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Objective:To determine whether chewing gum during the postoperative period facilitates the recovery of bowel function in patients after radical cystectomy with ileum urinary diversion.Methods:In the study,60 patients who underwent radical cystectomy followed by ileum urinary diversions during Nov.2014 and Nov.2015 in Department of Urology of Peking University First Hospital were randomized into three groups:gum chewing group,placebo group treated with the abdomen physical therapy machine and control group treated with ordinary method.Time to flatus,time to bowel movement,incidence of postoperative distension of the abdomen and abdominal pain,and gut related complications (such as ileus,intestinal fistula,and volrulus)of all the patients were recorded and analysed.Results:In gum chewing group,the median time to flatus was 57 hours (49 -72 hours),and the median time to bowel movement was 95 hours (88 -109 hours),which were significantly shortened compared with the other two groups of patients (82 hours,109 hours in placebo group and 81 hours,108 hours in control group, respectively).No significant difference of the median time to flatus and to bowel movement was observed between placebo group and control group.There were no significant differences in the incidence of post-operative distension of the abdomen and abdominal pain,and gut related complications among the three groups.Conclusion:Chewing gum had stimulatory effect on bowel function recovery after cystectomy fol-lowed by ileum urinary diversion.Chewing gum was safe and simple,and could be routinely used for postoperative treatment after cystectomy and ileum urinary diversion.
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Objective:To analyze the impact of different surgical methods on perioperative complication rate after radical cystectomy in patients over 75 years of age.Methods:A retrospective study reviewed 1 432 patients who received radical cystectomy from January 2003 to January 2015.A total of 239 pa-tients were ≥75 years (median age:78 years),of whom,74 patients (31.0%)suffered one or more perioperative complications.According to the different operation methods,patients could be divided into ileal conduit group and cutaneous ureterostomy group.The ileal conduit group included laparoscopic and open radical cystectomy with ileal conduit.The cutaneous ureterostomy group included transperitoneal laparoscopic,transperitoneal and extraperitoneal open radical cystectomy with cutaneous ureterostomy. Results:Perioperative complications were significantly associated with the patient’s age (P =0.012), American Society of Anesthesiologists (ASA)score (P =0.001),node staging (P =0.043),and dif-ferent surgical methods.Perioperative complications caused a prolonged hospital stay and delayed recovery (34 d vs.21 d,P =0.002).For different surgical methods,the perioperative complication rate of ileal conduit was higher than cutaneous ureterostomy (P =0.013).However,there were no significant differences between transperitoneal laparoscopic and open radical cystectomy with ileal conduit in perioperative complication rate (P =0.836).The perioperative complication rate was statistically signifi-cant among transperitoneal laparoscopic,transperitoneal and extraperitoneal open radical cystectomy with cutaneous ureterostomy (P =0.022).On multivariate analysis,age (hazard ratio =4.856,95% CI:1.465 -16.103,P =0.010),ASA score (P =0.008),and different surgical methods (P =0.016) were significantly associated with the perioperative complication rate.Conclusion:The perioperative complication rate after radical cystectomy in elderly patients was associated with the patients’age,ASA score,and different surgical methods.Patients who received extraperitoneal open radical cystectomy with cutaneous ureterostomy suffered fewer perioperative complications,which was an appropriate choice for elderly patients.
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Objective To evaluate the learning curve of three-port extraperitoneal laparoscopic radical prostatectomy(ELRP) and to minimize operative time and blood loss about this procedure.Methods From August 2013 to October 2014,the data from 95 consecutive patients,who had undergone three-port ELRP for prostate cancer,were retrospectively analyzed.The mean age was 65.9 ± 7.7 years,mean total PSA level was 15.4 ± 12.7 μg/L,and mean body mass index(BMI) was 24.8 ± 3.2 kg/m2.According to the number of procedures performed by the surgeon,all patients were classified into three chronologic groups,including group A (No.1-32),group B (No.33-64) and group C (No.65-95).There were no significant differences including age,BMI,tPSA,estimated prostate volume,clinical stages,history of neoadjuvant endocrine therapy,history of transurethral resection of the prostate (TURP) among group A,B and C (P ＞ 0.05).The operative outcomes analyzed were operative time,estimated blood loss,hospital stay,drainage tube indwelling days,pathological Gleason scores,pathological stages,positive surgical margin rates,biochemical recurrence rates and urinary incontinence rates.Among these 95 patients,the results of the first 32 cases were compared with those of the remaining 63 cases,the first 64 with the remaining 31.Results The average operative time in 95 patients was 81.0 ± 18.6 min.The sloping learning curve for this surgeon showed that the operative time for all 95 cases was strongly correlated with additional experience (| rs | =0.612,P＜0.01).Operative time,however,was not strongly correlated with the surgeon's experience in each group of A,B and C(P ＞0.05).Group A had longer operative time than that of Group B plus C(96.4 ± 11.3 min vs 73.2 ± 16.7 min,P ＜0.01).Group A plus B had longer operative time than that of group C (87.6 ± 17.2 min vs 67.5 ± 13.8 min,P ＜ 0.01).For all cases,the estimated blood loss was strongly correlated with additional experience (| rs | =0.677,P ＜ 0.01).Estimated blood loss was strongly correlated with the accumulation of experience for the initial 32 cases(| rs | =0.619,P ＜ 0.01).However,no strong correlation was observed over the next 63 cases.Group A had more blood loss than that of Group B plus C (158.7 ± 81.3 ml vs 74.1 ± 54.4 ml,P ＜ 0.01).Group A plus B had more blood loss than that of group C (125.5 ± 71.6 ml vs 55.3 ± 61.6 ml,P ＜ 0.01).But hospital stay,drainage tube keeping days were not strongly correlated with additional experience in each group(P ＞ 0.05).There were no significant correlation between the accumulation of experience and positive surgical margin rates,biochemical recurrence rates and urinary incontinence rates.Conclusion Our experience of three-port ELRP cases appears to be favorable with decreasing tendency in operative time,estimated blood loss with experience accumulation.Exposure to 32 surgeries,operative time and estimated blood loss reduced significantly,and after 64 cases operative time and estimated blood loss further reduced.
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Objective To compare the perioperative outcomes and short-term efficacy of three-port extraperitoneal laparoscopic radical prostatectomy (ELRP) and four-port ELRP.Methods Two hundred patients who had undergone ELRP for prostate cancer by a single surgeon from November 2010 to October 2014 were retrospectively analyzed.Among them,95 cases underwent three-port ELRP and 105 cases underwent four-port ELRP.On the basis of traditional four-port ELRP,three-port ELRP was characterized by the omission of the trocar on the inner side of right anterior superior iliac spine.The mean age was 66.8 ± 15.5 years,and mean total prostate specific antigen (tPSA) was 15.3 ± 12.4 μg/L.There were no significant differences including age,body mass index,tPSA,clinical stages,acceptance of neoadjuvant hormone therapy,history of transurethral resection of the prostate,history of diabetes mellitus between the 2 groups (P ＞ 0.05).Patients in three-port ELRP group had significantly smaller prostate volume than fourport group (35.6 ± 16.7 ml versus 42.2 ± 24.7 ml,P ＜ 0.05).The clinical factors as operative time,estimated blood loss,hospital stay,drainage tube keeping days,pathological Gleason scores,pathological stages,positive surgical margin rates,biochemical recurrence rates and urinary incontinence rates were compared between the 2 groups.Results The three-port group had significantly shorter operative time than the four-port group (81.0 ± 18.6 min versus 103.6 ±34.6 min),less estimated blood loss (102.6 ±75.8 ml versus 217.5 ± 182.9 ml),less positive surgical margin rates (13.7％ versus 27.6％).There were 9 patients having Gleason scores more than 7 in the three-port ELRP group and 29 patients in four-port ELRP group (P ＜ 0.05).There were no significant differences of hospital stay,drainage tube keeping days,pathological stages between the 2 groups (P ＞ 0.05).Eighty-three cases in the three-port ELRP group (87.4％) were followed up for 5-19 months with the median time of 11 months.Ninety-two cases in fourport ELRP group (87.6％) were followed up for 17-52 months and the median time was 27 months.There were no significant differences of biochemical recurrence rates and urinary incontinence rates between the 2 groups(P ＞ 0.05).Conclusions Compared to four-port ELRP,three-port ELRP can provide shorter operative time,less blood loss,better negative surgical margin rates,similar oncological control and recovery of postoperative continence.In experienced hands,three-port ELRP could be a feasible and effective option for localized prostate cancer.
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Objective To compare the perioperative outcomes and postoperative complications of retroperitoneal laparoscopic partial nephrectomy ( RLPN) for the treatment of endophytic renal tumors and non-endophytic tumors.Methods Three hundred and ninety-two patients who underwent RLPN for kidney neoplasms from May 2005 to September 2012 were retrospectively analyzed . They were divided into endophytic renal tumor group ( 48 cases ) and non-endophytic tumor group ( 344 cases ) .There were no significant differences in the aspects of gender , age, body mass index, tumor side, diameter, preoperative estimated glomerular filtration rate (eGFR) between the two groups.Operative time, warm ischemia time, method of renal vascular occlusion , repair rate of renal collecting system , estimated blood loss , usage of laparoscopic ultrasonography , intraoperative complications , pathological types , postoperative hospitalization days, postoperative complications and postoperative eGFR were collected and analyzed .Results Patients with endophytic tumors had significantly more usage of laparoscopic ultrasonography (95.8%versus 1.2%, P0.05) between the 2 groups.All the patients′surgical margins were negative.The rates of postoperative complication ( Clavien gradeⅠtoⅢb) were 4.2%and 2.9%in the endophytic group and non-endophytic group , respectively ( P >0.05 ) . Median follow-up was 42 ( 33 -108 ) months in endophytic group and 45 (33 -120) months in non-endophytic group.No local recurrence or metastasis occurred in the two groups .Conclusions In experienced hands , RLPN could represent a feasible , safe and effective treatment for selected patients diagnosed with endophytic renal tumors .Laparoscopic ultrasonography is valuable on locating the tumor and defining tumor margins in RLPN of endophytic renal tumors .
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<p><b>OBJECTIVE</b>To compare the transperitoneal laparoscopic radical prostatectomy procedures with extraperitoneal laparoscopic radical prostatectomy procedures to assess for differences in outcomes and complications.</p><p><b>METHODS</b>A retrospective review 190 patients who had received laparoscopic radical prostatectomy for prostate cancer from June 2002 to January 2013. The results were compared between 116 transperitoneal laparoscopic radical prostatectomy procedures and 74 extraperitoneal laparoscopic radical prostatectomy procedures.</p><p><b>RESULTS</b>The cohorts were similar in terms of mean patient age, height, weight, body mass index, Gleason score from biopsy, and clinical stage. Patients receiced extraperitoneal laparoscopic radical prostatectomy had shorter operation time (146 minutes vs. 224 minutes, Z = -7.220, P = 0.000), less postoperative drainage time (3 days vs. 7 days, Z = -7.115, P = 0.000) and shorter postoperative length of hospital stay (5 days vs. 10 days, Z = -7.250, P = 0.000) than patients receiced transperitoneal procedures. However, the Gleason score, pathological stage, positive margin rate, intraoperative and early postoperative complications has no differences between the 2 groups (P > 0.05).</p><p><b>CONCLUSIONS</b>The patients who received extraperitoneal laparoscopic radical prostatectomy had shorter operative time and revovered faster recovery and the effect of surgery was similar.</p>
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Aged , Humans , Male , Middle Aged , Laparoscopy , Methods , Operative Time , Postoperative Complications , Prostatectomy , Methods , Prostatic Neoplasms , General Surgery , Retrospective StudiesABSTRACT
Objective To evaluate the clinical features and treatment of pelvi-ureteric junction obstruction (PUJO) in a duplex kidney. Methods From 1993 to 2010, 752 patients were diagnosed as PUJO in our hospital and 18 patients (2.4%) with PUJO in duplex kidneys. Three patients had obstruction in the complete duplicated systems and 15 in the incomplete duplicated systems. Five patients had obstruction of the upper moiety and 13 of the lower moiety. All of the 18 patients underwent B-ultrasonography, with 15 enhanced CT scan, 11 intravenous urography and 10 retrograde pyelography.All patients had serum creatinine test after admission and during the follow-up. Results Sixteen patients underwent operations and 2 patients were treated conservatively. Nine patients underwent pyeloplasty and 7 patients underwent heminephroureterectomy. Pathology shows derangement of the lamina muscularis at pelvi-ureteric junction and infiltration of inflammatory cells in mesenchymal. They were followed up from 6 months to 3 years with a mean of 24 months. The clinical symptoms of patients who underwent surgery were cured in all cases. B-ultrasound and IVU showed that hydronephrosis was obviously relieved and the levels of serum creatinine remained the same or decreased. The hydronephrosis and serum creatinine of patients who underwent conservative treatment remained stabilized. Conclusions PUJO in duplicated system is a rare condition. Careful preoperative evaluation is needed to reach the final diagnosis and retrograde pyelography has high specificity. Treatment should be individualized according to split and partial renal function.