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【Objective】 To reduce the incidence of postoperative intestinal obstruction, we tried to improve surgical techniques by closing the cavity formed during radical cystectomy + ileal passage (Bricker) via laparoscopy to prevent the formation of abdominal hernia. 【Methods】 During Oct.2018 and Feb.2022, 41 patients were involved (conventional group). After standard laparoscopic radical cystectomy + pelvic lymphadenectomy, the ileum channel was established. The right medial retroperitoneum was sutured to cover the mesothelium and end of the ileum channel under open operation or endoscope. The space between the ureter and mesothelium of the ileum channel was sealed, and the end of the ileum channel and both ureters were externalized. During Feb.2022 and Dec.2022, 15 patients were involved (modified group). The right inner and outer lateral peritoneums below the ileal conduit were sutured to "bottom out" the gap between the ileal conduit and the right abdominal wall in addition to standard procedures. The recovery of intestinal function and incidence of bowel obstruction were compared between the two groups. 【Results】 In the conventional group, the intestinal function recovered within 2 to 6 days after surgery, with a median ventilation time of 3 days. Intestinal obstruction occurred in 3 patients, 2 of whom improved after conservative treatment while 1 underwent surgical exploration after ineffective conservative therapy. There were no significant differences in the time of discharge and ventilation between the two groups, but no intestinal obstruction occurred in the modified group. 【Conclusion】 Peritoneal externalization at the end of ileal passage can reduce the incidence of intra-abdominal hernia and postoperative intestinal obstruction, which is worthy of clinical application.
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Neurogenic bladder caused by herpes zoster is not common.An 86 years old male patient with 6 months of dysuria and urinary retention caused by herpes zoster underwent sacral neuromodulation (SNM) operation. The symptoms of dysuria and fecal incontinence were improved significantly after operation.
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Objective:To evaluate the clinical efficacy and safety of transurethral columnar balloon dilation of prostate (TUCBDP) in treatment of patients with benign prostatic hyperplasia(BPH).Methods:A retrospective analysis was performed on 25 cases of BPH treated by TUCBDP in the First Affiliated Hospital of Anhui Medical University from June 2016 to July 2018. The median age was 80(57-94) years, and the median volume of prostate was 75 (30-176) ml. The median preoperative maximum urine flow rate (Q max) was 6 (2-9) ml/s, the median quality of life score (QOL)was 4(3-5) points. The median preoperative international prostate symptom score (IPSS) and residual urine volume (RUV) was 25(18-34) and 85 (30-510) ml respectively.The median preoperative international index of erectile function questionnaire-5 (IIEF-5) score was 11(5-21)points and the median preoperative premature ejaculation diagnostic tool (PEDT) score was 10(6-17)points.The standard procedure of TUCBDP includes injecting 5ml of normal saline into the inner capsule, touching the inner capsule at the apex of prostate, fixing the catheter and then injecting water into the outer capsule to make the pressure reach 2.5 kPa. When the pressure of the outer capsule was maintained at 3 kPa for 5 minutes, the prostate was split. The peroperative IPSS, QOL, Q max and RUV was compared. The IIEF-5 and PEDT score before and after surgery were compared in patients with normal sexual activity to evaluate whether there were reverse ejaculation and semen reduction. Results:One case of BPH failed to rupture and the other two cases was split at 6 o’clock. The three cases were converted to plasma resection. The rest 22 cases were operated successfully with the median operation time of 17(11-23)min, the hemoglobin loss of 19(15-22)g/L. The continuous bladder flushing time was 1(1-2)d, the indwelling catheter time was 10(7-11)d and the hospital stay time was 11(7-12)d. Twenty of 25 cases were followed-up for 12 months. IPSS was 8 (4-14) points, Q max was 17(9-25)ml/s, and RUV was 10 (0-150) ml; there were significant differences between the peroperative and postoperative (all P<0.001). The median QOL was 1(1-2) point, decreased than peroperative( P<0.05). No adverse ejaculation and semen reduction were found in the post-operative patients with normal sexual life. The post-operative IIEF-5 and PEDT score was 16 (7-24) points and 8 (6-14) points respectively, which was not significantly different while compared with pre-operative IIEF-5 and PEDT score. Conclusions:TUCBDP was proved to be effective and safe for treating high-risk BPH patients with the advantages of short operation time, less bleeding, significant improvement of residual urine and dysuria.
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Objective To explore the potential value of applying three-dimensional visualization technology in the robot-assisted laparoscopic nephron sparing partial nephrectomy.Methods From January to December 2018,98 patients with renal carcinoma undergoing robot-assisted laparoscopic nephron sparing surgery were retrospectively analyzed.Forty-one patients in the experimental group accomplished kidney CT examination and three-dimensional reconstruction before surgery,and fifty-seven patients in the control group only completed kidney CT examination.There were 20 males and 21 females in the experimental group with the age of (51.39 ± 14.80) years and body mass index (BMI) of (23.54 ± 3.08) kg/m2.The median tumor diameter was 3.40 cm (range 1.90-8.30 cm) and the mean R.E.N.A.L.score was (5.83 ± 1.51) in the experimental group including 11 cases of transperitoneal,17 cases of retroperitoneal and 13 cases of combined transperitoneal and retroperitoneal access.There were 35 males and 22 females in the control group with the age of (52.84 ± 12.28) years and BMI of (24.01 ±3.30)kg/m2.The median tumor diameter was 3.35 cm (range 1.40-7.0 cm) and the mean R.E.N.A.L.score was (6.17 ± 1.77) in the control group including 15 cases of transperitoneal,31 cases of retroperitoneal and 11 cases of combined transperitoneal and retroperitoneal access.There was no statistical difference between two groups in term of age,gender,BMI score,R.E.N.A.L.score,tumor size,tumor location and operative approach.Results Ninety-eight cases of operation were successfully completed without causing vascular and ureteral injury.The warm ischemia time in the experimental group was significantly shorter than that of the control group [median 15.0 (7.0-26.0) min vs.20.0 (10.0-28.0) min,P--0.02],while no statistical difference was observed in term of operation time [median 130.0 (65.0-340.0) min vs.139.0 (67.0-250.0) min,P =0.22].There was no significant difference between the two groups in the decrease of hemoglobin within 24 hours after operation [median 20.0 (4.0-39.0) g/L vs.15.5 (2.0-40.0) g/L,P =0.56] and the average length of hospital stay after operation [median 6.0(4.0-14.0) d vs.6.0(5.0-14.0) d,P =0.86].The trend of creatinine declining was not statistically significant between the two groups at both 24 hours [median:2.0 (-10.0-28.0) μmol/L vs.7.5 (-17.0-51.0) μ mol/L,P =0.24] and 6 months after operation [median:2.0 (-12.0-57.0) μ mol/L vs.4.5 (-3.0-24.0) μmol/L,P =0.39].Conclusions Preoperative three-dimensional reconstruction is helpful to shorten the warm ischemia time,but it did not show short-term and long-term protection for renal function.