Hand-assisted-drawing-needle running suture with a curved needle: an effective technique to create a W-ileal neobladder / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>An important milestone in the area of urinary diversion was the advent of a series of orthotopic bladder substitution (OBS). However, reconstruction of OBS by the traditional hand suture method (THSM) is a time-consuming process. Stapling techniques are considered to be inferior to hand-sewn methods. We report our experience and functional results in patients with W-ileal neobladder by a hand-assisted-drawing-needle running suture (HADNRS).</p><p><b>METHODS</b>Between April 1993 and December 2011, 347 patients (338 men and 9 women) aged 28 - 77 years (median age: 59 years) underwent radical cystectomy, followed by the creation of a modified W-ileal neobladder by HADNRS with a curved needle. A total of 347 (20 patients in 2003) were evaluated by urodynamic tests.</p><p><b>RESULTS</b>The operative time ranged from 110 to 310 minutes (mean 148 minutes), and the mean time of reconstruction by HADNRS, excluding ureterointestinal and ileouretral anastomosis, was (20.2 ± 4.3) minutes. Histopathological analysis of removed specimens showed that 317 patients had transitional cell bladder carcinoma. Of these 317 patients, 19 also had squamous carcinoma and 13 had adenocarcinoma. Glandularis and prostate cancer occurred in 16 and 14 patients, respectively. Three patients (0.8%) had neobladder abdominal fistula. No other early complications or injury to the surgeon's hands occurred due to HADNRS. Of the 20 cases with urodynamic examinations in 2003, two suffered from daytime incontinence and six had nocturnal incontinence. The maximum capacity of the neobladder was (492.9 ± 177.8) ml, and the maximum pressure within the reservoir at the end of filling was (32.1 ± 8.6) cmH2O.</p><p><b>CONCLUSION</b>Reconstruction of W-ileal neobladder by HADNRS is effective and economical.</p>

Incidental prostate cancer in radical cystoprostatectomy specimens / 亚洲男科学杂志(英文版)

<p><b>AIM</b>To investigate the rates of prostate cancer (PCa) in radical cystoprostatectomy (RCP) specimens for bladder cancer in mainland China. To determine the follow-up outcome of patients with two concurrent cancers and identify whether prostate-specific antigen (PSA) is a useful tool for the detection of PCa prior to surgery.</p><p><b>METHODS</b>From January 2002 to January 2007, 264 male patients with bladder cancer underwent RCP at our center. All patients underwent digital rectal examination (DRE) and B ultrasound. Serum PSA levels were tested in 168 patients. None of the patients had any evidence of PCa before RCP. Entire prostates were embedded and sectioned at 5 mm intervals.</p><p><b>RESULTS</b>Incidental PCa was observed in 37 of 264 (14.0%) RCP specimens. Of these, 12 (32.4%) were clinically significant according to an accepted definition. The PSA levels were not significantly different between patients with PCa and those without PCa, nor between patients with significant PCa and those with insignificant PCa. Thirty-four patients with incidental PCa were followed up. During a mean follow-up period of 26 months, two patients with PSA > 4 ng/mL underwent castration. None of the patients died of PCa.</p><p><b>CONCLUSION</b>The incidence of PCa in RCP specimens in mainland China is lower than that in most developed countries. PSA cannot identify asymptomatic PCa prior to RCP. In line with published reports, incidental PCa does not impact the prognosis of bladder cancer patients undergoing RCP.</p>

The clinical study of 120 cases total cystectomy and W shape orthotopic ileal neobladder / 中华外科杂志

<p><b>OBJECTIVE</b>To study advantages or disadvantages of total cystectomy and W shape orthotopic ileal neobladder.</p><p><b>METHODS</b>Radical cystectomy and ileal new bladder was performed antegradly and retrogradly for 120 male patients. For the construction of the reservoir, the 40 cm ileal segment was isolated along its antimesenteric border and then arranged into a W shape. The incised ileum was sutured blanketly to create urine bag. The ureters were replanted at the two corners of the W shape by way of creating nipple.</p><p><b>RESULTS</b>The first 50 cases took 210-300 min with a mean of 270 min. The later 70 cases took 110-205 min with a mean of 143 min. Ninety-one of 120 cases had been followed up for 2-88 months with a mean of 30 months. Eighty-five cases had achieved excellent daytime continence, whereas 71 cases had nighttime continence. There were 9 cases of hydroureter and 2 cases of moderate hydronephrosis. Renal function of 2 cases were slightly abnormal. Hypokalemia occurred in 6 cases, and there was no metabolic-disorder. On voiding cystography, only 1 case showed reflux in right ureter. Only 2 case suffered from cancer recurrence of urethral and no patient suffered from cancer recurrence of neobladder. Twenty patients were evaluated by urodynamic examine. The urine flow curve showed continual shape in 12 cases, while intermittent shape in 8 cases. Voiding cystourethrography showed the neobladder outlet presented funnel shape and open well in continual group, while lack of funnel shape or bladder neck opened badly in intermittent group.</p><p><b>CONCLUSION</b>The modified total cystectomy and ileal new bladder are effective and reliable treatment for patients.</p>

Retroperitoneal iaparoscopic partial nephrectomy(report of 23 cases) / 中华泌尿外科杂志

Objective To report initial experience and the indications of retroperitoneal laparoscop- ic partial nephrectomy.Methods From December 2001 to October 2005,23 patients (including 14 cases of renal cell carcinoma,5 of hamartoma and 4 of duplex kidney) underwent retroperitoneal laparoscopic par- tial nephrectomy.One of the patients had solitary kidney.Results All the operations were successful ex- cept for only 1 requiring conversion to laparoscopic nephrectomy because of bleeding resulting from blocking anterior branch of renal artery.The mean operative time was 121 min (60-240 min),and mean ischemic time was 32 min (20-55 min).The estimated bleeding volume ranged from 100 ml to 300 ml,and no pa- tient needed blood transfusion.Pathology showed negative surgical margins in 14 cases of renal cell carcinoma and confirmed the diagnosis of hamartoma in 5 cases.One patient with duplex kidney required open partial nephrectomy because of renal cystic mass resulting from incomplete resection.Conclusions Retroperito- neal laparoscopic partial nephrectomy offers a new effective and minimally invasive treatment for selected pa- tients with renal mass.The long-term effects of the procedure need further investigation.