| Part ?ObjectiveTo test the biomechanical properties of the scrotal musculocutaneous dartos flap(SMDF).And to study the histological and cellular basis of biomechanical differences in different tissues to lay the foundation for the construction of functional urethra.MethodsThere are 43 tissue specimens provided:25 SMDFs,10 foreskin flaps,and 8 skin flaps.The biomechanical properties of these specimens are measured.Hematoxylin and Eosin(HE)staining,Masson staining and immunohistochemistry technique are adopted to evaluate the histological differences of these tissues.Traction force microscopy is used to measure the mechanical data of smooth muscle cells to understand the cellular basis of their mechanical properties.ResultsThe stress-strain curves,stress-relaxation curves and creep curves are fitted.The ANOVA test shows that the stress-strain,stress-relaxation and creep properties of the scrotal musculocutaneous dartos flap are better than others(p<0.05).The results of HE staining,Masson staining and immunohistochemistry show that the scrotal musculocutaneous dartos flap has abundant smooth muscle tissue.The traction force of a single smooth muscle cell is about 300Pa.Conclusion1)The elasticity and viscoelasticity of SMDF are better than the foreskin and normal skin.2)Smooth muscle tissue is the histological basis of its properties.3)A single smooth muscle cell can provide a force of about 300Pa.4)Macroscopically,SMDF is a functional tissue flap and can be used to reconstruct the function urethral.Part ?ObjectiveTo evaluate the outcomes of SMDF applied in urethral-defected diseases.And to analysis methods to analyze clinical data to find risk factors that affect the success rate.MethodsAll patients are diagnosed as urethral-defected diseases and treated between January 2010 and December 2019.Patients of the treatment group were treated by SMDF and the control group by the preputial flap.Evaluation methods include externalia appearance,HOSE,urination statue,urine flow rate.ResultsAs for adult patients,the complication rate of the treatment group is 22.0%,lower than the control group(p=0.025).The treatment method(OR=3.74,p=0.046)and nutrition status(OR=3.86,p=0.030)are two independent high-risk factors.The complication rate of the treatment group is also lower in survival analysis(p=0.034).The median of HOSE score was 15(IQR=13-15)in the treatment group and 13(IQR=11-14)in the control group(p=0.007).The multivariant analysis according to the good therapeutic result shows that the treatment method(OR=4.50,p=0.006)is the only factor that affects the result.In the treatment group,the maximum urine flow rate is 13.04±1.53ml/s,and 12.12±1.86ml/s in the control group(p=0.032);the average urine flow rate is 5.87±0.76ml/s and 5.41±1.00ml/s(p=0.04),respectively.The operation time is respectively 126.80±16.24min and 127.54±16.19min(p=0.842).As for juvenile patients,the complication rate is 24.2%in the treatment group and 16.7%in the control group(p=0.183).In the treatment group,the median of HOSE score is 14(IQR=13-16),and in the control group,it was 12.5(IQR=10-15,p=0.046).In the multivariant analysis according to the good therapeutic result,the treatment method is the only factor(OR=8.32,p=0.006).The maximum urine flow rate is 12.69±2.02ml/s in the treatment group,and 12.83±2.27ml/s in the control group;the average urine flow rate is 7.05±1.38ml/s and 6.51±2.20ml/s,respectively(p=0.416).The length of operative time in the treatment group is 134.90±15.94min,and 129.78±18.34min in the control group(p=0.269).Conclusion1)As for adult patients,the treatment group has better outcomes,including lower complication rate,higher HOSE score and better urine flow rate.2)Nutrition status is a high-risk factor of complications in adults.3)In the juvenile group,the treatment group has no statistical difference in complication rate compared with the control group,but its HOSE score is higher.4)Using SMDF will not significantly prolong the operation time. |
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