Study progress in erectile dysfunction after radical pelvic surgery / 中华泌尿外科杂志

Radical pelvic surgery is a surgical method mainly used to treat tumors in the pelvic cavity, and erectile dysfunction (ED) is a common sexual dysfunction after surgery. The incidence of ED after radical pelvic surgery is not uniformly understood due to differences in surgical approaches and methods of investigation. The main causes of postoperative ED include intraoperative neurovascular injury, psychosomatic factors and preoperative patient characteristics, with intraoperative injury to the neurovascular bundle being the most common. Studies have shown that the occurrence of postoperative ED can be prevented by active intervention, but still lack of effective treatment measures. This article reviews and summarizes the clinical epidemiological features and research progress in recent years on ED after radical pelvic surgery, and discusses specific measures for the prevention and treatment of postoperative ED.

Risk Factors for Difficult Sedation-free Colonoscopy / 胃肠病学

Background: Colonoscopy has been widely applied in clinic because of its value in screening, diagnosis and treatment of colorectal diseases. Discomfort and pain account for a great part of incomplete intubation during sedation-free colonoscopy. Aims: To identify the predictive factors for difficult sedation-free colonoscopy. Methods: Patients aged 18-80 years old undergone sedation-free colonoscopy at the Tenth People's Hospital of Tongji University from January to December in 2017 were enrolled. The clinical data and medical history were collected. Each patient completed the Eysenck Personality Questionnaire (EPQ) with the help of nurse before colonoscopy. Sedation-free colonoscopy was performed by experienced endoscopist. The Ottawa bowel preparation scale and Visual Analog Scale were used to evaluate the quality of bowel cleansing and pain during the procedure. Results: The total cecum intubation rate was 97.1% (198/204), and 192 patients completing the EPQ were enrolled for analyses. Twenty-four patients had a difficult colonoscopy (intubation time prolonged to >10 min). By univariate analysis, gender, age, body mass index (BMI), history of surgery, pain level and score of Extraversion-Introversion Scale of EPQ (EPQ-E) were associated with difficulty during colonoscopy (all P<0.05). Multivariate analysis revealed that history of pelvic surgery was a risk factor for difficult colonoscopy (OR=6.833, 95% CI: 2.396-19.488, P<0.001), whereas overweight (OR=0.190, 95% CI: 0.038-0.962, P=0.045) and score of EPQ-E ranged from 8-15 (OR=0.367, 95% CI: 0.150-0.896, P=0.028) were protective factors. Conclusions: History of pelvic surgery, lower BMI and extraversion or introversion personality may increase the difficulty during sedation-free colonoscopy. EPQ-E might be used for selecting candidates of sedation-free colonoscopy when it is performed by an inexperienced endoscopist.

Evaluation of the Role of Pre-Operative Ketamine Gargle to Control URTI in Patients with Endotracheal Intubation

Background: Postoperative sore throat is a common and disturbing complication after endotracheal intubation, leading to patient discomfort and dissatisfaction. Objective: To find out the efficacy of ketamine gargles in reducing the incidence and severity of postoperative sore throat after endotracheal intubation. Methods: We studied the role of preoperative ketamine gargles for reducing postoperative sore throat. Patients undergoing elective abdominal and pelvic surgery under general anaesthesia with endotracheal tube were included in the study. They were randomly allocated in two groups, each group comprising of 30 patients. Group 1 received preservative free ketamine 50mg in 29 ml distilled water. Group 2 gargled with 30 ml distilled water. Patients were asked to gargle for 30 seconds, 5minutes before induction of anaesthesia. Postoperatively sore throat was assessed at 0, 4, 8 and 24 hours after extubation. The severity of sore throat was assessed from mild to severe. Results: Immediately after extubation, 90% patients in group 2 had sore throat compared to 66.7% in group 1. 24 hours after extubation, the incidence decreased to 50% in group 2 and 13.3% in group 1. Similar decrease incidence was noted at 4 and 8 hours post extubation in group 1. No patient in group 1 complained of change in voice or hoarseness of voice. Conclusion: We found that preoperative gargling with ketamine is a simple and cost effective way to reduce the incidence and severity of postoperative sore throat.

Comprehensive analysis of unplanned abdominal - pelvic reoperations in Peking University Cancer Hospital and Institute from 2008 to 2018 / 中华胃肠外科杂志

Objective@#To summarize the characteristics of abdominal-pelvic unplanned reoperation (URO) in a cancer hospital.@*Methods@#Retrospectively descriptive cohort research was adopted. The classification of diseases was based on ICD-10, and surgical classification was based on ICD-9-CM-3. Medical record summary database from 2008 to 2018 in Beijing Cancer Hospital was collected, and all URO information of abdominal-pelvic surgery was retrieve. The time of URO, disease type, surgery type and cause were statistically analyzed. Distribution of main disease incidence and constituent ratio, and the application of major surgery and surgery type composition ratio were analyzed as well.@*Results@#From 2008 to 2018, a total of 46854 cases underwent abdominal-pelvic surgery (including gastrointestinal, hepatic-biliary-pancreatic, gynecological, urological, or esophageal cancer surgery) and 713 patients received URO (1.52%), including 486 males and 227 females (2.14:1.00) with a mean age of (58.1±12.2) years. A total of 246 patients (34.50%) had comorbidity, and with comorbidity: without comorbidity was 1.13:1.00. The hospital stay was (44.5±43.0) days, and the total cost was (178000±112000) yuan. There were 22 deaths (3.09%). The median interval between URO and the first operation was 8 (0 to 131) days. The highest rate of URO was 2.45% (89/3629) in 2012, while the lowest was 0.95% (53/5596) in 2015. The top 3 major cancer types of URO included colorectal cancer (222 cases, 31.14%), gastric cancer (166 cases, 23.28%) and esophageal cancer (45 cases, 6.31%). The cancer types with the highest URO rate included pancreatic cancer (3.97%, 30/756), gastric cancer (1.81%, 166/9171) and colorectal cancer (1.80%, 222/12333). The top 3 surgical procedures resulting in URO were rectal resection (109 cases, 15.29%), total gastrectomy (79 cases, 11.08%), and total pancreatectomy (64 cases, 8.98%). Focusing on 497 URO cases from 2012 to 2018, 465 cases (93.56%) followed relatively difficult grade III and IV surgery, while only 32 cases (6.44%) followed grade I and II surgery. The top 5 main causes of URO were bleeding (225 cases, 31.56%), anastomotic leak (225 cases, 31.56%), infection (89 cases, 12.48%), intestinal obstruction (53 cases, 7.43%), and wound dehiscence (35 cases, 4.91%), adding up to a total of 87.94% of all URO.@*Conclusion@#This study summarizes the epidemiology of abdominal - pelvic URO in our cancer institution, providing the solid baseline for future investigation of URO and the subsequent formulation of corresponding prevention and intervention measures.

Modalities of pelvic autonomic nerve-sparing surgery in pelvis-gynecology / 中国癌症杂志

Bladder function is controlled by the hypogastric nerves (sympathetic) and pelvic splanchnic nerves (parasympathetic) , and these two nerve fibers intermingle to form the pelvic plexus. Pelvic surgery was one of the important modalities being used in pelvis-gynecology, but it was commonly found that the modality could cause bladder dysfunction because of its damage to the pelvic plexus. Pelvis-gynecologic surgeries like Pive Ⅱ-Ⅳ radical hysterectomy (RH), total vaginectomy, Hartman, Dixon, and posterior pelvic exenteration are among the most important causes of urinary dysfunction. Recently, urinary dysfunction has become the major issue for patients undergoing pelvic surgery in terms of quality-of-life. Pelvic autonomic nerve-sparing (PANS) protects postsurgical bladder function in radical RH and other pelvic surgery. The review tried to discuss different types of PANS being used in variety of pelvis-gynecologic surgery. Type Ⅰ PANS can be performed in Piver Ⅱ RH in patients with endometrioid cancer, and urinary catheter will be removed 3 days after operation. Type Ⅱ PANS is used in Piver Ⅲ RH, and the catheter can be successfully removed 7 days after surgery. Sometimes, type Ⅲ PANS is administered in one-side tumor-free cardinal ligament resection, and the patients will retain their catheter for 3 weeks postoperatively. Type Ⅱ or type Ⅲ PANS may be used in total vaginectomy, Hartman, Dixon, and posterior pelvic exenteration.

Comparison of Perioperative Complications between Reconstructive Pelvic Surgery and General Gynecologic Surgery

The purpose of this study was to compare the perioperative complication rates of reconstructive pelvic surgery and general gynecologic surgery, and to identify the predictive risk factors for perioperative complications in reconstructive pelvic surgery. The medical records of 148 reconstructive pelvic surgery patients and 146 general gynecologic surgery patients were reviewed, and the types of complications, along with their rates and predictive risk factors were examined. The statistical analysis included descriptive statistics and logistic regression. There was no difference in the type of complications between reconstructive pelvic surgery and general gynecologic surgery. The prevalences of perioperative complications were 34.4% in the reconstructive pelvic surgery group and 26.7% in the general gynecologic surgery group. Intraoperative blood loss (p= 0.006) and the duration of surgery (p=0.014) were independent risk factors for perioperative complications in the reconstructive pelvic surgery group. The perioperative complication rates for the patients undergoing reconstructive pelvic surgery were not higher than those of the patients undergoing general gynecologic surgery, even though more procedures were performed and a longer duration of surgery was needed in the former cases. Since the duration of surgery and the amount of blood loss are the major factors affecting the complication rate, decreasing these two factors would be the key to improving the outcomes of patients undergoing reconstructive pelvic surgery

Management of vesicovaginal and ureterovaginal fistulas after pelvic surgery

Since vesicovaginal and ureterovaginal fistulas are generally the result of surgical accidents, their incidence is largely a measure of the skill of the surgeon and his use of all available safety measuresComplete urologic visualization of the urinary tract and identification of the lesion will greatly improve the subsequent care of these patients. Adherence to sound principles of surgical repair and wound healing and complete urinary drainage will increase the chance of successful treatment of vesicovaginal and ureterovaginal fistulas.(Summary)

A Comparative Study of Postoperative Adhesions and HistologicReactions Following Pelvic Surgery by Operative Pelviscopy VersusLaparotomy in the Rabbit / 대한산부인과학회잡지

Development of adhesions following pelvic surgery is a leading failure of reconstructive surgery. The aims of this study were to compare the occurrence of adhesions after a standard uterine injury infilicted by laparoscopy versus laparotomy, to compare the efficacy of 32% dextran 70 used for adhesion prophylaxis and to compare the tissue reactions to the catgut, polypropylene, polyglactin and polydioxanone suture materials. Forty rabbits were randomly assigned to four groups, of which group 1 and group 2 received operations via laparoscopy and group 3 and group 4 received via laparotomy. During operations, group 1 and group 3 were irrigated and administered with 10 ml of 32% dextran 70. The uterine horns were incised and anastomosed with four suture materials respectively. After six weeks, thirty eight rabbits were assigned to laparotomy to assess the extent of intraperitoneal adhesions. The intraperitoneal adgesions were graded according to their severity. Tissue block were obtained from the suture sites for histologic assessment. Adhesions were significantly less in laparoscopy-treated group than in laparotomy-treated group but there are no differences in the inflammatory reactions to suture material, operative manipulations or 32% dextran 70. Moderate fibrosis persisted around the catgut and oplypropylene suture, but not at all around the polydioxanone and polyglactin sutures. The routine use of intraperitioneal 32% dextran 70 has been suggested as an adjuvant to prevent postoperative adhesions, however it's user did not reduce the formation of adhesions in this study.

Iatrogenic Ureteral Injuries in Pelvic Surgery: A Review of 12 Cases / 대한비뇨기과학회지

We reviewed 12 patients with iatrogenic urethral injuries in pelvic surgery from May 1993 to May 1996. The patients ranged in age from 27 to 52 years (mean age 47). The diagnosis of urethral injury was made intraoperatively in 8 (66.7%) and postoperatively in 4 cases (33.3%). The ureteral injury patterns in intraoperative diagnosis group at recognition were classified into complete transsection in 5, partial transsection in 2 and ligation in 1 case. The clinical findings of postoperative diagnosis group were ureterocutaneous fistula in 1, ureteral obstruction in 2, and ureterovaginal fistula in 1 case. Presenting symptoms were fever in 1, urine leakage in 2, and flank pain in 1 case. The treatments in intraoperative diagnosis group included ureteroureterostomy in 4, ureteroneocystostomy in 2, and simple closure in 2 closes. In postopeative diagnosis group the treatments were initiated soon after establishment of the diagnosis, and consisted of ureteroneocystostomy with psoas hitch in 2, ureteral stunting with ureteroscope in 1, and ureteroureterostomy in 1 case. The RESULTS were good in 7 cases (87.5%) of intraoperative diagnosis group and 2 cases (50.0%) of postopertive diagnosis group. Of the 3 poor resulted cases 2 were managed with percutaneous nephrostomy, and 1 with ureteral stenting. We concluded that prompt recognition of ureteral injuries at occurrence with immediate repair RESULTS in few complications. Injuries detected postoperatively required more complicated procedures to repair the ureter. Because most of the ureteral injuries occurs by the non-urologic surgeon, especially gynecologist or general surgeon, it is important to let them know the fact that immediate repair of the ureter is important and cooperative relationships between urologist and non-urologist are also important during pelvic surgery.

Ureteral Injuries Acquired During Abdominal and Pelvic Surgeries / 대한비뇨기과학회지

For five years of period, 1956-1951, twelve cases of ureteral injuries acquired during abdominal and pelvic surgery were experienced as follows . Original surgical procedures which caused the injuries were radical total hysterectomy, 9 cases; simple total hysterectomy, 1 case; abdominal procedure for intra-abdominal hemorrhage, 1 case; and repair for vesicovaginal fistula, 1 case. Of twelve pervious procedures, 9 cases were for uterine cervix cancer, 1for uterine myoma, 1 for vesico-vaginal fistula and anther for rupture of a horse-shoe kidney. Injuries found were uretero-vaginal fistula, 4; bilateral complete severance, 1; unilateral complete severance. 2; simple ligation. 5; and ureterocutaneous fistula, 1. Lateralization of injuries was bilateral, 3; unilateral, 9; of which 7 were on the right and 2 on the left. Urological repairing procedures included 3 ureteroneocytostomies, 1 ureteral anastomosis to tube made from bladder flap.,1 end-to-end oblique anastomosis, 1 end-to-end transverse anastomosis, 1 deligation and 1 nephrectomy. It will be wise and advisable that a complete urological work-up and bilateral catheterization should be performed prior to abdominal and gynecological procedures to prevent accidental injury to the ureter.