Objective To improve the urethroplasty efficacy for female urethral obliteration by the use of 2 pedunculated flaps of the lip of pudenda. Methods 2 cases of female urethral obliteration were treated with the use of 2 pedunculated flaps of lip of pudenda to repair the urethral obliteration. Results Both the patients could pass urine freely and needed no dilation of the urethra during the 15 and 36 months of follow up.The maximum flow rate were 18.2 ml/s、17.7 ml/s,the average flow rate were 9.0 ml/s、 10.9 ml/s and the voiding volume were 206 ml、247 ml. Conclusions Urethroplasty with the use of pedunculated flaps of lip of pudenda is a safe and effective procedure.

Objective To evaluate the efficacy of transpubie access using pedicle tabularized la-bial urethroplasty for urethral reconstruction in female patients with urethral strictures associated with urethrovaginal fistulas.Methods Eight cases of urethral strictures were treated using pedicle labial skin flaps for urethral reconstructions.All cases were the mid-urethral strictures associated with ure-throvaginal fistulas.A single face pedicle flap was obtained from the labia minus or majus in 5 women,and double face pedicle labial flaps were used in 3 patients.Results There were no serious complica-tions.Two patients complained of dysuria symptoms for 2 weeks and one patient experienced stress incontinence which resolved after 4 weeks.The patients were followed up for 6 to 130 months (mean 52) postoperatively.All patients had normal micturition following catheter removal with urinary peak flow greater than 15 ml/s(17.4-42.0 ml/s).Conclusion Pedicle labial urethroplasty might be a reliable technique for the management of complex urethral strictures associated with urethrovaginal fis-tulas.

Objective To study the testicular breeding function and p63 expression in seminiferous tubules in androgen receptor(AR)knockout mice.Methods Eight AR knockout mice selected by Cre-lox and 8 Wistar male mice were studied.Testicular breeding function was determined by Makler score and p63 was detected by immunohistochemistry. Results Seminiferous tubules inner diameter deflated in AR knockout group than in Wistar group(60.0±1.5 μm vs 92.05±2.0μm,P＜0.01),peri-tube membrane thickened(4.0±0.7 μm vs 2.85=0.9 μm,P＜0.01),the number of cell layer decreased(2.0±0.3 vs 4.0±0.2,P＜0.01),generative eell maturation arrested(3.0±1.2 score vs 5.05±0.5 score,P＜0.01),Makler score was lower(8.0±0.3 vs 16.0±0.5,P＜0.01).p63 expression was lower in AR knockout group than in Wistar group and the expression was located at the stage of spermatogenous cell and spermatocyte.Conclusion Testicular breeding sperm function is damaged in AR knockout mice,lower expression of p63 mainly affects early differentiation in generative cells.

Objective To summarize the experience and evaluate the efficacy of treatment of urethral stricture using direct visual internal urethrotomy (DVIU).Methods The clinical data of 361 patients (age range 16 -72 years, mean age 38 years) with urethral stricture who underwent urethrotomy from 1990 to 2010 was retrospectively analyzed.The disease course ranged from three months to 78 months with a mean of 16 months.The stricture length ranged from 0.2 to 2.0 cm (mean 1.1 cm).Stricture length was split into four main groups:stricture length≤0.5 cm in 63 (group 1 ), stricture length ranging between 0.6 and 1.0 cm in 175 ( group 2), stricture length ranging between 1.0 and 1.5 cm in 85 ( group 3 ) , and stricture length ranging between 1.6 and 2.0 cm in 38 ( Group 4).Of the 238 patients with length less than 1.0 cm there were 148 who's scar thickness were less than 1.0 cm, and 90 who's scar thickness were greater than 1.0 cm.Of the 123 patients with length less than 2.0 cm there were 69 who's scar thickness was less than 1.0 cm, and 54 who's scar thickness was greater than 1.0 cm.Results Three patients with DVIU failed because of long occlusion and false passage.Three hundred and twenty patients were followed-up from 12 to 120 months (mean:42).Re-openiag procedures were performed on 174 patients (54.4%) due to recurrence.The re-openiag procedure rate was 3.3%, 49.7%, 83.3% and 97.1% in Group1, Group2,Group3 and Group4, respectively.On the basis of scar thickness, of the 207 patients with stricture length less than 1.0 cm, 38 of 136 patients (27.9%) with scar thickness less than 1.0 cm underwent opening operation, and 43 of 71 patients (60.6%) with scar thickness more than 1.0 cm underwent opening operation.One hundred and thirteen patients with stricture length more than 1.0 cm, 33 of 42 patients (78.6%) with scar thickness less than 1.0 cm underwent opening operation, and 60 of 71 patients (84.5%) with scar thickness more than 1.0 cm underwent opening operation.Conclusions Good efficacy can be achieved in patients whose urethral stricture length is less than 0.5cm or whose stricture length and scar thickness is less than 1.0 cm using DVIU.

Objective This study was to discuss various operative approaches for the repair complicated posterior urethral strictures. Methods 34 patients with posterior urethral strictures and associated ure-throrectal fistulas (URFs) were reviewed. The etiology of urethral strictures and fistula was due to pelvic fracture in 26 patients, iatrogenic in 6 cases and fall injury in the remaining 2 cases. The patients were treated by using a simple perineal approach (4 patients), a transperineal inferior pubectomy approach (21 patients) and combined abdominal transpubic perineal approach (9 patients) and URF repair and anastomotic urethroplasty were performed simultaneously in all cases. Results One-stage repair was successful in four patients (100%) using a simple perineal approach, in 19 of 21 (90. 48%) using the transperineal-inferior pubectomy approach and 7 of 9 (77. 78%) using the transpubic-perineal approach. Of the 34 patients, recurrent urethral strictures developed in two cases, recurrent URFs developd in two patients. Conclusions Surgical approaches for the special complex urethral strictures should be based on the location of the URF, its etiology and length of the urethral strictures, as well as a history of previous repairs. The transperineal-inferior pubic approach may be appropriate as a first-line procedure.

tionale and effective surgical approach, and technique.

Objective To examine the feasibility of using the serous-lined tunnel technique for orthotopic neobladder, continent cutaneous diversion and ureteral replacement by the intestinal segment. Methods In 31 patients of orthotopic ileal neobladder, the serous-lined tunnel techniques were used for antirefluxing ureteral implantation: In 13 patients of continent ileal pouch, the techniques were adopted for continent-valve construction and for uretersl implantation: In 3 patients (with lower ureteric cancer), the same techniques were applied for constructing the ileal ureters with a proximal antirefluxing mechanism. Results With a mean follow-up of 27 mon( 12-132 mon), 88 ureters implanted into ileal neobladders or continent pouches functioned well with neither obstruction nor reflux: 12 in 13 continent valves functioned well with no incontinence. 3 patients with ileal ureters showed no ileo-ureteric reflux and had reduced hydronephrosis comparing to that of before surgery.Conclusions Ureteral reimplantation and continent valve formation achieved by adopting the serouslined tunnel technique provide satisfactory results. The versatility of the technique is obvious in the present experience and the creative application of the serous-lined tunnel technique should be possible in urinary reconstruction.

Objective To discuss the curative effect of different operative methods for the treatment of urethrocutaneous fistula (UCF) after urethroplasty.Methods Clinical data of 54 cases of UCF from January 2003 to July 2011 were collected.Simple suture,advancement skin flap,pedicle penile skin flap urethroplasty,tongue/buccal mucosa urethroplasty were performed according to the size,location,number and whether there was urethral stricture of UCF.The treatment effect was recored and analyzed.Results The success rate of UCF repair was 85％ (46/54).There were 4 patients cured after second surgery.The success rates of repair of UCF with simple suture,advancement skin flap,pedicle penile skin flap urethroplasty,tongue/buccal mucosa urethroplasty were 95％,76％,82％,and 83％,respectively.Postoperative recurrence was observed in 5 patients in 6 months after the surgery and 4 of them received the re-operation.Conclusion According to the principle and the individual circumstance,taking personalized operative methods may improve the success rate of the repair of all kinds of UCF.

Objective:To explore management experience for post-adolescent postoperative urethral stricture of hypospadias in a single center.Methods:The clinical data of 71 cases of postoperative urethral stricture of post-adolescent hypospadias from January 2015 to December 2019 were retrospectively analyzed. The average age was 27.7(12-65) years. The mean duration of urethral stricture was 33.4(1-240) months. The number of prior surgeries was 2.5(1-9). There were 32 cases of ectopic urethral orifice, including 22 on penile, 8 on scrotum and 2 on perineum. There were 17 cases of urethral stricture with penile curvature, 11 with urethra-cutaneous fistula, 9 with urethral diverticulum, 11 with urethral calculus and 25 with urethral infection. Ten patients kept suprapubic tubes; 61 patients were able to urinate on their own, but suffered from dysuria and weak steam. The average maximum uroflow rate of 71 cases was 4.7(0-11.2) ml/s. The primary urethral reconstruction procedures were performed on 33 cases, included 11 penile or scrotal septum flap urethroplasty, 2 urethral diverticulum wall flap urethroplasty, 12 oral mucosal urethroplasty and 8 urethrotomy. Thirty-three cases underwent two-staged surgery. For patients with penile curvature greater than 30 degrees, the penis was straightened with a urethrotomy in first stage. Besides, the dorsal skin of penis or oral mucosal graft were transferred to the ventral side of the penis to the preset urethral plate. In second-stage, Denis Brown urethroplasty was performed on 23 patients, tubularized incised plate (Snodgrass) urethroplasty on 6, and oral mucosa inlay urethral plate (Snodgraft) urethroplasty on 4. In 5 cases, preplacing of oral mucosa was done in the second stage with a third-staged urethroplasty. Penile curvature was relieved by ventral scar resection with the folding the dorsal tunica albuginea of corpus cavernosum when necessary.Results:The mean follow-up time was 30.5(4-59) months. Sixty-one patients got satisfying postoperative urination, with an average maximum uroflow rate of 22.7 ml/s (15.8-37.2 ml/s). Restenosis occurred in 10 cases, and urethral fistula in 7 cases. Re-stricture patients underwent urethrotomy in 5 cases, augmented urethroplasty with flap in 4 cases, and urethroplasty with oral mucosal graft in 1 case. Among the 7 patients with urethral fistula, 5 were cured by one fistula repair, and 1 cured by second repair; the rest one was left untreated. 2 patients still had penile curvature after operation.Conclusions:It is difficult to manage post-adolescent postoperative urethral stricture of hypospadias, especially for patients with residual penile curvature greater than 30 degrees and lack of penile skin. Performing correction of the curvature and reconstruction of the urethral plate in first stage and Denis Brown urethroplasty or Snodgrass urethroplasty in second or third stage could achieve good results.

Objective:To evaluate the results of different urethroplastis for different severity' of urethral stric-ture. Methods:From January 1997 to December 2006, 296 patients with posterior urethral striciures due to pelvic fracture urethral distraction defects (PFUDD) were included in the study. Transperineal urethsa end-to-end anas-tomosis was performed: 70 patients (group Ⅰ) with simple perineal anastomosis; 70 patients (group Ⅱ) with separation of the corporeal bodies; 154 patients (group Ⅲ) with inferior pubectomy; 2 patients (group Ⅳ) with perineal anastomosis with rerouting of the urethra around the corpora cavernosum. Results:Of 296 cases with de-layed transperineal urethra end-to-end anastomosis procedures, 254 (85.8%) cases were successful and 42 (14.2%) were unsuccessful. Group Ⅰ had an 78. 6% success rate, group Ⅱ 90.0% , group Ⅲ 88.3% , and Group Ⅳ zero. Conclusions : Different transperineal posterior urethroplasty operations are efficient to treat urethral strictures following PFUDD.