Objective To investigate the effectiveness of longitudinal preputial pedicled flap urethroplasty for chordee of Donnahoo IV type. Methods Between June 1994 and October 2011, 30 patients with chordee (Donnahoo type IV) underwent longitudinal preputial pedicled flap urethroplasty. The patients’ age ranged from 2 to 16 years (mean, 5.8 years). The morphology of the balanus-navicular fossa-external urethral orifice ranged normal; the penis length was 2.5-6.8 cm (mean, 4.3 cm); the penis bending angle was 35-70° (mean, 40.1°). Primary and secondary operation was 27 cases and 3 cases, respectively. The size of flap ranged from 1.5 cm × 1.3 cm to 4.0 cm × 2.0 cm. Results After correction, the penis length was 3.0-8.5 cm (mean, 6.6 cm); the penis bending angle was 0-10° (mean, 1.2°). All patients were followed up 6 months to 12 years (mean, 33 months). No recurrence, stabbing pain of the balanus, or foreign body sensation occurred during follow-up. Of them, 4 patients (13.33%) had urinary fistular, they had satisfactory results after the second operation; 2 patients (6.67%) had urethral stricture 1 month after operation, they also had satisfactory results after arethral dilatation. The other patients showed no scattering urinary flow and good direction without complication. Six patients had satisfactory sexual function after puberty without erection disorder, pain, or dyspareunia. Conclusion Longitudinal preputial pedicled flap urethroplasty can achieve maximum utilization of prepuce and aesthetic and functional improvement with less complication, so it is a relatively ideal mean for treating chordee of Donnahoo type IV.
Objective To investigate the therapeutic effect of pedicled scrotal septal flap urethroplasty on longsegment posterior urethral stricture and to assess its appl ication value. Methods From January 2003 to December 2007, 24 patients (age range, 6-54 years old) with long-segment urethral stricture underwent pedicled scrotal septal flap urethroplasty.The duration of the disease was 1-5 years. The stricture was caused by traumatic urethral injury or disruption in 22 cases,postoperative compl ication of suprapubic transvesical prostatectomy in 1 case, and recurrent urethral infection due to long-term indwell ing urinary catheter in 1 case. Urethroscopy or cystourethrography examination confirmed that all cases had urethral stricture 2.0-5.5 cm in length. Eleven cases were compl icated with urethral false passage, 6 with urethral fistula, 2 with intestinal fistula, and 6 with erectile dysfunction. The result of excretion urography of bilateral upper urinary tracts was negative in all cases. Pedicled scrotal septal flap 2.5 cm × 2.0 cm-6.5 cm × 2.5 cm in size was harvested during operation, and urethroplasty was performed. Results Volume of blood loss during operation was 100-500 mL (average 270 mL). The operative time was 90-220 minutes (average 135 minutes). All flaps survived. All wounds healed by first intention. All patients had normal urination after operation. Over the follow-up period of 12-36 months (average 18.6 months), 1 of the 24 patients suffered from urinary incontinence, 2 from urethral stricture, 1 from urethral stricture and urethral fistula, and 1 from urethral diverticulum around the distal anastomosis. Those patients got normal urination after symptomatic treatment. No urethral stone, urinary incontinence, and new case of erectile dysfunction occurred. The maximum urinary flow rate 16 months after operation was 14-21 mL/s (average 17.6 mL/s). Voiding cystourethrography 22 months after operation showed unblocked urinary tract and no formation of stricture and fistula. Conclusion Pedicled scrotal septal flap urethroplasty, featured by simple operative method, easy flap harvest, and high survival rate of flap, is one of safe and effective methods for treating long-segment posterior urethral stricture.
Objective To compare and assess the efficacy of ventral/dorsal onlay graft urethroplasty in the treatment of urethral stricture. Methods We searched pertinent English literature via MEDLINE (1966 to 2007), EMBASE (1977 to 2007) and The Cochrane Library (Issue 4, 2007) for the use of ventral/dorsal graft urethroplasty in the reconstruction of urethral defect associated with urethral stricture. Data were extracted by two reviewers independently and analyzed by SPSS 13.0 software. Results A total of 50 studies involving 1 264 patients were included. Ventral onlay graft urethroplasty was used in 751 patients with a success rate of 82.6%, while dorsal onlay graft urethroplasty was used in 513 patients with a success rate of 86.9% (ventral vs. dorsal, χ2=4.432, P=0.035). Oral mucosa graft had the highest success rate (88.1%) of all grafts, and the success rate of free skin graft onlay urethroplasty was associated with the location of graft placement (ventral vs. dorsal, P=0.016). Concerning the location of stricture, urethroplasty for bulbar urethral stricture achieved the best results, with a success rate of 87.7%, which was also associated with the location of graft placement (ventral vs. dorsal, P=0.025). Conclusion Dorsal onlay graft urethroplasty is better than ventral onlay. It is better to place the free skin graft in the dorsal part of urethra. Bulbar urethral stricture is more suitable for graft onlay urethroplasty than penile urethral stricture.
ObjectiveTo explore the short-term effectiveness of hypospadias repairs with free inner prepuce tube. MethodsForty-two males with hypospadias were repaired with free inner prepuce tube between May and October 2015. The age ranged from 1 year and 1 month to 28 years and 2 months with a median of 2 years and 9 months. Initial operation for hypospadias was performed in 41 cases and re-operation in 1 case of chordee after 16 months of hypospadias repair. There were 36 cases of hypospadias (6 cases of proximal penile type, 1 case of penile scrotal type, 26 cases of scrotal type, and 3 cases of perineal type) and 6 cases of typeⅣchordee according to Donnahoo classification criteria. ResultsThe length of reconstructed urethra was 2.0-5.5 cm (mean, 3.6 cm). The patients were followed up 6-10 months (mean, 8 months). Urinary fistulae was noted in 10 patients, which healed spontaneously in 5 cases within 3 months after surgery, and was cured after repair in 5 cases. Urethral stenosis occurred in 4 cases (2 external orifice stricture and 2 distal urethral stricture) and urethral incision was performed. Wound infection was noted in 3 cases, 2 of them needed further surgery for a permanent fistula. Skin ischemic necrosis was found in 3 cases, 1 of them had infection and fistula, and needed further surgical repair. Diverticulum of scrotum developed in 1 case. Ten patients need re-operation, and the success rate was 76.2% (32/42). At 3 months after surgery, the HOSE score ranged from 11 to 16 (mean, 14.7). The maximum urinary flow rate was 1.9-28.4 mL/s (mean, 10.5 mL/s) in 22 cases of outpatient at 3 months after surgery. ConclusionFree inner prepuce tube can survive and play a role of normal neourethra. The short-term effectiveness has shown a relatively high complication rate and suggests this procedure should be carefully applied.