尿道下裂与扩大的前列腺囊

目的　探讨尿道下裂患者扩大的前列腺囊发生率及对尿道成形术的影响与处理方法。　方法　通过体检、尿道造影、尿道膀胱镜检查对 52例尿道下裂患者扩大的前列腺囊的发病率及程度 ,单纯尿道下裂与同时合并扩大的前列腺囊患者尿道成形术后尿瘘发生率进行分析。　结果　 52例中合并扩大的前列腺囊 1 6例 ,占 31 %。阴茎头型 5例、阴茎型 8例、阴茎阴囊型 2 0例、会阴型 1 9例 ,合并扩大的前列腺囊分别为 0、1、6、9例 ,且随尿道下裂严重程度的增加级别增高。术后尿瘘发生率单纯尿道下裂为 1 8.2 % ,合并扩大的前列腺囊者为 4 6 .7%。　结论　随尿道下裂程度增加 ,扩大的前列腺囊发生率及程度增加 ,术后尿瘘发生率亦逐渐增加。     

输尿管镜钬激光治疗尿道下裂术后尿道狭窄

目的:探讨尿道下裂术后尿道狭窄的治疗方法,研究输尿管镜联合钬激光治疗尿道下裂术后尿道狭窄的临床疗效。方法:对10例先天性尿道下裂尿道成形术后并发尿道狭窄患者进行输尿管镜下钬激光治疗,切除尿道息肉、线结及狭窄环。结果:10例患者手术顺利完成,术后3周拔除导尿管排尿通畅。结论:尿道下裂术后尿道狭窄多发生于成形尿道与原尿道交界处。传统的尿道扩张或开放手术均存在一定弊端,而输尿管镜联合钬激光治疗尿道下裂术后尿道狭窄临床疗效满意。     

输尿管镜检查术并发输尿管撕脱1例

患者,男,46岁.因左输尿管镜检查术后28 h伴左腰部及下腹部胀痛25 h,于2007年12月9日由外院转入.患者于4天前因酒后突发肉眼血尿,在外院经B超检查诊断为左肾积水(左输尿管结石待排),给予止血、解痉等治疗,症状无明显改善,排除手术禁忌,急诊行输尿管镜检查术.     

输尿管镜在原发性输尿管肿瘤诊断中的应用

近年来,原发性输尿管恶性肿瘤发病率有增高趋势,可能与发病者增多和诊断水平提高有关。其中移行细胞癌占绝大多数,其次为腺癌、鳞癌、未分化癌等。现将我们近年来诊治并经手术、病理证实的7例病例资料报告如下。     

输尿管镜碎石术并发输尿管损伤临床分析

目的总结输尿管镜碎石术并发输尿管损伤及其防治措施。方法对150例应用输尿管镜碎石术患者临床资料进行回顾性分析,统计术中、术后输尿管损伤发生情况及其处理方法。结果发生输尿管损伤7例,均术中发现,其中输尿管穿孔5例。均成功留置双J管;l例术中输尿管下段完全断裂改开放手术行输尿管膀胱再植术治愈;1例术中发现下段粘膜撕脱约lcm,经抗感染、留置双J管2个月等治疗后恢复。结论应用输尿管镜手术成功率高。输尿管损伤较少见.且绝大多数行保守治疗可得到解决;熟练的手术操作是减少输尿管损伤的关键。     

输尿管导引鞘在Ⅲ度以上前列腺增生患者输尿管中下段结石清除术中的应用

目的探讨为避免同期或分期先处理前列腺增生, 将输尿管导引鞘应用于Ⅲ度以上前列腺增生患者输尿管中下段结石清除术中的安全性和有效性。方法回顾性分析2018年4月至2020年12月于浙江衢化医院采用留置输尿管导引鞘+输尿管硬镜钬激光碎石取石术处理的27例Ⅲ度以上前列腺增生合并输尿管中下段结石患者的临床资料。患者均为男性, 年龄(69.7±12.8)岁(范围:55～87岁), 经直肠超声测量前列腺体积为(94.8±16.2)cm3(范围:85～186 cm3)。术中先留置输尿管导引鞘, 再从导引鞘引入输尿管硬镜, 进行钬激光碎石取石术, 并记录术中术后并发症。术后1、2个月复查泌尿系X线片或CT尿路造影了解结石残余、输尿管狭窄等情况, 评价临床疗效。结果 27例患者均顺利一期留置输尿管导引鞘并在输尿管硬镜下行钬激光碎石取石术, 术中及术后无输尿管撕脱穿孔、肾周血肿、感染性休克、严重血尿、尿潴留、医源性输尿管狭窄等重大并发症。术后1个月排石率92.6%(25/27), 术后2个月排石率为100%(27/27)。2例患者由于术前结石最大径>20 mm, 术后存在结石残余, 接受体外冲击波碎石...     

尿道下裂的术式选择-会阴型和阴茎阴囊型

目的 总结会阴型尿道下裂和阴茎包皮岛状皮瓣一期修复阴茎阴囊型尿道下裂的最佳术式.方法 将2000年1月至2015年1月本院收治的38例尿道下裂患儿,其中阴茎阴囊型25例、会阴型13例,按照尿道下裂的不同类型进行阴茎包皮岛状皮瓣设计、移位和尿道成形修复手术.阴茎包皮岛状最长7.5cm,宽1.5～1.8cm.结果 术后11例发生尿瘘,其中会阴型5例,阴茎阴囊型6例,经修补后痊愈.本组患者术后阴茎外形正常,无扭曲或臃肿、尿道开口达到正常解剖部位,均能正常排尿或有很大改善接近正常.结论 阴茎包皮岛状皮瓣一期修复阴茎阴囊型和会阴型尿道下裂是一种较为安全有效的手术方法.     

输尿管镜钬激光碎石术中输尿管狭窄的处理

目的探讨输尿管镜钬激光碎石术中输尿管狭窄的处理方法。方法 2008年4月至2009年12月,共行输尿管镜碎石术306例,其中75例合并输尿管狭窄,分别接受输尿管镜下狭窄扩张、钬激光内切开等治疗,回顾性总结处理方法、疗效及其并发症。结果 75例结石合并输尿管狭窄,9例直接开放手术,66例采用输尿管镜下扩张或内切开治疗,其中51例经腔内处理后成功碎石,2例出现术中并发症。出院前复查结石完全清除率84%(63/75),拔除双J管前结石清除率92%(69/75),拔管后1个月结石清除率97.2%(70/72),复查超声无肾积水加重者。结论输尿管结石合并其远端输尿管狭窄可通过输尿管镜腔内技术有效解决。     

会阴造瘘在尿道下裂成形术中的应用

目的:探讨尿道下裂成形术中会阴造瘘引流替代传统膀胱造瘘引流的优越性。方法:对于尿道下裂成形术会阴造瘘引流与膀胱造瘘引流随机分组分析。结果:会阴造瘘组手术成功率远大于膀胱造瘘组。结论:会阴造瘘引流在尿道下裂成形术中有很高的实用价值。     

输尿管镜下钬激光术治疗并发息肉的输尿管结石疗效观察

目的:探讨输尿管镜下钬激光术治疗并发息肉的输尿管结石的有效性、安全性及相关技巧.方法:采用硬性输尿管镜下钬激光术治疗并发息肉的输尿管结石患者60例.输尿管结石大小0.5 cm×0.5 cm～1.5cm×2.2 cm,在结石周围或下方均并发息肉.结果:手术时间10 min～1 h,平均21 min.60例患者息肉均一次治疗成功;除2例上段结石被冲入肾盂外,其余58例均单次原位碎石成功.中、下段结石术中破碎率及4周后碎石排净率均为100%.术中未发生输尿管黏膜撕脱、输尿管穿孔、输尿管黏膜隧道等严重并发症.术后仅有轻微血尿,无低热、肾区疼痛等不适.结论:输尿管镜下钬激光术是治疗并发息肉的输尿管结石有效而安全的方法.     

Giant prostatic utricle associated with proximal hypospadias: repair by mucosa divesting and muscular tunnel obliteration

Purpose

The purpose of this study was to evaluate the effectiveness of a new approach to repair the giant prostatic utricle (pseudovagina) associated with proximal hypospadias.

Methods

Three patients with giant prostatic utricle associated with proximal hypospadias sought medical advice in our department from 1998 to 2003. The giant prostatic utricles were repaired using the novel approach of divesting of utricular mucosa followed by muscular tunnel obliteration through the opening of the pseudovagina in the dorsal lithotomy position.

Results

Follow-up ranges from 3 to 8 years. The divesting of the prostatic utricle mucosa was successful, and the pseudovagina muscular tunnel was closed completely in all 3 patients. One patient underwent urethroplasty and another repair of urethrocutaneous fistula at the same setting. The third patient underwent a second-stage urethroplasty separately. On follow-up, both the urethral reconstruction and the pseudovagina repair remained successful in all the patients.

Conclusions

The technique of the divesting of the prostatic utricle mucosa and closure of the muscular wall is an effective alternative approach for repairing giant prostatic utricles. It is safe and simple. The surgical exposure is very good.     

Classification of enlarged prostatic utricle in patients with hypospadias

An enlarged prostatic utricle is often associated with hypospadias. To evaluate the relationship between the incidence of prostatic utricle and the degree of hypospadias, we performed retrograde urethrography and/or micturating cystourethrography on 280 patients with hypospadias. Prostatic utricles were demonstrated in 84 patients (27.5%) and the incidence increased according to the severity of hypospadias. The prostatic utricles were classified into four types from the standpoint of size and location of the opening of the utricle, and a direct relationship was demonstrated between the severity of hypospadias and increasing size of the prostatic utricle.     

Testicular function in patients with hypospadias associated with enlarged prostatic utricle.

Of 485 patients with hypospadias who underwent urethrography, enlarged prostatic utricles were found in 173 (35.7%). Utricles with a higher grade of enlargement were seen mainly in patients with a severe degree of hypospadias. Serum testosterone levels before and after 3 days' treatment with human chorionic gonadotrophin were determined by radioimmunoassay in 97 prepubertal boys with hypospadias and enlarged prostatic utricles. Lower levels of serum testosterone were found after hormonal stimulation in 22 patients with high grade utricular enlargement when compared with 5 controls and 75 patients with low grade enlargement; the difference was statistically significant. This finding supports the hypothesis that utricular enlargement may be due to androgenic insufficiency during the critical period of organogenesis.     

Surgical treatment for enlarged prostatic utricle and vagina masculina in patients with hypospadias

Fourteen patients with hypospadias were treated surgically for either an enlarged prostatic utricle (6) or vagina masculina (8). Six vaginae masculinae were removed by an extravesical abdominal approach. One enlarged prostatic utricle was removed by the perineal approach. Three enlarged utricles were removed by an abdominoperineal approach. The transtrigonal approach was recently used for three enlarged utricles and one vagina masculina in four patients. Surgical results in these 14 patients were satisfactory. One post-operative complication of transient mild bilateral vesicoureteric reflux was seen after a transtrigonal removal of an enlarged utricle. Potency was not affected in any approaches in four patients who were older than 12 years. The transtrigonal approach was found to be the best for good exposure of the lesion.     

先天性尿道下裂与SRY基因关系的探讨

目的 探讨尿道下裂与SRY基因的关系及意义。结果 采用PCR方法对42例先天性尿道下裂患者外周血白细胞进行SRY基因检测。结果 发现2例染色体核型为46,XY患者SRY基因缺失,DNA样品加入EF3、ER3引物及新Taq酶后,PCR反应结果可见332bp的Sox9基因片段,对照46,XY正常成年男性基因组DNA扩增产生436bpSRY基因片段。结论 （1）SRY基因不是性别决定的唯一基因。SRY基因缺失或突变可能导致性发育的一系列异常改变,尿道下裂的发生与SRY的缺失、变异有关。（2）先天性尿道下裂是一种性别发育异常,尿道缺失是性腺发育不全表现。（3）对尿道下裂患者进行SRY基因检测有一定的临床意义。     

A study of quantitative and qualitative abnormality of androgen receptor in patients with hypospadias associated with enlarged prostatic utricle]

The prostatic utricle, a rudimentary structure present in the male prostatic urethra, is currently thought to be of mixed origin, with its cranial portion being derived from müllerian duct and caudal segment from wolffian and müllerian ducts and the urogenital sinus. Enlargement of prostatic utricle has often been demonstrated in patients with hypospadias and its incidence increased according to the severity of hypospadias. It has been suggested that insufficient androgenic stimulation of the urogenital sinus and urethral groove during the critical period of sexual differentiation may cause this entity. Since 5 alpha-dihydrotestosterone (DHT) is a major androgen for the normal development of urogenital sinus, androgen receptor levels in the patients with hypospadias associated with enlarged prostatic utricle may concern this ontogenesis. Fibroblasts derived from penile skin in these patients were assayed for androgen receptor levels using dispersed whole cell binding assay after Eil (1970). Thermostability of androgen receptor in the same fibroblasts was also evaluated by the remaining androgen receptor activity after incubation at 42 degrees C, and expressed as a ratio (percentage) to the androgen receptor activity in the incubation at 22 degrees C. Preputial skin of endocrinologically normal boys in the same range of age (3 to 8 years) was served as controls. There was a significant difference in averages of maximum binding capacities of [3H]DHT to the androgen receptor between those of controls (n = 4) and patients with grade II utricle (n = 4) (89 +/- 5.7 (SE) x 10(2) sites/cell vs. 37 +/- 7.1 x 10(2) sites/cell).(ABSTRACT TRUNCATED AT 250 WORDS)     

尿道下裂患者MID1基因突变的研究

目的：探讨MID1基因在尿道下裂发病中的作用。方法：收集96例先天性尿道下裂患者外周静脉血，提取DNA，采用PCR扩增直接测序的方法检测MID1基因全部外显子序列。结果：在2个患者中发现2种突变，位于第一外显子的T64T同义突变和位于第九外显子的A620V错义突变，均没有报道过。结论：MID1基因在尿道下裂的发病中并不起主要作用。     

良性前列腺增生患者血清PSA与年龄变化的关系

目的　建立我国良性前列腺增生 (BPH)患者血清总前列腺特异性抗原 (T PSA)各年龄段特异性的参考范围。　方法　对 913例年龄 30～ 89岁、初诊为BPH或可疑为前列腺癌 (PCa)的患者行血清T PSA及游离PSA(F PSA)检查。患者均行B超检查 ,对可疑PCa者经直肠超声引导下行前列腺系统穿刺活检。采用单因素回归分析及动态序列分析方法分析患者T PSA、F PSA及F/T比值与年龄变化的关系。　结果　 10 3例患者经活检诊断为PCa ,检出率 11.3%。 810例BPH患者血T PSA及F PSA与年龄呈正相关 (r=0 .2 2 ,P <0 .0 0 1;r =0 .17,P <0 .0 0 1) ,F/T比值与年龄呈负相关 (r = 0 .16 ,P <0 .0 0 1)。T PSA及F PSA每年分别增加约 4 .4 %和 2 .7% ,F/T比值每年下降约1.3%。BPH患者年龄特异性T PSA值 4 0岁～为 0～ 1.5ng/ml;5 0岁～为 0～ 3.0ng/ml;6 0岁～为0～ 4 .5ng/ml;70岁～为 0～ 5 .5ng/ml;80岁～为 0～ 8.0ng/ml。 　结论　BPH患者血清T PSA和F PSA水平与年龄呈正相关 ,而F/T比值与年龄呈负相关 ;建立年龄特异性的T PSA界值范围可以提高PSA诊断PCa的特异性和敏感性     

尿道下裂患者SRD5A2基因突变的研究

目的 探讨SRD5A2基因在尿道下裂发病中的作用。方法 收集96例先天性尿道下裂患者外周静脉血，提取DNA，采用PCR扩增直接测序的方法检测SRD5A2基因全部外显子序列。结果 96例中有14例发现了8种突变，5种错义突变，1种同义突变，1种无义突变，1种移码突变。分别位于第1、4、5外显子。其中Gln6stop，His232His，Phe234Leu及移码突变没有报道过。结论 第4外显子是突变发生的热点区域，约1／10尿道下裂患者存在不同程度的SRD5A2基因结构异常。     

BPH膀胱出口梗阻患者的逼尿肌功能状况评价

为了解前列腺增生症（ＢＰＨ）膀胱出口梗阻（ＢＯＯ）患者的逼尿肌功能状况，对６７例ＢＰＨ患者进行了尿动力学及直肠Ｂ超检查，结果发现逼尿肌痉挛、逼尿肌低顺应性，逼尿肌括约肌功能不协调及逼尿肌收缩力亢进在梗阻病人中的发生率分别为３４．３％，１７．９％，２５．４％，２６．９％；有前列腺突入膀胱的患者更易发生逼尿肌功能受损。对ＢＰＨ患者的逼尿肌功能作出准确评价，在手术时机的选择及预后判断方面具有十分重要的临床意义。