Retroperitoneal laparoendoscopic single-site surgery for the treatment of retrocaval ureter.

PURPOSE: To present our surgical techniques for retroperitoneal laparoendoscopic single-site (LESS) pyelopyelostomy for retrocaval ureter and our initial experience with this method in 4 patients. METHODS: From June 2010 to May 2011, 4 patients with retrocaval ureter underwent retroperitoneal LESS pyelopyelostomy with a homemade single-port device and standard straight laparoscopic instruments. The single-port device was made with a surgical glove and Foley catheter and allowed the introduction of three trocars. A 3-cm incision was made at the middle axillary line, midway between the iliac crest and the twelfth rib. The retrocaval segment of the ureter was mobilized and transposed anteriorly to the inferior vena cava. The pyelopyelostomy anastomosis was completed with intracorporeal freehand suturing. A double-pigtail ureteral stent assembly was implanted in 3 of the 4 patients. RESULTS: All retroperitoneal LESS pyelopyelostomies were successful without conversion to standard laparoscopy or open surgery. The mean operating time was 105 min (range, 90-135 min). The mean blood loss was 18 mL (range, 5-50 mL). None of the patients required blood transfusion. The double-pigtail ureteral stent was removed 4-6 weeks postoperatively. The mean postoperative hospital stay was 7.3 days (range, 6-9 days). No intraoperative or postoperative complications occurred. At a mean follow-up of 10 months, excellent improvement in the ureteral obstruction was observed. CONCLUSIONS: We report our initial experience using LESS for the treatment of retrocaval ureter. Our results in 4 patients suggest that this minimally invasive approach is a feasible treatment of retrocaval ureter. Long-term follow-up of more cases is needed to confirm its benefits.

[Orthotopic T pouch ileal neobladder: evaluations of urodynamics and upper urinary tract functions].

OBJECTIVE: To evaluate the urodynamics and functions of upper urinary tract in a substitute of orthotopic T pouch ileal bladder. METHODS: From June 2004 through September 2009, 90 patients underwent the construction of an orthotopic T pouch ileal neobladder after radical cystectomy for muscle-invasive bladder cancer. The radiographic or ultrasound evaluation of upper urinary tract, determination of renal functions and urodynamic evaluation of T pouch ileal neobladder were performed by data analysis. RESULTS: Renal function as determined by serum creatinine remained in a normal range in all patients. Temporary dilation of renal pelvic and ureter was observed in 18 patients (20.0%) at Day 45 post-operation and then disappeared spontaneously in the late follow-up. A slight dilation of collecting system was found in other 4 patients (4.4%), but there was no negative impact on renal function. Reflux into afferent limb of neobladder was observed in 4 patients (4.4%) by cystography. Excellent daytime and nighttime continence was reported in 100% and 82.2% of evaluated patients respectively. The urodynamic assessment showed a mean capacity of (316 ± 96) ml with a mean intra-bladder pressure of (16 ± 10) cm H2O. These evaluated patients voided with a mean maximum intra-bladder pressure of (87 ± 25) cm H2O, a mean maximum flow rate of (17 ± 10) ml/s and a mean residual urine of (33 ± 29) ml. CONCLUSION: With an intermediate follow-up, the functional results of T pouch ileal neobladder are encouraging with an excellent capacity and compliance, successful daytime and nighttime continence and anti-reflux mechanism.

[Observation on therapeutic effect of peripheral facial paralysis treated by string puncture combined with electroacupuncture].

OBJECTIVE: To explore the effective treatment of peripheral facial paralysis. METHODS: Ninety-five cases of peripheral facial paralysis were randomly divided into an observation group (48 cases) and a control group (47 cases). In observation group, the acupoints located on paralyzed muscle, such as Yangbai (GB 14), Taiyang (EX-HN 5), Tongziliao (GB 1), Jiache (ST 6) and Dicang (ST 4), etc. were selected; string puncture was applied and the body of needles went through the muscular layer at 40 degrees-60 degrees angle with the direction of muscle fiber; Yangbai (GB 14), Taiyang (EX-HN 5) etc. were selected for electroacupuncture. In control group, the same acupoints and routine manipulations were applied. The clinical therapeutic effects, courses and the House-Brackmann (H-B) facial nerve function grading of both groups were compared. RESULTS: The total effective rate in observation group was 100.0% (47/47) which was superior to 93.6% (44/47) in control group (P < 0.01); the average effective, marked effective and cured durations of cured patients in observation group were much shorter than those in control group (all P < 0.01); the H-B facial nerve function grading of both groups were improved after treatment (all P < 0.01), and more significant in observation group (P < 0.01). CONCLUSION: By string puncture therapy, peripheral facial paralysis is treated more effective than that by routine puncture, and the curative courses are obviously shortened.