ABSTRACT
Objective:To explore the clinical characteristics of patients with female stress urinary incontinence(SUI) and efficacy of Transobturator Tension-free vaginal tape procedure.Methods:We retrospectively analyzed the clinical data of 319 cases who were operated transobturator tension free vaginal tape in Shanghai Changhai Hospital Affiliated of Naval Medical University from Oct.2009 to Jun.2018. Patients age ranged from 39 to 91 years old, with the average age of(59.2±9.7)years old. 145(45.5%) patients aged ≥60 years old. Among them, 155 (48.6%) patients with moderate SUI, 164(51.4%) with severe SUI.96 cases(30.1%) hypertension, 24(7.5%)diabetes, 2(0.6%)had not given birth, 317(99.4%)patients had given birth more than once. 31(9.7%) coexisting pelvic organ prolapse with POP-Q stage 2 and above. Maximum urinary flow rate ranged 5.2-72.6 ml/s. Cystometric capacity ranged 56.7-1 013.6 ml. Average preoperative ICIQ-SF score was 13.9 (range 9-19).Results:Operative time of 288 TVT-O procedures ranged 19-60 min, and 31 cases in the surgical management of cystocele with concomitant ranged 50-120 min. A total of 265 patients were evaluable followed up for 12-24 months, Objective cure rate and subjective cure rate were achieved in 95.8%(254 cases) and 93.6%(248 cases) respectively. POP was cured in 96.8% patients.Postoperative complications were 10.6% groin pain, 4.5% urgency, others including urinary tract infection(3.4%), de novo dysuresia(2.6%), dyspareunia(1.1%), and one case of bladder injury, one case sling erosion and one case scar hyperplasia.Conclusions:Female stress urinary incontinence were mainly in middle-aged and elderly people who had severely psychological quality of life lasting for several years. TVT-O may achieve a high success or improvement rate and no serious adverse effects. One operation could correct the stress urinary incontinence and simultaneously correct prolapse.
ABSTRACT
Objective To investigate feasibility and early stage postoperative complications of lapa-roscopic radical cystectomy ( LRC) . Methods We retrospectively analyzed the data of 63 consecutive pa-tents (58 males and 5 females) who underwent LRC from Oct .2011 to Oct.2013 in our institute.Of these patients, 46 patients underwent ileal conduit , 9 patients underwent ureterocutaneostomy , and 8 patients un-derwent orthotopic ileal neobladder urinary diversion .The average age and body mass index of patients were 67.7±11.1 (33-84) years and 23.3±2.1 (18.8-28.7) kg/m2, respectively.The mean hemoglobin and al-bumin of patients were (130.7±20.3) g/L and (38.9±4.1) g/L, respectively.Comorbidities of hyperten-sion, diabetes, coronary heart disease and decompensated liver cirrhosis were found in 10, 6, 2 and 1 pa-tient, respectively.10 of 61 patients had a history of abdominal surgery .The indications for cystectomy were classified as muscle invasive bladder cancer for 30 patients, unresectable superficial bladder cancer for 19 patients and recurrent bladder cancer for 14 patients.Postoperative data and early stage postoperative compli-cations within 3 months after surgery were collected . Results The median operative time for LRC and uri-nary diversion was 390 (260-480) min, with a median estimated blood loss of 400 (100-1 500) ml.This was one patient converted to open surgery .The mean postoperative hemoglobin and albumin of patients was 108.5±14.7 g/L and 29.5±3.7 g/L, respectively, both of which significantly reduced compared with pre-operative data (P<0.01).The median duration of hospital stay was 15 days.The median time for liquid in-take, abdominal drainage removal and ureteral stent removal was 4 days, 9 days and 2 months after surgery , respectively.Catheter was removed 2 weeks after laparoscopic orthotopic cystectomy .21 (33.3%) of 63 pa-tients suffered from perioperative complications .15 of 46 patients (32.6%) in ileal conduit group had com-plications including ileus ( 5, 1 of 5 need re-operation ) , lymphatic fistulas ( 5) , pulmonary infection ( 1) , pyelonephritis (1), delirium (1), anastomotic leak (1, re-operation was needed) and pneumothorax (1). 2 of 9 patients (22.2%) in ureterocutaneostomy group had complications such as ileus (1) and lymphatic fistulas (1).4 of 8 patients (50.0%) in orthotopic ileal neobladder group suffered from complications like ileus (2, 1 of 2 required re-operation), lymphatic fistulas (1) and arrhythmia (1). Conclusions LRC is technically feasible and safe .It reduces the estimated blood loss and postoperative complications .It is noteworthy to surgeons that serum albumin significantly reduced after LRC , nutrition should be kept balanced after surgery.