Objective To summarize the long-term efficacy of oral mucosal urethroplasty.Methods The clinical data of 324 patients with anterior urethral stricture who underwent oral mucosal urethroplasty from January 2013 to May 2018 were retrospectively analyzed.The patients were 27-65 years old with an average age of 47 years.Among them,51 patients had urethral meatal stenosis,174 patients had penile urethral stricture and 99 patients had bulbar urethral stricture.The length of urethral stricture was 2.8-14.0 cm,with an average of 6.4 cm.The preoperative maximal urinary flow rate Qmax was 3.2-8.4 ml/s,with an average of 4.8 ml/s.In the urethral meatal stenosis group (51 patients),15 underwent urethrotomy and 36 underwent meatal urethroplasty.In the penile urethral stricture group (174 patients),ventral sagittal incision was done in 21 patients,subcoronal circumferential incision in 49 patients and midline perineal incision in 104 patients.The perineal incision or verted Y incision were done in all the bulbar urethral strictures.Results The patients were followed-up for 3-75 months,with an average of 35.0 months.The results were satisfied in 290 (89.5％) patients.The post-operative maximal urinary flow rate Qmax was 15.8-32.2ml/s,with an average of 21.5 ml/s.Thirty-four patients (10.5％) developed recurrent urethral stricture,including 7 patients in the urethral meatus,17 patients in the penile urethra and 12 patients in the bulbar urethra.Among the recurrent urethral stricture patients,18 treated with the dilatation and 16 treated with the urethroplasty.Five patients (1.5％) developed fistula,including 2 patients in the ventral sagittal incision,1 patient in the circumferential incision and 2 patient in the perineal incision.Conclusions The long-term effect of oral mucosal urethroplasty is realistic.The rate of urethral stricture recurrence and fistula is low.The recurrence can be treated again by urethroplasty.The surgical approach for oral mucosa urethroplasty depends on the location and length of the anterior urethral stricture.

Objective To investigate the changing trends in etiology and treatment of male urethral stricture in recent 10 years.Methods A total of 940 male patients with urethral stricture admitted to the Department of Urology of Beijing Jishuitan Hospital during Jan.2013 and Dec.2022 were continually collected.The clinical data were divided into two groups according to the time of admission,namely the group from 2013 to 2017 and the group from 2018 to 2022,for a comparative analysis of the previous and subsequent 5 years.The etiology,location,length and the type of treatment of urethral stricture were retrospectively analyzed.Results The causes of the 940 cases of male urethral stricture were trauma in 447(47.55％),iatrogenic injury in 220(23.40％),idiopathic causes in 128(13.62％),lichen sclerosus(LS)in 78(8.30％),infection in 46(4.89％),and other causes in 21(2.23％).The treatment methods were urethroplasty in 691(73.51％),direct vision internal urethrotomy(DVIU)in 122(12.98％),urethral dilatation in 86(9.15％),and suprapubic cystostomy in 41(4.36％).Compared with the previous 5 years,in the past 5 years,the proportion of urethral stricture caused by trauma decreased significantly(60.34％vs.41.71％,P＜0.001),while the proportion of iatrogenic injury increased significantly(17.63％vs.26.05％,P=0.005).In the past 5 years,the proportion of urethroplasty increased from 68.81％to 75.66％(P=0.027),while the proportion of DVIU decreased from 19.66％to 9.92％(P＜0.001).Inthe past 5 years,the proportion of membranous urethral stenosis decreased significantly(26.98％vs.50.85％,x2=51.06,P＜0.001),the proportion of penile urethral stricture(21.40％vs.7.80％,=26.37,P＜0.001)and meatal stenosis(9.30％vs.4.75％,x2=5.80,P＜0.001)increased significantly.Conclusion In the past decade,trauma was the main cause of male urethral strictures,but its proportion showed a decreasing trend.Iatrogenic injury led to a gradual increase in urethral strictures,which was the second leading cause of male urethral stricture.The application of urethroplasty increased significantly,making it the main treatment method for male urethral stricture.

[Objective] To Compare the effectiveness of conventional local anesthesia (CLA) and two-plane local anesthesia (TPLA) in percutaneous nephrolithotomy (PCNL) so as to provide reference for clinical selection of appropriate anesthetic methods. [Methods] Clinical data of 345 patients with renal or ureteral calculi who underwent PCNL under local infiltration anesthesia in our hospital during Jan.2013 and Dec.2023 were retrospectively analyzed.The patients were divided into CLA group (n=114) and TPLA group (n=231) according to anesthetic methods.The intraoperative visual analogue scale (VAS) score, stone-free rate and incidence of complications were compared between the two groups. [Results] There were no significant differences in the baseline data between the two groups (P>0.05). When the cutaneous and renal channels were established, the VAS score was lower in the TPLA group than in the CLA group [(3.2±0.5) vs. (3.8±0.4), P=0.023]. However, there was no significant difference in the VAS score during lithotripsy [(3.3±0.5) vs. (3.4±0.5), P=0.061]. There were no significant differences between the two groups in terms of operation time, stone-free rate, hemoglobin drop, postoperative hospital stay, and time to remove nephrostomy tube and DJ tube retention time (P>0.05). [Conclusion] Both CLA and TPLA can provide good analgesia in PCNL, but TPLA can significantly reduce the pain sensation when the cutaneous and renal channels are established.