Objective:To explore the value of contrast enhanced ultrasonography(CEUS) combined with shear wave elastography (SWE) in the diagnosis of urethral stricture.Methods:One hundred and twenty patients with urethral stricture were recruited, and preoperative retrograde urography, common urethral ultrasound, and CEUS were used to measure the length of the stricture site, and SWE was used to detect the elasticity value of the stricture site and its nearby spongiosum. Intraoperative urethral stricture lesion site measurements were performed to confirm the actual lesion location and length during surgery and to compare them with the lengths measured in the preoperative examination;4 months after surgery, SWE was used to detect the stiffness of the surgical site and to assess the surgical efficacy and prognosis.Results:The stenosis length measured by CEUS and intraoperative measurement had no statistical difference: (4.41 ± 1.47) cm vs. (4.37 ± 1.36) cm, t = 0.22, P>0.05. The elastic value in urethra stenosis in SWE was higher than that in normal urethra: (33.1 ± 6.7) kPa vs. (23.3 ± 4.1) kPa, there was statistical difference ( t = 13.67, P<0.05). The elastic value of unobstructed urethra and that of normal urethra after reconstruction had no statistical difference ( t = 0.95, P>0.05). Conclusions:CEUS combined with SWE is a safe, accurate and effective method to evaluate urethral stricture. SWE can be used to measure postoperative outcomes and recurrence.

Objective:To explore the value of contrast enhanced ultrasonography(CEUS) combined with shear wave elastography (SWE) in the diagnosis of urethral stricture.Methods:One hundred and twenty patients with urethral stricture were recruited, and preoperative retrograde urography, common urethral ultrasound, and CEUS were used to measure the length of the stricture site, and SWE was used to detect the elasticity value of the stricture site and its nearby spongiosum. Intraoperative urethral stricture lesion site measurements were performed to confirm the actual lesion location and length during surgery and to compare them with the lengths measured in the preoperative examination;4 months after surgery, SWE was used to detect the stiffness of the surgical site and to assess the surgical efficacy and prognosis.Results:The stenosis length measured by CEUS and intraoperative measurement had no statistical difference: (4.41 ± 1.47) cm vs. (4.37 ± 1.36) cm, t = 0.22, P>0.05. The elastic value in urethra stenosis in SWE was higher than that in normal urethra: (33.1 ± 6.7) kPa vs. (23.3 ± 4.1) kPa, there was statistical difference ( t = 13.67, P<0.05). The elastic value of unobstructed urethra and that of normal urethra after reconstruction had no statistical difference ( t = 0.95, P>0.05). Conclusions:CEUS combined with SWE is a safe, accurate and effective method to evaluate urethral stricture. SWE can be used to measure postoperative outcomes and recurrence.

Objective:To explore the application value of shear wave elastography (SWE) in male anterior urethral stenosis.Methods:A total of 40 male patients with anterior urethral stenosis admitted to the Sixth People′s Hospital Affiliated to Medical College of Shanghai Jiaotong University from September 2022 to March 2023 were collected. SWE examination was performed before operation to measure the elasticity of urethra and surrounding normal tissues, and to evaluate the location and length of urethral stenosis. When the patient underwent urethral repair and reconstruction surgery, the lesion site of urethral stenosis was measured during the operation to confirm the actual location and length of the lesion during the operation, and the lesion site and length of the urethral stenosis were compared with the preoperative SWE assessment. The specimen of urethral lesion excised during the operation was sent for pathological examination to further confirm whether the tissue was pathological scar tissue.Results:The elastic value of urethral stricture in SWE [(32.9±6.2)kPa] was higher than that of normal urethra [(21.5±4.3)kPa], and the difference was statistically significant ( P<0.05). The length of urinary tract stricture measured by preoperative SWE examination [(3.51±1.09)cm] was basically the same as that of urethral stricture measured during operation [(3.51±1.10)cm], with no statistical significance ( P=0.825). The pathological examination proved that the surgically resected tissue was indeed pathological scar tissue, and the pathological results of the site of urethral stenosis determined by the preoperative SWE examination were 100% consistent with those of the postoperative stenosis. Conclusions:SWE can well evaluate the length of male anterior urethral stenosis and the location of the diseased urethra before surgery, and provide accurate guidance for the scope of urethral lesion and pathological scar resection during surgery.

Objective:To explore the application value of shear wave elastography (SWE) in male anterior urethral stenosis.Methods:A total of 40 male patients with anterior urethral stenosis admitted to the Sixth People′s Hospital Affiliated to Medical College of Shanghai Jiaotong University from September 2022 to March 2023 were collected. SWE examination was performed before operation to measure the elasticity of urethra and surrounding normal tissues, and to evaluate the location and length of urethral stenosis. When the patient underwent urethral repair and reconstruction surgery, the lesion site of urethral stenosis was measured during the operation to confirm the actual location and length of the lesion during the operation, and the lesion site and length of the urethral stenosis were compared with the preoperative SWE assessment. The specimen of urethral lesion excised during the operation was sent for pathological examination to further confirm whether the tissue was pathological scar tissue.Results:The elastic value of urethral stricture in SWE [(32.9±6.2)kPa] was higher than that of normal urethra [(21.5±4.3)kPa], and the difference was statistically significant ( P<0.05). The length of urinary tract stricture measured by preoperative SWE examination [(3.51±1.09)cm] was basically the same as that of urethral stricture measured during operation [(3.51±1.10)cm], with no statistical significance ( P=0.825). The pathological examination proved that the surgically resected tissue was indeed pathological scar tissue, and the pathological results of the site of urethral stenosis determined by the preoperative SWE examination were 100% consistent with those of the postoperative stenosis. Conclusions:SWE can well evaluate the length of male anterior urethral stenosis and the location of the diseased urethra before surgery, and provide accurate guidance for the scope of urethral lesion and pathological scar resection during surgery.

Objective:To summarize the ideal strategy for the treatment of female hypospadias.Methods:The data of 12 female patients with hypospadias admitted to the Sixth People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine from December 2011 to December 2019 were retrospectively analyzed. The patients was (31.0±16.6) years old (7-67 years old). Among them, 3 cases had a history of pelvic fracture trauma, 3 cases had a history of birth trauma, and the remaining 6 cases had no history of trauma and surgery. Among them, there were 6 cases of congenital hypospadias and 6 cases of acquired hypospadias. The clinical manifestations were urinary incontinence in 6 cases and dysuria in 6 cases. Examination of the normal position of the external opening of the genital urethra did not show the opening of the urethra, but moved down to different parts of the anterior wall of the vagina. All patients underwent urethral lengthening. For congenital hypospadias, the urethral plate is used to cut the coiled tube during the operation to prolong the urethra. For acquired hypospadias, the stenotic urethra was enlarged and lengthened with a labial pedicled flap coil. The subcutaneous fat pad of the labia majora was mobilized and transferred to the outside of the newly constructed urethra to prevent the occurrence of urethro-vaginal fistula and increase the pressure of the urethra. Five patients with significant urinary incontinence underwent bladder neck reconstruction at the same time. Anatomical success of the procedure was defined as the appearance of a normal-shaped external urethral opening beneath the clitoris. Functional success was defined as the absence of moderate to severe urinary incontinence after surgery, and the maximum urinary flow rate was >15ml/s during the 12-month follow-up period.Results:All operations were successfully completed. All patients had no perioperative complications, and were followed up for 18-96 months, with an average of 57.3±32.5 months. All patients were able to urinate spontaneously after operation, 4 cases of urinary incontinence disappeared, and 2 cases improved significantly; 4 cases of patients with strenuous urination urinated smoothly. The remaining 2 cases still complained of dysuria after operation, which was solved by subsequent urethral dilatation. The anatomical repair success rate was 100.0%(12/12) and the functional success rate was 83.3% (10/12).Conclusions:Urethral lengthening is an effective method for female hypospadias. The pedicled fat pad helps to increase urethral pressure and prevent fistulas. For female patients with hypospadias and severe urinary incontinence, bladder neck reconstruction is an ideal method. of the technique.

Objective:To explore the outcomes of urethra around corpora cavernosus anastomotic urethroplasty for the treatment of complex posterior urethral strictures.Methods:Between June 2008 and June 2020, 35 patients with complex posterior urethral strictures were treated using urethra rerouted under one corpora cavernosus anastomotic urethroplasty. The patients’ age was 3-54 years(mean 23.2 years), the urethral stricture or loss length was 4-7 cm(mean 5.2 cm), and 6 patients associated with urethrorectal fistula. The technique involved: ①The anterior urethra is dissected long more than 5 cm, separation of the proximal corporeal bodies, inferior pubectomy and the dissected proximal urethra.②A channel around the left crus of the penis through the inferior pubectomy is separated and urethra rerouted under left corpora cavernosus to allow a tension-free anastomosis to the proximal urethra.Results:Two patients lost follow-up; the remainder 33 patients were followed-up for 3 to 144 months(mean 37 months). Thirty-two patients could void normally(97%), The examination of maximal urinary flow rates(Q max) were taken in 21 patients, of whom Q max was 13.6-35.5 ml/s (mean 17.5 ml/s) in 7 children and 16.3-77.6 ml/s(mean 27.9 ml/s) in 14 adult patients. All 6 patients associated with urethrorectal fistula successful repaired, of these patients 1 had died of hemorrhage of brain 6 years postop. One patient developed urethral stenosis postoperatively. Continence was achieved in 29 patients, the remaining 3 patients had incontinence from mild to moderate. Conclusions:Urethra rerouted under left corpora cavernosus anastomotic urethroplasty is not only an effective surgical salvage option, with low recurrent rate for patients with complex posterior urethral strictures, but also do not cause curve and affect growth of corpora cavernosus.