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Objective To study the etiology,diagnosis,treatment and prophylaxis strategy of the urogenital fistula caused by gynecological and obstetrical surgery.Methods Data of 64 cases with urogenital fistula,who were admitted into second hospital of Tianjin medical university and Tianjin first central hospital from January 1992 to December 2012,were analyzed retrospectively.In Tianjin first central hospital,those cases include vesicovaginal fistula in 10,ureterovaginal fistula in 7 and urethro-vaginal fistula in one case.In second hospital of Tianjin medical university,those cases include vesicovaginal fistula in 26,ureterovaginal fistula in 18,urethro-vaginal fistula in 1 and ureterouterine fistula in one case.The median age was 42 years old (range 21-53).The history of diseased ranged from 16 days to 30 years.All patients were diagnosed by methylene blue test,cystoscopy,ureteroscopy,intravenous urography,ultrasound,computed tomography (CT) and magnetic resonance urography (MRU).The primary fistula was diagnosed in 50 cases and the recurrence was found in 14 cases.Single fistula existed in 56 cases and multiple fistulas were found in 8 cases.In 36 patients with vesicovaginal fistula,transabdominal repair of vesicovaginal fistula (n =20),transpubic surgery (n=10) and transvaginal surgery (n=6) were chosen.In 25 patients with ureterovaginal fistula,ureterocystostomy (n =10),ureterotomy with holmium laser (n =8),ureteral stent placement (n =6) and ureteral stricture excision and bladder-psoas suspension (n=1) were used.Two patients with urethro-vaginal fistulae were cured by the Latzko technique.One patient had uretero-uterine fistula and cured by ureteral stricture excision,ureterocystostomy and bladder-psoas suspension.Results Fifty-five(86％) cases were cured by single-stage surgical treatment and nine patients experienced more than two times of surgical treatment.The incipient patients have a higher success rate of first surgery than recurrent patients (92％ vs.64％,P＜0.05).Single and multiple fistulas have no significant difference about the surgical successive rate (88％ vs.75％,P＞0.05).In cases with vesicovaginal fistula,the success rate of vaginal and abdominal approaches are the same 85％ (P＞0.05).In cases with ureterovaginal fistula,abdominal and endoscopic approaches were 100％ and 85％,respectively (P＞0.05).The mean duration of follow was 20 months (range 3-48).There was no recurrence during follow-up.Conclusions Urogenital fistula caused by gynecological and obstetrical operation can be cured by surgery.Recurrent fistula is a challenge for diagnose and treatment,preoperative need reasonable operation mode to improve the success rate of operation.Both open surgery and endourology approaches are effective treatment options in management the urogenital fistula.
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Objective To evaluate the therapeutic effect and toxicities of low dose Gemcitabine combined with Oxaliplatin in the treatment of advanced or metastatic uroedthelial carcinoma.Methods A total of 42 patients pathologically confirmed advanced or metastatic urothelial carcinoma (23 bladder cancer cases,11 ureteral carcinoma cases,and 8 renal pelvic carcinoma cases) were reviewed.Karnofsky score for each patient before treatment was more than 60.Combined treatment with Gemcitabine and Oxaliplatin regimen was as follows:Gemcitabine 700 mg/m2,iv infusion at day 1,8 and day 15,Oxaliplatin 100 mg/m2,iv infusion at day 2.The regimen was administered for more than 2 cycles (every 4 weeks) and the response rate was evaluated.The regimen was used in palliative chemotherapy and adjuvant chemotherapy,respectively.Results According to WHO evaluation criteria on therapeutic effectiveness,7 patients (16.7％) had complete response,13 patients (30.9％) had partial response,14 cases (33.3％) remained stable status,and 8 cases (19.1％) had progression.The overall response rate was 47.6％.The main side effects included thrombocytopenia,leucopenia,nausea,vomiting and alopecia,which were mild to moderate and disappeared when the chemotherapy was ceased.No chemotherapy related death occurred.Conclusions Combined treatment with low dose Gemcitabine and Oxaliplatin is effective for advanced or metastatic urothelial carcinoma,with mild and tolerable toxicities.
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Objective To analyze the incidence and clinical features of urothelial tumors in renal allograft recipients.Methods A retrospective analysis of 1042 patients received renal allografts who had taken immunosuppression for at least six months between 2006 and 2011 in The First Centre Hospital of Tianjin was performed.Results Eleven cases of uroepithelial tumors were diagnosed in the 1042 cases of renal transplantation ( 1.06％ ),of whom 9 cases were noticed by hematuria ( 81.8 ％ ),2 cases ( 18.2％ ) by medical examination.Six patients were diagnosed with multifocal urothelial carcinomas.Surgery was performed on all the patients with renal tumors and followed by chemotherapy or radiotherapy.Conclusion Malignancies in urinary tract after renal transplantation should be bore in mind.Early diagnosis is very important.The treatment options include reducing immunosuppressive agents and removing tumor lesions completely.