ABSTRACT
Female pelvic organ prolapse (POP) is caused by damage or loss of pelvic floor support, resulting in displacement of the pelvic organs, which leads to abnormalities in the position and function of the organs, mainly due to damage to the pelvic floor mechanical support structures caused by transvaginal birth, loss of elasticity of the pelvic floor mechanical support structures in old women, and loss of the ability to maintain the pelvic floor. The key to POP surgery is the repair of the apical vagina, but treatment based on this theory has failed to achieve satisfactory clinical outcomes. This article will analyze the common procedures of apical suspension in the treatment of mid-pelvic prolapse from the perspective of pelvic floor morphological features and pelvic floor biomechanics axially.
ABSTRACT
Objective To evaluate the clinical efficacy of transurethral resection of ureteral orifice invaded by advanced prostate cancer caused hydronephrosis. Methods A retrospective study was done in 15 patients who were diagnosed by advanced prostate cancer with invasion of ureteral orifice and treated by transurethral resection of ureteral orifice and maximal androgen blockade. 24 kidneys were diagnosed as hydronephrosis by ultrasound. Before the procedure, the average serum BUN was 13.2 mmol/L (8.9~28.5), the average serum Cr was 243.3 μmol/L (126.7~369.2), the average GFR evaluated by renal radionuclide imaging was 48.6 mL/min (31.1~66.2), and the upper urinary tract was obstructed in kidneys with hydronephrosis. Results All 15 patients underwent successfully transurethral resection of ureteral orifice and discharged after 4 days stay. The average procedure time was 65 min (50~100 min) and mean blood loss was 45 mL (30~65 mL) . The patients were followed up for 2~4 weeks. Hydronephrosis examined by ultrasound was ameliorated in 18 kidneys (75%) and not obviously changed in 6 kidneys (25%) in one week after procedure. Hydronephrosis examined by ultrasound was ameliorated in 20 kidneys (83.3%) and not obviously changed in 4 kidneys (16.7%) in two weeks after procedure. Within two weeks after procedure,the average serum BUN was 10.75 mmol/L (6.6~21.30 mmol/L), the average serum Cr was 187.3μmol/L (97.5~286.6 μmol/L), the average GFR evaluated by renal radionuclide imaging was 58.1 mL/min (37.8~79.2 mL/min),and upper urinary tract was unobstructed. Conclusion Upper urinary tract obstruction and renal function were ameliorated and improved in a short time by transurethral resection of ureteral orifice invaded by advanced prostate cancer which caused hydronephrosis.
ABSTRACT
Objective To evaluate the clinical efficacy and safety of application of anterograde flexible ureteroscope in the treatment of ureterointestinal anastomotic strictures in patients after Bricker urinary diversion. Methods From March 2009 to July 2012, 6 patients with ureterointestinal anastomotic strictures after Bricker procedure were enrolled in this study. The average age of the patients was (61 ±7) years old. The first clinical presentation was averagely (6.3 ±2.5) months after the Bricker procedure. There were 4 cases with left side strictures and 2 cases with right side ones. The urinary tract ultrasound, CT, KUB+IVP and antegrade urography were carried out to identify the obstructive portion. The mean length of stricture was 0.9cm (0.4~2.5) . First, all patients underwent percutaneous nephrostomy (PCN), then inside incision by Holmium:YAG laser under anterograde flexible ureteroscopy and lithotripsy (with calculi) . The F6 double J ureteral stent was indwelled for 12 weeks. KUB+IVP was performed after removal of double J ureteral stents. Results The mean operative time was (53±8) min. The mean hospital stay was (5.5±2) days. The blood loss was 3~6 mL. The average follow-up was 18 months (6~30) . No recurrence was found in 5 patients. One case had recurrent stricture after the first procedure, which was successfully managed by the flexible ureteroscopy again and replacing double J ureteral stent every 12 months. Conclusion The inside incision by anterograde flexible ureteroscopic Holmium:YAG laser is safe and effective for ureterointestinal anastomotic strictures in patients after Bricker urinary diversion, with less complications.