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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.

Seeding cells efficiently and uniformly onto three-dimensional scaffolds is key for engineering urological tissue with an ideal histological structure in vitro. Using an optimized seeding technology allows cells to cooperate positively with biomaterials, resulting in successful reconstructive surgery. In this study, we used four different types of seeding methods in a scaffold of small intestinal submucosa (SIS). The efficiency of the sandwich co-culture, layered co-culture, static-agitation seeding, and centrifugation seeding methods were compared. It was demonstrated that dynamic seeding methods, such as static-agitation and centrifugation seeding, had superior cell-matrix infiltration and mechanical properties. The seeding time could be reduced by 5-10 min using the centrifugation method. Furthermore, functional assessment of the barriers revealed that this function was better in the centrifugation seeding method than in any other method. Our study suggests that both the static-agitation and centrifugation methods are suitable for cell seeding on SIS. There is no significant change in surface area of SIS with different seeding methods. These methods reinforce the physiological and mechanical properties of biomaterials and allow for the future in vivo study of tissue-engineered urethral reconstruction. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 104B: 1098-1108, 2016.

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 evaluate the clinical value of fluorescence in situ hybridization (FISH) for diagnosis and surveillance of bladder urothelial carcinoma (BUC).Between November 2010 and December 2013, patients suspected of having BUC were examined using urine cytology and FISH assay. Based on histopathological examination results, FISH results were com­pared with urine cytology. In addition, patients with a history of non-muscle invasive BUC were also examined using urine cytology and FISH assay at the first time of visit and then monitored with cystoscopy during follow-up period.A total of 162 patients included in this study and 12 patients were excluded due to uninformative FISH assays. The remaining 150 patients consisted of 108 patients suspected for BUC and 42 patients with a history of non-muscle invasive BUC. The sensitivities of FISH analysis and urine cytology were 72.8% and 27.2%, respectively, and the difference was statistically significant (P.05). Difference between specificity of urine cytology (100%) and FISH assay (85%) was not statistically significant (P.05). At the first visit, of 42 patients, one patient had positive cystoscopy, and FISH assay was positive in 26 of 41 patients with negative cystoscopy. During the follow-up period (mean, 29.5 months), 18 of 26 patients developed recurrence, and recurrence occurred in only one of 15 patients with negative FISH analysis.Our results suggest that FISH analysis can be used as a non-invasive diagnostic tool for patients suspect­ed of having new BUC. In addition, FISH analysis may provide important prognostic information to better define the individual risk for BUC recurrence.nbsp

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.

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.

To investigate the early and delayed effects of cavernous nerve electrocautery injury (CNEI) in a rat model, with the expectation that this model could be used to test rehabilitation therapies for erectile dysfunction (ED) after radical prostatectomy (RP).In all, 30 male Sprague-Dawley rats were randomly divided equally into two groups (15 per group). The control group received CNs exposure surgery only and the experimental group received bilateral CNEI. At 1, 4 and 16 weeks after surgery (five rats at each time point), the ratio of maximal intracavernosal pressure (ICP) to mean arterial pressure (MAP) was measured in the two groups. Neurofilament expression in the dorsal penile nerves was assessed by immunofluorescent staining and Masson's trichrome staining was used to assess the smooth muscle to collagen ratio in both groups.At the 1-week follow-up, the mean ICP/MAP was significantly lower in the CNEI group compared with the control group, at 9.94% vs 70.06% (P0.05). The mean ICP/MAP in the CNEI group was substantially increased at the 4- (35.97%) and 16-week (37.11%) follow-ups compared with the 1-week follow-up (P0.05). At all three follow-up time points, the CNEI group had significantly decreased neurofilament staining compared with the control group (P0.05). Also, neurofilament expressions in the CNEI group at both 4 and 16 weeks were significantly higher than that at 1 week (P0.05), but there was no difference between 4 and 16 weeks (P0.05). The smooth muscle to collagen ratio in the CNEI group was significantly lower than in the control group at the 4- and 16-week follow-ups (P0.05), and the ratio at 16 weeks was further reduced compared with that at 4 weeks (P0.05).In the CNEI rat model, we found the damaging effects of CNEI were accompanied by a decline in ICP, reduced numbers of nerve fibres in the dorsal penile nerve, and exacerbated fibrosis in the corpus cavernosum. This may provide a basis for studying potential preventative measures or treatment strategies to ameliorate ED caused by CNEI during RP.

Curcumin possesses chemopreventive properties against several types of cancer, but the molecular mechanisms by which it induces apoptosis of cancer cells and inhibits cancer cell proliferation are not clearly understood. To evaluate the antitumor activity of curcumin for prostate cancer, we used an androgen dependent LNCaP prostate cancer cell line and an androgen independent PC-3 prostate cancer cell line as experimental models. We treated these cells with curcumin and then evaluated the effects of curcumin on cell cycle profiling and apoptosis, as well as the activation of NF-kaapaB and c-jun in these cells. The results showed that the ratios of apoptosis in LNCaP and PC-3 cells were significantly elevated in a dose dependent manner after exposure to curcumin. In addition, curcumin induces the G2/M cell cycle arrest of LNCaP and PC-3 cells in a dose dependent manner. Mechanistically, we found that curcumin upregulated the protein level of NF-kappaB inhibitor IkappaBalpha and downregulated protein levels of c-Jun and AR. These data suggest that curcumin is a promising agent for the treatment of both androgen-dependent and androgen-independent prostate cancer.

To describe the complications of transperineal end-to-end anastomotic urethroplasty in patients with posterior urethral strictures resulting from pelvic fracture.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.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 (0.1%) patients before trauma and in 487 (85%) patients after trauma. There was no statistical difference between the incidences of preoperative and postoperative ED (85 vs 86%, P0.05). Nine (1%) patients were found to have false passage between the posterior urethra and bladder neck.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 assess the diagnostic value and potentially protective capacity of tumor necrosis factor-alpha (TNF-alpha), interleukin 1beta (IL-1beta) and heat-shock protein 70 (HSP70) in chronic bacterial prostatitis (CBP) and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).We determined the levels of cytokines TNF-alpha, IL-1beta and HSP70 by ELISA in the seminal plasma of 150 men: 36 with CBP, 43 with CP/CPPS IIIA, 46 with CP/CPPS IIIB, and 25 healthy controls. We analyzed the correlation of the HSP70 expression in the CBP and CP/CPPS patients with the chronic prostatitis symptom index (CPSI).Significantly increased levels of TNF-alpha, IL-1beta and HSP70 were observed in the seminal plasma of the CBP patients as compared with the CP/CPPS patients and healthy controls. The expression of IL-1beta was significantly higher in the patients with CP/CPPS IIIA than in those with CP/CPPS III B and the controls, while the HSP70 level remarkably lower in those with CP/CPPS than in the controls, and its concentration in the seminal plasma of the CBP patients was negatively correlated with CPSI.The levels of HSP70 and IL-1beta in the seminal plasma appear to be most reliable molecular biological markers for the diagnosis of CBP and CP/CPPS, respectively. HSP7O has an important protective role in the regulation of cell functions in CBP patients. CP/CPPS is probably detrimental to the function of T cells and consequently suppresses the expression of HSP70.

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.

Plasma antenna has characteristics such as low RCS, reconfigurable, etc. But compared with common metal antenna, it has larger size and weight and need extra exciting RF power. In plasma antenna research, the most serious problem is the antenna gain which is difficult to compare with common metal antennas. This article introduces the plasma antenna progress of the Chinese Academy of Science, which has begun this theme since 2004. In our research, we have got good antenna gain and pattern parameters that are very close to metal antennas.

The improved calculation method ofb value is presented in this paper. The method can enlarge the role of earthquake occurrence frequency inb value calculation and thus increase theb value variation amplitude. In this case, the combination structure variation between earthquake magnitudes and corresponding frequencies could be shown clearly. According to the calculation and analysis for limited mainshocks in the complete seismicity data of selected monitored area with assigned consistent lowest magnitude, the precursor anomaly features, quantitative indexes and the calculation formula of relative subject function ofb value variation have been preliminarily worked out. The prediction in short period (from 1 to 3 months) for damage earthquakes in the monitored area mentioned above can be put forward on the basis of the results of quantitative calculation and analysis.

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.

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.

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.

• 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.

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.