The Study Of Anatomy And Clinical Trial On The Reconstruction Of Male Urethra

The reconstruction of the male urethra is a difficult problem in today's urology. Although the treatments of posttraumatic posterior urethral stricture and hypospadias have obtained significant advancements, the controversies and complications after repair still occur, and sometimes they need several operations to repair completely. Consequently, the anatomical and clinical studies on the repair of the urethral defects are urgent, and necessary. For this aim, the purposes of the present thesis are: (l)To elucidate the relationship between the membranous, prostatic apex urethra and the cavernous nerves, urethral rhabdosphincter, and reveal the important anatomical structures around the membranous urethra. (2)To demonstrate whether the mechanisms of continence and potency could be damaged by the surgical approaches via perineum and inferior pubectomy, and to seek the operative techniques to avoid or reduce the damnification. (3)To uncover the blood supplies to the glans penis and the anterior urethra, and the innervations to the penis glans, with which to provide the theoretical foundations for the glanoplasty and urethral mobilizations. (4) To illustrate the anatomical basis and the development techniques of dartos-pedicled scrotal and penile skin flaps. (5) To apply the productions of anatomical studies to the clinical treatments, and observe the results.Materials and Methods1. Fifteen formalin marinated and three fresh adult cadavers were used. The tissues were dissected until the membranous and prostatic apex urethra appeared via the approach of perineum and inferior pubectomy. The membranous urethra, prostate apex and their accompanying structures were observed and measured. The operations of repair the urethra were simulatedthrough the perineum and inferior pubectomy approach, and the operative techniques, which could be used to avoid or reduce the damnification, were found out.2. Nine formalin marinated and three fresh adult penis were used to trace and observe the dorsal artery and dorsal never of the penis along the penile shaft to the glans penis after removing the penile skin and dartos layers.3. The arteries supplying the anterior urethra were dissected using nine formalin marinated adult cadavers. Urethral mobilization from corona to the membranous urethra was performed on one fresh cadaver, and from bulbar urethra to the corona on two fresh cadavers.4. The layers and blood supplies of the penis and scrotum were observed on 15 formalin marinated adult specimens, and the developments of dartos-pedicled penile and scrotal skin flaps were simulated on three fresh cadavers.5. The clinical applications of the surgical approaches: repairs of the posttraumatic posterior urethral strictures were carried out on 12 cases via the perineal route solely, and on 4 cases through the combining perineal approach with inferior pubectomy. 9 cases were performed end-to-end anastomosis, and 5 cases were performed urethroplasty with the dartos-pedicled scrotal septum skin flaps.6. The clinical usages of the dartos-pedicled penile and scrotal skin flaps: 1-stage dartos-pedicled penile skin flap urethroplasty was carried out for 19 hypospadias penis with severe chordee. Dartos-pedicled scrotal septum skin flap onlay urethroplasty was performed in 11 cases with complicated urethral stricture after the hypospadia repair. Nine cases with repeated urethrocutaneous fistula after hypospadias repair were managed with a vascularized dartos flap to cover the urethroplastied urethra. One case of posttraumatic long urethral defect was reconstructed with combined dartos-pedicle scrotal and penile skin flap urethroplasty.Results1. The line between the two lowest edges of the pubic tupercles is equal to the middle point of the base-apex span of the prostate, and the symphysial arc to the posterior part of the membranous urethra.2. The dorsal artery of the penis, which protruded back with a shape of arc, coursed the base of the penis laterally to the anterior me...