Application of tunica dartos flap coverage to tubularized incised plate urethroplasty / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the application of tunica dartos flap coverage to the prevention of urinary fistula in tubularized incised plate (TIP) urethroplasty.</p><p><b>METHODS</b>This study included 140 cases of hypospadias following TIP urethroplasty, aged 1.9-22 (mean 5.6) years. Of the total number, 85 cases of the distal type were treated by coverage of the neourethra with the longitudinal ventrolateral pedicled-dartos penile skin flap, while the other 55 cases of the proximal type with the pedicled-dartos flap of arteriae scrotales anteriories.</p><p><b>RESULTS</b>Urethrocutaneous fistula occurred in 12 of the patients, including 7 cases of distal and 6 cases of proximal hypospadias.</p><p><b>CONCLUSION</b>For distal hypospadias, the longitudinal ventrolateral pedicled-dartos penile skin flap can be used, while for proximal urethroplasty, the pedicled-dartos flap of arteriae scrotales anteriories can be applied in coverage of the neourethra, which can effectively reduce the incidence of fistula.</p>

Diagnosis and treatment of epididymal obstructive azoospermia by microsurgery / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the diagnosis and treatment of epididymal obstructive azoospermia (OA) by microsurgery.</p><p><b>METHODS</b>We performed surgical scrotal exploration for 57 cases of OA whose obstruction was suspected to be in the epididymis. Those confirmed to be epididymal OA cases and with motile sperm in the epididymis underwent longitudinal-2-suture intussusceptive vasoepididymostomy (LIVES). And for those with sperm in the epididymal head only or with bilateral obstruction or absence of the vas deferens in the distal epididymis, the sperm were collected and subjected to cryopreservation for intracytoplasmic sperm injection (ICSI). After surgery, the patients were followed up for observation of the semen parameters and the rate of pregnancy.</p><p><b>RESULTS</b>Of the total number of patients, 53 (92.9%) were diagnosed with epididymal OA by scrotal exploration, 47 (82.5%) underwent microsurgery, and the other 10 (17.5%) received sperm cryopreservation. At 1 to 18 months after surgery, motile sperm were found in the ejaculate in 46.8% of the cases (22/47), natural pregnancy in 10.6% (5/47), and ICSI pregnancy in 18.5% (6/32).</p><p><b>CONCLUSION</b>With the development of microsurgery, non-invasive means should be the first choice for the diagnosis of OA. And surgical exploration can be employed to determine the location of obstruction and the option for treatment.</p>

Effects of different fresh gas flow on pharmacodynamics of isoflurane during anesthesia induction / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the effect of different fresh gas flows (FGFs) on the pharmacodynamics of isoflurane during anesthesia induction.</p><p><b>METHODS</b>Sixty female ASA class I or II patients (aged from 18 to 49 years) scheduled for gynecologic laparoscopic surgery were randomly divided into groups I, II, and III (n=20). The FGFs for group I, II, and III was 1, 2 and 3 L/min, respectively, and each group was further divided into two equal subgroups according to the setting concentrations of isoflurane vaporizer (Co), which was 1% in groups I1, II1, and III1 and 2% in groups I2, II2, and III2. Isoflurane at different setting concentration was administered under different FGF in the patients after tracheal intubation following anesthesia induction. The systolic blood pressure (SBP), diastolic blood pressure (DBP), main arterial blood pressure (MAP), heart rate (HR) and bispectral index (BIS) were recorded before anesthesia induction and every 3 min after tracheal intubation. Patients given ephedrine and atropine were also recorded. The patients' consciousness during anesthesia were followed up and recorded. The inspiratory concentration (CIiso) and expiratory concentration (CEiso) of isoflurane in the airway were monitored and recorded every 3 min. The observation after intubation lasted for 18 min, during which stimulation of the patients was avoided, and the operation began after the observation.</p><p><b>RESULTS</b>There was a close correlation between BIS and CIiso and between BIS and CEiso (r=-0.904 and -0.893, respectively). The incidence of hypotension was significantly different between groups III and I (P<0.01), and between the subgroups in groups II and I (P<0.05). No bradycardia occurred and no consciousness reported awareness during anesthesia.</p><p><b>CONCLUSIONS</b>Between the completion of tracheal intubation and beginning of the surgery, 1% or 2% Co under a moderate FGF (1-3 L/min) may guarantee the patients' unconsciousness, but hypotension is less likely under a relatively low flow (1-2 L/min) than a higher flow (3 L/min). Higher FGF and Co result in faster induction of deep anesthesia and higher incidence of hypotension.</p>