Percutaneous nephrolithotomy through the upper pole calix access for complicated renal calculi: report of 581 cases / 南方医科大学学报

<p><b>OBJECTIVE</b>To discuss the optimal approach of percutaneous nephrolithotomy (PCNL) for treatment of complicated renal calculi.</p><p><b>METHODS</b>A total of 581 patients with complicated renal calculus were treated by PCNL through the upper pole calix access. Of the 581 patients, 55 had multiple upper pole calculi, 136 had staghorn stones, 145 had partial staghorn stones, and 245 had multiple renal calculi.</p><p><b>RESULTS</b>PCNL through the upper pole calix access was completed successfully in all the cases. Of these patients, 90.3% (525/581) were stone-free after a single access, with a total stone-free rate of 94.6% (550/581). Thirty-five patients needed two accesses, 10 needed 3 accesses, 2 required 4 accesses, and 1 patients had 5 accesses. The operative time ranged from 30 to 150 min (mean 45 min). The successful rate of puncture was 100% without occurrence of severe injury of the pleura, intestine, peritoneum or other adjacent organs.</p><p><b>CONCLUSIONS</b>Percutaneous nephrolithotomy through the upper pole calix access allows greater stone clearance rate due to its easy access into the intrarenal collecting system and can be an ideal approach for PCNL for complicated renal calculi.</p>

Laparoendoscopic single-site surgery radical cystectomy with orthotopic taenia myectomy sigmoid neobladder: initial report / 南方医科大学学报

<p><b>OBJECTIVE</b>To report the first case and detailed techniques of laparoendoscopic single-site surgery (LESS) radical cystectomy with orthotopic taenia myectomy sigmoid neobladder for organ-confined bladder cancer.</p><p><b>METHODS</b>A 74-year-old man presented with gross hematuria for 2 months and biopsy revealed bladder cancer. LESS radical cystectomy and bilateral pelvic lymphadenectomies were performed using a single multilumen port inserted through a solitary 3.5 cm lower abdominal incision with conventional laparoscopic instruments. The taenia myectomy sigmoid pouch was then constructed by open procedure.</p><p><b>RESULTS</b>The total operative time was 9.5 h, and the LESS procedure lasted for about 5.5 h. No other port incision was added. The final pathology revealed urothelial carcinoma. The estimated intraoperative blood loss was 600 ml with blood transfusion of 400 ml. The pelvic lymph nodes and the surgical margins of the ureters and urethra were all free of tumor invasion. No water electrolyte and metabolic acid-base balance disorders were observed perioperatively. The neobladder capacity was about 280 ml, with a residual urine volume of 10 ml and peak flow rate of 11.1 ml/s 3 months postoperatively.</p><p><b>CONCLUSION</b>Although with a steep learning curve, LESS surgery can be a less invasive and promising alternative to muscle-invasive bladder carcinoma.</p>

Expression of special AT-rich sequence-binding protein in bladder urothelial carcinoma and its clinical significance / 南方医科大学学报

<p><b>OBJECTIVE</b>To detect the expression of special AT-rich sequence-binding protein (SATB1) in bladder urothelial carcinoma and investigate its correlation to the biological behavior of the carcinoma.</p><p><b>METHODS</b>The expression of SATB1 mRNA was detected in 34 cases of bladder urothelial carcinoma and 14 normal bladder tissues by RT-PCR, and the protein expression of SATB1 was detected in 68 cases of bladder urothelial carcinoma and 17 normal bladder tissues by immunohistochemistry. The correlation between SATB1 expressions and the biological behavior of the tumor was analyzed.</p><p><b>RESULTS</b>The expression of SATB1 was significantly higher in bladder urothelial carcinoma tissues than in normal bladder tissues (P<0.05). and the expression of SATB1 in the tumor tissues was correlated to the clinical stage and metastasis of the tumor.</p><p><b>CONCLUSION</b>SATB1 expression can be associated with the development and metastasis of bladder urothelial carcinoma and may potentially serve as an indicator for predicting the prognosis of bladder urothelial carcinoma.</p>

Transurethral enucleation of the prostate for treatment of benign prostatic hyperplasia in patients less than 50 years old / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the therapeutic effect of transurethral enucleation of the prostate for treatment of benign prostatic hyperplasia in patients below 50 years of age.</p><p><b>METHODS</b>Twelve patients with benign prostatic hyperplasia patients (mean age 48.2 years, range 46-49 years) underwent transurethral enucleation of the prostate. The middle lobe and two lateral lobes were enucleated with the preprosthetic sphincter and anterior fibromuscular stroma preserved during the operation. The patients were followed up to evaluate the lower urinary tract symptoms and sexual activity after the surgery.</p><p><b>RESULTS</b>The 12 patients were followed up for 3 to 6 months. The symptoms of lower urinary tract obstruction were improved obviously after the surgery, and the International Prostate Symptom Score (IPSS) decreased from 24±5.1 to 8.8±1.4 and peak urine flow rate (Qmax) increased from 8.1±4.2 ml/s to 20.1±4.2 ml/s at 3 months postoperatively. All the 12 cases had residual urine (12-44 ml) preoperatively, but after the surgery, only 4 still had residual urine of less than 30 ml. All the patients had normal erection function postoperatively, and 10 had normal ejaculation; the other 2 patients recovered normal ejaculation 3 and 5 months after the operation, respectively.</p><p><b>CONCLUSIONS</b>Transurethral enucleation can alleviate the low urinary tract obstruction symptom and improve the sexual function by avoiding preprosthetic sphincter injury in relatively young patients with benign prostatic hyperplasia.</p>

Laparoscopic radical cystectomy and detenial sigmoid colon orthotopic neobladder reconstruction for bladder tumor in a 3-year-old boy / 南方医科大学学报

<p><b>OBJECTIVE</b>To present a case of laparoscopic radical cystectomy and detenial sigmoid colon orthotopic neobladder reconstruction for bladder tumor in a child.</p><p><b>METHODS</b>A 3-year-old boy with bladder rhabdomyosarcoma underwent laparoscopic radical cystectomy and detenial sigmoid colon orthotopic neobladder reconstruction. The bilateral pelvic lymphadenectomy and cystectomy were performed laparoscopically, and removal of the mobilized specimens and urinary diversion operation were managed through enlarged abdomen incision. The urinary diversion procedure included construction of the detenial sigmoid pouch, bilateral stented antiflux implantation of the ureters in the pouch and orthotopic anastomosis of the neobladder with the urethra.</p><p><b>RESULTS</b>The total operative time was 6 h, and the laparoscopic procedure lasted for about 3.5 h. The intraoperative blood loss was 50 ml, and 200 ml concentrated red blood cell transfusion was used for the safety of the patient. Six dissected lymph nodes in each pelvic side and the surgical margins of the ureter and urethra were all free of tumor invasion. Bowel peristalsis recovered 3 days after the operation, and the pelvic drainage and the neobladder drainage tubes were removed on day 7 and 14, respectively. The urethral catheter and ureteral stents were removed 25 days after the operation. The daytime urine control and micturition recovered 1 week after the operation. The neobladder capacity was about 110 ml, with residual urine volume of 10 ml and peak flow rate of 12 ml/s after 5 months. No perioperative complications occurred such as water-electrolyte and metabolic acid-base balance disorders, urinary leakage, reflux or bowel obstruction.</p><p><b>CONCLUSION</b>Laparoscopic radical cystectomy is minimally invasive, reduces intraoperative blood loss and allows rapid postoperative recovery, and can be a promising approach to management of bladder rhabdomyosarcoma in children.</p>