Laparoscopic Radical Cystectomy With Extracorporeal Neobladder: Our Initial Experience.

OBJECTIVE: To illustrate our technique to construct the Institute of Urology Peking University (IUPU) orthotopic ileal bladder and present our initial experience. METHODS: From August 2017 to April 2018, 12 patients with bladder cancer underwent radical cystectomy (RC), pelvic lymph node dissection and extracorporeal construction of an IUPU neobladder (IUPUB) by an experienced surgeon. We present the demographic, clinicopathologic, perioperative, and follow-up data. We also describe our step-by-step surgical technique for the IUPUB in this article. RESULTS: Laparoscopic RC with an extracorporeal IUPUB was successfully accomplished in 11 patients, and 1 patient was converted to open RC with an IUPUB. The median total operative time and median time spent suturing the pouch were 248 minutes and 23 minutes, respectively. The median estimated blood loss was 150 mL. The median time to recovery of bowel function (tolerance of a liquid diet) was 3½ days. The urinary catheter was removed on post-operative day 21 in 10 patients. The ureteral stents and stoma catheter were removed on day 7 after cystography. At a median followup of 7½ months, 2 patients had early complications (<30 days), and no major complications (grade ≥ 3) occurred. The follow-up outcomes were satisfactory. The limitations included the small sample size and short-term outcomes. CONCLUSION: Our technique of constructing the IUPUB is feasible and safe. The operative time and early complication rates are acceptable.

[Effects of snow removal on soil labile nitrogen in a subalpine spruce forest of western Sichuan, China]. / 雪被去除对川西亚高山云杉林土壤活性氮的影响.

Warming-induced decrease in seasonal snow cover has a great potential to affect soil nitrogen cycle in alpine cold forest ecosystems. In this study, a wooden-shelter method was used to remove the snow accumulation. Soil nitrogen pools and mineralization rates in the snow removal and control plots were measured synchronously in three critical periods (early snow cover, deep snow cover and snow cover melting) in a subalpine spruce forest of western Sichuan, China. Seasonal snow cover kept soil from cold air temperature. Snow removal decreased average and minimum soil temperatures (5 cm) by 0.33 and 1.17 ℃, respectively. In addition, snow removal caused a positive effect on soil frost depth and freeze-thaw cycle. There was a significant dynamic in soil labile nitrogen pool among different periods. Snow removal on average increased NH4+-N, NO3--N and dissolved organic nitrogen (DON) contents by 38.6%, 23.5% and 57.3%, respectively, over the winter. Moreover, snow removal increased soil net nitrification and mineralization rates in the snow co-ver melting period. Overall, warming-induced decrease in snow cover could stimulate winter soil nitrogen cycle of subalpine forests.