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To investigate the efficiency and complications of modified urethral reconstruction with lingual mucosa in the treatment of complicated anterior urethral stricture (CAUS).We retrospectively studied the clinical data on 10 cases of CAUS treated by modified urethral reconstruction with lingual mucosa from December 2017 to June 2019 concerning the age of the patients and the causes, location and length of urethral stricture. We statistically analyzed the pre- and post-operative maximum urine flow rate (Qmax), scores on Mental Status Scale in Non-psychiatric Settings (MSSNS) and quality of life (QOL) scores and observed post-operative complications such as abnormal taste, tongue numbness, urinary tract infection, urethral diverticulum, and urethral stricture.Compared with the baseline, Qmax was significantly improved and the MSSNS and QOL scores dramatically decreased at 3, 6 and 12 months after surgery (P0.01). Paraurethral infection developed in 1 case postoperatively, which was cured after dressing change, external urethral orifice stenosis occurred in another, which was improved after regular urethral orifice expansion, and mild tongue numbness was found in 2 cases at 1 month but gradually restored to abnormal. Urethrography showed no urethral diverticulum before catheter removal.Lingual mucosa is an ideal alternative material for urethral reconstruction in the treatment of CAUS, and lateral lingual mucosa can be easily obtained. Modified urethral reconstruction by embedding lingual mucosa in the dorsal base of the urethra, with the advantages of definite effectiveness and few postoperative complications, is worthy of clinical application.

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.

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.

The aim of this study was to compare the effectiveness and outcomes of lingual mucosa graft (LMG) urethroplasty versus pedicled skin flap (PSF) urethroplasty in the repair of anterior urethral strictures.A retrospective study in one urological center examined 293 male patients with anterior urethral strictures who received substitution urethroplasty from 2006 to 2015. Of these, 199 patients received PSF urethroplasty and 94 received LMG urethroplasty. The causes of stricture included catheter damage, transurethral instrumentation, trauma, infection, tumor and radiotherapy. Strictures caused by lichen sclerosus, hypospadias repair or failed urethroplasty were excluded. The success rate of PSF versus LMG in different urethra positions was analyzed.Overall, PSF and LMG had similar success rates (83.4% vs 85.1%, p = 0.713). In distal penile urethra, penile skin flaps and LMG achieved similar success rates (87.7% vs 82.1%, p = 0.297), but in proximal penile urethra, scrotal flaps had relatively low success rates (69.0% vs LMG 83.3%, p = 0.345) and in bulbar urethra, perineal skin flaps had significantly lower success rates than LMG (66.7% vs 92.3%, p = 0.036).Lingual mucosa is a good material for the repair of urethral defects and achieves results similar to or even better than those of PSF. Scrotal skin and perineal skin had lower success rates.

Aim To report on six cases of the diagnosis and treatment of patients with complete androgen insensitivity syndrome (CAIS) and a review of the relevant published work. Methods A retrospective analysis was performed on the clinical features, diagnosis and treatment of a total of six patients with CAIS who were admitted to our hospital between September 1985 and June 2012. All surgical patients were examined for sex chromosomes and sex hormone levels pre- and postoperatively, respectively, and underwent lower abdominal B ultrasounds and pathological examinations among other tests. Results Five of the patients were treated with castration, one patient aged 5 years was treated conservatively Tissue from surgical resections showed normal testicular tissue that comprised Leydig cells and Sertoli cells, and pathological examinations showed no sign of testicular cancer. Following corrective operations, postoperative complications, such as female secondary sexual characteristics, stagnation and osteoporosis, have not developed. Sex hormone level ratio changed significantly after being treated with castration compared with preoperative levels; mainly testosterone and estrogen decreased significantly (P 0.05). Conclusion The study show that removal of the testes in CAIS patients after puberty is safe and reliable. Meanwhile, it is essential to provide a hormone drug after being treated with castration. Further studies are needed to evaluate the safety and the quality of life for CAIS patients.

To compare the values of CT virtual cystourethroscopy and of conventional cystourethroscopy in diagnosing complex urethral strictures. From January 2012 to December 2012, 33 patients, suspected of having complex urethral strictures before operation, were enrolled in this study. After CT scanning, a virtual cystourethroscopic view was software-generated. Conventional cystourethroscopy was also used before operation. The time durations of virtual cystourethroscopy and conventional cystourethroscopy were recorded. The accuracies of both techniques were compared using the actual findings from the operation. For 16 patients suffering from urethral strictures associated with various fistulas, the duration of examination with virtual cystourethroscopy was statistically significantly shorter than with conventional cystourethroscopy (P

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.

Objective To describe the complications of transperineal end-to-end anastomotic urethroplasty in patients with posterior urethral strictures resulting from pelvic fracture. Materials and Methods A total of 573 patients, who underwent bulboprostatic anastomosis for posterior urethral strictures, were enrolled in this study. Distraction defects were measured using retrograde urethrography combined with voiding cysto-urethrography. All patients underwent perineal excision and primary anastomotic urethroplasty. The urethroplasty was considered successful if the patient was free of stricture-related obstruction and did not require any further intervention. The degree of stress incontinence was assessed daily by pad testing. The prevalence of pre- and postoperative sexual disorders was investigated using the International Index of Erectile Function-5 questionnaire. Results Of 573 bulboprostatic anastomosis procedures performed, 504 (88%) were successful and 69 (12%) were not successful. The mean (sd) maximum urinary flow rate, assessed by uroflowmetry 4 weeks after surgery, was 20.52 (5.1) mL/s. Intraoperative rectal injury was repaired primarily in 28 cases. Recurrence of urethral strictures was observed in 10 (1.7%) patients during the first 6 months after surgery, and in 45 patients from 6 months to 1 year. All of these patients underwent re-operation. Twenty-four (4.2%) patients had mild urge incontinence and 28 (4.9%) had mild stress incontinence. Erectile dysfunction (ED) was present in two ( 0.05). Nine (1%) patients were found to have false passage between the posterior urethra and bladder neck. Conclusion The majority of complications associated with transperineal bulboprostatic anastomosis can be avoided as long as meticulous preoperative evaluation to define the anatomy and careful intra-operative manipulation are ensured.

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.

We investigated a rationale for procedure selection to repair female urethral stricture associated with urethrovaginal fistula. We compared the outcomes of the 5 techniques used.Between January 1999 and October 2011, 44 female patients with urethral stricture associated with urethrovaginal fistula were treated using a total of 5 techniques. The surgical techniques were labial pedicle flap urethroplasty in 24 patients, vulvar flap urethroplasty in 3, anterior vaginal flap urethroplasty in 11, end-to-end anastomosis in 4 and bladder flap urethroplasty in 2. Supplementary procedures were performed in some patients during urethroplasty, including bladder neck reshaping for incontinence in 5, intestinal-vaginal fistula repair in 3, colpoplasty for island vulvar skin flaps in 3, middle vaginal stricture vaginoplasty in 2 and enlargement of the vaginal introitus in 1.Average postoperative followup was 42.3 months (range 6 to 140). Urethrovaginal fistula recurred in 2 patients because of infection, urethral stricture developed in 1 and stress incontinence appeared in 1. The other patients voided normally with an average maximum urine flow greater than 15 ml per second (range 16.7 to 46). The overall anatomical success rate was 93.18% (41 of 44 cases) and the functional success rate was 90.91% (40 of 44).Surgical procedures for treating female urethral strictures with urethrovaginal fistulas should be based on fistula location, stricture length and vaginal anatomy. A transvaginal approach might be optimal if the vagina is wide and easily dilated. Pedicle labial flap urethroplasty was a reliable technique for complex strictures.

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 • This study was to evaluate donor-site complications of lingual mucosal graft harvesting for substitution urethroplasty. PATIENTS AND METHODS • 110 patients with anterior urethral strictures or hypospadias underwent lingual mucosal grafts (LMGs) urethroplasty. Dual LMGs were harvested from both sites separately or a long mucosal graft was harvested from one side to other side of tongue in 29 patients (group one); a shorter mucosal graft was harvested from one side of tongue in 81 patients (group two). A standard proforma (Appendix) was used for all patients. RESULTS • The mean follow up time was 22 months (range 6~41). At six months follow-up, numbness of tongue was reported in 19 patients (17.27%), parageusias in six (5.45%) and slurring of speech in 9 (8.18%). • Ninety-six patients were followed up for more than 12 mo. Numbness in operative area of tongue was documented in seven patients (7.29%), parageusias in three (3.13%) and slurred speech in three (3.13%). • None of these complications occurred in the six pediatric cases (

The purpose of this study was to assess the diagnostic value and potentially protective capacity of heat-shock protein 70 (HSP70) in chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). In this study, seminal plasma levels of cytokines (tumor necrosis factor-α (TNF-α) and interleukin 1β (IL-1β)) and HSP70 were evaluated by enzyme-linked immunosorbent assay in 80 men: 15 healthy controls, 16 men with chronic bacterial prostatitis, 23 men with CP/CPPS IIIA and 26 with CP/CPPS IIIB. The HSP70 levels in chronic bacterial prostatitis and CP/CPPS patients were correlated with chronic prostatitis symptom index (CPSI). Significantly increased levels of cytokines (TNF-α and IL-1β) and HSP70 were observed in seminal plasmas from patients with chronic bacterial prostatitis compared with CP/CPPS patients and controls. However, only IL-1β was significantly elevated compared with CP/CPPS IIIB and controls in patients with CP/CPPS IIIA. HSP70 levels in CP/CPPS patients were significantly lower than that in controls. HSP70 concentration in seminal plasma was negatively correlated with CPSI in chronic bacterial prostatitis. The results indicated that HSP70 and IL-1β appear to be the most reliable and predictive surrogate markers to diagnose chronic bacterial prostatitis and CP/CPPS, respectively. HSP70 has an important protective role in the regulation of cell functions in chronic bacterial prostatitis. CP/CPPS would probably be detrimental to the ability of T cells and consequently suppress the expression of HSP70.

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 We evaluated the efficacy of bulbourethral composite sling procedure in the treatment of male urinary incontinence after radical prostatectomy, transurethral resection of the prostate, or prostatic enucleation for benign prostatic hyperplasia, and posterior urethroplasty. Methods Between May 2000 and April 2005, a bulbourethral composite sling was performed in 26 patients with acquired urinary incontinence. Eight (30.8%) of these patients had severe urinary incontinence, and 18 (69.2%) had mild to moderate urinary incontinence. A polyester patch plus tension-free vaginal tape (TVT) device was used in the procedure. Prolene threads were attached to the two ends of polyester taper then passed from the perineal incision to a suprapubic incision with a TVT needle. The ends of the sutures and TVT were tied over the rectus fascia in the midline after repeated urethral pressure measurements reached 80–90cmH 2 O. Results The follow-up period was 8–54 mo (mean: 28.3). The primary procedure failed in one patient. Of the remaining 25 patients, 1 patient died of cerebral hemorrhage 2 yr postoperatively, and 2 patients had recurrent stress incontinence in 1.5 and 2 yr postsurgery, respectively. The recurrent incontinence was severe in one patient and mild (one to two pads per day) in the other. The remaining 22 patients maintained urination and continence. The total success rate (cure and improved) was 92% (23 of 25). Conclusions Bulbourethral composite sling procedure is a minimally invasive, safe, effective surgical option in the treatment of male patients with mild to moderate incontinence, but is not suitable for severe incontinence. Temporary perineal discomfort or pain is a common complication of the procedure.

Purpose: It was the aim of this study to investigate the possibility of pedicled rectus abdominis muscle fascial flap wrapped around the penis for enhanced urethral pressure in dogs. Materials andMethods: Ten adult male Beagle dogs underwent a procedure in which surrounding tissue of the penis at the site of the bulbomembranous urethra was dissected and a pedicled rectus abdominis muscle fascial flap was wrapped around the penis. Profilometry of the urethral pressure was carried out before, during and after the operation in all dogs. Results: Before the operation, the mean maximal urethral pressure (MUP) was 48.9 ± 11 cm H2O, and the mean MUP was 78.3 ± 20.5 cm H2O after the penis was surrounded by a rectus muscle flap. There was a significant difference (t = 4.99, p = 0.0007). Ten weeks after the operation, the mean MUP was 88.3 ± 22.4 cm H2O, which was significantly higher than that before the operation (t = 6.0584, p = 0.0002). Conclusions: A pedicled rectus abdominis muscle fascial flap wrapped around the penis can raise the urethral pressure. This provided an experiment basis for treating male urinary incontinence with a pedicled rectus muscle flap.

The relationship between chronic prostatitis and fertility has been disputed for many years. Several groups have shown infection and autoimmune response against prostate antigens could have a deleterious effect on semen quality and fertility. This study was conducted to test the hypothesis that Omi/HtrA2-induced apoptosis in chronic prostatitis could be a mechanism underlying the observed clinical benefit. The Omi/HtrA2 serine protease is a nuclear-encoded mitochondrial protein, which can be released from mitochondria into the cytosol after apoptosis stimuli, inducing apoptosis in caspase-dependent and independent manners. Forty-one patients diagnosed as suffering from chronic prostatitis were included. Healthy normal individuals were included as controls. Human spermatozoa in the semen were purified by Percoll-gradient technique to separate the seminal plasma and other round cells. Measurements for sperm concentration, motility, morphology, proinflammatory cytokines, Omi/HtrA2 mRNA and protein levels in spermatozoa of chronic protatitis patients, were performed accordingly. Significantly increased levels of proinflammatory cytokines were detected in seminal plasma from these prostatitis patients. Omi/HtrA2 mRNA and protein levels were significantly higher in prostatitis men than in normal men. This study shows that chronic prostatitis patients present important alterations in their semen quality parameters, Omi/HtrA2 mRNA and protein levels of spermatozoa. We speculate that the inflammatory process involved may affect male fertility by release of proapoptotic protein Omi/HtrA2.

Purpose: To construct a reliable continent tube, which is easy to catheterize and surgically simple. Materials and Methods: 8 adult female mongrel dogs underwent a procedure in which an ileal segment was tapered as an efferent tube. The tapered ileum was fixed to the back surface of the rectus muscle with a polyester taper 1.5 cm in width and a suspension tension of 400 g. The internal orifice of the tapered ileum was anastomosed to the bladder and the external orifice of the tapered ileum was brought out to the abdominal skin. Urodynamic and radiological studies were carried out postoperatively in all dogs. Results: All stomas in dogs could be easily catheterized with a 14-french catheter. Urodynamic study of the efferent tubes showed that the maximum closure pressure ranged from 117 to 157 (mean 136.75) cm water. Retrograde radiogram of the efferent tubes showed perfect canalization without stenosis. Conclusion: This study suggests that the continent mechanism of the tapered ileum can be greatly enhanced by a suspension technique.

OBJECTIVE • To evaluate the management of traumatic posterior urethral stricture associated with false passage, as this remains a challenge for urologists. PATIENTS AND METHODS • From January 2000 to February 2010, 19 patients (mean (range) age 34 [25-52] years) with traumatic posterior urethral obliteration associated with false passage were evaluated and treated at our centre. • All patients underwent perineal excision and primary anastomotic urethroplasty using cystoscopy by the suprapubic route to insert a guidewire into the original bladder neck, allowing exposure of the normal posterior urethra. • Patients underwent voiding cysto-urethrography 1 month after the procedure. When symptoms of decreased force of stream were present and uroflowmetry was

Urethral fibrosis is an important pathological feature of urethral stricture. TGF-β1 and CXC chemokine receptor 3 (CXCR3) signaling have been reported as the critical pathways involved in the pathology of fibrosis. Here, we collected the urine samples from the patients with recurring urethral stricture, recurring stricture treated by cystostomy, and age- and gender-matched healthy people. ELISA detection revealed that TGF-β1 level was significantly up-regulated for the urethral stricture patients. By contrast, flow cytometry, real-time PCR detection, and immunofluoresecent staining showed that urethral stricture resulted in decreased expression of CXCR3. TGF-β1 treatment could increase cell proliferation and migration ability of urethra fibroblasts, whereas IP-10/CXCR3 signaling showed the opposite effect. Further, we found a crosstalk between TGF-β1 and CXCR3 signaling in the regulation of urethral fibrosis. Thus, pharmacological intervention of TGF-β1 or CXCR3 signaling has a potential as the therapeutic target for the prevention of urethral fibrosis.

Purpose: We constructed a reliable continent tube that is easy to catheterize and surgically simple.Materials and Methods: Eight patients with bladder cancer underwent a procedure in which ileal segment was tapered as an efferent tube, of which a part was placed between the back surface of the rectus muscle and the ileal pouch wall. The internal orifice of the tapered ileum was anastomosed to the ileal pouch and its external orifice was anastomosed to the umbilicus. Urodynamic and radiological studies were done postoperatively in 7 cases.Results: The stoma was easily catheterized with a 16Fr catheter in all cases. One patient died of heart disease 55 days postoperatively, while 6 of the remaining 7 were completely continent day and night. Urodynamic study of the efferent tubes showed that maximum close pressure with the pouch full was significantly higher than with the pouch empty (p

To report on six cases of the diagnosis and treatment of patients with complete androgen insensitivity syndrome (CAIS) and a review of the relevant published work.A retrospective analysis was performed on the clinical features, diagnosis and treatment of a total of six patients with CAIS who were admitted to our hospital between September 1985 and June 2012. All surgical patients were examined for sex chromosomes and sex hormone levels pre- and postoperatively, respectively, and underwent lower abdominal B ultrasounds and pathological examinations among other tests.Five of the patients were treated with castration, one patient aged 5 years was treated conservatively Tissue from surgical resections showed normal testicular tissue that comprised Leydig cells and Sertoli cells, and pathological examinations showed no sign of testicular cancer. Following corrective operations, postoperative complications, such as female secondary sexual characteristics, stagnation and osteoporosis, have not developed. Sex hormone level ratio changed significantly after being treated with castration compared with preoperative levels; mainly testosterone and estrogen decreased significantly (P 0.05), while luteinizing hormone and follicle-stimulating hormone significantly increased (P 0.05). However, prolactin did not change significantly (P 0.05).The study show that removal of the testes in CAIS patients after puberty is safe and reliable. Meanwhile, it is essential to provide a hormone drug after being treated with castration. Further studies are needed to evaluate the safety and the quality of life for CAIS patients.

Objective To report the outcome of 1-stage urethroplasty using lingual mucosal grafts (LMGs) and buccal mucosal grafts (BMGs) for the treatment of male urethral strictures associated with genital lichen sclerosus (LS). Materials and Methods This was a descriptive, observational retrospective study of male patients with urethral strictures who underwent 1-stage mucosal graft urethroplasty using different substitute materials for reconstructive urethral surgery. Study inclusion criteria were patients with histologically proven LS presenting with urethral strictures. Exclusion criteria were patients without histologically proven LS, traumatic strictures, failed hypospadias, and malignant lesions. Successful reconstruction was defined as normal voiding with a peak flow >12 mL/s, no obstructive symptoms, and no postoperative procedure, including dilation. Results Between January 2003 and December 2011, urethral strictures in 54 patients were considered associated with genital LS according to the inclusion and exclusion criteria, and 36 underwent 1-stage urethroplasty using oral mucosal grafts. The median age was 52 years (range, 32-80 years). The median stricture length was 12.5 ± 1.6 cm (range, 6-18 cm). One-stage single-sided dorsal LMG urethroplasty was performed in 22 of 36 patients. The remaining 14 patients received the same procedure combined with dual BMGs (n = 5) or with LMG combined with BMG (n = 9). The success rate was 88.9%. Postoperative urinary fistula occurred in 1 patient, and meatal stenosis developed in 3 patients. Mean follow-up was 38.7 months (range, 12-110 months). Conclusion Our survey suggests that 1-stage urethroplasty with single or combined LMGs or BMGs may be an effective option to treat urethral stricture associated with LS.

Urethral diverticula are pouches opening into the urethral canal that may be either acquired or congenital. Diverticula of the female urethra are fairly common. However, diverticula of the male urethra are relatively uncommon abnormalities. Clinical manifestation is frequently described with irritative and/or obstructive voiding symptoms or ventral bulging, but manifestation as a scrotal mass is extremely rare. We report a giant urethral diverticulum presenting as a scrotal mass in an adult male.

To investigate the feasibility of small intestinal submucosa graft for the repair of selected anterior urethral strictures.From June 2009 to May 2011, 28 men (mean age 39 years) with anterior urethral strictures underwent urethroplasty using a four-layer small intestinal submucosa patch graft in an onlay or inlay fashion. The stricture was localized to the bulbar urethra in eight patients, the bulbopenile area in nine patients and the distal penile urethra in 10 patients. Failed hypospadias was observed in one patient. The mean stricture length was 4.6 cm (range 3.5-7.0 cm).The mean follow-up period was 24.8 months (range 12-30 months). No postoperative complications, such as infection or rejection, were related to the use of heterologous graft material. The patients voided well postoperatively, with peak flows between 16 and 44 mL/s (mean 25.4 mL/s) in 26 patients. Two patients (7.1%) developed a urethral narrowing; this occurred at 5 months in one patient and 6 months in the other, and cystoscopy, which was carried out at 20 and 24 weeks, respectively, showed clear cicatricial tissue at the proximal anastomotic site. Dilation was carried out once every 4-6 months for recurrent stricture in one patient and lingual mucosal graft urethroplasty was carried out in the other patient at 18 months postoperatively. Biopsies were obtained in four patients at 18, 24, 36 and 42 weeks, respectively. Squamous epithelium with or without hyperkeratosis was observed on histological examination of the small intestinal submucosa-grafted areas.The small intestinal submucosa matrix appears to be a safe and effective reconstructive material for selective use in urethral reconstructive surgery.

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.

• To evaluate the management of traumatic posterior urethral stricture associated with false passage, as this remains a challenge for urologists.• From January 2000 to February 2010, 19 patients (mean (range) age 34 [25-52] years) with traumatic posterior urethral obliteration associated with false passage were evaluated and treated at our centre. • All patients underwent perineal excision and primary anastomotic urethroplasty using cystoscopy by the suprapubic route to insert a guidewire into the original bladder neck, allowing exposure of the normal posterior urethra. • Patients underwent voiding cysto-urethrography 1 month after the procedure. When symptoms of decreased force of stream were present and uroflowmetry was15 mL/s, urethrography and urethroscopy were repeated. • Clinical outcome was considered a failure when any postoperative instrumentation was needed, including dilatation.• The mean (range) follow-up was 12 (9-14) months. The overall success rate was 84%. • Three patients (16%) with persistent voiding difficulty developed a short anastomotic stricture 1-3 months after surgery. • The mean maximum urinary flow rate after surgery was 20.01 mL/s and no patient had urinary incontinence.• The preoperative use of flexible cystoscopy via the suprapubic route represented a successful key point of urethroplasty for posterior urethral stricture associated with false passage.

Papillary renal cell carcinoma in the horseshoe kidney is uncommon. We report a case of papillary renal cell carcinoma in the horseshoe kidney and discuss its incidence, diagnosis, and treatment.

Urethroplasty of complex urethral stricture is a difficult procedure, and there is no widely accepted standard approach described in the published literature. We evaluated the efficacy and safety of urethroplasty using lingual mucosa grafts (LMGs) for the repair of urethral strictures.Between August 2006 and April 2009, 92 cases of urethral strictures (length ranging from 2.5 cm to 18 cm, mean 6.5 cm) were treated using LMGs. Of the 92 patients, 38 with long-segment urethral strictures (9 - 18 cm) underwent dual LMG or LMG combined with foreskin flap or buccal mucosal graft urethroplasty.Follow-up was obtained for 3 - 33 months (mean 17.2 months) postoperatively. Complications occurred in 8 patients, including urinary fistulas in 4 patients; recurrent strictures developed in 4 patients at 3 - 4 months post-operatively. The remaining patients voided well postoperatively, with peak flows between 14.3 ml/s and 54.6 ml/s (mean 28.4 ml/s).The tongue is an excellent source of graft material for the repair of anterior mucosal strictures. Dual LMG substitution urethroplasty can successfully treat longer, more complex urethral strictures.

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.

To evaluate the influence of reconstructive surgery for male urethral stricture on erectile function and sexual life quality.We analyzed retrospectively the clinical data of 326 male patients who underwent urethroplasty for urethral stricture in our department and evaluated their erectile function and sexual life quality.A total of 172 groups of valid data were collected, with the mean follow-up of 28.5 months. The mean scores on IIEF-5 (P=0.002) and sexual life quality (P=0.026) were statistically significantly reduced after surgery. Erectile dysfunction was found in 88 (51.2%) of the patients after urethroplasty, as compared with 56 (32.6%) preoperatively.The location of urethral stricture, surgical method and urethral stricture recurrence may affect the erectile function and sexual life quality of the patient, but both can be gradually improved with the time after urethroplasty.

To investigate the possibility of urethral reconstruction with free buccal mucosa and colonic mucosa onlay graft.Twenty male mongrel dogs were randomly divided into 2 groups (n = 10 each). In group A: 4 cm x 0.8 cm segment of perineal urethra was excised and onlay urethroplasty was performed using free buccal mucosa. In group B: 4 cm x 0.8 cm segment of perineal urethra was excised and onlay urethroplasty was performed using free colonic mucosa. Retrograde urethrography was done at week 12. Autopsy specimens were calibrated with a 8Fr catheter. Graft length were measured immediately after scarification in all dogs. Histological study of all autopsy specimens was done.Urethral structures were diagnosed by radiology and confirmed by calibration in 1 of the 10 dogs (10%) in group A and 2 of the 10 dogs (20%) in group B. Graft shrinkage was less than 20% for buccal mucosa and colonic mucosa. Histological examination revealed that the buccal mucosa and colonic mucosa survived inside the urethral lumen of all dogs. Plicae surface and unilaminar cylindric epithelium of the buccal mucosa and colonic mucosa were not observed and metaplastic transitional epithelium covered a large proportion of the urethral mucosa in all dogs.Urethral mucosa can be replaced by colonic mucosa as well as buccal mucosa by using onlay urethroplasty.

To evaluate the various operative details of strictures of the posterior urethra that are essential for a successful result.The clinical data of 191 patients with posterior urethral strictures or distraction defects from January 1990 to January 2006 were analyzed retrospectively. All patients underwent a retrograde and voiding urethrogram, 62 patients had urethral ultrasonography, 48 patients had urethroscopy, 3 patients had MRI. Repair was performed with a simple anastomosis after urethral mobilization in 66 patients, separation of the corporeal bodies in 48 patients, separation of the corporeal bodies and inferior pubectomy in 30 patients, transpubic anastomosis in 18 patients, pull-through operation in 3 patients, and optical urethrotomy in 26 patients. Followup ranged from 6 to 48 months.The mean stricture length was 3.6 cm (range from 1.5 to 8.0 cm). Posterior urethral strictures is in 31 (16%), posterior distraction defects is in 160 (84%), of which the length of the distraction defects3 cm is in 102 (53.4%), and the the length of the distraction defects3 cm is in 58 (30.6%). The overall successful results (Qmax15 ml/s) after operation was 84.3%. Optical urethrotomy was 69%, the successful results with anastomotic urethroplasty were 97% with a simple anastomosis; 79% with separation of the corporeal bodies; 80% with separation of the corporeal bodies and inferior pubectomy; 83% with transpubic anastomosis; and 67% with pull-through operation.The anastomotic urethroplasty is better than the optical urethrotomy, the length of the strictures or distraction defect which is lower than 3 cm is much more successfully corrected.

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.

To evaluate the selection of different procedures and the feasibility for the treatment of long segment urethral stricture.Seventy-six patients with complex urethral stricture greater than 8 cm long underwent different procedures of urethroplasty. Of them various mucosa grafts urethral reconstruction were adopted in 42 cases (colonic mucosal graft, n = 26; buccal mucosal graft, n = 10; bladder mucosal graft, n = 6); One-stage pedicle flaps urethroplasty in 20; two-stage urethroplasty of Johanson procedure in 12; and penile urethra-prostatic urethra anastomosis, three-stage urethroplasty in 2.In early followed up (within 6 months postoperatively), 67 patients (88%) voided well and complications developed in 10. Among the 70 patients who lasted more than 1 year after operation, 51 cases were followed up. Forty-four patients voided well, and complications developed in 8. Of the 8 cases urethral restructure developed in 2 (18%) for pedicle flaps urethroplasty, 2 for colonic mucosal urethroplasty (9%), 1 for buccal mucosal graft (1/7), 1 for bladder mucosal graft (1/3); penile chordee in 2 (2/5), and one of them was accompanied by hair bearing neourethra for two-stage urethroplasty of Johanson procedure.Colonic mucosal and buccal mucosal grafts urethroplasty are feasible procedures for the treatment of long segment urethral stricture, and Colonic mucosal graft urethroplasty may be considered when more conventional procedures fail or complicated urethral strictures greater than 10 cm long.

To evaluate the diagnosis and management of adrenal myelolipoma.The clinical data of 26 cases were analyzed retrospectively and the selected articles were reviewed. There were no specific clinical symptom and endocrine abnormality, except increasing catecholamine in 2 cases. All cases but two were diagnosed by B-model ultrasound scanning (B-US), CT or magnetic resonance imaging (MRI).Twenty-six cases were surgically treated, the diameter of the tumor was 5 - 10 cm, simple tumor resection was performed in 16 cases, and complete adrenal resection was performed in 10 cases. All the operated cases were proved by pathologists. The duration of follow-up was from 6 - 28 months after surgery. No recurrence was observed.The diagnosis of adrenal myelolipoma could be established based on B-US, CT or MRI. The tumors whose diameter is larger than 5 cm in size should be removed.