We report a case involving an 85-year-old man who underwent laparoscopic radical prostatectomy for prostate cancer in 2011. During follow-up, he required long-term use of a penile clamp to manage urination due to permanent severe stress incontinence. In February 2023, he presented with a painless cystic mass in the scrotum. Upon pressing the mass with hand, fluid drained from the external urethral orifice, causing the mass to shrink in size, although it returned to its original size a few hours later. Urography and cystoscopy showed a globular urethral diverticulum located anteriorly. The patient underwent surgical excision of the diverticulum along with urethroplasty. Postoperatively, the urinary stress incontinence persisted, but he declined any further surgical intervention. An artificial urinary sphincter is currently the first-line treatment for male urinary incontinence. However, devices such as penile clamps can serve as an alternative when considering surgical suitability or cost. It is important to note that these devices can lead to serious complications such as urethral erosion, stricture, or diverticulum. Therefore, caution is advised when using such devices, and they should be removed periodically at short intervals.
Humans ; Male ; Diverticulum/surgery* ; Prostatectomy/adverse effects* ; Aged, 80 and over ; Urethral Diseases/surgery* ; Urinary Incontinence/surgery* ; Urinary Incontinence, Stress/surgery*

OBJECTIVE: To investigate the clinical effect of transposition of gracilis muscle flap in repairing urethral perineal fistula after Miles operation. METHODS: The clinical data of 3 patients with urethral perineal fistula treated in the Second Affiliated Hospital of Zhejiang University from September 2023 to November 2024 were analyzed retrospectively. All patients were male, aged from 59 to 68 years (mean 63 years). All patients underwent Miles operation because of low rectal cancer. Urethral perineal fistula occurred after 2 months to 13 years of the operation. The underlying comorbidities included diabetes (2/3), preoperative chemoradiotherapy (1/3), and chemotherapy alone (1/3). The endourethral fistula was located in the apical and membranous part of the prostate, with a diameter of 1.5-2.0 cm and a mean of 1.7 cm. Suprapubic cystostomy was performed one month before operation. In all 3 cases, perineal inverted "Y" incision was taken under general anesthesia to expose urethral fistula, cut off necrotic tissue and suture urethral fistula. The gracilis muscle of the right thigh was taken and turned through the perineal subcutaneous tunnel. and 6 stitches were suture at the urethral fistula. RESULTS: The operations of all 3 patients were completed successfully. The follow-up period ranged from 2 months to 12 months, with an average of 8 months. There was no case of urinary incontinence after removal of catheter 3 weeks after operation. In two patients, urethrography was reviewed 1 month after surgery to show no fistula residue and urethral stenosis, and the fistula was removed. In one patient with a history of radiotherapy, urethrography was reviewed 1 month after surgery to show a small amount of contrast overflow around the urethra, and urethrography was reviewed again 3 months after surgery to show no contrast overflow around the urethra. All the 3 patients had no disturbance of movement of the right lower limb, and the pain of different degrees of thigh incision was acceptable and basically relieved half a month after operation. CONCLUSION Gracilis muscle flap is one of the effective methods for repairing urethral perineal fistula after Miles operation，which has a precise surgical result and few complications.
Humans ; Male ; Middle Aged ; Aged ; Gracilis Muscle/transplantation* ; Urinary Fistula/surgery* ; Retrospective Studies ; Surgical Flaps ; Perineum/surgery* ; Rectal Neoplasms/surgery* ; Postoperative Complications/surgery* ; Urethral Diseases/surgery* ; Urethra/surgery*

The use of artificial urinary sphincter (AUS) for the treatment of stress urinary incontinence has become more prevalent, especially in the "prostate-specific antigen (PSA)-era", when more patients are treated for localized prostate cancer. The first widely accepted device was the AMS 800, but since then, other devices have also entered the market. While efficacy has increased with improvements in technology and technique, and patient satisfaction is high, AUS implantation still has inherent risks and complications of any implant surgery, in addition to the unique challenges of urethral complications that may be associated with the cuff. Furthermore, the unique nature of the AUS, with a control pump, reservoir, balloon cuff, and connecting tubing, means that mechanical complications can also arise from these individual parts. This article aims to present and summarize the current literature on the management of complications of AUS, especially urethral atrophy. We conducted a literature search on PubMed from January 1990 to December 2018 on AUS complications and their management. We review the various potential complications and their management. AUS complications are either mechanical or nonmechanical complications. Mechanical complications usually involve malfunction of the AUS. Nonmechanical complications include infection, urethral atrophy, cuff erosion, and stricture. Challenges exist especially in the management of urethral atrophy, with both tandem implants, transcorporal cuffs, and cuff downsizing all postulated as potential remedies. Although complications from AUS implants are not common, knowledge of the management of these issues are crucial to ensure care for patients with these implants. Further studies are needed to further evaluate these techniques.
Atrophy ; Humans ; Postoperative Complications/therapy* ; Prosthesis Failure ; Prosthesis Implantation ; Prosthesis-Related Infections/therapy* ; Urethra/pathology* ; Urethral Diseases/therapy* ; Urethral Stricture/surgery* ; Urinary Incontinence, Stress/surgery* ; Urinary Sphincter, Artificial

A 74-yr-old woman presented with fever and abdominal discomfort. She was in a septic condition caused by urinary tract infection. Her computed tomogram of the abdomen revealed features of hydronephrosis with ureteral stones in both kidneys. During percutaneous nephrostomies, right pyeloduodenal fistula (PDF) was diagnosed. Elective surgery was originally planned but the patient was in a poor condition to undergo surgery. Instead, 2 times endoscopic clipping and ligation by endoloop were applied with parenteral antibiotics for the fistula lesion. On admission day 30, she was discharged from the hospital after confirmation of no more contrast leakage on fistulography. We reviewed the literature and discuss the etiologies, clinical presentations, diagnosis, and treatment of PDF.
Aged ; Duodenal Diseases/complications/radiography/*surgery ; Female ; Humans ; Hydronephrosis/complications/radiography ; Intestinal Fistula/complications/radiography/*surgery ; Kidney/radiography/surgery ; Kidney Calculi/complications/radiography ; Kidney Diseases/complications/radiography/*surgery ; Ligation ; Urethral Obstruction/complications/radiography ; Urinary Fistula/complications/radiography/*surgery ; Urinary Tract Infections/complications/radiography

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

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

OBJECTIVETo investigate the techniques of surgical correction of penoscrotal transposition with hypospadias.

METHODSWe retrospectively studied 83 cases of penoscrotal transposition with hypospadias treated by surgery from January 2003 to June 2009, and analyzed the surgical techniques and follow-up results.

RESULTSThe patients underwent urethroplasty with simultaneous or staged surgical correction of penoscrotal transposition. Postoperative follow-up was conducted for 0.5-5 years. Eighty-one of the patients were satisfied with the appearance of the reconstructed penis and scrotum, and satisfactory outcomes were achieved in the other 2 with severe hypospadias after a second surgical correction of penoscrotal transposition.

CONCLUSIONUrethroplasty with simultaneous or staged surgical correction of penoscrotal transposition is recommendable for its resultant penile straightness, desirable penoscrotal appearance, good surgical prognosis and few postoperative complications.

Abnormalities, Multiple ; diagnosis ; surgery ; Child ; Child, Preschool ; Humans ; Hypospadias ; complications ; diagnosis ; surgery ; Infant ; Male ; Penis ; abnormalities ; surgery ; Retrospective Studies ; Scrotum ; abnormalities ; surgery ; Treatment Outcome ; Urethral Diseases ; complications ; diagnosis ; surgery

OBJECTIVETo investigate the application of Koyanagi technique for repairing proximal hypospadias with penoscrotal transposition.

METHODSKoyanagi procedure was used for repairing proximal hypospadias with penoscrotal transposition in 26 boys (mean age 4.2 years) between July 2005 and June 2010.

RESULTSPrimary healing was achieved in 22 cases. Three patients suffered from urinary fistula and the external urethral orifice in one patient was retracted to penis coronary sulcus, who were re-operated successfully. Two cases showed slight penile ventral curvature. Slight stricture of the urethral external orifice was noted in one case, which relieved after one to two times of urethral sounding every week for eight months. 20 patients were followed up for 6-36 months (mean 10.5 months) with good cosmetic result and normal urethra function. The penoscrotal transposition was also corrected.

CONCLUSIONSThe original Koyanagi procedure might be one of the simple and effective method for repairing proximal hypospadias with penoscrotal transposition.

Abnormalities, Multiple ; surgery ; Child ; Child, Preschool ; Free Tissue Flaps ; Humans ; Hypospadias ; surgery ; Male ; Penis ; abnormalities ; surgery ; Reconstructive Surgical Procedures ; methods ; Scrotum ; abnormalities ; surgery ; Urethra ; surgery ; Urethral Diseases ; surgery ; Urologic Surgical Procedures, Male ; methods

AIMTo investigate the feasibility of the autologous fascia graft in urethra defect reconstruction.

METHODSIn 24 adult male rabbits, a standardized defect (17 mm) was created within the midportion of each urethra. Two-cm long fascial tube grafts were interposed between the cut ends of the urethra. Twenty-four rabbits were divided into 12 groups. At 0, 3, 10, 15, 21, 30, 45, 60, 90, 120, 150, and 180 days postoperatively, one group was killed. In the first four groups, rabbits were killed and specimens were obtained for histological examination. After 21 postoperative days, in the subsequent eight groups, retrograde urethrograms were carried out to evaluate urethral patency and caliber, then rabbits were killed and specimens were obtained.

RESULTSIn the histological study, advancement of the urethral transitional epithelium along scaffold provided by the fascial graft was determined. At the 30th day, the new urethra was completely covered with the transitional epithelium. Fistula formation was observed in two of 24 rabbits. In urethrograms, narrowing was determined in three of 16 rabbits.

CONCLUSIONFor segmental urethral reconstruction, fascial graft is a good urethral substitute because of its rapid epithelization capacity, low contraction degree and thinness. We therefore propose the use of fascial grafts for reconstruction of male-urethra defects in humans.

Animals ; Disease Models, Animal ; Fascia ; diagnostic imaging ; pathology ; transplantation ; Male ; Pilot Projects ; Rabbits ; Radiography ; Urethra ; diagnostic imaging ; pathology ; surgery ; Urethral Diseases ; pathology ; surgery ; Urologic Surgical Procedures, Male ; methods

OBJECTIVETo investigate the application of tunica vaginalis flap in repairing the deformity of urethra and urethral fistulas.

METHODSTunica vaginalis flap from the scrotum were used to wrap the reconstructed urethra in the 38 cases of hypospadias urethroplasty and urethral fistulas repair from 2002.

RESULTSAll of cases were followed up for six months to one year. There was a fistula reoccurred after epispadias fistula repair, the repair was successful in other patients. There was no recurrent fistulas or urethral strictures. Penile cosmesis was excellent and erected well.

CONCLUSIONSThe application of tunica vaginalis flap in urethral repair can raise achievement ratio and reduce the incidence of urethral fistulas. The flap is ease to mobilize with no harmful effects on the testicles.

Adolescent ; Child ; Child, Preschool ; Follow-Up Studies ; Humans ; Hypospadias ; surgery ; Male ; Scrotum ; surgery ; Surgical Flaps ; Testis ; surgery ; Urethra ; surgery ; Urethral Diseases ; surgery ; Urinary Fistula ; surgery ; Young Adult