Objective To evaluate the effectiveness and indications of a new minimally invasive surgical procedure,the tension-free vaginal tape-SECUR (TVT-S),in the treatment of female stress urinary incontinence (SUI). Methods Twenty-seven consecutive women with stress urinary incontinence underwent the procedure under local anesthesia.The mean age of the study group was 51 (range 25-69)years,average disease duration was 7 (1-20) years.In one case,repair of pelvic floor defects had been made previously.According to the pelvic organ prolapse quantitive(POP-Q) (American College of Obstetrics and Gynecology),the Aa＞-1 cm.Swab tests have shown that the angle of urethra Was greater than 60 degrees,while the evaluation of clinical symptoms were grade Ⅱ.The urodynamie test preoperatively of 27 cases display that bladder compliance was normal,mean maximum urethral closure pressure was 40cm H2O(25-60 cm H2O),and VLPP was greater than 60 cm H2O.Minimum follow up was three months (range 3-15 months).The pre-operative maximal urethral cloSHre pressure (MUCP) of all patients was above 30 cm H2O.Ninety-six percent of patients had pure USI,one patient had mixed urodynamic incontinence (MUI).Collection of the data included operative time a well as pre-and post-operative complications.Patients were post-operatively assessed by a validated urinary incontinence-specific measure of Quality of Life (QoL) questionnaire which was completed by all patients at least three months after surgery. Results All patients who underwent the procedure were under local anesthesia.Of these patients,4 cases (MUCP＜30 cm H2O) underwent TVT-S with U position while the other 23 underwent TVT-S with Hammock position.The mean operation time was 8 minutes (range 6-15 min) and blood loss during operation was about 10 ml.There were no urethral and bladder injuries during the procedure.Postoperative indwelling duration was 0-1 day.After follow-up,26 patients were cured without pad usage and 1 with mixed UI had prominent improvement in urgency incontinence symptoms.The quality of life was also improved significantly.93 % patients were satisfied with the postoperative improvement in urinary incontinence symptoms,and the more severe preoperative symptoms the higher satisfaction rate postoperatively. Conclusions TVT-S iS a safe,effective and minimally invasive procedure for SUI with less complication.The patients with normal bladder compliance and MUCP,urethral hypermobility are indicated for this surgery,some elderly patients or patients with low urethral pressure were proposed to undergo U position TVT-S or TVT.

Objective To assess the outcome of vesicoureteral reflux after augmentation cystoplasty in patients with neurogenic bladder.Methods Between January 2008 and January 2014,a total of 25 patients,with a hypocompliant bladder associated with vesicoureteral reflux confirmed by video-urodynamics preoperatively,were recruited in this study.They all had undergone bladder augmentation with a generous detubularized segment of bowel at our institution.No effort had been made to correct existing reflux.Preoperatively assessment included urinalysis,kidney function tests,ultrasonography,video-urodynamic evaluation.All patients had various degrees of vesicoureteral reflux.The status of vesicoureteral reflux and bladder function were studied by video-urodynamic.Results Mean follow-up was 2.2 years (range 0.5 to 5.5 years).The video-urodynamics manifested a significant improvement of bladder capacity,diminution of intravesical pressure and resolution of reflux after bladder augmentation.Of the 25 patients,20 (80％) no longer had reflux,3 (12％) had improvement,2 (8％) had no change.Sixteen of 18 with grades Ⅰ to Ⅲ (89％),all refluxing units with grade Ⅳ to grade Ⅴ (100％) showed complete cessation of reflux.Symptomatic urinary infection was not found after surgery.Conclusions Augmentation enterocystoplasty without ureteral reimplantation is effective and adequate for patients with high pressure and hypocompliant neurogenic bladder.Therefore,ureteral reimplantation is not necessary underwent when augmentation enterocystoplasty is recommended to patients with neurogenic bladder and vesicoureteral reflux.

Objective The cyst excision is considered as priority management of the female paraurethral cyst.The purpose of this present study was to explore the feasibility and safety of the two-step excision with treatment for the female paraurethral cyst.Methods Twenty eight consecutive women with paraurethral cyst underwent paraurethral cyst removal were enrolled retrospectively in this study from October 1,2005 to August 12,2008 in Urology Department of West China Hospital.Results All cases were followedup from 6 months to 2 years,no recurrence occurred.No complications such as urethral stricture and urethralvaginal fistula were found.Conclusions The 2-step excision is the reference technique for cure of female paraurethral cyst.Urethra injury was avoided efficiently,because anatomical relationship between cyst and urethra could be clearer when the technique of 2-step excision was applied.

Objective To investigate the effects of amplitude dependent morphological and proliferative changes in human bladder smooth muscle cells (hBSMCs) undergoing physiological stretch in vitro.Methods The hBSMCs were cuhured on silicone membrane and stretched similarly to a bladder cycle at range of stretches and time.The elongation would increase up to 2.5％ every 3 h and 5％ (or 10％,15％,20％ and 25％ depending on the experiment design) in the next 1 h,followed by a rapid decrease,cyclically maintained for a total of 16 h.In subsequent 8 h (24 h cycles) the membrane was maintained in relaxed position.Immunofluorescence and confocal laser scanning microscope were employed to assess the morphological changes.Cell counting kit-8 (CCK-8) and flow cytometry were used to assess the cell proliferation.Results The hBSMCs showed contractile phenotype after application of mechanical strain.Compared with control,the strains at 5％,10％,15％,20％ and 25％ induced most of the cells to change from a more spread-out and stellate state with large cell surface contact areas to a typical spindle-like morphology.The orientation angle of BSMCs remarkably differed depending on the applied strain's magnitude.Absorbance value,which reflects the proliferation activity,analyzed by CCK-8 was improved from 0.471 ± 0.027 (control) to 1.320 ± 0.094 (5％ elongation group,P ＜ 0.0001),1.001 ± 0.029 (10％ elongation group,P ＜0.0001),0.821 ±0.032 (15％ elongation group,P＜0.0001),0.621 ±0.032 (20％ elongation group,P =0.0004) and 0.591 ± 0.056 (25％ elongation group,P =0.0268),respectively.Cell proliferation index increased from (29.35 ±0.55)％ (control) to (55.55 ± 1.05)％ (5％ elongation group,P ＜0.0001),(47.70 ±0.20)％ (10％ elongation group,P＜0.0001),(35.40 ±2.10)％ (15％ elongation group,P ＜0.0001),respectively.However,no significant difference was found in either 20％ elongation group (34.85 ±0.55)％ (P=0.1372) or 25％ elongation group (30.35 ±0.45)％ (P=0.5234).Conclusions Proliferative and morphological changes could be observed in hBSMCs in vitro.Maximal proliferative potential could be seen at 5％ of stretch.

Objective To observe the clinical curative effect of ginseng cream stickon in patients suffering from lack of lactation after parturition .Methods Ninety patients suffering from lack of lactation after parturition were divided into three groups :the treatment group (patients with ginseng cream stick by acupoint application ) ,and 2 control groups (control with lactation elixir ,and control with decavitamin) .The treatment last for 5 days for each group .And the breast filling degree ,the lactigenous volume ,the neonatal weight ,artificial feeding times ,the artificial feeding volume and the prolactin level before and after the treatment were all recorded .Results Ginseng cream stick by acupoint application dramatically improved breast filling ,the lactigenous volume ,the neo‐natal weight ,artificial feeding times ,the artificial feeding volume and the neonatal urination frequency ,there was a significant differ‐ence between the treatment group and the two control groups (P<0 .05) .Conclusion Ginseng cream stick by acupoint application could significantly relieve lack of lactation ,meet the need of breastfeeding ,and increase the breast‐feeding rate .

Objective To investigate surgical methods and long-term treatment outcomes of urinary mesh/sling urinary tract exposure after pelvic floor reconstruction.Methods A retrospective analysis was performed for 9 patients admitted to the Department of Urology,West China Hospital of Sichuan University during Nov.2011 and Sep.2020 due to urinary tract exposure to mesh or sling after pelvic floor reconstruction.Results The median age of the 9 patients was 53(39-73)years and the median body mass index was 23.0(19.5-27.3).Six patients underwent transvaginal mesh implantation for pelvic organ prolapse,and the remaining 3 patients underwent mid-urethral sling(MUS)surgery due to urinary incontinence.Of the 6 patients who experienced mesh exposure after transvaginal mesh implantation,3 underwent transvaginal mesh removal,and the remaining 3 cystoscopic holmium laser ablation.Among patients who experienced mesh exposure after mid-urethral sling,2 patients underwent transurethral removal and 1 cystoscopic holmium laser ablation.The median follow-up was 69(16-121)months.At the last follow-up,none of the patients had mesh/sling exposure.Conclusion Both transvaginal and transurethral mesh/sling removal are effective surgical methods for the treatment of urinary tract mesh/sling exposure after pelvic floor reconstruction.

OBJECTIVETo construct an eukaryotic expression plasmid for AY358935 gene and explore its function.

METHODScDNA of the AY358935 gene was amplified by reverse transcription-PCR and cloned into pGEM-Teasy. The pGEM-T-AY was validated by sequencing and served as a template for the construction of eukaryotic expression plasmid. The pcDNA3.1-AY recombinant was validated by double enzyme digestion and used for transient transfection of M14 cells. Expression of the AY358935 protein and proliferation of the M14 cells were determined respectively by Western blotting and 3-(4,5)-dimethylthiahiazo(-z-y1)-3,5-di-phenytetrazoliumromide (MTT) colorimetry.

RESULTSThe amplicons of RT-PCR were confirmed to have similar size with the cDNA fragment of the AY358935 gene as well as cloned region of pcDNA3.1-AY. The cloned region of pGEM-T-AY was sequenced to be identical with cDNA sequence of the AY358935 gene. M14 cells were transfected by the AY358935 gene, pcDNA3.1 and liposomes, respectively. After 48 h, expression of the AY358935 protein in M14 cells transfected with the AY358935 gene was significantly higher than other two groups. They also had a significantly higher absorbance value (A=0.74) than other two groups (A=0.39 and 0.46, respectively; P<0.05).

CONCLUSIONAn eukaryotic expression plasmid of the AY358935 gene was successfully constructed. Product of the AY358935 gene may promote the proliferation of M14 cells.

Objective:To evaluate the efficacy and safety of Yang-Monti tube in the operation of bladder controllable outflow tract, and to compare the efficacy of single and double segments Yang-Monti tube in patients with urethral damage.Methods:The clinical data of 27 patients who underwent Yang-Monti tube surgery in West China Hospital of Sichuan University from January 2009 to February 2018 were retrospectively analyzed, including 14 cases of single segment ileum (single segment group) and 13 cases of double segment ileum (double segment group). The age of single-segment group and double-segment group was (56.5±4.3) years and (50.2±6.8) years, respectively ( P=0.220). There were 2/12 and 3/10 males and females, respectively ( P=0.564). The body mass index (BMI) was (19.6±1.3) kg/m2 and (24.2±2.1) kg/m2, respectively ( P<0.001). The disease duration was 6 (3-24) months and 8 (3-48) months, respectively ( P=0.650). The preoperative quality of life (QOL) score was (46.7±1.7) and (45.5±1.7), respectively ( P=0.061). The number of patients with urinary tract infection before operation was 11 and 13, respectively ( P=0.480). In the single-segment group, a 2 cm ileum with mesangial vessels was cut at a distance of about 15 cm from the ileocecal part, and the intestine was cut longitudinally along the direction of the intestinal canal at the opposite mesangial margin. The intestinal piece was wrapped horizontally around the F12 urinary tube and wound into a Yang-Monti tube by intermittent suture with a 3-0 single thread. The bladder wall was cut anterolateral to the top wall of the bladder, about 1 cm in length, and the Yang-Monti tube was anastomosed end-to-end with the mucosal muscularis of the bladder wall. A circular incision with a diameter of about 1 cm was made at the level of the anterior superior iliac spine at the rectus abdominis muscle, and a tunnel was formed by puncture into the abdomen with curved forceps. The Yang-Monti tube was led out of the abdominal wall along the tunnel, and the tube opening was fixed with subcutaneous suture. At the same time, the tube wall was fixed in the peritoneum with 4-0 silk thread. In the double-segment group, two segments of 2 cm ileum were cut, and the intestinal tube was cut longitudes along the direction of the opposite mesangial margin. The intestinal piece was first sutured end to end, and then the tube was coiled and reconstructed to form a Yang-Monti tube with a diameter of 0.6-0.8 cm and a length of about 12 cm. The proximal end of the Yang-Monti tube was directly anastomosed with the mucosal muscle layer of the bladder. The operation time, intraoperative blood loss, postoperative catheterization interval, postoperative single catheterization volume, postoperative complications (bleeding, intestinal obstruction, anastomotic leakage, anastomotic stenosis, stoma infection, urinary tract infection, urinary tract infection) and QOL score were compared between the two groups. Results:The operation was successfully completed in both groups. The operation time of single-segment group and double-segment group were (165.8±17.8) min and (157.54±12.25) min, respectively ( P=0.302), and the intraoperative blood loss was (60.0±20.0) ml and (50.00±25.00) ml, respectively ( P=0.650). The postoperative recovery time was 3 (2-4) d and 3 (2-9) d, respectively ( P=0.790), and the postoperative hospital stay was 12 (9-40) d and 12 (10-32) d, respectively (P=0.259). The postoperative single catheterization volume was (240.4±42.7) ml and (261.5±36.3) ml ( P=0.186), and the postoperative QOL was (22.4±2.7) and (21.5±2.6), respectively ( P=0.325), and there was no significant difference. There were 2 cases of urinary tract infection in the single-segment group, and 1 case of urinary tract infection, postoperative bleeding, and intestinal obstruction in the double-segment group. There was no significant difference between the two groups ( P=0.222). The time interval of catheterization in single-segment group and double-segment group was (2.5±1.0) h and (3.5±1.3) h, respectively, and the difference was statistically significant ( P=0.029). The quality of life score after operation was statistically significant compared with that before operation ( P<0.001), and the incidence of urinary tract infection after operation was also statistically significant compared with that before operation ( P=0.011). Conclusions:Both single segment and double segment ileum Yang-Monti tube surgery are feasible surgical methods for patients with urethral damage. There was no difference in the effects of the two types of surgery, and both may improve the quality of life of patients.The postoperative QOL score could be greatly improved and the incidence of complications was low.

Objective:To explore the efficacy and safety of injection of botulinum toxin A (BTX-A) for female urethral pain syndrome (UPS).Methods:This study retrospectively included 8 women with UPS who were treated by injection of BTX-A in West China Hospital of Sichuan University from February 2021 to September 2021. The average age was (47.87±11.33) years old, the median disease duration was 3(1.0, 10.8) years. Before treatment, The visual analogue scale (VAS) was (5.38±1.92), the Pain, Urgency, Frequency score (PUF) was (10.75±5.12), and the female sexual function index (FSFI) was (14.53±11.63). 100U BTX-A was injected at the 3, 6, 9, and 12 o'clock positions of the urethral meatus, as well as at the mid-urethra and the left and right sides of the bladder neck, totaling 10 injections. The VAS, PUF score, FSFI score, and complications were recorded at 1, 3, and 6 months after treatment.Results:The VAS score decreased to (3.25±2.12), (2.88±2.23)and(2.88±2.23) at 1, 3, and 6 months, showing statistically significant differences compared to the pre-treatment scores ( P<0.05); post-treatment PUF score declined to (6.63±3.93), (6.25±4.03)and(5.13±3.31), respectively, with only the 6-month score showing a statistically significant difference compared to the pre-treatment score ( P=0.03). The FSFI score increased slightly to (14.68±11.56), (16.76±12.17) and (16.76±12.17)at 1, 3, and 6 months post-injection, respectively, with no statistically significant differences compared to the pre-treatment scores ( P>0.05). Only 1 patient had transient dysuria. Conclusion:BTX-A injection is a safe and effective treatment for UPS, and it can be used for UPS patients who are unresponsive to conservative therapy.

Objective:To investigate the safety and efficacy of sacral neuromodulation(SNM)therapy for the treatment of lower urinary tract dysfunction(LUTD)in elderly patients.Methods:Clinical data of 91 elderly patients with LUTD from multiple medical institutions who received SNM during the period from January 2012 to December 2016 were retrospectively analyzed.Patients were divided into four groups: the interstitial cystitis(IC)group(n=28), the neurogenic bladder(NB)group(n=36), the overactive bladder syndrome(OAB)group(n=13)and the idiopathic dysuria(ID)group(n=14). Different sets of evaluation parameters were used for different diseases.Patients’ baseline data and data in stage I(test phase)and stage Ⅱ(permanent SNM)were recorded, statistically analyzed and compared.Results:Ninety-one people underwent SNM treatment.Of them, 53 patients received permanent implants(stage Ⅱ), and the total conversion rate of stage I to stage Ⅱ was 58.2%(53/91). Patients receiving permanent implants(stage Ⅱ)had a preoperative period ranging from 3 months to 30 years, and were followed up for 2 to 58 months after treatment, with an average follow-up of 19.6 months.The improvement rates in stage I for urinary urgency, daily urination frequency, daily nocturnal urination frequency, maximum urine volume, daily average urine volume, daily urine leakage frequency, and quality of life score were 35.4%, 31.6%, 33.7%, 32.6%, 49.2%, 43.2% and 13.2%, respectively.The improvement rates in stage Ⅱ for urinary urgency, daily urination frequency, daily nocturnal urination frequency, maximum urine volume, daily average urine volume, daily urine leakage frequency, and quality of life score were 43.2%, 40.0%, 37.8%, 50.5%, 70.5%, 70.4% and 43.2%, respectively.Three adverse events occurred, including 1 case of recurrent symptoms, 1 case of moderate infection, and 1 case of electrical lead dislocation.Conclusions:Sacral nerve stimulation has definitive and consistent curative effects on LUTD in elderly people.The follow-up time should be extended to further study the safety of sacral nerve stimulation.