ABSTRACT
Vesicouterine fistula (VUF) represents a rare urogenital complication. It is considered to be the least common type of urogenital fistulae. Surgical repair remains the mainstay of treatment. Transabdominal repair is the most common surgical method and transvaginal route is rarely reported. Herein, we presented the successful transvaginal repair of 3 cases of VUF in our center, including 2 cases of vesicocervical fistula and 1 case of high vesico-uterine body fistula.All the 3 VUF cases were repaired through vagina and followed up for 6 months, 1 year and 2 years, respectively. There was no vaginal leakage or hematuria postoperatively. VUF was cured. Transvaginal repair of VUF was shown to be a feasible, safe and effective procedure with small trauma.
ABSTRACT
Objective To compare the efficacy of transvaginal and transabdominal repair surgery for the treatment of vesicovaginal fistula(VVF).Methods The data of 39 patients undertaken VVF repair in our department between January 2005 and December 2016 was retrospectively reviewed.The patients aged 19 to 69 years (median 45 years),and the median duration of the condition was 22 months (range:1 month to 20 years).The etiologies were all iatrogenic injuries.Thirty-nine patients underwent a total of 43 surgical repairs including 26 transabdominal approach(group 1)and 17 transvaginal approach(group 2).There was no significant difference in terms of the patients' age,fistula size,location and the proportion of patients undergoing repairs previously between the two groups.The operative and outcome data of the two groups was compared.Results The surgical time of group 2 was shorter than that of group 1 (median 85 min vs.178 min,Z =-4.436,P ＜ 0.01).The median blood loss was 20 (5-100) ml in group 2 and 50 (20-800) ml in group 1,and there was statistically significant difference (Z =-3.767,P ＜ 0.01).The postoperative hospital stay of group 2 was also shorter than that of group 1 (median 7 d vs.12 d,Z =-3.076,P ＜ 0.01).The follow-up period was 3 to 120 months (median 26 months).The success rate was 82.4％ (14/17) in group 2 and 80.8％ (21/26) in group 1,and there was no significant difference between the two groups (x2 =0.017,P ＞ 0.05).Conclusion Compared with transabdominal repair,transvaginal repair of VVF is a preferred surgical procedure in respect that it is more simple,less invasive and has similar success rate with transabdominal repair.
ABSTRACT
Objective To discuss the feasibility and safety of retroperitoneal laparoscopic nephrectomy for treatment of kidney tuberculosis. Methods From March 2005 to February 2009, 28 patients with kidney tuberculosis underwent retroperitoneal laparoscopic nephrectomy. The patients′ data were reviewed and analyzed. Results There were 18 men and tencwomen with an average age of 36 (26-51) in the cohort. Sixteen patients had lesions on the left kidney and 12 on right kidney. All patients had a normal renal function on the contra lateral side. The severely impaired renal function of the lesion side was confirmed before operation. Anti-tuberculosis chemotherapy was administered to patients for two weeks to six months in advance of the surgery. No active lesion of tuberculosis was found and ESR level was normal before operation. All the operations were successfully performed without switching to open surgery. The average operative time was 170 (121-258) minutes, blood loss was 110 (70-250) ml and average postoperative hospital stay was 5.7 (5-14) days. Peritoneum injury was seen in three patients and incision infection in two patients. No severe complications were observed. Anti-tuberculosis chemotherapy was continued for three months. Twenty-four patients were followed-up, and the average follow-up time was 12.5 (6-20) months. All patients recovered without any lesion remaining. Conclusions Retroperitoneal laparoscopic nephrectomy could be a safe and reliable method for the treatment of non-functioning kidney due to tuberculosis.
ABSTRACT
Objective To compare WHO 2004 and WHO 1973 pathological grading methods of non-muscle invasive urothelial neoplasms. Methods The clinical pathological features of 160 non-muscle invasive urothelial neoplasms patients, treated in our hospital from February, 1998 to Decem-ber, 2008, were re-graded according to WHO 2004 and WHO 1973 classification system. To evaluate recurrence and progression of all the patients during the follow up period, we used statistical method to analyses the differences between two classification system. Results There were 160 patients, ac-cording to WHO 1973 classification methods: 5 cases of papilloma, 52 cases of grade 1 tumors, 83 ca-ses of grade 2 and 20 cases of grade 3;By WHO 2004 classification method: 7 cases of papilloma, 31 cases of low-grade malignant potential of urothelial papilloma, 99 cases of low-grade papillary urotheli-al carcinoma and 23 cases of high-grade papillary urothelial carcinoma. There was no difference in re-currence among the grades of WHO 2004 and WHO 1973 pathological grading system (both P>0.05). Regarding the progress of non-muscle invasive papillary urothelial neoplasms, no significant difference was found among grades of WHO 1973 classification system(P>0.05)while difference exis-ted among grades of WHO 2004 pathological grading system (P<0.05), especially between papillary neoplasm of low malignant potential (PNLMP) and high grade papillary urothelial carcinomas(HG-PUC) (P<0.01). Moreover, HGPUC grade had more progression rate (30.4%) than G_3 grade (15.0%). Conclusions Compare to G_3 grade, HGPUC grade was more easily to make progress in pa-tients,due to this grade include more high malignant papillary urothelial carcinomas. Therefore, it is necessary for urologists to use a more rigorously follow up and therapy method in connection with HG-PUC grade of new classification system.
ABSTRACT
Objective To explore the risk factors, di ag nosis and treatment of renal pelvis and ureter cancer after surgery of bladder c ancer. Methods The clinical data of 13 patients (9 males and 4 females) with renal pelvis and ureter cancer after surgical operation of bladder cancer were retrospectively analyzed.Among them renal pelvis cancer was diagnosed in 9 cases;ureter cancer in 4.Clinical manifestations consisted of gro ss hematuria with flank pain in 11 cases,suspected renal pelvis cancer by ultras ound (US) in 2. Results Among the 13 patients,US,intrave nous urography (IVU) and CT located the focus exactly in 10,8 and all the 13 cas es,respectively.Upper urinary obstruction was diagnosed by US and IVU in 13 and 8 cases,respectively.No image was developed by IVU in 5 cases.CT located the foc us exactly in all the 13 cases;of them 11 cases were definitely diagnosed.Overal l,13 cases were cured and alive during the follow-up period. No recurrence or m etastasis developed.Renal dysfunction occurred in only 1 case (Cr,285 ?mol/L) d ue to the contralateral renal stones. Conclusions Multif ocal bladder cancer and cancerogenic tendency of urothelium may be the risk fact ors of this disease.IVU combined with US is the main diagnostic method for the d isease.CT is recommended for the further examination.Nephroureterectomy is the p referred treatment choice for this disease.