1.Management strategies for vesicovaginal fistula following cervical cancer radiotherapy in women
Jiemin SI ; Weidong ZHU ; Ranxing YANG ; Lujie SONG ; Chongrui JIN ; Jianwen HUANG ; Xuxiao YE ; Zuowei LI ; Wenxiong SONG ; Qiang FU ; Yinglong SA
Chinese Journal of Urology 2025;46(8):587-592
Objective:To investigate the treatment strategies for vesicovaginal fistula(VVF)in women following cervical cancer radiotherapy.Methods:A retrospective analysis was performed on the clinical data of 33 female patients with post-radiotherapy VVF after cervical cancer treatment at Shanghai Sixth People’s Hospital between January 2020 and June 2024. The patients were categorized into three groups based on surgical approaches:Group A(11 patients):Underwent prone-position VVF repair. Mean age:(50.0±9.6)years;mean radiotherapy sessions:(22.6±2.2). All had simple VVF without concurrent intestinal or surrounding soft-tissue fistulas. Among them,1 patient previously received laparoscopic VVF repair,1 transvaginal VVF repair,and 2 gracilis muscle flap packing for VVF repair. One month prior to surgery,the average daily usage of urine pads was 16.7(12.8,25.7)pieces,and the quality of life(QOL)score stood at 4.0(4.0,5.0)points. Preoperative cystoscopy revealed that 8 cases had fistulas located in the trigonal region of the bladder,while 3 cases had fistulas on the posterior bladder wall. The diameter of the fistula openings,measured under a microscope,was 1.2(0.8,1.6)cm. Based on the Goh classification criteria for vesicovaginal fistulas,this group included 3 cases of type 1,4 cases of type 2,2 cases of type 3,and 2 cases of type 4;7 cases of type A and 4 cases of type B;as well as 3 cases of typeⅠ,7 cases of type Ⅱ,and 1 case of type Ⅲ.Group B(20 patients):Underwent gracilis muscle flap packing for VVF repair. Mean age:(58.6±8.8)years;mean radiotherapy sessions:(29.8±3.9). Three patients had concurrent rectovaginal fistulas and received colostomy for fecal diversion. History of previous interventions:3 had laparoscopic VVF repair,4 transvaginal VVF repair,and 1 both transvaginal and laparoscopic VVF repair. One month prior to surgery,the average daily usage of urine pads was 19.7(15.8,27.7)pieces,and the QOL score stood at 5.0(5.0,6.0)points. Preoperative cystoscopy revealed that 13 cases had fistulas located in the trigonal region of the bladder,while 7 cases had fistulas on the posterior bladder wall. The diameter of the fistula openings,measured under a microscope,was 1.8(1.0,3.2)cm. Based on the Goh classification criteria for vesicovaginal fistulas,this group included 4 cases of type 1,9 cases of type 2,3 cases of type 3,and 4 cases of type 4;6 cases of type A,11 cases of type B and 3 cases of type C;as well as 1 cases of type Ⅱ,and 19 case of type Ⅲ. Group C(2 patients):Underwent ureterocutaneous diversion. Ages:67 and 73 years;radiotherapy sessions:51 and 60,respectively. Both had concurrent rectovaginal fistulas and bladder soft-tissue fistulas. The patient presented with recurrent thigh abscesses accompanied by fever. One month prior to surgery,the daily usage of urine pads was 29 and 23 pieces,respectively,and the QOL score was 6 points. Cystoscopic examination revealed that the vesicovaginal fistulas were located in the trigone of the bladder,with diameters of 3 cm and 4 cm,respectively. Additionally,partial defects were noted in the ventral wall of the urethra,while no bladder soft tissue fistulas were detected. According to the Goh classification for vesicovaginal fistulas,both cases were categorized as type 4,type C,and type Ⅲ. For Groups A and B,urinary catheters were indwelled for 3 weeks postoperatively,then removed to assess spontaneous urination and incontinence. QOL was evaluated,with a minimum 6-month follow-up. For confirmed postoperative VVF recurrence,re-repair was performed 3?6 months later based on patient preference. For Group C,double-J stents were placed in the ureters,and stoma bags were applied 3 days postoperatively. Stents were replaced every 1?2 months,with QOL assessment. Successful fistula repair in Groups A and B was defined as the absence of vaginal leakage confirmed by cystoscopy after six months of the procedure with no vaginal leakage. For Group C,surgical success was determined by the resolution of perineal urinary leakage and improvement in QOL.Results:All 33 patients completed surgery successfully. Group A:Follow-up duration:16.3(9.6,24.6)months. Surgical repair succeeded in 7 patients,with unobstructed spontaneous urination and no vaginal incontinence. Four patients had VVF recurrence:2 refused further treatment,and 2 underwent repeat gracilis muscle flap packing. One was successfully repaired,while one recurrence case refused further treatment. Group B:Follow-up duration:17.0(9.5,24.8)months(8?32 months). Thirteen patients restored spontaneous urination without recurrence. Seven had recurrence:5 refused further surgery,and 2 underwent re-repair. One repair succeeded without incontinence,while one recurrence case refused treatment. Group C:Follow-up durations were 6 and 22 months. Perineum remained dry without incontinence(no urine pads needed),and no recurrence of thigh soft-tissue redness/infection occurred. QOL scores were 2 and 3,respectively.Conclusions:Post-radiotherapy VVF in women after cervical cancer presents complex and variable conditions. The primary goal of treatment should be to improve patients’ quality of life. Treatment approaches should be selected based on the complexity of urinary fistulas and local tissue conditions. In general,patients who are younger,have received lower doses of radiation therapy,present with smaller fistula diameters,have well-vascularized and elastic perifistular tissues,and have no concurrent tissue fistulas are candidates for prone-position VVF repair. Patients who do not meet the criteria for transvaginal repair,have a history of at least two previous repair attempts,or have concurrent vaginorectal fistulas require gracilis muscle flap packing for VVF repair. Patients with three or more types of concurrent tissue fistulas,extensive pale and inelastic perifistular tissues,and who are not amenable to repair surgery undergo ureterocutaneous diversion.
2.Mapping the nutritional management journey of homebound patients after gastric cancer surgery and nursing countermeasures
Yuqing FAN ; Zuyang XI ; Yongting WEI ; Fei TIAN ; Fu NI ; Xiaoqian DONG ; Jiemin QIN
Chinese Journal of Nursing 2025;60(17):2124-2130
Objective To identify the multidimensional needs of postoperative gastric cancer patients for home-based nutritional management based on patient journey maps,and to provide a reference for carrying out nutritional management interventions.Methods Using descriptive qualitative research methods,we facilitated semi-structured in-depth interviews with 9 pairs of postoperative gastric cancer homebound patients and their primary caregivers from a tertiary general hospital in Yichang City,China,from September 2024 to January 2025,and analysed the data and drew the patient journey maps by content analysis.Results Totally 24 sub-themes were summarised from 4 aspects,namely tasks,emotions,pain points and opportunity points,and journey maps involving the acute recovery period,the transitional adaptation period and the nutritional reconstruction period were formed.Conclusion The nutritional needs of homebound patients after gastric cancer surgery are complex and variable,and their needs for dietary guidance,eating-related symptom management,and real-time counselling are highlighted.In the future,appropriate intervention strategies can be developed based on the journey maps to meet the multidimensional nutritional needs of patients.
3.Management strategies for vesicovaginal fistula following cervical cancer radiotherapy in women
Jiemin SI ; Weidong ZHU ; Ranxing YANG ; Lujie SONG ; Chongrui JIN ; Jianwen HUANG ; Xuxiao YE ; Zuowei LI ; Wenxiong SONG ; Qiang FU ; Yinglong SA
Chinese Journal of Urology 2025;46(8):587-592
Objective:To investigate the treatment strategies for vesicovaginal fistula(VVF)in women following cervical cancer radiotherapy.Methods:A retrospective analysis was performed on the clinical data of 33 female patients with post-radiotherapy VVF after cervical cancer treatment at Shanghai Sixth People’s Hospital between January 2020 and June 2024. The patients were categorized into three groups based on surgical approaches:Group A(11 patients):Underwent prone-position VVF repair. Mean age:(50.0±9.6)years;mean radiotherapy sessions:(22.6±2.2). All had simple VVF without concurrent intestinal or surrounding soft-tissue fistulas. Among them,1 patient previously received laparoscopic VVF repair,1 transvaginal VVF repair,and 2 gracilis muscle flap packing for VVF repair. One month prior to surgery,the average daily usage of urine pads was 16.7(12.8,25.7)pieces,and the quality of life(QOL)score stood at 4.0(4.0,5.0)points. Preoperative cystoscopy revealed that 8 cases had fistulas located in the trigonal region of the bladder,while 3 cases had fistulas on the posterior bladder wall. The diameter of the fistula openings,measured under a microscope,was 1.2(0.8,1.6)cm. Based on the Goh classification criteria for vesicovaginal fistulas,this group included 3 cases of type 1,4 cases of type 2,2 cases of type 3,and 2 cases of type 4;7 cases of type A and 4 cases of type B;as well as 3 cases of typeⅠ,7 cases of type Ⅱ,and 1 case of type Ⅲ.Group B(20 patients):Underwent gracilis muscle flap packing for VVF repair. Mean age:(58.6±8.8)years;mean radiotherapy sessions:(29.8±3.9). Three patients had concurrent rectovaginal fistulas and received colostomy for fecal diversion. History of previous interventions:3 had laparoscopic VVF repair,4 transvaginal VVF repair,and 1 both transvaginal and laparoscopic VVF repair. One month prior to surgery,the average daily usage of urine pads was 19.7(15.8,27.7)pieces,and the QOL score stood at 5.0(5.0,6.0)points. Preoperative cystoscopy revealed that 13 cases had fistulas located in the trigonal region of the bladder,while 7 cases had fistulas on the posterior bladder wall. The diameter of the fistula openings,measured under a microscope,was 1.8(1.0,3.2)cm. Based on the Goh classification criteria for vesicovaginal fistulas,this group included 4 cases of type 1,9 cases of type 2,3 cases of type 3,and 4 cases of type 4;6 cases of type A,11 cases of type B and 3 cases of type C;as well as 1 cases of type Ⅱ,and 19 case of type Ⅲ. Group C(2 patients):Underwent ureterocutaneous diversion. Ages:67 and 73 years;radiotherapy sessions:51 and 60,respectively. Both had concurrent rectovaginal fistulas and bladder soft-tissue fistulas. The patient presented with recurrent thigh abscesses accompanied by fever. One month prior to surgery,the daily usage of urine pads was 29 and 23 pieces,respectively,and the QOL score was 6 points. Cystoscopic examination revealed that the vesicovaginal fistulas were located in the trigone of the bladder,with diameters of 3 cm and 4 cm,respectively. Additionally,partial defects were noted in the ventral wall of the urethra,while no bladder soft tissue fistulas were detected. According to the Goh classification for vesicovaginal fistulas,both cases were categorized as type 4,type C,and type Ⅲ. For Groups A and B,urinary catheters were indwelled for 3 weeks postoperatively,then removed to assess spontaneous urination and incontinence. QOL was evaluated,with a minimum 6-month follow-up. For confirmed postoperative VVF recurrence,re-repair was performed 3?6 months later based on patient preference. For Group C,double-J stents were placed in the ureters,and stoma bags were applied 3 days postoperatively. Stents were replaced every 1?2 months,with QOL assessment. Successful fistula repair in Groups A and B was defined as the absence of vaginal leakage confirmed by cystoscopy after six months of the procedure with no vaginal leakage. For Group C,surgical success was determined by the resolution of perineal urinary leakage and improvement in QOL.Results:All 33 patients completed surgery successfully. Group A:Follow-up duration:16.3(9.6,24.6)months. Surgical repair succeeded in 7 patients,with unobstructed spontaneous urination and no vaginal incontinence. Four patients had VVF recurrence:2 refused further treatment,and 2 underwent repeat gracilis muscle flap packing. One was successfully repaired,while one recurrence case refused further treatment. Group B:Follow-up duration:17.0(9.5,24.8)months(8?32 months). Thirteen patients restored spontaneous urination without recurrence. Seven had recurrence:5 refused further surgery,and 2 underwent re-repair. One repair succeeded without incontinence,while one recurrence case refused treatment. Group C:Follow-up durations were 6 and 22 months. Perineum remained dry without incontinence(no urine pads needed),and no recurrence of thigh soft-tissue redness/infection occurred. QOL scores were 2 and 3,respectively.Conclusions:Post-radiotherapy VVF in women after cervical cancer presents complex and variable conditions. The primary goal of treatment should be to improve patients’ quality of life. Treatment approaches should be selected based on the complexity of urinary fistulas and local tissue conditions. In general,patients who are younger,have received lower doses of radiation therapy,present with smaller fistula diameters,have well-vascularized and elastic perifistular tissues,and have no concurrent tissue fistulas are candidates for prone-position VVF repair. Patients who do not meet the criteria for transvaginal repair,have a history of at least two previous repair attempts,or have concurrent vaginorectal fistulas require gracilis muscle flap packing for VVF repair. Patients with three or more types of concurrent tissue fistulas,extensive pale and inelastic perifistular tissues,and who are not amenable to repair surgery undergo ureterocutaneous diversion.
4.Efficacy of the transpubic access in the treatment of female urogenital tract injury
Weidong ZHU ; Jiemin SI ; Chongrui JIN ; Wenxiong SONG ; Xuxiao YE ; Lujie SONG ; Qiang FU ; Yinglong SA
Chinese Journal of Urology 2025;46(10):774-777
Objective:To explore the application value of transpubic access on female urogenital tract injury.Methods:A retrospective analysis was conducted on 15 female patients with urogenital tract injury caused by trauma admitted to our department from May 2020 to October 2024,all of whom were complicated urethral stricture or atresia,accompanied by urethrovaginal fistula or vaginorectal fistula. All patients underwent suprapubic vesicostomy before surgery,and 1 case underwent sigmoidostomy simultaneously. The mean age of the patients was(29.6 ± 3.2)years old,and the course of disease was 6-24 months. Preoperative urethrography and urethroscope showed the location of urethral stenosis,with proximal urethra stricture in 7 cases and distal urethra stricture in 8 cases. The average length of strictures was(2.8±0.2)cm. The urethral ultrasonography,magnetic resonance and CTU examination showed 8 patients were complicated with urethrovaginal fistula,and 1 patient was complicated with vaginorectal fistula. All patients underwent transpubic access and resection of symphysis pubis. According to the specific conditions of urethral stricture,7 of them underwent end-to-end urethral anastomosis,5 cases underwent bladder wall flap urethroplasty,3 cases underwent vulva flap urethroplasty,8 cases underwent urethral vaginal fistula repair,1 case underwent vagino-rectal fistula repair,and 7 cases underwent vaginoplasty during the operation.Results:All the 15 patients underwent successful operation without complication. After the catheter being removed 4 weeks after surgery,2 patients had urgent urinary incontinence and 3 patients had stress urinary incontinence. The bladder neck was reconstructed 3 months after surgery,the symptoms of urinary incontinence improved in 1 case,urinary incontinence remained in 2 cases,and pharmaceutical or physical therapy were continued. Two patients could not urinate normally after the catheter was removed and still carried the vesicostomy tube,waiting for further treatment. The other 8 patients had unobtrusive voiding after extubating,and were followed up for an average of(22.5±3.2)months. There was no recurrence of urinary fistula,and the average maximum urinary flow rate was(22.8±3.2)ml/s.Conclusions:The transpubic approach is a safe and effective way to treat female genital tract injury by different surgical methods according to specific conditions,especially for patients with severe trauma,poor local tissue conditions,complicated urethrovaginal fistula or vagino-rectal fistula.
5.Efficacy of the transpubic access in the treatment of female urogenital tract injury
Weidong ZHU ; Jiemin SI ; Chongrui JIN ; Wenxiong SONG ; Xuxiao YE ; Lujie SONG ; Qiang FU ; Yinglong SA
Chinese Journal of Urology 2025;46(10):774-777
Objective:To explore the application value of transpubic access on female urogenital tract injury.Methods:A retrospective analysis was conducted on 15 female patients with urogenital tract injury caused by trauma admitted to our department from May 2020 to October 2024,all of whom were complicated urethral stricture or atresia,accompanied by urethrovaginal fistula or vaginorectal fistula. All patients underwent suprapubic vesicostomy before surgery,and 1 case underwent sigmoidostomy simultaneously. The mean age of the patients was(29.6 ± 3.2)years old,and the course of disease was 6-24 months. Preoperative urethrography and urethroscope showed the location of urethral stenosis,with proximal urethra stricture in 7 cases and distal urethra stricture in 8 cases. The average length of strictures was(2.8±0.2)cm. The urethral ultrasonography,magnetic resonance and CTU examination showed 8 patients were complicated with urethrovaginal fistula,and 1 patient was complicated with vaginorectal fistula. All patients underwent transpubic access and resection of symphysis pubis. According to the specific conditions of urethral stricture,7 of them underwent end-to-end urethral anastomosis,5 cases underwent bladder wall flap urethroplasty,3 cases underwent vulva flap urethroplasty,8 cases underwent urethral vaginal fistula repair,1 case underwent vagino-rectal fistula repair,and 7 cases underwent vaginoplasty during the operation.Results:All the 15 patients underwent successful operation without complication. After the catheter being removed 4 weeks after surgery,2 patients had urgent urinary incontinence and 3 patients had stress urinary incontinence. The bladder neck was reconstructed 3 months after surgery,the symptoms of urinary incontinence improved in 1 case,urinary incontinence remained in 2 cases,and pharmaceutical or physical therapy were continued. Two patients could not urinate normally after the catheter was removed and still carried the vesicostomy tube,waiting for further treatment. The other 8 patients had unobtrusive voiding after extubating,and were followed up for an average of(22.5±3.2)months. There was no recurrence of urinary fistula,and the average maximum urinary flow rate was(22.8±3.2)ml/s.Conclusions:The transpubic approach is a safe and effective way to treat female genital tract injury by different surgical methods according to specific conditions,especially for patients with severe trauma,poor local tissue conditions,complicated urethrovaginal fistula or vagino-rectal fistula.
6.Mapping the nutritional management journey of homebound patients after gastric cancer surgery and nursing countermeasures
Yuqing FAN ; Zuyang XI ; Yongting WEI ; Fei TIAN ; Fu NI ; Xiaoqian DONG ; Jiemin QIN
Chinese Journal of Nursing 2025;60(17):2124-2130
Objective To identify the multidimensional needs of postoperative gastric cancer patients for home-based nutritional management based on patient journey maps,and to provide a reference for carrying out nutritional management interventions.Methods Using descriptive qualitative research methods,we facilitated semi-structured in-depth interviews with 9 pairs of postoperative gastric cancer homebound patients and their primary caregivers from a tertiary general hospital in Yichang City,China,from September 2024 to January 2025,and analysed the data and drew the patient journey maps by content analysis.Results Totally 24 sub-themes were summarised from 4 aspects,namely tasks,emotions,pain points and opportunity points,and journey maps involving the acute recovery period,the transitional adaptation period and the nutritional reconstruction period were formed.Conclusion The nutritional needs of homebound patients after gastric cancer surgery are complex and variable,and their needs for dietary guidance,eating-related symptom management,and real-time counselling are highlighted.In the future,appropriate intervention strategies can be developed based on the journey maps to meet the multidimensional nutritional needs of patients.
7.Chinese expert consensus on the diagnosis and treatment of traumatic supraorbital fissure syndrome (version 2024)
Junyu WANG ; Hai JIN ; Danfeng ZHANG ; Rutong YU ; Mingkun YU ; Yijie MA ; Yue MA ; Ning WANG ; Chunhong WANG ; Chunhui WANG ; Qing WANG ; Xinyu WANG ; Xinjun WANG ; Hengli TIAN ; Xinhua TIAN ; Yijun BAO ; Hua FENG ; Wa DA ; Liquan LYU ; Haijun REN ; Jinfang LIU ; Guodong LIU ; Chunhui LIU ; Junwen GUAN ; Rongcai JIANG ; Yiming LI ; Lihong LI ; Zhenxing LI ; Jinglian LI ; Jun YANG ; Chaohua YANG ; Xiao BU ; Xuehai WU ; Li BIE ; Binghui QIU ; Yongming ZHANG ; Qingjiu ZHANG ; Bo ZHANG ; Xiangtong ZHANG ; Rongbin CHEN ; Chao LIN ; Hu JIN ; Weiming ZHENG ; Mingliang ZHAO ; Liang ZHAO ; Rong HU ; Jixin DUAN ; Jiemin YAO ; Hechun XIA ; Ye GU ; Tao QIAN ; Suokai QIAN ; Tao XU ; Guoyi GAO ; Xiaoping TANG ; Qibing HUANG ; Rong FU ; Jun KANG ; Guobiao LIANG ; Kaiwei HAN ; Zhenmin HAN ; Shuo HAN ; Jun PU ; Lijun HENG ; Junji WEI ; Lijun HOU
Chinese Journal of Trauma 2024;40(5):385-396
Traumatic supraorbital fissure syndrome (TSOFS) is a symptom complex caused by nerve entrapment in the supraorbital fissure after skull base trauma. If the compressed cranial nerve in the supraorbital fissure is not decompressed surgically, ptosis, diplopia and eye movement disorder may exist for a long time and seriously affect the patients′ quality of life. Since its overall incidence is not high, it is not familiarized with the majority of neurosurgeons and some TSOFS may be complicated with skull base vascular injury. If the supraorbital fissure surgery is performed without treatment of vascular injury, it may cause massive hemorrhage, and disability and even life-threatening in severe cases. At present, there is no consensus or guideline on the diagnosis and treatment of TSOFS that can be referred to both domestically and internationally. To improve the understanding of TSOFS among clinical physicians and establish standardized diagnosis and treatment plans, the Skull Base Trauma Group of the Neurorepair Professional Committee of the Chinese Medical Doctor Association, Neurotrauma Group of the Neurosurgery Branch of the Chinese Medical Association, Neurotrauma Group of the Traumatology Branch of the Chinese Medical Association, and Editorial Committee of Chinese Journal of Trauma organized relevant experts to formulate Chinese expert consensus on the diagnosis and treatment of traumatic supraorbital fissure syndrome ( version 2024) based on evidence of evidence-based medicine and clinical experience of diagnosis and treatment. This consensus puts forward 12 recommendations on the diagnosis, classification, treatment, efficacy evaluation and follow-up of TSOFS, aiming to provide references for neurosurgeons from hospitals of all levels to standardize the diagnosis and treatment of TSOFS.
8.A case of bladder contracture and ureteral stenosis after radiotherapy for cervical cancer treated with bilateral ileal ureter substitution combined with " N-shaped" bladder augmentation and plasty
Kaile ZHANG ; Jiemin SI ; Song LI ; Wenzhuo FANG ; Ying WANG ; Ranxing YANG ; Xiaohui ZHOU ; Xiaoyong HU ; Qiang FU
Chinese Journal of Urology 2024;45(9):711-713
Ureteral stenosis and bladder contracture after radiotherapy for cervical cancer are challenging issues in urology. Ileal ureteroplasty combined with ileal bladder augmentation is a potential method to improve hydronephrosis and voiding function of patients, however, the surgical procedure is complex, with high surgical risks and numerous intraoperative and postoperative complications, which have hindered the widespread application of this surgical technique. This article introduces our hospital's experience through a typical surgical case. During the surgery, ileal substitution for bilateral ureters was performed in combination with ileal " N-shaped" augmentation. Two weeks after the surgery, the single-J stent was removed, and the urinary catheter was removed three weeks after the surgery. The patient achieved voluntary urination control with smooth voiding. Follow-up examinations at 3 months and 18 months postoperatively showed no hydronephrosis in the bilateral ureters, normal renal function, and a significantly expanded bladder capacity.
9.The outcomes of modified Kulkarni’s one-stage tongue mucosa graft urethroplasty in patients with anterior urethral stricture
Jiemin SI ; Lujie SONG ; Chongrui JIN ; Jianwen HUANG ; Xuxiao YE ; Zuowei LI ; Wenxiong SONG ; Qiang FU ; Yinglong SA
Chinese Journal of Urology 2024;45(10):761-766
Objective:To evaluate the efficacy of modified Kulkarni's one-stage tongue mucosal urethroplasty.Methods:From January 2020 to December 2022, 42 patients with anterior urethral stricture treated by modified Kulkarni one-stage tongue mucous urethroplasty in Shanghai Sixth People's Hospital. Stricture etiology was iatrogenic in 15 cases, trauma in 5 cases, unknown in 5 cases, infection in 6 cases, and lichen sclerosus in 11 cases. Twenty-one patients had previously undergone urethroplasty. The mean age of patients was (48.1±16.2) years. Median stricture length was (6.4±3.0)cm, including 11 cases with two strictures and 3 cases with multiple stenoses. The average preoperative Qmax was (4.6±2.3)ml/s, and the average residual urine was (96.6±24.7)ml. For treatment methods, a midline perineal incision was made, penis was invaginated into the incision, the distal extent of the stenosis was identified, urethra was rotated and dissected only on the left side, and incised dorsally to expose the whole stricture longitudinally. The tongue mucosal graft was fixed to the underlying albuginea and the right margin of the graft was sutured to the left margin of the urethral plate. Foley F14 silicon catheter was inserted. The urethra was rotated to its original position thus covering the oral graft. The improvements were as follows: First, we used tongue mucosa instead of cheek mucosa; Second, for the stenosis involving the urethral meatus, the narrowed urethral meatus was incised on the left side, which was continuous with the incision on the left side of the distal narrow segment, and then tongue mucosa was used as a whole. The catheter was removed 4 weeks after surgery, followed up 1, 3, 6 months, and then once a year.Results:All 42 patients underwent successful surgery without blood transfusion during the operation. The surgical time was 60-120 minutes. There were no complications such as infection, tissue necrosis, or bleeding during the perioperative period, and 16 patients complained of oral pain, which was relieved within one week after surgery. During the follow-up period, 39 cases presented with unobtrusive urination. One month after extubation, the maximum urine flow rate was (25.6±5.7)ml/s, and the residual urine volume was (11.3±7.1)ml. Three months after extubation, the maximum urine flow rate was (25.3±5.7)ml/s, and the residual urine volume was (11.9±7.5)ml. Six months after extubation, the maximum urine flow rate was (24.8±5.9)ml/s, and the residual urine volume was(12.4±7.9)ml. Two patients had recurrent stenosis 2 months after surgery, of which 1 patient underwent urethral dilation and recovered unobstructed urination, and 1 patient had recurrent stenosis after urethral dilation for 2 times and was cured after urethroplasty. No local wound infection, urethral shrinkage, urethral diverticulum, or urinary fistula occurred during the follow-up for 6 to 42 months.Conclusions:The modified Kulkarni’s one-stage tongue mucosa graft urethroplasty is suitable for most anterior urethral strictures, with high success rate, few complications, and avoidance of local wound complications
10.The outcomes of modified Kulkarni’s one-stage tongue mucosa graft urethroplasty in patients with anterior urethral stricture
Jiemin SI ; Lujie SONG ; Chongrui JIN ; Jianwen HUANG ; Xuxiao YE ; Zuowei LI ; Wenxiong SONG ; Qiang FU ; Yinglong SA
Chinese Journal of Urology 2024;45(10):761-766
Objective:To evaluate the efficacy of modified Kulkarni's one-stage tongue mucosal urethroplasty.Methods:From January 2020 to December 2022, 42 patients with anterior urethral stricture treated by modified Kulkarni one-stage tongue mucous urethroplasty in Shanghai Sixth People's Hospital. Stricture etiology was iatrogenic in 15 cases, trauma in 5 cases, unknown in 5 cases, infection in 6 cases, and lichen sclerosus in 11 cases. Twenty-one patients had previously undergone urethroplasty. The mean age of patients was (48.1±16.2) years. Median stricture length was (6.4±3.0)cm, including 11 cases with two strictures and 3 cases with multiple stenoses. The average preoperative Qmax was (4.6±2.3)ml/s, and the average residual urine was (96.6±24.7)ml. For treatment methods, a midline perineal incision was made, penis was invaginated into the incision, the distal extent of the stenosis was identified, urethra was rotated and dissected only on the left side, and incised dorsally to expose the whole stricture longitudinally. The tongue mucosal graft was fixed to the underlying albuginea and the right margin of the graft was sutured to the left margin of the urethral plate. Foley F14 silicon catheter was inserted. The urethra was rotated to its original position thus covering the oral graft. The improvements were as follows: First, we used tongue mucosa instead of cheek mucosa; Second, for the stenosis involving the urethral meatus, the narrowed urethral meatus was incised on the left side, which was continuous with the incision on the left side of the distal narrow segment, and then tongue mucosa was used as a whole. The catheter was removed 4 weeks after surgery, followed up 1, 3, 6 months, and then once a year.Results:All 42 patients underwent successful surgery without blood transfusion during the operation. The surgical time was 60-120 minutes. There were no complications such as infection, tissue necrosis, or bleeding during the perioperative period, and 16 patients complained of oral pain, which was relieved within one week after surgery. During the follow-up period, 39 cases presented with unobtrusive urination. One month after extubation, the maximum urine flow rate was (25.6±5.7)ml/s, and the residual urine volume was (11.3±7.1)ml. Three months after extubation, the maximum urine flow rate was (25.3±5.7)ml/s, and the residual urine volume was (11.9±7.5)ml. Six months after extubation, the maximum urine flow rate was (24.8±5.9)ml/s, and the residual urine volume was(12.4±7.9)ml. Two patients had recurrent stenosis 2 months after surgery, of which 1 patient underwent urethral dilation and recovered unobstructed urination, and 1 patient had recurrent stenosis after urethral dilation for 2 times and was cured after urethroplasty. No local wound infection, urethral shrinkage, urethral diverticulum, or urinary fistula occurred during the follow-up for 6 to 42 months.Conclusions:The modified Kulkarni’s one-stage tongue mucosa graft urethroplasty is suitable for most anterior urethral strictures, with high success rate, few complications, and avoidance of local wound complications

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