60 g in 15 cases).The operation time ranged from 35 to 85 minutes(mean,45),and the blood loss was 50-100 ml(mean,60 ml).No case needed blood transfusion.No rupture of the prostatic capsule,venous sinuses,or perforation of the bladder-prostate junction occurred in this series.The patients were followed up for 4 to 6 months,during which the Qmax increased to 16.4-23.2 ml/s(mean,19.8 ml/s),RU decreased to 0-15 ml(mean,5 ml),and IPSS score improved to 0-6.8(mean,4.2).No patient developed urinary incontinence.Conclusions Transurethral retrograde dissection of the prostate is effective for the treatment of BPH with a low morbidity rate of urinary incontinence.The procedure is simple and results in low blood loss.

Objective To investigate the diagnosis and treatment outcomes of testieulax endodermal sinus tumor. Methods Twenty-four cases diagnosed with testieular endodermal sinus tumors from November 1996 to April 2007 were retruspeetively reviewed. Eighteen patients presented with stage Ⅰ disease, 4 presented with stage Ⅰ , and 2 presented with stage Ⅲ. Inguinal radical or-chieetomy were performed in all patients. Retroperitoneal lymph node dissection was performed in 8 ea-ses. Results The histological structures were rather complicated in 24 tumors. Twenty-three eases (96%) were found with reticular pattern, 22(92%) with hyaline body, 20(83%) with glandlike structure, 16(67%) with Shiller-Dural body, and 13(54%) with solid formation. The former 3 kinds were regarded as the main diagnostic criteria. Twenty-one eases were followed up for 20 months to 12 years. During the follow-up, 2 patients died of the disease. Condesions Early diagnosis and combi-nation therapy, including radical orehieetomy and chemotherapy, are the keys to improve the curative effect of testieular endodermal sinus tumors. Active surveillance of AFP is critical for monitoring the recurrence and metastasis of this tumor.

Objective To explore the application of the paries anterior vagina U shape muscularis mucosal flap for the repairing of female complicated urethrovaginal fistula.Methods Fifteen complicated urethrovaginal fistulas patients resulted from severe pelvic fracture and with history of failing repairing urethrovaginal fistulas were analyzed retrospectively.The mean diameter of maximum urethrovaginal fistula was approximately 2.3 cm.The paries anterior vagina U shape mucosal flaps were used to repair the urethrovaginal fistulas,and the paries anterior vagina muscularis mucosae were used to cover the fistulas surface again.Results Fifteen patients were followed up for 6 to 80 months,and they gained normal voiding,with no urine leakage,urinary incontinence and urethral stricture occurring.Conclusion The paries anterior vagina U shape mucosal flap is an effective technique for repairing complicated urethrovaginal fistula.

Objective To evaluate the feasibility and effects of endoscopic thyroidectomy(ETE) for papillary thyroid carcinoma(PTC).Methods A total of 137 patients with PTC were enrolled from January 2013 to January 2016.The patients were divided into two groups depended on different surgical approaches.The patients'' characteristics,such as age,gender,pain,intraoperative blood loss,hospitalization,central lymph node metastasis etc were retrospectively analyzed in the two groups.Results In the study,78 patients performed ETE,and 58 performed COT.There was one case converted to open surgery from ETE due to intraoperative bleeding.The clinicopathological characteristics and operative complications between the two groups had no significant differences,such as gender,time of drainage,postoperative hospitalized days,positive lymph node metastasis,injury of recurrent laryngeal nerve,permanent injury of parathyroid glands.The age of patients was younger in ETE(t=-4.299,P=0.000).The drainage content(t=9.539,P=0.000),intraoperative blood loss(t=2.862,P=0.005) and subcutaneous ecchymosis (χ2=13.482,P=0.000) were found more in the ETE.ETE required a longer operative time(t=8.162,P=0.000).However,ETE provided better cosmetic outcomes than COT [(9.4±0.5)points vs.(5.4±1.0)points,t=30.142,P=0.000].No clinical recurrence and metastasis occurred for at least one-year follow-up.Conclusion With excellent cosmetic results,ETE is a feasible and safe operation for patients with PTC without metastasis to lateral cervical lymph nodes.

Objective To explore the application of the paries anterior vagina U shape muscularis mucosal flap for the repairing of female complicated urethrovaginal fistula. Methods Fifteen complicated urethrovaginal fistulas patients resulted from severe pelvic frac-ture and with history of failing repairing urethrovaginal fistulas were analyzed retrospectively. The mean diameter of maximum urethrovagi-nal fistula was approximately 2.3 cm. The parias anterior vagina U shape mucosal flaps were used to repair the urethrovaginal fistulas, and the paries anterior vagina muscularis mucosae were used to cover the fistulas surface again. Results Fifteen patients were followed up for 6 to 80 months, and they gained normal voiding, with no urine leakage, urinary incontinence and urethra] stricture occurring. Conclusion The paries anterior vagina U shape mucosal flap is an effective technique for repairing complicated urethrovaginal fistula.

ObjectiveSleep-related painful erections （SRPE） is a rare sleep disorder characterized by repeated awakening due to painful interruptions of penile erections during nighttime sleep， and its etiology is currently unclear. The purpose of this study is to explore the impact of potential risk factors on the incidence of SRPE. MethodsInformation was collected through questionnaires administered to patients who presented at the urology department and suffered from SRPE or did not suffer from SRPE. A total of 290 participants completed the study， including 145 controls and 145 cases. Logistic regression analysis was used to assess the impact of age， occupation， sleep initiation time per night， frequency of sexual intercourse per week， psychological status， erectile dysfunction， chronic prostatitis， prostate enlargement， lumbar spine disease， central nervous system disease， hypertension， diabetes and family history on the onset of SRPE. ResultsSingle-factor logistic regression analysis found that a history of chronic prostatitis， intellectual labor occupation， central nervous system disease， late sleep onset， frequency of sexual activity， and anxiety status might be related to the onset of SRPE. After incorporating these factors into a multivariate regression analysis model， it was found that having sexual activity ≥2 times/week （OR 95%CI = 0.326（0.179，0.592） and late sleep onset （after 24：00） （OR 95%CI = 0.494（0.265，0.918）might be protective factors for SRPE， while a history of chronic prostatitis（OR 95%CI = 3.779（2.082，6.859） might be a risk factor for SRPE. However， there was no significant statistical difference in the impact of central nervous system diseases and occupation on multivariate analysis. ConclusionChronic prostatitis and anxiety status may be independent risk factors for SRPE； having sexual activity ≥2 times/week and delaying sleep time appropriately may be independent protective factors.