Objective To investigate the feasibility of construction of orthotopic ileal neobladder after laparoscopic radical cystectomy(LRC)for female patients with bladder carcinoma.Methods From February 2003 to July 2006,we had performed construction of orthotopic ileal neobladder after laparoscopic radical cystectomy,hysterectomy,and ovariectomy on 8 women with bladder carcinoma.Under general anaesthesia,the patients were placed in the supine position with the head down at 15?,the thighs abduced,and the knee flexed.A 5-port transperitoneal approach was used.Under a laparoscope,the peritoneum was incised at the level of the bifurcation of the iliac vessels,and then the ureter was freed,and the round ligament of the uterus and the ovarian ligament were cut.Afterwards,the broad ligament was separated and pelvic lymphadenectomy was done.Then,the cardinal and uterosacral ligaments,bilateral ureters,and the lateral pedicles of the bladder were cut;the peritoneum was incised along the base of the broad ligament to open the vaginal vault so that the peritoneal reflection can be transected to expose the retropubic space.After that,the deep dorsal vein of the clitoris and the ureter was cut successively(the ureter was cut at 0.5 cm downwards from the neck of the bladder.Finally,the vagina was transected at the level adjacent to the vaginal vault,and the residual vagina was sutured.After the laparoscopy,the resected tissues were removed through a 4-to 5-cm incision on the midline of the lower abdomen,and then a M-shape ileal neobladder was constructed outside the incision.The ureter was reimplanted to the posterior wall of the pouch and replaced into the peritoneal cavity.The urethra-pouch anastomosis was completed by laparoscopy.Results The mean operation time in the 8 patients was(344.5?42.1)min,mean blood loss was(373.9?81.3)ml.The patients were followed up for 6 to 46 months with a mean of 26 months(over 12 months in 6 patients).During the follow-up,all the patients achieved automatic micturition in half a year.One patient had urinary incontinence occasionally,one had night-time urinary incontinence,and one had dysuria.The mean volume of the neobladders was(333.6?40.4)ml,and residual urine volume was(51.2?18.1)ml.After the operation,one patient developed uretero-neobladder anastomotic occlusion,and one had fistula of the neobladder.Conclusions Laparoscopic radical cystectomy,hysterectomy,and ovariectomy is feasible for female patients with bladder carcinoma.After the procedure,which is mini-invasive,most patients had automatic micturition;however,the rates of urinary incontinence and dysuria are relatively high.Further investigations are needed to study the long-term outcomes of LRC and reconstruction of orthotopic ileal neobladder.

The teaching quality of urology clinical noviceship was restricted by strained teaching time,relative shortage of teaching resources and the lack of patients cooperation.Through establishing the urological multimedia data bank was established and applying the multimedia technique to assist traditional instruction,the urology noviceship quality was improved.

Objective To observe the clinical efficacy of needle knife, Governor-Vessel moxibustion plus medication in treating ankylosing spondylitis (AS).Method Forty AS patients were randomized into a treatment group and a control group, 20 cases in each group. The control group was intervened by intravenous administration of Ossotide injection, while the treatment group was by needle knife and Governor-Vessel moxibustion in addition to Ossotide injection. Before and after the intervention, the symptoms and body signs, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and Bath Ankylosing Spondylitis Functional Index (BASFI) were observed in the two groups, and the clinical efficacies were compared between the two groups.Result The total effective rate was 90.0% in the treatment group versus 75.0% in the control group, and the between-group difference was statistically significant (P<0.05). After the intervention, the symptoms and body signs (spinal pain score, Schober test, morning stiffness duration, chest expansion degree, and occiput-wall distance) were changed significantly in both groups (P<0.05). The BASDAI and BASFI scores were significantly changed after the intervention in both groups (P<0.05). The BASDAI and BASFI scores in the treatment group were significantly different from those in the control group after the intervention (P<0.05).Conclusion Needle knife plus Governor-Vessel moxibustion and medication is an effective approach in treating AS.

Objective To evaluate the different methods of continent urinary diversion and the ileal orthotopic neobladder after total cystectomy. Methods 4 different kinds of continent urinary diversion were undertaken after total cystectomy for 68 cases.Continence and catheterization, volume and pressure of the reservoirs, image and hydroelectrolyte condition were investigated. Results Of the 3 cases with intussusceptive efferent tract,2 had partial deintussusception resulting in incontinence and had to be reoperated;44 cases with tapered terminal ileal efferent tract were continent and could be catheterized easily with 16～20F catheters, whereas only one case had difficulty in catheterization. 39 cases with detubularized and reshaped intestinal segment reservoirs, including 3 ileal,22 colonic and 14 ileocolonic, all achieved the demand of low intrareservoir pressure, whereas 8 cases operated in the early period had dilated reservoirs with a volume as large as 1 470～1 650 ml;8 cases with detenia cecocolonic reservoir had the volume of 430～600 ml and as intrareservoir pressure of 30～45 cmH 2O with peristalsis waves,2 of them had urine leakage in the early stage after operation.21 cases with ileal orthotopic neobladder had a volume of 350～480 ml and an intrareservoir pressure of 12～20 cm H 2O.1 being incontinent at daytime and 2 at night whereas all the others were continent. Conclusions Continent urinary reservoirs constructed by 30 cm detubularlized cecocolon can achieve the demand of low intrareservoir pressure.Detenial colonic reservoirs had more chance of urine leakage and adhesion, and higher intrareservoir pressure. Tapered terminal ileal efferent tract is better than ileal intussusception efferent tract for its excellent continence, large caliber, easy catheterization and fewer complications. Ileal orthotopic neobladder has the advantages of excellent continence, higher quality of life, but has limited indications.

Objective To present the initial experience and results of the laparoscopic radical cystectomy (LRC) with orthotopic ileal neobladder. Methods Fifteen patients (14 men and 1 women) with invasive bladder carcinoma underwent LRC with orthotopic ileal neobladder.The mean age was 59.5 years(range,39 to 71 years).The LRC with orthotopic ileal neobladder consists of 3 major steps,namely laparoscopic cystectomy,extracorporeal formation of ileal pouch and laparoscopic urethra-pouch anastomosis.With 5 trocars,the surgeon conducted the procedure through the 2 ports on the left side,and the assistants did so on the right side and hold the laparoscope.The bilateral pelvic lymphadenectomy were performed first.The ureters were dissected just outside the bladder.The radical cystoprostatectomy was performed for the male patients.The total bladder, uterus and appendage were removed for the female patient.A 4 to 5 cm median incision in lower abdomen was made to remove the surgical specimens and construct the ileal pouch.A 50 cm ileal loop was taken from the abdominal cavity,isolated,detubularized and reconfigured into “M” shaped pouch with running suture.The anti-refluxing ureter implantation was performed by inserting the 1 cm of ureter into the pouch and suturing them.For the first 4 cases,the urethra-neobaldder anastomosis was completed through the abdominal incision;while for the other 11 cases,the anastomosis was done under the laparoscope. Results The mean duration of surgery was 5 to 10 h with a mean of 6.5 h;the blood loss was 200 to 1000 ml with a mean of 387 ml.During a follow-up of 1 to 11 months,all patients were alive and asymptomatic with normal upper tracts and had no evidence of local recurrence or metastasis.4 to 6 weeks after surgery,all the patients with orthotopic ileal bladder had complete daytime continence,and nocturnal continence was achieved with 2 to 3 times voiding at night. Conclusions This procedure combines the advantages of minimally invasive laparoscopy with the speediness of open surgery.The laparoscopic cystoprostactomy has a magnified clear vision,which makes meticulous manipulation possible,and reduces bleeding,sphincter injury and nerve bundle injury.Shorter time of intestine exposure during the procedure is good for recovery of intestinal function and for reducing postoperative intestinal adhesion.External construction of ileal pouch shortens operation time remarkably.Ileal segment has long and mobile mesentery,thereby can be easily taken out through a small abdomen incision and anastomosed with urethra stump without tension,so it is more suitable for construction of a pouch.

Objective To evaluate the outcomes of M-shaped orthotopic ileal neobladder. Methods A total of 42 male patients with malignant bladder tumors underwent M-shaped orthotopic ileal neobladder after extraperitoneal total cystoprostatectomy.A segment of 45 to 50cm ileal loop was isolated,detubularized,and reconfigured in “M”- shape to form a pouch.Bilateral ureters were reimplanted by means of inserting the 1 cm distal segment into the pouch.The bottom of pouch was opened and anastomosed with the urethra. Results The 42 patients were followed up for 12 to 96 months with a mean of 44 months.38 cases(90.5%) were well continent during daytime,and 36 cases(85.7%) were continent at night.The volume of the pouch was (361?48)ml at 12 months postoperatively. Urodynamic examination showed that the peak voiding pressure was (86.8?21.4)cm H 2O(1 cm H 2O=0.098 kPa).The maximum flow rate (Q max ) was(18.4?6.1)ml/s.No remarkable ureter reflux and obstruction were found.No patient was detected to develop recurrent urethral carcinoma. Conclusions Extraperitoneal cystectomy can prevent the abdomen from tumor contamination and protect the operative field from intestine interference.The ureter-inserting reimplantation technique is a simple anti-reflux anastomosis with lower rate of ureteral stenosis.Isolating the neobladder and ureters from the peritoneal cavity can reduce the postoperative complications of adhesive ileus,internal hernia,and urine leakage to peritoneal cavity.The neobladder is similar to original bladder in position,volume,shape,and anti-reflux of ureter connection.

Objective To investigate the therapeutic effects of orthotopic urinary diversion in women. Methods From September 1995 to December 2003,34 female patients (mean age,58 years;range,53-64 years) with bladder cancer were included.Of them,30 cases were of primary tumors and 4,of recurrent ones.Pathology showed transitional cell carcinoma in 30 cases,bladder adenocarcinoma in 3 and squamous cell carcinoma in 1.Radical cystectomy was performed in all the 34 cases;and the technique of cystectomy with nerve-sparing was performed in 24 of them. Intraoperative frozen section of the distal urethra surgical margin showed no evidence of tumor,and ileal neobladder was formed in all.The clinical therapeutic effects were analyzed retrospectively. Results The mean operative time was 360 min(range,280-420 min),and mean blood transfusion was 600 ml(range,300-1000 ml).Thirty cases were followed up for a mean of 61 months(range,6-108 months).At 6 months after surgery the continence rate was 90%(27/30) during the day and 86%(26/30) at night.Twenty-three cases could empty the neobladder one time and 2 needed intermittent catheterization due to hyper-continence; the other 5 needed pushing the abdomen to empty the neobladder. Twenty-three patients had good urodynamic findings;the vesical capacity ranged 300-520 ml and maximum intravesical pressure were

Objective To investigate the effects of static magnetics on adhesion of neutrophil and endothelium and expression of intercellular adhesion molecule-1(ICAM-1) on human umbilical vein endothelial cell(HUVEC). Methods HUVEC were exposed to 0.05mT, 0.1mT, 1mT static magnetics adhesion of neutrophil was calculated after HUVEC was stimulated by LPS. Flow cytometry and ELSIA were used to study expression of ICAM-1 on endothelium with stimulating of LPS. Results The adhesion of neutrophil l on HUVEC was attenuated by 0.05mT, 0.1mT static magnetics(58% vs. 40%, 38%, P

Objective To evaluate the efficacy and technique of minimally invasive management for acute ureteral obstruction and severe infection caused by calculi.Methods A total of 51 patients with acute upper urinary tract obstruction and severe infection caused by calculi were enrolled in this study.When infection,sepsis,and electrolyte disorders were corrected,emergent drainage by retrograde ureteral catheterization using cystoscopy or B-ultrasonography-guided percutaneous nephrostomy were carried out.Ureteroscopic lithotripsy or extracorporeal shock wave lithotripsy(ESWL)were performed after the infection was controlled.Results Cystoscopic retrograde ureteral catheterization was completed in 8 cases,and the other 43 patients were treated successfully by B-ultrasonography-guided percutaneous nephrostomy.During the operations,purulent urine spurted out from the drainage tube.Ten patients had transient hematuria and lumbar pain postoperation.None of the patients developed pneumothorax,urinary extravasation,perirenal hematoma,or abdominal organ injuries,etc.In 3 cases,recauterization was done because the catheter dropped out.In all the patients,the body temperature and blood white blood cell counts returned to a normal range 3 to 7 days after the drainage.Among the cases,8 were treated with ESWL,35 received ureteroscopic lithotripsy,and 8 underwent ESWL after the ureteral stone being pushed upwards to the renal pelvis.No severe complications,such as ureteral perforation or tears,massive hemorrhage,or high fever occurred after lithotripsy.The stones were completely removed in all the cases in 3 weeks postoperation(in 1 week for 34 cases).The patients were followed up for 3 to 6 months,during which the renal function recovered to a normal level.Conclusions Retrograde ureteral catheterization using cystoscopy or B-ultrasonography-guided percutaneous nephrostomy combined with ureteroscopic lithotripsy or ESWL is efficient for patients with acute ureteral obstruction and severe infection caused by calculi.By using the method,ureteral infection can be controlled quickly without causing severe complications.

Objective: To evaluate happiness and the mental health of elderly who participate morning exercise in Wuxi area. Methods: 161 elderly who participated morning exercise and 111 elderly from urban area of Wuxi were investigated with Memorial University of Newfoundland Scale of Happiness (MUNSH), Symptom Checklist 90(SCL-90), and general health status questionnaire. Optimal Scaling was used to study the relationship between Happiness and affecting factors. Results: The average level of happiness of the morning exercises groups was higher than that of control. Factors having influence on mental health included interpersonal relationship, children satisfaction rating, and attitude to retirement, house condition.Conclusions: Elderly participating morning exercise have better mental health status.