OBJECTIVE: To explore the impact factors and the clinical significance of the urination intermittences in benign prostatic hyperplasia (BPH) patients. METHODS: A retrospective study was performed in BPH patients who underwent urodynamic studies in Beijing Jishuitan Hospital form January 2016 to June 2021. The patients were aged 45 to 84 years with a median age of 63 years, and all the patients had no previous history of neurological disease and had no positive findings in neurological examinations. All the patients had free uroflometry followed by urethral catheterization and urodynamic tests. The voiding work of bladder was calculated using the detrusor power curve method, and the voiding power of bladder and the voiding energy consumption were also calculated. The frequency of urination intermittences generated in uroflometry was also recorded and the patients were divided into different groups according to it. The detrusor pressure at maximal flow rate (P_detQ_max), the maximal flow rate (Q_max), the bladder contractile index (BCI), the bladder outlet obstruction index (BOOI), the voiding work, the voiding power, and the voiding energy consumption were compared among the different groups. Multiva-riate analyses associated with presence of urination intermittences were performed using step-wise Logistic regressions. RESULTS: There were 272 patients included in this study, of whom, 179 had no urination intermittence (group A), 46 had urination intermittence for only one time (group B), 22 had urination intermittence for two times (group C), and 25 had urination intermittence for three times and more (group D). The BCI were 113.4±28.2, 101.0±30.2, 83.3±30.2, 81.0±30.5 in groups A, B, C, and D, respectively; The voiding power were (29.2±14.8) mW, (16.4±9.6) mW, (14.5±7.1) mW, (8.5±5.0) mW in groups A, B, C, and D, respectively, and the differences were significant (P < 0.05). The BOOI were 41.6±29.3, 46.4±31.0, 41.4±29.0, 42.7±22.8 in groups A, B, C, and D, respectively; The voiding energy consumption were (5.41±2.21) J/L, (4.83±2.31) J/L, (5.02±2.54) J/L, (4.39±2.03) J/L in groups A, B, C, and D, respectively, and the differences were insignificant (P>0.05). Among the patients, 179 cases were negative in presence of urination intermittences and 93 cases were positive. Step-wise Logistic regression analysis showed that bladder power (OR=0.814, 95%CI: 0.765-0.866, P < 0.001), BCI (OR=1.023, 95%CI: 1.008-1.038, P=0.003), and bladder work (OR=2.232, 95%CI: 1.191-4.184, P=0.012) were independent risk factors for urination intermittences in the BPH patients. CONCLUSION The presence of urination intermittences in the BPH patients was mainly influenced by bladder contractile functions, and was irrelevant to the degree of bladder outlet obstruction. The increase of frequency of urination intermittences seemed to be a sign of the decrease of the bladder contractile functions in the BPH patients.
Prostatic Hyperplasia/physiopathology* ; Humans ; Male ; Urodynamics ; Urination ; Retrospective Studies ; Middle Aged ; Aged ; Aged, 80 and over ; Urinary Bladder/physiopathology* ; Urination Disorders/etiology*

Objective To investigate the changing trends in etiology and treatment of male urethral stricture in recent 10 years.Methods A total of 940 male patients with urethral stricture admitted to the Department of Urology of Beijing Jishuitan Hospital during Jan.2013 and Dec.2022 were continually collected.The clinical data were divided into two groups according to the time of admission,namely the group from 2013 to 2017 and the group from 2018 to 2022,for a comparative analysis of the previous and subsequent 5 years.The etiology,location,length and the type of treatment of urethral stricture were retrospectively analyzed.Results The causes of the 940 cases of male urethral stricture were trauma in 447(47.55％),iatrogenic injury in 220(23.40％),idiopathic causes in 128(13.62％),lichen sclerosus(LS)in 78(8.30％),infection in 46(4.89％),and other causes in 21(2.23％).The treatment methods were urethroplasty in 691(73.51％),direct vision internal urethrotomy(DVIU)in 122(12.98％),urethral dilatation in 86(9.15％),and suprapubic cystostomy in 41(4.36％).Compared with the previous 5 years,in the past 5 years,the proportion of urethral stricture caused by trauma decreased significantly(60.34％vs.41.71％,P＜0.001),while the proportion of iatrogenic injury increased significantly(17.63％vs.26.05％,P=0.005).In the past 5 years,the proportion of urethroplasty increased from 68.81％to 75.66％(P=0.027),while the proportion of DVIU decreased from 19.66％to 9.92％(P＜0.001).Inthe past 5 years,the proportion of membranous urethral stenosis decreased significantly(26.98％vs.50.85％,x2=51.06,P＜0.001),the proportion of penile urethral stricture(21.40％vs.7.80％,=26.37,P＜0.001)and meatal stenosis(9.30％vs.4.75％,x2=5.80,P＜0.001)increased significantly.Conclusion In the past decade,trauma was the main cause of male urethral strictures,but its proportion showed a decreasing trend.Iatrogenic injury led to a gradual increase in urethral strictures,which was the second leading cause of male urethral stricture.The application of urethroplasty increased significantly,making it the main treatment method for male urethral stricture.

[Objective] To Compare the effectiveness of conventional local anesthesia (CLA) and two-plane local anesthesia (TPLA) in percutaneous nephrolithotomy (PCNL) so as to provide reference for clinical selection of appropriate anesthetic methods. [Methods] Clinical data of 345 patients with renal or ureteral calculi who underwent PCNL under local infiltration anesthesia in our hospital during Jan.2013 and Dec.2023 were retrospectively analyzed.The patients were divided into CLA group (n=114) and TPLA group (n=231) according to anesthetic methods.The intraoperative visual analogue scale (VAS) score, stone-free rate and incidence of complications were compared between the two groups. [Results] There were no significant differences in the baseline data between the two groups (P>0.05). When the cutaneous and renal channels were established, the VAS score was lower in the TPLA group than in the CLA group [(3.2±0.5) vs. (3.8±0.4), P=0.023]. However, there was no significant difference in the VAS score during lithotripsy [(3.3±0.5) vs. (3.4±0.5), P=0.061]. There were no significant differences between the two groups in terms of operation time, stone-free rate, hemoglobin drop, postoperative hospital stay, and time to remove nephrostomy tube and DJ tube retention time (P>0.05). [Conclusion] Both CLA and TPLA can provide good analgesia in PCNL, but TPLA can significantly reduce the pain sensation when the cutaneous and renal channels are established.

OBJECTIVE: To evaluate the surgical methods for treating distal urethral stricture. METHODS: The clinical data of 80 patients with distal urethral stricture in Beijing Jishuitan Hospital, Captial Medical University between January 2018 and December 2022 were retrospectively collected. Including male genital lichen sclerosus (MGLS) 33 cases, iatrogenic injury 25 cases, postoperative hypospadias 12 cases, and other causes such as trauma 10 cases. Among these cases, strictures involved the urethral meatus in 54 instances, of which 38 were treated with meatotomy (MO), 7 with penile skin flap urethroplasty (PSFU), and 9 with oral mucosa graft urethroplasty (OMGU). There were also 26 instances where strictures involved both the navicular fossa and meatus; one case underwent PSFU while 25 underwent OMGU. Based on different surgical methods used for treatment purposes we divided the patients into MO group, PSFU group and OMGU group. The age of the three groups was (48.8±20.0) years, (53.3±21.8) years and (44.5±16.4) years. The mean±SD body mass index (BMI) was (28.6±3.9) kg/m², (29.6±3.2) kg/m² and (29.2±4.8) kg/m². The preoperative maximum flow rate was (5.8±2.3) mL/s, (6.8±2.4) mL/s and (5.7±3.1) mL/s. RESULTS: All the operations were successfully completed without Clavien Ⅲ or Ⅳ complications. The median length of strictures (measured intraoperatively) in the three groups were 1.1 (1.0, 1.6), 1.5 (1.1, 2.0) and 4.0 (2.5, 5.0) cm. The median operation time was 60.0 (60.0, 75.0), 85.0 (75.0, 112.5) and 180.0 (75.0, 330.0) min. The median estimated blood loss was 5.0 (2.0, 10.0), 15.0 (5.0, 42.5) and 180.0 (135.0, 216.3) mL. The median postoperative hospital stay was 3.5 (2.0, 5.0), 6.5 (3.5, 7.0) and 7.5 (7.0, 11.3) days. The median follow-up duration was 40.0 (26.3, 57.3), 55.0 (18.8, 62.8) and 52.5 (30.5, 64.0) months. The median postoperative maximum flow rate was 18.3 (15.5, 19.8), 19.2 (16.1, 20.1) and 17.2 (14.2, 19.6) mL/s. Among the 38 patients with MO, 33 cases had normal urination without reintervention, and 5 cases experienced recurrent strictures and required regular urethral dilation. Among the 8 patients with PSFU, 7 cases had normal urination without reintervention, and one case developed a urinary fistula, for which intervention was recommended but the patient opted to maintain the status quo. Among the 34 patients with OMGU, 28 cases had normal urination without reintervention. There were 6 instances of stenosis recurrence, with 5 cases requiring regular urethral dilations and one case requiring reconstructive surgery. The overall success rate of operation was 85.0%, and the reintervention rate was 15.0%. Statistical analysis revealed significant differences in etiologies among the three groups (P=0.002), as well as in stricture locations (P < 0.001), length of strictures (P < 0.001), operation time (P < 0.001), estimated blood loss (P < 0.001) and postoperative hospital stays (P < 0.001). However, no significant differences were observed in terms of age, BMI, history of previous urethral stricture surgeries, preoperative maximum flow rate, follow-up duration, postoperative maximum flow rate and reintervention rate. Univariate and multivariate Logistic regression analyses indicated that a history of previous urethral stricture surgeries was a risk factor for postoperative reintervention (P=0.026). CONCLUSION MO and PSFU are primarily suitable for treating short-segment (≤1.5 cm) distal penile urethral strictures, whereas OMGU is more appropriate for longer segment strictures. MO and OMGU can both be utilized in managing MGLS cases. PSFU and OMGU are more conducive to improving the appearance of the urethral meatus. The success rate of surgical management of distal penile urethral stricture is 85.0%, 15.0% of the patients still require surgical intervention after surgery, and having history of previous urethral stricture surgeries is a risk factor for postoperative reintervention.
Humans ; Urethral Stricture/surgery* ; Male ; Retrospective Studies ; Middle Aged ; Adult ; Urethra/surgery* ; Surgical Flaps ; Penis/surgery* ; Mouth Mucosa ; Urologic Surgical Procedures, Male/methods* ; Plastic Surgery Procedures/methods* ; Lichen Sclerosus et Atrophicus/surgery* ; Operative Time ; Skin Transplantation/methods* ; Aged

Objective To summarize the long-term efficacy of oral mucosal urethroplasty.Methods The clinical data of 324 patients with anterior urethral stricture who underwent oral mucosal urethroplasty from January 2013 to May 2018 were retrospectively analyzed.The patients were 27-65 years old with an average age of 47 years.Among them,51 patients had urethral meatal stenosis,174 patients had penile urethral stricture and 99 patients had bulbar urethral stricture.The length of urethral stricture was 2.8-14.0 cm,with an average of 6.4 cm.The preoperative maximal urinary flow rate Qmax was 3.2-8.4 ml/s,with an average of 4.8 ml/s.In the urethral meatal stenosis group (51 patients),15 underwent urethrotomy and 36 underwent meatal urethroplasty.In the penile urethral stricture group (174 patients),ventral sagittal incision was done in 21 patients,subcoronal circumferential incision in 49 patients and midline perineal incision in 104 patients.The perineal incision or verted Y incision were done in all the bulbar urethral strictures.Results The patients were followed-up for 3-75 months,with an average of 35.0 months.The results were satisfied in 290 (89.5％) patients.The post-operative maximal urinary flow rate Qmax was 15.8-32.2ml/s,with an average of 21.5 ml/s.Thirty-four patients (10.5％) developed recurrent urethral stricture,including 7 patients in the urethral meatus,17 patients in the penile urethra and 12 patients in the bulbar urethra.Among the recurrent urethral stricture patients,18 treated with the dilatation and 16 treated with the urethroplasty.Five patients (1.5％) developed fistula,including 2 patients in the ventral sagittal incision,1 patient in the circumferential incision and 2 patient in the perineal incision.Conclusions The long-term effect of oral mucosal urethroplasty is realistic.The rate of urethral stricture recurrence and fistula is low.The recurrence can be treated again by urethroplasty.The surgical approach for oral mucosa urethroplasty depends on the location and length of the anterior urethral stricture.