前尿道代后尿道成形术治疗男性复杂性后尿道狭窄

目的探讨长段复杂性后尿道狭窄治疗新方法。方法采用分期前尿道代后尿道成形术治疗3例复杂性后尿道长段狭窄（6．5—10．0cm）患者。第一期行阴茎转位尿道端端吻合术，术后3—6个月行二期阴茎伸直、尿道会阴造口术，6个月后行第三期前尿道成形术（Johanson Ⅱ期尿道成形术）。结果例1术后排尿通畅，膀胱尿道造影检查示尿道通畅，双侧输尿管返流近消失，最大尿流率18．8ml／s，随访2年，最大尿流率18ml／s，无剩余尿。例2术后排尿通畅，最大尿流率19．5ml／s，无剩余尿，尿道扩张可顺利通过22F尿道探子。例3经会阴一耻骨联合径路行第一期阴茎转位尿道端端吻合术、尿道直肠瘘、尿道会阴瘘切除、修补术，术后尿道直肠瘘及尿道会阴瘘治愈，但因耻骨联合切口感染致吻合口狭窄，有待进一步治疗。结论分期前尿道代后尿道加前尿道重建方法是治疗男性长段复杂性尿道狭窄的有效方法。     

Ultrasound evaluation of female urinary incontinence

Thirty women, 25 with incontinence and five asymptomatic volunteer control subjects, were evaluated urodynamically by a variety of techniques, including ultrasound cystourethrography. The ultrasound evaluation was found to be a helpful adjunct in diagnosis. In comparison with radiologic techniques it offers more safety, more comfort, more privacy, more viewing time, and less cost. Bladder and urethral morphology during voiding activity and the amount and direction of urethrovesical mobility are easily determined by utilizing ultrasound techniques.     

应用膀胱三角区壁瓣成形尿道治疗女性外伤性尿道缺损(附5例报告)

目的：探讨膀胱三角区壁瓣成形尿道治疗女性外伤性尿道损伤的疗效。方法：自膀胱颈后唇向上，取梯字形壁瓣，形成锥状管，经膀胱颈口，自阴道前壁外拉至外阴部，在原尿道外口处固定，替代尿道。结果：3例随访8年，1例6年，1例5年，平均随访7年，均排尿通畅，无尿失禁和尿道狭窄。结论：女性外伤性尿道缺损，应用膀胱三角区壁瓣形成锥状管替代尿道法治疗，手术简单，对患者打击小，成功率高，远期效果好。     

术后胆漏和继发胆管狭窄的内镜治疗

胆漏和继发胆管狭窄是严重的外科并发症，传统的治疗方法是再次开腹手术，但再手术并发症多，死亡率高。而内镜胆管造影不仅可明确诊断，且内镜下治疗具有安全、疗效肯定、创伤小和并发症少等优点，可作为大多数胆漏和胆管狭窄患者首选治疗方法。     

生物可降解性尿道内支架修复战伤性尿道狭窄的研究

目的建立战伤性尿道狭窄动物模型,探讨生物可降解性尿道内支架对其进行重建修复的可行性。方法将新西兰雄兔28只分为两组,实验组(n=20):以定位爆炸法建立尿道狭窄模型。一月后行逆行尿道造影、尿道镜检查,并切除狭窄段尿道,行病理组织学观察证实。后置入人工合成生物可降解尿道内支架,置入术后2、4、8、12周分别行逆行尿道造影、尿道镜检查以及尿流动力学检测。并在以上各时间点处死5只动物,取狭窄处尿道组织,观察组织学修复重建情况。对照组(n=8):于实验组爆炸处理后4周和支架置入12周,分别取对照组4只动物与实验组对比观察。结果实验组所有动物爆炸后4周在尿道球部狭窄形成稳定狭窄模型(狭窄段长5～10 mm,尿道腔缩窄50%以上)。尿道内支架置入后2周,组织学观察见黏膜上皮新生迹象,并有炎性细胞浸润;4周时上皮新生明显,炎性细胞消失;8周时出现尿道平滑肌细胞再生,12周时见损伤后尿道组织结构完全修复,与正常尿道组织比较差异无统计学意义(P>0.05)。。同时间点尿道镜检查证实尿道腔隙、黏膜形态结构无异于正常对照组。尿流动力学检测显示两组间差异无统计学意义(P>0.05)。。结论应用成功建立的战伤性尿道狭窄动物模型,证实生物可降解性尿道内支架能作为修复战伤性尿道狭窄的理想材料,具有损伤小,易操作,功能恢复快的特点。     

睾丸鞘膜瓣在尿道修复中的应用

目的探讨睾丸鞘膜瓣覆盖技术在尿道畸形和尿道瘘修复中的效果。方法2002年起对38例尿道下裂手术和术后尿道瘘,采用睾丸鞘膜下组织蒂鞘膜瓣覆盖修复。结果术后随访半年至1年,除1例尿道上裂术后瘘修复后再次发生尿道瘘外,其余均获成功,未再出现尿道瘘或尿道狭窄,阴茎外观满意,勃起正常。结论采用该方法可有效防止尿瘘再发生,提高手术成功率且易于获取,对睾丸无不良影响。     

Larger urethral catheter size leads to fossa navicularis stricture formation in robotic radical prostatectomy

Fossa navicularis strictures following radical prostatectomy are reported infrequently. We recently experienced a series of fossa strictures following robotic-assisted laparoscopic prostatectomy (RLP). We describe herein our experience to prevent fossa strictures and to determine its etiologic factors. From June 2002 to May 2006, 424 patients underwent robotic-assisted laparoscopic prostatectomy with the da Vinci surgical system. Fossa strictures were diagnosed based on the acute onset of obstructive voiding symptoms and bougie calibration. During our series, we switched from the intra-operative use of an 18 French (F) catheter to that of a 22 F one to avoid inadvertent stapling of the urethra when dividing the dorsal venous complex. After we observed a high incidence of fossa strictures, we reverted back to 18 F catheters during surgery. All patients had an 18 F catheter indwelling for 1 week after surgery. Parameters were evaluated using Fisher’s exact test and Student’s t-test for means. The 18 F catheter group of patients (n = 293) developed one fossa stricture, whereas the 22 F catheter group (n = 131) developed nine fossa strictures (P < 0.01). The fossa stricture rate in the 18 F group was 0.3% versus 6.9% in the 22 F group. The two groups had no differences in age, body mass index, cardiovascular disease, American Urological Association symptom score, urinary bother score, preoperative prostate-specific antigen, operative time, estimated blood loss, cautery use, prostate size, or catheterization time. Based on these results, a larger urethral catheter size – 20 F versus 18 F – during the intra-operative dissection would appear to increase the risk for fossa stricture by more than 20-fold. Statement of disclosure Dr. Thomas Ahlering is a meeting participant and lecturer for Intuitive Surgical Corp. The other authors have no direct or indirect commercial financial incentives associated with publishing the article. No research or project support funding was received.     

经尿道手术治疗尿道狭窄与闭锁(附364例报告)

目的 提高经尿道手术治疗尿道狭窄与闭锁的成功率。方法 总结364例经尿道手术治疗尿道狭窄与闭锁的经验。患者平均年龄43岁。病程1个月～23年。尿道狭窄与闭锁长度平均2．2cm。结果 364例中手术成功343例(94．23%)，其中一次成功290例，二次手术成功34例，三次手术18例，四次手术1例；手术失败21例，其中20例改为开放手术，失败原因主要为骨盆骨折致尿道错位成角，骨片压迫尿道。术后268例随访4～138个月，平均34个月。17例感染性尿道狭窄者及29例骨盆骨折后尿道狭窄者术后曾需短期尿道扩张，其余排尿通畅。结论经尿道手术治疗尿道狭窄与闭锁安全、有效，是尿道狭窄与闭锁的首选治疗方法。术后尿道扩张是防止再狭窄的重要手段．     

Role of the pelvic floor in bladder neck opening and closure I: Muscle forces

The aim of the study was to identify the striated muscle forces hypothesized to assist bladder neck opening and closure in females. Cadaveric dissection was used to identify the levator plate (LP), the anterior portion of pubococcygeus muscle (PCM), the longitudinal muscle of the anus (LMA), and their relation to the bladder, vagina and rectum. X-ray video recordings were made during coughing, straining, squeezing and micturition in a group of 20 incontinent patients and 4 controls, along with surface EMG, urethral pressure and digital palpation studies. During effort, urethral closure appeared to be activated by a forward muscle force corresponding to PCM, and bladder neck closure by backward muscle forces corresponding to LP and LMA. During micturition the PCM force appeared to relax, allowing LP and LMA to pull open the outflow tract. The data appear to support the hypothesis of specific directional muscle forces stretching the vagina to assist bladder neck opening and closure.     

Change in urethral pressure during voluntary pelvic floor muscle contraction and vaginal electrical stimulation

The purpose of the study was to compare the effect of voluntary pelvic floor muscle (PFM) contraction and vaginal electrical stimulation on urethral pressure. Twelve women with genuine stress incontinence, mean age 49.4 years (range 33–66) participated in the study. The urethral and bladder pressures were recorded simultaneously through a double-lumen 8 Ch catheter. The patients first performed three voluntary PFM contractions. Then two electrical stimulators, Conmax and Medicon MS 105, 50 Hz, were used in random order. A visual analog scale was used to measure pain and discomfort. Pain was reported to mean 6.8, SEM 0.64 (range 0.7–9.9) and mean 6.1, SEM 0.81 (range 0–9.1) with Conmax and Medicon MS 105, respectively. The mean paired difference in favor of voluntary contraction with Conmax was ?8.0, SD 6.7,P=0.0067, and with Medicon MS 105 it was ?12.2, SD 5.9,P=0.0022. The results demonstrated that voluntary PFM contraction increased urethral pressure significantly more than did vaginal electrical stimulation.