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.

Objective To assess the evolving disease burden of esophageal and gastric cancers in China from 1990 to 2021, with a focus on gender disparities, and construct a predictive model to forecast disease trends from 2022 to 2031, aiming to optimize targeted prevention strategies. Methods Epidemiological data for esophageal and gastric cancers in China (1990-2021) were extracted from the Global Burden of Disease (GBD) 2021 database. Temporal trends were analyzed using Joinpoint regression (version 4.9.1.0), and future trends were predicted via the GM (1, 1) model under grey system theory. Results From 1990 to 2021, tobacco- and alcohol-attributable burdens of esophageal cancer increased, while tobacco- and diet-related burdens of gastric cancer showed no significant change. Deaths and disability-adjusted life years (DALY) for esophageal cancer rose by 40.61% and 17.89%, respectively; gastric cancer deaths increased by 18.95%, though DALY decreased by 1.22%. Both cancers exhibited significant declines in age-standardized mortality rates (−45.78% for esophageal cancer, −53.29% for gastric cancer) and age-standardized DALY rates (−51.45% for esophageal cancer, −57.58% for gastric cancer). China’s age-standardized mortality and DALY rates for both cancers remained consistently higher than global averages. Males exhibited disproportionately higher burdens than females. Predictive modeling projected continued but decelerating declines in disease burdens for both cancers by 2031. Conclusion Over three decades, China achieves measurable reductions in esophageal and gastric cancer burdens, though gastric cancer burdens remain higher than esophageal cancer. Persistent disparities relative to global levels, elevated male burdens, and aging demographics highlight the urgency for prioritized interventions targeting high-risk populations.

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.

Objective:To investigate the therapeutic efficacy of the improved proximal urethral transection method in treating posterior urethral stricture.Methods:A retrospective analysis was conducted on clinical data from 1 787 male patients treated from January 2013 to May 2023 for pelvic fractures associated with posterior urethral disruption or obliteration. The ages of the patients ranged from 18 months to 76 years, with an average age of (34.3±4.1) years. Etiologies included pelvic compression injuries due to traffic accidents (867 cases), falls from height (464 cases), and machine-related pelvic compression injuries (456 cases). Preoperative suprapubic cystostomy was performed in 1 536 cases. All patients underwent preoperative excretory and retrograde urethrography, urethral ultrasonography in 187 cases, urethroscopy in 1 440 cases, and urethral MRI in 38 cases. The average length of the stricture or obliterated segment was (3.1±0.5) cm. Posterior urethral stricture was present in 281 cases (15.7%) with maintained urethral continuity, while complete posterior urethral obliteration occurred in 1 506 cases (84.3%). Preoperative urethrocystoscopy and urethral MRI were used to determine the distance from the verumontanum to the stricture or obliterated segment, >2 cm identified in 1 434 cases (80.2%) and ≤2 cm in 353 cases (19.8%). Before surgery, 1 073 cases had IIEF-5 scores≤21 points, 672 cases had IIEF-5 scores≥22 points, and 42 cases without sexual activity refused the questionnaire survey. Surgical method: The perineal region was disinfected, and a urethral probe was introduced through the suprapubic cystostomy site into the bladder neck, directly reaching the proximal end of the obliterated urethra. The tip of the probe was palpated with the left index finger on the body surface and marked. An inverted " Y" -shaped incision was made centered around this point, followed by dissection of the skin, subcutaneous tissue, and bulbospongiosus muscle to expose the bulbous urethra. The bulbous urethra was isolated and retracted. Scar tissue above the bulbous urethra was incised to expose the perineal transverse ligament. Guided by the probe, the perineal transverse ligament was transected using an electrosurgical knife above the urethra, while horizontal dissection was performed along the perineal central tendon to separate the urethra from the anterior rectal wall. Bilateral dissection of the surrounding scar tissues extended up to the tip of the probe at the posterior urethra. Scar tissue at the probe tip was incised, revealing the probe. Then, proximal urethra was prepared and set aside after its around scar tissue was trimmed. The distal urethra was mobilized to an adequate length upwards, with scar tissue trimmed and prepared as well. Using 4-0 absorbable sutures, eight sutures were placed at positions 1, 2, 4, 5, 7, 8, 10, and 11 on the urethra. An F16 urethral catheter was left in place, and the incision was closed. Record the duration of surgery, amount of bleeding, number of blood transfusions, and transfusion volume. Four weeks postoperatively, the catheter was removed, and patients were instructed to urinate spontaneously. Six months later, assessments included uroflowmetry and the international index of erectile function (IIEF-5) questionnaire, with a Q max>15 ml/s indicating successful surgery and an IIEF-5 score ≥ 22 indicating normal erectile function. Results:All patients successfully completed the surgery, the average operation time was (75.5±8.5) minutes, and the average intraoperative blood loss was (110.4±13.2) ml. 62 patients received intraoperative blood transfusion, with an average volume of (285.5±15.5)ml. The follow-up period was (26.1±4.5) months. A total of 1 729 patients (96.7%) achieved a Q max>15 ml/s. Among the 38 patients with postoperative voiding difficulties, 26 patients improved after internal urethrotomy, and 12 patients underwent a subpubic anastomosis three months later. Postoperative urinary incontinence occurred in 20 patients: 11 patients improved after urethral suspension surgery, and 5 patients achieved urinary control with an artificial urinary sphincter. The remaining patients were under follow-up (unwilling to undergo surgery). Erectile dysfunction (IIEF-5 score≤21) was observed in 1 202 cases (67.2%), with 528 treated with sildenafil, resulting in varying degrees of improvement in 120 cases. Fifteen patients restored erectile function with expandable penile prostheses. Conclusions:The perineal approach for the improved proximal urethral transection is suitable for most posterior urethral stricture surgeries. It enables rapid and accurate identification of the proximal urethra, simplifies the steps of urethral anastomosis, and demonstrates clinical efficacy.

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

Objective:To investigate the therapeutic efficacy of the improved proximal urethral transection method in treating posterior urethral stricture.Methods:A retrospective analysis was conducted on clinical data from 1 787 male patients treated from January 2013 to May 2023 for pelvic fractures associated with posterior urethral disruption or obliteration. The ages of the patients ranged from 18 months to 76 years, with an average age of (34.3±4.1) years. Etiologies included pelvic compression injuries due to traffic accidents (867 cases), falls from height (464 cases), and machine-related pelvic compression injuries (456 cases). Preoperative suprapubic cystostomy was performed in 1 536 cases. All patients underwent preoperative excretory and retrograde urethrography, urethral ultrasonography in 187 cases, urethroscopy in 1 440 cases, and urethral MRI in 38 cases. The average length of the stricture or obliterated segment was (3.1±0.5) cm. Posterior urethral stricture was present in 281 cases (15.7%) with maintained urethral continuity, while complete posterior urethral obliteration occurred in 1 506 cases (84.3%). Preoperative urethrocystoscopy and urethral MRI were used to determine the distance from the verumontanum to the stricture or obliterated segment, >2 cm identified in 1 434 cases (80.2%) and ≤2 cm in 353 cases (19.8%). Before surgery, 1 073 cases had IIEF-5 scores≤21 points, 672 cases had IIEF-5 scores≥22 points, and 42 cases without sexual activity refused the questionnaire survey. Surgical method: The perineal region was disinfected, and a urethral probe was introduced through the suprapubic cystostomy site into the bladder neck, directly reaching the proximal end of the obliterated urethra. The tip of the probe was palpated with the left index finger on the body surface and marked. An inverted " Y" -shaped incision was made centered around this point, followed by dissection of the skin, subcutaneous tissue, and bulbospongiosus muscle to expose the bulbous urethra. The bulbous urethra was isolated and retracted. Scar tissue above the bulbous urethra was incised to expose the perineal transverse ligament. Guided by the probe, the perineal transverse ligament was transected using an electrosurgical knife above the urethra, while horizontal dissection was performed along the perineal central tendon to separate the urethra from the anterior rectal wall. Bilateral dissection of the surrounding scar tissues extended up to the tip of the probe at the posterior urethra. Scar tissue at the probe tip was incised, revealing the probe. Then, proximal urethra was prepared and set aside after its around scar tissue was trimmed. The distal urethra was mobilized to an adequate length upwards, with scar tissue trimmed and prepared as well. Using 4-0 absorbable sutures, eight sutures were placed at positions 1, 2, 4, 5, 7, 8, 10, and 11 on the urethra. An F16 urethral catheter was left in place, and the incision was closed. Record the duration of surgery, amount of bleeding, number of blood transfusions, and transfusion volume. Four weeks postoperatively, the catheter was removed, and patients were instructed to urinate spontaneously. Six months later, assessments included uroflowmetry and the international index of erectile function (IIEF-5) questionnaire, with a Q max>15 ml/s indicating successful surgery and an IIEF-5 score ≥ 22 indicating normal erectile function. Results:All patients successfully completed the surgery, the average operation time was (75.5±8.5) minutes, and the average intraoperative blood loss was (110.4±13.2) ml. 62 patients received intraoperative blood transfusion, with an average volume of (285.5±15.5)ml. The follow-up period was (26.1±4.5) months. A total of 1 729 patients (96.7%) achieved a Q max>15 ml/s. Among the 38 patients with postoperative voiding difficulties, 26 patients improved after internal urethrotomy, and 12 patients underwent a subpubic anastomosis three months later. Postoperative urinary incontinence occurred in 20 patients: 11 patients improved after urethral suspension surgery, and 5 patients achieved urinary control with an artificial urinary sphincter. The remaining patients were under follow-up (unwilling to undergo surgery). Erectile dysfunction (IIEF-5 score≤21) was observed in 1 202 cases (67.2%), with 528 treated with sildenafil, resulting in varying degrees of improvement in 120 cases. Fifteen patients restored erectile function with expandable penile prostheses. Conclusions:The perineal approach for the improved proximal urethral transection is suitable for most posterior urethral stricture surgeries. It enables rapid and accurate identification of the proximal urethra, simplifies the steps of urethral anastomosis, and demonstrates clinical efficacy.

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

Background::Response to immune checkpoint inhibitors (ICIs) is affected by multiple factors. This study aimed to explore whether sites of metastasis are associated with clinical outcomes of ICIs in advanced non-small-cell lung cancer (NSCLC) patients.Methods::The data of NSCLC patients with high programmed death-ligand 1 expression and good performance status receiving first-line ICIs monotherapy from Guangdong Provincial People’s Hospital between May 2019 and July 2020 were retrospectively analyzed. Metastatic sites included liver, bone, brain, adrenal gland, pleura, and contralateral lung. Progression-free survival (PFS) and overall survival (OS) were compared between different metastatic sites and metastatic burden by the Kaplan-Meier method. Organ-specific disease control rate (OSDCR) of different individual metastatic sites was evaluated.Results::Forty NSCLC patients meeting the criteria were identified. The presence of liver metastasis was significantly associated with shorter PFS (3.1 vs. 15.5 months, P = 0.0005) and OS (11.1 months vs. not reached, P = 0.0016). Besides, patients with bone metastasis tend to get shorter PFS (4.2 vs. 15.5 months, P = 0.0532) rather than OS ( P = 0.6086). Moreover, the application of local treatment could numerically prolong PFS in patients with brain metastasis (15.5 vs. 4.3 months, P = 0.1894). More metastatic organs involved were associated with inferior PFS ( P = 0.0052) but not OS ( P = 0.0791). The presence of liver metastasis or bone metastasis was associated with more metastatic organs (Phi[φ]: 0.516, P = 0.001). The highest OSDCR was observed in lung (15/17), and the lowest in the liver (1/4). Conclusions::Metastases in different anatomical locations may be associated with different clinical outcomes and local tumor response to ICIs in NSCLC. ICIs monotherapy shows limited efficacy in patients with liver and bone metastasis, thus patients with this type of metastasis might require more aggressive combination strategies.

Objective:To compare the outcomes of combined lingual mucosal graft with buccal mucosal graft urethroplasty and combined lingual mucosal graft with ADM (acellular dermal matrix) urethroplasty for the treatment of repair failed hypospadias.Methods:From February 2017 to February 2019, 26 patients with failed hypospadias repairs were treated with combined lingual mucosal graft with buccal mucosal graft urethroplasty (14 cases in Group A), and combined lingual mucosal graft with ADM urethroplasty (12 cases in Group B). The mean age of Group A was (29.5±1.2) years (range 18.0-41.0 years), and (26.5±0.8) years (range 20.0-38.0 years) in Group B. The previous operation times was mean (3.6±0.7)(range 2-5 times) and (4.6±0.8)(range 3-5 times) in Group A and Group B respectively. Operation method: All patients were nasally intubated, the remaining curvature was corrected, the fibrous tissue or scar was removed, and the defected urethra was measured. In Group A, the lingual mucosa was spread and fixed to the corpora cavernosa over the midline as the urethral plate, the buccal mucosa was covered the lingual mucosa as ventral urethra, both the mucosa lateral edges was sutured. In Group B, the lingual mucosa was harvested and fixed to the corpora cavernosa the same as in Group A, the ADM was made appropriate length and width, covered and sutured with the lingual mucosa. The lingual mucosa was harvested mean (5.0±0.2)cm(range 4-6cm)long, mean (1.2±0.2)cm (range 1.0-1.5cm)wide and mean (5.0±0.2)cm(range 5-6cm)long, mean (1.2±0.2)cm (range 1.0-1.5cm)wide in Group A and Group B respectively( P<0.05). In Group A, the buccal mucosa was harvested mean (4.1±0.2)cm(range 3.5-5.5cm)long, mean (1.2±0.2)cm wide. Criteria for successful repair of hypospadias were set as: ①The appearance of the penis is nearly normal; ②The penis curvature was corrected; ③Urethra orifice in normal position; ④Urine flow line is normal. The outcomes of the two groups were analyzed and compared, statistical analysis was done using SPSS 18.0 software. Results:The mean follow-up time was (16.3±1.6)(8-24) months. The age, number of preoperative surgeries, number of previous oral mucous membranes, and length of urethral defects were no statistically significant differences between the two groups in A and B( P>0.05). The length of oral mucosa was harvested during the operation between group A and Group B were statistically significant differences( P<0.05). The incidence of oral complications in group A and B: Oral pain 7/14, 1/12; The feeling of tension in mouth 8/14, 1/12; The numbness in the oral 8/14, 1/12, A and Group B were statistically significant differences( P<0.05). The incidence of urethral complications in group A and Group B: the urethra fistula 1/14, 4/12; the urethral stricture 2/14, 6/12, there were statistically significant differences between the two groups ( P<0.05). Penile curvature 2/14, 1/12, ( P>0.05). The success rate was 12/14 and 5/12 in Group A and B respectively, with statistical difference( P<0.05). Conclusions:Combined lingual mucosal graft with buccal mucosal graft urethroplasty could be a good choice for repeated failed hypospadias repairs. Combined lingual mucosal graft with ADM urethroplasty has many complications and less success, should be performed in caution.

Objective To analyze the donor site complications of male patients with long segment anterior urethral strictures that underwent urethroplasty by using a long-strip lingual mucosal grafts (LMG) six months later.Methods Between August 2006 and December 2014,a total of 81 patients with long segment anterior urethral stricture underwent a procedure of urethroplasty using a long-strip LMG.The mean patients' age was 41.2 years (range 18-74) and the mean urethral stricture length was 12.1 cm (range,8-20 cm),a single LMG was more than 9 cm.Two techniques of urethroplasty were performed:One-sided dorsal graft augmentation urethroplasty was performed in 70 patients,12 of the 70 patients underwent urethroplasty by using a LMG in addition to a BMG,owing to the presence of very long strictures;Dorsal patch graft urethroplasty was performed in 11 patients.Results Of the 81 patients a single long-strip LMG with length of 9-11 cm was used in 52 patients,LMG measured ≥12 cm in 17,and LMG combined with buccal mucosal graft (BMG) in 12.The mean follow-up period was 41 months (range,15-86 months) postoperatively.The overall urethroplasty success rate was 82.7％.Six months after the operation,28 patients (34.6％) reported a minimal to moderate difficulty in fine motor movement of the tongue (difficulty with spitting tiny fish bones).Among these 28,22 patients (27.2 ％) had associated numbness over the donor site,10 patients (12.3％) had parageusia,and 11 patients (13.6％) reported slurring of speech.The donor site complications occurred higher in patients with LMG length ≥ 12 cm (14/29) than those patients with LMG length ＜ 12 cm (14/52)(x2 =19.049,P ＜0.01).At 12 months,5 patients (6.2％)reported minimal difficulty in fine motor movement of the tongue,and reduced to 1 patient at 24 months.Conclusions The donor side complications after long-strip lingual mucosal graft for the treatment of longsegment anterior urethral strictures are primarily limited to the first postoperative year,the incidence of complications appeared to be related to the length of the harvested graft.