The safety and efficacy of radiofrequency in the treatment of overactive bladder / 中华泌尿外科杂志

Objective:To explore the safety and efficacy of radiofrequency in the treatment of overactive bladder(OAB).Methods:A prospective, multicenter, non-randomized controlled trial was conducted. Eligible patients were divided into test group and control group in Zhejiang Provincial People’Hospital, The First Affiliated Hospital of Wenzhou Medical University, and Sir Run Run Shaw Hospital affiliated to Zhejiang University School of Medicine from March 2019 to June 2020. Inclusion criteria: patients diagnosed with OAB, and bladder capacity>100ml. Exclusion criteria: pregnant and lactating women; patients with secondary OAB symptoms such as urinary tract obstruction; patients with uncontrolled urinary tract infection within 1 week; patients in stable stage by using other treatment methods; patients implanted with any nerve stimulator, cardiac pacemaker or implantable defibrillator; patients with malignant tumors, serious cardiovascular, cerebrovascular diseases, renal insufficiency or received BTX treatment in recent 12 months. The patients were allocated to test group and the control group in a ratio of 2∶1 according to the time sequence of the visit. The patients in the test group were treated with radiofrequency treatment. After entering the group, they were treated for 4 times at the 1st, 2nd, 7th and 8th week respectively. In the control group, the energy was turned off during the radiofrequency treatment. The patients were followed-up every week until the end of the 12th week. The treatment success rate [the average frequency of urination in 24 h was reduced more than 50% from the baseline or returned to the normal (≤8 times/day) or the average frequency of urgent urination in 24 h was reduced more than 50% from the baseline], the frequency of urination, urgent urination and nocturnal urination before and after treatment, the residual urine volume of the bladder, the quality of life (QOL) score and the occurrence of catheter related adverse events in two groups were compared.Results:114 patients were enrolled in the study, including 76 patients in the test group and 38 patients in the control group. There were no significant differences in the age [(44.2±12.8) vs. (41.7 ± 12.1) years old], male female ratio (13/63 vs. 4/34), average course of disease [2.0(1.2, 5.0) vs. 2.0 (1.0, 4.0) years], the frequency of urination[12.8 (10.6, 16.8) vs. 12.8 (10.3, 17.0) times], urgency urination [11.8(9.3, 15.8) vs. 11.8 (9.0, 17.0) times], nocturia [2.7 (1.3, 3.7) vs. 2.3(0.7, 3.3) times], residual urine volume of bladder [12.0 (3.0, 28.0) vs. 14.0 (3.7, 20.0) ml ] and the QOL score [5.0(4.0, 5.0) vs. 4.0(4.0, 5.0)]before the treatment between the two groups ( P>0.05). The treatment success rate in the test group was 76.3% (58/76), while 26.3% (10/38) in the control group, with a statistically significant difference ( P<0.01). There were significant differences between the test group and control group in the frequency of urination [9.7 (7.7, 12.0) vs. 12.9 (9.6, 15.7) times], urgent urination [7.3 (5.0, 10.0) vs. 11.7 (7.3, 15.3) times], nocturia [1.3 (0.7, 2.0) vs. 1.7 (1.0, 3.0) times] and the QOL score of the patients[3.0(1.0, 3.0) vs. 4.0(3.0, 4.5)]after the treatment(all P<0.05). The frequency of urination, urgency urination, nocturia, the residual urine volume and the QOL score in the test group were significantly improved ( P<0.05) after the treatment.The frequency of urination, nocturia, residual urine volume and the QOL score in the control group were improved ( P<0.05) after the treatment. 13 (11.4%) patients had catheter related adverse events. In the test group and the control group, there were 7 cases of macroscopic hemorrhage caused by the placement of instruments (5/76 vs. 2/38), 5 cases of acute urinary tract infection within 3 days (3/76 vs. 2/38), and 1 case of instrument breakage (catheter breakage) (0/76 vs. 1/38). There were no significant differences in the adverse events between the two groups ( P> 0.05). Conclusions:Radiofrequency treatment of OAB can effectively improve the symptoms of patients, improve the QOL of patients, and has low incidence of adverse events, with good efficacy and safety.

The efficacy and safety of green laser enucleation of prostate with end-fire fiber in treating benign prostatic hyperplasia / 中华泌尿外科杂志

Objective:To investigate the efficacy and safety of green laser vaporization enucleation of the prostate with end-fire fiber in the treatment of benign prostatic hyperplasia.Methods:The clinical data of 218 patients with benign prostatic hyperplasia admitted to Zhejiang Provincial People's Hospital from August 2018 to July 2019 were retrospectively analyzed. All 218 patients presented symptoms of varying degrees of frequent voiding, urgency, nocturia, and progressive dysuria, with age of(76.2±8.4) years, prostate volume of(77.3±21.6) ml, and preoperative PSA of (3.5±0.9)ng/ml, preoperative maximum urine flow rate (Qmax)of(7.9±1.8)ml/s, residual urine volume of(82.3±26.3)ml, quality of life score(QOL) of(4.9±1.1)points, and International Prostate Symptom Score (IPSS) of (25.4±7.6) points. Lithotomy position was used intraoperatively, and intravenous combined general anesthesia or intraspinal anesthesia was performed before the green laser vaporization enucleation of the prostate. Intraoperatively, green laser equipment used a vaporization power of 80W, an optical fiber with a end-fire fiber of 800μm in diameter, and hemostasis power of 20W. The surgical procedure was firstly to vaporize and cut 3 grooves from the bladder neck to the ejaculatory hole plane of the prostate at 5, 7 and 12 o'clock, reaching deep enough to expose the surgical capsule, in order to set up" three lines and one side" anatomical landmarks. A combination of sheath peeling and vaporization cutting along the envelope layer was used to enucleate the hyperplastic glands according to the " three-leaf " method. After enucleation, the tissue was pushed into the bladder, and the enucleated tissue was crushed and aspirated with a tissue morcellation. Perioperative and postoperative parameters including vaporized enucleation time, tissue morcellation time, hemoglobin changes, bladder irrigating time, indwelling catheterization time, postoperative hospital stay, postoperative Qmax, residual urine volume, postoperative complications, IPSS and QOL were recorded. Urgency with involuntary urine leakage was diagnosed as urge incontinence, involuntary urine leakage after coughing was diagnosed as stress urinary incontinence, and the incontinence degree was defined according to the amount of pad used, with mild of 1-2 pads/day, moderate of 3-4 pads/day, and severe of 5 or more pads/day.Result:All 218 operations were successfully completed. Capsule perforation occurred in 8 cases(3.7%), and there was no bladder perforation. The time of vaporization and enucleation was (42.5±8.3)min, and the time of tissue morcellation was(12.1±3.4)min. The intraoperative and postoperative hemoglobin loss was(4.7±1.3)g/L, and there were no blood transfusion or re-operation for stopping bleeding. The average bladder irrigation time after operation was(6.3±1.6)h, the average indwelling catheterization time was(1.2±0.2)days, and the average postoperative hospital stay was (2.2±0.7)days. The Qmax 1 month after operation was(18.5±4.8) ml/s, and the residual urine volume of the bladder was(6.4±1.9)ml, which showed a statistical difference compared with the preoperative parameters( P<0.01). In addition, the QOL(2.1±0.4) and IPSS(7.1±2.1)showed a statistical difference at 3 months follow-up, compared with the parameters before or 1 month after the operation( P<0.01). The volume of the prostate at 3 months after the operation was(34.6±6.3) ml, and the PSA was(2.4± 0.5) ng/ml, which was statistically different from the preoperative corresponding parameters( P<0.01). During the follow-up within one year, 11 cases were detected incontinence during the 1-month follow up, including 6 cases of urge incontinence. After drug treatment, good continence achieved 3 months after the operation. The other 5 cases had stress urinary incontinence, 3 of whom got good continence after the drugs treatment and pelvic floor muscle exercise, and two patients recovered to one pad per day. A total of 24 cases of urethral stricture were found during the 12-month follow-up, including 16 cases of anterior urethral stricture, which was treated with 3 months of regular urethral dilation. Another 8 cases had bladder neck contracture, and were treated by bladder neck resection and regular urethral dilatation. All of them did not recur 6 months after the procedure. Conclusions:The end-fire green laser vaporization enucleation of the prostate has the advantages of short operation time, less intraoperative bleeding, and obvious improvement in postoperative symptom scores. The short-term effect is obvious, and the long-term effect still needs further study to confirm.

Efficacy and safety study of Chinese botulinum toxin A 100U in patients with overactive bladder: a prospective, multicenter, double-blind and randomized controlled trial / 中华泌尿外科杂志

Objective:To assess the efficacy and safety of 100 units of botulinum toxin A (BTX-A) intradetrusor injection in patients with overactive bladder.Methods:From April 2016 to December 2018, 17 tertiary hospitals were selected to participate in this prospective, multicenter, randomized, double-blind, placebo-controlled study. Two phases of study were conducted: the primary phase and the extended phase. This study enrolled patients aged 18 to 75 years who had been inadequately managed by anticholinergic therapy (insufficient efficacy or intolerable side effects) and had spontaneous voiding with overactive bladder. Exclusion criteria included patients with severe cardiac, renal and hepatic disorders, patients with previous botulinum toxin treatment for 6 months or allergic to BTX-A, patients with urinary tract infections, patients with urinary stones, urinary tract tumors, diabetes mellitus, and bleeding tendency. Eligible patients were randomly assigned to BTX-A group and placebo control group in a ratio of 2∶1. Two groups of patients received 20 intradetrusor injections of BTX-A 100U or placebo at the depth of the submucosal muscle layer respectively under cystoscope, including 5 injections at the base of the bladder, 3 injections to the bladder triangle, 5 injections each to the left and right walls and 2 injections to the top, sparing the bladder neck. As a placebo control group, patients received same volume of placebo containing no BTX-A and only adjuvant freeze-dried preparations for injection with the same method. A combination of gelatin, sucrose, and dextran served as adjuvants. Average micturition times per 24 hours, urinary incontinence (UI) episodes per day, average micturition volume per day, OAB symptom score(OABSS), and quality of life (QOL) score were recorded at baseline and the 2nd, 6th and 12th week after treatment. The primary efficacy endpoint was the change from baseline in the average micturition times per 24 hours at the 6th week after treatment. The secondary efficacy endpoints included the change from baseline in the average micturition times per 24 hours at 2nd and 12th week, as well as the change from baseline in the OABSS, QOL score, average frequency of urgency and UI episodes per day, urgency score, average micturition volume per day at 2nd, 6th and 12th week after treatment. Patients were followed for 12 weeks to assess adverse events (AEs). After assessed at week 12, if the micturition times has decreased less than 50% compared to baseline and the patient is willing to receive retreatment, then patients could enter the extended trial phase. In that phase, patients in both groups were injected with 100 units BTX-A from 12th week onwards and then followed up the same indicators for 12 weeks.Results:216 patients were enrolled in this trial (144 cases in the BTX-A group and 72 cases in the placebo control group). Baseline characteristics such as age (47.75±14.20 in the BTX-A group and 46.39±15.55 in the control group), sex (25 male/117 female in the BTX-A group and 10/61 in the control group), and disease duration (0.51 years in the BTX-A group and 0.60 years in the control group) were balanced between the two groups( P>0.05). A marked reduction from baseline in average micturition times per 24 hours was observed in all treatment groups at the 6th week and the reduction of the two groups was statistically different ( P<0.001 and P=0.008 respectively). Compared with the baseline, the average micturition times per 24 hours at the 6th week decreased from baseline by 2.40(0.70, 4.60)times for the BTX-A group and 0.70(-1.00, 3.30) times for the placebo control group respectively, and the difference between the two groups was considered to be statistically significant ( P=0.003). The change rates of average micturition times per 24 hours from baseline at the 6th week of the two groups were (16±22)% and (8±25)% respectively, and the difference between the two groups was statistically significant ( P=0.014). Compared with the baseline, the average micturition times per 24 hours at 2nd and 12th week decreased by 2.00(0.00, 4.00)and 3.30(0.60, 5.03)for the BTX-A group, 1.00(-1.00, 3.00)and 1.70(-1.45, 3.85)for the placebo control group respectively. The difference between two groups was considered to be statistically significant ( P=0.038 and P=0.012); the changes of average urgency times per day for the BTX-A group and the control group at the 2nd, 6th and 12th week were 2.00(0.00, 4.30)and 2.40(0.30, 5.00), 3.00(0.30, 5.70)and 0.70(-1.30, 2.70), 0.70(-1.30, 3.00) and 1.35(-1.15, 3.50), respectively. There were significant differences between two groups at the 2nd, 6th and 12th week, ( P=0.010, P=0.003 and P=0.025, respectively). The OABSS of the BTX-A group and the control group at the 6th week decreased by 1.00(0.00, 4.00)and 0.50(-1.00, 2.00) compared with the baseline, and the difference between the two groups was statistically significant ( P=0.003). 47 cases of BTX-A group and 34 cases of placebo control group entered the extended trial phase, and 40 and 28 cases completed the extended trial phase, respectively. The average micturition volume per 24 hours changed by -16.60(-41.60, -0.60)ml and -6.40(-22.40, 13.30)ml, (-35.67±54.41)ml and(-1.76±48.69)ml, (-36.14±41.51)ml and (-9.28±44.59)ml, (-35.85±43.35)ml and(-10.41±40.29)ml for two groups at the 12th, 14th, 18th and 24th week, and the difference between two groups was statistically significant at each follow-up time ( P=0.01, 0.006, 0.012 and 0.016, respectively). There was no significant difference in other parameters( P>0.05). However, adverse reactions after intradetrusor injection included increased residual urine volume (27 in the BTX-A group and 3 in the control group), dysuria (21 in the BTX-A group and 6 in the control group), urinary infection (19 in the BTX-A group and 6 in the control group), bladder neck obstruction (3 in the BTX-A group and 0 in the control group), hematuria (3 in the BTX-A group and 1 in the control group), elevated alanine aminotransferase (3 in the BTX-A group and 0 in the control group), etc. During the follow-up period, there was no significant difference in the other adverse events between two groups except the increase of residual urine volume( P<0.05). In the primary trial phase, among the 27 cases with increased residual urine volume in BTA group, only 1 case (3.70%) with PVR more than 300 ml; the PVR of 3 patients in the placebo group was less than 100 ml. The increase of residual urine volume caused by the injection could be improved or disappeared with the passage of time. Conclusions:Intradetrusor injection of Chinese BTX-A improved the average micturition times per 24 hours, the average daily urgent micturition times, OABSS, and average micturition volume per time, and reduced the adverse effects in patients with overactive bladder.Chinese BTX-A at dose of 100U demonstrated durable efficacy and safety in the management of overactive bladder.

Genomic characteristics of 2019 novel coronavirus in Suzhou City / 中华传染病杂志

Objective:To investigate the viral molecular mutations of 2019 novel coronavirus (2019-nCoV) and host adaptability in Suzhou City.Methods:The throat swab specimens from nine local cases and six imported cases with 2019-nCoV viral nucleic acid test positive in Suzhou City were sequenced for the whole genome of the virus, and the Wuhan-Hu-1 strain was used as the reference sequence for alignment and analysis. The phylogenetic tree of the viral whole genome sequence was constructed by MEGA 7.0 software.Results:According to the Chinese typing method, Nextstrain typing method, Pangolin classification method and Global Initiative on Sharing All Influenza Data (GISAID) typing method, the 15 2019-nCoV genome sequences could be divided into seven types, six types, eight types and five subtypes, respectively. Compared with Wuhan-Hu-1 strain, the median number of amino acid sequence mutation sites based on nucleotide translation was three (ranging from 0 to 12). D614G mutation of spike protein was identified from all six imported viral strains, which could enhance the transmissibility. No Alpha, Beta, or Gamma mutants, which also could enhance the transmissibility, was found in the genomic sequences of the imported cases. The median number of nucleotide mutation sites in 15 sequences was eight (ranging from three to 23).Conclusions:2019-nCoV is constantly mutating, and a variety of evolutionary lineages/genotypes have been derived. All imported viruses in Suzhou City carry mutations that can increase infectivity.

Primary experience in the treatment of neurogenic bladder with robotic assisted ileum augmentation cystoplasty / 中华泌尿外科杂志

Objective:To explore the feasibility, safety and clinical efficacy of ileum augmentation cystoplasty assisted by Da Vinci robot for the treatment of neurogenic bladder.Methods:Retrospective analysis was performed on the data of 12 patients with neurogenic bladder admitted to Zhejiang Provincial People’s Hospital from March 2017 to November 2018, including 11 males and 1 female, with the mean age of 38(12-67). Preoperative symptoms were urinary incontinence, dysuria, decreased bladder capacity, or increased bladder pressure leading to ureteral reflux. All the 12 patients underwent preoperative intermittent catheterization, including 8 patients with spinal cord injury and 4 patients with spinal cord dysplasia. Preoperative serum creatinine(129.58±44.60)μmol/L and total glomerular filtration rate(61.63±18.04)ml/(min·m 2) were observed in 12 patients. Preoperative urodynamic examination showed the safe bladder volume of (95.67±39.10)ml, bladder internal pressure of(63.30±6.02)cmH 2O(1 cmH 2O=0.098 kPa)at the end of filling period, bladder compliance of(10.24±1.14)ml/cmH 2O, residual urine volume of(152.58±80.89)ml, and urine flow rate of(3.88±3.63)ml/s. Bladder contracture was evident on preoperative cystography. Ultrasound examination showed different degree of hydronephrosis and ureter expansion, in all cases, with ureteral reflux grading Ⅰin 2 cases, grade Ⅱ in 4 cases, grade Ⅲ in 4 cases, grade Ⅳ in 2 cases. All the 12 patients underwent robot-assisted ileum augmentation cystoplasty with 5-point puncture. Transverse incision of the bladder wall before full thickness, according to the amount of bladder and quality to decide 30 cm(normal), longitudinal cut back loops and one point after suture fixation in the bladder wall midpoint, fixed point as starting point, in turn, will be blind to the bladder stitching on both sides, the bilateral ureteral placing a single J tube respectively, evaluation of surgical success rate (including intraoperative bleeding, interception of bowel loops are no damage adjacent viscera, ureter openings with and without damage, impermeability, match insufflate whether unobstructed), postoperative complications, anastomotic fistula, intestinal obstruction, abdominal bleeding), urine dynamics test parameters, and patients’ quality of life. Patients were regularly given anticholinergic drugs(2 mg/d) for 6 months after surgery. Results:All the 12 cases in this group were successfully completed without any transfer to open surgery. The operation time was(120.8±12.0)min. Intraoperative blood loss(84.0±23.2)ml. Postoperative intestinal function recovery time(3.3±1.3) d. Postoperative hospital stay(12.1±3.1)d. Postoperative pelvic drainage tube indwelling time (3.8±1.2) d. Catheter and single J tube were removed 2 weeks after operation. Postoperative follow-up averaged 19.4(3-24) months. At 3, 12, 24 months after surgery, the bladder safety volume was rechecked(435.83±33.56), (450.90±31.09), (462.00±33.72)ml, the bladder internal pressure at the end of filling was(18.60±0.92), (15.70±1.42), (12.96±1.34)cmH 2O, the blood creatinine level was(81.43±21.10), (74.34±15.70), (72.90±15.90)μmol/L, and the bladder compliance was(37.94±4.22), (40.40±3.98), (43.42±4.20)ml/cmH 2O and the total glomerular filtration rate(91.52±9.49), (102.18±5.65), (112.41±6.50)ml/(min·m 2) were significantly improved compared with those before surgery( P<0.001). After 24 months of bladder urination training, 1 patient could basically urinate by herself. Three patients were treated with intermittent urinary catheterization supplemented by automatic urination. The remaining 8 patients were completely dependent on urinary catheter for intermittent catheterization. Postoperative complications such as anastomotic fistula, ileus and abdominal bleeding were not found in 12 patients. Conclusions:Ileum bladder enlargement assisted by robot can effectively expand bladder volume, reduce bladder internal pressure, improve bladder compliance, prevent ureteral reflux and protect renal function.

Preliminary study on treatment of large-volume(>90 ml ) benign prostatic hyperplasia with low power end-fire greenlight laser vaporization and enucleation / 中华泌尿外科杂志

Objective:To study the feasibility, efficacy and safety of low-power greenlight laser vaporization and enucleation with end-fire fiber in the treatment of large-volume (>90 ml ) benign prostatic hyperplasia.Methods:A retrospective analysis of 138 patients with benign prostatic hyperplasia volume greater than 90ml at Zhejiang Provincial People's Hospital from January 2016 to July 2018. The average age of the patients was (73.5±7.3) years and the average prostate volume was (110.2±23.7) ml, the median maximum urine flow rate before surgery was 5.3 (1.0-10.0)ml/s, and the median residual urine before surgery was 78.5 (51.6-108.5) ml. All patients underwent transurethral enucleation with greenlight laser vaporization and enucleation. The intraoperative vaporization power was 80 W and the optical fiber was end-fire fiber, the hemostasis power was 20 W. The optical fiber was straight out of the greenlight laser fiber. The combination of green laser vaporization and blunt dissection of the lens sheath was used to find the capsule, and the " three-leaf method" was used to enucleate the two and middle lobes of the prostate along the capsule level. After the enucleation, the tissues were pushed into the bladder, and the tissue morcellation was used. The tissue was crushed and removed after enucleation. After operation, an F20 three-cavity catheter was placed, and the balloon was filled with 50 ml of water. After 24 hours, the bladder was given a normal saline irrigation, and the catheter was removed 48 hours after the operation. Statistical analysis of these patients' baseline characteristics, perioperative results and complications.Results:The operation of 138 cases was successfully completed. The time of vaporization and enucleation was (58.6±6.1) minutes, and the time of morcellation was (12.6±5.6) minutes. Intraoperative and postoperative hemoglobin loss was (6.2±1.5) g/L, and no transfusion was required. Postoperative pain score(NRS) of 89 cases was 0, and 49 cases was 1. 123 patients who were removed catheter after 48 hours could urinate well, and 15 patients need re-catheterization. The catheter was removed again 7 days after surgery, and all patients returned to normal urination. Two cases of transient urinary incontinence occurred after the operation, both of which were urgent urinary incontinence. Both patients improved after oral tolterodine treatment and there was no stress urinary incontinence. There were 5 cases of urethral stricture after operation, all of which occurred 3 months after operation. They were cured after urethral stricture dilation or bladder neck orifice resection. The median maximum urinary flow rate was 17.5 (14-22) ml/s and the residual urine was 6.2 (2.7-11.3) ml in 1 month after operation, which were significantly different from preoperative parameters ( P <0.05). The maximum urinary flow rate was 16.1 (13-20) ml/s at 3 months postoperatively and 17.3 (11-24) ml/s at 12 months postoperatively, and remained stable. Conclusions:Low-power greenlight laser vaporization and enucleation in treating large-volume>90 ml has the advantages of short operation time, less pain, less blood loss, and quick recovery after surgery. The incidence of urinary incontinence and postoperative cardiovascular accident is low.

A multicenter clinical study of comparing the efficacy of two mid-urethral slings in the treatment of female stress urinary incontinence / 中华泌尿外科杂志

Objective:The clinical efficacy, safety and quality of life in female patients with stress urinary incontinence (SUI)treated by midurethral sling were studied by multicenter retrospective study.Methods:From January 2018 to December 2018, 531 female patients with severe stress urinary incontinence from seven domestic urinary center were included in this study, including 78 cases from General Hospital of Central Theater Command, 122 cases from Shanghai Jiao tong University School of Medicine Affiliated Ren Ji Hospital, 67 cases from Shanghai Jiaotong University Affiliated First People’s Hospital, 68 cases from People’s Hospital of Jiangsu Province, 71 cases from The First Affiliated Hospital of Xi’an Jiaotong University, 65 cases from Zhejiang Provincial People’s hospital, 60 cases from Xiamen University First Affiliated Hospital. Among the 531 patients, 214 cases received TVT sling with an average age of (58.14±10.16) years. 181 cases were in postmenopausal(84.6%). The number of births ≥2 times was 89 (41.6%) cases. The score of ICI-Q-SF was 16.00±1.73. There were 166 cases of moderate incontinence (77.6%) and 48 cases of severe incontinence (22.4%). There were 317 patients in the TOT/TVT-O group with an average age of (58.33±10.25) years. 247 cases were in postmenopausal(77.9%). The number of births ≥2 times was 120 (37.8%) cases. The score of ICI-Q-SF was 15.79±1.75. There were 256 cases of moderate incontinence (80.8%) and 61 cases of severe incontinence (19.2%). There was no statistically significant difference in general data parameters between the two groups ( P>0.05). 1, 6, 12 months after the operation, the two groups of patients incontinence questionnaire Summary(ICI-Q-SF), common complications and Patient Global Impression of Improvement(PGI-I), satisfaction evaluation follow-up. ICI-Q-SF score improved > by 50% (cure + significant improvement) and 1-hour pad test <10 g (qualitative index) were used as the evaluation index of surgical success. Result:Both of the two surgical methods have high successive rate. There was no significant difference between 94.9% (203/214) of the TVT group and 93.7% (297/317) of the TOT/ TVT-O group ( P>0.05). Postoperative improvement of urinary incontinence (cure rate) [88.3% (189/214)]in the TVT group was slightly higher than that in the TOT/ TVT-O group [77.0% (244/317)] ( P<0.05). There was no change in the recurrence rate of urinary incontinence in the follow-up 6 and 12 months after the operation. There was no statistically significant difference between 4.4% (9/203) in the TVT group and 5.4% (16/297) in the TOT/TVT-O group ( P>0.05). The subjective cure rate 12 months after the operation was 96.3% (206/214) in the TVT group and 95.9% (304/317) in the TOT/TVT-O group ( P>0.05). 10 patients occurred bladder perforation occurred in the TVT group, and no bladder perforation occurred in the TOT/TVT-O group ( P<0.001). The incidence of pain and discomfort in the TVT group was significantly lower at 1.9% than that in the TOT/TVT-O group at 6.9% ( P<0.01). There was no statistically significant difference between the two groups in the incidence of complications such as dysuria/urinary retention, frequent urination/urgency incontinence. Both of them exposed sling ( P>0.05). Conclusion:Both TVT and TOT/TVT-O sling can effectively treat female stress urinary incontinence, and both can improve the sexual satisfaction of patients after the surgery, with fewer complications and other advantages. The selection of specific surgical methods in clinical practice can be individualized according to the patient's physical conditions, clinical needs and the operation methods familiar to doctors.

Safety and efficacy of sacral neuromodulation therapy for lower urinary tract dysfunction in elderly people: A multicenter study / 中华老年医学杂志

Objective:To investigate the safety and efficacy of sacral neuromodulation(SNM)therapy for the treatment of lower urinary tract dysfunction(LUTD)in elderly patients.Methods:Clinical data of 91 elderly patients with LUTD from multiple medical institutions who received SNM during the period from January 2012 to December 2016 were retrospectively analyzed.Patients were divided into four groups: the interstitial cystitis(IC)group(n=28), the neurogenic bladder(NB)group(n=36), the overactive bladder syndrome(OAB)group(n=13)and the idiopathic dysuria(ID)group(n=14). Different sets of evaluation parameters were used for different diseases.Patients’ baseline data and data in stage I(test phase)and stage Ⅱ(permanent SNM)were recorded, statistically analyzed and compared.Results:Ninety-one people underwent SNM treatment.Of them, 53 patients received permanent implants(stage Ⅱ), and the total conversion rate of stage I to stage Ⅱ was 58.2%(53/91). Patients receiving permanent implants(stage Ⅱ)had a preoperative period ranging from 3 months to 30 years, and were followed up for 2 to 58 months after treatment, with an average follow-up of 19.6 months.The improvement rates in stage I for urinary urgency, daily urination frequency, daily nocturnal urination frequency, maximum urine volume, daily average urine volume, daily urine leakage frequency, and quality of life score were 35.4%, 31.6%, 33.7%, 32.6%, 49.2%, 43.2% and 13.2%, respectively.The improvement rates in stage Ⅱ for urinary urgency, daily urination frequency, daily nocturnal urination frequency, maximum urine volume, daily average urine volume, daily urine leakage frequency, and quality of life score were 43.2%, 40.0%, 37.8%, 50.5%, 70.5%, 70.4% and 43.2%, respectively.Three adverse events occurred, including 1 case of recurrent symptoms, 1 case of moderate infection, and 1 case of electrical lead dislocation.Conclusions:Sacral nerve stimulation has definitive and consistent curative effects on LUTD in elderly people.The follow-up time should be extended to further study the safety of sacral nerve stimulation.

Application of sacral neuromodulation in lower urinary tract diseases related to pelvic floor dysfunction / 中国医师杂志

Pelvic floor dysfunction associated with lower urinary tract diseases,is a common disease in women.Sacral neuromodulation is a safe and effective new technique with small trauma,which has significant advantages for patients with refractory pelvic floor dysfunction-related lower urinary tract diseases and has good clinical application prospects.

Postoperative urinary function recovery after complete robotic assisted radical cystectomy and in situ U-shaped ileal neobladder / 中华泌尿外科杂志

Objective To investigate postoperative urinary function recovery after complete robotic assisted radical cystectomy and in situ U-shaped ileal neobladder.Methods Retrospective analysis of 79 cases of local progression bladder cancer (cT2-3 N0-2 Mo) in our hospital from September 2014 to September 2018.79 cases were confirmed by pathology as high-grade uroepithelium cell carcinoma of bladder.Posterior urethra and bladder neck biopsy did not see tumor invasion.The urodynamic examination for all patients before surgery showed no significant decrease in urinary control function.Preoperative International urinary Incontinence Advisory Committee urinary Incontinence Questionnaire summary confirmed that there was no obvious urinary incontinence symptoms.All patients underwent radical bladder resection and in situ Ushaped ileum new bladder surgery.40 cases in the experimental group were treated with complete robot assisted radical bladder resection and in situ U-shaped ileum new bladder.39 cases in control group were treated with laparoscopic surgery.There was no statistically significant difference between the two groups of general data (both P ＞ 0.05).The operation time,bleeding volume,positive rate of postoperative incision,postoperative hospitalization time,new bladder capacity,residual urine volume,maximum urinary flow rate,bladder internal pressure,unilateral ureteral reflux and stenosis incidence,as well as immediate urinary control rate after extraction of catheter and 1,3,6 and 12 months of urinary control recovery were compared.Results 79 cases of this study were successfully completed.The operation time of the two groups [(286.5 ±37.2) min vs.(288.5 ±32.9) min,P =0.801],intraoperative blood loss[(185.1±41.6) ml vs.(189.3 ±54.2) ml,P =0.700].There was no significant difference in the average postoperative hospital stay [(14.3 ± 1.6)d vs.(14.9 ±2.2)d,P =0.168].The margins of the pathological examinations in both groups were negative.New bladder volume after surgery [(300 ± 10) ml vs.(245 ± 10) ml,P ＜ 0.001].Urodynamic examination of residual urine volume [(20 ± 10) ml vs.(50 ± 10) ml,P ＜0.001],maximum urine flow rate [(16 ±4) m1/s vs.(13 ±2) m1/s,P =0.006].Intravesical pressure [(22.5 ±3.0) cmH2Ovs.(17.5 ± 2.5) cmH2O,P ＜ 0.001] (1 cmH2O =0.098 kPa).The two groups of postoperative cystoscopy showed that unilateral ureteral reflux was 5％ (2/40) and 20.5％ (8/39),respectively,and the unilateral ureteral anastomotic stenosis was 2.5％ (1/40) and 15.4％ (6/39) after operation,and the difference was statistically significant (P =0.038,P =0.044).The urine control rate of the observation group and the control group immediately after removal of the catheter was 37.5％ (15/40) and 15.4％ (6/39),respectively.The urine control rate in 1 month was 62.5％ (25/40) and 38.5％ (15/39),respectively.The urine control rate in 3 month was 82.5％ (33/40)and 56.4％ (22/39),the difference was statistically significant (P =0.026,P =0.033,P =0.012).At other follow up time points,there was no significant difference in point-controlled urine rate (P ＞ 0.05).Conclusions Complete robot-assisted radical cystectomy and in situ U-shaped ileal neobladder surgery are more advantageous than standard laparoscopic surgery in time of the early recovery urinary function.

Robotic-assisted laparoscopic Boari flap ureteroplasty for ureteral strictures after kidney transplantation / 中华泌尿外科杂志

Objective To evaluate the clinical efficacy and safety of robotic-assisted laparoscopic Boari flap ureteroplasty for ureteral strictures after kidney transplantation.Methods The clinical data of 2 patients with ureteral stricture after kidney transplantation in our department from May 2017 to September 2017 were retrospectively analyzed.All 2 cases were male.Case 1 was 73 years old and the transplanted kidney was located in the left iliac fossa.The patient was hospitalized due to still recurrent fever with longterm retention of nephrostomy tube because of hydronephrosis with repeated urinary tract infection after calculi surgery.Case 2 was 62 years old and the transplanted kidney was located in the right iliac fossa.The patient was hospitalized due to hydronephrosis and ureteral calculi after calculi surgery.All 2 cases were treated by robotic-assisted laparoscopic Boari flap ureteroplasty.The operative and postoperative complications were recorded and the postoperative examination data were collected.Results The operation time of the 2 cases were 165min and 189min,and the bleeding amount were 50ml and 100ml respectively.No urinary leakage,renal colic,high fever and other complications occurred.In case 1,nephrostomy tube was removed 8d after operation.The urinary catheters were removed 14d after operation in the 2 cases.The postoperative hospital day was 9d and 6d respectively.CT examination was performed 3 months after surgery.Compared with preoperative,case 1 had no significant change in hydronephrosis and the hydronephrosis of case 2 obviously relieved.In case 1,double J tube was removed in 3 months after operation.In case 2,double J tube was replaced in 3 months after operation and was removed after 3 months.2 patients were followed up to 18 months and 14 months after operation,respectively.Nohydronephrosis aggravated.Conclusions Robotic-assisted laparoscopic Boari flap ureteroplasty is a safe and effective treatment for ureteral strictures after kidney transplantation.It has the advantages of small trauma,quick recovery,exact effect and few complications.

Efficacy analysis of sacral neuromodulation in treating juvenile neurogenic chronic urinary retention

This study aims to investigate the efficacy and safety of sacral neuromodulation [SNM] in treating juvenile neurogenic chronic urinary retention [NCUR]. The clinical data of three juvenile NCUR patients treated with SNM from June 2013 to December 2014 were retrospectively analyzed. The results of urodynamic examination of these three patients were all weak detrusor contraction. Nerve leads were implanted into the 3[rd] sacral nerve for 4-week in vitro testing. Urination diary, residual urine volume, constipation score and urodynamic parameters were recorded to assess the results. All these patients received significant improvements, so they subsequently underwent permanent implantation of the stimulator. The symptoms of dysuria, frequent urination and constipation were significantly reduced after surgery, and the residual urine volumes were decreased to 20 ml, 50 ml and 20 ml, respectively. Urination diary and urodynamic parameters were improved, compared with those before surgery. The patients were followed up until 18, 23 and 6 months after surgery, with stable efficacies and no adverse reaction. SNM could improve such symptoms as urination and constipation in juvenile NCUR patients, and the safety was high

Pure robotic-assisted radical cystectomy with orthotopic U-shape ileal neobladder:surgical technique / 中华泌尿外科杂志

Objective To investigate the surgical skills of pure robotic-assisted radical cystectomy with orthotopic U-shape ileal neobladder.Methods From October 2014 to September 2016,37 patients with locally advanced bladder cancer(cT2-3 N0-2 Mo)were diagnosed,including 29 males and 8 females,Their age ranged from 52 to 71 years old.According to preoperative cystoscopy,pathological diagnosis and bladder enhanced CT and other examination,25 patients were staged as cT2,12 cases were staged as cT3.25 cases of them were primary tumors,who underwent pure robotic-assisted radical cystectomy and Endo-GIA assisted orthotopic U-shape ileal neobladder reconstruction.First,bilateral lymph nodes were dissected.And the ureter was explored and dissected to the outer wall of the bladder.Then,we ligated the superior artery of bladder and expose the seminal vesicle,vas deferent duct.The DV fascia was opened to expose the posterior wall of prostate.Incise was performed along the both sides of the bladder and prostate fascia to maintain the vascular nerve bundle until the tip of prostate.The urethra was cut off and then the bladder was remove.We used Endo-GIA to cut 30-35 cm ileum and construct U-shaped bladder.The anastomosis between ureter and neo-bladder and the anastomosis between urethra and neo-bladder were performed.Perioperative and followup data were collected.Results The surgeries were successful in all 37 cases.The operation time ranged from 245 to 335 min,mean (285 ± 37) min.The mean intraoperative blood loss was (187 ± 56) ml (ranging 90-300 ml).The average postoperative hospital stay was (17 ± 2)days (ranging 15-20 days).Postoperative intestinal function recovery time ranged from 1.3 to 2.2 days,mean (1.7 ± 0.4) days.Surgical margins were all negative.Lymph node positive rate was 21.6％ (8/37).After 1 nonth,22 cases achieved complete continence.After 3 months,35 cases get fully self-control urination,8 cases have noctual incontinence.Postoperative follow-up ranged from 6 to 24 months,no recurrence or distant metastasis was found in this study.After 6 months,cystoscopy showed no obvious formation of bladder stones.Neo-bladder capacity ranged from 270 to 350 ml.The urodynamic examination showed bladder pressure was maintained between 19 and 25cm H2O.Conclusions Pure robotic-assisted radical cystectomy can achieve better bladder resection,better remaining of urethral and neurovascular bundles and good control of urinary continence after operation.Endo-GIA assisted orthotopic U-shaped ileal bladder need shorter intestinal tract and cause less influence to the intestinal function.The neo-bladder shape is more regular,simple doing,earn shorter operation duration,less bleeding,quick recovery,which is a safe and effective surgical approach.

Therapeutic Analysis of Two Kinds of Muscular Relaxation in Airway Foreign Body Removal Operation in Children / 中山大学学报(医学科学版)

[Objective] To observe the muscle relaxation clinical effect and the occurrence of intraoperative and postoperative complications,and the postoperative extubation and muscle strength recovery of Rocuronium and Succinylcholine in children during airway foreign body removal operation.[Methods] 80 cases of children (ASA I) with airway foreign body,among them,30 cases were older than 3 years old,were agreed to be on electively airway foreign body removal surgery.According to anesthesia induction,intravenous injection muscle relaxants were randomly divided into two groups (n =40):Rocuronium group (Group R) 0.9 mg/kg,Succinylcholine group (Group S) 1.5 mg/kg.According to the degree of muscle relaxation and operation time,if necessary,patients in Group R were added intravenous injection with Rocuronium 0.3 mg/kg,patients in Group S were added intravenous injection with Succinylcholine 0.5 mg/kg,the other drugs were consistent.Observation items included:the bronchoscopy conditions,the degree of muscle relaxation during operation,the numbers of intravenous injection muscle relaxant and atropine,the times of tracheal extubation,the dynamic observation about vital sign and hemodynamic intraoperative and postoperative,and the occurrence situation of complications,the incidence rate of muscle soreness in children older than 3 years old 24 h after operation.[Results] (1) There was no significant statistics difference between the two groups in the condition of bronchoscopy (P ＞ 0.05).(2)The patients in Group R were not required to add muscle relaxants and atropine,but all patients in Group S were required to add muscle relaxants and atropine (P ＜ 0.01).(3)The complications such as body movement,hypoxemia,restlessness during recovery period were happened in Group S,and in Group R,there were only 1 case of laryngeal spasm and restlessness during recovery period,there was statistically significant difference between the two groups (P ＜ 0.05).(4)The muscle strength recovery of 15 min in Group S was significantly higher than the Group R (P ＜ 0.01).(5) The time of tracheal cannula extubation was extended after the operation in Group R,there was statistically significant difference between the two groups (P ＜ 0.05).(6)30 cases patients older than 3 years old were followed up 24 h after operation,14 cases in Group S were found with the muscle soreness of trunk and limb,but none was found in 16 cases in Group R,there was statistically significant difference between the two groups (P ＜ 0.01).[Conclusions] The muscle relaxant effect was well during the removal of forcign body in children with Rocuronium and Succinylcholine,but the former provided a more security anesthesia condition,the muscle soreness of trunk and limb was not found in patient 24 h after operation;and the latter must continue to add drugs in operation,and the complications were found during and after the operation,the muscle soreness of trunk and limb was found in patient 24 h after operation.

Effect of quality control circle on maternal breastfeeding by parturients with nipple defects / 现代临床护理

Objective To explore the effect of quality control circle (QCC) on nipple maternal breastfeeding by parturients with nipple defects. Method A QCC with a theme ofimprove the maternal breastfeeding rate among the partureints with nipple defectswas established to investigate the current status, analyze the main causes, propose countermeasures and finally carry out countermeasures and check the effects according to the PDCA principles. Result The post-QCC adverse events of maternal breastfeeding in not enough lactation, breast swelling, cracked nipples, failure in the first suck and unqualified breastfeeding at discharge were significantly lower than those of pre-QCC ones (P<0.01). Conclusion Quality control circle can effectively solve the problems in nipple maternal breastfeeding and meanwhile improve the nurse work enthusiasm as well as their ability to solve problems.

The preliminary clinical results of laparoscopic ileum augmentation cystoplasty for low compliance bladder / 中华外科杂志

<p><b>OBJECTIVE</b>To study the effectiveness and safety of the laparoscopic ileal bladder augmentation treatment for low compliance bladder.</p><p><b>METHODS</b>A retrospective analysis was performed based on 36 cases admitted to the Zhejiang Provincial People's Hospital with highly reflective and low compliance bladder accepted laparoscopic ileal bladder augmentation surgical treatment from June 2011 to December 2013. In accordance with inclusion and exclusion criteria, 22 patients were enrolled in this study, including 13 males, 9 females who aged from 22 to 62 years with an average of 35.8 years. Among the selected sample, there were 15 cases of spinal cord injury, 4 cases of spinal cord dysplasia, and 3 cases of urinary tuberculosis. The duration of disease varied from 1 to 15 years, with an average of 8.5 years. For surgery, intraoperative and perioperative complications were observed, and preoperative serum creatinine in patients with postoperative at 3, 6, 12, 18, 24, 36 months, hydronephrosis, and glomerular filtration rate urodynamic parameters were used for univariate analysis of variance.</p><p><b>RESULTS</b>All patients were successfully completed in laparoscopic surgery, the operative time were (105 ± 17) minutes (90-150 minutes), blood loss was (90 ± 26) ml (60-150 ml), postoperative intestinal function recovery time were (2.5 ± 0.7) d (2-5 d), and postoperative hospital stay was (15.0 ± 4.2) d (11-20 d), while postoperative anastomotic leakage, intestinal blockage, severe abdominal infection or sepsis and other complications did not occur. Patients were followed up for 6 to 36 months, with an average of 16.5 months, among which 17 patients were followed up for over 12 months. The bladder safety capacity increased from (103 ± 38) ml preoperatively to (405 ± 46) ml at the end of the follow-up (F = 381.7, P = 0.000), and bladder compliance increased from (10 ± 3) cmH₂O (1 cmH₂O = 0.098 kPa) preoperatively to (38 ± 4) cmH₂O (F = 678.1, P = 0.000); the average pressure within the bladder filling at the end of the follow-up was (16 ± 6) cmH₂O, which was significantly lower (F = 221.5, P = 0.000) compared to preoperative level of (45 ± 16) cmH₂O, preoperative serum creatinine went down from (184 ± 32) µmol/L to (120 ± 28) µmol/L at the end of the follow-up (F = 189.1, P = 0.000); total glomerular filtration rate rose from (40 ± 26) ml⁻¹ · min⁻¹ · 1.73 m⁻² preoperatively to (66 ± 32) ml⁻¹ · min(-1) · 1.73 m⁻² (F = 137.7, P = 0.000). Qmax of the 3 cases of urinary bladder contracture tuberculosis patients increased significantly, while 4 female patients with residual urine volume decrease had voluntary urination.</p><p><b>CONCLUSIONS</b>Laparoscopic ileal bladder augmentation treatment for low compliance bladder is feasible and safe, with less trauma, less bleeding, less post-operative complications, and faster recovery of bowel function. Urinary function improves significantly after surgery, and function of upper urinary tract can also be effectively improved and protected in patients.</p>

Effect of Electroacupuncture on Nerve Root of Sacral Spinal Nerve 3 for Detrusor Hyperreflexia after Spinal Cord Injury / 中国康复理论与实践

@#Objective To observe the effect of electroacupuncture on nerve root of sacral spinal nerve 3 for detrusor hyperreflexia after spinal cord injury. Methods 32 spinal cord injury patients with detrusor hyperreflexia accepted electroacupuncture at sacral 3 nerve root.Their voiding diary, urodynamics and quality of life were observed before and 8 weeks after treatment. Results The frequency of urination,urine leakage, and filling the final detrusor pressure decreased (P<0.05), and the urine output, maximum bladder capacity, bladder compliance,score of quality of life increased (P<0.05) after treatment. There was no significant change in residual urine volume after treatment (P>0.05). Conclusion Electroacupuncture on nerve root of sacral spinal nerve 3 is effective on detrusor hyperreflexia after spinal cord injury.

The application of decompression in the treatment of gnathous cystic lesions / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the application of decompression in the treatment of ganthous cystic lesions.@*METHOD@#Decompression surgery were performed on 32 patients with gnathous cystic lesions, the cavities of cysts were open and the cysts pressure was relieved. The cavities of cysts were flushed after the operation and the prognosis were assessed in the regular follow-up.@*RESULT@#All cysts cavities were shrinks afer decompression operation. Through the X-line and/or CT scans, we could observe that the new bones formed around cysts cavities, tilt shift teeth were gradually corrected and the permanent tooth germs of pediatric patients almost returned to the right places and erupted; There were the only remaining small bone indentations in the 18 cases, which do not need the Phase II surgery. Eight cases of cysts cavities shrinks more than 50%, which needed cystectomy. Six cases of cysts cavities shrinks less than 50%, which were still in the follow-up treatment.@*CONCLUSION@#The decompression surgery is a simple, economical and effective method for the treatment of gnathous cystic lesions.

Sigmoid Colon Enterocystoplasty for Urge Incontinence of Neurogenic Bladder: 16 Cases Report / 中国康复理论与实践

@#Objective To observe the effect of sigmoid colon enterocystoplasty on urge incontinence of neurogenic bladder. Methods 16 patients with urge incontinence without bladder-ureter reflux or hydronephrosis accepted the sigmoid colon enterocystoplasty. They were followed up for 3~24 months. Results No bladder-ureter reflux and hydronephrosis was found. The biochemical parameters were stable. Constipation relieved. All the patients could urinate with abdominal pressure and no urge incontinence happened. The residual urine volume was 10~40 ml. Conclusion Sigmoid colon enterocystoplasty is effective on urge incontinence of neurogenic bladder, as well as on constipation.

Experimental Study on Yinhuang Solution on Bladder Mucosal Injury in Rat / 中国康复理论与实践

@#ObjectiveTo investigate the effects of Yinhuang solution on the bladder mucosal before and/or after mucosal injury.Methods32 SPF female SD rats were randomly divided into 4 groups with 8 rats in each group. Group A was used for the normal control group, group B for the model control group, group C for preventive group, group D for preventive and therapeutic group. Injured rats were created by hydrochloric acid applied on bladder mucosa. After the models were established or before and after the models were established, bladders were perused with Yinhuang solution. Severity of inflammatory infiltration were observed by HE staining, histological score and heat shock protein 70 (HSP70) expressed in the mucosa.ResultsEndoscopic pathological change showed that group B had a large number of inflammatory cell infiltration, significant expansion of capillary, epithelial cell necrosis. Group C had a small amount of expansion of capillary, inflammatory cell infiltration. Group D scattered in expansion of capillary, a small amount of inflammatory cell infiltration. Concerning the results of histological score and HSP70 expression, there was a significant difference between group A and groups B, C or D (P<0.01); there was a significant difference between group B and groups C or D (P<0.01); there was a significant difference between group C and group D (P<0.05).ConclusionYinhuang solution can evidently improve the repair capability of bladder mucosa after injury.