaginal fistulas secondary to pelvic fracture.

Objectives: To study the results and complications of the potassium-titanyl-phosphate (KTP, green) laser during transurethral incision of the bladder neck in the treatment of female voiding dysfunction due to bladder neck obstruction. Methods: A total of 40 women (43–79 years of age) with obstruction were identified. Patients with neurogenic, traumatic, or iatrogenic causes of obstruction were excluded. Preoperative investigations included a full urodynamic examination and urethrocystoscopy. Transurethral bladder neck incision with KTP was performed in all patients. Urodynamic results, clinical improvements in voiding symptoms, and volume of bleeding were assessed. Results: Of the 40 patients, 12 had chronic urinary retention and 28 had difficult micturition. The most common findings on urodynamic study were a high voiding pressure plus low flow rate and high urethral pressure. After treatment, the lower urinary tract symptoms were resolved or improved in all patients. Urodynamic study revealed decreased voiding pressure, post-void residual urine volume, and increased maximal flow rate. Conclusions: Transurethral incision of the bladder neck is effective in relieving voiding difficulties owing to anatomic or functional bladder neck obstruction in women. KTP has great efficacy in the treatment of female voiding dysfunction due to bladder neck obstruction.

Erectile dysfunction (ED) is a well-known consequence of pelvic fracture, particularly in cases involving urethral injury. There are several risk factors that may be related to ED. However, no systemic approach is used to assess erectile function secondary to urethral trauma.To investigate ED associated with urethral injury secondary to pelvic fracture and perineal trauma.Forty patients with traumatic urethral strictures secondary to blunt traumatic impact episode to the pelvis or perineum were included in our study. Pelvic fractures and urethral strictures were categorized according to injury types and radiological findings. All patients underwent nocturnal penile tumescence (NPT) monitoring, dynamic color-duplex Doppler ultrasonography (D-CDDU) before surgery. NPT monitoring was conducted again after surgery.The events of NPT and D-CDDU were recorded.In all patients, 11 had organic ED demonstrated by NPT. Vascular pathology was identified in three of 11 patients (27%). The peak systolic velocity of cavernosal artery was lower in patients with pubic diastasis in comparison to those without diastasis (P0.05). Significant changes in penile length and circumference were noted in posterior urethral injury compared with anterior urethral injury during erection (P0.05). The erectile duration time has a similar statistical difference in two groups mentioned above. However, no significant difference could be observed in the end-to-end anatomosis procedure before and after surgery (P0.05).The pelvic fracture type, especially pubic diastasis, is a risk factor for ED following urethral injury. Location of the stricture is also a risk factor for subsequent erectile dysfunction.

The objective of this study is to compare the influence on erectile function between urethral cystoscopic realignment and early end-to-end anastomosis treating ruptured bulbous urethra. 58 cases were selected, 32 had urethral cystoscopic realignment (group I) and 26 cases had urethral end-to-end anastomosis (group II). The parameters of P-CDU (Penile Color Duplex Ultrasound), NPT (Nocturnal Penile Tumescence), and IIEF-5 (International Index of Erectile Function) were compared between the two groups 6 months after operation. Group I was higher than group II in IIEF (21 vs 14) with significant differences. With P-CDU we observed an improvement in penile vascularization in group I as confirmed by the detection of an increase in peak systolic velocity (PSV) (26 cm/s vs 16 cm/s, p0.01) and a decrease in end diastolic velocity (EDV) (3 cm/s vs 6 cm/s p0.05), resulting in an increase in resistive index (RI) (0.85 vs 0.56, p0.05). The parameters of NPT showed a significant increase compared to group II (p0.01) in satisfactory erection number (5 vs 1.5), maximum rigidity (80% vs 42%), and total time that the increase in circumference was greater than 30% of baseline during sleep (100 sec vs 30 sec). Urethral cystoscopic realignment treating ruptured bulbous urethra can reduce the incidence of erectile dysfunction [ED]. A long term follow-up should be studied.

This study examines the hypothesis that varicocele would impair the testicular expression of cAMP response element modulator (CREM) in experimental rats. Thirty (30) rats were selected at random, of 20 were operated as varicocele's group; of 10 were for sham-operation as controlled group, testes were removed, fixed and stained in three months. Makler Score was adopted to analyze the bore, limitan's thickness, layer number of cell, the degree of cell's maturity and average score in 200 and 100 seminiferous tubulae, respectively. CREM, HSP60 was determinated by hybridization in situ, the difference between two groups were compared. In varicocele group, seminiferous tubule's bore was decreased (101 +/- 2.2) vs 146 +/- 4.1), limitan became thicker (3.5 +/- 0.1 vs 1.9 +/- 0.2), cell's layer number was reduced (3.0 +/- 0.2 vs 5.5 +/- 0.1), cell's maturity turned to disturbance (3.6 +/- 0.3 vs 4.9 +/- 0.1), the average score was lower than controlled group (8.5 +/- 0.6 vs 16.0 +/- 1.2), they had significant differences (P < 0.001). The testicular CREM expression was significantly lower in varicocele group than in controlled one (VG2.0 +/- 0.32, SoG3.90 +/- 0.32) (p < 0.001), which was located in spermatogenous cell to spermatocyte stage. However, HSP60 expression in VG was higher than in SoG (3.85 +/- 0.3 versus 2.1 +/- 0.32) with significant differences (P < 0.001), the expression located in spermatid. Varicocele could lead to lower testicular CREM expression and breeding sperm functional lesion.

To study the ultrastructural changes of acrosomes in fertile and infertile males and to identify the morphological alterations closely related to male infertility, forty spermatozoa from 8 fertile males and 60 spermatozoa from 12 infertile males were collected and observed by scanning electron microscope. There were significant changes in the morphology of the circular sulcus, acrosome membrane and head of the infertile sperm. The circular sulcus of spermatozoa was more serrated (39/60 vs 2/40) and blurred (40/60 vs 4/40) in the infertile group than in the fertile group. The acrosome of infertile group occupied a bigger proportion of sperm head (70+/-8% vs 57+/-6%) than in the fertile group. The acrosome membrane in the infertile group was less intact (18/60 vs 31/40) and less smooth (19/60 vs 32/40) than in the fertile group. More droplets were attached to the acrosome membrane in the infertile (39/60 vs 11/40) than in the fertile groups. The abnormality in acrosome ultrastructure seems to be significantly higher in infertile than in fertile males, suggesting a potential role of such defects for male fertility defect.

To construct a reliable continent tube, which is easy to catheterize, we created and evaluated a new continent cutaneous diversion using a tapered ileum combined with extramural support from the pouch-abdominal wall.Six dogs underwent a procedure in which two ileal segments were tapered and anastomosed to the ileal pouch. One of the segments (continent) was placed between the back surface of the rectus muscle and the wall of the ileal pouch creating a continent tube. The other segment (control) was brought out into the abdominal skin directly without any support from the pouch-abdominal wall. Urodynamic and radiological studies were carried out postoperatively in all dogs.In the continent tubes, the maximum closure pressure with a full pouch was significantly higher than those with an empty pouch (p0.01). The maximum closure pressures of the continent tubes were significantly higher than those of the control tubes when the pouch was empty (p0.01). The leak point pressures of the continent tubes were significantly higher than those of the control tubes (p0.001). In all dogs, the retrograde radiogram of the continent tubes showed perfect canalization without stenosis.This study suggests that the continent mechanism of tapered ileum can be greatly enhanced by fixing it between the abdominal and pouch walls, also allowing easy catheterization in contrast to the submucosal tunnel technique.

If the urethral mucosa is replaced by another mucosa, urethral recurrence might decrease in patients who undergo neobladder construction for bladder cancer. We determined whether such replacement is possible.Six dogs underwent an operation consisting of a longitudinal urethral incision at its full length and immediate closure. In 6 other dogs, after the urethral mucosa was totally removed, a tubularized sublingual mucosa was closely set inside the urethral lumen. Postoperatively, the urinary stream and external meatus were observed every day. To measure urine leakage, a 10-minute pad test was performed once a month. All dogs were sacrificed 3 to 12 weeks after the operation for histological examination of the urethra. The excised urethras were examined with a 12F catheter for urethral patency.All dogs were continent postoperatively. The results of the 10-minute pad test showed no significant difference in the weight increase of the pad among the control, sham-operated and mucosa-replaced dogs. Urethral stricture developed in 1 mucosa-replaced dog. Histological examination revealed that all of the grafted oral mucosa survived in the urethra.These results indicate that the urethral mucosa can be replaced by oral mucosa without damaging the continence mechanism in female dogs.

The aim of this study was to present our experi-ence of patients with penile strangulation. The clinical data of 6 patients (mean age, 36 years; range, 18-72 years) with penile strangulation caused by a metal hoop are provided, where the duration of strangulation was between 3 h and 1 month. Among these patients, the case of a 22-year-old patient with a steel hoop entrapment on his penis for 5 is described; due to days serious injury of the skin at the root of penis, an intermediate split-thickness thigh skin graft was used to repair the skin loss. A review of the literature is also provided in this study, and current treatment options and outcomes are evaluated . In a ll the cases described, the metal hoops were successfully removed, without gangrene of the penis. These patients were discharged 2-27 days later with a satisfactory outcome. Penile strangula-tion is an unusual clinical condition and the consequences may be severe. The choice of method for removal depends on the type and size of metal hoop, incarceration time, trauma grade and availability of equipment. Early treatment is essential to avoid potential complications, including ischemic necrosis and autoamputation.

The study in China is the first on photoselective vaporization of the prostate (PVP) applied to bladder outlet obstruction (BOO) or urinary retention from advanced-stage prostate cancer (PCa). The aim is to evaluate the efficacy and safety of PVP in the treatment of patients with BOO secondary to advanced-stage PCa.Forty-five patients (mean age 76.13±5.88 years, range 62-89 years) with BOO or urinary retention secondary to advanced-stage PCa received PVP with a potassium-titanyl-phosphate laser. The treatment outcome was evaluated with subjective and objective tests at 1, 3, 6, and 12 months after PVP using the International Prostate Symptom Score (IPSS), quality of life (QoL) score, postvoid residual (PVR) urine volume, and maximum urinary flow rate (Qmax). The operative time, indwelling catheterization time, and operative complications were also observed.All 45 patients recovered without incident. The mean operative time was 50±7.6 minutes. The catheterization duration was 3.2 days (range 2-7 days). There was significant improvement in Qmax from 7.29±0.93 to 12.16±2.75 mL/sec after treatment at 12 months. Mean PVR volume decreased from 210.94±179.49 to 54.45±33.16 mL. Mean IPSS score decreased from preoperative 28.19±3.64 to postoperative 14.61±2.81 (P0.05), QoL score decreased from 5.03±0.69 to 3.66±0.65 (P0.05). There were no intraoperative adverse events. Postoperative complications included mild transient hematuria in 12 (26.7%) patients and mild dysuria in 11 (24.4%) patients within 4 weeks.The clinical results suggest that PVP is a safe, efficient, and less-invasive treatment for patients with BOO or urinary retention secondary to advanced-stage PCa.

Acquired and congenital abnormalities of the lower urinary tract often require eventual reconstruction. Traditionally, different types of autologous tissue can be chosen for surgery, depending on which organ requires reconstruction. Bladder reconstruction, for example, is usually performed with intestinal tissue while urethral reconstruction can us buccal mucosa, lingual mucosa, colonic mucosa or prepuce skin. However, the problems of a shortage of patients’ own tissues, and of nmany complications related to surgery, have not yet been resolved. There is therefore an effort to obtain sufficient tissue resources, to involve fewer complications, to reduce surgery to relatively minor invasion and to achieve better surgical outcomes. These goals may be attainable by the use of tissue engineering techniques.

Extensive or panurethral strictures that involve both the pendulous and bulbar urethra were difficult to treat surgically. Successful repair of panurethral strictures was challenging, particularly in patients with recurrent panurethral strictures after previous surgical attempts. Such therapeutic efforts were well-known risk factors for the failure of urethroplasty, because of spongiofibrosis and poor vascular supply. Such strictures were traditionally managed with 2-stage repairs using scrotal skin (1, 2). However, as the field of urethral reconstruction developed, there was a move towards 1-stage repair using free grafts made of skin, pedicle-based flaps or combined approaches (3-9). Numerous substitution urethroplasty techniques have been described and there were, however, no universally accepted graft material for either primary urethral substitution or technique of reconstruction after multiple failed attempts. (3-9). The penile skin flap provided a versatile mechanism for achieving excellent results in the single-stage repair of complex anterior urethral strictures. The distal penile circular fasciocutaneous flap (FCF) technique of urethroplasty was first reported in 1993 by McAninch (10). The flap meets all criteria for tissue transfer and urethral reconstruction. It reliably provides ample hairless tissue, usually 13 to 15 cm long (depending on penile size), flexibility, versatility, and without compromising cosmesis or function (11). In addition, the circular fasciocutaneous penile flap is easily combined with other tissue-transfer techniques when necessary, enabling one-stage reconstruction in the majority of cases. For those patients in whom genital skin was insufficient or panurethral strictures involving more than the distal bulbar urethra, alternative tissue or combined grafts urethroplasty was needed for urethral reconstruction. Wessells et al (3) reported a series of seven patients with pan-urethral strictures (mean length, 19 cm.) treated using a fasciocutaneous flap combined with buccal mucosa, bladder epithelium or skin grafts. Elliott et al (4) described nine patients who underwent distal penile fasciocutaneous flap repair of a concomitant penile urethral stricture and buccal graft reconstruction for a bulbar stricture; the repair was successful in eight of the nine patients. Berglund et al (5) reported a series of 18 patients with a mean stricture length of 15.1 cm using combined buccal mucosal graft and genital skin flap for reconstruction of extensive anterior urethral strictures. For those patients in whom no adequate donor skin was available for grafting because of multiple penile surgeries or diseased skin existing, mucosal grafts urethroplasty may be appropriate (7,8). Several experimental studies and clinical experiences have contributed to

Majority of posterior urethral stricture results from pelvic fracture, straddle injuries, or crush injuries. The management of traumatic posterior urethral strictures remains one of the most difficult tasks in urologic practice. In developed countries, agricultural activities have reduced over time and the number of accidents with pelvic fracture due to tractors tipping over has markedly decreased. Work site accidents have also markedly decreased due to the effective prevention of these kinds of accidents, and pedestrian, bicycle, and motorcycle accidents have diminished due to the increased using of cars. But patient conditions are so different from those present in developing countries, such as Egypt, India, Nepal, and China. In those countries, agricultural activities are still quite prevalent, the prevention of accidents on the work site has not dramatically lessened, and bicycles and motorcycles are the most popularly vehicles (1). Moreover, the emergency treatment of patients with PFUDDs in developing and developed countries is quite different. In Italy, emergency treatment for PFUDD was often provided by a urologist in 92.7% of cases, while in india emergency it is done by a general surgeon in 70.1% of cases. Since the majority of those patients have been treated using incorrect maneuvers in some developing country, iatrogenic damage to the urethra may be added (2). In our country, as China is large population, vast territory and uneven development of medical standards, many iatrogenic injurys were caused by inappropriate treatment, complex posterior strictures are not uncommon. Our center received nearly 200 complex posterior urethral strictures every year from all over the country. Hence, this chapter focuses on the management of traumatic posterior urethral injuries typically sustained in association with pelvic fracture. Complex posterior urethral strictures continue to represent a genuine challenge and they pose one of the most difficult management problems in urology, which represents 5% of all urethral strictures. It is characterized by a stricture gap exceeding 3cm, previous failed repair, associated perineal fistulas, rectourethral fistulas, periurethral cavities, false passages or an open bladder neck. Destruction or rupture of the posterior urethra is caused mainly by forces that occur during traumatic pelvic fracture. This trauma results in partial or complete rupture of the urethra. A complete rupture often results in destruction of the posterior urethra and may damage the sphincteric structures, while always damaging the neurovascular bundles, which results in impotence and incontinence. Due to prior repeated surgery, patients with complex strictures are often found significant scar tissue formation of the urethra. The problems arise from a lack of the healthy elastic tissue needed to reconstruct the urethra.

A patient with carcinosarcoma of the urethra occurring 15 years after a radical cystoprostatectomy for transitional cell carcinoma is presented. The tumor arose from the penile urethra and invaded the glans penis and penile corpus cavernosum. The tumor was composed of mixed carcinoma (squamous cell carcinoma, adenocarcinoma and transitional cell carcinoma) and rhabdomyo-sarcoma. Biopsy of the right inguinal lymph node showed simultaneous metastasis of sarcomatous and transitional cell carcinoma elements.

Inflammatory pseudotumor of the urinary bladder is a rare reactive proliferation with a clinical presentation similar to malignant neoplasms. We present the case of a 35-year-old woman who presented with left lower quadrant pain and gross hematuria. A diagnosis of cystitis glandularis was initially considered; however, the symptoms did not resolve following transurethral resection. Subsequently, a partial cystectomy was performed after malignancy was excluded based on intraoperative frozen sections. Further histopathological evaluation confirmed the diagnosis of inflammatory pseudotumor.

Background Urethrorectal fistulas (URF) in patients with complex posterior urethral strictures are rare and difficult to repair surgically. There is no widely accepted standard approach described in the published literature. Objective The aim of this study was to describe the outcomes of various operative approaches for the repair of URFs in patients with complex posterior urethral strictures. Design, setting, and participants From January 1985 to December 2007, 31 patients (age: 6–61 yr; mean: 28.4) with URFs secondary to posterior urethral strictures were treated using a perineal or combined abdominal transpubic–perineal approach. Interventions A simple perineal approach was used in 4 patients; a transperineal inferior pubectomy approach was used in 18 patients; and a combined transpubic–perineal approach was used in 9 patients. A bulbospongiosus muscle and subcutaneous dartos pedicle flaps were interposed between the repaired rectum and urethra in 22 patients. The combined transpubic–perineal approach used either a gracilis muscle flap (one patient) or a rectus muscle flap (eight patients). Measurements Suprapubic catheterisation was used for bladder drainage, and a urethral silicone stent was left indwelling for 4 wk. Results and limitations One-stage repair was successful in 4 patients (100%) using the perineal approach, in 16 of 18 patients (88.9%) using the transperineal–inferior pubectomy approach, and in 7 of 9 patients (77.8%) using the transpubic–perineal approach. Recurrent urethral strictures developed in two cases; one patient required regular dilation, and the other patient was treated successfully with tubed perineoscrotal flap urethroplasty. Recurrent URFs developed in two additional patients. Conclusions Surgical approaches for the treatment of URFs associated with complex urethral strictures should be based on a number of considerations including the location of the URF, its aetiology, the length of the urethral strictures, and a history of previous unsuccessful repairs. These results demonstrate that the transperineal–inferior pubic approach may be appropriate as a first-line procedure.

Aim: To investigate the transformation of characteristics of epidermal cells from foreskin which were used to reconstruct male rabbit anterior urethra in combination with acellular collagen matrices. Methods: In three rabbits, autologous foreskin epidermal cells were isolated, expanded in vitro, and seeded (inoculated) onto a tubular acellular collagen matrix, acquired from allogeneic rabbit bladder submucosa. A urethral mucosal defect was created, and urethral reconstruction was performed with the tubular acellular collagen matrix seeded with epidermal cells. Results: On gross examination at 12 months following the procedure, the mucosa of the urethral grafts appeared lubricous and smooth. Urethrography showed that a wide urethral caliber had been maintained without any sign of strictures. Histological examination showed a transitional cell layer in the graft without evidence of a margin between the graft and the host tissue at 12 months postoperatively. Conclusion: Epidermal cells seeded onto acellular collagen matrices can be successfully used to reconstruct urethras that have defects and are transformed to transitional epithelial cells.

The objective of this study was to investigate the feasibility of tissue engineering of corpus cavernosal smooth muscle. Acellular corporal collagen matrices (ACCMs) were obtained from the penis of adult rabbits by a cell removal procedure. ACCMs were implanted into the back muscles of allogenic rabbits to investigate the resulting immunological reaction. Human umbilical artery smooth muscle cells (HUASMCs) were isolated from human umbilical arteries through explant techniques and expanded in vitro. Subsequently, third and fifth passage HUASMCs were seeded to ACCMs at a concentration of 30 x 10(6) cells/mL. Then, seeded ACCMs were implanted subcutaneously in athymic mice. The implants were retrieved at 10, 20 and 40 days after implantation. Histochemistry, immunohistochemistry and scanning electron microscopy were performed to analyse the morphological characteristics of the engineered tissues. Additionally, organ bath studies were performed to address the contractility of the engineered tissues. The decellularization process successfully extracted all cellular components while preserving the original collagen fibers. The immunological reaction to ACCMs consisted of only a transient nonspecific inflammatory response. Light and scanning electron microscopy demonstrated that HUASMCs extended onto the three-dimensional ACCMs scaffolds in vitro. Histological analyses of the explants from all time points demonstrated a progressive regeneration of smooth muscle, with structures very similar to native corpus cavernosum smooth muscle. The maximum contraction force induced by phenylephrine and electrical stimulation were 3.64 +/- 0.18 g/100 mg and 2.50 +/- 0.21 g/100 mg, respectively. Our study demonstrates that HUASMCs can be seeded on three-dimensional ACCM scaffolds and will develop tissues similar to that of the native corpus cavernosum smooth muscle.

OBJECTIVE To investigate the feasibility of urethral substitution using free lingual mucosa grafts (LMGs) in a dog model. MATERIALS AND METHODS The study included 10 female mongrel dogs in which a 4 × 1 cm2 section of urethral mucosa was excised. The defect was immediately repaired with a size-matched free LMG harvested from the inferior lateral surface of the tongue. A 12 F urethral catheter was kept inside the urethra for a mean of 7 days. At 3 months after the procedure, the patency of the urethra was assessed by both insertion of a 12 F catheter and by retrograde urethrography. Dogs were killed, the grafted areas excised, and evaluated by gross and histopathological examination. RESULTS All dogs survived the procedure and there were no tongue complications. One of the 10 dogs developed a slight urethral stricture near the proximal anastomosis. The remaining nine dogs voided spontaneously with no difficulty. Retrograde urethrography showed that no strictures or fistulas had formed. The LMGs shortened by 9.5% after surgery, from a mean (sd) of 4 (0.13) to 3.62 (0.11) cm (statistically significant, P

Objectives We evaluated the applications and outcomes of substitution urethroplasty, using a variety of techniques, in 65 patients with complex, long-segment urethral strictures. Methods From January 1995 to December 2005, 65 patients with complex urethral strictures >8cm in length underwent substitution urethroplasty. Of the 65 patients, 43 underwent one-stage urethral reconstruction using mucosal grafts (28 colonic mucosal graft, 12 buccal mucosal graft, and 3 bladder mucosal graft), 17 patients underwent one-stage urethroplasty using pedicle flaps, and 5 patients underwent staged Johanson's urethroplasty. Results The mean follow-up time was 4.8 yr (range; 0.8–10 yr), with an overall success rate of 76.92% (50 of 65 cases). Complications developed in 15 patients (23.08%) and included recurrent stricture in 7 (10.77%), urethrocutaneous fistula in 3 (4.62%), coloabdominal fistula in 1 (1.54%), penile chordee in 2 (3.08%), and urethral pseudodiverticulum in 2 (3.08%). Recurrent strictures and urethral pseudodiverticulum were treated successfully with a subsequent procedure, including repeat urethroplasty in six cases and urethrotomy or dilation in three. Coloabdominal fistula was corrected only by dressing change; five patients await further reconstruction. Conclusions Penile skin, colonic mucosal, and buccal mucosal grafts are excellent materials for substitution urethroplasty. Colonic mucosal graft urethroplasty is a feasible procedure for complicated urethral strictures involving the entire or multiple portions of the urethra and the technique may also be considered for urethral reconstruction in patients in whom other conventional procedures failed.

We investigated the possibility of urethroplasty with a free graft of colonic mucosa for long, complex urethral strictures. We report our initial experience with colonic mucosa graft urethroplasty for such urethral strictures in 16 patients.Between September 2000 and December 2002, 16 patients with a long, complex urethral stricture were treated with colonic mucosal graft urethroplasty. Patients had undergone an average of 2.5 previous unsuccessful repairs. Urethral reconstruction was done with a 10 to 17 cm (median 13) graft of colonic mucosaPatients were followed 6 to 33 months postoperatively. Meatal stenosis that developed in 1 patient 3 months postoperatively needed reoperation. The patient was voiding well with a urinary peak flow of 28.7 ml per second during 9-month followup after reoperation. Hyperplasia of the verumontanum was observed during urethroscopy and transurethral colliculectomy was performed in 1 patient more than 14 months postoperatively. Uroflowmetry showed a urinary peak flow of 46.5 ml per second postoperatively. The other patients were voiding well with a urinary peak flow of greater than 15 ml per second. Urethrogram revealed a patent urethra with an adequate lumen and no significant graft sacculation.This initial experience in 16 patients indicates that colonic mucosa graft urethroplasty is a feasible procedure for long, complex anterior urethral strictures. The technique may be considered for urethral reconstruction when more conventional procedures have failed.

AIM: To investigate the possibility of urethral reconstruction with a free colonic mucosa graft and to present our preliminary experience with urethral substitution using a free graft of colonic mucosa for treatment of 7 patients with complex urethral stricture of a long segment. METHODS: Ten female dogs underwent a procedure in which the urethral mucosa was totally removed and replaced with a free graft of colonic mucosa. A urodynamic study was performed before the operation and sacrifice. The dogs were sacrificed 8 to 16 wk after the operation for histological examination of urethra. Besides, 7 patients with complex urethral stricture of a long segment were treated by urethroplasty with the use of a colonic mucosal graft. The cases had undergone an average of 3 previous unsuccessful repairs. Urethral reconstruction with a free graft of colonic mucosa ranged from 10 to 17 cm (mean 13.1 cm). Follow-up included urethrography, urethroscopy and uroflowmetry. RESULTS: Urethral stricture developed in 1 dog. The results of urodynamic studies showed that the difference in the maximum urethral pressure between the pre-operation and pre-sacrifice in the remaining 9 dogs was not of significance (P > 0.05). Histological examination revealed that the colonic free mucosa survived inside the urethral lumen of the 10 experimental dogs. Plicae surface and unilaminar cylindric epithelium of the colonic mucosa was observed in dogs sacrificed 8 wk after the operation. The plicae surface and unilaminar cylindric epithelium of the colonic mucosa was not observed, and metaplastic transitional epithelium covered a large proportion of the urethral mucosa in dogs sacrificed 12 wk after the operation. Clinically, the patients were followed up for 3-18 mo postoperatively (mean 8.5 mo). Meatal stenosis was developed in 1 patient 3 mo postoperatively and needed reoperation. The patient was voiding very well with urinary peak flow 28.7 mL/s during the follow-up of 9 mo after reoperation. The other patients were voiding well with urinary peak flow greater than 15 mL/s. Urethrogram revealed a patent urethra with an adequate lumen with no significant graft sacculation. Neither necrosis of neourethral mucosa nor stenosis at the anastomosis sites has been observed on urethroscopy in 4 patients over 6 mo after operation. CONCLUSION: Urethral mucosa can be replaced by colonic mucosa without damaging the continence mechanism in female dogs. Colonic mucosa graft urethral substitution is a feasible procedure for the treatment of complex urethral stricture of a long segment. The technique may be considered when more conventional options have failed or are contraindicated.

We constructed a reliable continent tube that is surgically simple.In 12 patients with malignant bladder tumor we performed radical cystectomy with isolation of a 50 cm. ileal loop with pedicle. The proximal segment (8 to 10 cm.) was tapered over a 16Fr catheter as an efferent tube, the remaining segment was detubularized to create a W-shape pouch and the tapered ileum was fixed to the back surface of the rectus muscle with 2 polyester tapers 1 cm. wide with a suspension tension of 500 g. The external orifice of the tapered ileum was anastomosed to the umbilicus. In 2 patients with neuropathic bladder a 15 cm. ileal loop with pedicle was isolated, the proximal segment (8 cm.) was tapered as an efferent tube with 500 g. suspension tension, and the remaining segment was detubularized and anastomosed to the bladder.The patients were followed for 6 to 17 months (mean 11.4) and were completely continent day and night. The stoma was easily catheterized with a 16Fr catheter in all cases. Urodynamic study of the efferent tubes revealed maximum pressure of 84 to 159 cm. water (mean 114). Retrograde radiography of the efferent tubes demonstrated perfect canalization without stenosis.This study suggests that the continent mechanism of the tapered ileum can be greatly enhanced by a suspension technique. This maneuver also provides easy catheterization and surgical simplicity.

We treated 5 patients with Cushing's disease by total adrenalectomy and left adrenal autotransplantation with attached blood vessels. An end-to-end vascular anastomosis was made between the adrenal central vein and the inferior epigastric artery, and the saphenous vein and adrenal middle artery were anastomosed by intussuscepting the artery into the vein in 4 patients. Steroid replacement was withdrawn 7 to 90 days after bilateral total adrenalectomy. The patients were followed for 1 to 4 years. Repeated measurement of plasma cortisol, 24-hour urinary 17-hydroxycorticosteroid and 17-ketosteroid levels in all cases was normal. As soon as the adrenal central vein and inferior epigastric artery were anastomosed part of the adrenal gland was then excised. Oozing of blood from the cut surface was retained and the adrenal gland was then embedded into the inguinal muscle in 1 patient. Small doses of steroid replacement (12.5 mg. cortisone per day) were still necessary 1 year postoperatively. The result thus indicates that this procedure is feasible and valuable for the treatment of patients with Cushing's disease and no evidence of pituitary adenoma on magnetic resonance imaging or computerized tomography.

We treated 80 patients with recurrent chyluria (68 men and 12 women) by a microsurgical technique since 1978. Transinguinal spermatic lymphangiovenous anastomosis was performed in 64 patients and inguinal lymph node-saphenous vein anastomosis was performed in 16. Followup was 6 months to 11 years in 50 of the former and 12 of the latter patients. Chyluria disappeared completely in 30 (60%) and 8 (66.7%) patients, respectively. In 6 of the former patients (12%) chyluria had disappeared immediately after the operation but it recurred within 1.5 to 3 years. The procedure has the advantage of a superficial operative field, and is simple and less traumatic.

OBJECTIVES To develop and report our initial experience with a novel antirefluxing technique for segmental ileal ureteric replacement for the treatment of long ureteric strictures. PATIENTS AND METHODS Between January 2000 and January 2007, 12 cases of ureteric strictures (nine bilateral and three unilateral) were treated using a novel surgical technique in which the ureter was replaced with a segment of ileum using an end-to-side anastomosis. An antireflux valve was constructed by fixing the distal part of upper ureter (4 cm) between the psoas muscle and ileal segment (the ileo-psoas tunnel technique). The distal ileum was connected to the urinary bladder with an end-to-side anastomosis. RESULTS The 12 cases were followed-up for a mean (range) of 39.42 (12-64) months. There were no cases of pyelonephritis or signs of renal failure after surgery. There was dramatic improvement in hydronephrosis, as assessed by intravenous urography, in the 4-9 months after surgery. Cystography showed no evidence of ileo-ureteric reflux. Mild hyperchloraemic acidosis was detected in two patients and was successfully treated with oral alkalization. CONCLUSIONS In our initial experience, ileal ureteric replacement combined with the ileo-psoas tunnel antirefluxing technique is a highly effective procedure for the treatment of ureteric strictures.

A case of Cushing's disease was treated successfully by staged total adrenalectomy, left adrenal autotransplantation with the attached blood vessels and pituitary irradiation. In the first stage the left adrenal gland was removed with its attached blood vessels intact, and adrenal autotransplantation then was performed. An end-to-end anastomosis was made between the adrenal central vein and the right inferior epigastric artery. The anastomosis between the right saphenous vein and the adrenal middle artery was accomplished by intussuscepting the artery into the vein followed by suturing. The second stage operation was total right adrenalectomy. Steroid replacement therapy was stopped 7 days postoperatively and all laboratory studies were normal. Two months after total right adrenalectomy the patient had a sensation of facial fullness. Plasma cortisol and 24-hour urinary 17-hydroxycorticosteroid levels were elevated. Part of the graft was excised with the patient under local anesthesia. The symptoms disappeared and the laboratory studies returned to normal. Pituitary irradiation was administered as supplementary treatment of Cushing's disease. This method for the treatment of Cushing's disease has proved feasible. The inguinal region is the optimal site for adrenal autotransplantation.