ABSTRACT
Objective:To explore the application value and initial clinical experience of fluorescence-enhanced laparoscopy combined with indocyanine green in radical cystectomy with pelvic lymphadenectomy.Methods:A retrospective analysis was performed on the clinical data of a total of 8 patients admitted from May 2018 to August 2019 who underwent laparoscopic radical cystectomy with pelvic lymphadenectomy for muscle-invasive bladder cancer using the fluorescent laparoscopy system.There were 6 males and 2 females; aged 58 to 71 years, with an average of 65.8 years. The preoperative pathology was urothelial carcinoma, with 2 cases in T 2a stage, 4 cases in T 2b stage, and 2 cases in T 3a stage. The patient was injected a total of 2 ml of 2.5 mg/ml of indocyanine green through a rigid cystoscope using a 18 gauge cystoscope injection needle before surgery. The PINPOINT endoscopic fluorescence camera system performed surgery in real-time. A systematic examination of the surgical area under near-infrared fluorescence was performed every 5 minutes. Observation and recording of indocyanine green combined with fluorescence laparoscopy to mark the bladder tumor area and identify the sentinel drainage. Results:Eight cases were successfully completed under the fluorescence laparoscopic system.In terms of tumor markers, cystoscopy with indocyanine green allowed 7 of the 8 patients to successfully identify the tumor area under fluorescent laparoscopy. Six of the 8 patients with sentinel lymph nodes identified by indocyanine green lymphangiography were also successful, of which 3 were positive for lymph nodes. At the same time, intravenous indocyanine green was used to observe that the blood supply to the bladder and the end of the ureter was good. The operation time was 190-310 minutes, with an average of 235 minutes; the bleeding volume was 150-380 ml, with an average of 180 ml; the postoperative hospital stay was 10-22 days, with an average of 14.5 days. Postoperative pathological staging 2 cases in T 2a stage, 3 cases in T 2b stage, 3 cases in T 3a stage, with total number of lymph nodes 8-14, average 10. The 8 cases were followed-up for 4-12 months, average 5.5 months, without indocyanine green related complications. Conclusions:Indocyanine green fluorescent laparoscopy can accurately locate and identify the bladder tumor area and pelvic lymph nodes during radical cystectomy, which can reduce positive margins and unnecessary enlarged lymph node dissection.
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Objective To evaluate the efficacy and safety of single flexible ureteroscope vs.flexible ureteroscope combined with intraoperative ultrasonography guided in the endogenous renal cyst incision and drainage.Methods Retrospective analysis of case data of 64 patients with endogenous renal cysts admitted from January 2015 to December 2017.All the patients undrwent contrast-enhanced CT,urinary tract imaging,ultrasound B to confirm bosniak classification Ⅰ and Ⅱ renal cyst.The patients (38 males,26 females) were divided into single flexible ureteroscope group [group A,32 cases of patients,average age (54.2 ±6.6) years,unilateral or bilateral cystic patients:19 cases/ 13cases,simple cyst of kidney or polycystic kidney:24 cases/8 cases,average maximum diameter of the renal cyst (5.4 ± 1.3) cm,combined with renal calculus:8 cases,combined with hydronephrosis:7 cases,1 case who had the history of laparoscopic renal cyst decapitation,1 case who had the history of percutaneous renal cyst puncture] and flexible ureteroscope group combined with intraoperative ultrasonography guided [group B,32 cases of patients,average age (52.3 ± 9.3) years,unilateral or bilateral cystic patients:21 cases/11 cases,simple cyst of kidney or polycystic kidney:25 cases/7 cases.Average maximum diameter of the renal cyst (5.3 ±1.2) cm,combined with renal calculus:9 cases,combined with hydronephrosis:8 cases,2 case who had the history of laparoscopic renal cyst decapitation,1 case who had the history of percutaneous renal cyst puncture].The double J stent was placed two weeks before the surgery into the body of patients.During the operation,the surgical procedure were used by the electronic flexible ureteroscope and holmium laser (0.8 J,20 Hz),combined with ultrasound B in the monitoring,to find the suitable incision position.It would be defined as the successful result if we could put the head of flexible ureteroscope into the inside of renal cyst and see the image of mist in the screen of ultrasound B.According to the standard,the result of operation wound be defined compared to before operation (success:shrink more than 80％ or maximum diameter was smaller than 1 cm;improvement:shrink about 50％-79％;ordinary result:shrink about 30％-49％;failure:shrink smaller than 30％).Effective rate =(success cases + improvement cases)/total cases.We compared the differences of two groups in the time,efficacy,safety and complication of surgery.Results Compared the results of single flexible ureteroscope groups vs flexible ureteroscope group combined with intraoperative ultrasonography guided in the success cases of surgery,after 8-30 months following-up,total operative complication rate was [8 cases(25％)vs.1 case(3.1％)],success rate of operation in 6 month later [(20 cases (62.5％) vs.28 cases (87.5％)].Flexible ureteroscope group combined with intraoperative ultrasonography guided had advantages statistically (P ＜ 0.05).However,there was no statistical difference for the two groups in the time of operation [(33.4 ± 6.7) min vs.(35.1 ± 8.6) min],single operative complication (intraoperative wounding bleeding:3 cases vs.1 case,postoperative urinary infection:3 cases vs.0 case,perinephric space effusion:2 cases vs.0 case,renal function impairment:1 case vs.0 case)(P ＞0.05).Conclusions Flexible ureteroscope combined with intraoperative ultrasonography guided can help the urologist can improve the success rate of surgery and reduce the chance of surgical injury intraoperatively.
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Objective To discuss the risk of factors influencing persistent frequency after transurethral resection of the prostate (TURP).Methods The clinical data of 119 post-TURP patients treated from January 2014 to June 2015 was retrospectively analyzed.The age was (72.1 ±2.3)years old.There were 15 cases with hypertension,23 cases with diabetes and 6 cases with heart disease.The preoperative IPSS score of 119 cases was (22.1 ± 5.9) points,with (10.2 ± 1.8) points in urinary storage period and (11.8 ± 4.7) points in urination period.Urination frequency was (10.8 ± 2.6) times per day and there were (3.8 ± 0.8) times of nocturnal urination.B-ultrasound:residual urine volume was (38.1 ± 9.1) ml and prostate volume was (34.1 ± 4.2) ml.Preoperative maximum urine flow rate was (8.8 ± 3.9) ml/s.The detrusor pressure at maximum urinary flow rate was (43.9 ± 14.1) cm H2O (1 cmH2O =0.098 kPa),maximum detrusor pressure was (99.7 ± 12.2) cmH2O and effective bladder volume was (217.5 ± 14.8) ml.Contraction of bladder weakened in 40 cases (33.6％) and 36 cases (30.2％) had detrusor overactivity.According to whether continuous urinary frequency was developed,the patients were divided into frequency-positive group and frequency-negative group.The differences between the patients in two groups were compared and univariate analysis was performed.A multivariate logistic regression was performed on statistically significant indicators.Results Among the 119 patients,21 were frequency-positive and 98 were frequency-negative.Univariate analysis showed that age,IPSS score,preoperative urinary storage score,detrusor pressure at maximum urinary flow rate,maximum detrusor pressure,effective bladder volume,contraction decrease of bladder,preoperative detrusor activity were important indicators affecting the condition of postoperative urinary frequency (all P ＜ 0.05).Multivariate analysis showed that old age (OR =3.842,P =0.021),high total IPSS score (OR =5.109,P =0.011),low maximum detrusor pressure (OR =3.477,P =0.039),low effective volume of bladder (OR =4.051,P =0.017) and detrusor overactivity (OR =3.662,P =0.025) were independent risk factors for urinary frequency after TURP.Conclusions The age,the high IPSS score before operation,low maximal detrusor pressure,low effective bladder capacity and the bladder detrusor activity could be independent predictive factors of persistent frequency after TURP.