Adenoma of the posterior urethra:131 case report

Aim: A case-report on adenoma of the posterior urethra. Methods: In 131 cases of adenoma of the posteriorurethra, aged 17-79 (mean: 36.4) years, a detailed medical history was taken and urinalysis, urethroscopy, and pro-static specific antigen (PSA) immunohistochemical staining were performed. They were then treated with transurethralresection (TUR) or transurethral electric coagulation (TUEC). Results: Hemospennia occurred in 51% of the cas-es, hemamria in 38%, blood overflow from the urethral orifice in 6%, and dysuria in 5%. The position of the tumorwas at or around the vemmontanum. The appearance of the tumor was similar to those of a papilla, a villus, a dactylor polyp, or simply an engorgement. The tumor contained glandular alveoli and adeno-epithelial cells. PSA immuno-histochemistry was positive in the cytoplasm and nucleus of the adeno-epithelial cell. One hundred and tweenty-ninecases were cured after TUR or TUEC, while 2 patients recurred and were operated again. Conclusion: Adenoma ofthe posterior urethra is a common cause of hemospennia and hematuria in young men. Urethroscopic examination andbiopsy are the principal diagnostic measures. TUR or TUEC are believed to be the treatment of choice with a short-termrecurrence rate of around 1.5%. (Asian J Androl 2000; 3: 67-70)

Management of Posterior Urethral Valves about 26 Cases

Aim: To improve management of the posterior urethral valve (PUV) in children in a hospital environment. Patients and Methods: This was a retrospective descriptive study that covered a sixteen (16) years period, from January 1, 2002 to December 31, 2017, In pediatric surgery and urology departments of our teaching hospital, 26 cases of posterior urethral valve (PUV) were involved. The diagnosis was made by retrograde urethrocystography and micturition, supplemented by ultrasound. Results: During this period, 26 patients (1.7%) had a PUV. The mean age of the patients was 73, 2 months with extremes ranging from 6 to 180 months. Fifteen patients consulted for dysuria, 8 for complete retention of urine. Only one patient had a history of rolling the valves to the benign ones. The main complications found were urinary tract infection in 15 children, urolithiasis in 3 children and renal failure in 2 children. Two children had serum creatinine values of 50 and 58 mg/L. The lamination of the posterior urethral valves was performed in all patients. In our series, we had one death from chronic renal failure in a 6-year-old child with a bilateral mute kidney at IVU. Conclusion: The valve diagnosis of the posterior urethra is made late because the diagnosis is still postnatal.

Micturition pattern in young boys with posterior urethral valves—A pilot study in small boys who are potty-trained from infancy

Introduction: To investigate if potty training from infancy can affect bladder dysfunction in boys with posterior urethral valves (PUV). Subjects and Methods: The voiding pattern and emptying ability were followed using the 4-hour voiding observation method in 17 Vietnamese boys with PUV aged 3 months to 4 years who had been potty-trained from infancy. This group was compared with a group of healthy Vietnamese boys. Results: In the boys with PUV, the bladder volume increased according to age, and interrupted voiding was rare. However, when comparing boys with PUV with healthy boys, a significant difference was noted with more frequent voidings and lower voided volumes in the age group 0 - 1 year (P < 0.001). Despite the minimum amount of residual urine, average 8 ml or less in the boys with PUV, the age groups 1 - 2 and 2 - 4 years had significantly higher residual volumes compared with those of the healthy boys (P The findings from the 4-hour voiding observation showed few signs of dysfunctional bladder in the Vietnamese boys with PUV, including residual urine, even if there were signs of dysfunction compared with the healthy Vietnamese boys. Potty training from infancy could favor early bladder rehabilitation in boys with PUV.

Posterior Urethral Valves without Reflux Associated with Bilateral Renal Cortical Atrophy: Diagnosis and Management

The objective of this case report was to highlight the characteristics of posterior urethral valves observed in a 3-year-old patient and to describe their management. The case of a 4-year-old patient treated for a posterior urethral valve with bilateral renal cortical atrophy was reviewed. The diagnosis was confirmed by abdominal ultrasound, cystography and abdominal CT. He was referred to Martinique (a tertiary health establishment) for effective support. From the acute situation to the fortuitous discovery, its understanding must be deepened because of the potential immediate symptomatic impact in the form of renal colic which can be associated with sepsis, as well as in the long term on renal function. This observation is intended to help the attending physician to initiate his diagnosis and treatment.

Diagnosis and treatment of penetrating wounds through the anorectum and urinary bladder or posterior urethra

Penetrating wound of the anal canal is relatively rare, which is often complicated with injuries of the rectum, urinary bladder or posterior urethra. Misdiagnosis and improper treatments of the disease may lead to pelvic abscess, anal stenosis, fecal incontinence, or rectovesical fistula. From 1985 to 2004, 16 patients with penetrating wounds through the anorectum and urinary bladder or posterior urethra were treated in our hospital.

Are There Prognostic Factors for Failure of Surgical Treatment of Post-Traumatic Posterior Ureteral Stenosis? About 30 Cases and Review of the Literature

Introduction: The management of post-traumatic stenosis of the posterior urethra is divided between early endoscopic realignment and delayed surgery. In the latter case, several techniques are used taking into account several factors. Our objective was therefore to investigate the possible prognostic factors of failure of this surgical management. Material and Methods: We conducted a retrospective study from January 2006 to December 2017 on patients admitted to the Urology Department of the Mohammed 6 University Hospital of Marrakech for management of post-traumatic posterior urethral stenosis. The parameters studied were age, medical and surgical history, causes, characteristics of the stenosis (location, number, length), associated lesions, surgical technique used, and evolution. The descriptive analysis consisted of calculation of absolute and relative frequencies for the qualitative variables, and of position and dispersion parameters for the quantitative variables (mean, standard deviation). In bivariate analysis, the comparison of categorical variables used Pearson’s Chi-square statistical test and Fisher’s test if necessary. The significance threshold was set at p Results: A total of 30 cases were selected. The age of our patients varied between 18 and 68 years, with an average of 38.33 years (16 - 80 years);the most affected age group was between 20 and 39 years. The mode of revelation of urethral damage was dominated by acute retention of urine present in 76% of patients, followed by dysuria (33%). The stenosis extended over 21.91 mm on average (14 - 40 mm). It was accompanied by bone involvement in 15 patients (53.3%). Erectile dysfunction was present in 23 patients (23%). Terminal urethrogram was the main surgical technique used, followed by internal urethrotomy (60% and 30% respectively). 15 patients had a recurrence, with an average of 1-second operation. Statistical analysis of the different factors studied showed no correlation with the occurrence of recurrence after surgical treatment. Conclusion: The medium and long term results of anastomotic repair of the posterior urethra do not seem to depend on the lesion parameters of the stenosis (site, number, extent, presence of associated bony lesions or erectile disorders).

Summarizing the evidence for robotic-assisted bladder neck reconstruction: Systematic review of patency and incontinence outcomes

Objective:Bladder neck contracture and vesicourethral anastomotic stenosis are difficult to manage endoscopically,and open repair is associated with high rates of incontinence.In recent years,there have been increasing reports of robotic-assisted bladder neck reconstruction in the literature.However,existing studies are small,heterogeneous case series.The objective of this study was to perform a systematic review of robotic-assisted bladder neck reconstruction to better evaluate patency and incontinence outcomes.Methods:We performed a systematic review of PubMed from first available date to May 2023 for all studies evaluating robotic-assisted reconstructive surgery of the bladder neck in adult men.Articles in non-English,author replies,editorials,pediatric-based studies,and reviews were excluded.Outcomes of interest were patency and incontinence rates,which were pooled when appropriate.Results:After identifying 158 articles on initial search,we included only ten studies that fit all aforementioned criteria for robotic-assisted bladder neck reconstruction.All were case series published from March 2018 to March 2022 ranging from six to 32 men,with the median follow-up of 5e23 months.A total of 119 patients were included in our analysis.A variety of etiologies and surgical techniques were described.Patency rates ranged from 50%to 100%,and pooled patency was 80%(95/119).De novo incontinence rates ranged from 0%to 33%,and pooled incontinence was 17%(8/47).Our findings were limited by small sample sizes,relatively short follow-ups,and heterogeneity between studies.

后尿道超声形态改变与良性前列腺增生致下尿路症状发生的相关性

目的探讨与分析后尿道超声形态改变与良性前列腺增生致下尿路症状发生的相关性。方法选择2020年月—2023年5月在商洛市商州区人民医院诊治的92例良性前列腺增生男性患者作为病例组,92名体检健康男性为对照组。检测病例组与对照组的后尿道超声形态的改变情况,同时对下尿路症状进行记录,并采用Spearman分析分析尿道超声形态改变与良性前列腺增生致下尿路症状的相关性。结果病例组的后尿道超声形态异常率为53.26%,对照组为5.43%,病例组的后尿道超声形态异常率显著高于对照组,差异有统计学意义(P<0.05)。病例组的膀胱出口梗阻指数、残余尿量都显著高于对照组,差异有统计学意义(P<0.05)。病例组最大尿流率明显低于对照组,差异有统计学意义(P<0.05)。在病例组中,Spearman分析显示后尿道超声形态异常与膀胱出口梗阻指数、残余尿量、最大尿流率等都存在相关性(P<0.05)。多因素logistic回归分析显示,良性前列腺增生患者后尿道超声形态异常为影响膀胱出口梗阻指数、残余尿量、最大尿流率的重要因素(P<0.05)。结论良性前列腺增生患者多表现为后尿道超声形态异常,伴随有膀胱出口梗阻指数、残余尿量、最大尿流率异常,后尿道超声形态改变与良性前列腺增生致下尿路症状的发生存在相关性。

膀胱软镜在骨盆骨折后尿道狭窄患者中的应用及疼痛耐受性研究

目的研究膀胱软镜在骨盆骨折后尿道狭窄患者中的应用价值并对接受镜检患者的疼痛耐受性情况进行比较分析。方法 120例男性骨盆骨折后尿道损伤(PFUDDs)导致尿道狭窄患者,平均年龄(36.2±9.5)岁(20~58岁)。87例患者接受膀胱软镜检查,33例患者行膀胱硬镜检查,所有患者接受膀胱尿道镜检查完善膀胱、后尿道情况。对膀胱及后尿道结石、膀胱颈部结构异常、后尿道假道、尿道直肠瘘的检查结果与传统的尿道造影检查进行比较分析。依据视觉模拟疼痛评分量表(VAS)对检查中、检查后1天的疼痛情况进行疼痛评分,对膀胱软镜与传统硬镜检查的疼痛评分情况进行分析并比较两组间的差异。结果膀胱软镜检查可以更直观地了解尿道狭窄位置、后尿道结构、膀胱及膀胱内结石等异常情况,通过镜检发现后尿道内结石、膀胱颈部结构异常、后尿道内假道、尿道直肠瘘瘘口分别为21、5、7和5例,与传统的影像学检查异常发现情况比较差异有统计学意义。进行膀胱软镜检查时经尿道及经膀胱造瘘口的疼痛评分明显低于硬镜检查,检查后的延时疼痛评分比较均显示差异有统计学意义。结论对骨盆骨折后尿道狭窄患者进行传统影像学检查的基础上,膀胱软镜检查能提供更全面、更有效的术前评估。患者对检查的疼痛耐受性高,对疾病正确诊治有较高的临床价值,是值得推广的术前检查方法。

手术治疗复杂尿道狭窄的技术探讨(附光盘)

尿道狭窄的疗效近年显著提高。对于前尿道狭窄,目前临床上应用口腔黏膜尿道成形术疗效满意,被公认为治疗前尿道狭窄的金标准。但对于长段前尿道狭窄,口腔黏膜移植物选取较长,手术颇为复杂。对于后尿道狭窄(或闭锁)的治疗,狭窄段切除端端吻合术是标准术式,但对于复杂的后尿道狭窄,由于狭窄段长、局部瘢痕较多、术野位置深、局部解剖层次不清而增加手术难度。本文重点阐述相关技术的注意事项和技术要点。

经会阴途径后尿道端端吻合术治疗创伤性后尿道狭窄37例

目的探讨经会阴途径后尿道端端吻合术治疗创伤性后尿道狭窄的临床疗效。方法 37例创伤性后尿道狭窄患者术前均常規行膀胱尿道造影,复杂病例加行尿道B超、多层CT尿道重建（CTU）、磁共振尿道成像（MRU）及尿道镜或软性膀胱镜检查。37例患者均行经会阴途径后尿道端端吻合术,其中单纯尿道端端吻合术11例,阴茎海绵体中隔切开＋后尿道端端吻合术23例,阴茎海绵体中隔切开＋耻骨下缘楔形切除＋后尿道端端吻合术3例。结果 37例患者术后随访3~20个月,平均12.3个月,术后最大尿流率为13.3~51.2 mL.s-1,平均（21.81±8.04）mL.s-1。手术总的成功率为86.5%（32/37）,其中经会阴单纯尿道端端吻合术的成功率为90.9%（10/11）,阴茎海绵体中隔切开＋后尿道端端吻合术的成功率为86.9%（20/23）,阴茎海绵体中隔切开＋耻骨下缘楔形切除＋后尿道端端吻合术的成功率为66.7%（2/3）;手术不成功5例（13.5%）。结论经会阴途径后尿道端端吻合术可有效治疗创伤性后尿道狭窄。

U形多孔引流支架管在复杂性后尿道手术中的应用

目的探讨复杂性后尿道手术中使用一种新的引流支架的方法.方法对55例复杂性后尿道病人行手术治疗,其中复杂性后尿道直肠瘘15例,复杂性后尿道狭窄及闭锁35例,膀胱外翻5例.术后均采用自制U形多孔引流支架管引流.结果随访1～10年,术后病人排尿正常,无尿道狭窄等并发症.结论 U形多孔引流支架管具有支架和引流双重作用,值得在复杂性后尿道手术中临床推广应用.

治疗复杂性后尿道狭窄3种手术入路的比较解剖学研究

目的评价经耻骨上、耻骨下、会阴3种手术入路治疗复杂性后尿道狭窄的优劣。方法解剖35具成年男性尸体标本,测量并比较耻骨上缘中点(A)、耻骨下缘中点(B)及会阴部两坐骨结节连线中点(C)分别到尿道球膜部连接处(D)、前列腺尖(E)及膀胱颈(F)的距离及相关角度;对另20具成年男性尸体标本分别经3种手术入路显露后尿道,标记可能损伤的组织器官并评分。结果各点之间的距离AD=(6.5±0.5)cm,BD=(2.2±0.5)cm,CD=(3.4±0.6)cm,BD<CD<AD (P<0.05,SNK法);AE=(6.6±0.5)cm,BE=(3.0±0.5)cm,CE=(4.4±0.7)cm,BE<CE<AE (P<0.05,SNK法);AF=(5.7±0.6)cm,BF=(4.5±0.5)cm,CF=(6.5±0.6)cm,BF<AF<CF(P<0.05,SNK法)。各点连线所成角度中,∠EAD (α1)=(9.3±2.0)o,∠EBD (α2)=(17.4±3.8)o,∠ECD (α3)=(9.2±1.6)o,α1与α2有显著性差异(P<0.05,t=11.1),α3与α2有显著性差异(P<0.05,t=12.1),α1与α3无显著性差异(P>0.05,t=0.13);∠FAE (β1) =(22.7±2.6)o,∠FBE (β2 )=(32.9±6.4)o,∠FCE (β3)= (15.0±3.2)o,其中β2>β1>β3(P<0.05,SNK法)。经耻骨上入路损伤评分为13分,经耻骨下为20分,经会阴为15分。结论暴露从优到劣依次为经耻骨下、经耻骨上、经会阴;损伤从大到小依次为经耻骨下、经会阴、经耻骨上部分。

骨盆骨折引起后尿道损伤的早期处理

目的:探讨骨盆骨折引起后尿道损伤早期合理的处理方法。方法:回顾性分析36例男性骨盆骨折并发后尿道损伤患者的临床资料,其中8例尿道黏膜裂伤或尿道部分断裂患者行留置导尿,另28例尿道完全断裂患者均在伤后24h内行手术治疗,其中18例行尿道会师加牵引,其余10例单纯膀胱造瘘。结果::随访6个月～5年,8例留置尿管患者,拔管后排尿通畅6例,尿线变细2例,经定期尿道扩张,排尿正常。18例尿道会师加牵引患者,拔管后适时扩张尿道,排尿通畅15例,尿线较细3例,经定期尿道扩张后,1例排尿通畅,2例失败。10例单纯膀胱造瘘患者,术后均不能排尿,分别于伤后6～12个月行开放手术及尿道内切开治疗。结论:尿道会师加牵引术是治疗骨盆骨折所致后尿道断裂的有效方法。

后尿道假性憩室的诊断与治疗

目的探讨后尿道假性憩室病因、发病特点及有效诊治手段。方法对尿道膀胱镜与尿道造影检查确诊的9例患者进行回顾性分析。所有患者均经尿道进行手术切除，比较手术前后平均膀胱剩余尿及最大尿流率。结果本组患者经尿道手术切除后平均膀胱剩余尿及最大尿流率与术前比较差异有统计学意义（P〈0.01）。结论后尿道假性憩室致病因素与反复尿道扩张相关。膀胱尿道镜检查及尿道造影在诊断上具有实用价值。经尿道进行后尿道假性憩室切除疗效确切。

膀胱黏膜法治疗复杂性外伤性后尿道狭窄

目的总结用膀胱黏膜法治疗复杂性外伤性后尿道狭窄的经验。方法1989年-2004年本院收治的外伤性复杂性后尿道狭窄患儿20例,均采用膀胱黏膜法手术治疗。结果12例60%术后正常排尿。6例(30%)行定期尿道扩张术后正常排尿。2例术后再行膀胱镜下冷刀切开术。结论膀胱黏膜法可用于治疗儿童复杂性后尿道损伤狭窄。

前列腺增生梗阻程度与尿道形态的相关性分析

目的 探讨良性前列腺增生症梗阻程度与尿道形态之间的关系。方法 回顾性分析2018年9月至2020年9月于云南省第二人民医院就诊的86例前列腺增大患者的临床资料。所有患者完成CT排泄性膀胱尿道造影扫描,将扫描图像导入minics生成三维图像,选取排尿期间尿道体积及截面最大的一组图像并进行尿道测量,同期尿动力学检查并计算膀胱出口梗阻指数(AG值),数据对AG值进行多元线性回归分析。结果 多元线性回归分析结果显示前列腺后叶厚度及尿道长度是AG值的独立影响因素,其标准化系数分别为0.615及0.293。结论 前列腺增生导致的尿道变形与梗阻程度及症状严重程度相关,前列腺后叶厚度是前列腺增生梗阻程度最重要的影响因素。

经尿道治疗复杂性后尿道狭窄(附22例报告)

为提高经尿道治疗复杂性后尿道狭窄的疗效，采用二步切开及会师切开法治疗22例复杂性后尿道狭窄和闭锁。结果：22例患者手术顺利。随访3～8个月，19例排尿通畅，疗效满意。并对切开尿道的方法、瘢痕切除的范围及导尿管留置的时间进行了探讨。

输尿管镜下Nd:YAG激光切除后尿道瓣膜症的研究

目的 :探索激光治疗后尿道瓣膜症的方法 ,提高治疗后尿道瓣膜症的疗效。 方法 :采用输尿管镜下Nd :YAG接触式激光切除后尿道瓣摸 8例。结果 :8例均一次手术成功 ,术后排尿通畅 ,平均随访 1.5年 ,均能保持排尿良好状态 ,最大尿流率平均 16.5ml/s。结论 :输尿管镜下激光切除后尿道瓣膜操作简单易行 ,安全有效。

后尿道损伤伴膀胱破裂的诊断(附34例报告)

目的 探讨后尿道损伤合并膀胱破裂的诊断。方法 回顾性分析 34例后尿道损伤伴膀胱破裂的诊断及治疗结果。结果 34例患者均行手术治疗。 32例痊愈 ,2例因合并胸外伤、脑外伤而死于呼吸功能衰竭和脑疝 ,死亡率 5 9%。术中发现膀胱破裂漏诊 6例 ,占 17 6 %。结论 尿道损伤不能放置尿管行灌洗实验时 ,易于漏诊膀胱破裂 ,此时B超、腹腔穿刺、大剂量静脉肾盂造影。