改良尿道套入法治疗后尿道狭窄

目的评价改良尿道套入法治疗外伤性陈旧性后尿道狭窄或闭锁的疗效.方法回顾性分析1991～2002年采用改良尿道套入法治疗67例后尿道狭窄或闭锁病人的临床资料.结果59例术后排尿通畅,4例术后近期需行尿道扩张,4例失败.无严重并发症.结论改良尿道套入术是治疗后尿道狭窄或闭锁安全有效方法,而且操作简单、并发症少.     

Parameatal urethral cyst

Parameatal urethral cyst is a rare clinical entity, resulting in asymptomatic cosmetic concerns, distortion of urinary stream or difficulty in urination. Though they cause considerable parental concerns, natural history is to resolve spontaneously or rarely surgical excision is needed. We report a neonate with asymptomatic parameatal urethral cyst.     

种植尿道黏膜细胞的可降解尿道支架重建战伤后尿道的形态学研究

目的:比较种植尿道黏膜上皮细胞的网状生物可降解尿道支架与单纯螺旋形尿道支架重建战伤后尿道狭窄的组织相容性及形态学变化。方法:成年新西兰雄兔18只,取原代培养兔尿道上皮细胞,种植于网状生物可降解尿道支架上,进行形态学鉴定及染色,观察存活状态。将种植尿道黏膜细胞的支架与单纯尿道支架,植入战伤性尿道狭窄动物模型,观察两种尿道支架重建损伤后尿道的组织相容性及形态学改变。结果:培养的尿道黏膜上皮细胞在网丝孔隙中黏附、增殖状态良好。结论:种植尿道黏膜上皮细胞的网状生物可降解尿道内支架,具有良好的修复重建战创伤后尿道狭窄的功能,有望成为修复重建战伤性尿道狭窄的有效方法。     

膀胱穿刺尿道探子辅助腔镜尿道会师治疗11例尿道球部完全断裂

目的探讨球部尿道完全断裂在腔镜下尿道会师寻找断端困难时,完成腔镜下尿道会师术的辅助方法。方法 11例尿道球部完全断裂患者在单一腔镜下尿道会师术时,发现难以找到断裂近端尿道,及时采取耻骨上膀胱穿刺,插入尿道探子。结果 9例患者均在膀胱穿刺尿道探子插入辅助引导下完成一期尿道会师。结论球部尿道完全断裂在腔镜下尿道会师寻找断端困难时,采取膀胱穿刺尿道探子插入辅助引导,可完成一期腔镜下尿道会师术。     

A surface-modified biodegradable urethral scaffold seeded with urethral epithelial cells

Background  Efficient cell adhesion and proliferation is a central issue in cell-based tissue engineering, which offers great promise for repair of urethral defects or strictures. This study evaluated the adhesion and growth of rabbit uroepithelium on a surface-modified three-dimensional poly-L-lactic acid (PLLA) scaffold.

Methods  Urethral mucosa were harvested from male New Zealand rabbits and the urothelium were dissociated and then cultured. Immunocytochemistry on cultured uroepithelium for pancytokeratin and uroplakin II and TE-7 confirmed pure populations. After in vitro proliferation, cells were seeded onto a surface-modified urethral scaffold with non-knitted filaments. The morphology and viability of the cells were examined by immunohistochemical and fluorescence staining. Inverted and scanning microscopes were used to document cell growth and adhesion.

Results  Three to five days after primary culture, the uroepithelial cells gradually became confluent, assuming a cobblestone pattern. The filaments of the urethral scaffold had excellent biocompatibility and allowed growth of the uroepithelium, without affecting viability. The uroepithelial cells adhered to and grew well on the scaffold. After 3–7 days, the cells grew vigorously and meshes of the scaffold were full of uroepitheliums.

Conclusions  The surface-modified urethral scaffold with non-knitted filaments allows the growth of uroepithelium and can serve as a carrier for the tissue engineering of urethra.

     

双内镜尿道会师术微创治疗尿道断裂伤

目的:探讨双内镜尿道会师术双内镜进行治疗手术方法的临床价值和操作技巧。方法:对9例尿道断裂伤患者运用双内窥镜技术,进行尿道会师术治疗。结果:9例患者均顺利完成手术,手术时间30～108 min,平均72 min。术后4～5周拔除导尿管,患者均自主排尿,定期尿道扩张,随诊6～12个月,7例无尿道狭窄,2例失随访。结论:双内镜尿道会师术微创治疗尿道断裂伤是一种操作简单、微创、疗效确切的方法。     

Congenital urethral fistula

A 3-year-old male child was presented with the history of passage of urine coming from the undersurface of penis and its tip since birth. An opening was present on the ventral aspect of midshaft of penis through which a catheter could be passed. It was diagnosed as urethral fistula which was managed surgically.     

Male urethral cancer

A 55 years old man presented with long standing voiding obstructive symptoms like poor stream, frequency of micturition, straining at micturition and a sense of incomplete evaluation since 2002. He was clinically diagnosed a case of stricture urethra. Later he developed a swelling in the penoscrotal region with retention of urine in March 2005 and was treated by dilatation. But on removal of the catheter he developed retention again for several times and ultimately for gross periurethral sepsis, urinary diversion was required in May 2005. In October 2005, biopsy from the scrotal abscess wall established the diagnosis of urethral carcinoma. In November 2005 extensive penoscrotectomy was done followed by chemo-radiotherapy. But the prognosis was so bad that the patient died in November 2006. Urethral carcinoma is a rare disease diagnosed in the department of urology, Mymensingh Medical College Hospital, the prognosis of which is also poor even after extensive operations.     

无痛导尿管联合利多卡因可减轻术后导尿管引起的尿道刺激症状

目的 研究无痛导尿管联合利多卡因行膀胱冲洗对患者术后留置导尿管引起的尿道刺激症状的疗效.方法 将2011年6月～2012年1月男性患者,在我科行手术治疗,术后留置导尿管的患者分为两组,每组病例60人,第1组患者采用无痛导尿管联合利多卡因,术后第1天将利多卡因配生理盐水行膀胱冲洗,第2组患者采用普通导尿管,不行利多卡因配生理盐水膀胱冲洗,观察术后患者出现尿道刺激症状(尿道疼痛,尿急,会阴部不适等)情况.结果 第1组患者出现尿道刺激症状的患者人数11人,其余患者无特殊不适,第2组患者出现尿道刺激症状的患者人数约24人,其余患者无特殊不适,两组数据资料,具有明显的统计学差异(P＜0.05).结论 无痛导尿管联合利多卡因行膀胱冲洗可明显减轻术后留置导尿管给患者带来的尿道刺激症状,值得临床推广应用.     

尿道狭窄术后反复尿道扩张的临床疗效

目的：探讨尿道狭窄术后反复行尿道扩张治疗的临床疗效。方法：142 例各类尿道狭窄患者,将其 中尿道狭窄术后排尿症状无改善患者分为再次行手术治疗或反复行尿道扩张组,随访1~3 个月分析比较2 组的 临床疗效。结果：术后排尿症状无改善者42 例,其中27 例再次行手术治疗,21 例症状明显改善;15 例行反 复尿道扩张,5 例症状改善;再次行手术治疗组与反复行尿道扩张组比较,差异有统计学意义(P<0.01)。结论： 反复尿道扩张对尿道狭窄术后尿线变细症状有一定改善,但对于手术效果不满意、术后再次狭窄的治疗并无明 显疗效。     

A new urethral catheter

A new balloon catheter for women with a flexible urethral portion that conforms to the shape of the closed urethra was tested. In sheep control catheters caused epithelial destruction, which was absent with the conformable catheter. A 12 week crossover trial compared control catheters in 52 long stay geriatric patients. Eighty two out of 91 conformable catheters were rated as comfortable compared with 68 of 87 control (p = 0.006). The average length of time in situ was 15.9 days for the conformable catheter compared with 12.9 days for the control (p = 0.001). The average number of bypasses a week with the conformable catheter was 1.1 compared with 1.3 for the control; this difference was not significant. Examination of 249 used catheters showed significantly fewer with intraluminal obstruction with struvite among the conformable than control catheters (1 (0.8%) versus 15 (11.5%); p less than 0.001). This new catheter for women is a substantial improvement over the Foley catheter and (except in urethral stricture) is suitable for all forms of drainage.     

Reconstruction of urethral injuries

OBJECTIVES: To highlight the complexity of urethral injuries and to emphasise their prevention. DESIGN: A retrospective study. SETTING: Coast Province General Hospital, Mombasa, Kenya. SUBJECTS: Twenty two male patients operated between 1997 and 2007. RESULTS: Surgery for urethral injuries was done on 22 patients; 16 were of the posterior urethra, five bulbar urethra and one proximal penile urethra. The posterior urethral injuries were due to: pelvic fracture in 14, penetrating stick in one, and one animal injury by a buffalo. The bulbar urethral injuries were due to straddle injuries in four and one gunshot injury. The penile urethral injury was by compression of the subject by a motor vehicle against a wall. Anastomotic urethroplasty was performed in 20 patients, of whom 16 had complete recovery. Surgery for all bulbar and the penile urethral injuries was successful. Failure of repair with restenosis occurred in four patients with posterior urethral injuries. Bouginage was done in one patient who subsequently required no further treatment. Eventual total obliteration occurred in three patients. Reoperation was done in two of these with complete recovery in one and failure in the other who had two further urethroplasties, optical urethrotomy and is currently on clean intermittent self catheterisation. The fourth patient awaits reoperation. Sutureless membranous urethroplasty was done in two patients with posterior urethral injuries in whom sutures could not be inserted into the proximal prostatic urethra. One developed stenosis a year later, had optical urethrotomy and commenced on clean intermittent self catheterisation for a while, without further trouble. The other developed total obliteration. At repeat surgery enhanced scarring with urethral shortening were found and the operation was abandoned. The Mitrofanoff principle was applied with an appendicovesicostomy; one form of urinary diversion with a continent catheterisable conduit. On follow up, now nine years, the diversion is continent, has no catheterisation difficulties, and no urinary calculi. CONCLUSION: Urethral injuries are difficult to manage. A two pronged approach is advanced; prevention and competent repair. Surgeons managing these injuries are encouraged to acquire the needed reconstruction skills. Emphasis on prevention is paramount. Appropriate road, industrial and occupational safety measures should be enforced. Iatrogenic injuries can be avoided by due care during catheterisation and urethral instrumentation.