Robot-assisted radical cystectomy with total intracorporeal ileal conduit: comparative analysis with extracorporeal ileal conduit / 中华泌尿外科杂志

Objective:To compare the perioperative complications and prognosis of intracorporeal and extracorporea lileal conduit urinary diversion(ICUD or ECUD)following robot-assisted radical cystectomy(RARC).Methods:The data of 95 patients who underwent RARC treatment in Nanjing Drum Tower Hospital from March 2016 to June 2019 were retrospectively analyzed. Among them, 37 underwent ICUD and 58 underwent ECUD. In the ICUD group, there were 32 males and 5 females, aged(68.0±7.8) years, body mass index (BMI) of (24.1±3.4) kg/m 2, American Society of Anesthesiologists(ASA)score of 1-2 in 4 cases(10.8%), ASA score of 3-5 in 33 cases(89.2%), preoperative hemoglobin of(126.5±14.2)g/L, albumin of(39.0±2.2)g/L, and C-reactive protein of 4.0(2.0-8.5) mg/L. In the ECUD group, there were 53 males and 5 females, aged(67.5±9.0)years, BMI of(24.2±3.6)kg/m 2, ASA score of 1-2 in 16 cases(27.6%), ASA score of 3-5 in 42 cases (72.4%) , preoperative hemoglobin of(129.0±12.4)g/L, albumin (38.2±3.1) g/L, and C-reactive protein of 4.9 (3.1-14.4) mg/L. There was no significant difference in preoperative data between the two groups ( P>0.05). The two groups underwent RARC and pelvic lymph node dissection similarly. The ICUD group underwent a total intracorporeal ileal conduit and the ECUD group underwent extracorporeal ileal conduit with direct vision through a median incision in the lower abdomen.There were 32 cases (86.5%) and 46 cases (79.3%) undergoing expanded pelvic lymph node dissection in the ICUD group and the ECUD group respectively, and the difference was not statistically significant ( P=0.374). The complications were graded according to the Clavien-Dindo grading system. The perioperative complications and prognosis of the two groups were compared. Results:The operation time of the ICUD group and the ECUD group were (430±63) min vs. (410±69) min, respectively ( P=0.163). The estimated blood loss were (435±233) ml vs. (388±277) ml, respectively ( P=0.182). Intraoperative blood transfusion were 10 cases (27.0%) and 12 cases (20.7%)( P=0.475). None of the above differences were statistically significant. Postoperative albumin of the ICUD group and the ECUD group were (31.5±2.4) g/L vs. (31.0±2.8) g/L ( P=0.387), postoperative C-reactive protein were 30.9 (10.4-52.1) mg/L vs.29.5 (14.4-58.5) mg/L ( P=0.655) and postoperative hemoglobin were (110.0±13.8) g/L vs. (113.7±13.4) g/L ( P=0.187). The postoperative feeding recovery were 4(3-5) d vs. 4(3-5) d ( P=0.752) and the postoperative hospital stay were 13(10-19) d vs. 13(11-18) d ( P=1.000). There was no statistically significant difference in perioperative data. The postoperative pathological examination results of ICUD group and ECUD group showed that there were 17 cases (45.9%) vs.19 cases (32.8%) in T a/T 1/Tis stage, 12 cases (32.4%) vs. 18 cases (31.0%) in T 2 stage, 5 cases (13.5%) vs. 19 cases (32.8%) in T 3 stage, 3 cases (8.1%) vs. 2 cases (3.4%) in T 4 stage, respectively and the difference was not statistically significant( P=0.166). The number of lymph nodes removed were (18.2±6.7) vs.(16.5±7.9)( P=0.178) and the number of patients with positive lymph nodes were 6(16.2%) vs.11(19.0%), respectively( P=0.733). None of the patients had positive margins. There was no statistically significant difference in pathological examination overall. There were 14 cases (37.8%) in the ICUD group and 21 cases (36.2%) in the ECUD group experiencing complications within 30 days after operation and the difference was not statistically significant( P=0.872). The complications within 90 days after operation were 14 cases (37.8%) vs. 24 cases (41.4%) respectively and the difference was not statistically significant( P=0.731). Clavien-Dindo grade Ⅲ-Ⅴ complications in the two groups were 1 case (2.7%) vs.1 case (1.7%) respectively, with no significant difference ( P=0.849). One patient in the ICUD group developed an intestinal anastomotic leakage and underwent reoperation for repairing and 1 patient in the ECUD group developed mechanical intestinal obstruction and underwent reoperation. The rate of readmission within 90 days after operation of the ICUD group was lower than that of the ECUD group, but the difference was not statistically significant [3 cases (8.1%) vs. 11 cases (19.0%), P=0.090]. Postoperative follow-up was 13-53 months and the median follow-up of ICUD group and ECUD group were 19 months and 31 months respectively. There was no significant difference in the survival curve between the two groups( P=0.746). The 1-year survival rate was 91.9% in the ICUD group and 91.4% in the ECUD group. Routine re-examination of urinary system CT or B-ultrasound was performed 3 months, 6 months and 1 year after surgery. The incidence of ureteral dilatation/hydronephrosis in the ICUD group was lower than that of the ECUD group, with 4.1%(3 sides) vs. 14.7%(17 sides)( P=0.020). Conclusion:Compared with RARC+ ECUD, RARC+ ICUD does not increase the incidence of complications within 90 days after surgery and may reduce the risk of upper urinary tract dilatation.

Extraperitoneal approach robotic-assisted urethra-sparing simple prostatectomy for large-gland benign prostatic hyperplasia: initial experience / 中华泌尿外科杂志

Objective@#To report our initial experience with extraperitoneal approach Robotic-Assisted Urethra-sparing simple prostatectomy(US-RASP)on large-gland (>100 ml) benign prostatic hyperplasia(BPH).@*Methods@#From August 2015 to April 2018, 32 patients with large volume prostate underwent US-RASP performed by single surgical team were retrospectively reviewed. The patient's median age was 73 (range 59-80) years, and median BMI was 24.9 (19.3-34.8 ) kg/m2, The estimated prostate volume(V), postvoid residual volume(PV) by transrectal ultrasonography and PSA were 152.0(119.0-223.1)ml, 145(0-280)ml and 13.7(5.2-27.3)ng/ml, respectively. Four of 32 patients underwent preoperative urinary catheterization. The perioperative functional parameters including international prostate symptom score (IPSS) questionnaire, maximum flow rate (Qmax), maximum voided volume(Vmax), quality of life questionnaires (QOL) and International Index of erectile function-erectile function (IIEF-EF) were 27(23-33), 5.9 (2.5-7.8) ml/s, 110 (80-210)ml, 5(3-6), and 27(26-29), respectively. Functional parameters including IPSS, QOL, Qmax, Vmax, PV and IIEF-EF were compared and analyzed at 3 and 12 months postoperatively during the following-up.@*Results@#The US-RASP was completed in all 32 patients and no open conversion. Median operation time was 180 (115-240) min, the estimated blood loss was 300(range 100 to 400)ml, Hemoglobin loss was 17(5-38)g/L. The median Foley catheterization time was 7 (5-12) days and drainage was removed after a median of 5 (4-7) days with median hospital stay of 8(6-14)days. Median specimen weight on pathological examination was 107.7 (79.8-147.4)g with median of 64.2% (49.4%-86.2%) resection ratio. At 3-mo follow-up, median IPSS score, Qmax, Vmax, PV and QOL were 6(4-18), 17.3 (13.8-21.1)ml/s, 167(140-310)ml, 50(0-61)ml, 1(0-3) , respectively. At 12-mo follow-up, median IPSS score, Qmax, Vmax, PV and QOL were 4(1-9), 20.1 (17.9-24.1)ml/s, 205(176-305)ml, 24(0-35)ml and 1(0-2) , respectively. All patients showed great improvement of IPSS, Qmax, Vmax, PV and QOL after median 17 (12-44) months follow-up compared with preoperative parameters (P<0.05). Erectile function was not impaired in 17 patients who have normal erectile function pre-operatively and 14 cases (82.4%) preserved satisfactory anterograde ejaculation. No significant complication occurred during the procedure. No patient developed permanent urinary incontinence.@*Conclusions@#US-RASP is a safe and effective treatment option for selected patients with large-gland obstructive BPH(>100 ml). Our data showed significant improvement in voiding function and maintaining satisfactory anterograde ejaculation following urethral-sparing technique. It may be a new alternative method in the future for large-volume symptomatic BPH.

Extraperitoneal approach robotic-assisted urethra-sparing simple prostatectomy for large-gland benign prostatic hyperplasia: initial experience / 中华泌尿外科杂志

Objective To report our initial experience with extraperitoneal approach RoboticAssisted Urethra-sparing simple prostatectomy (US-RASP)on large-gland (＞ 100 ml) benign prostatic hyperplasia(BPH).Methods From August 2015 to April 2018,32 patients with large volume prostate underwent US-RASP performed by single surgical team were retrospectively reviewed.The patient's median age was 73 (range 59-80) years,and median BMI was 24.9 (19.3-34.8) kg/m2,The estimated prostate volume(V),postvoid residual volume(PV) by transrectal ultrasonography and PSA were 152.0 (119.0-223.1) ml,145 (0-280) ml and 13.7 (5.2-27.3) ng/ml,respectively.Four of 32 patients underwent preoperative urinary catheterization.The perioperative functional parameters including international prostate symptom score (IPSS) questionnaire,maximum flow rate (Qmax),maximum voided volume(Vmax),quality of life questionnaires (QOL) and International Index of erectile function-erectile function (IIEF-EF) were 27(23-33),5.9 (2.5-7.8) ml/s,110 (80-210)ml,5(3-6),and 27(26-29),respectively.Functional parameters including IPSS,QOL,Qmax,Vmax,PV and IIEF-EF were compared and analyzed at 3 and 12 months postoperatively during the following-up.Results The US-RASP was completed in all 32 patients and no open conversion.Median operation time was 180 (115-240) min,the estimated blood loss was 300(range 100 to 400)ml,Hemoglobin loss was 17 (5-38)g/L.The median Foley catheterization time was 7 (5-12) days and drainage was removed after a median of 5 (4-7) days with median hospital stay of 8(6-14)days.Median specimen weight on pathological examination was 107.7(79.8-147.4) g with median of 64.2％ (49.4％-86.2％) resection ratio.At 3-mo follow-up,median IPSS score,Qmax,Vmax,PV and QOL were6(4-18),17.3 (13.8-21.1)ml/s,167(140-310)ml,50 (0-61)ml,1(0-3),respectively.At 12-mo follow-up,median IPSS score,Qmax,V PV and QOL were 4(1-9),20.1 (17.9-24.1)ml/s,205(176-305)ml,24(0-35)ml and 1(0-2),respectively.All patients showed great improvement of IPSS,Q V PV and QOL after median 17 (12-44) months follow-up compared with preoperative parameters (P ＜ 0.05).Erectile function was not impaired in 17 patients who have normal erectile function pre-operatively and 14 cases (82.4％) preserved satisfactory anterograde ejaculation.No significant complication occurred during the procedure.No patient developed permanent urinary incontinence.Conclusions US-RASP is a safe and effective treatment option for selected patients with large-gland obstructive BPH(＞ 100 ml).Our data showed significant improvement in voiding function and maintaining satisfactory anterograde ejaculation following urethral-sparing technique.It may be a new alternative method in the future for large-volume symptomatic BPH.

Diagnosis and treatment of Castleman′s disease / 医学研究生学报

Objective Castleman′s disease ( CD) is a rare lymphoproliferative disorder, which has a very high misdiagnosis rate according to its lack of clinical and imaging specificity.The study was to improve the recognition, diagnosis and management of this disease by analyzing the clinicopathological characteristics and concluding diagnosis and treatment as well as literature review. Methods Retrospective analysis was conducted on clinical data of 31 CD patients (13 males and 18 females) who were hospitalized in the Affiliated Drum Tower Hosipital to Medical college of Nanjing University from January 2006 to Feburary 2014.Their mean age was (47.4 ±13.3) years.There were 24 cases with unicentric Castleman′s disease (UCD) and 7 cases with multicentric Castleman′s disease ( MCD) .UCD tended to be present in the form of an enlarged and painless mass which generally remained asymptomatic by accidental touch or regular physical examination.MCD was usually associated with constitutional symptoms.All the 24 patients with UCD underwent complete surgical resection.7 patients with MCD received different treatment methods, such as surgical resection, ste-riod and rituximab in combination with chemotherapy ( CHOP) . Results Postoperative pathology confirmed 23 cases were hyaline vascular type while 8 were plasma cell type.25 cases had been followed up (46.3 ±32.3) months after operation, among which 1 UCD case died of pancreatic head carcinoma 13 months after operation, 1 case with MCD plus pemphigus died 2 months after surgical resection of retroperitoneal lymphadenectasis, another MCD case died in 1 month without any treatment.The remaining 22 cases were alive. Conclusion CD is lack of clinical specificity and its diagnosis should be made by pathology.Each subtype differ greatly in prognosis, therefore different treatments should be taken after definitive subtype diagnosis.

The renal boipsy data analysis of 107 patients at high altitude area in Tibet / 医学研究生学报

[Abstract ] Objective Chronic renal disease,a common and frequent disease,is the most cause inducing chronic renal failure. There is an important guiding significance for renal biopsy in the diagnosis,treatment and prognosis of renal disease.The aim of this study was to analyze the characteristics of renal biopsy and the relation between pathological types and clinical presentation in Tibet. Methods Between June 2011 and December 2013 in General Hospital of Tibetan Military Command, Lhasa, percutaneous renal biopsy were per-formed in 107 renal patients.In this study, the gender, age, pathologic entities, and clinical manifestation were analyzed retrospectively. The final diagnosis was made by the clinical manifestation, laboratory examination,and pathologic results. Results The mean age at renal biopsy was 29.8 ±12.2(10~66)years in 47 male cases (43.9%) and 69 female cases (56.1%).This includes 75 Tibetan cases (70.1%), 31 Han cases (28.9%), and Bai cases (1.0%).The primary glomerular disease was 95.3%and the secondary glomerular disease was 4.7%in the total 107 cases.Fourty-four point three percent of the primary glomerular disease were male cases and 100%of secondary glomerular disease were female cases.The main pathological type of the primary glomerular disease was podocyte nephropathy (43.9%), followed by membranous nephropathy (18.7%), IgA nephropathy (11.2%), focal segmental glomerulosclerosis (9.3%) and mesangiocapillary glomerulonephritis (5.6%).The clinical manifestations of 107 cases were classified as syndrome of nephrotic syn-dromn(69.1%),urinary abnormalities(14.9%),isolated macrographic haematuria (3.7%),chronic renal failure(2.8%).Among the nephrotic syndrome,podocyte disease was 63.5%,membranous glomerulopathy was 18.9%,focal segmental glomeruolsclerosis was 8.1%,and membranoproliferative glomerulonephritis was 5.4%. Conclusion The primary glomerulonephritis was the most common glomerular diseases at high altitude area in Tibet.The most frequent type of pri-mary glomerular nephritis was podocyte disease, and the most frequent type of secondary glomerular nephritis was Henoch-Schonlein purpura glomerulonephritis.

One-year follow-up of the effect of shadowboxing on cardiovascular function in elderly patients with hypertension / 中国组织工程研究

The present study was aimedobserve the effect of shadowboxing on the cardiovascular function of elderly patients with hypertension. Sixty-two elderly patients with hypertension were required to do one-year shadowboxing (no intake of hypotensive drug in the shadowboxing treatment) four times a week with 40-60 minutes each time. The heart rate,blood pressure,blood lipid blood viscosity and the platelet aggregation rate of subjects were determined before and after the exercises. The results showed that after one year of shadowboxing,the blood pressure of patients decreased with the indexes in cardiovascular function significantly ameliorated,which indicated that shadowboxing could reduce the blood pressure,boost up the irritability adaptability and endurance of cardiovascular system in elderly patients with hypertension.

Comparison of hypercoagulable state in patients with nephrotic syndrome at high altitude and in plain area / 第三军医大学学报

0.05),and the levels of Fib and D-dimer were obviously higher but AT-Ⅲ was obviously lower in 2 NS groups than those in normal control group(P

Tubular damage and its relationship with effect of prednisone in patients with primary nephrotic syndrome in high altitude areas / 第二军医大学学报

50% of that before treatment; (3)Normal control group( n =10). The urinary retinol binding protein(RBP) and N acetal D amino glucosidase(NAG)were measured by ELISA. The urinary osmosis, 24 h urinary protein excretion and serum creatinine (Cr) were measured. Results: (1) The urinary RBP[(0.54?0.19) mg/L], NAG[(112.84?42.82) U/L] and osmosis [(553.62?248.91) mmol/L] in PNS patients were significantly higher than normal control group ( P