The success rate for urethral reconstruction was related with many factors. Urethroplasty is a diffi-cult skill that takes years to master. We give a detailed views on how to properly and accurately evaluate urethral strictures by imaging, cystourethroscopy and physical examination; and on operation occasion, as to patient selec-tion and the key point of urethroplasty.

Objective:To evaluate the results of different urethroplastis for different severity' of urethral stric-ture. Methods:From January 1997 to December 2006, 296 patients with posterior urethral striciures due to pelvic fracture urethral distraction defects (PFUDD) were included in the study. Transperineal urethsa end-to-end anas-tomosis was performed: 70 patients (group Ⅰ) with simple perineal anastomosis; 70 patients (group Ⅱ) with separation of the corporeal bodies; 154 patients (group Ⅲ) with inferior pubectomy; 2 patients (group Ⅳ) with perineal anastomosis with rerouting of the urethra around the corpora cavernosum. Results:Of 296 cases with de-layed transperineal urethra end-to-end anastomosis procedures, 254 (85.8%) cases were successful and 42 (14.2%) were unsuccessful. Group Ⅰ had an 78. 6% success rate, group Ⅱ 90.0% , group Ⅲ 88.3% , and Group Ⅳ zero. Conclusions : Different transperineal posterior urethroplasty operations are efficient to treat urethral strictures following PFUDD.

Objective:To evaluate the application value of fast frozen section in end-to-end anastomosis of pos-terior urethra. Methods.. 102 cases of posterior urethral atresia were randomly enrolled into two groups. After re-secting the scar tissue, 46 cases (group A) underwent end-to-end anastomosis of posterior urethra by the surgeon 's experience of urethral mucosa tissue. 56 cases (group B) underwent the same process by fast frozen section con-firmed urethral mucosa. All patients were pulled out catheter after 3 weeks. Clinical outcomes of the patients were compared between the two groups. Results: The successful results of group A is 78% (34/46), and group B is 93% (52/56). Conclusions: Frozen section can avoid mistakes due to lack experience of the operator, and guide to operation scientifically and accurately, and improve the surgical success rate.

Objective:To explore the efficacy of urethrolplasty for anterior urethral stricture using lingual mu-cosal graft. Methods.. Between December 2006 and January 2009, 36 patients with complex anterior urethral stric-tures were treated with lingual mucosal graft. Results: Follow-up was performed for 3-25 months (mean 13.6 months) postoperatively. Complications occurred in 4 patients, including urinary fistulas in 2 patients, which im-proved by the second urethrolplasty; recurrent stricture in 2 patients, which was cured after urethral dilation. The remaining patients voided well postoperatively, with mean peak flows 23.8 ml/s. Conclusions:The lingual mucosal graft has the advantages of accessibility, lower complication rate and better compatibility for treatment of anterior urethral strictures.

Objective:To evaluate the long-term results of direct visual internal urethrotomy (DVIU) and its value in clinical application. Methods:From January 2003 to January 2007, 65 patients suffered with urethral stric-ture accepted DVIU procedure. The data of follow-up were recorded in this study. The length of stricture ranged from 0.5 to 2 cm (mean 1.2 cm). Of the 65 men, 25 were found obvious urethra stricture in less than 1.0 cm, and the others 1.1 to 2.0 cm. Urethral ultrasound was conducted in 30 patients, which showed that 10 patients with thickness of scar around urethra were less than 1 cm, 20 patients more than 1 era, and 9 patients with both length and thickness of scar less than 1 cm. Results:Of the 65 patients, DVIU were conducted 72 times. All the operations were successful. 63 patients were followed-up from 24 to 60 months (mean 40.5 months). Opening procedures were performed in 48 patients (76.2%) due to recurrence. In 10 patients whose scar thickness around urethra less than 1 cm, only 1 patient was accepted opern operation. However, 18 of 20 patients with scar thick-ness more than 1 cm underwent opern operation. 9 patients with scar length and thickness less than 1 cm were completely successful. Conclusions: Patients whose scar length and thickness less than 1 cm may be optimal for DVIU. Repeated DVIU are unnecessary. Reasonable indication is related to the efficacy of this procedure.

Objective:To evaluate the effect of improved Snodgrass operation of hypospadias repair. Methods: From January 2005 to December 2008, 31 patients with hypospadias underwent improved Snodgrass operation. Their ages ranged from 2 to 18 years with a mean of 7.2 years. The type of hypospadias were glans (n=11), pe-nile shaft (n= 18) and scrotal (n=2) respectively. Results:29 cases were cured in the first operation (93.55%). Urethral fistula occurred in 1 patient (1/31, 3.22%), who recovered after the second repair with improved snodgrass operation at 6 months post the first surgery. One patients (3. 22%) developed mild meatal stenosis and were successfully managed by simple dilatation. Conclusions:Improved snodgrass operation can retain the urethral plate, and has several advantages including simple technique, short operative time, fewer complications and cos-metic results. Cosmetic results can be gained for the second repair by using improved snodgrass operation. Im-proved snodgrass operation is a better method for patients with hypospadias.

Objective:To summarize our clinical experience of robot-assisted laparoscopic partial nephrectomy (RALPN), and to discuss its efficacy and safety. Methods:Between December 2007 and October 2008, 6 patients with small exophytie renal masses underwent intraperitoneal robotic partial nephrectomy utilizing the Da Vinci sur-gical system. The perioperative data were collected, and were compared with those performed the same operation in abroad and those performed laparoseopic partial nephrectomy(LPN) with the same team in internal. Results: All the operations were accomplished successfully except the one which required conversion to open nephron-sparing surgery (NSS) due to bleeding occured after the renal artery had been clamped. The mean lesion diameter was 3.2 (2.2-3.6)cm; the mean operative time (not including preoperative set-up time of the Da Vinci surgical system) was 130 (110-160) minutes; the mean warm ischemia time were 40(33-50)minutes; the mean estimated blood loss was 188 (100-380) ml. The patients were ambulant in the 7th postoperative days, and tubes were removaled in 3 days, and mean hospital stay was 9 (8-12)days. Renal function of all patients was in the normal range. Pathology revealed renal cell carcinoma in five, papillary renal cell carcinoma in one. All resection margins were negative. Follow-up ranged from 4 to t5 months, no local residual lesions, local recurrence, incision implantation and dis-tant metastasis were found in all patients. Conclusions.. Robot-assisted laparoscopic partial nephrectomy can be safe-ly performed in selected patients, and it is a feasible approach and a minimally invasive operation for small renal tumors.

Objective:To study the mechanism of stem brain functional reorganization in a spinal bifida patient compli-cated with congenital urinary incontinence after treatment with artificial nerve arc. Methods=Compared the stem brain func-tional map in the patient pre-and post-operatively with functional magnetic resonance imaging (fMRI). Results: No activa-tion was found in the patient before operation while strong activation was found after operation. Conclusions: The micturi-tion center was formed in the stem brain after construction of artificial nerve arc.

Objective:To evaluate the effect of biofeedback/electrical stimulation combined with tolterodine in the treatment of female overactive bladder (OAB). Methods:60 eases of female OAB were treated wih biofeedback/ electrical stimulation (20 days) combined with tolterodine (4 weeks). The effects were evaluated after 3 months and followed up for 6 months. Results: The total efficiency rate was 90% ; the cure rate, the alleviation rate, and the nullity rate was 53.3 % (32 eases), 36.7% (22 cases), 10% (6 cases) respectively. 54 eases were followed up for 6 months and no one relapsed. Conclusions: Biofeedback/electrical stimulation combined with tolterodine could be an effective therapeutic method for patients with OAB.

Objective:To investigate the clinical value of nadir PSA level after ADT for prostate cancer. Mcth-ods:Reviewed clinical data of patients with prostate cancer treated with bilateral orchiectomy between June 1999 and June 2007. The patient swere divided into two groups based on whether nadir PSA level after ADT decreased to 0.2 ng/ml, and were made multivariate analysis. Results:71 patients with a mean age of 76.0 years old (range 56 to 90) treated with bilateral orchiectomy were included in this study. Mean follow-up was 43.9±27.8 months. 45 patients (63.4%) presented with nadir PSA level ≤0. 2 ng/ml,and 26 (36.6%) >0.2 ng/ml. There were sig-nificant difference in mean nadir PSA levels between the two groups (P<0.002). The interval until PSA level reached nadir after ADT was similar (P>0.5). However ≤0.2 ng/ml group provided a longer period free of na-dir PSA level progression than >0.2 ng/ml group(P<0.05). Of the ≤0.2 ng/ml group the 5-year cumulative PSA progression-free survival was higher than >0.2 ng/ml group significantly (log-rank test, χ2= 8.68, P< 0.005), the clinical progression rate (22%) in PSA level lower than the >0.2 ng/ml group (50%) (χ2= 5.80, P <0.025), overall survival time (48.4 months) longer than the >0.2 ng/ml group(33.1 months) (t=2.22,P< 0.05). In patients died of prostate cancer a mean survival time for ≤0.2 ng/ml group(58.2 months) was longer than >0.2 ng/ml group(19.8 months) (t= 6.29 P<0.001). Conclusions: The nadir PSA level after ADT may be an important predictor of the sensitive degree for ADT in patients with prostate cancer. The lower nadir PSA level is a better prognostic factor of prostate cancer. Patients whose nadir PSA level after ADT could not reach 0.2 ng/ ml have a higher risk of biochemical and clinical progress.