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ABSTRACT Background Robotic-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) is associated with significant morbidity and mortality. We present an alternative technique that preserves the complete mesenteric vascularization during the isolation of the intestinal segment used in ICUD, including distal vessels. This approach aims to minimize the risk of ischemia in both the ileal anastomosis and the isolated loop at the diversion site. Methods This cohort study included 31 patients, both male and female, who underwent RARC with ICUD from February 2018 to November 2023, performed by a single surgeon. Intraoperative and postoperative complications data were retrieved for analysis, employing our proposed mesentery-sparing technique in all cases. The primary endpoint was the incidence of intraoperative and postoperative complications directly attributable to the mesentery-sparing approach in ICUD. Secondary endpoints included other postoperative variables not directly related to mesentery preservation, such as the incidence of postoperative ileus requiring parenteral nutrition and the duration of hospitalization. Results None of the patients experienced intraoperative or postoperative complications directly related to mesentery-sparing, such as intestinal fistulae or internal hernias. The median duration of hospitalization was 6 days, and postoperative ileus necessitating total parenteral nutrition occurred in 19% of the patients. Minor complications (Clavien-Dindo grades I-II) accounted for 27.6% of the cases and major complications (grades III-V) accounted for 20.6%. Conclusion The mesentery-sparing technique outlined herein offers an alternative method for preserving the vascularization of intestinal segments and reducing the risk of intestinal complications in ICUD during RARC.
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ABSTRACT Introduction: The increasing adoption of robotic-assisted cystectomy with intracorporeal urinary diversion (ICUD), despite its complexity, prompts a detailed comparison with extracorporeal urinary diversion (ECUD). Our study at a single institution investigates perioperative outcomes and identifies risk factors impacting the success of these surgical approaches. Methods: In this retrospective analysis, 174 patients who underwent robotic-assisted cystectomy at the University of Louisville from June 2016 to August 2021 were reviewed. The cohort was divided into two groups based on the urinary diversion method: 30 patients underwent ECUD and 144 underwent ICUD. Data on demographics, complication rates, length of hospital stay, and readmission rates were meticulously collected and analyzed. Results: Operative times were comparable between the ICUD and ECUD groups. However, the ICUD group had a significantly lower intraoperative transfusion rate (0.5 vs. 1.0, p=0.02) and shorter hospital stay (7.8 vs. 12.3 days, p<0.001). Factors such as male sex, smoking history, diabetes mellitus, intravesical therapy, higher ASA, and ACCI scores were associated with increased Clavien-Dindo Grade 3 or higher complications. Age over 70 was the sole factor linked to a higher 90-day readmission rate, with no specific characteristics influencing the 30-day rate. Conclusion: Robotic cystectomy with ICUD results in shorter hospitalizations and lower intraoperative transfusion rates compared to ECUD, without differences in operative time, high-grade postoperative complications, or readmission rates. These findings can inform clinical decision-making, highlighting ICUD as a potentially more favorable option in appropriate settings.
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【Objective】 To investigate the efficacy and surgical technique of total laparoscopic radical cystectomy with intracorporeal ileal conduit urinary diversion, so as to provide reference for the selection of surgery for patients with bladder cancer. 【Methods】 Clinical data of 48 patients with bladder cancer who underwent laparoscopic radical cystectomy during Mar.2017 and Aug.2022 in our hospital were retrospectively analyzed, including 23 cases who received traditional laparoscopic radical cystectomy combined with extracorporeal ileal conduit, and 25 who received total laparoscopic radical cystectomy with intracorporeal ileal conduit.The operation time, blood loss, postoperative intestinal function recovery time, drainage tube removal time and hospital stay were compared between the two groups. 【Results】 All procedures were successfully performed, and no Clavien-Dindo>grade 3 complications were observed.The operation time, and amount of estimated blood loss of the traditional group and total laparoscopic radical group were (227.0±46.4) min vs. (253.6±58.9) min, and (131.7±79.8) mL vs. (154.0±93.0) mL, respectively.There were no differences in postoperative intestinal function recovery time and drainage tube removal time (P>0.05).The hospital stay was shorter in the total laparoscopic radical group than in the traditional group (P=0.035). 【Conclusion】 Total laparoscopic radical cystectomy with intracorporeal ileal conduit urinary diversion is safe and feasible.which is comparable to the traditional laparoscopic surgery, while the hospital stay in the total laparoscopic group is shorter, which is conducive to rapid postoperative recovery.
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Objective To make a further understanding of the curative efficacy of Surpass Streamline flow diversion treatment for intracranial aneurysms.Methods The clinical data of a total of 68 patients with intracranial aneurysm,who received Surpass Streamline flow diverter treatment at the Affiliated Suzhou Hospital of Anhui Medical University of China between January 2020 and January 2022,were retrospectively analyzed.The preoperative and postoperative changes in hemodynamic parameters,and the preoperative and postoperative 3-,6-,and 12-month modified Rankin Scale(mRS)scores were collected.The imaging findings were analyzed,and the status of aneurysm occlusion was determined.Results Compared with the preoperative values,the postoperative blood flow velocity at the WSS and the tumor neck was decreased,while the blood flow velocity of LSA,RRT,tumor carrier artery and M1 on the affected side was increased(P＜0.05),and the blood flow velocity of Ml on the healthy side showed no significant change(P＞0.05).After surgery,the proportion of patients with low-grade mRS score gradually increased with the time passing,and the difference was statistically significant(P＜0.05).The postoperative 6-month and 12-month incidences of in-stent stenosis were 7.35％ and 8.82％ respectively,incidences of aneurysmal complete occlusion were 52.94％and 63.24％ respectively,and the differences were not statistically significant(P＞0.05).Of the 68 patients having been treated with Surpass Streamline flow diverter,4 patients developed ischemic complications,and 2 of the 4 presented with blurred vision and cortical blindness,one patient had limb weakness and one patient had a in-stent thrombus,all of which were effectively relieved after intervention therapy.Conclusion For the treatment of intracranial aneurysms,Surpass Streamline flow diversion treatment has good efficacy,it can improve hemodynamics,besides,it carries high postoperative complete aneurysmal occlusion rate with satisfactory safety.Therefore,this technique is worthy of clinical popularization.(J Intervent Radiol,2024,33:285-288)
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Abstract Diversion of substances from the care of the intended patient is a significant problem in healthcare. Patients are harmed by the undertreatment of pain and suffering, transmission of disease, as well as the risk associated with impaired vigilance. Healthcare providers may be harmed by the physical and mental impact of their addictions. Healthcare systems are placed in jeopardy by the legal impact associated with illegal routes of drug release including sanction and financial liability and loss of public trust. Healthcare institutions have implemented many measures to reduce diversion from the perioperative area. These efforts include education, medical record surveillance, automated medication dispensing systems, urine drug testing, substance waste management systems, and drug diversion prevention teams. This narrative review evaluates strengths, weaknesses, and effectiveness of these systems and provides recommendations for leaders and care providers.
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Humanos , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Anestesiologistas , Dor , Pessoal de Saúde , Desvio de Medicamentos sob Prescrição/prevenção & controleRESUMO
Objective:To compare the prognosis and complications of muscle-invasive bladder cancer (MIBC) and non-muscle-invasive bladder cancer (NMIBC) patients undergoing radical cystectomy (RC) followed by ileal neobladder.Methods:The clinical data of 103 patients who underwent orthotopic ileal neobladder in Jiangsu Province Hospital from April 2010 to October 2021 were retrospectively analyzed. There were 51 MIBC patients and 52 NMIBC patients. In the MIBC group, there were 49 males and 2 females, aged (58.1 ± 8.9) years, with American Society of Anesthesiologists (ASA) score of 1-2 in 48 cases and 3 in 3 cases. Open radical cystectomy (ORC) was performed in 2 cases, laparoscopic (LRC) in 34 cases and robot-assisted radical cystectomy (RARC) in 15 cases. In the NMIBC group, there were 49 males and 3 females, aged (55.7 ± 9.9) years, ASA score of 1-2 in 51 cases and ASA score of 3 in 1 case. LRC was performed in 41 cases, and RARC in 11 cases. There were no statistically differences between the two groups in above indicators ( P>0.05). The Clavien-Dindo grading system (CCS) was used to assess the complications, defining CCS Ⅰ-Ⅱ as mild complications and CCS Ⅲ-Ⅴ as severe complications. According to their relationship to the neobladder, complications were be classified as neobladder-related and non-neobladder-related complications. The occurrence of complications and the prognosis of neobladder between MIBC and NMIBC were compared. Results:The average operation time of the MIBC group and NMIBC group were (421.2 ± 119.7) min vs. (439.8 ± 106.2) min. The blood loss were 400 (300, 700) ml vs. 400 (300, 625) ml. The frequency of lymph nodes removed were (14.9 ± 8.3) vs. (14.8 ± 8.5). The postoperative defecation time were 5 (4, 6) d vs. 5 (3, 6) d. And the postoperative hospital stay were 20 (15, 28) d vs. 22 (19, 28) d. There were no statistically differences between the two groups in above indicators ( P>0.05). The MIBC group had a significantly lower rate of pelvic lymph node metastasis [17.6% (9/51) vs. 0(0/52), P=0.001] and tumor thrombosis [23.5% (12/51) vs. 5.8% (3/51), P=0.011] than the MIBC group. Moreover, the NMIBC group had a considerably superior 5-year overall survival (OS) (97.6% vs. 70.2%, P=0.035). The proportion of pads needed in the daytime of the MIBC group and NMIBC group were 14.6% (7/46) vs. 6.7% (3/45). The frequency of urination were (2.0 ± 0.7) h vs. (2.4 ± 0.7) h. Furthermore, The proportion of pads needed at night were 47.9% (23/48) vs. 53.3% (24/45). The frequency of nocturnal urination were 3.1±1.5 vs. 2.3 ± 1.7. And the number of pads needed at night were all 1 (0, 1) pad. The daytime and nighttime incontinence rate were 25.0% (12/48) and 62.5% (30/48) respectively in MIBC, compared to 11.1% (5/45) and 62.2% (28/45) respectively in NMIBC. And the proportion of erectile function retention were 15.8% (6/38) vs. 25.0% (10/40). There were no statistically significant differences in the prognosis of neobladder function between the two groups ( P>0.05). Furthermore, the proportions of mild complications in the MIBC group and NMIBC group were [41.2% (21/51) vs. 51.9 (27/52)]. The proportions of severe complications were [21.6% (11/51) vs. 19.2% (27/52)]. The proportions of neobladder-related complications were [27.5% (14/51) vs. 25.0% (13/52)]. And the proportions of non-neobladder-related complications were [39.2% (20/51) vs. 25.0% (13/52)]. There were no statistically significant differences in the complications between the two groups ( P>0.05). Conclusions:There was no statistically significant difference in functional prognosis and complications of neobladder between MIBC group and NMIBC group, and NMIBC had a better oncologic prognosis.
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There are few clinical reports on the diagnosis and treatment of upper urinary tract stones secondary to urinary diversion. This study included 30 patients with upper urinary tract stones secondary to urinary diversion, and all of which were successfully managed. The individualized treatment with the ureteroscopy and/or percutaneous nephrolithotripsy with antegrade, retrograde, or a combination of antegrade and retrograde is safe and feasible.
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Objective To investigate the related factors of nursing dependence in bladder cancer patients with urinary diversion and abdominal wall stoma.Methods The clinical data of 120 patients with bladder cancer undergoing abdominal ostomy with urinary diversion in the hospital from June 2020 to June 2022 were retrospectively analyzed.The self-esteem scale,the civilian version of the Post-traumatic Stress Disorder Scale,the Personal Sense of Control Scale,and the Nursing Care Dependence Scale were used to evaluate the self-esteem level,post-traumatic stress disorder level,personal sense of control level and nursing dependence degree of patients,and carry out univariate and multivariate regression analysis on the influencing factors of nursing dependence in patients with bladder cancer urinary diversion and abdominal stoma.Results The total score of nursing dependence in 120 bladder cancer patients with urinary diversion and abdominal wall stoma was 56.95±7.94.The lowest score was activity,followed by excretion and cleanliness.Univariate analysis showed that there were statistically significant differences in the nursing dependence scores of patients with different age,marital status,educational level,work status,per capita monthly income,and comorbidities(P＜0.05);the patients'self-esteem,the civilian version of the Traumatic Stress Disorder Scale,and the Personal Sense of Control Scale scores were 25.08±2.59,46.04±5.72,24.18±2.95,respectively;after multi-factor a-nalysis,it can be seen that age,education level,comorbidities,self-esteem level,post-traumatic stress obstacles and personal control finally entered the regression equation as factors influencing dependence on care for pa-tients with urinary diversion abdominal wall stoma for bladder cancer(P＜0.05).Conclusion Bladder cancer patients with urinary diversion abdominal wall stoma have the highest degree of dependence on nursing care for mobility,excretion and cleaning.Age,education level,complications,self-esteem,post-traumatic stress dis-order,and personal sense of control are related factors that affect the degree of dependence on nursing care.
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Objective:To compare the complications associated with various urinary flow diversion methods and identify the factors that contribute to the decline in renal function after radical total cystectomy for myoinfiltrating urothelial carcinoma.Methods:This study conducted a retrospective analysis on the clinical data of 46 patients with pathologically confirmed muscle-invasive bladder cancer.The patients underwent laparoscopic radical cystectomy with either ileal conduit diversion(n=21)or ureterocutaneous diversion(n=25)between January 2017 and December 2021.Perioperative data, postoperative pathology, postoperative complications, and follow-up results were compared between the two groups.Results:The study found significant differences between the two groups in terms of age[(67±6)years vs.(73±8)years, t=3.132, P=0.003], Charlson comorbidity index adjusted for age[(3.80±1.15) vs.(4.52±1.03), t=2.223, P=0.031], prognostic nutritional index[(48.81±5.74) vs.(43.64±4.74), t=3.347, P=0.002], operation time[(449±108)minutes vs.(326±130)minutes, P=0.001]], hospital stay[(20.1±11.1)days vs.(13.3±5.2)days, t=2.762, P=0.008], proportion of Clavien grade 3 or higher complications within 3 months after surgery(4/21 vs 0/25, χ2=2.105, P<0.05), and proportion of stoma-free patients(18/21 vs.5/25, χ2=6.373, P<0.01). According to Logistic multivariate analysis, perioperative blood transfusion and urinary tract infection were identified as independent risk factors for renal function decline 12 months after surgery.Escherichia coli was found to be the most common bacteria cultured from urinary tract infections in both groups after surgery. Conclusions:Laparoscopic radical cystectomy with ureterocutaneous diversion offers benefits such as shorter hospital stays and fewer perioperative complications for older and frail patients.However, a higher proportion of patients may require ureteral stenting.It is important to note that perioperative blood transfusion and urinary tract infection are major risk factors for renal function decline following radical cystectomy.
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Objective:To determine the impact of body mass index (BMI) on perioperative and oncological outcomes after robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion.Methods:Clinical data of bladder cancer patients undergoing robot-assisted radical cystectomy with intracorporeal urinary diversion in Zhejiang Provincial People's Hospital from January 2017 to January 2020 were retrospectively analyzed. Patients were divided into three groups according to BMI, including 61 cases in normal group (<25.0 kg/m2), 52 cases in overweight group (25.0-29.9 kg/m2) and 33 cases in obese group (≥30.0 kg/m2). In the normal group, the median age was 73.6(59, 79), including 45 male(73.8%), with 51 cases(83.6%) of ASA score 0-2, 10 cases (16.4%)of 3 or higher, and 10 cases (16.4%) undergoing neoadjuvant chemotherapy. Past medical history included smoking in 34 cases (55.7%), hypertension in 19 cases (31.1%), diabetes in 10 cases (16.4%), heart disease in 12 cases (19.7%), and abdominal surgery in 6 cases (9.8%). In the overweight group, the median age was 69.7(60, 78), including 38 male (73.1%), with 25 cases (48.1%)of ASA score 0-2, 27 cases (51.9%) of 3 or higher, and 9 cases (17.3%) undergoing received neoadjuvant chemotherapy. Past medical history included smoking in 30 cases (57.7%), hypertension in 20 cases (38.5%), diabetes in 10 cases (19.2%), heart disease in 9 cases (17.3%), and abdominal surgery in 5 cases (9.6%). In the obses group, the median age was 69.9(61, 78), including 21 male(63.7%), with 20 cases (60.6%)of ASA score 0-2, 13 cases(39.4%) of 3 or higher, 9 cases (27.3%) undergoing neoadjuvant chemotherapy. Past medical history included smoking in 18 cases (54.5%), hypertension in 17 cases (51.5%), diabetes in 19 cases (57.6%), heart disease in 7 cases (21.2%), and abdominal surgery in 4 cases (12.1%). After statistical comparison among the three groups, it was found that the proportion of patients with hypertension and diabetes in the obesity group and overweight group was higher than that in the normal group (all P<0.05), but there was no significant difference in other factors (all P>0.05). During the surgical process, robot-assisted radical cystectomy and bilateral pelvic lymph node dissection were performed firstly. The scope of lymph node dissection was divided into standard range and expanded range, and the diversion was divided into orthotopic neobladder and ileal bladder. During the orthotopic neobladder process, 40-50 cm ileum at the distance of 15 cm away from ileocecum was obtained by stapler, and then the U-shaped neobladder was made, and the new bladder was anastomosed with urethra and bilateral ureter. For ileal bladder, the ileum was cut off 15cm away from the ileocecum with stapler to obtain the 15 cm ileum to prepare the ileal conduit and restore the continuity of the ileum. The bilateral ureteral spacing 3cm was implanted on the ileal conduit. In the normal group, standard range lymphatic dissection was performed in 20 cases (32.8%), enlarged dissection in 41 cases (67.2%), orthotopic neobladder in 22 cases(36.1%), and ileal conduit in 39 cases (63.9%). In the overweight group, standard range lymphatic dissection was performed in 12 cases (23.1%), enlarged dissection in 40 cases (76.9%), orthotopic neobladder in 26 cases (49.1%), and ileal conduit in 26 cases (50.9%). In the obesity group, the standard range of lymphatic dissection was performed in 7 cases (21.2%), enlarged dissection in 26 cases (78.7%), orthotopic neobladder in 7 cases (21.2%), and ileal conduit in 26 cases (78.8%). There was no significant difference among the three groups (all P>0.05). Compared the operation time, intraoperative blood loss, postoperative exhaust time, postoperative time of taking solid food, postoperative hospital stay, postoperative complications (according to the Clavien-Dindo grading system, postoperative complications are reported inⅠ-Ⅱ grade as mild complications and above Ⅲ grade as serious complications) and pathology results in three groups. Results:All cases successfully underwent robotically without conversion or major intraoperative complications. The operation time in overweight and obsess group were longer than that of normal group with RARC or orthotopic neobladder [310(250, 350) min, 370(310, 420) min, 250(230, 310) min, ( P<0.05)], but there was no significant difference in RARC and ileal conduit[270(220, 300) min, 280(230, 300) min, 240(220, 290)min, P>0.05]. The estimated blood loss in overweight and obsess group was more than that in normal group [230(150, 450)ml, 310(250, 600)ml, 190(100, 350)ml, P<0.05], but there was no difference in blood transfusion rate [4(7.7%), 2(6.1%), 5(8.2%), P>0.05]. The exhaust time [2(1, 3) days, 2(1, 4)days, 2(1, 4)days], postoperative solid food intake time [4(3, 5)days, 4(3, 6)days, 4(3, 6)days] and the hospital stay[10(5, 16)days, 10(6, 17)days, 12(6, 20)days] were not different in three groups(all P>0.05). The mild complication rates in 90 days were significant higher in overweight and obsess groups[28 (53.8%), 16(48.5%), 20(32.8%), P<0.05], but the total and severe complication rates were not significantly different. The incidences of urinary system complications and incision complications in obese and overweight patients were significantly higher than those in normal group ( P<0.05). There was no significant difference in the incidence of gastrointestinal complications and ureteral anastomosis-related complications (stricture or urinary leakage)( P>0.05). There was no significant difference in the number of dissected lymph node, positive lymph node, positive rate of incisional margin and postoperative pathological stage among three different BMI groups(all P>0.05). Conclusion:Robot-assisted radical cystectomy combined with intracorporeal urinary diversion is a safe and effective method for the treatment of overweight, obese and even morbidly obese patients with bladder cancer. The recovery of intestinal function and the oncological results are not affected by body mass index. However, laparoscopic radical cystectomy for overweight and obese patients, especially for orthotopic neobladder, has the risk of long operation time, large amount of intraoperative bleeding and increased risk of minor postoperative complications.
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Objective:To evaluate the clinical value of Xing's ureteroileal anastomosis technique in radical cystectomy.Methods:The data of 38 patients who underwent radical cystectomy with Xing's ureteroileal anastomosis technique at Cancer Hospital, Chinese Academy of Medical Sciences and Beijing Chaoyang Hospital from July 2013 to June 2021 were retrospectively reviewed. There were 30 males and 8 females. The mean age was 61.6±15.1 years old. The mean body mass index (BMI) was 25.1±2.7 kg/m 2. The American Society of Anesthesiology (ASA) graded 25 cases as grade 1, 10 cases as grade 2 and 3 cases as grade 3. There were 35 cases with stage cT 2N 0M 0 and 3 cases with cT 3N 0M 0. All patients underwent radical cystectomy and ileal conduit, and the ureteroileal anastomosis was performed using the Xing's ureteroileal anastomosis technique. Afferent loop entry was divided equally into two lumens. After 1.5 cm-long lengthwise incisions, each ureter was directly and end-to-end anastomosed to the aforementioned lumens. Postoperative information was recorded, including ureteric stricture, ureteric reflux, hydronephrosis, anastomotic leakage, renal calculus, urinary tract infection, and pyelonephritis. Results:Ureteroileal anastomosis was performed successfully in 38 cases with 76 units. The median follow-up time was 35.6 (17.0, 46.3) months. Three patients developed unilateral anastomotic stenosis after operation. Five patients had unilateral ureteral reflux. Two patients had unilateral hydronephrosis. No anastomotic leakage, urinary tract infection, or pyelonephritis occurred after the operation. Renal calculus appeared in 3 cases, all on the left unit.Conclusions:Xing's ureteroileal anastomosis technique is a simple method with few postoperative and good functional outcomes.
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Objective:To explore the effect of enhanced recovery after surgery (ERAS) protocols in patients undergoing laparoscopic radical cystectomy (LRC) and intracorporeal urinary diversion (ICUD).Methods:A total of 83 patients who received LRC+ ICUD in Beijing Chaoyang Hospital from March 2014 to September 2020, were divided into 2 groups based on different perioperative management, including 29 ERAS cases and 54 conventional recovery after surgery (CRAS) cases. The ERAS group included 26 males and 3 females , with an average age of (62.07 ± 9.26) years. There were 26 patients with ASA class Ⅰ-Ⅱ, 3 patients with ASA class Ⅲ, 4 patients received neoadjuvant chemotherapy, and 7 patients had a history of abdominal surgery in ERAS group. The CRAS group included 44 males and 10 females , with an average age of (61.59 ± 10.16) years. There were 50 patients with ASA class Ⅰ-Ⅱ, 4 patients with ASA class Ⅲ, 9 patients received neoadjuvant chemotherapy, and 10 patients had a history of abdominal surgery in CRAS group. There were no statistically significant differences in the baseline characteristics between the two groups. The patients in both groups underwent LRC+ ICUD procedures. The perioperative results and complications between the two groups were compared.Results:In the ERAS group, there were 20 patients who underwent Bricker ileal conduit surgery and 9 patients who underwent Studer orthotopic ileal neobladder surgery. Pathological staging included 3, 3, 7, 7, 5 and 4 cases in stage T a, T is, T 1, T 2, T 3 and T 4a, respectively. There were 23, 2, 3 and 1 patient with pathological stage N 0, N 1, N 2 and N 3, respectively. Pathological diagnosis included 3 cases of low-grade urothelial carcinoma, 24 cases of high-grade urothelial carcinoma, and 2 cases of other histological subtypes. In the CRAS group, there were 31 patients who underwent Bricker ileal conduit surgery and 23 patients who underwent Studer orthotopic ileal neobladder surgery. Pathological staging included 5, 3, 12, 9, 15 and 10 patients in stage T a, T is, T 1, T 2, T 3 and T 4a, respectively. There were 35, 6, 7 and 6 patients with pathological stage N 0, N 1, N 2, and N 3, respectively. Pathological diagnoses included 6 cases of low-grade urothelial carcinoma, 45 cases of high-grade urothelial carcinoma, and 3 cases of other histological subtypes. There were no statistically significant differences ( P>0.05) in surgical methods, pathological staging, or pathological types between the ERAS and CRAS groups. ERAS group presented less albumin loss [(25.73±8.63)% vs. (32.63±9.05)%, P=0.001], shorter hospital stay [9(7, 13)d vs. 12(9, 16)d, P=0.006], less 30-day overall complications [55.2% (16/29) vs. 83.3% (45/54), P=0.009]. In multivariable analysis, maximum albumin loss≥20% was independently associated with 30-day minor complications ( P=0.049), and maximum albumin loss ≥25% was independently associated with hospital of stay≥10 days ( P=0.038), respectively. Conclusions:For patients who received LRC+ ICUD, ERAS was associated with reduced perioperative albumin loss, shorter length of stay, less 30-day complications, accelerated recovery time, improved clinical outcome and less albumin injection.
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【Objective】 To investigate whether the current retention methods in blood stations can fully meet the traceability requirements of blood test results by analyzing the traceability of retained samples for syphilis antibody testing. 【Methods】 Thirty-four one-assay-positive deep-well plate retention samples, 68 double-assay-positive deep-well plate retention samples and 263 negative retention blood braids and corresponding deep-well plate retention samples that expired retention period for syphilis antibody testing from 2014 to 2020 in our center were collected. The TP-ELISA assays of two manufacturers were used for retesting, and the results were recorded and compared with the original results statistically. 【Results】 The concordance rate of the double-assay-positive and single-assay-positive samples with their corresponding deep-well plate samples was 98.53%(67/68) and 67.65%(23/34), respectively(P<0.05). Specific results for single-assay-positive syphilis antibody samples and their corresponding deep-well plate retention samples were as follows: 1) Single positive (reagent A): 13 out of 14 original samples were 0.65
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Abstract Artificial impoundments are frequently built to mitigate the water scarcity in the drylands such as the Caatinga region in Brazil. The São Francisco Interbasin Water Transfer (SF-IWT) megaproject implemented many artificial reservoirs for that purpose. A checklist of fish species from the SF-IWT reservoirs is provided based on samples from eight years of monitoring. The collections were conducted semiannually at 28 reservoirs divided into three groups: the East Axis, North Axis, and Agreste Branch. The SF-IWT reservoirs presented a total of 47 species, 46 were recorded in the North Axis, 27 in the East Axis, and only seven in the Agreste Branch. Characids and cichlids represented most of the species. The three analyzed groups of reservoirs presented distinct communities and the reservoirs' age, richness and abundance were relevant variables responsible for fish composition. The SF-IWT reservoirs present a diverse and heterogeneous ichthyofauna, typical of lentic environments. The main colonizers of the SF-IWT reservoirs were fish from the São Francisco donor basin, invasive species anthropically released in those sites, and eventual species from the surrounding receiving basins. As the accumulation curves suggested, a continuous effort could reveal additional species, patterns in long-term colonization, and contribute to data on the reservoirs' future stabilization phase. Since invasive species were present in most reservoirs, along with donor-basin native species with potential to disperse to the receiving basins, a continuous and detailed monitoring is key for management planning and possible impacts assessment.
Resumo Barramentos artificiais são comumente construídos para mitigar a escassez hídrica em áreas semiáridas como a região da Caatinga brasileira. O Projeto de Integração do Rio São Francisco (PISF) com Bacias Hidrográficas do Nordeste Setentrional implementou muitos reservatórios artificiais com este propósito. Uma lista de espécies de peixes dos reservatórios do PISF foi obtida após amostragens realizadas em oito anos de monitoramento. As campanhas foram realizadas semestralmente em 28 reservatórios divididos em três grupos: Eixo Leste, Eixo Norte e Ramal do Agreste. Os reservatórios amostrados apresentaram um total de 47 espécies, 46 delas foram registradas no Eixo Norte, 27 no Eixo Leste e apenas sete no Ramal do Agreste. Characidae e Cichlidae foram as famílias mais representativas. Os três grupos de reservatórios analisados apresentaram comunidades distintas e a idade, a riqueza e a abundância de cada reservatório foram as variáveis que mais influenciaram a composição das espécies de peixes. Os reservatórios do PISF apresentaram uma ictiofauna diversa e heterogênea, característica de ambientes lênticos. Os principais colonizadores dos reservatórios do PISF foram peixes da bacia doadora do São Francisco, espécies invasoras antropicamente liberadas nesses locais e eventuais espécies das bacias receptoras do entorno. De acordo com o resultado das curvas de acúmulo, um esforço contínuo poderia revelar espécies adicionais, padrões na colonização em longo prazo e contribuir com dados para a fase futura de estabilização dos reservatórios. Visto que espécies invasoras estiveram presentes em quase todos os reservatórios, juntamente com espécies nativas da bacia doadora com potencial de dispersão para as bacias receptoras, um monitoramento continuo e detalhado é essencial para o planejamento de manejo e avaliação de impactos.
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ABSTRACT Purpose: We aimed to perform a systematic review to assess perioperative outcomes, complications, and survival in studies comparing ureteral stent and percutaneous nephrostomy in malignant ureteral obstruction. Materials and Methods: This review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework. Meta-analyses were performed on procedural data; outcomes; complications (device-related, accidental dislodgement, febrile episodes, unplanned device replacement), dislodgment, and overall survival. Continuous variables were pooled using the inverse variance of the mean difference (MD) with a fixed effect, and 95% confidence interval (CI). The incidences of complications were pooled using the Cochran-Mantel-Haenszel method with the random effect model and reported as Odds Ratio (OR), and 95% CI. Statistical significance was set two-tail p-value <0.05 Results: Ten studies were included. Procedure time (MD −10.26 minutes 95%CI −12.40-8.02, p<0.00001), hospital stay (MD −1.30 days 95%CI −1.69 − −0.92, p<0.0001), number of accidental tube dislodgments (OR 0.25 95% CI 0.13 - 0.48, p<0.0001) were significantly lower in the stent group. No difference was found in mean fluoroscopy time, decrease in creatinine level post procedure, overall number of complications, interval time between the change of tubes, number of febrile episodes after diversion, unplanned device substitution, and overall survival. Conclusion: Our meta-analysis favors stents as the preferred choice as these are easier to maintain and ureteral stent placement should be recommended whenever feasible. If the malignant obstruction precludes a stent placement, then PCN is a safe alternative.
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Objective:To evaluate the efficacy and safety of Yang-Monti tube in the operation of bladder controllable outflow tract, and to compare the efficacy of single and double segments Yang-Monti tube in patients with urethral damage.Methods:The clinical data of 27 patients who underwent Yang-Monti tube surgery in West China Hospital of Sichuan University from January 2009 to February 2018 were retrospectively analyzed, including 14 cases of single segment ileum (single segment group) and 13 cases of double segment ileum (double segment group). The age of single-segment group and double-segment group was (56.5±4.3) years and (50.2±6.8) years, respectively ( P=0.220). There were 2/12 and 3/10 males and females, respectively ( P=0.564). The body mass index (BMI) was (19.6±1.3) kg/m2 and (24.2±2.1) kg/m2, respectively ( P<0.001). The disease duration was 6 (3-24) months and 8 (3-48) months, respectively ( P=0.650). The preoperative quality of life (QOL) score was (46.7±1.7) and (45.5±1.7), respectively ( P=0.061). The number of patients with urinary tract infection before operation was 11 and 13, respectively ( P=0.480). In the single-segment group, a 2 cm ileum with mesangial vessels was cut at a distance of about 15 cm from the ileocecal part, and the intestine was cut longitudinally along the direction of the intestinal canal at the opposite mesangial margin. The intestinal piece was wrapped horizontally around the F12 urinary tube and wound into a Yang-Monti tube by intermittent suture with a 3-0 single thread. The bladder wall was cut anterolateral to the top wall of the bladder, about 1 cm in length, and the Yang-Monti tube was anastomosed end-to-end with the mucosal muscularis of the bladder wall. A circular incision with a diameter of about 1 cm was made at the level of the anterior superior iliac spine at the rectus abdominis muscle, and a tunnel was formed by puncture into the abdomen with curved forceps. The Yang-Monti tube was led out of the abdominal wall along the tunnel, and the tube opening was fixed with subcutaneous suture. At the same time, the tube wall was fixed in the peritoneum with 4-0 silk thread. In the double-segment group, two segments of 2 cm ileum were cut, and the intestinal tube was cut longitudes along the direction of the opposite mesangial margin. The intestinal piece was first sutured end to end, and then the tube was coiled and reconstructed to form a Yang-Monti tube with a diameter of 0.6-0.8 cm and a length of about 12 cm. The proximal end of the Yang-Monti tube was directly anastomosed with the mucosal muscle layer of the bladder. The operation time, intraoperative blood loss, postoperative catheterization interval, postoperative single catheterization volume, postoperative complications (bleeding, intestinal obstruction, anastomotic leakage, anastomotic stenosis, stoma infection, urinary tract infection, urinary tract infection) and QOL score were compared between the two groups. Results:The operation was successfully completed in both groups. The operation time of single-segment group and double-segment group were (165.8±17.8) min and (157.54±12.25) min, respectively ( P=0.302), and the intraoperative blood loss was (60.0±20.0) ml and (50.00±25.00) ml, respectively ( P=0.650). The postoperative recovery time was 3 (2-4) d and 3 (2-9) d, respectively ( P=0.790), and the postoperative hospital stay was 12 (9-40) d and 12 (10-32) d, respectively (P=0.259). The postoperative single catheterization volume was (240.4±42.7) ml and (261.5±36.3) ml ( P=0.186), and the postoperative QOL was (22.4±2.7) and (21.5±2.6), respectively ( P=0.325), and there was no significant difference. There were 2 cases of urinary tract infection in the single-segment group, and 1 case of urinary tract infection, postoperative bleeding, and intestinal obstruction in the double-segment group. There was no significant difference between the two groups ( P=0.222). The time interval of catheterization in single-segment group and double-segment group was (2.5±1.0) h and (3.5±1.3) h, respectively, and the difference was statistically significant ( P=0.029). The quality of life score after operation was statistically significant compared with that before operation ( P<0.001), and the incidence of urinary tract infection after operation was also statistically significant compared with that before operation ( P=0.011). Conclusions:Both single segment and double segment ileum Yang-Monti tube surgery are feasible surgical methods for patients with urethral damage. There was no difference in the effects of the two types of surgery, and both may improve the quality of life of patients.The postoperative QOL score could be greatly improved and the incidence of complications was low.
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Objective:To investigate the clinical efficacy of different surgical methods for radical cystectomy plus Bricker's ileal conduit urinary diversion.Methods:212 patients, who underwent radical cystectomy plus Bricker's ileal conduit urinary diversion in Armed Police Marine Police Corps Hospital from January 2010 to January 2020, were included in this study. Among them, 98 patients underwent laparoscopic surgery, and 114 patients received open surgery. Perioperative clinical indexes, urodynamic indexes, immune function indexes, and quality of life were compared between the two groups.Results:All 212 patients succeeded in surgery, and none of them received other surgeries. Intraoperative blood loss [(305.89 ± 92.98) mL vs. (954.76 ± 200.87) mL], operative time [(355.76 ± 38.82) minutes vs. (411.56 ± 41.13) minutes], and length of hospital stay [(12.12 ± 2.27) days vs. (20.47 ± 2.44) days] were significantly lower or shorter in the observation group than in the control group ( t = 29.33, 10.11, 25.65, all P < 0.001). Bladder volume [(300.65 ± 20.52) mL vs. (245.87 ± 19.78) mL], maximum urinary flow rate [(16.71 ± 4.32) mL/s vs. (13.74 ± 2.13) mL/s], and intravesical pressure [(22.65 ± 3.11) cmH 2O vs. (17.74 ± 2.01) cmH 2O] were significantly greater in the observation group than in the control group ( t = 19.76, 6.48, 13.83, all P < 0.001). Residual urine volume was significantly lower in the observation group than in the control group [(20.74 ± 10.03) mL vs. (50.09 ± 13.96) mL, t = 17.32, P < 0.001]. CD 4+ cell count [(33.18 ± 4.63)% vs. (30.21 ± 4.91)%] and CD 4+/CD 8+ cell count ratio [ (1.21 ± 0.12) vs. (1.05 ± 0.11)] measured at 3 days after surgery were significantly higher in the observation group than in the control group ( t = 4.508, 10.124, both P < 0.001]. CD 8+ cell count measured at 3 days after surgery was significantly lower in the observation group than in the control group [(27.98 ± 3.67)% vs. (29.47 ± 3.79)%, t = 2.90, P = 0.004]. Scores of quality of life evaluated at 6 months [(101.44 ± 11.52) points vs. (90.23 ± 15.14) points] and 12 months [(114.72 ± 16.26) points vs. (101.34 ± 10.56) points] after surgery were significantly lower in the observation group than in the control group ( t = 5.99, 7.20, both P < 0.001]. Conclusion:Laparoscopic radical cystectomy plus Bricker's ileal conduit urinary diversion is highly effective in the treatment of bladder cancer. The combined method can shorten the operative time, promote rehabilitation, and thereby is worthy of clinical popularization.
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Objective:To explore and compare the perioperative result and complications of robot-assisted radical cystectomy with intracorporeal and extracorporeal urinary diversion.Methods:Clinical data of bladder cancer patients undergoing robot-assisted radical cystectomy with ileal conduit in Zhejiang Provincial People's Hospital from January 2015 to March 2020 were retrospectively analyzed. Eighty-two patients underwent extracorporeal urinary diversion (ECUD group), and 122 underwent intracorporeal urinary diversion (ICUD group). In the ECUD group, the median age was 70(61, 76)years old, including 67 male (81.7%), the median BMI was 26.1(24.3, 28.5), 67 cases(81.7%) was ASA score 0-2, 15 cases (18.3%)was 3 or higher, 15 cases (18.3%) were high risk non-muscular invasive bladder cancer. 67 cases (81.7%) were muscular invasive bladder cancer. 16 cases (19.5%) received neoadjuvant chemotherapy. Past medical history included smoking in 35 cases (43.2%), hypertension in 31 cases (37.5%), diabetes in 17 cases (21.3%), heart disease in 13 cases (15.7%), and abdominal surgery in 15 cases (17.8%). In the ICUD group, the median age was 68 (62, 75), 95 male (77.9%), the median BMI was 25.6 (23.4, 27.8)kg/m 2, 105 cases(86.1%) was ASA score 0-2, 17 cases (13.9%)was 3 or higher, 29 cases (24.9%) were high risk non-muscular invasive bladder cancer, and 93 cases (75.1%) were muscular invasive bladder cancer. There were 22 cases (18.0%) undergoing neoadjuvant chemotherapy. Past medical history included smoking in 58 cases (47.3%), hypertension in 44 cases (32.6%), diabetes in 33 cases (22.8%), heart disease in 28 cases (26.7%), and abdominal surgery in 17 cases (14.2%). No significance was detected in characteristics between the two groups. For ileal bladder making and ureteral implantation method in ICUD group, 15 cm ileum was taken using stapler at the 15 cm from ileocecum to make ileal conduit and restore the continuity of the ileum. The proximal end of the ileal conduit was closed. The bilateral ureteral were implanted 3 cm apart on the ileal bladder. F6 single J tube was placed into both of the ureters to drain urine. For ECUD group, the subumbilical 5 cm incision was taken to enter the abdominal cavity. The ileocecum was found and the terminal ileum was taken out of the body. A segment of 15 cm in length ileocecum 15 cm away from the cecum was cut off with a linear cutting stapler and the blood vessels of arterial arch were ligated, then a small opening at the same ileum position was cut. The continuity of the ileocecum was restored. The ileal conduit was irrigated, and the bilateral ureters were placed into a single J tube and anastomosed to the ileal conduit 3 cm apart. The operation time, intraoperative blood loss, postoperative exhaust time, postoperative feeding time, postoperative hospital stay, postoperative incision pain score, postoperative readmission rate, peri-operative mortality, postoperative complications and pathology results were compared between the two groups. Results:All cases were successfully performed robotically without conversion or major intraoperative complications. There was no significant difference in operation time between ICUD group and ECUD group [260(230, 310) min and 235(220, 290) min, P=0.078]. The estimated blood loss in ECUD group was more than that in ICUD group [300(200, 400) ml and 150(100, 300), P=0.037], but there was no difference in blood transfusion rate between the two groups [7(8.6%) and 9(7.4%), P=0.196]. The exhaust time [4(2-6) days and 2(1, 3) days] and postoperative solid food feeding time [7(4, 9) days and 4(3, 5) days] in the ECUD group were longer than those in the ICUD group (all P<0 05). The exhaust time[4(2-6)day and 2(1, 3)day] and solid food feeding time[7(4, 9)day and 4(3, 5)day] in ECUD group were longer than those in ICUD group. There was no significant difference in postoperative hospital stay between ECUD group and ICUD group[8(5, 11)day and 6(5, 9)day, P=0.212]. Clavien-Dindo Ⅰ-Ⅱ grade was defined mild complication, Ⅲ grade or above was defined serious complication, early complication was defined within 30 days after operation, and late complication was defined 30-90 days after operation. The overall early postoperative complication rate were 19.6%(24) and 34.2%(28)(ICUD vs.ECUD), the mild complications rate were 13.9%(17) and 25.6%(21)(ICUD vs.ECUD), and the late severe complication rate were 4.1%(5)and 10.1%(8)(ICUD vs.ECUD). ICUD group were significantly lower than those of ECUD group (all P<0.05). There was no difference in the early severe complication rate [5.7%(7) and 8.5%(7)], the total late complication rate [15.6%(19) and 16.1%(13)], and the late mild complication rate [11.5% (14) and 6.0% (5)] (all P>0.05). There was no significant difference between ICUD group and ECUD group, in term of the number of lymph nodes dissected [21(14, 25) and 19(15, 24)], the positive rate of lymph nodes [10.7%(13) and 10.0%(8)], the positive rate of surgical margin [3.3%(4) and 4.8%(4)] and postoperative pathological stage T 1-T is [25(20.3%) and 14(17.1%)], and T 2-T 3 [97(79.7%) and 68(82.9%)]. The number of patients with postoperative incision pain (pain score >5) was 43 (35.6%) in ICUD and 46 (56.5%) in ECUD( P< 0.05). The 30-day and 90-day readmission rates were 1.6% (2/82) and 4.9% (6/82) in ICUD group, and 1.2% (1/122) and 9.8% (8/122) in ECUD group, respectively. There was no peri-operative mortality in both groups. Conclusions:Robot-assisted radical cystectomy with ileal conduit is a safe and repeatable method for the treatment of muscular invasive or high-risk non-muscular invasive bladder cancer. Complete intracorporeal bladder reconstruction is feasible and has the advantages of less intraoperative bleeding, faster postoperative intestinal function recovery and less complications.
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In this study, a new ileal orthotopic bladder (Urumqi Bladder) modified by our center based on the ileal "W" type orthotopic bladder and Studer bladder was used on 8 patients with invasive bladder cancer. All of patients were male and aged between 54 and 66 years. The history of disease ranged from 1 month to 3 years, including 5 patients with initial onset, 3 patients with ≥2 TURBT history. 6 patients had multiple tumors, tumor size from 0.5 cm to 2.5cm. There were 2 patients with single tumor. Preoperative PET-CT examination showed no distant metastasis and pelvic lymph node enlargement, no urinary tract hydronephrosis, and cystoscopy showed no suspected tumor in the urethra. Preoperative pathological results: high-grade invasive urothelial carcinoma was found in 6 cases and muscular invasive urothelial carcinoma in 2 cases. In 8 patients, 50cm ileum was taken from 15cm away from ileocecum after radical cystectomy, which was crimped clockwise inward from the right end into a nearly circular shape, with 10cm left at the left end. The remaining 40cm ileum was formed into 3 sections of about 13cm each, which were decanted to form a storage capsule. The last 10cm intestinal tube was crossed from the front of sigmoid colon. The end of intestine was anastomosed with the left ureter. The right ureter was anastomosed with the top of the right intestine pouch, and the urethra was anastomosed with the pouch to complete the diversion of urine flow. During 3-12 months of postoperative follow-up, 4 patients had short-term mild urinary incontinence. All had complete urinary control at 12 months. 1 patient still had mild left ureter reflux 12 months after surgery, and the other 7 patients had no ureter reflux. In this group of 8 patients, postoperative excretory cystography showed satisfactory effect of bladder voiding, residual, and bladder capacity. Follow-up review of chest CT, urinary CT and abdominal ultrasound showed no hydronephrosis, and no tumor recurrence or distant metastasis.
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ABSTRACT Objective: To characterize the contribution of the extirpative and reconstructive portions of radical cystectomy (RC) to complications rates, and assess differences between urinary diversion (UD) types. Materials and Methods: We conducted a retrospective cohort study comparing patients undergoing UD alone or RC+UD for bladder cancer from 2006 to 2017 using ACS National Surgical Quality Improvement Program database. The primary outcome was major complications, while secondary outcomes included minor complications and prolonged length of stay. Propensity score matching (PSM) was utilized to assess the association between surgical procedure (UD alone or RC+UD) and outcomes, stratified by diversion type. Lastly, we examined differences in complication rates between ileal conduit (IC) vs. continent UD (CUD). Results: When comparing RC + IC and IC alone, PSM yielded 424 pairs. IC alone had a lower risk of any complication (HR 0.63, 95% CI 0.52-0.75), venous thromboembolism (HR 0.45, 95% CI 0.22-0.91) and bleeding needing transfusion (HR 0.41, 95% CI 0.32-0.52). This trend was also noted when comparing RC + CUD to CUD alone. CUD had higher risk of complications than IC, both with (56.6% vs 52.3%, p = 0.031) and without RC (47.8% vs 35.1%, p=0.062), and a higher risk of infectious complications, both with (30.5% vs 22.7%, p<0.001) and without RC (34.0% vs 22.0%, p=0.032). Conclusions: RC+UD, as compared to UD alone, is associated with an increased risk of major complications, including bleeding needing transfusion and venous thromboembolism. Additionally, CUD had a higher risk of post-operative complication than IC.