ABSTRACT
Objective To summarize our experience in the modified total cystectomy and neobladder in patients with invasive bladder cancer.Methods Twenty one male patients with invasive bladder cancer were treated with modified total cystectomy and neobladder.Reconstruction of the lower urinary tract using modifiled ileal neobladder(in 17 patients)and sigmoid neobladder(in 4 patients)were performed.The median age of the patients was 62 years.The patients were followed up for 1-4 years.Clinical outcomes of these patients was evaluated,including the function of the neobladder,urinary function,renal function,serum electrolytes and QOL.Results There was no surgical mortality.The operating time was 3.5-6.5 h(mean,4.5 h).Blood transfusion was required in 4 cases.Fifteen patients(97 ％ had voluntary control of urination at daytime and 6 at night.They were functional to control urination 3-6 months after operation.Hydronephrosis to certain extent occurred in 5 patients,but was recovered after 6-8 months.There were one case of intestinal obstruction and one case of metabolic acidosis.Residual urinary volume was 30 ml in 1 cases and 40 ml in another.Conclusions Modified total cystectomy and neobladder is an ideal technique to treat invasive bladder cancer with good clinical outcomes of tumor control,high life quality,few severe complications and good urination control.
ABSTRACT
Objective To assess the safety and efficacy of percutaneous nephrolithotripsy withpneumatic and ultrasonic power in pediatric renal calculi. Methods The clinical data of 44 patientstreated with combination of pneumatic and ultrasonic power during pereutaneous nephrolithotripsywere retrospectively analyzed. The 44 patients had 49 renal calculi. The patients were all under 14years old. The average age was 11 years (range 7-14 years). There were 39 unilateral and 5 bilateralcalculi. Among the 44 patients,metabolic disturbance occurred in 19 cases (43.2%),anatomical dys function occurred in 15 cases (34.1%),urinary tract infection occurred in 14 cases (31.8%). Ante grade percutaneous access was established under ultrasound guidance,a combination of pneumatic andultrasonic lithotripsy were used. The effect was evaluated by postoperative KUB and ultrasonic. Re suits The access was successfully established in all patients. Complete stone clearance was achievedin 36 kidneys in phase Ⅰ,stones from 9 kidneys were completely removed with second lithotripsy.Leftover stone in 2 kidneys were treated by ESWL. Open surgery was performed in 2 kidneys due toexcessive bleeding. The operative time ranged from 52 132 min,average time was 79 min. Two pa tients needed blood transfusion. No severe complications occurred in all patients. Thirty seven pa tients were followed up for 3 18 months. The renal function was not worsened and hydronephrosiswas not aggravated in these patients. Conclusion The percutaneous nephrolithotripsy with pneumatic and ultrasonic power is a safe,effective treatment for pediatric renal calculi.