尿道外口镜下尿道肉阜电切术治疗尿道肉阜115例疗效和安全性分析

目的 探讨尿道外口镜下尿道肉阜电切术治疗尿道肉阜的临床疗效和安全性。方法 对2008年11月至2022年6月115例术前诊断为尿道肉阜的患者实施尿道外口镜下尿道肉阜电切术,观察手术时间、术中出血量、术后住院时间、拔除尿管时间、术中术后并发症以及手术效果。结果 115例手术均顺利完成,平均手术时间（18.2±8.9）min,术中出血极少,术后住院时间（4.9±3.8）d,中位拔除尿管时间为7天。术后随访1～91个月,无尿道狭窄及肿物复发,患者原有的血尿、尿痛及排尿不适症状均已消失。结论 尿道外口镜下尿道肉阜电切术治疗尿道肉阜安全可靠,不仅精准、手术时间短,而且并发症少、恢复快,疗效确切,值得临床推广。     

尿道肉阜环切加尿道-阴道间距延长术治疗尿道肉阜的临床观察(附13例临床资料)

目的：观察尿道肉阜环切加尿道阴道间距延长术治疗尿道肉阜的临床疗效。方法：对2003年2月～2008年2月我科收治的13例女性尿道肉阜患者采用尿道肉阜环切加尿道-阴道间距延长术,观察其术后疗效及并发症发生情况。结果：本组12例患者治愈,手术时间15～30min,术中出血少。术后随访11例,随访时间3～15个月,治疗效果满意,无并发症出现。结论：尿道肉阜环切加尿道-阴道间距延长术治疗尿道肉阜具有治愈率高、复发率低、并发症少等优点,对肉阜较大及尿道-阴道间距过短者可考虑应用该手术治疗。     

女性尿道肉阜并发尿道—阴道壁融合症诊治（附42例报告）

目的　探讨尿道肉阜并发其他尿道综合症的诊断及防治方法。方法　尿肉阜者 ,若同时阴道口 -尿道口之间的最短距离 <0 .5cm ,则诊断为该症。采用尿道肉阜电切术加尿道外口阴道壁间距延长术 ,保持间距 >0 .6cm。结果 :痊愈 35例 (83.4% ) ,好转 6例 (14.2 % ) ,无效 1例 (2 .3% )。结论　尿道肉阜并发尿道 -阴道壁融合症的手术治疗必须同时处理。     

尿道外口粘膜环形切除术治疗女性尿道肉阜60例报告

女性尿道肉阜是女性尿道外口的常见疾病。治疗方法多以单纯切除或电烧灼为主,但其复发率很高,有的报告甚至超过50％。为了提高治疗效果,减少复发,我院对经过治疗复发的和基底广泛的以及较大的女性尿道肉阜60例,应用尿道外口粘膜环形切除术     

尿道肉阜行环切联合尿道-阴道间距延长术的临床分析

目的探讨尿道肉阜患者接受环切联合尿道-阴道间距延长术与尿道外口黏膜环切术治疗的临床效果及并发症发生情况。方法回顾分析2013年6月~2014年12月于我院接受治疗的80例尿道肉阜患者临床资料,随机将80例患者分为观察组(n=40)与对照组(n=40),对照组行尿道外口黏膜环切术进行治疗,观察组给予环切联合尿道-阴道间距延长术治疗,比较观察组与对照组临床疗效及术中出血量、手术时间、住院时间及并发症发生率。结果观察组与对照组并发症发生率分别为12.5%、32.5%,且观察组的总有效率(95.0%)明显优于对照组(72.5%),观察组患者手术所用时间(59.2±7.7)min、术中出血量(26.7±6.3)mL、住院时间(7.2±2.1)d,明显比对照组的(99.6±11.8)min、(46.5±9.5)mL、(9.3±2.8)d少,两组数据比较差异有统计学意义(P0.05)。结论尿道肉阜患者采用环切联合尿道-阴道间距延长术治疗效果明显,值得在临床大力推广使用。     

尿道外口粘膜环形切除治疗女性尿道肉阜

我院自1989～1993年治疗复发的和基底广泛的及较大的女性尿道肉阜，应用尿道外四粘膜环切术，取得较好效果，报道如下。1临床资料本组15例，年龄31～63岁，其中40岁以上者11例；经产妇12例；病程半年～10年。主要症状：排尿时尿道外四疼痛者最多，呈烧灼痛，次为肿物；出血者。直体：肿物突出于尿道外四，位置多在尿道后缘处，约黄豆大小不等。呈鲜红色或暗红色，质脆弱，易出血，多数为单个，少数呈环状分布尿道外口内底部，术后经病理检查确诊为尿道肉阜。手术方法：用0．1％新法尔灭液消毒后，局麻下用三角皮外把小阴唇分别缠于同侧大阴…     

尿道肉阜行环切联合尿道-阴道间距延长术的临床效果观察

目的:对尿道肉阜行环切联合尿道-阴道间距延长术的临床应用效果观察.方法:在该院2015年2月至2017年2月实施治疗的尿道肉阜患者中随机选取60例,依照患者治疗方式将其分成两组,其中对照组患者实施尿道外口黏膜环切术治疗,观察组患者实施环切联合尿道-阴道间距延长术,对比两组患者的临床效果.结果:和对照组患者相比,观察组患者的治疗有效率显著偏高,同时手术所用时间、术中出血量显著偏少,差异对比显著P ＜0.05.结论:环切联合尿道-阴道间距延长术在尿道肉阜患者治疗中的应用,能够显著改善患者临床效果,提高手术疗效,值得推广.     

经尿道前列腺切除后尿道狭窄原因分析(附22例报告)

目的探讨经尿道前列腺汽化(TUVP)联合电切术(TURP)切除前列腺增生(BPH)后尿道狭窄的原因及减少并发症发生的有效方法。方法分析22例施行TUVP加TURP切除前列腺后发生尿道狭窄的原因。结果尿道外口狭窄3例,反复尿扩后症状消失;尿道球部2例,经尿道冷刀切开后梗阻解除;前列腺尖部狭窄6例,膀胱颈部狭窄11例。重新给予电切治疗后治愈。感染、尿道损伤、前列腺尖部切除不完整、膀胱颈部挛缩是尿道狭窄的主要诱因。结论严格掌握手术指征,手术前后充分抗炎治疗及熟练细致地操作能有效地降低并发症的发生。     

经尿道前列腺电切术后尿道狭窄的相关因素分析

目的探讨经尿道前列腺电切术后导致尿道狭窄的原因。方法对本院36例经尿道行前列腺电切术后发生尿道狭窄患者的临床资料进行回顾性分析,总结其出现尿道狭窄的原因。结果 36例尿道狭窄患者中狭窄发生在尿道外口者14例,发生于阴茎悬垂部者10例,尿道球膜部者6例,前列腺尿道部者6例;36例患者经临床干预后均排尿畅通。结论经尿道前列腺电切术后导致尿道狭窄以尿道外口及悬垂部尿道多见,相关原因主要为术中器械操作、术后感染及留置导尿管等。     

钬激光治疗尿道肉阜42例体会

尿道肉阜是女性尿道外口常见的良性肿瘤，治疗方法多样，以手术为主。我科自2001年10月-2006年11月共收治尿道肉阜患者46例，其中42例做了尿道肉阜钬激光切除术，效果较好，现报告如下。[第一段]     

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。     

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。     

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.     

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。     

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.     

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.

     

Management of urethral strictures

Controlled clinical trials are unusual in surgery, rare in urology, and almost non-existent as far as the management of urethral stricture is concerned. What data there are come largely from so called "expert opinion" and the quality of this is variable. None the less, the number of so called experts, past and present, is comparatively small and in broad principle their views more or less coincide. Although this review is therefore inevitably biased, it is unlikely that expert opinion will take issue with most of the general points raised here.     

尿道损伤的护理

目的：探讨尿道损伤的护理方法。方法：回顾性分析166例尿道损伤伴急性尿潴留患者的临床护理资料,依据病情的严重程度及尿道损伤的类型进行相应治疗及护理。尿道部分断裂88例,完全断裂78例。42例留置导尿管成功,48例输尿管镜下留置导尿管,24例行尿道会师,42例尿道一期吻合术,10例病重仅行耻骨上穿刺造瘘。结果：42例拔出导尿管排尿正常,仅需1~2次尿道扩张,87例出院后定期尿道扩张,56例轻度尿路感染,无严重并发症发生。结论：严密观察病情、正确的治疗护理是保证患者生命安全、减少并发症、提高治愈率的重要保障。     

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。