Round ligament suspending treatment in orthotopic ileal-neobladder after radical cystectomy in women: a single-centre prospective randomised trial.

OBJECTIVES: To compare the occurrence of emptying dysfunction between surgical techniques for orthotopic neobladder suspended with round ligament (rONB) and the standard procedure (sONB). PATIENTS AND METHODS: A prospective randomised controlled trial was performed in a single centre of female patients undergoing creation of an ONB using rONB or sONB. Patients were followed for ≥24 months after ONB. The primary endpoints were significant post-void residual urine volume (sPVR) and need for clean intermittent catheterisation (CIC) at 24 months postoperatively. The secondary endpoints included early and late complications, urodynamic profile, and ONB continence. RESULTS: Between January 2011 and October 2017, the trial enrolled 85 patients, of whom 82 were randomised. A total of 41 patients had a rONB and 41 a sONB. At 24 months, 17 of the 37 patients with a sONB and nine of the 39 patients with a rONB had a sPVR. The cumulative risk of a sPVR was significantly lower in the rONB group (23.1%) vs the sONB group (45.9%) (hazard ratio [HR] 0.43, 95% confidence interval [CI], 0.19-0.96; P = 0.040). In all, 15 of the 37 patients with a sONB and four of the 39 patients with a rONB needed CIC. The cumulative risk of requiring CIC was significantly lower in the rONB group (10.3%) vs the sONB group (40.5%) (HR 0.22, 95% CI 0.07-0.67; P = 0.008) at 24 months. Multivariable Cox regression analysis also showed that the rONB type was an independently protective factor for sPVR and CIC. The rates of early (0-90 days) and late complication (>90 days) were 54.1% and 13.5% in the sONB group, and 64.1% and 10.3% in the rONB group, respectively. There were no significant differences in complications, urodynamic profile or ONB continence. A major limitation is the small sample size at a single centre. CONCLUSION: Posterior support with round ligament for an ONB significantly improved the emptying of the ONB and resulted in a reduced need for CIC. The surgical modification is a feasible and safe technique without additional complication-related surgeries.

Downregulated XPA promotes carcinogenesis of bladder cancer via impairment of DNA repair.

Bladder cancer is the most common malignant tumor of urinary system, largely resulting from failure of repair of DNA damage to the environmental insults. The function of XPA in nucleotide excision repair pathway has been well documented. However, participation of XPA in the repair of DNA double-strand break remains unknown. Here, we reported that bladder cancer expressed low XPA levels compared to adjacent non-tumor bladder tissue, and this phenotype was closely associated with chromosomal aberrations. Moreover, downregulated XPA appeared to increase incidence of chromosome aberration. XPA reduction increased cell viability of a bladder cancer cell line RT4, while XPA re-expression decreased the cell viability of RT4 cells. Since high mutation frequency is the basis of mutations of oncogenes and anti-oncogenes, and may be the essence of bladder cancer susceptibility, our study suggests that downregulated XPA may promote carcinogenesis of bladder cancer via impairment of DNA repair.

Controlled transurethral resection and incision of the bladder neck to treat female primary bladder neck obstruction: Description of a novel surgical procedure.

OBJECTIVES: To investigate the efficacy and complications of controlled transurethral resection and incision of the bladder neck to treat female primary bladder neck obstruction. METHODS: A total of 59 patients who were diagnosed with female primary bladder neck obstruction by urodynamic examination underwent surgical procedures at Urological Institute of the People's Liberation Army, First Affiliated Hospital of Third Military Medical University, Chongqing, China, between March 2010 and March 2014. For all patients, neurogenic, anatomical and dysfunctional voiding causes of bladder outlet obstruction had been excluded. Perioperative and follow-up data, including operative time, maximum urine flow rate, residual urine volume, International Prostate Symptom Score and Quality of Life Score, were prospectively investigated. RESULTS: All of the operations were completed uneventful. The median operative time was 15 ± 8 min (range 10-22 min). No massive hemorrhage or infection was reported. Follow-up data were available for 59, 59, and 57 of the patients at 1, 6 and 12 months postoperatively, respectively. The mean maximum urine flow rate increased from 7.2 ± 3.9 mL/s preoperatively to 26.1 ± 5.2 mL/s postoperatively. The mean residual urine volume decreased from 162 ± 75 to 20 ± 7 mL. The mean International Prostate Symptom Score decreased from 24.5 ± 7.2 to 5.5 ± 3.6. The mean Quality of Life Score decreased from 5.4 ± 1.7 to 1.9 ± 1.1. All of the differences between the preoperative and postoperative values were significant (P < 0.001). CONCLUSIONS: The novel technique described here shortens the length of the urethra to 2.5 cm, which both released the obstruction and maintained continence. The results of the present preliminary study show that this method represents a safe and effective treatment for female primary bladder neck obstruction.

Long-term evaluation of patients undergoing genitoplasty due to disorders of sex development: results from a 14-year follow-up.

PURPOSE: To summarize the experience in treating patients with genitoplasty due to disorders of sex development in China. METHODS: The operative procedures, gender of rearing, surgical outcome, and psychosocial and family adjustments of 262 patients were reviewed retrospectively. RESULTS: At initial diagnosis, the mean age was 14.3 ± 2.8 years (range: 2-38 years). There were 96 children, 133 adolescents, and 33 adults. Follow-up was done every 6 months. Patients with female sex assignment had no urinary incontinence or voiding difficulty. Five patients underwent the second surgery (3%); vaginal dilation was performed in 35 patients with postoperative vaginal stenosis; 12 patients (7.4%) were unsatisfactory with the outcome. For patients with male sex assignment, the median length of penis was 2.2 cm in prepubertal patients, 4.2 cm in pubertal patients, and 5.0 cm in adults; 39 patients developed postvoid dribbling (39%); 21 patients underwent a second surgery (21%); urethral dilation was done in 28 patients (28%) due to urethral stricture; 38 patients were unsatisfactory with the outcome (38%). In addition, 136 patients (83%) with female sex assignment and 54 (54%) with male sex assignment had favorable psychosocial adjustment. CONCLUSIONS: Patients with male sex assignment have more surgical complications and difficulties in psychosocial adjustment as compared to those with female sex assignment.

Human telomerase reverse transcriptase transfection reduces apoptosis in human penile smooth muscle cells and slows down cellular aging.

INTRODUCTION: Erectile dysfunction (ED) is one of the most common diseases in male urology that greatly affects the quality of life in senior people. Relaxation of corpus cavernosum smooth muscle is the key to penile erection. AIM: To explore effects of human telomerase reverse transcriptase (hTERT) gene transfection on biological behaviors of human penile smooth muscle cells. METHODS: Human penile smooth muscle cells were grown in primary culture. A fluorescent eukaryotic expression vector, hTERT-internal ribosome entry site 2 (IRES2)-enhanced green fluorescent protein (EGFP), was constructed and transfected into human penile smooth muscle cells using Lipofectin reagent. MAIN OUTCOME MEASURE: The telomerase activity, mitotic index, cell apoptosis, and cell growth curves of transfected smooth muscle cells were determined; the potential formation of malignant phenotypes in these transfected cells was investigated. RESULTS: Telomerase activity, mitotic index, and cell growth of hTERT-transfected cells were significantly higher than those of nontransfected cells and cells transfected with the empty EGFP vector, while apoptosis rates were the lowest in hTERT-transfected cells. No changes in cell morphology, chromosome number, and tumorigenicity were observed between hTERT-transfected cells and control cells. CONCLUSION: In this study, for the first time, the hTERT gene was transfected into human penile smooth muscle cells, and the gene increased telomerase activity in cells, reduced cell apoptosis, and slowed down cell aging. We believe that this finding is of potential clinical value in the prevention and treatment of organic ED.

The lncRNA PTTG3P promotes the progression of CRPC via upregulating PTTG1.

BACKGROUND: Overexpression of certain long non-coding RNAs (lncRNAs) promotes the progression of castration-resistant prostate cancer (CRPC). The significance and potential role of the lncRNA designated pituitary tumour-transforming 3, pseudogene (PTTG3P) in CRPC is unknown. METHODS: We detected PTTG3P expression by qPCR. Upregulated PTTG3P expression was performed to explore the role of PTTG3P in PCa cells resistant to ADT (androgen deprivation therapy). The relationship among PTTG3P, mir-146a-3p and PTTG1 were validated by qPCR, western blot and luciferase assay. RESULTS: PTTG3P levels were significantly increased in the androgen-independent PC cell lines, as well as in CRPC tissues compared with those of the androgen-dependent prostate cancer cell line LNCaP and tumour tissues of patients with hormone-naive prostate cancers. Enforced expression of PTTG3P in androgen-deprived LNCaP cells significantly enhanced survival, clonogenicity, and tumorigenicity. Further, PTTG3P acted as a competing endogenous RNA (ceRNA, natural miRNA sponge) to upregulate PTTG1 expression by competing for mir-146a-3p in the progression to CRPC. CONCLUSION: Our findings suggest that PTTG3P promotes the resistance of prostate cancer cells to androgen-deprivation therapy via upregulating PTTG1. PTTG3P may therefore represent a potential target for therapy of CRPC.

XPC epigenetic silence coupled with p53 alteration has a significant impact on bladder cancer outcome.

PURPOSE: Varied XPC genetics are related to bladder cancer susceptibility. We determined whether decreased XPC expression influences bladder cancer malignancy and clinical outcome. MATERIALS AND METHODS: Changes in XPC and p53 expression were detected by immunochemistry in 108 bladder cancers, including 29 papillary neoplasms of low malignant potential, and 48 low and 31 high grade lesions, of which 47 were stage Ta-T1 and 61 were stage T2-T3. XPC mRNA and methylation were evaluated in fresh tissue by real-time reverse transcriptase and methylation specific polymerase chain reaction. The clinical value of altered XPC and p53 expression was analyzed in 66 bladder cancers, including 6 papillary neoplasms of low malignant potential, and 41 low and 19 high stage lesions, of which 26 were stage Ta-T1 and 40 were stage T2-T3, by the Kaplan-Meier method and Cox proportional hazards regression. RESULTS: The XPC defect was associated with bladder cancer higher pathological grade, metastasis and p53 mutation. Patients with XPC(-)/p53(+) had shorter survival than those with bladder cancer without XPC(-)/p53(+) (p = 0.0127). Cox regression analysis showed that XPC expression may be a potential predictive factor for bladder cancer (p = 0.043). In bladder cancer xpc gene hypermethylation was significantly higher than in normal mucosa (p = 0.0437). CONCLUSIONS: Lower mRNA may be the result of XPC hypermethylation in bladder cancer. Epigenetic defects in the XPC gene impact bladder cancer malignant behavior and may also predict poor outcome in some bladder cancer cases, as characterized by p53 pathway alteration.

A modified single-port technique for the minimally invasive treatment of pediatric inguinal hernias with high ligation of the vaginal process: the initial experience.

The aim of this study is to evaluate a modified single-port technique for treating pediatric inguinal hernias (PIH) with high ligation of the vaginal process by combining the use of a ureteroscope and a custom-made puncture guide under pneumoperitoneum. The cases of 86 patients with PIH who underwent the procedure in our institution were reviewed. All of the operations were completed uneventfully. The median operative times for unilateral and bilateral lesions were 11 min (range, 8-15 min) and 16 min (range, 12-20 min), respectively. All of the patients were discharged from the hospital on the day of surgery. No massive hemorrhages or infections were reported. The median follow-up was 15 months (range, 12-24 months), during which no recurrences were reported. In conclusion, with the aid of a ureteroscope and a modified custom-made puncture suit, the described single-port technique allowed easier induction of the ligation suture and a shorter operative time than other methods reported previously. However, the determination of long-term efficacy requires additional studies with larger sample sizes and longer follow-up times.

[Study on the neurophysiologic of detrusor overactivity due to partial bladder outflow obstruction].

OBJECTIVE: To study the neurophysiologic of detrusor overactivity (DO) due to partial bladder outflow obstruction (PBOO). METHODS: Twenty four female Wistar rats with DO caused by PBOO were studied simultaneously with ten sham-operated rats. An electrophysiological multi-channel simultaneous recording system was used to record pelvic afferent fiber potentials as well as the pudendal nerve motor branch potentials, external urethral sphincter electromyogram (EUS EMG) and abdominal muscle EMG during filling cystometry. To test the effect of the unstable contraction in DO rats after the decentralization of the central nervous system, DO rats were studied the changes of the unstable contraction after transection of the spinal cord (T(8) level), pelvic nerve, the sympathetic trunk, and the pudendal nerve. RESULTS: The incidence of DO was 62.5% in filling cystometry. During filling cystometry, there are two type of DO contraction according to the changes of pelvic afferent fiber signals, the relevant nerves and muscles responses: the small pressure of the unstable contraction (S-DO) and the big pressure of the unstable contraction (B-DO). For the B-DO, there were significant changes in the recordings of pelvic afferent fiber, the motor branch of the pudendal nerve, EUS EMG, and abdominal muscle EMG. While all these differences have not been recorded during S-DO. Both the filling-voiding cycle and the unstable contraction of B-DO were eliminated and the base line of bladder pressure increased after T(8) spinal cord transection. While the S-DO was not affected by such transection. When bladder relevant nerves were transected by the sequence of the pelvic nerve, the sympathetic trunk, and the pudendal nerve, the filling-voiding cycle was eliminated. The base line of bladder pressure increased significantly. No B-DO was recorded, but the S-DO still existed. CONCLUSION: There are some bladder-genic factors take part in the DO contractions induced by PBOO.

Treatment and outcomes of urethral recurrence after orthotopic neobladder replacement in patients with bladder cancer - practice in a single centre.

Objectives To report on the treatment of urethral recurrence after orthotopic urinary diversion at our institution. Methods We retrospectively reviewed clinical information of urethral recurrence in patients who underwent radical cystectomy and orthotopic urinary diversion between January 1998 and January 2013. Results Of 341 patients, 282 presented for follow-up (median follow-up: 56 months; range: 1-174 months). Eight patients developed local recurrence of urothelial cancer after radical cystectomy. The rate of urethral recurrence (1.4%) in female patients who underwent orthotopic urinary diversion was lower than in male patients (3.3%). The median (range) time to recurrence was 33 (6-120) months after radical cystectomy and orthotopic urinary diversion. Recurrences were treated by transurethral resection of tumour, urethrectomy, neobladder resection, revision of urinary diversion, adjuvant chemotherapy, or radiation therapy, based on individual circumstances. Survival analysis showed that 5-year cancer-specific survival was significantly higher in patients with urethral recurrence alone (83.3%), compared with patients with other recurrences, including pelvic/abdomen recurrence and distant metastasis (26.8%). Conclusions En bloc urethrectomy and revision of urinary diversion remain the principle surgical choices. Selection of transurethral tumour resection was based on tumour stage and was used in carefully chosen patients. Cancer-specific survival might depend on multidisciplinary therapy.

Increased expression of EZH2 indicates aggressive potential of urothelial carcinoma of the bladder in a Chinese population.

Here, we attempt to better define the long-term outcomes of radical cystectomy (RC) for urothelial carcinoma (UC) in a Chinese population and to investigate the relationship between EZH2 protein expression levels and the clinicopathological parameters and outcomes in patients with UC. We detected the relative EZH2 protein expression levels by immunohistochemistry in tumour specimens from a cohort of 189 Chinese UC patients. In patients who underwent RC, the 5-year cancer-specific survival (CSS) and overall survival (OS) were 69% and 61% respectively. EZH2 expression was increased in UC compared with normal urothelium. The expression levels of EZH2 were elevated in parallel with tumour stage (p = 0.001) and tumour grade (p = 0.001) and were increased in cases with lymph node metastasis compared with node-negative cases (p = 0.018). Kaplan-Meier analyses showed that higher EZH2 expression was related to significantly shorter CSS and OS in patients who underwent RC. High EZH2 expression was associated with worse CSS (HR = 3.51; p = 0.037) and OS (HR = 2.15; p = 0.047) in the univariate analysis, but only lymph node invasion maintained its predictive value for CSS in a multivariate model. This contemporary and homogeneous single-centre series found acceptable outcomes for Chinese UC patients who underwent RC. Clinically, our retrospective studies suggest that EZH2 levels can be used to identify more aggressive phenotypes in UC patients, thereby improving our prognostic knowledge.

[Transurethral resection of the prostate for patients with the permanent cardiac pacemaker].

OBJECTIVE: To evaluate the transurethral resection of the prostate (TURP) for patients with the permanent cardiac pacemaker. METHODS: A retrospective study was made on TURP for 8 patients aged from 62 to 71 and equipped with the cardiac pacemaker for 2 to 7 years, because of sick sinus syndrome (5 cases), complete atrioventricular block (2 cases), and three-cord block (1 case). The pacemakers varied accordingly, Type DDD in 4, Type AAI in 3 and Type VVI in 1 of the patients. RESULTS: All the operations were successful, and all the patients experienced satisfactory recovery. CONCLUSION: Patients with the permanent cardiac pacemaker can receive TURP.

Use of urostomy bags in the management of perioperative urine leakage after radical cystectomy.

BACKGROUND: Urine leakage is a common complication in patients with bladder cancer after radical cystectomy and neobladder reconstruction. OBJECTIVE: The aim of this study was to evaluate the clinical value of the use of urostomy bags in the management of urine leakage in patients with bladder cancer after radical cystectomy. METHODS: Urine leakage during the perioperative period was retrospectively analyzed in 483 patients with bladder cancer who underwent radical cystectomy from 2004 to 2010. Before 2008, all patients with urine leakages were treated by routine dressing changes (group A). After 2008, the leakages were managed with urostomy bags (group B). The perioperative quality of life (EQ-5D) and cost for urine leakage for both groups were compared in this controlled study. RESULTS: The average cost in management of preoperative urine leakage was significantly higher in group A than in group B as well as the patients with extravasations of urine or lymphoceles. Patients in group B had an overall better perioperative life quality compared with group A. In particular, the score for pain/discomfort was significantly higher in group A than in group B. CONCLUSIONS: The management of perioperative urine leakage with urostomy bags avoided constant body wetness and significantly increased the quality of life and reduced the special costs of urine leakage in patients with bladder cancer after cystectomy. IMPLICATIONS FOR PRACTICE: Early use of urostomy bag is a good choice for perioperative urine leakage in patients with bladder cancer after radical cystectomy and neobladder reconstruction.

A report of 918 cases of circumcision with the Shang Ring: comparison between children and adults.

OBJECTIVE: To compare the clinical outcome and surgical complications in circumcision using the Shang Ring between children and adults. METHODS: Circumcision using the Shang Ring was performed on 702 adults and 216 children. Comparative analysis on indices including operative time, healing time, postoperative edema, postoperative bleeding, postoperative pain, and postoperative infection was conducted. RESULTS: When the ring was removed after surgery, the pain was tolerable in the adult group, but more substantial in the child group. The optimal time for removing the ring was 2 weeks after surgery. CONCLUSION: Special attention to the pain management is needed when using the Shang Ring to treat redundant foreskin or phimosis in children. The timing of the ring removal is critical to avoiding complications. Surgeons' knowledge in urology is also critical to the clinical outcome.

Celastrol suppresses tumor cell growth through targeting an AR-ERG-NF-κB pathway in TMPRSS2/ERG fusion gene expressing prostate cancer.

The TMPRSS2/ERG (T/E) fusion gene is present in the majority of all prostate cancers (PCa). We have shown previously that NF-kB signaling is highly activated in these T/E fusion expressing cells via phosphorylation of NF-kB p65 Ser536 (p536). We therefore hypothesize that targeting NF-kB signaling may be an efficacious approach for the subgroup of PCas that carry T/E fusions. Celastrol is a well known NF-kB inhibitor, and thus may inhibit T/E fusion expressing PCa cell growth. We therefore evaluated Celastrol's effects in vitro and in vivo in VCaP cells, which express the T/E fusion gene. VCaP cells were treated with different concentrations of Celastrol and growth inhibition and target expression were evaluated. To test its ability to inhibit growth in vivo, 0.5 mg/kg Celastrol was used to treat mice bearing subcutaneous VCaP xenograft tumors. Our results show Celastrol can significantly inhibit the growth of T/E fusion expressing PCa cells both in vitro and in vivo through targeting three critical signaling pathways: AR, ERG and NF-kB in these cells. When mice received 0.5 mg/kg Celastrol for 4 times/week, significant growth inhibition was seen with no obvious toxicity or significant weight loss. Therefore, Celastrol is a promising candidate drug for T/E fusion expressing PCa. Our findings provide a novel strategy for the targeted therapy which may benefit the more than half of PCa patients who have T/E fusion expressing PCas.

Association of BLCA-4 hypomethylation in blood leukocyte DNA and the risk of bladder cancer in a Chinese population.

Global DNA hypomethylation has been associated with increased risk for cancers of the colorectum, bladder, breast, head and neck, and testicular germ cells. The aim of this study was to examine whether global hypomethylation measured at BLCA-4 repeat regions through bisulfite pyrosequencing in blood leukocyte DNA is associated with the risk of bladder cancer(BC). A total of 312 bladder cancer patients and 361 healthy control subjects were included in Chongqing, China. Global methylation in blood leukocyte DNA was estimated by analyzing BLCA-4 repeats using bisulfite-polymerase chain reaction (PCR) and pyrosequencing. The median methylation level in BC cases (percentage of 5-methylcytosine (5 mC) = 75.7 %) was significantly lower than that in controls (79.7 % 5 mC) (P = 0.002, Wilcoxon rank-sum test). The odds ratios (ORs) of BC for individuals in the third, second, and first (lowest) quartiles of BLCA-4 methylation were 1.2 (95 % confidence interval (CI) 0.8-1.9), 1.6 (95 % CI 1.1-2.3), and 2.7 (95 % CI 1.5-3.8) (P for trend <0.001), respectively, compared to individuals in the fourth (highest) quartile. A 2.1-fold (95 % CI 1.5-2.8) increased risk of BC was observed among individuals with BLCA-4 methylation below the median compared to individuals with higher (>median) BLCA-4 methylation. Our results demonstrate for the first time that individuals with global hypomethylation measured in BLCA-4 repeats in blood leukocyte DNA have an increased risk for BC. Our data provide the evidence that BLCA-4 hypomethylation may be a useful biomarker for poor prognosis of patients with BC.

Angiosarcoma of the penis: a case report and literature review.

We reported one case of penile angiosarcoma in a 49-year-old patient who had been misdiagnosed as syphilis. Based on our experience, we suggest that if sexually transmitted diseases and Peyronie's disease can be ruled out, diagnosis of the penile angiosarcoma be warranted if unexplained rash, ulceration on the penis, and induration in corpus cavernosum are observed. It should be noted that if the anti-inflammatory or anti-viral treatment is prescribed for some time but the lesion does not disappear or even gets worse, the penile angiosarcoma should be suspected and penile biopsy is necessary.

High expression level of BLCA-4 correlates with poor prognosis in human bladder cancer.

OBJECTIVES: To evaluate the association between BLCA-4 tissue expression and patients' prognosis in bladder cancer (BC). METHODS: BLCA-4 expression was analyzed using immunohistochemical staining methods on tissue samples from a consecutive series of 325 BC patients who underwent resections between 2000 and 2006. The correlation of BLCA-4 expression and patients' clinicopathological parameters was evaluated. Survival analysis was performed using the Kaplan-Meier method and Cox's proportional hazards model. RESULTS: BLCA-4 was highly expressed in 54.8% of the BC patients. BLCA-4 overexpression was significantly associated with tumor grade (P<0.001), and stage (P<0.001). Kaplan-Meier survival analysis showed that high expression level of BLCA-4 resulted in a significantly poor prognosis of BC patients. Multivariate analysis revealed that the BLCA-4 expression level was an independent prognostic parameter for the overall survival rate of BC patients. CONCLUSIONS: These findings provide evidence that high expression level of BLCA-4 serves as a poor prognostic biomarker for BC. BLCA-4 may be a potential target of antiangiogenic therapy for BC.

Identification and management of emptying failure in male patients with orthotopic neobladders after radical cystectomy for bladder cancer.

OBJECTIVE: To treat neobladder emptying failure after radical cystectomy in patients with bladder cancer. The etiology of neobladder emptying failure should be identified. METHODS: We analyzed the outcome of neobladder emptying in 231 male patients who received neobladder reconstruction after radical cystectomy. The clinical characteristics, urodynamic evaluation, and treatment information were collected from all patients with emptying failure. RESULT: The total occurrence of neobladder emptying failure was 37 of 231 (16%). Emptying failure was a result of mechanical obstruction in 25 (10.8%) patients; obstructions were caused by strictures of the neobladder-urethral anastomosis (13 cases, 5.6%), anterior urethral strictures (3 cases, 1.2%), obstructive mucosal valves (2 cases, 0.9%), primary cystolithiasis (1 case, 0.4%), mucus plugs (2 cases, 0.9%), urethral tumor recurrence (2 cases, 0.9%), and pelvic tumor recurrence (2 cases, 0.9%). In 21 of 25 patients with mechanical obstructions, bladder function was completely recovered via an endourological approach. However, in 12 of patients with dysfunctional voiding, 3 patients presented higher compliance of neobladder. Two patients were found with a narrower posterior urethral angle. Eventually, 10 patients of 12 with dysfunctional voiding performed intermittent self-catheterization. CONCLUSIONS: The obstructive outlet was the primary cause of emptying failure in neobladders. Most of the patients with mechanical obstructions could obtain satisfactory neobladder emptying by a minimally invasive surgical approach. However, nearly all the patients with dysfunctional voiding will have to receive clean intermittent catheterization until the mechanisms causing failure are better understood.

Better compliance contributes to better nocturnal continence with orthotopic ileal neobladder than ileocolonic neobladder after radical cystectomy for bladder cancer.

OBJECTIVES: To investigate, in a randomized controlled study, the degree of continence after the creation of orthotopic ileocolonic and ileal neobladders after cystectomy and to explore a possible mechanism for the difference in continence between these 2 types of orthotopic neobladder. METHODS: From 2003 to 2007, 71 male patients underwent orthotopic lower urinary tract reconstruction with either an ileocolonic or ileal neobladder after radical cystectomy. The degrees of continence and voiding patterns were individually evaluated using urodynamic examinations and a detailed patient questionnaire. The abnormal upper tract was evaluated using intravenous urography and ultrasonography. RESULTS: Complete daytime continence was achieved in 90.9% and 89.4% of the patients and functional nocturnal continence 48.5% and 76.3% of patients in the ileocolonic neobladder and ileal neobladder groups, respectively. The urodynamic data showed that the initial volume of both the ileocolonic and the ileal neobladder appeared to not be significantly different statistically, although the compliance of the ileocolonic neobladder was lower than that of the ileal neobladder (P < .05). No difference was found in the parameters such as flow rate, urethral profile length, maximal urethral pressure, or neobladder neck pressure between the 2 neobladder types. CONCLUSIONS: Although the ileocolonic and ileal neobladders can both achieve a large initial volume, the ileal neobladder has an advantage in the aspect of obtaining satisfactory nocturnal continence because of its greater compliance compared with that of the ileocolonic neobladder.