Objective To survey cognitive and processing mode of urethral distraction defect associated with pelvic fracture (PFUDD) in China and hope to find a reasonable treatment scheme for (PFUDD).Methods From Jan 2011 to Dem 2015,a questionnaire on surgical treatment for PFUDD was sent to 286 Chinese consultant urologists in more than 56 comprehensive hospitals throughout the China.The investigation includes the age of urologsit,the type of hospital,the number of patients treated during the last 5years,operation mode and optional time to do the surgery,the selection of operation approach,evaluation of the treatment effect were analyzed.At same time,we also investigated the methods of 260 cases about PFUDD.Results The age of the urologist were 30-55 years old.Over the past five years,229 urologists had fewer than 10 patients diagnosed each year,and only 57 had 10 patients diagnosed each year.There were many different kinds of operation method,including urethral realignment 36 (14％),direct vision internal urethrotomy 121 (46％),internal urethrotomy plus laser 57 (22％),trans-perineal urethral anastomosis 46(18％).The success rates were 58％ (21/36),50％ (60/121),46％ (26/57),76％ (35/46)respectively.70％ (200/286) of specialists did an open exploration urethral realignment or cystostomy when patients were injured in 2-6 hours.28％ (80/286) of specialists did urethral realignment with endoscopic surgery.About 75％ (216/286) of specialists believed that the treatment of patients with posterior urethral atresia should follow the ladder principle.Minimally invasive methods at the start,including urethral dilation,direct vision internal urethrotomy was the first choice.They would prefer open surgery only after intial treatment failure.65％ (186/286) of doctors believed that the overall outcome of the surgery was moderated.Conclusions Urethral distraction defect associated with pelvic fracture (PFUDD) was rare to be done.The direct vision internal urethrotomy was the first choice for most of the urologists(75％).They considered the urethroplast only after the failure of initial mini-invasive surgery.Trans-perineal urethral anastomosis had the best results.

10 ng/ml). Results The diagnost ic rate of 3 groups was 44.5%,29.8%,57.4% respectivly. Conclusions The advantages of the procedure were correct acquiring of prastate ti ssue,more accurate approach and depth of the puncturing needle,avoiding injury t o the nearby tissue and raising the diagnosis rate of prostatic carcinoma.

Objective To evaluate bulbourethral sling procedure in the treatment of post prostatectomy incontinence. Methods 5 patients with post prostatectomy incontinence underwent the bulbourethral sling procedure.Preoperatively 1 patient was completely incontinent and 4 patients required a mean of 3.5 pads per day.The mean duration of incontinence was 4.5 years. A sling tension of a mean of 500 g was used to correct incontinence. Results 4 patients have been completely dry,whereas postoperative difficulty in voiding occurred in the other patient and was corrected by subsequent transurethral bladder neck revision resulting in free passage of urine and continence. Conclusions The bulbourethral sling procedure is an effective means in the treatment of post prostatectomy incontinence.

Objective To elucidate the clinical features of nonspecific granulomatous prostatitis(NSGP). Methods From February 1994 to February 2002,26 cases of NSGP confirmed histologically were retrospectively analysed.Of them 20 cases were treated with anti-inflammatory therapy alone;4 cases with anti-inflammatory therapy plus ?-receptor blocker,and 2 cases who concomitantly had retention of urine underwent TURP. Results All the 26 patients were followed up for 6 to 42 months.The therapeutic results were satisfactory.The Qmax increased from 4.6～12.8 ml/s to 16～28 ml/s,and the hard prostate mass became soft,with reduction from 2.5 cm?3.5 cm to 0.5 cm?1.0 cm.The serum PSA decreased from 15.5～60.8 ng/ml to 1.5～10.6 ng/ml. Conclusions In clinical practice NSGP is often mistaken for prostatic carcinoma,so special attention should be paid to the differential diagnosis.The definite diagnosis depends on histopathological examination.

Objective To improve the diagnosis and treatment of renal oncocytoma. Methods The clinical data of 3 cases with renal oncocytoma treated from 1999 to 2002 were retrospectively analyzed and discussed with literature reviewed. The 3 tumors’size was 7.6 cm?8.5 cm?6.8 cm,10.0 cm?11.5 cm?9.8 cm,10.0 cm?8.0 cm?6.8 cm,respectively.The clinical features were atypical.Renal oncocytoma was characterized by homogeneous attenuation with a central, margined stellate area on CT scan. Results The 3 cases underwent nephrectomy,and the resected tumors were examined by pathology.On light microscopy,there was strong eosinophilic cytoplasm with granules,the tumor cells being tubular or adenoid in pattern with no necrosis and very rare or no mitosis.Enormous mitochondria were noted on electron microscopy.The immunohistochemical staining was positive for cytokeratin and EMA,whereas it was negative for vimentin.The follow-up lasted for 16 to 30 months without recurrence or metastasis. Conclusions Renal oncocytoma is a type of benign,parenchymatous tumor,and it has no specific clinical feature.The diagnosis can be established on histopathologic,immunohistochemical and electron microscopic studies.

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 To study the diagnostic value of 3-dimensional CT reconstruction in posterior urethral strictures or ankylurethria.Methods Thirty patients with strictures or ankylurethria of posterior urethra caused by pelvic fracture underwent helical CT scan and 3-dimensional reconstruction of the urethral canal as well as radiographic urethrography before and post open urethral reconstruction to observe the urethral anatomy,the length and position of the urethral strictures,the depth of periurethral scar.Results The mean stricture or ankylurethria length measured by radiographic urethrography was 4.0 cm (range from 1.0 cm to 7.0 cm),and the correlation coefficient of stricture or ankylurethria length was 0.92,21 (70%) patients were diagnosed accurately by radiographic urethrography.The mean stricture or ankylurethria length measured by 3-dimensional CT reconstruction was 4.3 cm (range from 1.2 cm to 7.6 cm),and the correlation coefficient of stricture or ankylurethria length was 0.96,there were 28(93%) patients diagnosed accurately by 3-dimensional CT reconstruction.The mean stricture or ankylurethria length measured by open urethral reconstruction was 4.2 cm (range from 1.5 cm to 7.5 cm).Five patients with urethrorectal fistula were also diagnosed accurately by 3-dimensional CT reconstruction rather than by radiographic urethrography.Conclusions 3-dimensional CT reconstruction of the urethral canal can accurately evaluate the urethral anatomy,the length and position of the urethral strictures,as well as the depth of periurethral scar after crush injury and provide useful information for operation that may not be provided by radiographic urethrography.3-dimensional CT reconstruction may become the most valuable means for detecting posterior urethra strictures or ankylurethria with urethrorectal fistula.

Objective To investigate the clinical efficacy of modified YV-plasty for refractory bladder neck contracture (BNC) caused by transurethral resection of prostate (TURP).Methods From June 2013 to March 2016,11 patients with BNCs secondary to TURP were included in this study.Their mean age was 63.7 years (range,56-73 years).All patients presented voiding difficulty and failed after 2 or more prior endoscopic treatments.Modified YV-reconstruction of bladder neck was performed,by incising the anterior wall of bladder neck in a T-shaped manner,and creating two well-vascularized and tension-free flaps,which offer the possibility to reconstruct a wide bladder neck.Results After a mean follow-up of 14.6 months (ranging 3-24 months),successful outcome was achieved in 9 patients without incontinence secondary by surgery.Recurrent voiding difficulty developed in 2 patients,which was cured after a following endoscopic treatment.Conclusion A wider bladder neck can be obtained through modified YV-reconstruction of bladder neck,while avoiding external urethral sphincter injury.It is an available option for refractory bladder neck contracture.

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 study the value of flexible cystoscopy in diagnosing posterior urethral strictures resulting from pelvic fracture and the pain score of the examination. Methods Between 2014 and 2015, 120 male patients with pelvic fracture urethral distraction defect were evaluated by cystoscopy before surgery. In this study, flexible cystoscopy was used in 87 patients, 33 patients received conventional rigid cystoscopy. The cystoscopy was introduced into the posterior urethra and the area was evaluated for the length of the proximal urethra and any possible fistulas, false passages, calculi or displacement of the posterior urethra. The patient’s pain feeling was recorded during the examination, 24 hrs after cystoscopy examination. The pain feeling result was achieved by visual analogue pain scale. Results Severe allergic reaction or obvious discomfort did not occur in any patients after cystoscopy. By comparing the data obtained from lfexible cystoscopy to those from conventional urethrography, the rate of detection in other abnormalities was higher in lfexible cystoscopy than in conventional urethrography. 21, 5, 7 and 5 patients were detected with calculus, posterior urethral structure damage, false passage and ifstula respectively. In comparison, the abnormalities were only observed in 3, 2, 3 and 1 patients respectively through conventional urethrography imaging. However, the pain feeling of the flexible cystoscopy is better than the convenional rigid cystoscopy. The statistical difference was found in the pain feeling score during the examination and later after the examination. Conclusions Flexible cystoscopy is a safe and valuable procedure in the evaluation of the posterior urethra in patients with pelvic fracture urethral distraction defect before surgery.