1.Current diagnosis and treatment of male genital lichen sclerosus.
National Journal of Andrology 2014;20(7):579-585
Male genital lichen sclerosus (MGLSc) is a chronically relapsing disease characterized by a long course, gradual aggravation, and a tendency towards malignancy. Once called balanitis xerotica obliterans, MGLSc has a distinct predilection for the prepuce and glans, involving the urethra when aggravating, forming scarring tissues, and causing urethral stricture, which may seriously affect the patients'quality of life with such symptoms as urinary stream narrowing, dysuria, and painful penile erection. The etiology and pathogenesis of MGLSc have not yet been adequately explained though it is generally thought to be associated with autoimmune mechanism, genetic factors, infections, local trauma, and chronic urinary irritation. MGLSc can be fairly easily diagnosed according to its clinical manifestations and histopathological results, but can be hardly cured. Early diagnosis and prompt treatment are the most important approaches, which may relieve its symptoms, check its progression, and prevent its long-term sequelae. Ultrapotent topical corticosteroids are the choice for the treatment of MGLSc. For those who fail to respond to expectant medication or have dysuria due to urethral stricture and painful erection, rational surgery may be resorted to, with importance attached to long-term follow-up. This article presents an update of the diagnosis and treatment of MGLSc and MGLSc-induced urethral stricture.
Genital Diseases, Male
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diagnosis
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etiology
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therapy
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Humans
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Lichen Sclerosus et Atrophicus
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complications
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diagnosis
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therapy
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Male
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Urethral Stricture
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etiology
2.Application of V shape flap for the urethral external meatus and glanuloplasty.
Qiyu LIU ; Yangqun LI ; Zhe YANG ; Muxin ZHAO ; Wen CHEN ; Ning MA ; Weixin WANG ; Lisi XU ; Jun FENG
Chinese Journal of Plastic Surgery 2016;32(1):49-51
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
3.Endoscopic realignment with drainage via a peel-away sheath for the treatment of urethral rupture: A report of 21 cases.
Cong-Xiang HAN ; Wei-Jie XU ; Wei LI ; Zhong-Ying YU ; Jin-Yu LI ; Xia-Cong LIN ; Li ZHAO
National Journal of Andrology 2016;22(7):613-616
ObjectiveTo study the clinical effect endoscopic realignment with drainage via a peel-away sheath in the treatment of urethral rupture.
METHODSWe treated 21 urethral rupture patients by endoscopic realignment with drainage via a peel-away sheath using normal saline for irrigation under the normal nephroscope or Li Xun nephroscope, followed by analysis of the clinical results.
RESULTSThe operation was successfully accomplished in 20 cases but failed in 1 and none experienced urinary extravasation. In the 14 cases of bulbar urethral rupture, the mean operation time was (5.1±1.6) min and the mean Foley catheter indwelling time was (26.0±5.1) d. Urethral stricture developed in 57.1% (8/14) of the cases after catheter removal, of which 1 was cured by internal urethrotomy and the other 7 by urethral sound dilation, with an average maximum urinary flow rate of (18.8±1.8) ml/s at 12 months after operation. In the 6 cases of posterior urethral rupture, the mean operation time was (15.8±7.5) min and the mean Foley catheter indwelling time was 8 weeks. Urethral stricture developed in all the 6 cases after catheter removal, of which 3 cases were cured by urethral dilation, 1 by internal urethrotomy, and 2 by open urethroplasty. The average maxium urinary flow rate of the 4 cases exempt from open surgery was (17.9±1.9) ml/s at 12 months after operation.
CONCLUSIONSEndoscopic realignment with drainage via a peel-away sheath can keep the operative field clear, avoid intraoperative rinse extravasation, shorten the operation time, improve the operation success rate, and achieve satisfactory early clinical outcomes in the treatment of either bulbar or posterior urethral rupture.
Device Removal ; Drainage ; Endoscopy ; Humans ; Operative Time ; Rupture ; surgery ; Treatment Outcome ; Urethra ; injuries ; Urethral Stricture ; etiology ; Urinary Catheterization
4.Transurethral resection of the prostate stricture management.
Asian Journal of Andrology 2020;22(2):140-144
For more than nine decades, transurethral resection of the prostate remains the gold standard for the surgical treatment of lower urinary tract symptoms due to benign prostatic obstruction. The occurrence of urethral strictures after transurethral resection of the prostate is one of the major late complications and has been reported as the leading cause of iatrogenic urethral strictures in patients older than 45 years who underwent urethroplasty. Although several postulations have been proposed to explain the urethral stricture after transurethral resection of the prostate, the exact etiology of urethral stricture after TURP is still controversial. Suggested etiological factors of urethral stricture formation after transurethral resection of the prostate include infection, mechanical trauma, prolonged indwelling catheter time, use of local anesthesia, and electrical injury by a stray current. One single treatment option is not appropriate for all stricture types. The management of urethral stricture following transurethral resection of the prostate includes minimally invasive endoscopic methods, including urethral dilation and direct visual incision, or open surgical procedures with varying urethroplasty techniques. Although scientific studies focusing on urethral strictures after transurethral resection of the prostate are relatively limited and sparse, we can apply the principles of urethral stricture management before making decisions on individual stricture treatment.
Humans
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Male
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Middle Aged
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Prostate/surgery*
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Prostatic Hyperplasia/surgery*
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Transurethral Resection of Prostate/adverse effects*
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Urethra/surgery*
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Urethral Stricture/etiology*
5.Application of modified koyanagi technique with coverage by tunica vaginalis of testis in severe hypospadias.
Wenyong XUE ; Jinchun QI ; Caiyun YANG ; Qiang GAO ; Junxiao CHEN ; Xiaoqian SU ; Lei DU ; Shuwen YANG ; Chanebao QU
Chinese Journal of Plastic Surgery 2014;30(6):436-438
OBJECTIVETo investigate the clinical effect of modified Koyanagi technique with coverage by tunica vaginalis of testis in severe hypospadias.
METHODS49 cases with severe hypospadias treated from Jan. 2009 to Sep. 2011 were retrospectively studied. 25 patients underwent Koyanagi technique with coverage by tunica vaginalis of testis. 24 cases underwent one-stage Duplay + Duckett technique in the same term. The patients were followed up for 7-24 months.
RESULTSAmong the 25 children treated with Koyanagi procedure, 20 cases were cured, 5 patients had postoperative complications, including urethral fistula in 3 cases,urethral stenosis in 2 cases. At the same time, in the Duplay + Duckett group, 17 cases were cured, 7 children had postoperative complications, including urethral fistula in 4 cases, and urethral stenosis in 3 cases. All the patients with urethral fistula were repaired successfully 6 months after the first surgery; The urethral stenosis were cured by dilatation within 1 to 3 months. The successful rate in the 2 groups had no significant difference(P >0.05).
CONCLUSIONSKoyanagi technique with coverage by tunica vaginalis of testis is relatively simple with similar effect as Duplay + Duckett technique for severe hypospadias.
Child ; Child, Preschool ; Humans ; Hypospadias ; surgery ; Male ; Postoperative Complications ; etiology ; therapy ; Retrospective Studies ; Surgical Flaps ; transplantation ; Testis ; surgery ; Urethral Diseases ; etiology ; therapy ; Urethral Stricture ; etiology ; therapy ; Urinary Fistula ; etiology ; surgery
6.Urethral reconstruction using lingual mucosal graft for the treatment of complex hypospadias.
Zhong-hua LIU ; Zhi-qiang FAN ; Xue-jun HUANGFU
Chinese Journal of Plastic Surgery 2012;28(6):440-443
OBJECTIVETo review and summarize the experience of urethral reconstruction using lingual mucosal graft for the treatment of complex hypospadias.
METHODSWe evaluated the methods using lingual mucosal graft for the treatment of complex hypospadias. The dorsal inlay graft method and the tube graft method were used in our study.
RESULTSFrom Nov. 2010 to Oct. 2011,21 cases were treated. All the cases had at least one failed hypospadisa surgery before. The dorasl inlay grafting technique was used for 16 patients, the tube grafting technique was carried out in 5 patients(2 cases received Tube + Duply method). The follow-up period ranged from 3 months to 12 months (by average 6 months). The success rate of the methods was 61.9% with complications in 8 cases. Urethral fistula developed in 3 patients and urethral stricture developed in 5 patients. All cases who suffered stricture received the tube grafting technique. The fistula and urethral stricture were occurred at the site of the urethral termonoterminal anostomosis. Urethral stricture is the most common complication after the tube graft method for the treatment of the complex hypospadias.
CONCLUSIONSHarvesting the lingual mucosal graft is feasible and easy to perform. The complex hypospadias repair technique using lingual mucosal graft method provides good results. There fore it should be one of the preferred techniques for complex hypospadias repair. The dorsal inlay grafting technique has lower complication rate than the tube grafting technique. Early and regular urethral sounding should be carried out when patients received the tube graft method.
Adolescent ; Child ; Humans ; Hypospadias ; surgery ; Male ; Mouth Mucosa ; transplantation ; Reconstructive Surgical Procedures ; adverse effects ; Tongue ; Urethra ; surgery ; Urethral Diseases ; etiology ; Urethral Stricture ; etiology ; Urinary Fistula ; etiology ; Urologic Surgical Procedures, Male ; adverse effects
7.Meatoplasty with pedicle flap for meatal stenosis secondary to chronic balanitis.
Sheng-song HUANG ; Ya-ping GUI ; Hua-rong LUO ; Min WU ; Qi-min ZHANG ; Jun-fiang LI ; Deng-long WU
National Journal of Andrology 2015;21(7):630-633
OBJECTIVETo evaluate the effect of meatoplasty with the pedicle flap in the treatment of meatal stenosis secondary to chronic balanitis.
METHODSWe retrospectively analyzed 32 cases of meatal stenosis secondary to chronic balanitis treated by meato- plasty with the pedicle flap. All the patients had a history of chronic balanitis and had received meatal dilatation or simple ventral mea- totomy without significant effect. Their mean maximum urinary flow rate (Qmax) was (4.3 ± 2.4) ml/s. During the operation, A "/\"-shaped incision was made in the healthy epidermis and a flap was harvested from the frenulum. After complete removal of the scar, the flap was placed into the urethral wall, followed by reconstruction of the external urethral orifice.
RESULTSThe patients were fol- lowed up for 6 to 30 months, which revealed smooth urination in all the patients with Qmax of (26.7 ± 4.5) ml/s and normal erectile function and uresiesthesis.
CONCLUSIONWith little invasiveness and few complications, meatoplasty with the pedicle flap is an ideal surgical method for the treatment of meatal stenosis secondary to chronic balanitis. However, there might be some change in the normal appearance of the balanus postoperatively, and its long-term effect needs further observation.
Balanitis ; complications ; Constriction, Pathologic ; etiology ; surgery ; Dilatation ; Humans ; Male ; Postoperative Period ; Reconstructive Surgical Procedures ; Retrospective Studies ; Surgical Flaps ; Urethra ; surgery ; Urethral Stricture ; etiology ; surgery ; Urination
8.Foley catheter versus urethral stent plus gastric tube for urine drainage following urethroplasty.
Qi-Gen XIE ; Cheng SU ; Zuo-Qing LI ; Sui-Sheng LI ; Zhe XU ; Jun-Jie SUN ; Li ZHOU
National Journal of Andrology 2014;20(5):439-441
OBJECTIVETo compare the advantages and disadvantages of the Foley catheter draining method versus the urethral stent plus gastric tube draining method for urine drainage following urethroplasty for hypospadias.
METHODSWe retrospectively analyzed the clinical data of 361 cases of hypospadias treated by urethroplasty. After operation, 91 of the cases received urine drainage with the Foley catheter (group A) and 270 with a urethral stent plus a gastric tube (group B). We compared the incidence rates of bladder irritation, fistula, urethral stricture, and urethral diverticulum between the two groups of patients.
RESULTSNo statistically significant differences were found between groups A and B in the incidences of bladder irritation (9.89% vs 10.70%, P > 0.05) and urethral diverticulum (1.09% vs 2.22%, P > 0.05). The incidence rate of fistula was markedly higher in group A than in B (20.80% vs 13.30%, P < 0.05), and so was that of urethral stricture (10.90% vs 5.55%, P < 0.05).
CONCLUSIONThe urethral stent plus gastric tube draining method is more effective than the Foley catheter draining method for urine drainage following urethroplasty.
Aged ; Child ; Diverticulum ; etiology ; Drainage ; methods ; Humans ; Hypospadias ; surgery ; Incidence ; Male ; Retrospective Studies ; Stents ; Urethra ; surgery ; Urethral Stricture ; etiology ; Urinary Catheterization ; instrumentation ; methods
9.Urethral dilation with a zebra guidewire-guided fascia dilator for complex urethral stricture after hypospadias surgery.
National Journal of Andrology 2011;17(9):823-824
OBJECTIVETo evaluate the clinical effect of urethral dilation with a zebra guidewire-guided fascia dilator in the treatment of complex urethral stricture after hypospadias surgery.
METHODSThis study included 12 cases of complex urethral stricture after hypospadias surgery that had failed to respond to other urethral dilation therapies. A zebra guidewire was put into the urethra via a ureteroscope placed in through a suprapubic puncture hole. Then a fascia dilator was inserted along the zebra guidewire for urethral dilation. A silicone catheter was reserved for 2 weeks after the dilation.
RESULTSAll the 12 patients achieved smooth urination after removal of the catheter. During the 6 - 28 months follow-up, 8 of the cases were cured after 1 - 6 regular urethral dilations and the other 4 experienced no more dysuria.
CONCLUSIONUrethral dilation with a zebra guidewire-guided fascia dilator is a safe and effective method for the treatment of complex urethral stricture after hypospadias surgery.
Adolescent ; Child ; Child, Preschool ; Dilatation ; instrumentation ; methods ; Fasciotomy ; Humans ; Hypospadias ; surgery ; Male ; Treatment Outcome ; Urethral Stricture ; etiology ; surgery ; Urologic Surgical Procedures ; instrumentation ; methods
10.Operative techniques of anastomotic posterior urethroplasty for traumatic posterior urethral strictures.
Zhan-song ZHOU ; Bo SONG ; Xi-yu JIN ; En-qing XIONG ; Jia-hua ZHANG
Chinese Journal of Traumatology 2007;10(2):101-104
OBJECTIVETo elucidate the details of operative technique of anastomotic posterior urethroplasty for traumatic posterior urethral strictures in attempt to offer a successful result.
METHODSWe reviewed the clinical data of 106 patients who had undergone anastomotic repair for posterior urethral strictures following traumatic pelvic fracture between 1979 and 2004. Patients'age ranged from 8 to 53 years (mean 27 years). Surgical repair was performed via perinea in 72 patients, modified transperineal repair in 5 and perineoabdominal repair in 29. Follow-up ranged from 1 to 23 years (mean 8 years).
RESULTSAmong the 77 patients treated by perineal approaches, 69 (95.8%) were successfully repaired and 27 out of the 29 patients (93.1%) who were repaired by perineoabdominal protocols were successful. The successful results have sustained as long as 23 years in some cases. Urinary incontinence did not happen in any patients while impotence occurred as a result of the anastomotic surgery.
CONCLUSIONSThree important skills or principles will ensure a successful outcome, namely complete excision of scar tissues, a completely normal mucosa ready for anastomosis at both ends of the urethra, and a tension-free anastomosis. When the urethral stricture is below 2.5 cm long, restoration of urethral continuity can be accomplished by a perineal procedure. If the stricture is over 2.5 cm long, a modified perineal or transpubic perineoabdominal procedure should be used. In the presence of a competent bladder neck, anastomotic surgery does not result in urinary incontinence. Impotence is usually related to the original trauma and rarely (5.7%) to urethroplasty.
Adolescent ; Adult ; Anastomosis, Surgical ; Child ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Urethra ; surgery ; Urethral Stricture ; etiology ; surgery ; Urologic Surgical Procedures