Analysis of the clinical effect of single J tube of bilateral ureter through the bladder stoma to treat vesicovaginal fistula after radiotherapy of cervical cancer / 中华泌尿外科杂志

This article retrospectively analyzed the clinical data of 8 patients with vesicovaginal fistula after radiotherapy for cervical cancer admitted in our hospital from January 2015 to October 2021. All of them underwent cystostomy under local anesthesia. A single J tube of bilateral ureters was retained under cystoscope, and the single J tube was introduced into the fistula bag through the cystostomy opening. All patients wore diapers for a long time before operation, and used urine pads 0-2 pieces/day after operation. QOL score was 5.3±0.5 points before operation, and 2.5±0.5 points after operation. The patient's body odor basically disappeared. The vesicovaginal fistula can be repaired by surgery, but for patients who cannot be operated or failed repeatedly due to various reasons, a single J tube of bilateral ureters can be drawn out through the cystostomy opening, which can improve the quality of life of patients through minor trauma.

The efficacy of urinary continence in patients undergoing radical prostatectomy with bladder neck extension and mucosal eversion reconstruction anastomosis / 中华泌尿外科杂志

Objective To discuss the efficacy of urinary continence in patients undergoing radical prostatectomy with bladder neck extension and mucosal eversion reconstruction anastomosis.Methods From August 2016 to November 2018,31 patients with prostate cancer underwent laparoscopic radical prostatectomy.The patients were 62-85 years old(mean 74.8 years),and the mean PSA score was 16.5 ng/ml(6.8-34.2 ng/ml).The pathological examination confirmed that the Gleason score was 6-9 and the prostate size was 44-83 ml.All patients underwent laparoscopic radical prostatectomy with bladder neck extension and mucosal eversion reconstruction anastomosis.Surgical procedure:After resection of the prostate in laparoscopic radical prostatectomy,the bladder neck was sutured at 6 o'lock position to narrow the bladder neck (" tennis racquet" reconstruction).The interval was 1 cm,and 2-3 needles were sutured,the distance between the neck of the bladder and the ureter was extended.The bladder neck mucosa and urethral mucosa eversion were performed.The posterior wall of the bladder neck was sutured at interval of 1 cm on both sides of the midline.After the knot was tightened,the posterior wall of the bladder was folded and bladder neck was elevated.The posterior wall of the bladder and the posterior wall of the urethra were sutured to reduce the distance between the bladder and the urethra.Finally,the bladder and urethra were anastomosed.The postoperative urinary continence recovery and the clinical effect were recorded.Results The operation time of 31 patients ranged from 80 to 210,with an average of 139.7 minutes.Intraoperative bleeding was 50-330 ml,with an average of 144.2 ml.None of the patients switched to open surgery during the operation,and there was no injury to large vessels and rectum,and no anastomotic leakage.Postoperative pathology showed 21 cases of pT2 stage,10 cases of pT3 stage,2 cases of positive margin,including 1 case of basal part and 1 case of apex part,both of which received medical castration therapy postoperatively.The surgical margin was positive in 2 cases (6.45％).31 patients removed the urinary catheter in ten days after surgery.17 cases (54.8％) recovered instantly urinary continence;7 cases (22.6％) urinary continence in 1 month after operation;4 cases (12.9％) urinary continence in 3 months after operation;and 3 cases (9.7％) urinary control in 6 months after operation.One case had urinary retention after removing the urinary catheter,and cathetered for 2 more weeks.After pulling out again,the urinary continence was good.Conclusions Laparoscopic radical prostatectomy with bladder neck extension and mucosal eversion reconstruction anastomosis may be helpful for early recovery of urinary continence.

A novel complete retroperitoneal laparoscopic nephroureterectomy via modified three ports approach / 中华泌尿外科杂志

Objective To assess the clinical efficacy of a modified complete retroperitoneal laparoscopic nephroureterectomy via 3 port approach.Methods From August 2013 to February 2016,23 patients with complete retroperitoneal laparoscopic renal and ureteral sleeve resection were treated with modified three port approach,including 15 males and 8 females.The average age was 67 years old (ranging 44-83 years old).All patients had complained about the hematuria before operation and urine exfoliated cells showed moderate to severe nuclear atypia.All patients accepted the abdominal CT and urography CTU examination,pre-operatively.All of them was diagnosed localized upper urinary tract malignant tumors based on those images,including 13 cases in the pelvis,and 10 cases in the upper segment of the ureter.No chemotherapy,radiotherapy or immunotherapy was performed before surgery.No patients have the history of severe basic disease or upper urinary procedure.The operations were performed under general anesthesia,patients take the contralateral back 30 degrees slope,low elevation head foot,waist bridge,side waist stretch.In the anterior superior iliac spine perpendicular to the line 2 cm parallel to the lower intersection of the rib border were disposed into the 12 mm trocar.Above the anterior superior iliac spine two cross finger level with the intersection of the anterior axillary node,we placed into the 10 mm trocar placement lens.Laparoscopic placement of third casing form an isosceles triangle with the first two casing.The renal fascia was incised with an ultrasonic knife from the renal dorsal side,and the renal hilum was isolated from the kidney by suction aspirator.The renal artery and vein were separated and closed by hem-o-lok.Along the psoas muscle surface to ureter,ureteral clipping by hem-o-lok but not to cut off the free distal ureteral,the lens is composed of first casing into,using ultrasonic knife to free ureter to the bladder wall segment,with 30 mm endoscopic stapler ureter and bladder wall cut off part.Operation time,blood loss and postoperative recovery were recorded in 23 cases.Results All 23 cases were successfully operated without related the operative complication.The operative duration ranged from 3.5 to 6.1 h (mean 4.8 h),the blood loss was 30-880 ml (mean 304 ml),and the postoperative stay was 8-30 d (mean 17.8 d).There are 3 cases of positive lymph node by postoperative pathological reports.Within 2 to 30 months following up,2 patients died of tumor progression in 6 months after surgery.4 patients were diagnosed with bladder cancer in 15 months,15 months,21 months,24 months after surgery,respectively.And the transurethral resection of bladder tumor was performed.Conclusion The modified complete retroperitoneal laparoscopic nephroureterectomy via three ports is safe and reliable.

The efficacy of supine half-sitting lithotomy position in the treatment of upper ureteral calculi by surgery of ureteroscopic Holmium laser lithotripsy / 中华泌尿外科杂志

Objective To evaluate the efficacy and economic results in the treatment of upper ureteral calculi by surgery of ureteroscopic Holmium laser lithotripsy under the supine half-sitting lithotomy position.Methods To analyze the clinical data of upper ureter calculi patients who underwent ureteroscopy Holmium laser lithotripsy retrospectively.Patients in traditional lithotomy position with assistance of stone basket during the surgery were in group A.Those in traditional position surgery without stone basket were in group B.Those in supine,half-sitting,lithotomy position and without the assistance of stone basket were in group C.There were 62,31 and 75 patients in group A,B and C respectively.In group A,there were 32 males and 30 females;37 cases in left side,25 in right side,with degree of hydronephrosis of (2.9 ±0.6) cm and stone size of (1.7 ±0.4) cm.In group B,there were 18 males and 13 females;14 cases in left side,17 in right side,with degree of hydronephrosis of (2.8 ± 0.6) cm and stone size of (1.6 ±0.5) cm.In group C,there were 44 males and 31 females;36 cases in left side,39 in right side,with degree of hydronephrosis of (2.8 ± 0.7) cm and stone size of (1.7 ± 0.5) cm.There was no significant difference in aspects of age,degree of hydronephrosis and stone maximum diameter.Statistical analysis was performed regarding operation time,fee for hospitalization and stone free rate among the three groups.Results Ittook (71.8±9.6) min,(62.2±ll.4) min and (65.4±6.8) min in group A,BandC respectively,and there was significant difference among three groups.When comparing two groups respectively,the operation time in group A was more than group B and C significantly,while group B and C shared no difference.As for fees in hospitalization,they were (27.2 ± 4.0),(22.4 ± 5.0) and (22.4 ±3.8) thousand Yuan in three groups,and significant difference was found.By comparing two groups,we found that the fees in group A were more than group B and C significantly,while group B and C had no difference.Finally,stone free rate was compared among three groups,they were 90.3％,64.5％,96％ respectively,and there was significant difference as well.By further study,we found that stone free rate in group C was the highest,followed by A and B group.Conclusions There were higher stone free rates,less operation time and expense to perform ureteroscopic Holmium laser lithotripsy in supine half-sitting lithotomy position.

Effect observation of a novel pressure controlled water jet in transurethral resection of bladder tumor / 肿瘤研究与临床

Objective To observe the effect of a novel pressure controlled water jet used in transurethral resection of bladder tumor. Methods Clinical data of 12 patients who underwent a transurethral resection of bladder tumor by using a novel water jet was retrospectively analyzed. Results All 12 cases were successfully operated. Estimated blood loss during operation was less than 5 ml. Operation time was 20-45 minutes (median was 28 min), time of water injection was 8-15 minutes (median was 12 min). There were no significant complications. All patients were followed up for 4-10 months, and tumor recurrence or progression was not found by cystoscopic examination. Conclusion Transurethral resection of bladder tumor by using a novel pressure controlled water jet is advantageous with favorable safety and feasibility.