Atlas of the Urologic Clinics of North America

Prostatomembranous urethral disruption and distraction are associated with pelvic fractures in approximately 10% of pelvic fractures. The transmission of shearing forces through the bony pelvis to the membranous urethra results in an avulsion injury at this level that typically results in a defect of varying length, occurring somewhere between the prostatic apex and the departure of the bulbous urethra (Fig. 1). This injury may also occasionally disrupt the prostatic urethra and bladder neck in prepubertal males but is seldom seen in adults. The striated urethral sphincter was previously felt to be invertably damaged in these injuries; however, in many cases, the injury appears distal to the sphincter. The adjacent neurovascular bundles (and erectile function) may also be jeopardized by this injury.

Daniel Rosenstein

Gerald H Jordan

Atlas of the Urologic Clinics

The perineal approach to membranous urethral distraction injuries

经会阴途径治疗膜部尿道损伤

This issue of the Atlas of the Urologic Clinics is a comprehensive assessment of urethral and genital reconstruction. It includes a broad range of topics, addressing congenital and traumatic subjects, in addition to those conditions related to aging. Although it is unlikely that all urologists will perform each of the procedures described, it is expected that most urologists will benefit from the review of these procedures and will apply the principles in their other surgical procedures related to the genitourinary tract.

Martin I. Resnick

Genital and pelvic reconstructive surgery

生殖器与盆腔重建手术

Based on success and superior cosmetic results for repair of distal and middle-level hypospadias defects, the tubularized incised plate (TIP) urethroplasty has gained popularity for use in proximal hypospadias [1–3]. The purpose of this article is to describe the authors' technique for TIP urethroplasty for repair of proximal hypospadias.

Joseph G Borer

Alan B Retik

Tubularized incised plate urethroplasty for repair of proximal hypospadias

管状切开板尿道成形术修复近端尿道下裂

Currently, the AMS 800 artificial urinary sphincter (AUS) is the “gold standard” for the treatment of urinary incontinence in men, particularly following radical prostatectomy. Excellent continence rates are usually achieved, and patient satisfaction is high [1]. There are times, however, when it is necessary to revise an existing AUS cuff (eg, for recurrent incontinence secondary to subcuff atrophy) or to reimplant a new cuff after prior removal for infection or erosion and, in these scenarios, it is often necessary to select a more distal site on the urethra for cuff placement. Placement of an AUS cuff more distally risks dissection injury to the urethra, particularly dorsally, because the urethra is mobilized off the overlying, very adherent corporal bodies. Often, urethral dissection in this region leaves the roof of the urethra precariously thin, which increases the risk of subsequent cuff erosion. In addition, the circumference of this more distal urethra may be too small for a good fit with the smallest AUS cuff size available (4.0 cm), which decreases the likelihood of a successful result. The authors describe in this article the technique of transcorporal AUS cuff placement more distally on the urethra. This is a technique that minimizes the difficult/dangerous dorsal dissection of the urethra, leaving it better protected, thereby minimizing the risk of urethral injury/erosion, and increasing the girth of the urethra, allowing for a better cuff fit.

Michael L Guralnick

George D Webster

Transcorporal insertion of AMS800 artificial urinary sphincter

AMS800人工尿道括约肌的经体腔植入术

Ureteropelvic junction (UPJ) obstruction in horseshoe or ectopic kidneys presents a unique challenge to the urologist. Although in the past open surgery was the rule, growing experience with minimally invasive techniques and thorough understanding of anatomic variations has opened the door to safe and effective management of patients with complex anomalies. This article presents the relevant anatomy and describes the technique modifications required to care for these patients.

Avrum I Jacobson

Robert Marcovich

Arthur D Smith

Management of ureteropelvic junction obstruction in horseshoe and ectopic kidneys

马蹄肾和异位肾的肾盂输尿管连接部梗阻管理

Anterior compartment vaginal prolapse, also known as cystocele, is one of numerous types of pelvic floor relaxation that arise from weakening of the endopelvic fascia and herniation of pelvic viscera through the potential space of the vagina. Weakness of the levator fascia results in loss of pelvic floor support and subsequent formation of anterior compartment defects (the preferable term, according to International Continence Society terminology) [1] or cystoceles.

Patrick B. Leu

Harriette S. Scarpero

Roger R. Dmochowski

Cystocele repair with interpositional grafting

膀胱膨出修补术中置入移植物

Recent advances in minimally invasive surgery include the increased use of laparoscopic techniques for the performance of a variety of complex genitourinary reconstructive surgeries. Advances in suturing and technologies for hemostasis, tissue reapproximation, and implants have allowed conversion of many open procedures to minimally invasive procedures. Urologic surgeries, such as upper tract reconstruction in the form of laparoscopic pyeloplasty, and complex extirpative procedures with reconstruction, such as laparoscopic prostatectomy and cystectomy, have been developed and have increasing widespread clinical use.

S. Duke Herrell

Robotic pelvic prolapse surgery

机器人盆腔脱垂手术

It is becoming increasingly recognized that the associated morbidity and costs associated with urinary incontinence is placing a greater and greater burden on patients, their caregivers, and third-party payers. These patients often become social outcasts and withdraw from society, which only adds to their personal burden. Newer and more effective treatment modalities are evolving that are of value in managing this common disorder, and these successes have been associated with improved outcomes, often at reduced costs.

Advances in Surgery for Incontinence

失禁手术的进展

Since its introduction in 1973 (American Medical Systems [AMS] model 721), the artificial urinary sphincter (AUS) has become a widely accepted therapy, particularly for male urinary incontinence. Over the years, improvements in product design, surgical techniques, and patient selection have led to increased reliability with durable success. The current American Medical Systems model 800 (AMS 800) AUS was introduced in 1983 and has a 20-year history of use. This device has become the gold-standard treatment for incontinence of many causes, including prostatectomy, radiation therapy, neuropathy, and as a part of reconstructive procedures.

Andrew C. Peterson

George D. Webster

Artificial urinary sphincter: lessons learned

人工尿道括约肌：经验教训

The female urethra is relatively short compared with its male counterpart and is generally between 2 and 4 cm in length. It is made up of an inner layer of mucosal epithelium with numerous infoldings that create an effective seal against the passive loss of urine. Beneath the mucosa lies a rich, vascular network of elastic tissue that is much like the corpus spongiosum. Surrounding the spongy vascular tube is a collagen-rich fibromuscular envelope comprising the periurethral fascia. These three components of a normal urethra are crucial in maintaining continence and enabling dynamic function during increases in abdominal pressure and during normal micturition.

Nirit Rosenblum

Victor W. Nitti

Female urethral reconstruction

女性尿道重建

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