Male ; Humans ; Hypospadias/surgery* ; Urologic Surgical Procedures, Male ; Urethra/surgery*

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

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

OBJECTIVETo introduce a new procedure for repairing coronal or subcoronal hypospadias with severe chordee.

METHODSA modified technique of elongating the anterior urethra, combined with the MAGPI procedure, was used to repair the coronal or subcoronal hypospadias in 19 severe chordee patients (aged 5 to 12 years). The fibrous bands on the ventral aspect of the penis were excised to correct the chordee. If the penile curvature still remained, the corpora cavernosa dissection and elongation could be applied.

RESULTSAll of the patients were successfully treated by this procedure in one stage.

CONCLUSIONSThe modified technique of the anterior urethra elongation, combined with MAGPI procedure, might be one of the simple and effective method for repairing coronal or subcoronal hypospadias with severe chordee.

Child ; Child, Preschool ; Humans ; Hypospadias ; surgery ; Male ; Penile Diseases ; surgery ; Penis ; surgery ; Urethra ; surgery

Trauma, tumor, disease and congenital abnormalities may lead to genital organ damage or function failure, and consequently the requirement of its reconstruction. Tissue engineering follows the principles of cell transplantation, materials science and engineering toward the development of biological substitutes that would restore and maintain normal function. These new techniques have been recently introduced into the field of andrology. Based on the latest advances, the present paper afferds a general prospect of the future direction of the development of tissue engineering in andrology.
Genitalia, Male ; surgery ; Humans ; Male ; Penis ; surgery ; Tissue Engineering ; Urethra ; surgery

BACKGROUNDIn order to improve the clinical treatment level of urinary system injury, it is necessary to build up an animal model of urinary system wound, which is not only analogous to real clinical practice, but also simple and practical.

METHODSWe have developed the third generation of firearm fragment wound generator based on the first and the second producer. The best explosive charge of the blank cartridge was selected by gradient powder loading experiments. The firearm fragment injuries were made to the bulbous urethra of 10 New Zealand male rabbits. One week preoperatively and 2, 4 and 8 weeks postoperatively, all the animals underwent urethroscopy and urethrography. At 2, 4 and 8 weeks postoperatively, two animals were randomly selected and killed, and the urethra was cut off for pathological examination.

RESULTSThe shooting distance of the third generation of firearm fragment wound generator is 2 cm. The best explosive charge of the blank cartridge is 1 g of nitrocotton. All rabbits survived the procedures and stayed alive until they were killed. Injuries were limited to bulbous urethra and distal urethra. Round damaged areas, 1-1.5 cm in length, on the ventral wall were observed. Ureteroscopy results showed that canal diameter gradually shrank by over 50% in 9 rabbits. The rate of success was 90%. Urethrography result noted that a 1-1.3 cm stricture was formed at the bulbous urethra. Histology results of injured stricture urethra showed that fibrous connective tissue hyperplasia and hyaline degeneration caused further stricture in the canal.

CONCLUSIONSThe third generation of firearm fragment wound generator imitates the bullet firing process and is more accurate and repeatable. The corresponding rabbit model of traumatic complex urethral stricture simulates the real complex clinical conditions. This animal model provides a standardized platform for clinical researches on treating traumatic injuries to the urinary system.

Animals ; Disease Models, Animal ; Male ; Penis ; surgery ; Rabbits ; Urethra ; surgery ; Urethral Stricture ; surgery

OBJECTIVETo Explore the effect of oblique preputial island flap for the treating of hypospadias.

METHODSFifty-one patients were performed one-stage urethroplasty with oblique preputial island flap to repair hypospadias.

RESULTSAll cases resulted in a good contour of the penis without any redundancy and a normal anatomic position of slit-shaped urethral meatus. The urination was perfect. Six patients occurred complications (3 cases of urinary fistula, 3 cases of meatal stenosis).

CONCLUSIONWith extensive scope of materials, reliable blood supply of skin flap, satisfactory appearance of shaping penis and few complications, one-stage urethroplasty with oblique preputial island flap is an effective method to repair hypospadias of penile type and penile-scrotal type.

Adolescent ; Child ; Child, Preschool ; Humans ; Hypospadias ; surgery ; Male ; Penis ; surgery ; Surgical Flaps ; Urethra ; surgery

Objective: To document the anatomical structure of the area anterior to the anorectum passing through the levator hiatus between the levator ani slings bilaterally. Methods: Three male hemipelvises were examined at the Laboratory of Clinical Applied Anatomy, Fujian Medical University. (1) The anatomical assessment was performed in three ways; namely, by abdominal followed by perineal dissection, by examining serial cross-sections, and by examining median sagittal sections. (2) The series was stained with hematoxylin and eosin to enable identification of nerves, vessels, and smooth and striated muscles. Results: (1) It was found that the rectourethralis muscle is closest to the deep transverse perineal muscle where the longitudinal muscle of the rectum extends into the posteroinferior area of the membranous urethra. The communicating branches of the neurovascular bundle (NVB) were identified at the posterior edge of the rectourethralis muscle on both sides. The rectum was found to be fixed to the membranous urethra through the rectourethral muscle, contributing to the anorectal angle of the anterior rectal wall. (2) Serial cross-sections from the anal to the oral side were examined. At the level of the external anal sphincter, the longitudinal muscle of the rectum was found to extend caudally and divide into two muscle bundles on the oral side of the external anal sphincter. One of these muscle bundles angled dorsally and caudally, forming the conjoined longitudinal muscle, which was found to insert into the intersphincteric space (between the internal and external anal sphincters). The other muscle bundle angled ventrally and caudally, filling the gap between the external anal sphincter and the bulbocavernosus muscle, forming the perineal body. At the level of the superficial transverse perineal muscle, this small muscle bundle headed laterally and intertwined with the longitudinal muscle in the region of the perineal body. At the level of the rectourethralis and deep transverse perineal muscle, the external urethral sphincter was found to occupy an almost completely circular space along the membranous part of the urethra. The dorsal part of the external urethral sphincter was found to be thin at the point of attachment of the rectourethralis muscle, the ventral part of the longitudinal muscle of the rectum. We identified a venous plexus from the NVB located close to the oral and ventral side of the deep transverse perineal muscle. Many vascular branches from the NVB were found to be penetrating the longitudinal muscle and the ventral part of rectourethralis muscle at the level of the apex of the prostate. The rectourethral muscle was wrapped ventrally around the membranous urethra and apex of the prostate. The boundary between the longitudinal muscle and prostate gradually became more distinct, being located at the anterior end of the transabdominal dissection plane. (3) Histological examination showed that the dorsal part of the external urethral sphincter (striated muscle) is thin adjacent to the striated muscle fibers from the deep transverse perineal muscle and the NVB dorsally and close by. The rectourethral muscle was found to fill the space created by the internal anal sphincter, deep transverse perineal muscle, and both levator ani muscles. Many tortuous vessels and tiny nerve fibers from the NVB were identified penetrating the muscle fibers of the deep transverse perineal and rectourethral muscles. The structure of the superficial transverse perineal muscle was typical of striated muscle. These findings were reconstructed three-dimensionally. Conclusions: In intersphincteric resection or abdominoperineal resection for very low rectal cancer, the anterior dissection plane behind Denonvilliers' fascia disappears at the level of the apex of the prostate. The prostate and both NVBs should be used as landmarks during transanal dissection of the non-surgical plane. The rectourethralis muscle should be divided near the rectum side unless tumor involvement is suspected. The superficial and deep transverse perineal muscles, as well as their supplied vessels and nerve fibers from the NVB. In addition, the cutting direction should be adjusted according to the anorectal angle to minimize urethral injury.
Humans ; Male ; Rectum/surgery* ; Anal Canal/anatomy & histology* ; Rectal Neoplasms/surgery* ; Proctectomy ; Urethra/surgery*

Male ; Humans ; Infant ; Hypospadias/surgery* ; Urologic Surgical Procedures, Male ; Urethra/surgery* ; Penis/surgery* ; Follow-Up Studies

OBJECTIVETo discuss the methods for urethral external meatus and glanuloplasty after correction of hypospadias.

METHODSThe V shape flap on the dorsal side of glan, combined with the bilateral glan flaps were moved to the ventral side. The flap at the ventral side of urethral external meatus was turned over. Then the urethral external meatus was repositioned to the top end of glan with the ventral defects covered by the dorsal flaps. Then the coniform glan was reconstructed.

RESULTSFrom January 2008 to December 2013, 28 cases were treated, including glandular hypospadias, postoperative retraction of external urethral meatus and meatal stenosis. 21 patients were followed up for 1 -12 months (average, 1 month) with marked improvement of glan appearance and retraction of external meatus. No meatal stenosis happened.

CONCLUSIONSPostoperative retraction of urethral external meatus and meatal stenosis can be corrected by V shape flap on the dorsal side of glan combined with the bilateral glan flaps. The flat appearance of glan can be improved. It is an ideal method for glandular hypospadias.

Humans ; Hypospadias ; surgery ; Male ; Penis ; surgery ; Postoperative Complications ; surgery ; Postoperative Period ; Surgical Flaps ; Urethra ; surgery ; Urethral Stricture ; etiology ; surgery