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1.
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.

2.
Article in Chinese | WPRIM | ID: wpr-911429

ABSTRACT

To investigate the clinical features and prognostic significance in myelodysplastic syndrome (MDS) patients with DTA (DNMT3A,TET2,ASXL1) mutations. Clinical characteristics of 140 patients diagnosed as de novo MDS at People′s Hospital of Xinjiang Uygur Autonomous Region from September 2015 to December 2019 were retrospectively analyzed. Next-generation sequencing was used to detect 34 related genes in MDS patients. DTA mutations and the correlation with progression-free survival (PFS) and overall survival (OS) in MDS patients were evaluated. Among 140 MDS patients, DTA mutations was detected in 62 (44.3%) patients. And the positive rate of DTA mutations in IPSS-R lower-risk group was 65.4%, significantly higher than that of higher-risk group (31.8%)( P=0.000). Compared with the non-mutated group, patients with DTA mutations had a lower rate of conversion to leukemia (9.7% vs . 29.5%, P=0.004).Survival analysis showed that PFS in patients with DTA mutations was comparable as that in MDS patients without DTA mutations ( P=0.787), but the median OS was significantly shorter (16 months vs . 20 months, P=0.022).According to IPSS-R classification, the median OS in patients with and without DTA mutation was only statistically significant in the higher-risk group (15 months vs. 18 months, P=0.034).Among 62 patients with DTA mutations, 60 (96.8%) had additional gene mutations. DTA mutations were not independent prognostic factors when mutation frequency is greater than 10% were considered in Cox regression model ( P>0.05). DTA mutations often developed in the early stage of MDS, therefore they were more common in IPSS-R lower-risk subgroup which was correlated to the low rate of conversion to leukemia. In conclusion, DTA mutations are not associated with disease progression, but predict unfavorable survival when other add-on genes are mutated.

3.
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.

4.
Article in Chinese | WPRIM | ID: wpr-908484

ABSTRACT

Hepatic venous pressure gradient (HVPG) is the gold standard for diagnosing portal hypertension in patients with liver cirrhosis. In recent years, the clinical application status of HVPG in cirrhotic portal hypertension has been increasing. HVPG plays an extremely important role in predicting the long‐term prognosis of patients with liver cirrhosis, but its prognostic value in surgical risks for patients with liver cirrhosis has long been ignored. The authors analyze the current clinically commonly used evaluation system for the prognosis of patients with liver cirrhosis and existing problems, and summarize the application status and prospects of HVPG in surgery for patients with liver cirrhosis.

5.
Article in Chinese | WPRIM | ID: wpr-908479

ABSTRACT

Objective:To investigate the current status of prevention and treatment of esophagogastric variceal bleeding (EVB) in cirrhotic portal hypertension patients in Ningxia region.Methods:The retrospective and descriptive study was conducted. The clinical data of 820 cirrhotic portal hypertension patients who were admitted to 21 medical centers in Niangxia region from January 2018 to December 2020 were collected, including 85 cases in Ningxia Hui Autonomous Region People′s Hospital, 73 cases in the Fifth People′s Hospital of Ningxia Hui Autonomous Region, 59 cases in the Wuzhong People′s Hospital, 52 cases in the Qingtongxia People′s Hospital, 50 cases in the Guyuan People′s Hospital, 47 cases in the Yuanzhou District People′s Hospital of Guyuan City, 47 cases in the Yinchuan Second People′s Hospital, 40 cases in the General Hospital of Ningxia Medical University, 40 cases in the Tongxin People′s Hospital, 35 cases in the Yinchuan First People′s Hospital, 34 cases in the Third People′s Hospital of Ningxia Hui Autonomous Region, 32 cases in the Zhongwei People′s Hospital, 30 cases in the Lingwu People′s Hospital, 30 cases in the Wuzhong New District Hospital, 30 cases in the Yanchi People′s Hospital, 29 cases in the Ningxia Hui Autonomous Region Academy of Traditional Chinese Medicine, 28 cases in the Shizuishan Second People′s Hospital, 25 cases in the Shizuishan First People′s Hospital, 21 cases in the Haiyuan People′s Hospital, 20 cases in the Pengyang People′s Hospital, 13 cases in the Longde People′s Hospital. There were 538 males and 282 females, aged (56±13)years. Observation indicators: (1) clinical charac-teristics of cirrhotic portal hypertension patients; (2) overall prevention and treatment of EVB in cirrhotic portal hypertension patients; (3) prevention and treatment of EVB in cirrhotic portal hypertension patients from different grade hospitals. Measurement data with normal distribution were represented as Mean± SD. Count data were described as absolute numbers, and comparison between groups was analyzed using the chi-square test. Results:(1) Clinical characteristics of cirrhotic portal hypertension patients: of 820 cirrhotic portal hypertension patients, 271 cases were in compensated stage and 549 cases were in decompensated stage. Of the 271 cases in compensated stage, there were 183 maels and 88 females, aged (53±12)years. There were 185 Han people, 85 Hui people and 1 case of other ethic group. The etiological data of liver cirrhosis showed 211 cases of viral hepatitis B, 4 cases of alcoholic liver disease, 8 cases of viral hepatitis C, and 48 cases of other etiology. There were 235 cases of Child-Pugh grade A and 36 cases lack of data. Of the 549 cases in decompensated stage, there were 355 males and 194 females, aged (57±14) years. There were 373 Han people, 174 Hui people and 2 cases of other ethic group. The etiological data of liver cirrhosis showed 392 cases of viral hepatitis B, 33 cases of alcoholic liver disease, 10 cases of viral hepatitis C, and 114 cases of other etiology. There were 80 cases of Child-Pugh grade A, 289 cases of grade B, 170 cases of grade C and 10 cases lack of data. (2) Overall prevention and treatment of EVB in cirrhotic portal hypertension patients: of 271 patients in compensated stage, 38 cases received non-selective β-blocker (NSBB) therapy, 16 cases received endoscopic treatment, 6 cases received interventional therapy. Of 549 patients in decompensated stage, 68 cases received NSBB therapy, 46 cases received endoscopic treatment, 28 cases received interventional therapy. (3) Prevention and treatment of EVB in cirrhotic portal hypertension patients from different grade hospitals: of 271 patients in compensated stage, 181 cases came from tertiary hospitals, of which 28 cases received NSBB therapy, 15 cases received endoscopic treatment, 6 cases received interventional therapy. Ninety cases came from secondary hospitals, of which 10 cases received NSBB therapy, 1 cases received endoscopic treatment. There was no significant difference in NSBB for prevention of EVB between tertiary and secondary hospitals ( χ2=0.947, P>0.05), while there was a significant difference in endoscopic treatment for prevention of EVB between tertiary and secondary hospitals ( χ2=5.572, P<0.05). Of 549 patients in decompensated stage, 309 cases came from tertiary hospitals, of which 22 cases received NSBB therapy, 29 cases received endoscopic treatment, 22 cases received interventional therapy. Two hundreds and fourty cases came from secondary hospitals, of which 46 cases received NSBB therapy, 17 cases received endoscopic treatment, 6 cases received interven-tional therapy. There were significant differences in NSBB and interventional therapy for prevention of EVB between tertiary and secondary hospitals ( χ2=18.065, 5.956, P<0.05). Conclusions:The proportion of receiving EUB prevention in cirrhotic portal hypertension in Ningxia is relatively low. For patients with compensated liver cirrhosis, the proportion of NSBB therapy and endoscopic treatment in the secondary hospitals was lower than that in tertiary hospitals. For patients with decompensated liver cirrhosis, the proportion of interventional treatment in secondary hospitals is lower than that of tertiary hospitals, but the proportion of NSBB in secondary hospitals taking is higher than that of tertiary hospitals.

6.
Article in Chinese | WPRIM | ID: wpr-908474

ABSTRACT

Portopulmonary hypertension is a rare and serious complication of portal hypertension, which is very easy to miss diagnosis in clinic, and relatively difficult to treat. The authors elaborate in depth of the epidemiology, pathogenesis, diagnosis, treatment and prognosis of portopulmonary hypertension.

7.
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.

8.
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.

9.
J Cancer Res Ther ; 2020 Jan; 15(6): 1435-1449
Article | IMSEAR | ID: sea-213553

ABSTRACT

Molecular target anticancer drugs are commonly used in various forms of cancers. It is a concern that the risk of serious adverse events (SAEs) and fatal adverse events (FAEs) of molecular target drugs are increasing. An up-to-date meta-analysis of all Phase II/III/IV randomized trials of molecular target anticancer drugs was conducted to calculate the increased risk of SAEs and FAEs. A systematic search of PubMed, Web of Science, and Cochrane Library up to April 6, 2017, was conducted. The study enrolled Phase II/III/IV randomized trials of cancer that compared molecular target drugs alone versus placebo or performed single-arm analysis of molecular target drugs. Data on SAEs and FAEs were extracted from the included studies and pooled to compute risk ratio (RR), the overall incidence, and 95% confidence interval (CI). In this meta-analysis, a total of 19,965 and 26,642 patients in randomized 53 and 65 Phase II/II/IV trials were included in the analysis of SAEs and FAEs associated with molecular target anticancer drug, respectively. There were significant differences in the relationship of molecular target anticancer drugs with SAEs (RR = 1.57, 95% CI = 1.35–1.82, P < 0.01, I2 = 81%) and FAEs (RR = 1.51, 95% CI = 1.19–1.91, P < 0.01, I2 = 0%) compared to placebo. The overall incidence of SAEs and FAEs was 0.269 (95% CI = 0.262–0.276, P < 0.01) and 0.023 (95% CI = 0.020–0.025, P < 0.01), respectively. Molecular target anticancer drugs significantly increased the risk of SAEs and FAEs. For patients taking molecular target drugs, efforts are needed to prevent the occurrence of SAEs and FAEs

10.
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.

11.
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.

12.
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.

13.
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.

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Chinese Journal of Hepatology ; (12): 148-152, 2020.
Article in Chinese | WPRIM | ID: wpr-811672

ABSTRACT

Objective@#To analyze the clinical characteristics of cases of novel coronavirus pneumonia and a preliminary study to explore the relationship between different clinical classification and liver damage.@*Methods@#Consecutively confirmed novel coronavirus infection cases admitted to seven designated hospitals during January 23, 2020 to February 8, 2020 were included. Clinical classification (mild, moderate, severe, and critical) was carried out according to the diagnosis and treatment program of novel coronavirus pneumonia (Trial Fifth Edition) issued by the National Health Commission. The research data were analyzed using SPSS19.0 statistical software. Quantitative data were expressed as median (interquartile range), and qualitative data were expressed as frequency and rate.@*Results@#32 confirmed cases that met the inclusion criteria were included. 28 cases were of mild or moderate type (87.50%), and four cases (12.50%) of severe or critical type. Four cases (12.5%) were combined with one underlying disease (bronchial asthma, coronary heart disease, malignant tumor, chronic kidney disease), and one case (3.13%) was simultaneously combined with high blood pressure and malignant tumor. The results of laboratory examination showed that the alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin (ALB), and total bilirubin (TBil) for entire cohort were 26.98 (16.88 ~ 46.09) U/L and 24.75 (18.71 ~ 31.79) U/L, 39.00 (36.20 ~ 44.20) g/L and 16.40 (11.34- ~ 21.15) mmol/L, respectively. ALT, AST, ALB and TBil of the mild or moderate subgroups were 22.75 (16.31- ~ 37.25) U/L, 23.63 (18.71 ~ 26.50) U/L, 39.70 (36.50 ~ 46.10) g/L, and 15.95 (11.34 ~ 20.83) mmol/L, respectively. ALT, AST, ALB and TBil of the severe or critical subgroups were 60.25 (40.88 ~ 68.90) U/L, 37.00 (20.88 ~ 64.45) U/L, 35.75 (28.68 ~ 42.00) g/L, and 20.50 (11.28 ~ 25.00) mmol/L, respectively.@*Conclusion@#The results of this multicenter retrospective study suggests that novel coronavirus pneumonia combined with liver damage is more likely to be caused by adverse drug reactions and systemic inflammation in severe patients receiving medical treatment. Therefore, liver function monitoring and evaluation should be strengthened during the treatment of such patients.

15.
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.

16.
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.

17.
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.

18.
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.

19.
Chinese Journal of Urology ; (12): 194-199, 2019.
Article in Chinese | WPRIM | ID: wpr-745573

ABSTRACT

Objective To investigate the outcome of patients underwent anatomic periurethral reconstruction during robotic assisted laparoscopic radical prostatectomy (RARP).Methods During August 2016 to May 2018,anatomic periurethral reconstruction was performed during RARP in 58 consecutive patients.The control group consists of another 50 patients had no anatomic periurethral reconstruction procedure during RARP.Perioperative data of these patients were collected retrospectively,including operation time,anastomosis timeintraoperative blood loss,duration of indwelling catheter,length of hospital stay,complications,postoperative pathology,and continence outcome at 1,3,6,12 months after surgery.Results All cases were successfully performed without conversion to open or laparoscopic surgery.There were no major intraoperative or postoperative complications.Operative time and anastomosis time was (145.3 ± 12.3)mins and (31.6 ± 8.2)mins in reconstruction group comparing to (122.4 ± 11.4)mins and (21.2 ± 4.4) in control group (both P < 0.05).Duration of indwelling catheter was (7.0 ± 0.5) days in reconstruction group and (11.0 ± 0.6) days in control group (P < 0.05).In reconstruction group,estimated blood loss was (108.1 ± 8.3) ml,duration of drainage tube was (3.0 ± 1.2) d,postoperative hospital stay was (8.0 ± 1.1) d,failure of leak test in 1 case,and postoperative complications in 4 cases (6.9%),comparing to (103.3 ± 10.4) ml,(4.0 ± 1.6) d,(10.0 ± 1.5) d,3 cases and 4 cases (8.0%) in control group with no significant difference (all P > 0.05).Postoperative pathology confirmed 53 T2a-T2b diseases and 5 pT2c diseases in reconstruction group,in comparison with 46 T2a-T2b and 4 pT2c diseases in nonreconstruction group (P > 0.05).There were 19 and 15 cases with a final Gleason score of 6,30 and 27 cases with Gleason 7,9 and 10 cases with Gleason 8,in reconstruction group and non-reconstruction group respectively(all P > 0.05).There was no significant difference between the two groups regarding incidence of positive surgical margins (3 in reconstruction group and 2 in control group,P > 0.05).The percentage of patients maintain continence in reconstruction group and non-reconstruction group:at 1 month [84.5 % (49/58) and 70.0% (35/50)],at 3 months [89.7% (52/58) and 78.0% (39/50)],at 6 months [91.3 % (53/58)and 86.0% (43/50)] and 1 year after surgery [100.0% (58/58) and 96.0% (48/50)].Reconstruction group showed better continence outcome at 1 and 3 month (P < 0.05),with no statistical differences at 6 month and 1 year.The IPSS 1 year after surgery was 10.4 ± 1.6 and 12.1 ± 1.3,with anastomotic stricture in 0 and 2(4%) patients in reconstruction group and control group,respectively (both P > 0.05).Conclusion Anatomic reconstruction of periurethral structure during RARP is safe and feasible with reduced duration of indwelling catheter and better continence outcome.

20.
Chinese Journal of Urology ; (12): 178-182, 2019.
Article in Chinese | WPRIM | ID: wpr-745570

ABSTRACT

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.

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