Clinical experience in a modified Roux-Y-shaped sigmoid neobladder: assessment of complications and voiding patterns in 43 patients.

OBJECTIVE: To evaluate the complications and urinary voiding patterns in patients with a new Roux-Y-shaped continent neobladder, using a modified sigmoid pouch. PATIENTS AND METHODS: Between June 2003 and July 2008, 43 patients (26 men and 17 women, mean age 69.5 years) underwent a modified Roux-Y-shaped sigmoid continent neobladder reconstruction after radical cystectomy. The surgical procedures involved the construction of a Roux-Y-shaped sigmoid pouch, making an antifeces-refluxing valve into the sigmoid urine reservoir and ureterosigmoidostomy using the Leadbetter method. This pouch method has not been described before. The patients' clinical, biochemical, radiological and urodynamic variables were assessed. RESULTS: During the mean (range) follow-up of 24 (6-65) months, there were no deaths related to the procedure. In 16% of the patients, early complications occurred, whereas 12% had late complications. There were no cases with local recurrence and metastasis. Routine electrolyte evaluation revealed a slight metabolic acidosis in six patients (14%). Hypovitaminosis B(12) did not occur in any patients. All patients were continent in the daytime and night-time continence was poor in eight patients (19%). The mean (sd, range) neobladder capacity and residual urine volume was 330 (110, 120-410) mL and 48 (26, 25-80) mL, respectively. Moreover, the maximum urinary flow rate was 9.2-25.3 mL/s. CONCLUSION: The modified Roux-Y-shaped sigmoid neobladder replacement provides a new simple surgical procedure with low complication rates. The procedure offers comparatively satisfactory daytime continence with low postvoid residual urine volumes and voiding patterns. This technique is a valid alternative to continent urinary diversion.

[The clinical observation of bipolar transurethral plasma kinetic resection of prostate for high risk benign prostate hyperplasia].

OBJECTIVE: To evaluate therapeutic effect and reliability of bipolar transurethral plasma kinetic prostatectomy (TUPKP) for high risk level benign prostatic hyperplasia (BPH). METHODS: A total of 230 cases of high risk of BPH were treated with TUPKP. Among them, 132 cases with the residual urine of 40 to 420 ml had accepted long term but inefficient medical therapy, 98 cases were suffered with repeating acute urinary retention. One hundred and seventy-three cases with the functional capacity>4 MET were performed the standard transurethral resection of the prostate (TURP), the other 57 cases with the functional capacity<4 MET were accepted the minimally invasive TURP. Among them 12 cases complicated with bladder stones accepted Ho: YAG lithotripsy priory. The international prostate symptom score (IPSS), The maximal urinary flow rate (Qmax) and residual urine of the 2 groups before and after operation were analyzed. RESULTS: There was no transurethral resection syndrome occurred in both groups. After 3 to 12 months of follow-up postoperatively, the IPSS of the two groups were reduced from (21.9+/-5.7) and (23.7+/-5.0) to (4.4+/-2.3) and (5.5+/-2.4), residual urine were reduced from (61.8+/-18.4) ml and (103.9+/-77.3) ml to (13.0+/-6.2) ml and (15.8+/-6.1) ml, respectively. The Qmax was increased from (5.7+/-3.0) ml/s and (4.8+/-2.8) ml/s to (20.9+/-6.3) ml/s and (16.8+/-3.9) ml/s, there existed significant differences (P<0.01). However the IPSS, Qmax and residual urine of the standard group had progressed more obviously than the minimally invasive TURP group (P<0.05). CONCLUSIONS: It is safe and effective to use TUPKP for treating high risk patients of BPH with classic TURP and minimally invasive TURP according to different functional capacity. When the functional capacity is more than 4 MET, the standard procedures is preferred.