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Objective:To discuss the classification and treatment of ureteroileal anastomotic stricture (UAS) after radical cystectomy.Methods:The clinical data of 34 patients with UAS after radical cystectomy in the Department of Urology of Tongji Hospital from January 2017 to January 2022 were reviewed and analyzed. There were 25 males and 9 females. The average age was (66.3±7.7)years, including 2 cases of bilateral hydronephrosis and 32 cases of unilateral hydronephrosis. The average time of UAS was detected (14.7±6.5)months after radical cystectomy. There were 32 patients of unilateral hydronephrosis and 2 patients of bilateral hydronephrosis. Two patients had undergone nephrostomy in an external hospital. Three patients had elevated leukocytes in blood routine. Among them, two patients had fever. First, nephrostomy on the hydronephrosis side and anti-infection treatment were performed. After routine blood tests showed that the white blood cells were normal and antibiotics were stopped for 24 hours without fever, the operation was performed. 34 patients had preoperative hydronephrosis of (2.7±0.6) cm. Of the 34 cases in this group, 5 cases were injected with methylene blue through a preoperative nephrostomy tube, and 29 were injected with methylene blue through the renal pelvis using an 18G puncture needle under ultrasound guidance. Using a ureteroscope to observe in the ileal bladder, methylene blue was seen in 4 cases. Methylene blue was used to guide the search for the stenosis and a super smooth guide wire was inserted. Among them, 3 cases were dilated with a 5 mm ureteral dilation balloon catheter, 1 case was dilated with a F14 ureteral access sheath, and then a F6 single J stent was inserted. Methylene blue was not seen in the ileal conduit in 30 cases, of which 16 cases were treated with a flexible ureteroscope through the nephrostomy to locate the stenosis, incised with a 30 W holmium laser. 9 cases were treated with 5 mm ureteral dilation balloon catheter, and 7 cases were treated with a F14 ureteral access sheath, and then an F6 single J stent was inserted. 14 cases were unable to find the stenosis by antegrade method. According to the operation time and patient's condition, it was decided to perform immediate or second stage dual endoscope surgery. Through the nephrostomy, a flexible ureteroscope was used to enter the stenosis along the super slide guide wire. A rigid ureteroscope was used to observe the stenosis through the ileal conduit, and the stenosis was found. The stenosis was found in 10 cases and incised with a 30 W holmium laser. 8 cases were treated with 5 mm ureteral dilation balloon catheter, and 2 cases were treated with a F14 ureteral access sheath, and then an F6 single J stent was inserted. 4 cases were still unable to accurately locate the stenosis using the dual endoscope surgery(one case was bilateral stenosis, and one side was relieved), and continued indwelling nephrostomy. The definition of successful removal of stricture in this study is that an F6 single J stent can be inserted into the ureter.Results:UAS were classified into four types based on the severity of the intraoperative findings: Type Ⅰ, the narrow ureteral lumen is more than 50% narrower than the normal ureteral lumen, but methylene blue can pass through in strands; Type Ⅱ, needle like stricture of the ureteral lumen, allowing only methylene blue filaments to pass through; Type Ⅲ, membranous atresia of the ureter, with a narrow segment of 1 to 3 mm in length, and methylene blue cannot pass through; Type Ⅳ, long segment stenosis. Of the 34 cases in this group, 4 cases were type Ⅰ, and the stenosis was dredged by retrograde method; 16 cases were type Ⅱ, and the stenotic segments were dredged by antegrade method; 10 cases were type Ⅲ, and the stenosis was dredged by the dual endoscope surgery; Four cases were of type Ⅳ (one case was of bilateral UAS, one side was of type Ⅲ, and the other side was of type Ⅳ, which was classified as type Ⅳ). The stenotic segment could not be solved through the above methods. Among the 34 patients, 30 patients were successfully relieved of anastomotic obstruction, and 1 patient with bilateral obstruction was unilaterally relieved of anastomotic obstruction. In the other 3 cases, because the stenosis segment was too long, 2 cases were changed to nephrostomy, and 1 case was changed to open surgery, with a success rate of 88.2%. UAS was classified into 4 types based on the severity of UAS seen during surgery. No serious complications occurred during and after the operation. During the follow-up of 6-24 months, the imaging evaluation of 4 patients showed that hydronephrosis was aggravated, with an average increase in creatinine of (32.5±10.9)μmol/L, requiring replacement of a single J tube. The imaging evaluation of the remaining 26 patients showed that the postoperative hydronephrosis was 0.9 ± 0.6 cm less than the preoperative hydronephrosis 2.6 ± 0.6 cm, with a statistically significant difference ( P<0.01). The quality of life score at 3 months after surgery was (1.9±0.6), which was significantly improved compared to the preoperative indwelling nephrostomy period (5.2±0.7), with a statistically significant difference ( P<0.01) Conclusions:The treatment of UAS after radical cystectomy with retrograde, antegrade, and dual endoscope surgery has a high success rate, which can help some patients avoid the inconvenience of indwelling external drainage tubes and the risk of open surgery. Choosing an appropriate surgical method can achieve the goal of treating UAS with minimal trauma.
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Prostate cancer is a common malignant tumor in elderly men in western countries. In the past decade, the incidence and mortality of prostate cancer in China have shown a rapid upward trend. With the changes of social economy, life style and the progress of diagnosis and treatment, the epidemiological characteristics of prostate cancer are constantly changing. Therefore, understanding the epidemiological characteristics of prostate cancer is helpful to provide scientific basis for prevention and treatment of this malignant tumor. This article reviews the research progress on the morbidity, mortality, epidemiological distribution, survival and risk factors of prostate cancer in China.
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Objective The prevention effect of CAUTI by long-acting antibacterial material JUC was evaluated by meta analysis.Methods China digital hospital library full-text database,Chinese biomedical literature CD database,China hosptial knowledge database (CHKD) in China national knowledge internet (CNKI),VIP information Chinese science and technology periodical database were retrieved to fully collect the literature from 1995 to 2012 regarding JUC's prevention effect of CAUTI.The inclusion and exclusion standard of literature was made,and the effect index was made from the literature.Two researchers collected the literatures independently,and the included literatures were meta-analyzed by Review Manager 4.2 software,and the risk difference of infection rate and 95％ CI were calculated in both the treatment group and control group.Those literatures which could not be meta-analyzed were performed descriptive analysis to evaluate the efficacy of JUC objectively.Results 20 related articles were retrieved,including 1 multicenter randomized control study,18 monocentric randomized control studies,and 1 uncontrolled study.3172 cases were included with 1526 cases in control group (usual care) and 1646 cases in treatment group (usual care with JUC).The difference between the two groups is significant (RD =-0.15,95％ CI:-0.18 ～-0.13,P ＜ 0.05).Conclusions Long-acting antibacterial material JUC can diminish the incidence of CAUTI significantly.
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Objective To assess the effect of extracorporeal shock waves(ESWs)as a treatment for ⅢB chronic prostatitis(CP).Methods Forty-six men with ⅢB CP were randomly divided into an experimental group (n=34)and a control group(n=12).The patients in experimental group received low energy ESW treatment,20000 impulses in 10 sessions over 2 weeks.The patients in control group received sham ESW treatment without shock waves energy under the same other conditions as in experimental group.Pain,urination and quality of life/impact were assessed with National Institutes of Health-chronic prostatitis symptom index(NIH-CPSI).Both groups were assessed at baseline,post-treatment and at a 4-week follow-up.Resuits The total NIH-CPSI scores,pain scores and quality of life/impact scores in experimental group decreased significantly post-treatment(P＜0.01),but urination scores did not(P＞0.05).Similar decreases of these scores were also found in control group post-treatment.The total NIH-CPSl scores and pain scores maintained at a lower level at the 4-week follow-up in experimental group,but the scores returned to the level as pre-treatment in control group.The effectiveness rates and prominent effectiveness rates in experimental group were significantly higher than those in control group post-treatment and at the 4-week follow-up(all P＜0.05). Conclusions ESWs was effective in the treatment for ⅢB CP.After ESWs treatment pain alleviated,symptoms reducea and quality of life improved.
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Objective To investigate the P2X3 receptor expression in L6-S1 dorsal root ganglion (DRG)and bladder detrusor in a rat model of neurogenic bladder and urethra. Methods Eighty Sprague-Dawley rats wererecruited and randomly divided into a sacral injury group, a suprasacral injury group and a control group. Spinal tran-section was performed to establish the animal model of neurogenic bladder and urethra in rats of the sacral injurygroup and suprasacral injury group. Check the P2X3 receptor expression in DBG and bladder detrusor among thethree groups by Western blot test at 20 days after model establishment. Results P2X3 receptor expression in L6-S1DRG of sacral injury group was significantly less than that of the suprasacral injury group, which was in turn signifi-cantly higher than that of the control group. P2X3 receptor expression in bladder detrusor of sacral injury group wassignificantly lower than that of the suprasacral injury group, which was in turn significantly higher than that of thecontrol group. Conclusion There was close relationship between P2X3 receptor expression and dysfunction of blad-der and urethra.
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<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of celecoxib in treating inflammatory(Type IIIA) chronic prostatitis/chronic pelvic pain syndrome(CP/CPPS-IIIA type).</p><p><b>METHODS</b>Sixty-four patients with diagnosed CP/CPPS-IIIA were randomized equally into two groups, Group A treated with celecoxib 200 mg daily(qd), while Group B with 200 mg twice a day(bid), both for 6 weeks. The white blood cell (WBC) count in expressed prostate secretion(EPS) and National Institutes of Health Chronic Prostatitis Symptom Index(NIH-CPSI) were assessed and compared at baseline(0 week) and at 2, 4, 6 weeks or the endpoint.</p><p><b>RESULTS</b>The mean number of WBC in EPS and the mean NIH-CPSI total scores were decreased gradually after treatment from baseline in both groups. The mean number of WBC of in EPS of either group at the endpoint was decreased by 46.2% and 69.4% respectively(Group A vs Group B) compared with the baseline level. The mean NIH-CPSI total scores of the two groups were decreased respectively by 5.6 and 8.3 points (Group A vs Group B). In terms of the above two parameters, Group B, responded better than Group A to the treatment. The differences observed above were statistically significant(all P < 0.05). No serious adverse event presented.</p><p><b>CONCLUSION</b>Celecoxib is effective and safe for patients with CP/CPPS(IIIA). The dosage of 200 mg twice a day is more efficacious than that of 200 mg daily.</p>