Adult ; Humans ; Kidney ; surgery ; Laparoscopy ; Male ; Needles ; Urethra ; injuries

Four cases of complete traumatic rupture of female urethra were reviewed. Herein the incidence, etiology and treatment modalities of complete rupture of female urethra are discussed to propose guidelines for the proper management of these unusual injuries. I recommend the following: Through the retropubic approach in children, a primary realignment with either surgery or an interlocking Foley catheterization should be performed as in the delayed retropubic urethroplasty when primary realignment was not accomplished. Transvaginal repair is considered choice approach for the urethro-vaginal laceration due to other than pelvic fracture in adults.
Adult ; Catheters, Indwelling ; Female ; Human ; Male ; Urethra/injuries* ; Urethra/surgery ; Urography

A total of 92 patients with benign prostatic hyperplasia (BPH) were subjected to modified Madigan prostatectomy (MPC) for a much satisfactory effect in open prostatectomy surgery. Exposing anterior prostatic urethra near the bladder neck and conjunct cystotomy modified the MPC procedure. This modified procedure preserved prostatic urethra intact and could also deal with intracystic lesions at the same time. The intact of prostatic urethra was kept completely or largely in 86 cases. The amount of blood loss during modified procedure was less. The mean operative time was 105 min. Seventy patients had been followed up for 3-24 months. The postoperative average Qmax was 19. 2 ml/s. The cystourethrography revealed that the urethra and bladder neck were intact in 10 patients postoperatively. Furthermore, the prostatic urethra was obviously wider after modified MPC. The modified MPC can reduce the occurrence of urethra injury and enlarge the MPC indications. The modified technique is easy to perform with less complications and much satisfactory clinical result.
Follow-Up Studies ; Postoperative Complications/*prevention & control ; Prostatectomy/*methods ; Prostatic Hyperplasia/*surgery ; Retrospective Studies ; Urethra/injuries

OBJECTIVEPenile fracture, being defined as rupture of the tunica albuginea of the corpus cavernosum, is uncommon. Here, we analyze findings on our patients during a 10-year period and evaluate the role of retrograde urethrography.

METHODSFrom February 2002 to April 2012, 116 patients were admitted with penile fracture at Ghaem Medical Center. Patient history and physical examination were taken at their admittance to detect probable urethral injury. Before surgery, retrograde urethrography was performed in all patients. The size and site of the tunical rupture were recorded. Then the rupture of tunica albuginea was sutured with nonabsorbable (3-0 nylon) sutures and the ties were placed on the internal surface (continuous method). All patients were followed up for 12 months.

RESULTSPatients' mean age was (32.78 ± 10.61) years and ranged (16-62) years. The mechanism of trauma was sexual intercourse in 103 patients (89%) and masturbation in 13 patients (11%). The most common site of injury found after exploration was right (55%) and lateral (74%) of the corpus cavernosum. The size of the tunical rupture was from 0.5 to 3.0 cm (mean 1.88 ± 0.72). Three of the patients had Marphan's syndrome. Urethral injury was detected by retrograde urethrography in 4 patients (3%) who had macroscopic hematuria and urethrorrhagia. During 12 months follow-up, no complication was seen.

CONCLUSIONThere is no need to perform retrograde urethrography unless the patients have gross hematuria or urethrorrhagia. The key to success in treatment of penile fracture is to achieve a rapid diagnosis based on history and a physical examination, avoid unnecessary imaging tests and perform immediate surgery to reconstruct the site of injury.

Adolescent ; Adult ; Humans ; Male ; Middle Aged ; Penis ; injuries ; surgery ; Rupture ; Sutures ; Urethra ; diagnostic imaging ; Young Adult

The use of a gracilis myocutaneous flap to overlay an extensively traumatized scrotoperineal soft tissue defect, through which both testes and the ruptured bulbous urethra were exposed, is discussed. The transplanted gracilis myocutaneous flap, which included vascularized and innervated tissue, was well taken and covered the perineal defect, exposed testes and urethral stricture both cosmetically and functionally.
Adult ; Case Report ; Human ; Male ; Muscles/surgery ; Perineum/*surgery ; Rupture ; Scrotum/*surgery ; Surgical Flaps/*methods ; Testis/*injuries/surgery ; Urethra/*injuries/surgery

A locked pubic ramus body is an unusual variant of lateral compression injury. Till date, there have been only 25 cases reported in the published literature. We herein described a case where the right pubic ramus was entrapped within the opposite obturator foramen with an overlap of greater than 4 cm, with associated urethral injury. When all maneuvers of closed and instrumented reduction failed, we performed a superior pubic ramus osteotomy on the left side and unlocked the incarcerated right pubic ramus. The osteotomy site was stabilized with a 6-hole recon plate. The patient underwent delayed urethral repair 10 weeks after the index surgery. At 3-year follow-up, the patient has sexual dysfunction especially difficulty in maintaining erection, secondary urethral stricture, heterotopic ossification, and breakage of implants.
Humans ; Pubic Bone/injuries* ; Follow-Up Studies ; Osteotomy, Sagittal Split Ramus ; Pelvis ; Urethra/surgery* ; Pubic Symphysis/injuries*

OBJECTIVETo explore selection and efficacy assessment for membranous urethral trauma caused by pelvic fracture.

METHODSFrom June 2000 to August 2010, 72 patients with membranous urethral trauma caused by pelvic fracture were selected. There were 46 males and 26 females,ranging age from 26 to 62 years (averaged 35.2 years). The time from injury to hospitalization time was 1 to 3 hours. According to Tile pelvic fracture classification, there were 8 patients with type A, 45 patients with type B, 19 patients with type C. Thirty of the 35 patients with partial rupture of posterior urethral were treated by catheterization,5 patients treated by rupture anastomosis on the stage I combined with cystostomy; 25 of the 37 patients with complete rupture of posterior urethra were treated by early realignment, and 12 patients were treated by cystostomy. Urinary incontinence, impotence and urethrostenosis were evaluated.

RESULTSAll patients were followed up for 5 to 10 years (mean 7.7 years). Incidence of urethrostenosis, impotence and urinary incontinence in patients treated by cystostomy were significantly higher than rupture anastomosis on the stage I and early realignment (P < 0.05); while incidence in patients treated by catheterization was significantly lower than other groups (P < 0.05).

CONCLUSIONFor patients with partial rupture of posterior urethral, catheterization and rupture anastomosis on the stage I are preferred methods; while patients with complete rupture of posterior urethra, early realignment is a preferred method with advantages of simple operation and less complications.

Adult ; Female ; Fractures, Bone ; complications ; Humans ; Male ; Middle Aged ; Pelvic Bones ; injuries ; Retrospective Studies ; Urethra ; injuries ; surgery

OBJECTIVETo assess the biocompatibility of a urethral acellular matrix graft (UAMG) and evaluate its effect in repairing urethral defect in rabbit models.

METHODSThe UAMG was prepared and its structural features were observed using optical and electron microscopy. In vitro cultured rabbit bladder smooth muscle cells were seeded on UAMG and the cell proliferation was observed. The cytotoxicity of the aqueous extract of the UAMG against the cells was evaluated by MTT assay, and its biocompatibility was assessed by implanting the grafts subcutaneously on the back of the rabbits. In 24 male rabbits, a 2-cm urethral defect was induced and repaired with UAMG (experimental group, n=12) or left untreated (control group, n=12). In both groups, the rabbits were sacrificed 2, 4, 8 and 12 weeks after the operation for histological and immunohistochemical examination of the tissue regeneration.

RESULTSThe UAMG had a reticular fibrous structure without cell residues. The bladder smooth muscle cells showed normal proliferation on UAMG with normal cell morphology. The rabbits receiving the implants showed no abnormal response, and the UAMGs gradually degraded in vivo with grade 0 or 1 cytotoxcity showing satisfactory cytocompatibility. In the experimental group, new urethral tissues that were histologically compatible with normal urethral tissues were regenerated in the defect area 12 weeks after UAMG implantation.

CONCLUSIONAs a tissue engineered scaffold material for urethral reconstruction, the UAMG possesses good biocompatibility and can induce the regeneration of urethral epithelial cells and smooth muscle cells.

Animals ; Extracellular Matrix ; transplantation ; Male ; Rabbits ; Random Allocation ; Reconstructive Surgical Procedures ; methods ; Regeneration ; physiology ; Tissue Engineering ; methods ; Urethra ; injuries ; surgery

OBJECTIVETo evaluate endourethral surgery for urethratresia under the X-ray guide.

METHODSWe performed transurethral urethroplasty for 11 patients with urethratresia using the PlasmaKinetic electrodes under the guidance of C arm xanthippe.

RESULTSIn the 11 cases, operations were all successful, 9 achieved smooth urination and 2 needed regular urethral dilation.

CONCLUSIONX-ray guided internal urethroplasty with PlasmaKinetic electrodes is a simple and efficient treatment for urethratresia.

Adult ; Aged ; Electrodes ; Humans ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; methods ; Urethra ; injuries ; Urethral Obstruction ; surgery ; X-Rays

OBJECTIVETo search for a safe and convenient surgical method for management of urethral disruption.

METHODSWe performed urethral realignment for 18 cases of posterior urethral disruption and 4 cases of ruptured bulbous urethra using the urethral guidance probe following bladder puncture stoma.

RESULTSUrethral realignment was accomplished in 21 of the cases, 18 under epidural and 3 under local anesthesia, with the mean blood loss of 20 ml and the average operation time of 18 minutes. Open surgery was necessitated in 1 case due to the complication of bladder rupture. Routine postoperative urethral dilation extended for 3 months, and all the cases were followed up for 3 to 24 months. The maximum urine flow rate was 15-22 ml/s in 13 cases and 10-14 ml/s in 7. One case received urethral anastomosis 3 months later because of urethrostenosis.

CONCLUSIONSUrethral realignment with the urethral guidance probe is a safe, convenient and effective surgical strategy for the management of urethral disruption.

Adolescent ; Adult ; Anastomosis, Surgical ; instrumentation ; methods ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Treatment Outcome ; Urethra ; injuries ; surgery ; Young Adult