[York-Mason procedure for urethrorectal fistula: A report of 10 cases].

OBJECTIVE: To evaluate the effect of the York-Mason procedure (posterior sagittal approach) in the treatment of urethrorectal fistula. METHODS: Ten 15－80 (mean 54) years old male patients with urethrorectal fistula were treated by the York-Mason procedure, 3 by anoplasty for congenital anal atresia, 5 by laparoscopic radical prostatectomy, and the other 2 by radical rectal cancer resection. All the cases were single fistula with a history of 3 months to 18 years. Enterostomy was performed in 6 of the cases before the York-Mason procedure. RESULTS: The York-Mason procedure lasted 90－130 (mean 104) minutes, with no perioperative complications. Nine of the cases were successfully repaired in the first surgery and 1 in the second. The patients were discharged after an average of 7 hospital days postoperatively and followed up for 6－90 months without recurrence. CONCLUSIONS: The York-Mason procedure is a reliable and effective option for the treatment of urethrorectal fistula, with the advantages low morbidity, short operation time and fast recovery.

Reconstruction of massive skin avulsion of the scrota and penis by combined application of dermal regeneration template (Pelnac) and split-thickness skin graft with vacuum-assisted closure: A case report.

BACKGROUND: Although skin avulsions to male external genitalia are rare, they can be both physically and psychologically traumatic. Thus, the necessity for judicious management poses significant challenges to surgeons in order to avoid potential permanent disabilities. We report a case of massive penoscrotal skin avulsion and a composite graft was creatively applied to cover the defect which achieved good results. We believe that this case is of great reference value for fellow surgeons. CASE SUMMARY: A 52-year-old male presented with massive traumatic avulsion of the penile and scrotal skin following mishandling of an electric drill. The avulsed skin was missing. The patient was diagnosed with massive skin avulsion of external genitalia. Following initial complete debridement of devitalized or infected tissues, Pelnac dermal substitute was secured to the defect with the assistance of negative-pressure wound closure. In the final step, the silicone layer of Pelnac was removed and a split-thickness skin graft was applied. The defect had healed at the two-month follow-up. The patient now has normal erections and satisfactory sexual function. CONCLUSION: Our experience with this wound repair demonstrated that the combination of a dermal regeneration template and a split-thickness skin graft with vacuum-assisted closure is a safe, well-tolerated and efficient solution for the reconstruction of massive penoscrotal skin defects.

[Effects of long non-coding RNA-HOTAIR on the cell cycle and invasiveness of prostate cancer].

OBJECTIVE: To investigate the expression of long non-coding RNA-HOTAIR in prostate cancer cells and its effects on the growth and metastasis of the cells. METHODS: Using quantitative reverse-transcription PCR (qRT-PCR), we determined the relative expression of HOTAIR in the normal human prostate epithelial cell line RWPE-I and prostate cancer cell lines PC-3 and DU145. We detected the effects of HOTAIR on the cell cycle and invasiveness of prostate cancer cells by RNA interference, flow cytometry, and Transwell mitration assay. RESULTS: The expressions of HOTAIR in the PC3 and DU145 cells were increased 3.2 and 5.7 times, respectively, as compared with that in the normal RWPE-1 cells. After si-HOTAIR interference, the prostate cancer cells were arrested in the G2 phase and downregulated in the G1 phase. The invasive ability of the prostate cancer cells was evidently inhibited, with the inhibition rates of 32% and 44% of the PC3 cells and 43% and 34% of the DU145 cells for si-HOTAIR1 and si-HOTAIR2, respectively. CONCLUSION: IncRNA HOTAIR is highly expressed in prostate cancer, which is associated with the growth and invasiveness of prostate cancer cells. HOTAIR is potentially a novel marker for the diagnosis and prognosis of prostate cancer.

[Penile necrosis resulting from post-circumcision microwave diathermy: A report of 9 cases].

OBJECTIVE: To investigate the pathogenesis and treatment of penile necrosis resulting from microwave diathermy following circumcision. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

[Efficacy and safety of vardenafil in the treatment of erectile dysfunction: a report of 700 cases].

OBJECTIVE: To evaluate the efficacy and safety of long-term on-demand use of vardenafil in the treatment of erectile dysfunction (ED). METHODS: We conducted a questionnaire investigation among 891 ED patients treated by on-demand use of oral vardenafil at 20 mg every 3 days from March 2007 to January 2010, covering the general information of the patients, their need for and attitudes towards the treatment, clinical efficacy and adverse events of the drug, and satisfaction of the patients and their partners after 12 weeks of treatment. RESULTS: Treatment and follow-up were completed in 700 patients, of whom 504 (72%) achieved sufficient hardness and duration of penile erection and overall sexual satisfaction, 84 (12%) admitted to improvement of erectile hardness and duration but not adequate satisfaction, and the other 112 (16%) experienced no significant changes. Significant differences were found in IIEF-5 scores, Rigiscan test results and partners TSS scores before and after the treatment (P < 0.05). Most frequent adverse events included flushing (15%), dizziness and headache (10%), dyspepsia (3%), and nasal congestion (1%). CONCLUSION: Long-term on-demand use of oral vardenafil, in addition to its safety and good tolerance, can effectively improve the erectile function of ED patients, their success rate of sexual intercourse, and overall quality of sexual life.

[Type V phosphodiesterase inhibitor erection-provoking test with audio-visual sexual stimulation for the diagnosis of erectile dysfunction].

OBJECTIVE: To evaluate the type V phosphodiesterase (PDE-5) inhibitor erection-provoking test with audio-visual sexual stimulation in the diagnosis of erectile dysfunction. METHODS: A total of 853 out-patients diagnosed with erectile dysfunction were divided into an injury and a non-injury group. After scored on IIEF-5 questionnaires, all the patients received oral administration of PDE-5 inhibitors and, 30 minutes later, audio-visual sexual stimulation. The data on penile erection were recorded with Rigiscan Plus. RESULTS: The patients with mild, moderate and severe ED accounted for 18.8, 31.9 and 49.3% in the injury group, and 50.6, 39.8 and 9.6% in the non-injury group, with statistic differences between the two groups in the mild and severe parts (P < 0.05). The rates of conspicuous effectiveness, effectiveness, ineffectiveness and total effectiveness of the combined method were 13.0, 14.5, 72.5 and 27.5% in the injury group, but 55.7, 20.7, 23.6 and 76.4% in the non-injury group, with significant differences (P < 0.05). CONCLUSION: The PDE-5 inhibitor erection-provoking test with audio-visual sexual stimulation is a simple, practical, safe and effective method for the differentiation of organic from psychological erectile dysfunction.

[Deep sarcoma of the penis: a report of 2 cases and review of the literature].

OBJECTIVE: To investigate the clinical characteristics, diagnosis, treatment and prognosis of deep sarcoma of the penis. METHODS: The pathological and clinical data of 2 cases of deep sarcoma of the penis were analyzed retrospectively and the literature reviewed. RESULTS: Both of the cases were treated by total penectomy. Epithelioid angiosarcoma of the penis was confirmed by postoperative pathology in one patient, who died of pulmonary metastasis in the eighth month after the operation; and epithelioid sarcoma of the penis was confirmed in the other, who died of brain metastasis in the second month after the operation. CONCLUSION: Deep sarcoma of the penis is rare but can be diagnosed pathologically. Total penectomy is the main option for its treatment. Node dissection, with poor prognosis, is not recommended unless adenopathy is palpable.

Effect of cocaine on germ cell apoptosis in rats at different ages.

AIM: To investigate the effect of cocaine on apoptosis and caspase-3 activity in germ cells in male rats at different ages. METHODS: Cocaine hydrochloride was given (15 mg/kg body weight s.c.) to male Sprague-Dawley rats of 3 weeks (n = 8), 6 weeks (n = 8) and 12 weeks (n = 8) of age, daily for 28 Days. The serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), testosterone (T) and estrogen (E2) were assayed, and the DNA fragmentation of germ cells was determined by gel eletronphoresis. The cell cycle, apoptosis and caspase-3 activity of germ cells were tested by flow cytometry. RESULTS: After the 28-day cocaine treatment, testes weight of the 3-week-old rats, the testes and body weights of the 6-week-old rats were decreased significantly compared to those of their corresponding controls (P < 0.05). The serum level of T was decreased significantly in the 3-week-old and 6-week-old rats, and the serum level of PRL was also decreased significantly in 12-week-old rats compared to the controls (P < 0.05). In all the three cocaine-treated groups, the isolated DNA displayed a clear ladder pattern, especially in the 6-week old rats. The number of apoptosic germ cells increased significantly in 3- and 6-week-old rats treated with cocaine (P < 0.05). The caspase-3 activity in all three groups increased significantly compared to the controls (P < 0.05), especially in the 6-week-old rats. CONCLUSION: Cocaine exposure for 28 Days leads to significant damage to male gonad and apoptosis elevation in testes of rats of different ages, especially in those of 6 weeks of age. The increase in caspase-3 activity might be a key pathway related to the early stage of apoptosis as the mechanism of cocaine-induced germ cell loss.

[Observation of safety and efficacy of tadalafil for men with erectile dysfunction].

OBJECTIVE: To observe the safety and efficacy of tadalafil in the treatment of erectile dysfunction in clinical research. METHODS: Eighty patients with ED, before and after 20 mg tadalafil administered orally, received respectively the rigiscan examination with aural and visual sexual stimulation at the same time, and then Bphallic circumference variation, stiffness index, duration were compared before and after the treatment. RESULTS: Phallic stiffness index, duration revealed a statistically (P < 0.05) obvious improvement before and after the treatment for all patients. A significant difference (P < 0.01) on the phallic stiffness index, duration were found between the patients with psychogenic ED and others with organic or mixed ED after the treatment. Overall satisfaction with tadalafil was 82.5%. There was an obvious difference on the curative rates between the patients with psychogenic ED (92.3%) and others with organic ED (68.7%) or mixed ED (58.3%). All adverse events (11 cases of headache and dizziness, 8 cases of digestive canal unwell, 5 cases of flushing, 2 cases of back muscle pain) associated with tadalafil were mild and recovered without any treatment. CONCLUSION: Tadalafil improves erectile function significantly in most patients. Adverse reactions are generally transient and mild to moderate in nature.