Surgical techniques for the ureterointestinal anastomosis in continent urinary diversion / 中华外科杂志

<p><b>OBJECTIVE</b>To compare the complications of direct and antirefluxing techniques of ureterointestinal anastomosis in continent urinary diversion.</p><p><b>METHODS</b>Sixty-three patients underwent continent urinary diversion. Twenty-four patients were treated by the direct ureteroenteric anastomosis and the others treated by the antirefluxing technique. The follow up studies included following-up the information of ureteric stricture, ureteric reflux, renal function and acute urinary infection. It was assessed for 3 months to 6 years with a mean follow up of 26 months after operation.</p><p><b>RESULTS</b>Of 78 ureters reimplanted using antirefluxing technique. A total of 12 ureters had anastomotic stricture formation postoperatively. Only one of 48 ureters reimplanted using direct anastomoses had anastomotic stricture. The difference between the direct and antirefluxing technique groups was remarkable (chi2 = 4.375, P < 0.05). Furthermore, there was no significant difference between the direct and antirefluxing technique groups in regard to ureteric reflux, renal function and acute urinary infection.</p><p><b>CONCLUSIONS</b>Antirefluxing anastomoses resulted in obviously higher rate of ureterointestinal anastomotic stricture in comparison with the direct anastomosis. The direct ureteroenteric anastomosis may be the suitable choice for patients undergoing continent urinary diversion.</p>

Modified Madigan prostatectomy / 中华外科杂志

<p><b>OBJECTIVE</b>To improve Madigan prostatectomy (MPC) for a much satisfactory effect in open surgery.</p><p><b>METHODS</b>A total of 52 patients with benign prostatic hyperplasia (BPH) were treated using MPC. The MPC procedure was modified by exposing anterior prostatic urethra near the bladder neck and conjunction with cystotomy. This modified procedure preserved prostatic urethra intact and could also deal with intracystic lesions at the same time.</p><p><b>RESULTS</b>The intact of prostatic urethra was kept completely or almost for 48 cases. The hemorrhage amount during modified procedure was a less. The mean operative time was 120 minutes. The 35 patients had been followed up for 1 - 12 months. The average Qmax was 18.9 ml/s. The cystourethrography revealed that the urethra and bladder neck were intact in 8 patients postoperatively. Furthermore, the prostatic urethra was obviously wider after modified MPC.</p><p><b>CONCLUSIONS</b>The modified MPC can reduce the urethra injury and enlarge the MPC indications. The modified technique is easy to perform with little complications and much more satisfactory clinical result. The modified MPC is highly recommended.</p>