Preliminary experience of suprapubic three-arm robot-assisted laparoscopic radical prostatectomy / 中华泌尿外科杂志

To evaluate the feasibility and safety of suprapubic three-arm robot-assisted laparoscopic radical prostatectomy (STA-RLRP). Fifteen patients with prostatic cancer underwent STA-RLRP. All the 15 procedures were completed successfully, without the need for ancillary trocars or additional instruments. No patient required conversion to standard laparoscopy or open surgery. STA-RLRP is feasible and safe with good short-term tumor control, satisfactory recovery of urinary control function and good cosmetic outcome, which is worthy of clinical application.

Feasibility and safety of transurethral plasmakinetic enucleation of prostate with suprapubic bladder puncture and gland fixation / 中华泌尿外科杂志

Objective:To investigate the feasibility and safety of suprapubic bladder puncture and gland fixation in transurethral enucleation of the prostate.Methods:The clinical data of 15 patients with benign prostatic hyperplasia admitted to the First Affiliated Hospital of Guangxi Medical University from January 2020 to June 2020 were retrospectively analyzed. The age was (70.27±5.35) years old, preoperative serum prostate-specific antigen (PSA) level was (3.03±1.37) ng/ml, preoperative total prostate weight was 80.3(70.49, 96.78)g, preoperative postvoid residual urine volume(PVR)was 80 (55, 108)ml, and the maximum urine flow rate (Q max) was (6.13±2.25) ml/s. The international prostate symptom score(IPSS) was 25(22, 27), quality of life (QOL)score was 5(5, 6), international erectile function index-5 (IIEF-5) score was (15.38±5.10). All 15 patients underwent conventional transurethral plasma enucleation of prostate by using the three-lobe method, and the enucleated gland was pushed into the bladder completely. Then a laparoscopic pneumoperitoneum needle was used to perform suprappubic cystipuncture, and ureteral grasping forceps were inserted through the outer sheath. The forceps were used to fix the enencied gland. A rapid harvesting electric resection was performed in the broad space of the bladder, and the Ellick was rinsed to remove the tissue fragments. Surgical indicators and complications were recorded. The improvement of subjective score (IPSS, QOL, IIEF-5) and objective index (Q max, PVR) was compared between preoperative and postoperative. Results:All the 15 operations were completed successfully and there were no complications such as blood transfusion, capsule perforation, transurethral resection syndrome, bladder injury, bladder puncture site laceration and bleeding. The weight of resected prostate tissue was 44(40, 60)g, with blood loss (79.20±18.93)ml.The time of enucleation operation was (54.13±10.88)min, with harvest cutting time (14.67±2.50)min, evisceration efficiency (0.89±0.08)g/min, harvesting efficiency (3.26±0.36)g/min, bladder irrigation time (2.47±0.52) d. The time of indwelling catheter was (3.73±0.80)d.The postoperative hospital stay was (4.40±0.91) d. Temporary urinary incontinence occurred in 1 case after operation. All patients were followed up for 6 months after operation. The IPSS score was 3(2, 3), QOL score was 0(0, 1), IIEF-5 score was (20.12±2.30), Q maxwas (21.80±2.14) ml/s and PVR was 10(5, 15)ml, which were all significantly different compared with those before surgery ( P<0.05). The symptoms of the patients were significantly improved. Conclusions:Transurethral plasma enucleation of prostate combined with suprapubic bladder puncture and fixed gland is effective in the treatment of benign prostatic hyperplasia. The subjective symptoms and objective examination of patients have been significantly improved, and no adverse operation-related complications have occurred. It is a suitable method for enucleation of prostate in units which are not equipped with transurethral tissue planer.

Catheter induced hypospadias, urethral trauma and penile abscess in completely recoverable neurological afflictions: preventable entities

Background: Catheter associated complications are very common in the emergency departments of medicine, general surgery, orthopaedics and in community. They mostly occur in patients with neurological afflictions because of inexperience of the first handlers as they lack the insight of altered physiology and anatomy in the lower urinary tract because of neurological lesions and also because of an inadequate advice at the time of discharge regarding the catheter care. Objectives of this study were to find the prevalence of per-urethral catheter associated injuries in patients with neurological lesions in a tertiary care centre of south-eastern Punjab and their prevention in completely recoverable neurological afflictions.Methods: This is a cross-sectional observational study conducted in urology department from 1st August 2017-31st August 2018. The data was taken from medicine, general surgery and orthopedic emergency departments. A total of 82 patients were taken from 19-78 years and 49 patients had per-urethral catheter placement. Analysis was done using Statistical Program of Special Sciences, version 20.Results: It was observed that overall neurological lesions are more common in males (80.48%) as compared to females (19.51%) and distributed over an age range of 19-84 years in both sexes. Out of total patients, 59.75% required per urethral catheterization. The prevalence of per-urethral catheter associated complications was 20.40%.Conclusions: Insertion of per-urethral catheter is a simple procedure but an error of omission on the part of health professionals’ results in a serious complication in a neurological patient. Proper insertion technique and catheter care are to be followed to prevent avoidable complications in this subset of patients.

Hemicolectomía derecha laparoscópica con abordaje suprapúbico: una técnica novedosa para el tratamiento del cáncer de colon / Suprapubic laparoscopic right hemicolectomy: a novel technique for the treatment of colon cancer

Antecedentes: la hemicolectomía derecha laparoscópica con abordaje suprapúbico (HDLS) y empleo de tecnología robótica o laparoscópica de incisión única ha sido recientemente informada. La utilización de la técnica estándar multipuerto en HDLS no se ha descripto previamente. Material y métodos: entre enero y agosto del año 2018 fueron intervenidos 4 pacientes, 3 mujeres y 1 hombre, con mediana de 64 años de edad y diagnóstico de adenocarcinoma de colon derecho. Resultados: el procedimiento se realizó exitosamente en todos los pacientes, con una mediana de tiempo operatorio de 210 minutos (r:170-240). Ningún paciente tuvo complicaciones y fueron dados de alta en una mediana de 4 días (r:3-5). Todas las piezas quirúrgicas tuvieron márgenes negativos y un recuento ganglionar > 12 ganglios. A 7, 5, 4 y 2 meses del seguimiento, los pacientes se hallan vivos y libres de enfermedad. Conclusión: la técnica de HDLS multipuerto es una alternativa sencilla, factible y segura para el tratamiento del cáncer de colon en pacientes seleccionados, con un resultado funcional, estético y oncológico favorable.

Background: The suprapubic approach for laparoscopic right hemicolectomy has been reported with robotic surgery or single incision laparoscopy. The use of the suprapubic approach for standard multiport laparoscopic right hemicolectomy has not been previously described. Material and methods: Between January and September 2018, four consecutive patients (three women and one man; median age: 64 years) with right-sided colon cancer underwent laparoscopic right hemicolectomy using the suprapubic multiport approach. Results: The procedure was successful in all the patients and mean operative time was 210 minutes (IQR: 170-240). There were no complications and were discharged on postoperative day 4 (IQR: 3-5). All the surgical specimens had negative margins and lymph node count was > 12 lymph nodes. All the patients are alive and free from disease at 7, 5, 4 and 2 months of follow-up. Conclusion: The suprapubic approach for standard multiport laparoscopic right hemicolectomy is an easy, feasible and safe alternative for the treatment of colon cancer in selected patients, with a favorable functional, esthetic and oncological result.

Preliminary application of 3D printing navigation template in the screw insertion of the suprapubic fracture / 中国综合临床

Objective To introduce the method of using hollow pull screw insertion for the suprapubic fracture with 3D printing navigation template and to evaluate its clinical effect.Methods From March 2016 to August 2017,eighteen cases of suprapubic ramus fractures treated with hollow lag screw fixation in the Department of Orthopedics of Yanan University Affiliated Hospital were retrospectively collected was collected.Before operation,the thin slice CT scan of pelvis was used to get raw data,and the mimics17.0 software was used to reconstruction the model,to design and make the personalized navigation template assisting the suprapubic fractures surgery.The navigation template was printed out pre-operatively,and the nail was inserted via the assisted by the template intra-operatively.After the operation,the fracture reduction was evaluated by Matta imaging scores and the pelvis function was evaluated by Majeed scores.Results All the operations were successfully completed.The Matta scores were excellent in 11 cases,good in 6 cases,and fair in 1 case.The Majeed scores were excellent in 13 cases,good in 3 cases,and fair in 2 cases.Conclusion 3D Printing navigation template assisted the placement of the hollow screw on the suprapubic fracture could provide personalized treatment,reduce the difficulty of operation and satisfy the clinical effect.

Development and evaluation of a training model for paracentetic suprapubic cystostomy and catheterization

OBJECTIVES: Minimally invasive paracentetic suprapubic cystostomy is a technique that should be learned by all surgical trainees and residents. This study aimed to develop a self-made training model for paracentetic suprapubic cystostomy and placement of the suprapubic catheter and then to evaluate its effectiveness in training fourth-year medical students. METHODS: Medical students were divided into an experimental group receiving comprehensive training involving literature, video, and model use and a control group receiving all the same training protocols as the experimental group except without hands-on practice using the model. Each student's performance was video-recorded, followed by subjective and objective evaluations by urology experts and statistical analysis. RESULTS: All students completed the surgical procedures successfully. The experimental group's performance scores were significantly higher than those of the control group (median final performance scores of 91.0 vs. 86.8, respectively). Excellent scores were achieved by more students in the experimental group than in the control group (55% vs. 20%), and fewer poor scores were observed in the experimental group than in the control group (5% vs. 30%). CONCLUSIONS: Based on its cost-effectiveness, reusability, and training effectiveness, this paracentetic suprapubic cystostomy training model is able to achieve goals in teaching practice quickly and easily. Use of the model should be encouraged for training senior medical students and resident physicians who may be expected to perform emergent suprapubic catheter insertion at some time.

La técnica de separación de componentes como adyuvante quirúrgico en la reparación de hernias suprapúbicas / The component separation technique as surgical adjuvant in suprapubic hernia repair

La hernia incisional suprapúbica constituye una enfermedad infrecuente, consecuencia generalmente de cirugías pélvicas en especial las que abordan el espacio retropúbico de Retzius. El objetivo dle trabajo es reportar los resultados del tratamiento quirúrgico de la hernia suprapúbica mediante el proceder tradicional de Rives-Stoppa asociado a la técnica de separación de componentes con bioprótesis de polipropileno como refuerzo. Se reportan tres pacientes con hernias suprapúbicas grandes. Estas se definieron como: todo defecto localizado en una distancia no mayor de 5 cm a la sínfisis del pubis con diámetro del anillo herniario superior a los 10 cm en su eje mayor medido transoperatoriamente. Fueron intervenidos quirúrgicamente tres pacientes, un hombre y dos mujeres. El primero con antecedentes de prostatectomía retropúbica y las dos últimas de cirugía ginecológica. En el primero, se complementó la operación de Rives-Stoppa con la técnica de separación anterior de componentes y refuerzo supra aponeurótico. Las dos últimas preferimos la separación posterior de componentes para evitar la disección anterior extensa. Las complicaciones más frecuentes fueron los seromas y hasta la fecha no se han reportado recurrencias. La reparación preperitoneal combinada con la técnica de separación de componentes anterior o posterior, constituyen alternativas válidas en la reparación de hernias incisionales complejas como son las hernias suprapúbicas. Esto permitió el cierre del defecto aponeurótico para cubrir y proteger la bioprótesis con la reconstrucción consiguiente de la línea alba(AU)

Suprapubic incisional hernia is a rare disease, generally the result of pelvic surgeries, especially those approaching the retropubic space of Retzius. To report the results of the surgical treatment of the suprapubic hernia by means of the traditional procedure of Rives-Stoppa associated to the component separation technique with polypropylene bioprosthesis as reinforcement. Three patients with large suprapubic hernias are reported. These were defined as: any defect located at a distance of no more than 5 cm from the symphysis pubis with diameter of the hernial ring over 10 cm at its major axis measured trans-operatively. Three patients, one man and two women were operated. The first, with a history of retropubic prostatectomy and the last two, with a history of gynecological surgery. In the first, the operation of Rives-Stoppa was complemented with the component separation technique and supra-aponeurotic reinforcement. For the last two, we preferred the posterior component separation in order to avoid extensive anterior dissection. The most frequent complications were seromas and, to date, no relapses have been reported. Preperitoneal repair combined with the technique of anterior or posterior component separation are valid alternatives in the repair of complex incisional hernias, such as suprapubic hernias. This allowed closure of the aponeurotic defect to cover and protect the bioprosthesis with the consequent reconstruction of the linea alba(AU)

Suprapubic cystostomy versus nonsuprapubic cystostomy during monopolar transurethral resection of prostate: A propensity score-matched analysis / 亚洲男科学杂志(英文版)

We aim to reassess the safety of the monopolar transurethral resection of the prostate (M-TURP) without suprapubic cystostomy at our institution over the past decade. This retrospective study was conducted in patients who underwent M-TURP at Peking University First Hospital between 2003 and 2013. A total of 1680 patients who had undergone M-TURP were identified, including 539 patients in the noncystostomy group and 1141 patients in the cystostomy group. After propensity score matching, the number of patients in each group was 456. Smaller reductions in hemoglobin and hematocrit (10.9 g vs 17.6 g and 3.6% vs 4.7%, respectively) were found in the noncystostomy group. In addition, patients undergoing surgery without cystostomy had their catheters removed earlier (4.6 days vs 5.2 days), required shorter postoperative stays in the hospital (5.1 days vs 6.0 days), and were at lower risk of operative complications (5.7% vs 9.2%), especially bleeding requiring blood transfusion (2.9% vs 6.1%). Similar findings were observed in cohorts of prostates of 30-80 ml and prostates >80 ml. Furthermore, among patients with a resection weight >42.5 g or surgical time >90 min, or even propensity-matched patients based on surgical time, those with cystostomy seemed to be at a higher risk of operative complications. These results suggest that M-TURP without suprapubic cystostomy is a safe and effective method, even among patients with larger prostates, heavier estimated resection weights, and longer surgical times.

Comparison of the clinical effects of transurethral plasmakinetic enucleation of prostate and suprapubic transvesical prostatectomy in the treatment of large volume benign prostatic hyperplasia / 中国综合临床

Objective To assess the clinical efficacy and safety of transurethral plasmakinetic enucleation of prostate (PKEP) and suprapubic transvesical prostatectomy (SPP) in the treatment of large volume benign prostatic hyperplasia (BPH).Methods A total of eighty patients with large volume BPH were selected in the First People''s Hospital of Xuzhou from March 2014 to December 2016,and they were randomly divided into two groups,the PKEP group and SPP group,with 40 cases in each group.The comparison was made between the two groups in terms of operation indicators,postoperative complications followed up for 6 months after surgery and other related curative effect indexes.Results In the SPP group,the intraoperative blood loss was significantly higher than that of the PKEP group ((215.7±10.4) ml vs.(75.6±9.2) ml,t=6.541,P0.05).But the catheterization time after operation,bladder irrigation time and length of hospital stay were significantly longer in the PKEP group than in the SPP group ((6.3±1.8) d vs.(2.4±0.6) d,(5.5±1.4) d vs.(1.3±0.6) d,(7.7±2.3) d vs.(3.1±0.7) d,t=4.357,2.542,2.975,P0.05).The rate of complication occurrence in the PKEP group were lower than that of the SPP group (P<0.05).Conclusion PKEP was effective in the treatment of BPH,with less bleeding loss,fewer complications and quick recovery.It can significantly improve the life quality of the patients and will be an ideal treatment for large volume BPH.

Minimally Invasive Approach to Supra-pubic and Non-Midline Lower Abdominal Ventral Hernia: An Extended Indication of TAPE Technique

Repair of lower abdominal incisional hernia is always a surgical challenge. TAPE technique has been described for the repair of supra-pubic midline incisional hernia with satisfactory outcome. Its indication can be extended for treatment of non-midline lower abdominal hernia. Peritoneal incision is created just below the hernia defect with pre-peritoneal dissection to expose supra-pubic preperitoneal space with Cooper's ligament exposed. Non-adhesive mesh then placed over preperitoneal space and partially intra-peritoneally, and cover the whole extra-peritoneal space prepared to ensure enough overlapping. Mesh is fixed by tackers for intra-peritoneal part, most inferior fixation points were at peritoneal incision line. Extra-peritoneal part of meshes is fixed at the safety zone and covered up by the peritoneal flap to avoid mesh migration. Fixation of the meshes at the lateral aspects were facilitated by the peritoneal flap and subsequent fibrosis and adhesion to the extra-peritoneal structures in cases of lateral lower abdominal hernia. Repair of midline and lateral lower abdominal incisional hernia with this novel modified technique with prosthetic mesh is safe and effective. A larger case series and longer follow-up is required for validation of this technique.

The clinical research of suprapubic small cut method combined with transurethral resection prostate on the treatment of benign prostatic hyperplasia complicated with bladder stones / 中国综合临床

Objective To explore the clinical effect of suprapubic small cut method combined with transurethral resection prostate(TURP) on the treatment of benign prostatic hyperplasia(BPH) complicated with bladder stones.Methods Sixty patients with BPH complicated with bladder stones ≥ 3 cm in the People's Hospital of Futian Affiliated to Guangdong Medical College from January 2013 to September 2014 were selected as the study group,and another 60 patients with BPH complicated with bladder stones＜3 cm during the same period were selected as the control group.The cases in the study group were treated with suprapubic small cut method combined with TURP,and the cases in control group were treated with transurethral method combined with TURP.The intraoperative indicators (including the time used for crushed stone,total operation time,blood loss,conversion to laparotomy,blood transfusion and bladder perforation),residual bladder stones and complications of postoperative were compared.Results The operations of the two groups of patients were successfully,and there was no conversion to laparotomy and either bladder perforation.The stone removal time and total operative time of patients of the study group were shorter than of the control group,the difference was statistically significant((12.20±3.55) min vs.(24.05±7.68) min,(62.31± 10.49) min vs.(82.46± 16.75)min;t =10.849,7.897;P＜0.001).The intraoperative blood loss and the cases of blood transfusion of patients of the study group were less than the control group,but the prevalence of urinary tract infection were higher(6vs.4),but the difference was not statistically significant(P＞0.05).Residual stones were more commonly in the control group than in the study group (study group:0,control group:6 cases),the difference was statistically significant(x2 =6.316,P=0.012).Conclusion BPH complicated with bladder stones can be treated by the suprapubic small cut method combined with TURP or transurethral method combined with TURP,but suprapubic small cut method combined with TURP is safer and more effective,which is worthy of popularization and application in clinic.

Trapped after Coming Buttocks: A Consequence of Sacrococcygeal Teratoma: A Case Report.

Sacrococcygeal teratoma (SCT) is the commonest fetal tumour but a rare cause of obstructed labour. If undiagnosed during antenatal period, high index of suspicion is required during labour to make a diagnosis. In this case report, we present a case of sacrococcygeal teratoma (SCT) which was diagnosed at the time of delivery. The fetus, with a massive ruptured sacrococcygeal mass, was delivered by traction and suprapubic pressure. Histology report revealed malignant sacrococcygeal teratoma. The diagnosis of sacrococcygeal teratoma (SCT) should form part of the differential diagnoses when there is obstructed labour after the delivery of the fetal shoulders so that appropriate management can be instituted.

Clear Cell Acanthoma Clinically Presenting as an Erosive Nodule / 대한피부과학회지

No abstract available.

Unusual Foreign Body in Urinary Bladder: A Case Report.

In the urinary tract, foreign body is most commonly found in the urinary bladder. It is commonly self-inflicted but can rarely be introduced by other person. Various types of foreign bodies have been reported, which includes infusion set, aluminum rod, gold chain, pearl, fish, pencil etc. Here we report a case of a 28-year young man who gave the history of forceful introduction of a long wire of mobile charger into the bladder by another person. It could not be removed by himself and by the local doctors. Then he was referred to Enam Medical College & Hospital and subsequently was removed by suprapubic cystostomy.

The diagnosis, treatment and prevention of dysuria within 6 months after suprapubic transvesicle prostatectomy / 中国综合临床

Objective To summarize the diagnosis,treatment and prevention of dysuria within 6 months after the suprapubic transvesical prostatectomy. Methods Twenty-four cases were retrospectively reviewed,including the data on the diagnosis, treatment and prognosis. Results Twenty-one of the 24 cases had received surgery. There were 9 cases with bladder neck stricture,9 cases with posterior urethra stricture and 3 cases with of remnant glands. Nine cases received transurethral bladder neck incision, 9 received open surgery ( bladder neck,posterior urethral incision) and 3 received transurethral resection of the prostate (TURP) plus bladder neck incision. The other 3 diagnosed as detrusor weakness were conservatively treated by indwelling catheter and they were improved one months later. None of these patients was readmitted into hospital for dysuria within 6 months after treatment. Conclusion The recurrence of dysuria post prostatectomy mostly ( 75% ) occurred within 6 months after surgery. A majority of these patients need a second surgery. To avoid a second surgery for postoperative dysuria, much attention should be paid to the operating technique and postoperative management.

Myeloid sarcoma of the urinary bladder with cutaneous tumour seeding after percutaneous suprapubic catheterization

Myeloid sarcoma (MS) is a rare extramedullary myeloid tumour. It has been reported in various sites, including lymph node, bone, skin, soft tissue, various organs and the CNS. It may precede or occur concurrently with acute myeloid leukemia. Urinary bladder involvement is extremely uncommon. We report a 70-year-old female who had MS of the urinary bladder, presented with frank and persistent hematuria associated with lower abdominal pain. She subsequently had tumour seeding in the abdominal skin via percutaneous suprapubic catheter. Tumours from both the urinary bladder and skin showed immature cells that were immunoreactive toward LCA (focal), MPO (strong), CD99 (weak) and CD117 (weak). Summary of cases in the literature is presented. The potential of its misdiagnosis and the useful markers for the diagnosis of MS are discussed

The evaluation of the efficacy of the suprapubic arch sling in female stress urinary incontinence by video-urodynamic tests / 中国医师进修杂志

Objective To evaluate the efficacy of the suprapubic arch sling(SPARC)in female stress urinary incontinence by video-urodynamic tests.Method From January 2007 to October 2008,video-urodynamic tests,the pad test and ICI-Q-SF had been performed in all patients who received the SPARC before operation and 3,6 months after operation.Results Thirty-two cases of an effective follow-up for 6 to 20 months,31 patients were satisfied with urinary control,1 patient had mild urinary incontinence.Urodynamics:3,6 months after operation the maximum bladder capacity(MCC),residual urine(RU),detrusor pressure at maximum flow rates(Pdet,Qmax)were no statistical differences compared with those before operation(P＞ 0.05),3 months after operation,abdominal leak point pressure(ALPP)difference was statistically significant compared with that before operation(P =0.000),6 months after operation,the maximum urinary flow rate(Qmax),ALPP differences were statistically significant compared with those before operation(P values were 0.003,0.000).Static urethral pressure profile parameters before operation and 3,6 months after operation,the maximum urethral closure pressure(MUCP)was(35.2 ± 20.4),(53.1 ±22.5),(62.3 ± 19.8)cm H2O(1 cm H20 =0.098 kPa),respectively,functional urethral length(FUL)was (3.5 ± 1.3),(3.9 ± 0.9),(4.2 ± 1.1)cm,respectively,6 months after operation,MUCP,FU L differences were statistically significant compared with before operation(P values were 0.000 and 0.002).Conclusion Urodynamic evaluation by image,SPARC is one of the effective methods to treat the female stress urinary incontinence,the image within 6 months of urodynamic evaluation prompt surgery can increase urethral pressure,strengthen the control of urinary function,while no significant effect on bladder function.

The Effect of Suprapubic Magnetic Stimulation in Patients with Neurogenic Detrusor Overactivity

PURPOSE: To evaluate the effect of suprapubic magnetic stimulation (SMS) with the use of an arm-type magnetic stimulator for the treatment of patients with neurogenic detrusor overactivity. MATERIALS AND METHODS: Eleven patients with neurogenic detrusor overactivity were enrolled in this study. All patients underwent more than 16 SMS sessions, two times per week, with the use of an arm-type magnetic stimulator. Objective success was defined as a significant reduction (> or =50%) in the total number of leakage episodes per 24 hours, whereas subjective success was defined as the request to continue treatment. RESULTS: Five (71.4%) of 7 patients who had urinary incontinence before treatment reported objective success, and 3 patients showed no incontinence. A total of 6 (75.0%) of 8 patients showed increased average voiding volume. One patient showed an adverse effect of back pain after SMS and dropped out. Seven patients (70.0%) of 10 patients wanted to continue this treatment. They showed significant improvements in frequency/volume chart data, quality of life scores, and urodynamic data. CONCLUSIONS: SMS can be a safe, non-invasive and effective option for the treatment of neurogenic detrusor overactivity.

Application of Suprapubic Arc Sling for Stress Urinary Incontinence in Female:30 Cases Report / 中国康复理论与实践

@#Objective To evaluate the surgical approaches,complications,safety and efficacy of the suprapubic arc sling(SPARC) applied for stress urinary incontinence(SUI).Methods 30 female patients with SUI accepted SPARC through the anterior vaginal wall.Results All the cases clinically improved.1 patient experienced bladder injury,and get well 5 d after the operation;1 patient experienced post-procedure voiding dysfunction,but got well after the tape was cut 2 weeks later.All of the cases were followed up for 12～20 months with good results.Complete dryness was seen in 93.3%(28/30),6.7%(2/30) showed significant improvement.No leakage occurred.Conclusion SPARC is a simple,reliable procedure for anti-incontinence with good results.

A Case of Malignant Eccrine Poroma Developing on the Suprapubic Area

Malignant eccrine poroma is a rare skin appendageal tumor arising from the intraepidermal ductal portion of the eccrine sweat gland. It may develop either spontaneously or from a long-standing eccrine poroma. It usually affects the aged and is located most commonly on lower extremities. We report a case of malignant eccrine poroma occurring on the suprapubic area of a 75-year-old Korean man. He underwent wide excision and flap coverage.