A locked pubic ramus body is an unusual variant of lateral compression injury. Till date, there have been only 25 cases reported in the published literature. We herein described a case where the right pubic ramus was entrapped within the opposite obturator foramen with an overlap of greater than 4 cm, with associated urethral injury. When all maneuvers of closed and instrumented reduction failed, we performed a superior pubic ramus osteotomy on the left side and unlocked the incarcerated right pubic ramus. The osteotomy site was stabilized with a 6-hole recon plate. The patient underwent delayed urethral repair 10 weeks after the index surgery. At 3-year follow-up, the patient has sexual dysfunction especially difficulty in maintaining erection, secondary urethral stricture, heterotopic ossification, and breakage of implants.
Humans ; Pubic Bone/injuries* ; Follow-Up Studies ; Osteotomy, Sagittal Split Ramus ; Pelvis ; Urethra/surgery* ; Pubic Symphysis/injuries*

The field of prosthetic urology demonstrates the striking impact that simple devices can have on quality of life. Penile prosthesis and artificial urinary sphincter implantation are the cornerstone procedures on which this specialty focuses. Modern research largely concentrates on decreasing the rates of complication and infection, as the current devices offer superior rates of satisfaction when revision is not necessary. These techniques are also able to salvage sexual function and continence in more difficult patient populations including female-to-male transgender individuals, those with ischemic priapism, and those with erectile dysfunction and incontinence secondary to prostatectomy. This review summarizes modern techniques, outcomes, and complications in the field of prosthetic urology.
Erectile Dysfunction/surgery* ; Humans ; Male ; Penile Implantation/methods* ; Penile Prosthesis ; Postoperative Complications/epidemiology* ; Prostatectomy/adverse effects* ; Prosthesis Failure ; Prosthesis Implantation/methods* ; Prosthesis-Related Infections/epidemiology* ; Surgical Wound Infection/epidemiology* ; Urethra/injuries* ; Urinary Incontinence, Stress/surgery* ; Urinary Retention/epidemiology* ; Urinary Sphincter, Artificial ; Urology

ObjectiveTo investigate the diagnosis and management of penile fracture.

METHODSFrom June 1993 to May 2017, 46 cases of penile fracture were treated in our hospital, averaging 33.5 (25－42) years of age and 3.45 (1－10) hours in duration, of which 41 occurred during sexual intercourse, 4 during masturbation and 1 during prone sleeping, 4 with hematuria, but none with dysuria or urethral bleeding. Hematoma was confined to the penis. Emergency surgical repair was performed for all the patients, 45 under spinal anesthesia and 1 under local anesthesia, 16 by coronal proximal circular incision and the other 30 by local longitudinal incision according to the rupture location on ultrasonogram. The tunica albuginea ruptures averaged 1.31 (0.5－2.5) cm in length, which were sutured in the "8" pattern for 6 cases and with the 3－0 absorbable thread for 18 cases. The skin graft or negative pressure drainage tube was routinely placed, catheters indwelt, and gauze used for early pressure dressing. In the recent few years, elastic bandages were employed for 3－5 days of pressure dressing and antibiotics administered to prevent infection. The stitches and catheter were removed at 7 days after surgery.

RESULTSShort-term postoperative foreskin edema occurred in 14 of the 16 cases of circular degloving incision, but no postoperative complications were observed in any of the cases of local incision. Twenty-eight of the patients completed a long-term follow-up of 49.4 (10－125) months, which revealed good erectile function, painless erection, and satisfactory sexual intercourse.

CONCLUSIONSFor most penile fractures, local longitudinal incision is sufficient for successful repair of the tunica albuginea, with mild injury, no influence on the blood supply or lymph reflux, and a low rate complications. It therefore is obviously advantageous over circular degloving incision except when the cavernous body of urethra is to be explored, which necessitates circular degloving incision below the coronal groove.

Adult ; Coitus ; Edema ; etiology ; Hematoma ; diagnosis ; etiology ; Humans ; Male ; Masturbation ; complications ; Penile Erection ; Penis ; injuries ; Postoperative Complications ; etiology ; Rupture ; diagnosis ; etiology ; surgery ; Surgical Wound ; Ultrasonography ; Urethra ; surgery

ObjectiveTo study the clinical effect endoscopic realignment with drainage via a peel-away sheath in the treatment of urethral rupture.

METHODSWe treated 21 urethral rupture patients by endoscopic realignment with drainage via a peel-away sheath using normal saline for irrigation under the normal nephroscope or Li Xun nephroscope, followed by analysis of the clinical results.

RESULTSThe operation was successfully accomplished in 20 cases but failed in 1 and none experienced urinary extravasation. In the 14 cases of bulbar urethral rupture, the mean operation time was (5.1±1.6) min and the mean Foley catheter indwelling time was (26.0±5.1) d. Urethral stricture developed in 57.1% (8/14) of the cases after catheter removal, of which 1 was cured by internal urethrotomy and the other 7 by urethral sound dilation, with an average maximum urinary flow rate of (18.8±1.8) ml/s at 12 months after operation. In the 6 cases of posterior urethral rupture, the mean operation time was (15.8±7.5) min and the mean Foley catheter indwelling time was 8 weeks. Urethral stricture developed in all the 6 cases after catheter removal, of which 3 cases were cured by urethral dilation, 1 by internal urethrotomy, and 2 by open urethroplasty. The average maxium urinary flow rate of the 4 cases exempt from open surgery was (17.9±1.9) ml/s at 12 months after operation.

CONCLUSIONSEndoscopic realignment with drainage via a peel-away sheath can keep the operative field clear, avoid intraoperative rinse extravasation, shorten the operation time, improve the operation success rate, and achieve satisfactory early clinical outcomes in the treatment of either bulbar or posterior urethral rupture.

Device Removal ; Drainage ; Endoscopy ; Humans ; Operative Time ; Rupture ; surgery ; Treatment Outcome ; Urethra ; injuries ; Urethral Stricture ; etiology ; Urinary Catheterization

Adult ; Humans ; Kidney ; surgery ; Laparoscopy ; Male ; Needles ; Urethra ; injuries

OBJECTIVEPenile fracture, being defined as rupture of the tunica albuginea of the corpus cavernosum, is uncommon. Here, we analyze findings on our patients during a 10-year period and evaluate the role of retrograde urethrography.

METHODSFrom February 2002 to April 2012, 116 patients were admitted with penile fracture at Ghaem Medical Center. Patient history and physical examination were taken at their admittance to detect probable urethral injury. Before surgery, retrograde urethrography was performed in all patients. The size and site of the tunical rupture were recorded. Then the rupture of tunica albuginea was sutured with nonabsorbable (3-0 nylon) sutures and the ties were placed on the internal surface (continuous method). All patients were followed up for 12 months.

RESULTSPatients' mean age was (32.78 ± 10.61) years and ranged (16-62) years. The mechanism of trauma was sexual intercourse in 103 patients (89%) and masturbation in 13 patients (11%). The most common site of injury found after exploration was right (55%) and lateral (74%) of the corpus cavernosum. The size of the tunical rupture was from 0.5 to 3.0 cm (mean 1.88 ± 0.72). Three of the patients had Marphan's syndrome. Urethral injury was detected by retrograde urethrography in 4 patients (3%) who had macroscopic hematuria and urethrorrhagia. During 12 months follow-up, no complication was seen.

CONCLUSIONThere is no need to perform retrograde urethrography unless the patients have gross hematuria or urethrorrhagia. The key to success in treatment of penile fracture is to achieve a rapid diagnosis based on history and a physical examination, avoid unnecessary imaging tests and perform immediate surgery to reconstruct the site of injury.

Adolescent ; Adult ; Humans ; Male ; Middle Aged ; Penis ; injuries ; surgery ; Rupture ; Sutures ; Urethra ; diagnostic imaging ; Young Adult

OBJECTIVETo explore selection and efficacy assessment for membranous urethral trauma caused by pelvic fracture.

METHODSFrom June 2000 to August 2010, 72 patients with membranous urethral trauma caused by pelvic fracture were selected. There were 46 males and 26 females,ranging age from 26 to 62 years (averaged 35.2 years). The time from injury to hospitalization time was 1 to 3 hours. According to Tile pelvic fracture classification, there were 8 patients with type A, 45 patients with type B, 19 patients with type C. Thirty of the 35 patients with partial rupture of posterior urethral were treated by catheterization,5 patients treated by rupture anastomosis on the stage I combined with cystostomy; 25 of the 37 patients with complete rupture of posterior urethra were treated by early realignment, and 12 patients were treated by cystostomy. Urinary incontinence, impotence and urethrostenosis were evaluated.

RESULTSAll patients were followed up for 5 to 10 years (mean 7.7 years). Incidence of urethrostenosis, impotence and urinary incontinence in patients treated by cystostomy were significantly higher than rupture anastomosis on the stage I and early realignment (P < 0.05); while incidence in patients treated by catheterization was significantly lower than other groups (P < 0.05).

CONCLUSIONFor patients with partial rupture of posterior urethral, catheterization and rupture anastomosis on the stage I are preferred methods; while patients with complete rupture of posterior urethra, early realignment is a preferred method with advantages of simple operation and less complications.

Adult ; Female ; Fractures, Bone ; complications ; Humans ; Male ; Middle Aged ; Pelvic Bones ; injuries ; Retrospective Studies ; Urethra ; injuries ; surgery

OBJECTIVETo assess the biocompatibility of a urethral acellular matrix graft (UAMG) and evaluate its effect in repairing urethral defect in rabbit models.

METHODSThe UAMG was prepared and its structural features were observed using optical and electron microscopy. In vitro cultured rabbit bladder smooth muscle cells were seeded on UAMG and the cell proliferation was observed. The cytotoxicity of the aqueous extract of the UAMG against the cells was evaluated by MTT assay, and its biocompatibility was assessed by implanting the grafts subcutaneously on the back of the rabbits. In 24 male rabbits, a 2-cm urethral defect was induced and repaired with UAMG (experimental group, n=12) or left untreated (control group, n=12). In both groups, the rabbits were sacrificed 2, 4, 8 and 12 weeks after the operation for histological and immunohistochemical examination of the tissue regeneration.

RESULTSThe UAMG had a reticular fibrous structure without cell residues. The bladder smooth muscle cells showed normal proliferation on UAMG with normal cell morphology. The rabbits receiving the implants showed no abnormal response, and the UAMGs gradually degraded in vivo with grade 0 or 1 cytotoxcity showing satisfactory cytocompatibility. In the experimental group, new urethral tissues that were histologically compatible with normal urethral tissues were regenerated in the defect area 12 weeks after UAMG implantation.

CONCLUSIONAs a tissue engineered scaffold material for urethral reconstruction, the UAMG possesses good biocompatibility and can induce the regeneration of urethral epithelial cells and smooth muscle cells.

Animals ; Extracellular Matrix ; transplantation ; Male ; Rabbits ; Random Allocation ; Reconstructive Surgical Procedures ; methods ; Regeneration ; physiology ; Tissue Engineering ; methods ; Urethra ; injuries ; surgery

OBJECTIVETo evaluate endourethral surgery for urethratresia under the X-ray guide.

METHODSWe performed transurethral urethroplasty for 11 patients with urethratresia using the PlasmaKinetic electrodes under the guidance of C arm xanthippe.

RESULTSIn the 11 cases, operations were all successful, 9 achieved smooth urination and 2 needed regular urethral dilation.

CONCLUSIONX-ray guided internal urethroplasty with PlasmaKinetic electrodes is a simple and efficient treatment for urethratresia.

Adult ; Aged ; Electrodes ; Humans ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; methods ; Urethra ; injuries ; Urethral Obstruction ; surgery ; X-Rays

OBJECTIVETo search for a safe and convenient surgical method for management of urethral disruption.

METHODSWe performed urethral realignment for 18 cases of posterior urethral disruption and 4 cases of ruptured bulbous urethra using the urethral guidance probe following bladder puncture stoma.

RESULTSUrethral realignment was accomplished in 21 of the cases, 18 under epidural and 3 under local anesthesia, with the mean blood loss of 20 ml and the average operation time of 18 minutes. Open surgery was necessitated in 1 case due to the complication of bladder rupture. Routine postoperative urethral dilation extended for 3 months, and all the cases were followed up for 3 to 24 months. The maximum urine flow rate was 15-22 ml/s in 13 cases and 10-14 ml/s in 7. One case received urethral anastomosis 3 months later because of urethrostenosis.

CONCLUSIONSUrethral realignment with the urethral guidance probe is a safe, convenient and effective surgical strategy for the management of urethral disruption.

Adolescent ; Adult ; Anastomosis, Surgical ; instrumentation ; methods ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Treatment Outcome ; Urethra ; injuries ; surgery ; Young Adult