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1.
Chinese Journal of Urology ; (12): 128-131, 2022.
Article in Chinese | WPRIM | ID: wpr-933176

ABSTRACT

Objective:To investigate the feasibility and safety of single-position robotic assisted laparoscopic anterograde bilateral inguinal lymphadenectomy for penile cancer.Methods:The clinical data of 6 patients with penile cancer admitted to our hospital from January 2019 to January 2020 were retrospectively analyzed. The mean age was (52.0±8.6)years old. The pathology was primary focal squamous cell carcinoma, with 2 cases of high differentiation, and 4 cases of medium differentiation. All the 6 patients underwent single-position robotic assisted laparoscopic anterograde bilateral inguinal lymphadenectomy. Preoperative physical and imaging examinations indicated bilateral inguinal lymph node enlargement, and no distant metastasis was found in all of the 6 patients. The supine position was taken, with the head low and feet high about 15°, the legs straight and separated as far as possible in the shape of "Chinese eight" . The da Vinci robotic patient cart was placed between legs of the patient, after inserting the trocars. The external boundary of bilateral inguinal lymph node dissection was the line between the anterior superior iliac spine and 20 cm lower, the inner boundary was the pubic tubercle and its 15cm medial lower measurement, and the line between the inner boundary and the external lower edge was the lower boundary.Results:All the 6 operations were successfully completed without transfer to open surgery. Both sides of the inguinal lymph nodes were dissected at the same time. The space establishment and trocar insertion were performed simultaneously. There was no need for mobile robotic arm system during the operation. The average operative time was (105.0±20.5) min, and the amount of intraoperative blood loss was less than 50ml, the average hospital stay was(7±3) days. An average of(15.0±2.5) lymph nodes were dissected on each side. Intraoperative freezing suggested single positive lymph nodein 2 patients and no positive lymph node in 4 patients. There was no skin necrosis, 1 case of delayed wound healing, and 2 cases of lymphatic leakage. All patients were cured by conservative treatment. The 6 patients were followed up for 12-14 months, and there was no recurrence or metastasis.Conclusions:Single-position robotic assisted laparoscopic anterograde bilateral inguinal lymphadenectomy can achieve the expected surgical outcome, and has fewer perioperative complications. The surgery is safe and effective.

2.
Chinese Journal of Urology ; (12): 101-106, 2022.
Article in Chinese | WPRIM | ID: wpr-933171

ABSTRACT

Objective:To explore and compare the perioperative result and complications of robot-assisted radical cystectomy with intracorporeal and extracorporeal urinary diversion.Methods:Clinical data of bladder cancer patients undergoing robot-assisted radical cystectomy with ileal conduit in Zhejiang Provincial People's Hospital from January 2015 to March 2020 were retrospectively analyzed. Eighty-two patients underwent extracorporeal urinary diversion (ECUD group), and 122 underwent intracorporeal urinary diversion (ICUD group). In the ECUD group, the median age was 70(61, 76)years old, including 67 male (81.7%), the median BMI was 26.1(24.3, 28.5), 67 cases(81.7%) was ASA score 0-2, 15 cases (18.3%)was 3 or higher, 15 cases (18.3%) were high risk non-muscular invasive bladder cancer. 67 cases (81.7%) were muscular invasive bladder cancer. 16 cases (19.5%) received neoadjuvant chemotherapy. Past medical history included smoking in 35 cases (43.2%), hypertension in 31 cases (37.5%), diabetes in 17 cases (21.3%), heart disease in 13 cases (15.7%), and abdominal surgery in 15 cases (17.8%). In the ICUD group, the median age was 68 (62, 75), 95 male (77.9%), the median BMI was 25.6 (23.4, 27.8)kg/m 2, 105 cases(86.1%) was ASA score 0-2, 17 cases (13.9%)was 3 or higher, 29 cases (24.9%) were high risk non-muscular invasive bladder cancer, and 93 cases (75.1%) were muscular invasive bladder cancer. There were 22 cases (18.0%) undergoing neoadjuvant chemotherapy. Past medical history included smoking in 58 cases (47.3%), hypertension in 44 cases (32.6%), diabetes in 33 cases (22.8%), heart disease in 28 cases (26.7%), and abdominal surgery in 17 cases (14.2%). No significance was detected in characteristics between the two groups. For ileal bladder making and ureteral implantation method in ICUD group, 15 cm ileum was taken using stapler at the 15 cm from ileocecum to make ileal conduit and restore the continuity of the ileum. The proximal end of the ileal conduit was closed. The bilateral ureteral were implanted 3 cm apart on the ileal bladder. F6 single J tube was placed into both of the ureters to drain urine. For ECUD group, the subumbilical 5 cm incision was taken to enter the abdominal cavity. The ileocecum was found and the terminal ileum was taken out of the body. A segment of 15 cm in length ileocecum 15 cm away from the cecum was cut off with a linear cutting stapler and the blood vessels of arterial arch were ligated, then a small opening at the same ileum position was cut. The continuity of the ileocecum was restored. The ileal conduit was irrigated, and the bilateral ureters were placed into a single J tube and anastomosed to the ileal conduit 3 cm apart. The operation time, intraoperative blood loss, postoperative exhaust time, postoperative feeding time, postoperative hospital stay, postoperative incision pain score, postoperative readmission rate, peri-operative mortality, postoperative complications and pathology results were compared between the two groups. Results:All cases were successfully performed robotically without conversion or major intraoperative complications. There was no significant difference in operation time between ICUD group and ECUD group [260(230, 310) min and 235(220, 290) min, P=0.078]. The estimated blood loss in ECUD group was more than that in ICUD group [300(200, 400) ml and 150(100, 300), P=0.037], but there was no difference in blood transfusion rate between the two groups [7(8.6%) and 9(7.4%), P=0.196]. The exhaust time [4(2-6) days and 2(1, 3) days] and postoperative solid food feeding time [7(4, 9) days and 4(3, 5) days] in the ECUD group were longer than those in the ICUD group (all P<0 05). The exhaust time[4(2-6)day and 2(1, 3)day] and solid food feeding time[7(4, 9)day and 4(3, 5)day] in ECUD group were longer than those in ICUD group. There was no significant difference in postoperative hospital stay between ECUD group and ICUD group[8(5, 11)day and 6(5, 9)day, P=0.212]. Clavien-Dindo Ⅰ-Ⅱ grade was defined mild complication, Ⅲ grade or above was defined serious complication, early complication was defined within 30 days after operation, and late complication was defined 30-90 days after operation. The overall early postoperative complication rate were 19.6%(24) and 34.2%(28)(ICUD vs.ECUD), the mild complications rate were 13.9%(17) and 25.6%(21)(ICUD vs.ECUD), and the late severe complication rate were 4.1%(5)and 10.1%(8)(ICUD vs.ECUD). ICUD group were significantly lower than those of ECUD group (all P<0.05). There was no difference in the early severe complication rate [5.7%(7) and 8.5%(7)], the total late complication rate [15.6%(19) and 16.1%(13)], and the late mild complication rate [11.5% (14) and 6.0% (5)] (all P>0.05). There was no significant difference between ICUD group and ECUD group, in term of the number of lymph nodes dissected [21(14, 25) and 19(15, 24)], the positive rate of lymph nodes [10.7%(13) and 10.0%(8)], the positive rate of surgical margin [3.3%(4) and 4.8%(4)] and postoperative pathological stage T 1-T is [25(20.3%) and 14(17.1%)], and T 2-T 3 [97(79.7%) and 68(82.9%)]. The number of patients with postoperative incision pain (pain score >5) was 43 (35.6%) in ICUD and 46 (56.5%) in ECUD( P< 0.05). The 30-day and 90-day readmission rates were 1.6% (2/82) and 4.9% (6/82) in ICUD group, and 1.2% (1/122) and 9.8% (8/122) in ECUD group, respectively. There was no peri-operative mortality in both groups. Conclusions:Robot-assisted radical cystectomy with ileal conduit is a safe and repeatable method for the treatment of muscular invasive or high-risk non-muscular invasive bladder cancer. Complete intracorporeal bladder reconstruction is feasible and has the advantages of less intraoperative bleeding, faster postoperative intestinal function recovery and less complications.

3.
Chinese Journal of Urology ; (12): 5-9, 2022.
Article in Chinese | WPRIM | ID: wpr-933153

ABSTRACT

Objective:To evaluate the efficacy of robot-assisted partial nephrectomy (RAPN)and laparoscopic partial nephrectomy(LPN)in the treatment of giant (>7cm) renal angiomyolipoma (RAML).Methods:The clinical data of 43 patients with giant RAML(>7cm) who underwent surgery in Zhejiang People's Hospital from October 2014 to May 2020 was retrospectively analysed, including 23 routine RAPN and 20 routine LPN. The median age of patients in the RAPN group was 45(17-65) years old, with 4 males and 19 females.The median body mass index(BMI) was 20.3(18.0-25.7) kg/m 2. Tumors located on the left side in 11 cases and on the right side in 12 cases. Tumors located on upper pole in 9 cases, middle pole in 5 cases , lower pole in 5 cases. The median R. E.N.A.L. score was 8(4-12) points and the largest tumor diameter was 7.5(7.1-17.0) cm. The median age of patients in the LPN group was 53(27-78) years old, with 1 males and 19 females. The median BMI was 21.4(19.0-25.5) kg/m 2. Tumors located on the left side in 9 cases and right side in 11 cases. Tumors located on the upper pole in 7 cases, middle pole in 4 cases and lower pole in 5 cases. 4 cases were multiple tumors, 2 cases were bilateral, and 2 cases were unilateral. The median R. E.N.A.L. score was 8(4-12) points and the median maximum diameter of tumor was 7.3(7.0-20.0) cm. There was no statistically significant difference in general information between the two groups ( P>0.05). The operation time, warm ischemia time, intraoperative blood loss, postoperative complications, postoperative recovery, renal function and other indicators of the two groups were compared, as well as the follow-up results. Results:The operations in both groups were successfully completed, and none of them were transferred to open surgery. Patients in the RAPN group had markedly lower median operation time [115(90-220) vs.145(120-240) min], and reduced median time of warm ischemia [15(10-25) vs. 23(20-28) min] than those in the LPN group, the difference between the two groups was statistically significant ( P<0.05). There were no significant differences in the median time of eating [1(1-2) vs. 1(1-3)d], time of extubation [4(3-16) vs. 5(3-14)d], postoperative absolute time in bed [4(3-7) vs. 4(2-12)d], hospitalization time [7(5-16) vs. 8(4-14)d], creatinine change[11.3(1.6-44.8) vs. 18.2(1.0-54.8)μmol/L], eGFR change [21.5(1.8-43.5) vs. 22.1(5.6-51.3) ml/(min·1.73m 2)], and hemoglobin change[22.5(11-43) vs. 23.0 (9-62) g/L] between the two groups( P>0.05). The incidence of postoperative complications in the RAPN group and the LPN group were 0 and 15%(3/20), respectively, and the difference was statistically significant ( P<0.05). 3 patients had blood transfusion during the operation, because 2 patients had renal wound hemorrhage. During the operation, ultrasonic scalpel electrocoagulation to halt bleeding and hemostatic cotton padding were performed, which improved after suture. One case had active hemorrhage from the renal wound arteries after surgery, which improved after blood transfusion and embolization. Another 2 patients had postoperative fever, improved after anti-infection and antipyretic treatment. There was no leakage of urine after operation in RAPN group and LPN group. The RAPN group was followed up for 6 months to 45 months with a median time of 12 months, and the LPN group was 8 months to 50 months with a median time of 15 months. No tumor recurrence or delayed renal stump bleeding was identified. Conclusions:Compared with LPN, RAPN therapy of giant RAML can shorten the operation time and warm ischemia time, and decrease postoperative complications, the two have similar short-term follow-up results in terms of tumor control and renal function protection.

4.
Chinese Journal of Urology ; (12): 104-109, 2021.
Article in Chinese | WPRIM | ID: wpr-884967

ABSTRACT

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.

5.
Chinese Journal of Urology ; (12): 63-64, 2021.
Article in Chinese | WPRIM | ID: wpr-884960

ABSTRACT

Single-docking robot-assisted laparoscopic radical nephroureterectomy is difficult to deal with the distal ureter and bladder. Thirty-two patients with ureter carcinoma underwent single-docking robot-assisted nephroureterectomy in rectus rectilinear cannula placement in our hospital. The advantages include lower surgical difficulty, shorter operation time, less surgical bleeding and damage. This surgical method is a safe and effective minimally invasive treatment for ureter carcinoma.

6.
Chinese Journal of Urology ; (12): 819-823, 2021.
Article in Chinese | WPRIM | ID: wpr-911126

ABSTRACT

Objective:To investigate the feasibility and safety of the transvesical approach of robot-assisted radical prostatectomy.Methods:From June 2017 to May 2020, 41 patients underwent transvesical approach of robot-assisted radical prostatectomy. The patients’ mean age was 62.5(51-69)years. The mean prostate volume was 36.3(22.0-57.8)ml. The mean preoperative PSA value was 7.3(3.7-12.3)ng/ml. All preoperative Gleason score was less than or equal to 7 points and preoperative TNM stage ranged from T 2a to T 2b . All patients were diagnosed by prostate biopsy before surgery or pathological diagnosis after prostate enucleation. Robot-assisted radical prostatectomy through the longitudinal incision of the bladder neck was used. It was easy to identify and preserve the bladder neck during the operation. The bladder was opened with a small longitudinal incision, and the prostate was removed intrafascial. The pubic prostatic ligament and pudendal artery were fully preserved to achieve complete reduction of the anatomical structure. Results:All the operations were completed by robot-assisted radical prostatectomy with no transition to open surgery. The mean surgery time was 111.3(105-131)min. The mean estimated blood loss was 95.5 (50-220) ml. The mean postoperative hospital stay was 5.2(3-8)d. The time of postoperative catheter removal was 6.3(5-7)d. After 6 to 24 months of follow-up, 35 patients (85.4%, 35/41) received immediate recovery of continence, 4 patients had no urine leakage after 1 week, and 2 patients had no urine leakage after 1 month. All patients had regained continence 6-month postoperatively. No tumor biochemical recurrence (tPSA<0.2 ng/ml).Conclusions:The transvesical approach of robot-assisted radical prostatectomy was a safe and effective surgical technique, which was beneficial in early continence recovery, and also suitable for prostate cancer patients after prostate enucleation.

7.
Chinese Journal of Urology ; (12): 801-805, 2021.
Article in Chinese | WPRIM | ID: wpr-911122

ABSTRACT

Objective:To evaluate the clinical efficacy and safety of ultrasound negative pressure suction with percutaneous nephroscope in the treatment of perirenal abscess.Methods:The clinical data of 11 patients with perirenal abscess admitted to Zhejiang Provincial People's Hospital from January 2013 to February 2021 were retrospectively analyzed. There were 4 males and 7 females. The average age was 59(51-76) years. The abscess was located on the left side in 4 cases and on the right side in 7 cases. The average diameter of abscess was 11.2(8.1-19.2) cm. All patients had fever, low back pain and abdominal mass, accompanied by bladder irritation in 6 cases, gross hematuria in 5 cases, abdominal distension, nausea and anorexia in 3 cases. There were 7 cases with type 2 diabetes, 2 cases with rheumatoid arthritis and 6 cases with ipsilateral kidney and ureter stone. Among the 11 patients, 6 had a history of urinary tract infection, 1 had a history of upper respiratory tract infection, 1 had secondary infection of perirenal hematoma after traumatic renal rupture, and 3 had secondary infection of perirenal hematoma after percutaneous nephroscopy. All patients were treated with ultrasound negative pressure suction with percutaneous nephroscope under local anesthesia by single operator. The operation time, intraoperative blood loss, drainage volume, drainage tube indwelling time, postoperative body temperature returned to normal time, postoperative hospital stay, therapeutic effect and complications were analyzed.Results:All operation procedures of 11 patients were successfully completed, including 8 cases of single channel, 2 cases of double channels and 1 case of three channels. The average operation time was 44(20-74)min, the average amount of blood loss was 15(10-20)ml, the average amount of pus was 325(200-500)ml, the average indwelling time of drainage tube was 8(6-12)d, the average time of body temperature returned to normal was 0.9(0.5-2.0)d, and the average hospitalization time was 9.6(7.0-14.0)d. Before discharge, CT reexamination showed that the perirenal abscess disappeared. There were no serious complications during and after operation. The average follow-up time was 4.4(3-8) months. There was no recurrence in all patients.Conclusions:Ultrasound negative pressure suction with percutaneous nephroscope is one of the safe and effective surgical methods for the treatment of perirenal abscess. It has the advantages of small trauma, quick recovery, complete drainage, exact effect and fewer complications.

8.
Chinese Journal of Urology ; (12): 758-762, 2021.
Article in Chinese | WPRIM | ID: wpr-911110

ABSTRACT

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.

9.
Chinese Journal of Urology ; (12): 717-720, 2021.
Article in Chinese | WPRIM | ID: wpr-911102

ABSTRACT

Prostate cancer (PCa) is one of the most common invasive cancers in men. Radical prostatectomy is the gold standard for localized prostate cancer, but the postoperative biochemical recurrence rate can reach 20%-50%. In some cases, salvage lymph node dissections (SLND) seem to improve cancer control and delay systemic treatment. In this article, we review the current state of diagnostic imaging, accurate patient selection criteria, exploration of SLND surgical procedures, as well as the safety and tumor outcomes of SLND. Overall, although there is still a lack of strong prospective evidence to support the role of SLND, advances in preoperative imaging techniques and the widespread use of minimally invasive surgery have led to encouraging tumor outcomes with SLND. However, further large-scale and high quality trials are needed to confirm the effectiveness and safety of SLND.

10.
Chinese Journal of Urology ; (12): 581-585, 2021.
Article in Chinese | WPRIM | ID: wpr-911076

ABSTRACT

Objective:To explore the detection rate of prostate cancer and clinically significant prostate cancer (CsPCa) in three puncture methods: targeted biopsy fusion with MRI and ultrasound imaging, system puncture, and combined puncture.Methods:The clinical data of 164 patients who underwent both targeted biopsy and systematic biopsy in Zhejiang Provincial People's Hospital from April 2019 to April 2020 were retrospectively analyzed. The median age was 67(33-90)years. Preoperative serum tPSA was 8.97(0.64-95.63)ng/ml and fPSA was 1.31(0.29-9.25)ng/ml. There were 96 patients result in tPSA<10 ng/ml, 65 and 3 patients result in 10≤tPSA<50 ng/ml and tPSA≥50 ng/ml. The prostate volume was 34.9(11.6-152.0) cm 3. According to result of PI-RADS score, there were 42 patients got 3 points and 66, 56 patients got 4 and 5 points respectively in PI-RADS score of suspicious nodules. First, a targeted puncture (targeted biopsy) was performed on the suspected lesions by fusion imaging of magnetic resonance and ultrasound. Then 12-needle systematic prostate biopsy was performed under the guidance of ultrasound. Those two methods performed together was called combined biopsy. This study compared the detection rates of prostate cancer and CsPCa among the three popular methods in all cases, different PI-RADS cases, and different tPSA cases. Results:In this study, patients was detected as positive result in 126 of 164 patients. The detection rates of prostate cancer in targeted biopsy and systematic biopsy were 66.46%(109/164) and 64.02%(105/164), respectively, the result reveals no statistical significance ( P=0.64). In contrast, the positive rate of combined biopsy [76.83%(126/164)] was higher than targeted biopsy ( P=0.04) and systematic biopsy ( P=0.01), and the difference was statistically significant. In the detection rate of CsPCa, the positive detection rates of targeted biopsy group, systematic biopsy group and combined biopsy group were 50.61%(83/164), 45.12%(90/164) and 54.88% (126/164), respectively. Moreover, there was no significant statistical significance among the three groups ( P>0.05). Group comparison was analyzed according to PI-RADS score. In PI-RADS 4 group and PI-RADS 5 group, combined biopsy was[90.91%(60/66), 100.00%(56/56)] and systematic biopsy was [71.21%(47/66), 87.50%(49/56)] which reveals significant difference in prostate cancer detection rates ( P=0.00, P=0.01). In PI-RADS 4-5 groups, the detection rate of prostate cancer by targeted biopsy [86.89%(106/122)] was significantly higher than systematic biopsy [78.69%(96/122), P=0.01], but still lower than that by combined biopsy [95.08%(116/122), P=0.03]. The CsPCa detection rates of PI-RADS 3 group targeted biopsy, systematic biopsy and combined biopsy were 2.38%(1/42), 7.14%(3/42) and 7.14%(3/42), respectively. There were 59.09%(39/66), 46.97%(31/66) and 62.12%(41/66) in PI-RADS 4 groups, respectively; There were 78.57%(44/56), 71.43%(40/56) and 82.14%(46/66) in PI-RADS 5 groups, respectively, with no statistical significance ( P>0.05). However, in PI-RADS 4-5 groups, the CsPCa detection rate of combined biopsy [71.31%(87/122)] was higher than that of systematic biopsy [58.20%(71/122)], with statistical significance ( P=0.03). In the tPSA<10 ng/ml group, the prostate cancer detection rate of combined biopsy[72.92%(70/96)] was higher than that of systematic biopsy[59.38%(57/96)], and the difference was statistically significant ( P<0.05). There was no significant difference between the detection rate of targeted biopsy[61.43%(59/96)]and combined biopsy ( P=0.09). In the group of 10ng/ml≤tPSA<50ng/ml, the prostate cancer detection rates of targeted biopsy, systematic biopsy and combined biopsy were 72.31%(47/65), 69.23%(45/65) and 81.54%(53/65), respectively, and there was no statistical significance ( P>0.05). In tPSA≥50 ng/ml group, the prostate cancer detection rate of the three biopsy methods was 100.00% (3/3), and there was no statistical significance ( P>0.05). Conclusion:For patients with highly suspected prostate cancer on multiparameter MRI(PI-RADS 4-5) or tPSA<10 ng/ml, combined biopsy was an appropriate method to diagnose the prostate cancer.

11.
Chinese Journal of Urology ; (12): 830-834, 2020.
Article in Chinese | WPRIM | ID: wpr-869767

ABSTRACT

Objective:To investigate the perioperative and oncological outcomes in patients undergoing laparoscopic radical cystectomy with intracorporealorthotopic neobladder reconstruction.Methods:Clinical data of bladder cancer patients undergoing laparoscopic radical cystectomy(LRC) or robot-assisted radical cystectomy(RARC) with intracorporealorthotopic neobladder reconstruction in Zhejiang Provincial People's Hospital from March 2010 to December 2019 were retrospectively analyzed. There were 166 males and 52 females. The median age was 62 (52, 70) years old. The ASA score was 1-2 in 183 cases (83.9%) and 3 in 35 cases (16.1%). There were 61 cases of hypertension, 28 cases of diabetes, 26 cases of heart disease, 33 cases of history of abdominal surgery, and 3 cases received neoadjuvant chemotherapy. LRC was performed in 82 cases and RARC in 136 cases. The operation was performed by dissecting pelvic lymph nodes from right to left and then cystoprostatectomy. The periureteral blood supply and periperitoneal peritoneum were preserved, and the prostate was resected by intrafascial resection. The 30 cm terminal ileum was used to make a U-shaped new bladder, and then the urethral stump and both sides of the ureter were anastomosed on new bladder without tension. During the operation, two single J tubes were used as ureteral stent.The perioperative and pathological results results were evaluated.Results:The operations of 218 patients were completed successfully and there was no conversion to open operation. The median operation time was 281 (229, 400) ml. Intraoperative blood transfusion was performed in 24 cases (11.0%). Hospital stay was 15 (13, 22) days.Intraoperative complications happened in 11 cases (5.0%). Exhaust time was 2 (1, 3) days. Solid food intake time was 4 (3, 5) days. Total complications within 30 days after operation were 61 cases (28.0%), and total complications within 30-90 days after operation were 81 cases (37.2%). The number of median lymph node dissection in all patients was 19 (14, 24). Positive lymph nodes in 21 cases (9.6%). Positive margin in 6 cases (2.7%). Postoperative tumor pathological stages were T a/T 1/T is stage 48 cases, T 2 stage 134 cases, T 3 stage 36 cases. The median follow-up time of all patients was 33 (20.6, 48.2) months. There were 77 cases of tumor recurrence and 55 cases of death, of which 39 cases were tumor-specific death. The 5-year disease free survival, overall survival , and cancer-specific survival of all patients were 55.4%, 62.4% and 66.4%, respectively. Conclusions:Laparoscopic radical cystectomy and intracorporealorthotopic new bladder reconstruction can be well used in the treatment of muscle invasive or high-risk non-muscle invasive bladder cancer.Laparoscopic intracorporeal bladder reconstruction is feasible with few postoperative complications.

12.
Chinese Journal of Urology ; (12): 584-589, 2020.
Article in Chinese | WPRIM | ID: wpr-869713

ABSTRACT

Objective:To discuss the effect and experience of laparoscopic vesicovaginal fistula repairs though inferior of bladder longitudinal incision.Methods:54 patients were included in this study. Clinical data of patients collected from our hospital since January 2010 to October 2019 who underwent laparoscopic vesicovaginal fistula repair. The median age is 49.5 (8-80) years old. Main complaints were urine flows out through the vagina. 14 cases (25.9%) and 23 cases (42.6%)were post-hysterectomy of benign lesions and gynecological malignant tumors. The symptoms presented at 11 (1-20) days post urinary catheter removal. There were 11 cases (20.4%) of cervical malignant tumors, symptoms presented at 10 (5 to 25) months after radiotherapy. The symptoms of rest of cases 6 (11.1%)presented at 21 (3 to 50) days. One of them had rectal fistula, another had ureteral injury, 6 had bladder contracture, 2 patients had bilateral hydronephrosis. Preoperative CT examination revealed that 4 cases had no obviously hydroureter at upper urinary tract, and 2 cases had mild hydronephrosis in bilateral kidneys. The diameter of the fistula was 0.5-4.0 cm. There were 50 cases of single fistula and 4 cases of multiple fistula. The urine pad test evaluated the degree of urine leakage in patients reveals that 7 and 42 cases with mild and moderate, rest of 5 cases presented with severe result. 37 cases performed with vesico-vaginal fistula repair for the first time; 13 and 2 cases had once and twice vesico-vaginal fistula repair history and there were other two patients had vesico-vaginal fistula repair history for three and four times. All patients underwent general anesthesia under the laparoscopic bladder bottom longitudinal incision bladder vaginal fistula repair, 8 cases performed with Da Vinci robotic assist surgery system. Main steps of the operation include: ①search for bladder and vaginal fistula, assessed the size, number, and location of the fistula; ②To set single J stents in the bilateral ureter; ③Fully separated the bladder and vaginal wall, remove scar tissue, and suture the bladder incision with low or no tension way; ④To use great omentum; for patients with low, complex, and mixed bladder vaginal fistulas, recommend to use bladder wall flaps (6 cases), bladder enlargement (3 cases), and ureteral replantation (6 cases). The clinical data of the patients were collected, and a univariate analysis was performed on the cure rate.Results:The mean of blood boss and duration in operation were (33.3±26.5) ml and 85 (60-240) minutes. Mean of hospitalization was (11.3±8.2)days. The postoperative urinary indwelling time were (20.8±8.3)days. 50 cases were completed recovered and 4 cases failed, the curative ratio was 92.6% (50/54). It revealed that the curative ratio of vesicovaginal fistula repair had correlation with history of surgical interventions before operation. The curative effect was reduced ( P=0.00) when the patient had previous laparoscopic vesicovaginal fistula repairs. Patients with multiple fistulas (≥2) had a lower cure rate than single fistulas ( P=0.00). In addition, patients with fistulas above the triangle of the bladder had a higher cure rate than fistulas outside the triangle of the bladder and the urethra ( P=0.00). There was no statistically significant difference in the cure ratio of Age ( P=0.79), operation time ( P=0.06), intraoperative bleeding ( P=0.78), post-operative hospitalization ( P=0.73), indwelling catheterization time ( P=0.30), and size of fistula ( P=0.31). Conclusions:The operation could be effective with fewer complications procedure, which could fix mixed fistula and bladder contracture at the same time.

13.
Chinese Journal of Urology ; (12): 522-526, 2020.
Article in Chinese | WPRIM | ID: wpr-869699

ABSTRACT

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.

14.
Chinese Journal of Urology ; (12): 356-361, 2020.
Article in Chinese | WPRIM | ID: wpr-869656

ABSTRACT

Objective:To Investigate the postoperative sexual function outcomes in patients with bladder cancer who underwent robot-assisted radical cystectomy (RARC)or laparoscopic radical cystectomy(LRC)followed by orthotopic neobladder reconstruction.Methods:We performed a retrospective review of 84 bladder cancer patients having undergone laparoscopic radical cystectomy(LRC)and robotic-assisted radical cystectomy(RARC)with≥21 IIEF-5 in our institution from Jan 2014 to Jan 2019. All of them were diagnosed as high grade urothelial carcinoma by biopsy or TURBT. Biopsy of the posterior urethra and bladder neck reveal negative result of tumor invasion. Their PSA level was less than 4.0 ng/ml with negative result of DRE. All patients undergone laparoscopic radical cystectomy and orthotopic neobladder reconstruction by one medical team. 45 patients underwent robotic assistant radical cystectomy(RARC group), and the rest of patients 39 were treated with laparoscopic radical cystectomy(LRC group). In RARC group, the mean age were 53 years old(ranging 50-67 years old)and clinical stage of the tumor was cT 1 in 10 patients, cT 2 in 21 patients and cT 3 in 14 patients. In the LRC group, the mean age were 56 years old(ranging52-65 years old) and the clinical staging of the tumors was 6 patients in cT 1, 23 patients in the cT 2 and 12 patients in the cT 3. The RARC group paid special attention to the protective function of the following surgical details: ①To detect the abdominal organs, reveal the pelvic cavity, observe the blood vessels and ureter, open the perinatal membrane next to the cross of the ureter, along the outer venous veins and closed-hole nerves around the standard or expand the pelvic lymph node cleaning. In this study, the patients who did not have obvious suspected lymph node metastasis were removed within the standard range of the pelvic lymph nodes on both sidesin order to protect the nerves at the pelvic floor as much as possible. ② With the robot 3rd arm lifting the bladder, the peritoneum was opened at the site of seminal vesicle and ampulla of vas deferent duct, which connected to the two sides with the open peritoneum. Along the vasectomy and the sac free, the denonvillier fasica was opened and exposing the back of the prostate. With the third arm pulling down, the umbilical ligament was observe. The peritoneal was opened to the retropubic space so that the prostate region was revealed. Continue to dissect the bladder front space until the pelvic fascia and the osteopathic prostate ligament are exposed. The Hem-o-1oks were used to ligate the bilateral bladder lateral ligaments. The bladder and prostate were removed in the fascia level. The NVB bundle on both sides was kept to the apex of prostate. The urethra was exposed and remove the catheter.With Hem-o-lok clamping, the urethra was dissected in the level of prostatic apex. The distal end of urethral tissue was sent to the rapid freeze pathology examination. In the procedure of prostate removing, parallel prostate fascia excision was considered and pubo-prostatic ligament could be preserved.③ Preserving the bilateral neurovascular bundle (NVB) and try to avoid the damage of NVB. Retaining the bladder lateral ligament neurovascular bundle. Retaining the1.2-1.5 cm urethra and surrounding continent control structure. The cold knife is advocated. Blood vessel clamp can be used to stop bleeding. We compared with operative time, bleeding amount, postoperative hospitalization, IIEF-5 scores and satisfaction of sexual between those groups. Results:All operations were successfully performed without conversion and serious surgical complications. The operative time in the RARC group and LRC group were [(313.5±31.9)min and (276.5±32.3)min, P>0.05] .The intraoperative amount of blood loss and postoperative hospitalization were [(190.1±44.1) ml and (212.3±39.2) ml, P>0.05], [(14.3±2.1) d and (15.2±3.0) d, P>0.05]. There was no significantly difference between the two groups. The median follow-up period of 84 patients was 18 months. The IIEF-5 score of the RARC group was higher than LRC group at 6 months(18.5±1.6 vs.10.6±1.3)and 12 months (18.6±2.4 vs.11.2±1.4) ( P<0.05). In addition, the satisfaction of sexual in the RARC group was relative better than LRC group (both P<0.05) at 6 months[44.4%(20/45)vs.25.6%(10/39)], and 12 months[51.1%(23/45) vs.28.2%(11/39)] post-operation. Conclusion:Robot-assisted radical cystectomy(RARC) and orthotopic neobladder reconstruction revealed relative better recovering in post-operative sexual function and improvements in patient quality of life.

15.
Chinese Journal of Urology ; (12): 95-101, 2020.
Article in Chinese | WPRIM | ID: wpr-869604

ABSTRACT

Objective To discuss outcome and safety after implementation of enhanced recovery after surgery(ERAS) protocols to patients who underwent robotic assisted radical cystectomy (RARC) with intracorporeal orthotopic "U" shaped ileal neobladder creation using STAPLER technique.Methods Between October 2014 and April 2019,71 patients(59 males and 12 females)with MIBC (Muscle Invasive Bladder Cancer) who underwent RARC with intracorporeal urinary diversion using orthotopic "U" shaped ileal neobladder in Zhejiang Provincial People's Hospital (People's Hospital of Hangzhou Medical College) were studied retrospectively.They had an average age of (65.2 ± 5.6)y and BMI of (22.18 ± 3.75) kg/m2.The median age-adjusted charlson comorbidity index (aCCI) was 4,median ASA score was 2.All patients underwent these inspections pre-RARC:chest Xray,vascular ultrasound (jugular vein included),abdominal ultrasound,CT urography,cystoscopy with biopsy or TURBT(trans-urethral resection of a bladder tumour).All patients were pathological diagnosed with MIBC,with no evidence of systemic metastasis and no history of radiotherapy,systemic chemotherapy and open abdominal surgery before RARC.All 71 patients received RARC with intracorporeal orthotopic "U" shaped ileal neobladder creation using STAPLER technique.Between October 2014 and September 2016,37 cases (29 males and 8 females) were managed without ERAS protocols perioperatively.They had an average age of (65.3 ±5.7)y and BMI of (23.66 ± 3.47)kg/m2.The median aCCI was 4,median ASA score was 2.Between October 2016 and April 2019,another group of 34 cases (30 males and 4 females) were managed with ERAS protocols including nutritional assessment,thrombosis prevention,pain assessment and management,perioperative diet management etc.They had an average age of (64.5 ± 4.3) y and BMI of (21.87 ± 4.85) kg/m2.The median aCCI was 4,median ASA score was 2.There were no statistical significance between the two groups with regard to general information.Surgical and follow-up data were collected for all patients.Results Surgeries were successful in all 71 cases with postoperative follow up for 3-51 months.In ERAS group,there were 22 cases in pT2 and 12 cases pT3 according to classification of malignant tumours:with 2 cases of incidental prostate cancer (IPCa).In non-ERAS group,pT2 in 25 cases and pT3 in 12 cases:with 1 case of IPCa.Statistical significance were observed between groups with regard to the first anal exhaust time [(20.5 ± 18.7) h vs.(29.9 ± 17.4)h,P =0.032],the first defecation time [(72.6 ±27.1)h vs.(88.7 ±35.8)h,P =0.004],length of hospital stay after surgey [(14.1 ± 3.3) d vs.(16.2 ± 4.8) d,P =0.037],numeric rating scales (NRS) Pain Score 8.0,24.0,48.0 h after surgery [(3.2 ±0.5)vs.(3.6 ±0.8),P =0.015;(1.9 ±0.3) vs.(2.2 ± 0.6),P =0.011;(1.3 ± 0.4) vs.(1.6 ± 0.7),P =0.032],respectively.There were no significance between groups with regard to operating time [(290 ± 65) min vs.(282 ± 46) min,P =O.549],intraoperative blood loss [(190.5 ± 235.6) ml vs.(221.1 ± 250.3) ml,P =0.438],transfusion rate [5.9% (2/34) vs.8.1% (3/37),P =0.922],readmission within 30 days after surgery [2.9% (1/34) vs.5.4% (2/37),P =0.940],early severe complications(within 30 days) [2.9% (1/34) vs.2.7% (1/37),P =0.940],late severe complications (after 30 days) [5.9% (2/34) vs.8.1% (3/37),P =0.922].Conclusions The implementation of ERAS protocols to patients who underwent RARC with intracorporeal orthotopic "U" shaped ileal neobladder using STAPLER technique is safe and effective.It can reduce postoperative pain and hospital stay,shorten bowel recovery time,improve early functional recovery without increasing major complications.This adoption should be encouraged.

16.
Chinese Journal of Urology ; (12): 905-908, 2019.
Article in Chinese | WPRIM | ID: wpr-824606

ABSTRACT

Objective To analyze the main causes for unplanned re-operation of prostatic cancer.Methods The clinical data of 4 patients with prostatic cancer who underwent an unplanned re-operation were analyzed retrospectively between September 2014 and July 2019 in our hospital.Preoperative data of patients was collected as follows:mean age of 65 years,ranged from 56 to 71 years.tPSA ranged from 5.17-13.20 ng/ml.Gleason score of 3 + 3 in 1 case,3 +4 in 2 cases,4 +4 in 1 case.pTNM pT2a in 2 Cases,pT2b in 2 cases.LRP(extraperitoneal approach) in 1 case,RARP(transperitoneal approach) in 3 cases.Results The main causes for unplanned re-operation were as follows:perioperative hemodynamic instability(75%,3/4),post-operative fever(25%,1/4).All 4 re-operations were performed by urologists using Laparoscopic exploration of abdomen.Conclusions Inadequate and inappropriate surgical hemostasis are the key to lead a second-look surgery of prostatic cancer.A complete hemostasis could help to lower the re-operation rate.Laparoscopic exploration of abdomen could be one of the choices to deal with re-operation after minimally invasive radical prostatectomy.

17.
Chinese Journal of Urology ; (12): 838-842, 2019.
Article in Chinese | WPRIM | ID: wpr-824598

ABSTRACT

Objective To investigate the incidence rate of parastomal hernia (PH) among patients who have received laparoscope radical cystectomy and ileal conduit diversion and to discover the risk factors for PH.Methods Data of 162 patients who underwent surgery of laparoscope radical cystectomy and ileal conduit diversion for bladder cancer between Jan 2012 and Dec 2017 were studied.The patients who had suffered other tumors before surgery or without follow-up data were excluded.At last,148 patients were enrolled in this retrospective study.According to the occurrence of PH,the patients were divided into two groups:PH group and non-PH group.There were 21 patients (12 males and 9 females) in PH group.The mean age was (66.5 ± 8.6) years old,and mean body mass index (BMI) was (33.4 ± 5.2) kg/m2.11 patients with synchronous disease and 10 patients without synchronous disease before operation in PH group.Postoperative T stage <T3 in 17 cases,≥T3 in 4 cases.4 Cases received neoadjuvant chemotherapy and 5 cases received adjuvant chemotherapy.Tumor recurrence was found in 6 cases.16 cases had hypoproteinemia.Ileal conduit was made through abdominal incision in 9 cases,and 12 cases was made with laparoscopy.After the surgery,there was severe cough in 7 cases and abdominal distension in 7 cases.3 cases had previous abdominal operation,and 5 cases had history of glucocorticoid use.The mean size of the stoma was (3.0±0.6) cm.The mean length of the outflow tract was (11.2 ±1.3) cm.We did trans-rectus stoma in 4 cases,and para-rectus stoma in 17 cases.There were 127 patients (82 males and 45 females) in non-PH group.The mean age was (71.4 ±7.4) years,and the mean BMI was (28.8 ±4.1)kg/m2.60 patients with synchronous disease and 67 patients without.Postoperative T stage < T3 in 96 cases,≥T3 in 31 cases.29 patients received neoadjuvant chemotherapy and 39 cases received adjuvant chemotherapy.Tumor recurrence was found in 38 cases.66 cases had hypoproteinemia.Ileal conduit was made through abdominal incision in 55 cases,under laparoscopy in 72 cases.There was severe cough in 34 cases and abdominal distension in 38 cases.21 cases had previous abdominal operation,and 35 cases had history of glucocorticoid use.The mean size of the stoma was (2.3 ± 0.4) cm.The mean length of the outflow tract was (12.2 ± 1.6) cm.4 cases had trans-rectus stoma,and 17 cases had para-rectus stoma.Postoperative rate of PH was estimated using the Kaplan-Meier methods.Chi-square test were used for the univariate analysis between group of PH and the normal one.Multivariate Logistic regression analysis was used to judge the independent risk factors of PH.Results Patients were followed up for 24 months.PH occurred in 21 cases,the 1,2,5 year cumulative incidence of PH was 9.9%,5.4% and 16.7% respectively.Clinical characteristics,including age at surgery (x2 =4.018,P =0.045),obesity (x2 =3.949,P =0.047),perioperative hypoproteinemia (x2 =4.279,P =0.039),chronic constipation(x2 =5.416,P =0.020),stoma location (x2 =6.464,P =0.011),stoma size (x2 =3.915,P =0.048),were significantly different between the PH group and the normal group (P < 0.05).Multivariate Logistic regression analysis shows that obesity (OR =1.326,95% CI =1.102-1.548,P =0.043),stoma location (OR =0.892,95 % CI =0.854-0.931,P =0.028),stoma size (OR =1.365,95% CI =1.089-1.631,P =0.028) were the independent risk factors for PH.Conclusion We demonstrated that most of PH usually develop in 2 years after undergoing radical cystectomy with ileal conduit diversion.Obesity,stoma location and stoma size are independent risk factors.Preoperative counseling and preventative measures regarding PH formation should be emphasized,particularly in those patients with risk factors.

18.
Chinese Journal of Urology ; (12): 838-842, 2019.
Article in Chinese | WPRIM | ID: wpr-801141

ABSTRACT

Objective@#To investigate the incidence rate of parastomal hernia(PH) among patients who have received laparoscope radical cystectomy and ileal conduit diversion and to discover the risk factors for PH.@*Methods@#Data of 162 patients who underwent surgery of laparoscope radical cystectomy and ileal conduit diversion for bladder cancer between Jan 2012 and Dec 2017 were studied. The patients who had suffered other tumors before surgery or without follow-up data were excluded. At last, 148 patients were enrolled in this retrospective study. According to the occurrence of PH, the patients were divided into two groups: PH group and non-PH group. There were 21 patients (12 males and 9 females) in PH group. The mean age was (66.5±8.6) years old, and mean body mass index (BMI) was (33.4±5.2) kg/m2. 11 patients with synchronous disease and 10 patients without synchronous disease before operation in PH group. Postoperative T stage <T3 in 17 cases, ≥T3 in 4 cases. 4 Cases received neoadjuvant chemotherapy and 5 cases received adjuvant chemotherapy. Tumor recurrence was found in 6 cases. 16 cases had hypoproteinemia. Ileal conduit was made through abdominal incision in 9 cases, and 12 cases was made with laparoscopy. After the surgery, there was severe cough in 7 cases and abdominal distension in 7 cases. 3 cases had previous abdominal operation, and 5 cases had history of glucocorticoid use. The mean size of the stoma was (3.0±0.6) cm. The mean length of the outflow tract was (11.2 ±1.3) cm. We did trans-rectus stoma in 4 cases, and para-rectus stoma in 17 cases. There were 127 patients (82 males and 45 females) in non-PH group. The mean age was (71.4 ±7.4) years, and the mean BMI was (28.8±4.1)kg/m2. 60 patients with synchronous disease and 67 patients without. Postoperative T stage <T3 in 96 cases, ≥T3 in 31 cases. 29 patients received neoadjuvant chemotherapy and 39 cases received adjuvant chemotherapy. Tumor recurrence was found in 38 cases. 66 cases had hypoproteinemia. Ileal conduit was made through abdominal incision in 55 cases, under laparoscopy in 72 cases. There was severe cough in 34 cases and abdominal distension in 38 cases. 21 cases had previous abdominal operation, and 35 cases had history of glucocorticoid use. The mean size of the stoma was (2.3±0.4) cm. The mean length of the outflow tract was (12.2±1.6) cm. 4 cases had trans-rectus stoma, and 17 cases had para-rectus stoma. Postoperative rate of PH was estimated using the Kaplan-Meier methods. Chi-square test were used for the univariate analysis between group of PH and the normal one. Multivariate Logistic regression analysis was used to judge the independent risk factors of PH.@*Results@#Patients were followed up for 24 months. PH occurred in 21 cases, the 1, 2, 5 year cumulative incidence of PH was 9.9%, 5.4% and 16.7% respectively. Clinical characteristics, including age at surgery(χ2=4.018, P=0.045), obesity(χ2=3.949, P=0.047), perioperative hypoproteinemia(χ2=4.279, P=0.039), chronic constipation(χ2=5.416, P=0.020), stoma location(χ2=6.464, P=0.011), stoma size(χ2=3.915, P=0.048), were significantly different between the PH group and the normal group(P<0.05). Multivariate Logistic regression analysis shows that obesity(OR=1.326, 95%CI=1.102-1.548, P=0.043), stoma location(OR=0.892, 95%CI=0.854-0.931, P=0.028), stoma size(OR=1.365, 95%CI=1.089-1.631, P=0.028) were the independent risk factors for PH.@*Conclusion@#We demonstrated that most of PH usually develop in 2 years after undergoing radical cystectomy with ileal conduit diversion. Obesity, stoma location and stoma size are independent risk factors. Preoperative counseling and preventative measures regarding PH formation should be emphasized, particularly in those patients with risk factors.

19.
Chinese Journal of Urology ; (12): 905-908, 2019.
Article in Chinese | WPRIM | ID: wpr-800255

ABSTRACT

Objective@#To analyze the main causes for unplanned re-operation of prostatic cancer.@*Methods@#The clinical data of 4 patients with prostatic cancer who underwent an unplanned re-operation were analyzed retrospectively between September 2014 and July 2019 in our hospital.Preoperative data of patients was collected as follows: mean age of 65 years, ranged from 56 to 71 years.tPSA ranged from 5.17-13.20 ng/ml.Gleason score of 3+ 3 in 1 case, 3+ 4 in 2 cases, 4+ 4 in 1 case. pTNM pT2a in 2 Cases, pT2b in 2 cases. LRP(extraperitoneal approach) in 1 case, RARP(transperitoneal approach) in 3 cases.@*Results@#The main causes for unplanned re-operation were as follows: perioperative hemodynamic instability(75%, 3/4), post-operative fever(25%, 1/4). All 4 re-operations were performed by urologists using Laparoscopic exploration of abdomen.@*Conclusions@#Inadequate and inappropriate surgical hemostasis are the key to lead a second-look surgery of prostatic cancer.A complete hemostasis could help to lower the re-operation rate.Laparoscopic exploration of abdomen could be one of the choices to deal with re-operation after minimally invasive radical prostatectomy.

20.
Article in Chinese | WPRIM | ID: wpr-796495

ABSTRACT

Patient safety is an integral part of a successful health care system. It addresses and reduces risks and incidents that may negatively impact patients through implementation of improvement projects in various aspects. We discussed proven experiences in surgical patient safety management in Singapore public hospitals, with focus on hospital leadership and management, patient consultation and adoption of clinical protocols. Hierarchy and teamwork were used together with modern information technologies to reduce human errors. During patient consultation, standard informed consent acquisition process was advocated with full respect for patient′s right of decision making. Limited medical resources and manpower were assigned by careful triage and meticulous clinical protocols, which can ensure quality of surgical care. These experiences are inspirational for improving surgical patient safety in China.

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