Modified Y-V plasty based on MRU evaluation for iatrogenic bladder outlet obliteration: a multicentre experience in China.

PURPOSE: To compare the diagnostic ability of traditional radiographic urethrography and magnetic resonance urethrography (MRU) for iatrogenic bladder outlet obliteration (BOO), and explore the efficacy and complications of laparoscopic modified Y-V plasty for patients selected based on MRU evaluation. METHODS: 31 patients with obliteration segments ≤ 2 cm and no false passages or diverticula based on MRU evaluation from eight centers in China were included. Obliteration segments were measured preoperatively by MRU and conventional RUG/VCUG and compared with intra-operative measurements. Surgical effects were evaluated by uroflow rates, urethrography, or cystoscopy at 1, 3, 6, and 12 months post-operation and then every 12 months. Postoperative urinary continence was assessed by 24-h urine leakage (g/day). RESULTS: The results showed that MRU measured the length of obliteration more accurately than RUG/VCUG (MRU 0.91 ± 0.23 cm, RUG/VCUG 1.72 ± 1.08 cm, Actual length 0.96 ± 0.36 cm, p < 0.001), and clearly detected false passages and diverticula. Laparoscopic Y-V plasty was modified by incisions at 5 and 7 o'clock positions and double-layer suture with barbed sutures. All operations were successfully completed within a median time of 75 (62-192) minutes and without any complications. Urethral patency and urinary continence rates were 90.3% (28/31) and 87.1% (27/31), respectively. Three recurrences were cured by direct visual internal urethrotomy. Four patients had stress urinary incontinence after catheter removal 14 days post-operation, with urine leakage of 80-120 g/day, not relieved during follow-up. CONCLUSIONS: Laparoscopic modified Y-V plasty based on MRU evaluation is a promising approach for iatrogenic BOO, with a high patency rate and a low incontinence rate.

Anterior substitutional urethroplasty using a biomimetic poly-l-lactide nanofiber membrane: Preclinical and clinical outcomes.

The aim of this study is to investigate the feasibility and efficacy of a novel biomimetic poly-l-lactide (PLLA) nanofiber membrane in repairing anterior urethral strictures from both preclinic and clinic. Biomimetic PLLA membrane was fabricated layer by layer according to the structure of human extracellular matrix. Microstructure, tensile strength, and suture retention strength were fully assessed. Before the clinical application, the safety and toxicology test of the biomimetic PLLA membrane was performed in vitro and in experimental animals. The patients underwent urethroplasty used dorsal onlay or lateral onlay technique. Then, they were followed up for 1 month, 3 months, 6 months, and then annually after the surgery. The mechanical experiments showed well property for application. Biomimetic PLLA membrane was safe according to the in vitro and animal studies. Then, a total of 25 patients (mean age 48.96 years) were included in the study from September 2016 to December 2018. After a mean follow-up of 33.56 months, 20 patients successfully treated with biomimetic PLLA membrane. Five patients (2 bulbar and 3 penile) suffered postoperational urethral stricture recurrence. None of infection or urinary fistula or any other adverse events related to the use of biomimetic PLLA membrane were observed during the follow-up period for all patients. The preliminary result confirmed the feasibility and efficacy of the biomimetic PLLA membrane as a novel material for anterior urethral repair. The long-term effects with more patients should be investigated in further studies.

Streptozotocin-induced diabetes causes upregulation of serotonin (5-HT)2A/C receptors in lumbosacral cord motoneurons and down regulation of serotonergic paraneurons in the urethra.

Lower urinary tract (LUT) dysfunction is the most common complication of diabetes mellitus (DM). An involvement of the 5-HT2A receptor in spinal micturition control has been demonstrated in urethane anaesthetized DM rats in which i.v. administration of the 5-HT2A/2C receptor agonist 2,5-methoxy-4-iodoamphetamine (DOI), stimulated high frequency oscillations (HFOs) and improved micturition. However, the mechanisms involved in these effects are not completely understood. The present work showed that 5-HT2A and -2C receptors were upregulated in lumbosacral cord motoneurons, and the number of serotonergic paraneurons were downregulated in the urethra in DM group. The importance of the downregulation of urethral paraneurons in DM remains to be elucidated but may be related to the reduced urethral sensation caused by the disease. We suggest that targets of 5-HT receptor agonists for improvement of voiding function may be found both in the LUT and lumbosacral spinal cord.

The serotonin (5-hydroxytryptamine) 5-HT7 receptor is up-regulated in Onuf's nucleus in rats with chronic spinal cord injury.

OBJECTIVES: To examine the effect of intrathecal (i.t.) serotonin (5-hydroxytryptamine) 5-HT7 agonist administration on voiding function in the urethane-anesthetised rat, and the change in 5-HT7 receptor (5-HT7 R) expression in the lumbosacral cord Onuf's nucleus after spinal cord injury (SCI). MATERIALS AND METHODS: In all, 32 female Sprague-Dawley (SD) rats were equally divided into a spinally intact (SI) group and SCI group (n = 16 each). At 8 weeks after transection, half of the rats underwent continuous cystometry under urethane anaesthesia, and the 5-HT7 R-selective agonist LP44 was given (i.t.). The remaining rats were used for pseudorabies (PRV) retrograde tracing, immunofluorescence, and Western Blot. RESULTS: LP44 administered i.t. had no effect in the SI rats. In SCI rats, LP44 (1-30 µg/kg) induced significant dose-dependent increases in micturition volume, voiding efficiency, number of high-frequency oscillations per micturition; and decreases in residual volume, bladder capacity, peak bladder pressure, threshold pressure and non-voiding contractions. The 5-HT7 R antagonist, SB-269970 (10 µg/kg), partially reversed LP44-induced changes. Using PRV retrograde tracing and immunofluorescence, 5-HT7 Rs were found in the L6-S1 spinal cord Onuf's nucleus in both SI and SCI rats, but the expression was significantly greater in the SCI rats. Western blot showed significantly more 5-HT7 Rs in the ventral L6-S1 spinal cord in SCI rats. CONCLUSION: A 5-HT7 R agonist, given i.t., improved voiding efficiency in urethane-anesthetised SCI rats, and the 5-HT7 R was significantly up-regulated in the lumbosacral cord Onuf's nucleus. If valid for humans, these findings suggest that the 5-HT7 R could be a target for therapeutic interventions.

Effect of 5-HT2A receptor antagonist ketanserin on micturition in male rats.

OBJECTIVES: This study aimed to investigate the effects of ketanserin on micturition mediated via the 5-HT2A receptor in the motoneuron nucleus of the Lumbosacral cord, as reflected in high frequency oscillations (HFOs) of intravesical pressure and the external urethral sphincter electromyogram (EUS-EMG) in anesthetized male rats. METHODS：: Male Sprague-Dawley rats were used. Cystometry and EUS-EMG were performed in all rats under urethane anesthesia to examine the variations after successive intrathecal (i.t.) administration of various doses of ketanserin into the lumbosacral cord. Immunofluorescence staining and Western blotting were made to observe the distribution of 5-HT2 A and -2C receptors in the lumbosacral cord motor neurons. RESULTS: Compared to the controls, ketanserin-treated rats showed a declined trend of dose-dependent manner in the HFOs, in accordance with the variation of EUS-EMG, while decreased micturition volume, voiding efficiency, and increased post-void residual volume was only observed at the dose of 0.1 mg/kg. The effects of ketanserin on the HFO and EUS-EMG activity were partially or completely reversed by the 5-HT2A/2C receptor agonist, DOI. Meanwhile, immunofluorescence staining and Western blot analysis showed that immunoreactivity of 5-HT2A receptor was higher than that of 5-HT2C, labeling in the lumbosacral cord motoneurons. CONCLUSIONS: The intrathecally administrated 5-HT2A receptor antagonist ketanserin can weaken the EUS bursting activity, decrease HFOs, and reduce voiding efficiency as dose dependently. The effects of ketanserin on micturition may be mainly mediated via the 5-HT2A receptors in the motoneuron nucleus of the lumbosacral cord.

Efficacy of different spinal nerve roots for neuromodulation of micturition reflex in rats.

Electrical stimulation of peripheral nerves controlling the bladder is an alternative, nondestructive medical treatment for urinary incontinence and retention. In this study, we aimed to identify the most efficient sensory and motor spinal nerve roots involved in the micturition reflex. Unilateral L5-S2 dorsal and ventral roots were electrically stimulated, and bladder reflex contractions were recorded under isovolumetric conditions. Repeated stimulation of the L6 and S1 dorsal roots not only abolished bladder reflex contractions but also induced a poststimulation inhibitory effect, whereas repeated stimulation of the L5 and S2 dorsal roots had no effect. Only the L6 ventral root directly caused bladder contraction when ventral roots L5-S2 were stimulated in sequence. Upon retrograde tracing using pseudorabies virus (PRV), the sacral parasympathetic nucleus of the L6 segment had more PRV-positive cells than the other segments, though the S1 segment of the dorsal root ganglia had the highest density of PRV-positive neurons. These results suggest the L6 ventral root is most efficient in producing detrusor muscle contraction, and the S1 dorsal root best inhibits the micturition reflex.

Chronic spinal cord injury causes upregulation of serotonin (5-HT)2A and 5-HT2C receptors in lumbosacral cord motoneurons.

OBJECTIVES: To investigate whether the voiding dysfunction caused by spinal cord injury (SCI) in rats can be improved by i.v. administration of the serotonin (5-HT)2A/2C receptor agonist 2,5-dimethoxy-4-iodophenyl-2-aminopropanehydrochloride (DOI), and to discuss whether the mechanism can be ascribed to 5-HT2A and 5-HT 2C receptor upregulation in lumbosacral cord motoneurons. MATERIALS AND METHODS: Female Sprague-Dawley rats were divided into two groups (SCI group vs normal control [NC] group). Under urethane anaesthesia, cystometry was performed to examine the variation in urodynamic variables before and after successive intrathecal (i.t.) administration of various doses of DOI into the lumbosacral cord. Changes in 5-HT2A and -2C receptors in the lumbosacral cord were also investigated using immunohistochemical staining and Western blot analysis. RESULTS: Compared with NC rats, the SCI rats had higher bladder capacity and post-void residual urine volume, and lower voiding efficiency. After SCI, DOI improved voiding efficiency, probably via external urethral sphincter (EUS) activity. Immunohistochemical staining and Western blot analysis showed that 5-HT2A and -2C receptors were upregulated in lumbosacral cord motoneurons. CONCLUSION: In rats with SCI, DOI can improve voiding efficiency; this may be attributable to 5-HT2A and -2C receptor upregulation in lumbosacral cord motoneurons controlling EUS activity.

Is repeat Botulinum Toxin A injection valuable for neurogenic detrusor overactivity-A systematic review and meta-analysis.

AIM: To investigate the value of repeat botulinum toxin A (BTX-A) injections in patients with neurogenic detrusor overactivity (NDO). METHODS: We searched the PubMed, EMBASE, and EBSCO databases for articles published until June 2016. Studies that reported the efficacy and safety of repeat BTX-A injections for adult patients with NDO were eligible. The effect size for each outcome was calculated as the standardized mean difference ± standard error and 95% confidence interval, and was graded as small, >0.2; moderate, >0.5; or large, >0.8. The outcomes included maximum cystometric capacity (MCC), maximum detrusor pressure (MDP), reflex volume (RV), bladder compliance (BC), quality of life (QOL), and injection interval. Descriptive reviews were performed for urinary incontinence (UI) and adverse events (AEs). RESULTS: Eighteen studies involving 1533 patients whose level of evidence ranged from 3 to 4 were included in this study. We noted non-significant changes in MCC, MDP, RV, and BC between the first and last injections. Patients who had received ≤4 injections were found to have stable QOL improvements after the first and last injections, whereas patients who had received ≥5 injections were found to have a significant decrease in QOL after the last injection. No significant differences in injection intervals were noted after repeat BTX-A injections, and the repeat injection failure rate was low. CONCLUSION: Our study demonstrated that repeat BTX-A injections allow sustained improvements in patients with NDO. The rate of AEs was stable and low. However, additional high-quality, large-scale, and long-term trials are necessary to establish the efficacy and safety of ≥5 repeat BTX-A injections.

The Characteristics of the Transitional Zone in Prostate Growth With Age.

OBJECTIVE: To investigate the age-related growth variation in prostatic parameters by transrectal ultrasound with a simultaneous evaluation of the transitional zone measurements in different prostate volumes. METHODS: A retrospective study of 2001 subjects derived from the outpatient clinic at our institution (Shanghai Jiao Tong University Affiliated Sixth People's Hospital in Shanghai) who were diagnosed with benign prostatic hyperplasia (BPH) and prostatitis was reviewed. All subjects were evaluated by the International Prostatic Symptom Score and transrectal ultrasound of the prostate. Statistical analysis was conducted between prostatic parameters and age. RESULTS: The prostate volume, index, length, and width of transitional zone were the parameters most closely associated with increasing age. Notably, the transitional zone measurements showed a significant difference among individuals greater than 50 years old. Moreover, the fastest increasing rate of prostatic parameters was found to be between the ages of 50 and 69. Additionally, we also discovered that the difference between transitional zone parameters and different prostate volumes varies along with increasing age. CONCLUSION: These results suggest that transitional zone growth is the main contributor to total prostate growth, especially at the ages of 50-69, which may elucidate the higher incidence of the lower urinary tract symptoms from BPH. In view of the increasing rate of transitional zone and the level of total prostate volume, further research is needed to identify the underlying mechanism for such differences in prostate growth.

The RevoLix(™) 2 µm Continuous Wave Laser Vaporesection for the Treatment of Benign Prostatic Hyperplasia: Five-Year Follow-Up.

OBJECTIVE: The purpose of this study was to evaluate the long-term efficacy and safety of laser vaporesection using the RevoLix(™) 70 W 2 µm continuous wave (CW) laser in the treatment of benign prostatic hyperplasia (BPH). BACKGROUND DATA: From January 2008 to December 2008, 162 patients with BPH underwent vaporesection using 2 µm CW laser. MATERIALS AND METHODS: The International Prostate Symptom Score (IPSS), quality of life (QoL), urinary flow rate (Qmax), post-voiding residual urine volume (PVR), and postoperative complications were observed at baseline and were followed at 3-, 6-, and 12-month intervals (range: 3-60 months). RESULTS: A total of 146 patients completed the 5-year follow-up. At 60 months postoperatively, the mean Qmax increased from 7.5 to 21.2 mL/sec, the mean PVR decreased from 94.3 to 9.4 mL, the mean IPSS score decreased from 20.4 to 6.6, and the mean QoL score decreased from 4.7 to 1.9. Complications included urinary tract infection (3.4%), urethral stricture rate (2.7%), and recurrent bladder outlet obstruction rate (2.1%). Overall, the reoperation rate was 3.4%, and no transurethral resection (TUR) syndrome or blood transfusion was reported. CONCLUSIONS: The 2 µm CW laser is a safe and effective option for the treatment of BPH. At the 5-year follow-up, the long-term clinical efficacy and safety are excellent, with low incidence of complications.

Two Micrometer Continuous-Wave Thulium Laser Treating Primary Non-Muscle-Invasive Bladder Cancer: Is It Feasible? A Randomized Prospective Study.

BACKGROUND AND OBJECTIVE: Until now, various laser types have been used in the treatment of bladder cancer. The purpose of this study is to evaluate the feasibility and effectiveness of 2 µm continuous-wave (CW) thulium laser in treating primary non-muscle-invasive bladder cancer (NMIBC). METHODS: A comparative (randomized prospective) interventional study was conducted in our center. A total of 400 patients with Ta or T1 bladder cancer were enrolled and randomized to transurethral resection of bladder tumor (TURBT) or laser vaporesection (LVRBT). Patients in the TURBT group received standard transurethral resection with a bipolar electrocautery system, while those in the LVRBT group received transurethral vaporesction with a 2 µm CW thulium laser. All patients received intravesical irrigation with sterile water for at least 12 h immediately after the procedure. The end-points of this study were tumor recurrence and/or progression, or the completion of 36 months of follow-up (10 cystoscopies) with no recurrence. RESULTS: A total of 292 patients were included in our analysis, of whom 143 received TURBT and 149 received LVRBT. During 36 months of follow-up, 129 cases (44.2%) had recurrence: 61 (42.7%) in the TURBT group and 68 (45.6%) in the LVRBT group (p = 0.608). Tumor progression was found in 19 patients (6.5%): 11 in the TURBT (7.7%) and 8 (5.4%) in the LVRBT group (p = 0.421). Median tumor-free survival was 25.2 months (25.46 in the TURBT group vs. 24.9 in the LVRBT group, p = 0.729). Overall recurrence rate was 14.7%, 42.1%, and 62.5% in the low, intermediate low, and intermediate high risk subgroups, respectively. Operation time was significantly lower in the TURBT than in the LVRBT group (28.43 vs. 31.5 min, p = 0.044). CONCLUSIONS: Use of a 2 µm CW thulium laser is feasible and effective in treating primary NMIBC. With a cystoscopic biopsy of the bladder muscle, 2 µm CW thulium laser could retrieve sufficient diagnostic and prognostic specimens.

Serotonin (5-HT)2A/2C receptor agonist (2,5-dimethoxy-4-idophenyl)-2-aminopropane hydrochloride (DOI) improves voiding efficiency in the diabetic rat.

OBJECTIVES: To examine the effects of the serotonin (5-HT)2A/2C receptor agonist (2,5-dimethoxy-4-idophenyl)-2-aminopropane hydrochloride (DOI) on micturition in rats with diabetes mellitus (DM). METHODS: Female Sprague-Dawley rats (n = 16) were divided into two groups: rats with Type 1 DM and age-matched control rats. DM was induced by i.p. injection of streptozotocin (65 mg/kg) and detailed cystometrogram (CMG) studies were performed 8 weeks post-injection in all rats under urethane anaesthesia. The selective 5-HT2A antagonist ketanserin was administered after each DOI dose-response curve was plotted. All drugs were administered i.v. RESULTS: Compared with controls, comprehensive urodynamic studies showed that DM rats had a higher bladder capacity and post-void residual urine volume (PVR), and a markedly lower voiding efficiency. In DM rats, DOI (0.01-0.3 mg/kg) induced significant dose-dependent increases in micturition volume and reductions in PVR, resulting in greater voiding efficiency. CMG measurements showed a dose-dependent increase in high-frequency oscillation (HFO) activity, evidenced by an increased duration of HFOs per voiding. This correlated with the improved voiding efficiency. Ketanserin (0.1 mg/kg) partially or completely reversed the DOI-induced changes. CONCLUSIONS: The HFOs observed in the present study seem to correlate with external urethral sphincter bursting activity during voiding. Bladder voiding efficiency was reduced in DM rats. The 5-HT2A receptor agonist can enhance HFO activity and improves voiding efficiency, and so may represent a new strategy to improve voiding efficiency after DM in experimental studies.

The RevoLix 2 micron continuous wave laser vaporesection for the treatment of high-risk patients with benign prostatic hyperplasia.

OBJECTIVE: To evaluate the safety and efficacy of the RevoLix 70W 2 micron continuous wave laser vaporesection in the treatment of high-risk patients with benign prostatic hyperplasia (BPH). BACKGROUND DATA: Forty-six high-risk patients (mean age, 82.6 y old) with BPH underwent 2-µm continuous wave laser vaporesection. MATERIALS AND METHODS: The operative time, drop in hemoglobin, drop in serum sodium, indwelling catheterization time, operative complications, international prostatic symptom scores (IPSS), quality of life (QoL), urinary flow rate (Qmax), and post voiding residual urine volume (PVR) were observed. RESULTS: All 46 patients recovered without incident. The mean operative time was 68 ± 16.3 min. Occasional venous hemorrhage occurred during the operation, but no arterial hemorrhage was observed. Hemoglobin decreased from preoperative 15.0 g/dL to postoperative 14.3 g/dL, serum sodium decreased from preoperative 142.4 mmol/L to postoperative 141.6 mmol/L. IPSS decreased from preoperative 22 ± 6.2 to postoperative 9 ± 3.3, QoL scores decreased from 5.1 ± 0.7 to 2.1 ± 0.7, Qmax increased from 8.4 ± 5.2 to 21.2 ± 12.3 mL/sec, PVR decreased from 94.2 ± 60.2 to 21.6 ± 6.4 mL. The parameters were significantly different between pre- and postoperative results. CONCLUSIONS: The RevoLix 70W 2-µm continuous wave laser vaporesection is safe and effective in the treatment of high-risk patients with BPH.

Treatment of urethral strictures using lingual mucosas urethroplasty: experience of 92 cases.

BACKGROUND: Urethroplasty of complex urethral stricture is a difficult procedure, and there is no widely accepted standard approach described in the published literature. We evaluated the efficacy and safety of urethroplasty using lingual mucosa grafts (LMGs) for the repair of urethral strictures. METHODS: Between August 2006 and April 2009, 92 cases of urethral strictures (length ranging from 2.5 cm to 18 cm, mean 6.5 cm) were treated using LMGs. Of the 92 patients, 38 with long-segment urethral strictures (9 - 18 cm) underwent dual LMG or LMG combined with foreskin flap or buccal mucosal graft urethroplasty. RESULTS: Follow-up was obtained for 3 - 33 months (mean 17.2 months) postoperatively. Complications occurred in 8 patients, including urinary fistulas in 4 patients; recurrent strictures developed in 4 patients at 3 - 4 months post-operatively. The remaining patients voided well postoperatively, with peak flows between 14.3 ml/s and 54.6 ml/s (mean 28.4 ml/s). CONCLUSIONS: The tongue is an excellent source of graft material for the repair of anterior mucosal strictures. Dual LMG substitution urethroplasty can successfully treat longer, more complex urethral strictures.

Oral mucosal grafts urethroplasty for the treatment of long segmented anterior urethral strictures.

OBJECTIVE: To evaluate the efficacy and safety of using oral mucosal grafts for urethroplasty in the treatment of complex segmented urethral strictures. METHODS: Between January 2002 and January 2008, 25 cases of long or multi-segmented urethral strictures (10-18 cm, mean 11.72) were treated using combined two oral mucosal graft urethroplasty. Of the 25 patients, combined double buccal mucosal graft (BMG) urethroplasty was performed in nine patients, double lingual mucosal graft (LMG) urethroplasty in seven patients and combined lingual and buccal mucosal graft urethroplasty in nine patients. RESULTS: Follow-up was obtained for 6-72 months (mean 26.83) post-operatively. Urethrocutaneous fistulas developed in two patients. Urethral strictures developed in one patient undergoing BMG urethroplasty; the patient underwent five urethral dilations, after which he voided well with a urinary peak flow of 26.4 ml/s. Meatal stenosis developed in one patient undergoing LMG and a second operation was required, after which the patient voided well (urinary peak flow of 28.7 ml/s). The other patients voided well and urinary peak flow rates ranged from 16.8 to 49.2 ml/s (mean 28.65 ml/s). CONCLUSION: Combined two oral mucosal grafts substitution urethroplasty is an effective technique for the treatment of long, segmented urethral strictures.

Ileal ureteric replacement with an ileo-psoas muscle tunnel antirefluxing technique for the treatment of long segment ureteric strictures.

OBJECTIVES: To develop and report our initial experience with a novel antirefluxing technique for segmental ileal ureteric replacement for the treatment of long ureteric strictures. PATIENTS AND METHODS: Between January 2000 and January 2007, 12 cases of ureteric strictures (nine bilateral and three unilateral) were treated using a novel surgical technique in which the ureter was replaced with a segment of ileum using an end-to-side anastomosis. An antireflux valve was constructed by fixing the distal part of upper ureter (4 cm) between the psoas muscle and ileal segment (the ileo-psoas tunnel technique). The distal ileum was connected to the urinary bladder with an end-to-side anastomosis. RESULTS: The 12 cases were followed-up for a mean (range) of 39.42 (12-64) months. There were no cases of pyelonephritis or signs of renal failure after surgery. There was dramatic improvement in hydronephrosis, as assessed by intravenous urography, in the 4-9 months after surgery. Cystography showed no evidence of ileo-ureteric reflux. Mild hyperchloraemic acidosis was detected in two patients and was successfully treated with oral alkalization. CONCLUSIONS: In our initial experience, ileal ureteric replacement combined with the ileo-psoas tunnel antirefluxing technique is a highly effective procedure for the treatment of ureteric strictures.

[Adrenal myelolipoma:clinical diagnosis and management of 26 cases].

OBJECTIVE: To evaluate the diagnosis and management of adrenal myelolipoma. METHODS: The clinical data of 26 cases were analyzed retrospectively and the selected articles were reviewed. There were no specific clinical symptom and endocrine abnormality, except increasing catecholamine in 2 cases. All cases but two were diagnosed by B-model ultrasound scanning (B-US), CT or magnetic resonance imaging (MRI). RESULTS: Twenty-six cases were surgically treated, the diameter of the tumor was 5 - 10 cm, simple tumor resection was performed in 16 cases, and complete adrenal resection was performed in 10 cases. All the operated cases were proved by pathologists. The duration of follow-up was from 6 - 28 months after surgery. No recurrence was observed. CONCLUSIONS: The diagnosis of adrenal myelolipoma could be established based on B-US, CT or MRI. The tumors whose diameter is larger than 5 cm in size should be removed.

[One-stage urethroplasty using colonic mucosa in the treatment of complex lengthy urethral stricture].

OBJECTIVE: To investigate the feasibility of urethral reconstruction with colonic mucosa graft in the treatment of complex lengthy urethral stricture. METHODS: Between October 2000 and May 2003, 19 male patients with complex lengthy urethral stricture that had undergone unsuccessful urethral repair 3 times on average, aged 18 - 65, were treated with free graft of colonic mucosa 10 to 17 cm (mean 13.2 cm) long. The patients were followed-up for 6 - 36 months (17 months on average) by retrograde urethrography, urethroscopy, and uroflometry. RESULTS: Meatal stenosis that needed reoperation was developed in 1 patient 3 months postoperatively. This patient became voiding very well with a urinary peak flow of 28.7 ml per second during the follow-up of 12 months after the second operation. Hyperplasia of verumontanum was observed during urethroscopy in 1 patient 14 months postoperatively. Uroflometry examination showed a urinary peak flow of 46.5 ml/s after transurethral colliculectomy. The other 17 patients were voiding well with a urinary peak flow greater than 15 ml/s (16 to 28.5 ml/s). CONCLUSION: Colonic mucosa graft urethroplasty is a feasible procedure for the treatment of complex lengthy urethral stricture, particularly when the more conventional options fail or are contraindicated.