Objective To investigate the effect of reinforcing spleen and kidney method on adriamycin-induced CKD in rats and to explore its possible mechanism.Methods Totally 36 Sprague-Dawley rats were randomly divided into a Adriamycin-induced model group and a control group.The model group was further divided into five groups:the Adriamycin-induced model control group,bennazepril-treated group,and TCM treated low,moderate,and high dose groups.The level of serum creatinine,urea nitrogen,24hours urine protein and urine creatinine were measured at 14,28,42 days after establishing the model rats.And the protein expression of transforming growth factor-β1 (TGF-β1) and cyclin-dependent kinase inhibitor p21cip1 (p21)were detected by immunohistochemistry.Results The proteinuria was observed on the seventh day after injection of adriamycin in adriamycin nephropathy model group,and reached summit on the fourteenth day.Both TCM treated groups and benazepril group reduced the level of urine protein within 24 hours (P＜0.05),the reduction was most remarkable in the TCM high dose group.The expression of p21 and TGF-β1 (p21 288627.66±97021.65,TGF-β1 98405.14± 19216.89) in kidney increased in the model groups,while the TCM treated high dose group (p21 518886.35±6810.89,TGF-β1 222012.95± 50484.73) was significantly lower than the model control group (P＜ 0.05).Conclusion Reinforcing spleen and kidney method could decrease the level of urine protein within 24 hours by regulating the expression of p21 and TGF-β1,so thus to protect renal function and delay progress of kidney disease.

Objective To investigate the risk factors of pelvic fracture related urethral injury (PFUI).Methods We retrospectively reviewed 120 patients with pelvic fracture from March 2014 to October 2016 in our hospital.Of all the patients,87 were males and 33 were females.The average age was (42.6 ± 15.4) years old (ranging 1 1-78 years old).The etiology of pelvic fracture included traffic accident in 70 cases,fall injury in 27 case.Heavy crash in 23 cases.43 male patients had an PFUI.Their average age was (40.4 ± 14.5) years old (ranging 14-61 years old).Of PFUI patients,the location of urethral injury included membranous part in 16 cases,bulbomenbranous part in 17 and prostatic part in 10 cases.The average length of stricture was (3.0 ± 1.9) centimeter.One patient suffered the stricture,combined with bladder rupture.One patient had urethro-rectal fistula.Two patients had urethrocutaneous fistula.The pelvic fractures were categorized using Tile classification,including type A1 fractures in 10 cases,A2 in 10 cases,B1 in 14 cases,B2 in 31 cases,B3 in 42 cases,C1 in 2 cases and C2 in 11 cases.The patients' number of urethral injury in each type was 1,2,2,7,29,0,2,respectively.Hazard degree analysis and chisquare test were used to evaluate the risk factors.Variables with an association of P ＜ 0.05 were then tested using binary logistic regression and the area under the curve(AUC).Results On hazard degree analysis,female(x2 =25.419,P ＜ 0.05,OR =0.571) and type B3 fracture (x2 =31.002,P ＜ 0.05,OR =10.198)have a significant impact on the occurrence of PFUI.On binary logistic regression,female(Walds =16.528,P ＜ 0.05,adjusted OR =0.003)is the protective factor of PFUI while type B3 fracture (Walds =10.853,P ＜0.05,adjusted OR =28.537) is the risk factor.The area under the curve (AUC =0.891,95％ CI0.826-0.956) illustrates the regression model has a high credibility.Conclusions Pelvic fracture urethral injury is much less likely to occur in females than men.Type B3 fracture is more likely to cause an PFUI than the others type.

Objective To investigate the presentation,diagnosis and surgical treatment of female urethral diverticulum.Methods From June 2005 to June 2016,56 female patients with urethral diverticulum were treated in our department.The presenting symptoms,clinical characteristics and surgical outcomes were reviewed.Mean age was 43.6 years (range 34 to 63).Patients were classified as simple and complex diverticulum (extend partially around the urethra ＞ 50％,U-shaped or circumferential) according to MRI features.Thirty-two patients hadsimple diverticulum locating in distal urethra with a mean age of 42.1 years,and 24 patients had complex diverticulum locating in proximal (8 cases) or distal urethra (16 cases) with a mean age of 45.7 years.The average diameter of the diverticulum was 2.5cm and 3.1cm respectively.There were 23 cases (71.8％) with recurrent urinary tract infection,22(68.7％) with pelvic pain,19(59.4％) with postvoid dribbling in simple diverticulum and 22 (91.7％),23 (95.8％),21 (84.5％) in complex diverticulum respectively.Patients with complex diverticulum were more likely to present with these symptoms than simple diverticulum(P ＜ 0.05).The statistical differences in preoperative frequency and urgency(68.7％ vs.75.0％),urinary incontinence(56.2％ vs.66.7％),dyspareunia(15.6％ vs.16.6％) and dysuria(9.4％ vs.4.2％) were not found between simple and complex groups.Transvaginal diverticulectomy and multiple layers closures were performed in 49 patients.A Martius flap interposition was used in 7 complex cases with severe urethral damage and insufficient periurethral fascia.Presenting symptoms and surgical outcomes were assessed according to different types of diverticulum.Results Fifty-six operations were completed successfully.The mean follow-up was 14.2 months (range 6-48 months).Recurrent urinary tract infection,pelvic pain,postvoid dribbling,urinary incontinence,dyspareunia and dysuria improved after surgery in both groups.There were statistical differences in symptom improvement before and after surgery (P ＜ 0.05) except for frequency and urgency.Postoperative symptoms in patients with complex and simple diverticulum were recurrent urinary tract infection (16.6％ vs.21.8％),pelvic pain (12.5％ vs.9.4％),postvoid dribbling (25.0％ vs.15.6％),frequency and urgency(58.3％ vs.53.1％),urinary incontinence(12.5％ vs.9.4％),dyspareunia(8.3％ vs.6.2％).There were no statistically significant differences between the postoperative symptoms of complex and simple diverticulum (P ＞ 0.05).Three(12.5％) cases of complex diverticulum recuredand cured after a following surgery.Conclusions For female patients with recurrent urinary tract infection,pelvic pain,postvoid dribbling and vaginal mass,the possibility of urethral diverticulum should be considered.MRI is an excellent imaging method for urethral diverticulum dignosis and classification.Transvaginal complete diverticulectomy,multiple layers closures are feasible and effective treatments.

Objective To evaluate the clinical efficacy of different tissue flaps interposition in reconstructing urethra-rectal fistulas associated with posterior urethral strictures.Methods Twenty-nine patients with urethra-rectal fistulas associated with posterior urethral strictures (15 patients after traffic accident trauma,9 after falling injury,and 5 after pelvic crush injury) were included in this study.Transperineal urethral reconstruction and fistula repair with perineal subcutaneous dartos pedicled flap transposition was performed in 15 patients in whom fistulas were near the anus (＜ 5 cm) and the perineal subcutaneous tissues were rich in blood supply.An interposition gracilis muscle flap was placed in 14 patients with fistulas located farther from the anus (≥Scm) or poor perineal local tissue condition.Results After a mean follow-up of 24.5 months (5-67 months),successful repair was achieved in 12 of 15 patients (80.0％) undergoing perineal subcutaneous dartos pedicled flap transposition,and in 11 of 14 patients (78.6％) undergoing gracilis muscle transposition.The overall success rate was 79.3％.No longterm procedure related complications occurred except medial thigh numbness in 1 patient.Conclusions The perineal subcutaneous dartos pedicled flap is suitable for hypervascular and low-positioned urethra-rectal fistulas located less than 5 cm from the anus.For patients with high-positioned fistulas or poor perineal local tissue conditions,the gracilis muscle flap is recommended.The technique of vascularized tissue pedicled flap transposition is essential for urethra-rectal fistula repair.

Objective To compare donor site complications of buccal or lingual mucosa grafts harvesting for substitution urethroplasty.Methods From June 2014 to December 2016,a total of 50 patients who were diagnosed anterior urethral strictures or hypospadias underwent buccal or lingual mucosa grafts urethroplasty.The mean age of the patients was 43.6 years (range 32-56 years).25 patients used buccal mucosa grafts (BMG group) for urethroplasty with the median age of 43.1 years (range 32-54 years);the other 25 patients received lingual mucosa grafts (LMG group) for urethroplasty,aged 44.2 years (range 35-56 years).Patients were evaluated for postoperative oral pain morbidity using the visual analogue pain scale (0-10) as well as an questionnaire for difficulty with eating,speech impairment,dysgeusia,tightness of the mouth.The evaluations were carried out at 3 days,2 weeks and 3 months postoperatively.Results In BMG group,the length and width of the graft was (5.24 ± 0.89) cm and (1.48 ± 0.50) cm;the graft length was (5.68 ± 0.90) cm and the width was (1.56 ± 0.51) cm in LMG group.There was no difference between the two groups.The mean followup time was (7.8 ± 1.2) months (6-12 months).The median visual analogue pain scale scores of the BMG group 3 days,2 weeks after surgery was 5.84 ±0.85,3.04 ±0.45,and the LMG group 7.20 ±0.57,4.16 ±0.62,respectively,with no statistical difference between two groups.The incidence of events with LMG group versus the BMG group were as follows:difficulty with eating (64％ vs.24％,P =0.004),speech impairment (92％ vs.56％,P=0.004) and dysgeusia (48％ vs.16％,P =0.015)at day 3.The difficulty of eating,speech impairment and dysgeusia of BMG group were lower than that of the LMG group(16％ vs.32％,P =0.031;8％ vs.40％,P =0.008;12％ vs.40％,P =0.024) two weeks after the surgery,whereas the incidence of tightness of the mouth was higher in BMG group(36％ vs.12％,P =0.04).After 3 months,36％ and 32％ of patients treated with buccal and lingual mucosa grafts urethroplasty still reported sensitivity perioral numbness(P ＞ 0.05).Conclusions Oral mucosa grafts are good for substitution urethroplasty,but also with some donor site complications.The early postoperative complications are more common in lingual mucosa graft donor site.Buccal mucosa may be used as the preferred graft for urethroplasty.Lingual mucosal graft may be considered in cases of unavailable buccal mucosa graft or the length of the graft not enough and combined graft treatment.

Objective To explore the reason that the neo-urethra infection after urethroplasty,and improve the perioperation procedures to reduce infection rate.Methods The clinical data of 62 anterior urethral stricture patients undergoing surgical treatment from July 2014 to April 2017 were analyzed.Then samples from urine,material for urethral reconstruction,urethra orifice and urethra were collected respectively.The bacterial culture,identification and pulsed field gel electrophoresis (PFGE) was performed.All the patients were males,and the mean age was 35.6 years (ranging 10-68 years).Operation methods were urethroplasty using oral mucosa in 40 cases,using penile flap in 23,using scrotal flap in 5,using penile flap combined with oral mucosa in 9,using penile flap combined with scrotal flap in 3 and using preputial flap in 1.Results The bacteria isolated from urethra orifice after operation were consistent with bacteria isolated from the neo-urethral lumen in 41 cases.There were 18 cases that shared the identical bacteria isolated from material for urethral reconstruction and neo-urethral lumen.In 7 patients,under careful isolation and identification,same bacteria were found to exist in both preoperative urethral lumen and neo-urethral lumen.Bacteria were not detected in the neo-urethral lumen in 13 cases.The bacteria isolated from urine were consistent with bacteria isolated from the neo-urethral lumen in 3 cases.Conclusions The bacteria in the neo-urethra mainly come from urethra orifice.Urine is not the main source for bacteria in neo-urethra.Perioperative intervention for sources of bacteria is an effective measure to improve the success rate of operation.