Objective To introduce the application of the scrotal flap on reconstructing partial urethra defect. Methods From March 1998 to August 2004, 31 patients with urethra defect were treated with scrotal flap. Their ages ranged from6 to 34 years. Thirty-one patients included 8 cases of congenital deformity of urethra and 23 cases of complication of urethral fistula, urethral stenosis and phallus bend after hypospadias repair. The flap widths were 1. 2. cm in child and 2.3. cm in adult. The flap lengthwas 1. -2.0 times as much as the width. Nine cases were classified as penile type, 10 cases as penoscrotal type, 7 cases as scrotal type(3 children in association withcleft scrotum) and -cases as perrineal type because of pseudohermaphroditism.Urethroplasty was given by scrotal fascia vascular net flap to reconstruct urethra defect. Results All the flaps survived, and the incision healed well. Twenty four cases achieved healing by first intention and 7 cases by second intention. And fistula occurred and healed after 2 weeks in 1 case. 27 cases were followed up 14 years, 2 cases had slight chordee, the others were satisfactivly. Conclusion Urethroplasty with scrotal fascia vascular net flap is an ideal method for the partial defect urethra.
Objective To resolve the tough problem of how to observe the growing cells in an opaque vector. Methods The urethral epithelial cells from a young male New Zealand rabbit were inoculated, and were primarily cultured in vitro and subcultured for 3 passages. Then, the urethralepithelial cells were cultured in the collagen chitosan complex for 3, 7, 14 and 21 days. The cells were dyed with 6-carboxyfluorescein diacetateacetoxymethyl ester and propidium iodine, respectively. Then, Interactive Laser Cytometer was used to detect the growing cells. Results The urethral epithelial cells grew and proliferated very well in the collagen chitosan complex vector. After the urethral epithelial cells grew in the collagen-chitosan complex vector for 3 and 7 days, the fluorescent density amount of the surviving cells were(1.09±0.13)×10.8 and (2.04±0.13)×10.8, respectively. However, after 14and 21 days, the fluorescent density amount of the surviving cells was (0.55± 0.09)×10.8 and (0.47±0.03)×108, respectively. There was a significant difference when compared with the amount of the surviving cells at 3 and 7 days（P＜0.05）.Conclusion Using Interactive Laser Cytometer for measurement of the green and red fluorescent densities of different waves, the activity of the cultured urethral epithelial cells in vitro can be rapidlymeasured with the in situ quantitation method. This method solves a difficult problem of observing the growing cells in an opaque vector. The dynamic growing state of the engineering tissues can be observed.
Objective To provide the anatomic basis for the posterior urethral repair via the perineal approach. Methods The anatomicconstructions andtheir relationships of the perineal approach from skin to the membranous and prostate apical urethra were observed and some related data were measured in 12 adult male specimens by microanatomy, and the procedures of urethral repair via the perineal approach were carried out in 3 fresh male specimens. Results All the blood vessels and nerves, which supplied the scrotum, the perineum, and bulbourethra, passed lateral-medially. The cavernous nerves coursed posterolaterally from the bottom to the apex of the prostate, pierced the urogenital diaphragm and passed laterally to themembranous urethra in a status of gridding, whose width was (12.11±2.32) mm.Conclusion The structures of the perineum and around the posterior urethra are complicated. The strategy for diminishing the damages to them is that all structures must be dissected strictly in the midline. Confining the dissections strictly to the range of 5 mm from the membranous urethra and resecting the apical prostatic tissues anterolaterally could avoid impairments of the cavernous nerves.
Objective To explore and describe the clinical feasibility and value of reconstruction of complex urethral stricture with free postauricular graft. Methods Urethroplasties-with free postauricular grafts were performed in 17 patients with complex urethral strictures, including 6 cases in anterior urethras and11 cases in posterior urethras.The grafts were transplanted onto the opened urethras in the first stage;6 months later, the new urethras were shaped with the second stage urethroplasties in 14 patients.There patients succeeded in single-stage urethroplasties. The urethras and bladders were washed with antibiotic solution everyday after urethroplasties. Results Good- and satisfactoryresults were obtained in 15 cases 6 months after urethroplasties, regardless of the strictured sites and lengths. Maximal urinary flow rates ranged 14-32 ml/s. There were 2 cases accompanied with complications 6 months after urethroplasties,1 case of fistula was repaired,1 case of severe urethral stricture was reconstructed with opposite side free postauricular graft later. Three patients had mild urethral strictures 6 months after urethroplasties, they were cured with urethral dilatationsfor 4-8 times. Conclusion Reconstruction of complex urethralstricture with freepostauricular graft is a good and effective method to treat long or complex urethral strictures, especially for patients without adequate foreskin or penis skin.
Objective To investigate the effect of scrotal septum vascular pedicle flap with two wing-l ike spl itthickness skin graft in reconstructing urethra in patients with hypospadias and in reducing the compl ications. Methods From January 2007 to March 2008, 30 cases of hypospadias were treated, with a median age of 10 years (2-20 years). There were 13 cases of proximal shaft type, 12 cases of penoscrotal type and 5 cases of scrotal type. There were 8 cases with operation history. The flap size ranged from 4.0 cm × 0.8 cm to 9.0 cm × 1.0 cm and 5 mm with two wing-l ike spl it-thickness skin graft.When the downward curvature corrected, length of the flap could be determined by the length of the urethra that neededto be reconstructed. Results All flaps survived. The incision healed by first intention in all patients except one whose incision healed after change dressing because of frequent erection. Incision at donor site healed well. Eighteen patients were followed up for 6-12 months, including 8 with second operation history. The reconstructed urethras were unobstructed and no urethrostenosis or urinary fistula happened. Conclusion This is an improved technique of the scrotal septum flap in urethra reconstruction. It takes advantages of both flap and spl it-thickness skin graft in reconstructing urethra and avoides the disadvantages of a single tissue. It is a good choice for treating hypospadias whose urinary meatus locates neighborly to penoscrotal junctional zone.
Objective To sum up the research advances in urethra reconstruction with tissue engineering techniques. Methods The recent original articles about urethra reconstruction with engineering techniques were extensively reviewed. Results At present, human urothelium and smooth muscle cells have been successfully harvested，cultivated, and expanded in vitro in sufficient quantitiesfor reconstruction. Tissue engineering for urethral reconstruction includes matrices alone, the body’s natural ability which induces new tissue growth, or the use of matrices with cells. Conclusion The tissue engineering materials for urethral reconstruction has been used successfully to repair defect of hypospadias and urethral strictures. The reconstructionof complex urethral defects need to be improved and developed.
Objective To investigate the effect of ventral urethroplasty for postoperative anastomotic stricture in patients with hypospadias. Methods From August 2000 to December 2005, 20 patients with anastomotic stricture after hypospadias repair were treated with ventral urethroplasty. The age ranged from 2 to 27 years with an average of 6.4 years. All patients showed dysuria after operation. Main clinical manifestation included dysuria and acraturesis. Interruption of urinary stream occurred in 17 cases; of them, 3 cases had urinary stasis and 4cases had frequent micturition, urgent micturition and pain in urination. Urethrography and cystourethrography showed 0.5-1.0 cm stricture with proximal dilat ion of urethra in 16 cases and obvious diverticularization in 9 cases. Urine routine examination showed that white blood cell was ++ to ++++ in 16 cases and pus cell was ± to++ in 13 cases.Results Twenty cases were followed up 2 months to 4 years (mean 2.3 years). All the cases achieved good results in urination with normosthenuria and normal force of urinary stream. No recurrent stricture, urethrocutaneous fistula, or penile curvature occurred. The cosmesis was satisfactory, and the results of urine routine examination was normal. Conclusion Ventral urethroplasty for postoperative anastomotic stricture inpatients with hypospadias is a simple and effective procedure.
Objective To summarize the cl inical effect of a new operative technique of combining penis flap with buccal mucosa graft in the treatment of phall ical urethral stricture. Methods From March 2006 to December 2007, 6 patients with phall ical urethral stricture, aged 3-26 years old, were treated by the method of combining degloved penis flap with buccalmucosa graft. All of them had the symptom of dysuria within 2-10 months after urethroplasty. The urethral stent of highelasticity sil ica was kept for 2-3 weeks after operation. Results Five patients’ incisions obtained heal ing by first intention with satisfying urination and there were no compl ications. Sl ight infection appeared in 1 case at 3 days after operation, with small quantities of suppurative exudate in the incision, which healed through open drainage and washing with antibacterial 2 weeks later. The thinning of the urinary stream was presented at 1 month after operation, and then disappeared after 2-month urethral dilatation. All the 6 patients were followed up for 6-10 months and they felt satisfied with emiction. They had a l ittle bit thicker urinary streams than those of their own age. There was not any residual urine in bladder after emiction. Conclusion The method of combining penis flap with buccal mucosa graft is effective in the treatment of phall ical urethral stricture. It deserves to be popularized due to its simple operation and credible effects.
OBJECTIVE: To study the technique and method of urethral epithelium culture in vitro, so as to lay the groundwork for reconstructing a tissue engineering urethra and to provide an experimental model of urethral mucosa in physiological, pathological, toxicological and microbiological study. METHODS: The urethral mucosa from a young male New Zealand hare that had just been out of milk, was digested into single cell liquid with Dispase II and mixed enzyme, and the fibroblast were removed. After being seeded, the cells were cultured by using L929 cells as trophoderm. The medium was changed regularly and the cells were subcultured when they grew to mix together 80% to 90%. The cultured cells were analyzed with histochemistry, immunohistochemistry dyeing and flow cytometry examination. We observed the ultrastructure of cells with scanning electron microscope and transmission electron microscope. RESULTS: The primary cultured cells fused when they had been cultured for about ten days. They were the same in size like road rocks. The cultured cells were all epithelial cells without fibroblasts and were diploid cells. The cells could be subcultured 11-13 generations, and could survive 50-60 days. CONCLUSION: The urethral epithelium of young New Zealand hare can be cultured in vitro and maintain the ability to proliferate within a certain time. The study result not only sets a role in reconstructing a tissue engineering urethral mucosa, but also provides an experimental model for the research of urethral mucosa in vitro.
Objective To investigate a method of repairing hypospadias by combining buccal mucosal graft with scrotal flap and its therapeutic effect. Methods From March 2002 to December 2007, 42 patients with hypospadias underwent primary urethral reconstruction using buccal mucosal graft and scrotal flap. The patients ranged in age from 18 months to 18 years. There were 21 cases of penoscrotal type, 12 cases of scrotal type and 9 cases of perineal type. Among them,8 cases were at initial operation, and 34 cases suffered from the failure of hypospadias repair 6-19 months (average 10 months) after initial operation. During operation, the defect of urethra was 3-7 cm (average 4.2 cm) when the penis was straightened; the buccal mucosa (3.0 cm × 1.2 cm-7.0 cm × 1.5 cm) was transplanted to the tunica albuginea in the ventral aspect of the penis, and was paired with the scrotal flap (3.0 cm × 1.5 cm-7.0 cm × 1.5 cm) to repair urethra. Results The incision of 38 cases healed by first intention, and no compl ication occurred. At 7 days after operation, 4 cases had urinary fistula at either coronary sulcus or anastomotic stoma, one of which spontaneously closed 2 months after operation and the rest 3 recovered by repairing urinary fistula 6 months after operation. All patients were followed for 3-48 months (average 18 months). Urination was smooth, the reconstructed urethral opening was at the tip of glans peins without retraction and with apperance similar to the normal urethral opening. The appearance of penis and scrotum was satisfying, and the penis was straightened completely. Conclusion Combined buccal mucosal graft and scrotal flap, with considerable tissue for uretha tract reconstruction and low incidence rate of urethral stricture, is one of the effective methods to repair hypospadias.