Penile necrosis resulting from post-circumcision microwave diathermy: A report of 9 cases / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the pathogenesis and treatment of penile necrosis resulting from microwave diathermy following circumcision.</p><p><b>METHODS</b>We retrospectively analyzed the clinical data about 9 cases of penile necrosis resulting from postoperative microwave diathermy following circumcision. The 9 males, aged 20 - 39 (mean 26) years, underwent traditional circumcision for redundant prepuce or phimosis in other hospitals, followed by microwave diathermy for 30 - 60 minutes daily, which resulted in penile necrosis. With no response to conservative therapy, the patients were referred to our hospital at 3 -30 days postoperatively. Of the 9 patients, 5 presented with dry gangrene and 4 with moist gangrene. Six of the patients underwent partial penectomy, including 1 that received penis lengthening.3 months later, while the other 3 underwent total penectomy for total penile necrosis followed by penile reconstruction 3 months later, with deep inferior epigastric perforator (DIEP) flaps and by implantation of the 12th costal cartilage in 2 cases and with epigastric groin island flaps and by urethroplasty in the other.</p><p><b>RESULTS</b>The patients were followed up for 2 - 8 years, and all could urinate smoothly in the standing position. Of the 6 men treated by partial penectomy, 1 received penis lengthening and achieved a penile length of 7 cm and 5 had the remaining penile length of 3 -5 cm, 4 with erectile function and the other 2 capable of sexual intercourse. The 3 men treated by total penectomy achieved nearly normal external appearance of the penis, with a finalized length of (11.7 ± 1.3) cm, a circumference of (11.4 ± 2.1) cm, and a normal feel of the skin. Of the 3 cases of penile reconstruction, 2 achieved sufficient erectile hardness of the penis (grade 3) for sexual intercourse, while the other 1 remained impotent.</p><p><b>CONCLUSION</b>Post-circumcision microwave diathermy may result in penile necrosis, for the management of which, early debridement is necessitated and penile lengthening or reconstruction can be performed according to the severity of the lesion and needs of the patient.</p>

Hand-assisted-drawing-needle running suture with a curved needle: an effective technique to create a W-ileal neobladder / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>An important milestone in the area of urinary diversion was the advent of a series of orthotopic bladder substitution (OBS). However, reconstruction of OBS by the traditional hand suture method (THSM) is a time-consuming process. Stapling techniques are considered to be inferior to hand-sewn methods. We report our experience and functional results in patients with W-ileal neobladder by a hand-assisted-drawing-needle running suture (HADNRS).</p><p><b>METHODS</b>Between April 1993 and December 2011, 347 patients (338 men and 9 women) aged 28 - 77 years (median age: 59 years) underwent radical cystectomy, followed by the creation of a modified W-ileal neobladder by HADNRS with a curved needle. A total of 347 (20 patients in 2003) were evaluated by urodynamic tests.</p><p><b>RESULTS</b>The operative time ranged from 110 to 310 minutes (mean 148 minutes), and the mean time of reconstruction by HADNRS, excluding ureterointestinal and ileouretral anastomosis, was (20.2 ± 4.3) minutes. Histopathological analysis of removed specimens showed that 317 patients had transitional cell bladder carcinoma. Of these 317 patients, 19 also had squamous carcinoma and 13 had adenocarcinoma. Glandularis and prostate cancer occurred in 16 and 14 patients, respectively. Three patients (0.8%) had neobladder abdominal fistula. No other early complications or injury to the surgeon's hands occurred due to HADNRS. Of the 20 cases with urodynamic examinations in 2003, two suffered from daytime incontinence and six had nocturnal incontinence. The maximum capacity of the neobladder was (492.9 ± 177.8) ml, and the maximum pressure within the reservoir at the end of filling was (32.1 ± 8.6) cmH2O.</p><p><b>CONCLUSION</b>Reconstruction of W-ileal neobladder by HADNRS is effective and economical.</p>

Diagnosis of the testicular tumor (57 case reports) / 中华男科学杂志

<p><b>OBJECTIVE</b>To improve the diagnosis of the testicular tumor.</p><p><b>METHODS</b>Fifty-seven cases, including their signs and symptoms, imaging studies, tumor markers and histologic diagnoses, were reviewed.</p><p><b>RESULTS</b>31.3% of the patients failed to go to hospital in time. B mode ultrasound and CDFI had sensitivity of 93.5% and 96.4% respectively. Compared with final diagnoses, 23 from 26 cases (88.5%) were correspondingly diagnosed by intraoperative frozen section examination (FSE), which, however, had no definitive influence on the surgical management. Histologic examination showed 22 patients with seminoma, 9 with embryonal carcinoma, 7 with teratoma, 3 with yolk sac tumor, 9 with combined patterns, 4 with lymphoma, and 3 with other histologic types of tumor.</p><p><b>CONCLUSIONS</b>For earlier diagnosis, patients testicular self-examination counts for much, and ultrasound and CT should be used before possible histologic examination, while all patients with testicular tumors should have intraoperative FSE, which is very practical in identifying malignant and benign masses, and in choosing between enucleation of the tumor and radical orchiectomy.</p>

Retroperitoneal iaparoscopic partial nephrectomy(report of 23 cases) / 中华泌尿外科杂志

Objective To report initial experience and the indications of retroperitoneal laparoscop- ic partial nephrectomy.Methods From December 2001 to October 2005,23 patients (including 14 cases of renal cell carcinoma,5 of hamartoma and 4 of duplex kidney) underwent retroperitoneal laparoscopic par- tial nephrectomy.One of the patients had solitary kidney.Results All the operations were successful ex- cept for only 1 requiring conversion to laparoscopic nephrectomy because of bleeding resulting from blocking anterior branch of renal artery.The mean operative time was 121 min (60-240 min),and mean ischemic time was 32 min (20-55 min).The estimated bleeding volume ranged from 100 ml to 300 ml,and no pa- tient needed blood transfusion.Pathology showed negative surgical margins in 14 cases of renal cell carcinoma and confirmed the diagnosis of hamartoma in 5 cases.One patient with duplex kidney required open partial nephrectomy because of renal cystic mass resulting from incomplete resection.Conclusions Retroperito- neal laparoscopic partial nephrectomy offers a new effective and minimally invasive treatment for selected pa- tients with renal mass.The long-term effects of the procedure need further investigation.