[Clinical efficacy of Yougui capsules and Wuziyanzong pills on oligoasthenospermia].

OBJECTIVE: To investigate the clinical effects of the Chinese traditional medicine Yougui Capsules and Wuziyanzong Pills on sperm viability and motility in patients with oligoasthenospermia. METHODS: A total of 80 infertile men oligoasthenospermia were equally randomized into a trial and a control group, the former treated with Yougui Capsules at 1.68 g tid, while the latter with Wuziyanzong Pills at 6 g bid, both for a course of 12 weeks. The sperm viability and motility of the patients were detected and compared before and after medication. RESULTS: After 12 weeks of medication, the sperm viability and percentages of grade a and grade a + b sperm were (65.7 +/- 13.1), (22.5 +/- 9.1) and (47.6 +/- 15.8)% in the trial group, significantly higher than (38.1 +/- 11.1), (13.2 +/- 6.8) and (24.1 +/- 10.9)% in the control (P<0.05). What's more, the above three parameters of the two groups were also significantly higher than those before medication, which were (31.9 +/- 16.9), (8.2% +/- 3.7) and (15.7 +/- 13.9)% in the former and (31.7 +/- 17.0), (7.9 +/- 4.5) and (16.9 +/- 13.6)% in the latter (P<0.05). CONCLUSION: Both Yougui Capsules and Wuziyanzong Pills can improve sperm viability and motility in patients with oligoasthenospermia, and the former is even more efficacious than the latter.

Tissue engineering penoplasty with biodegradable scaffold Maxpol-T cografted autologous fibroblasts for small penis syndrome.

In this study, we investigated the safety and efficacy of a poly acid-co-glycolide biodegradable scaffold (Maxpol-T) coated by autologous fibroblasts (AF) for penile girth enlargement in small penis syndrome (SPS). Eighty patients with SPS were enrolled in a clinical study at 2 medical centers; 69 patients completed the study protocol. Scrotal skin was harvested under local anesthesia, and AFs were cultured and seeded on a Maxpol-T scaffold; the cografted scaffold was implanted under the Buck's fascia of penile shaft via a circumcising incision. Patients were followed up at 1, 3, and 6 months to evaluate penile girth changes. Patient satisfaction was assessed via Visual Analogue Scale and scored on the International Index of Erectile Function-5 (IIEF-5). Mean preoperative penile girth in the flaccid and erect state was 8.18 ± 0.83 cm and 10.26 ± 1.22 cm, respectively. At the 6-month postoperative follow-up, mean penile girth in the flaccid and erect state was increased to 12.19 ± 1.27 cm and 13.18 ± 1.31 cm, respectively (P < .001 for change in both flaccid and erect state). Sixty-five patients (94.2%) reported satisfaction with the procedure. Among them, 4 cases (5.8%) were dissatisfied, 7 cases (10.1%) were satisfied, 26 cases (37.7%) were very satisfied, and 32 cases (46.4%) were extremely satisfied. All men maintained IIEF-5 scores of more than 22. Complications included prolonged subcutaneous edema in 3 patients (4.3%) and pinpoint erosion at the suture area in 3 patients (4.3%). Implantation of autologous fibroblasts seeded on a Maxpol-T collagen scaffold holds promise as a safe and novel technique for penile girth enhancement in patients with SPS.

Clinical features and treatment options for Chinese patients with severe primary erectile dysfunction.

OBJECTIVES: To investigate clinical features of Chinese patients with severe primary erectile dysfunction (S-PED) and to identify the ideal treatment options for this population. METHODS: Patients with PED were screened for enrollment in our study. Sexual history, marital status, and erectile function were evaluated by inquiry including International Index of Erectile Function-5. Individuals with severe PED (defined as refractory to management with phosphodiesterase type 5 inhibitor [PDE5i]) underwent serum hormone analysis, penile color duplex Doppler ultrasound, neuroelectromyogram, and cavernosography as appropriate. Long-term treatment results were determined. RESULTS: Among 220 PED patients, 72 (32.7%) suffered from severe PED (PDE5i nonresponse). Mean age was 31.5 +/- 4.5 years and mean duration of attempts at sexual activity was 2.4 +/- 3.2 years, Sixty-eight men (94.5%) had organic etiologies for erectile dysfunction, including arteriogenic (n = 13), venogenic (n = 35), endocrinologic (n = 6), neurologic (n = 9), and cavernosal fibrosis (n = 5). Sixteen men (22.2%) had been divorced. Mean erectile function and quality-of-life were significantly improved (P <.001) in the 25 men (34.7%) who were treated by penile prosthesis implantation, at a mean follow-up of 5.6 years. Satisfaction with penile prosthesis for patients and partner was 93.4% and 92.3%, respectively. CONCLUSIONS: Severe PED has a major impact on young couple's life quality. Venous leak is the most common cause of severe PED. Penile prosthesis implantation is safe and effective for severe PED.

High-flow priapism: superselective cavernous artery embolization with microcoils.

OBJECTIVES: To determine the effectiveness of superselective cavernous artery embolization. METHODS: Eight patients with high-flow priapism were included in this study. All were treated by superselective cavernous artery embolization with microcoils and gelatin sponges. The follow-up examinations consisted of color duplex ultrasonography. The International Index of Erectile Function 5-item questionnaire was used to investigate the patients' erectile function before the onset of priapism, at embolization, and 6 months after embolization. RESULTS: A unilateral cavernous fistula was found in 7 patients and bilateral fistulas in 1. Of the 8 patients, 2 (1 with unilateral and 1 with bilateral fistulas) initially underwent embolization with a gelatin sponge but presented with recurrence of tumescence 1 week after treatment and required a repeat embolization procedure with microcoils. The other 6 patients (75%) were successfully detumescent after embolization with microcoils. The 6 patients (75%) who underwent embolization with microcoils alone had normal erectile function with a mean International Index of Erectile Function score of 22.20 at 6 months after embolization. The 2 patients (25%) who had required repeat embolization had erectile dysfunction, with a mean International Index of Erectile Function score of 13.00. CONCLUSIONS: Superselective cavernous artery embolization with microcoils is a safe and effective treatment of high-flow priapism. The use of microcoils resulted in greater embolization success and preservation of erectile function, especially in the treatment of a unilateral arterial fistula in a young patient.

[The establishment of hypospadias rat model and embryoteratogenic test of Atrazine].

OBJECTIVE: To establish an easily reproducible animal model of hypospadias and to test whether Atrazine can induce hypospadias in animal experiment. METHODS: From the 11th to 16th day after conception, 120 conceived SD rats were divided randomly into 6 groups: one coin oil group (1 ml/kg/d), two finasteride groups (10 mg/kg/d, 20 mg/kg/d), three Atrazine groups (25 mg/kg/d, 100 mg/kg/d, 200 mg/kg/d). When all pregnant rats had delivered, the new born rats were counted and the penis appearance, urethral orifice position and micturition were observed with magnifying lens and anatomy microscope. RESULTS: Hypospadias were found in new born male rats treated prenatally with Finasteride (10 mg/kg/d, 20 mg/kg/d) and 200 mg/kg/d Atrazine groups. The incidence was 28.30%, 67.03%, 10.23% respectively. Embryotoxic effects were observed at 25 mg/kg/d Atrazine group in 2 rats and associated with no severe maternal toxicity. CONCLUSIONS: (1) A hypospadias SD rats model can be established by Finasteride and it is easily reproducible. (2) The Atrazine was teratogenic to the SD rats, embryotoxic effects were observed at the low dose level and associated with no severe maternal toxicity.

[The clinical application of acellular urinary bladder submucosa to reconstructive the urethral duct of hypospadias patients].

OBJECTIVE: Attended to apply the acellular urinary bladder submucosa in the operation of the urethral duct reconstruction of penile hypospadias. METHODS: In 2 cases, the urethral ducts were reconstructed by using the acellular urinary bladder submucosa as dorsal half of the urethra, while the preputial island flap as ventral side. In the other patient, the urethral plate was incised, similar to Snodgrass operation, the matrix was fixed to the corpora cavernosa beneath. RESULTS: Uroflowmetry and the urethroscopy were been performed in the one year follow up. A bell-shaped flow curve was obtained in the patient after urethroplasty using matrix graft combined with a local flap, and no fistula, stricture was found after a year or half a year follow-up. CONCLUSIONS: The freeze-dried acellular urinary bladder submucosa had three-dimensional network structure, and the acellular urinary bladder submucosa graft combined with preputial flap for hypospadias repair provided satisfactory functional results.

[Twice delaying of the expanded flap].

OBJECTIVE: To introduce a new method for enlarging the survival area of an expanded flap. METHODS: After the skin expander was inflated with enough injection, the first delaying was performed. In the operation, two incisions were made in the skin and subcutaneous tissue superficial to the expander capsule on both sides of the long axis of the expanded flap. After 10 to 14 days, the second delaying followed, in which one pedicle was divided to form a unilateral-pedicled, super-long random flap. When the flap was transferred to the recipient Since 2000,this technique has been used in 16 patients. All the area, the door site was closed directly. RESULTS: flaps survived completely. CONCLUSIONS: The technique of twice delaying can enlarge the survival area of the expanded skin flap.

[Autologous buccal mucosal graft pre-transplantation for urethral reconstruction of complicated hypospadias].

OBJECTIVE: Applicate autologous buccal mucosal graft pre-transplantation for urethral reconstruction of complicated hypospadias by staging. METHODS: From 1999 to 2003, 40 patients have been treated by method of autologous buccal mucosal graft pre-placing. There were two models: graft onlay and graft-tube for urethral reconstruction, and the 2rd operation was accomplished half year later. RESULTS: All patients healed without urethral fistula. CONCLUSION: The method is valuable for treatment of complicated hypospadias.

[Clinical application of the fibrous capsule to prevent muscle tendon adhesion].

OBJECTIVE: To observe the effect of fibrous capsule to prevent the flexor tendon adhesion. METHODS: Six bum patients with 33 digits were treated with the fibrous capsule of the expanded flaps which was used to wrap the exposed flexor tendon in zone III in order to prevent the flexor tendon adhesion. RESULTS: From 1999-2001 ,all of the patients were followed up to 1-3 years. The functions, assessed with the TAM method, were excellent in 18 digits, fair in three and poor in one. The excellent and good rate was 87.88%. CONCLUSION: The fibrous capsule could be used to prevent or reduce the tendon adhesion.

[Applications of ultrasound in the treatment of the complications of breast augmentation with polyacrylamide hydrogel injection].

OBJECTIVE: To search for a simple and non-invasive method to assist the treatment of the complications of breast augmentation with polyacrylamide hydrogel injection. METHODS: High-frequency ultrasound was used to examine the breast and observe the distributions of the injected polyacrylamide hydrogel. The operation procedure was predetermined according to the ultrasound information. The ultrasound results were compared with what was seen during the operation. RESULTS: 40 patients (80 breasts) were examined. The ultrasound results were coincident with the outcomes of surgery. The results of postoperative follow-up were coincident with the predicted. CONCLUSION: Ultrasound is an accurate method for examining the augmented breast with polyacrylamide hydrogel injection. It is helpful in predetermining the operation procedure, predicting postoperative results.

[Clinical analysis of 80 cases of breast reconstruction].

OBJECTIVE: To summarize the reasons for the complications after breast reconstruction. METHODS: The reasons for the complications after breast reconstruction were analyzed in flap necrosis, abdominal wall laxity or hernia and seroma. RESULTS: The partial necrosis rate of LDF, TRAM and DIEP was 7.5%, 26% and 14.2% respectively. The total flap necrosis rate in DIEP was 7.1%. In 19 cases using breast prosthesis, the capsular contracture rate was 21%. CONCLUSIONS: The key to reduce the complications is proper selection of an operative method and the indications. The plastic surgeon should be qualified and with better comprehension of the knowledge about breast reconstruction.