5 cm in diameter)were enrolled in this study.Aomong the patients,17 underwent RLRN,and 14 patients received open radical nephrectomy(ORN).The outcomes of the two groups were compared.Results In both the groups,the operations were completed.The blood loss in RLRN group was less than that in ORN group [(245.9?75.5)ml vs(640.5?174.8)ml,t=-8.425,P=0.000].No significant difference was found between the two groups in operation time [(164.8?44.6)min vs(182.7?30.3)min,t=-1.277,P=0.212],postoperative hospital stay [(7.1?3.2)d vs(9.6?5.7)d,t=-1.541,P=0.134],and survival rate(Log-rank test,?2=0.243,P=0.622).Conclusion The efficacy of RLRN is similar to that of ORN.RLRN is safe and induce less blood loss.

Objective To evaluate the outcome and the feasibility of retroperitoneal laparoscopic total nephroureterectomy with resectoscopic excision of bladder cuff for upper urinary tract transitional cell carcinoma.Methods A total of 83 patients with upper urinary tract transitional cell carcinoma underwent retroperitoneal laparoscopic total nephroureterectomy with resectoscopic excision of bladder cuff from March 2003 to July 2006.The bladder cuff was transurethrally resected for 1.5 cm in circumference from the ureteric orifice.Then the total nephroureterectomy was performed laparoscopically through retroperitoneal approach.Intraurethral catheter was indwelled for 7 days postoperatively.Adjuvant radiotherapy was given in 11 patients.Results The operation was successfully completed in all the 83 patients.The operation time was 115-205 min(mean,156 min),the intraoperative estimated blood loss was 50-150 ml(mean,80 ml),and the postoperative hospital stay was 7-11 d(mean,8.5 d).Follow-up examinations were conducted for 3-38 months(mean,10.8 months).Pathological findings revealed transitional cell carcinoma in 82 patients and moderate-to-severe atypical hyperplasia of the renal pelvis epithelium in 1 patient.Cystoscopic examinations within 12 months postoperatively found bladder tumors in 6 patients,5 of whom underwent transurethral resection of tumor and 1 of whom was given laparoscopic en bloc cystectomy with left cutaneous ureterostomy.Liver metastasis was found in 2 patients with tumor of renal pelvis(pT3G3 and pT2G3)3 months after operation.Local recurrence and lung metastasis was found in 2 patients with tumor in middle segment of the ureter(pT3G3 and pT3G2-3)6 months after operation.Bone metastasis was found in 1 patient with tumor in lower segment of the ureter(pT3G3)6 months after operation.There was 1 case of loss to follow-up,while in the remaining 71 cases no recurrence or metastasis was seen.Conclusions Retroperitoneal laparoscopic total nephroureterectomy with resectoscopic excision of bladder cuff appears to be a technically feasible operation for upper urinary tract transitional cell carcinoma,which is worthy of clinical application.

Objective To investigate the value of transurethral electrocision of the ureteric orifice in total nephroureterectomy. Methods Transurethral electrocision in combination with lumbar incision was employed in total nephroureterectomy for treating 28 cases of transitional cell carcinoma of the renal pelvis or the upper ureter from January 2002 to September 2003 in this hospital. Transurethral electrocision of the ureteric orifice on the diseased side was performed, and then the kidney and the whole ureter were excised through a lumbar incision. A catheter was placed for 7 days postoperatively. Results The operation time was 70~95 min (mean, 81 min). No urinary leakage, severe hematuria or wound infection occurred. The length of postoperative hospitalization was 7~9 days (mean, 7.4 days). Follow-up for 8~15 months (mean, 12 months) in 28 cases found no recurrence. Conclusions Total nephroureterectomy through transurethral electrocision in combination with lumbar incision is proved to be minimally invasive and safe, with a quick recovery.

Objective To investigate the techniques and effects of percutaneous nephroscopic pneumatic and ultrasoud lithotripsy for complicated renal calculi.Methods Under the guidance of B-ultrasonography,a F_(24) working channel for percutaneous nephroscopy was established.Renal stones were fragmented and extracted under a F_(20.8) nephroscope by using the LithoClast Master(EMS,Switzerland).Results The time for unilateral complete stone clearance was 5~115 min(mean,35 min).All the stones were successfully fragmented and the stone clearance rate was 91.8%(45/49).The renal fistulization tube was removed at 4~6 days after operation and the urethral catheter was removed 2 days afterwards.The double-J tube was removed at 1 month after operation.The postoperative hospital stay was 4~6 days(mean,8 days).Residual stones

Objective To discuss a modified laparoscopic pyeloplasty. Methods A total of 32 patients presenting ureteropelvic junction obstruction underwent a modified laparoscopic pyeloplasty which included the dissection of the ureteropelvic junction under laparoscope and the pyeloplasty through an extended trocar-incision 2.5~3 cm in length as open surgery did. Results The operation was successfully completed in all the 32 patients.Intraoperative findings demonstrated renal inferior polar compression by ectopic blood vessels in 1 patient and primary ureteropelvic stricture in 31 patients.The operative time was 40~70 min(mean,52 min) and the intraoperative blood loss was 20~30 ml(mean,23 ml).No surgery-related complications were observed.Follow-up checkups in 27 patients for 7~15 months(mean,9.6 months) showed disappearance of lumbar distending pain.Intravenous pyelography revealed no anastomotic obstruction.In 17 patients presenting the separation of the renal collective system,(B-ultrasonography) revealed a decrease from 2.0~4.2 cm(mean,2.8 cm) preoperatively to 1.0~2.3 cm(mean,1.5 cm) postoperatively.Conclusions The modified laparoscopic pyeloplasty simplifies the operation performance and shortens the operation time.

Objective To evaluate the application of inguinal incision in retroperitoneal laparoscopic nephroureterectomy(LNU)in the treatment of upper urinary urothelial carcinoma(UUUC).Methods From Mar.2007 to Jan.2012,186 retroperitoneal LNU procedures on 115 males and 71 females for the treatment of UUUC were performed in our institute.All cases were grouped as inguinal incision group(n =112)and lumbar incision group(n =74)according to specimen retrieval incision.Operative time,estimated blood loss,postoperative analgesia,hospital stay,incision complications,cosmetic satisfaction and tumor recurrence were compared between the 2 groups.Results All the 186 cases of operation were successfully accomplished.There were no differences in tumor stage,tumor grade,mean operative time,blood loss between the 2 groups.In inguinal incision group,the incidence of incision fat liquefaction,incision hernia,incision bulging,lumboabdominal unsymmetry and postoperative analgesia was less than that of lumbar incision group.In inguinal incision group,the mean hospital stay was shorter,cosmetic satisfaction(Ⅰ/Ⅱ/Ⅲ)was better(7/24/81 versus 22/18/34,P ＜ 0.01).Recurrence rate of UUUC in middle and inferior segment of ureter was fewer than that of lumbar incision group(5.3％ versus 35.0％,P ＜0.01).Conclusion Retroperitoneal LNU for UUUC combined with inguinal incision offers advantage of less trauma,less complications,higher cosmetic satisfaction and lower tumor recurrence.

ObjectiveTo investigate the clinical outcome of laparoscopic nephroureterectomy (LUNT) for native upper tract urothelial carcinoma (UC) in renal transplant (RT) recipients.Methods We conducted a retrospective analysis on 1130 RT recipients,and 9 patients (0.8％,9/1130) with native upper tract UC were identified. UC was confirmed pathologically in the 9 patients,including 3 cases of unilateral ureter tumor (2 on the right,and 1 on the left),4 cases of unilateral renal pelvis tumor (2 on the right,2 on the left),1 case of bilateral ureter tumor and 1 case of tumor in the right ureter and left kidney.Females predominated (8/9) in the 9 patients with upper tract UC.The patients with left upper urinary tract cancer underwent LUNT using a retroperitoneal approach with a technique of transurethral circumcision of the ureteral orifice.The patients with right upper urinary tract cancer were subjected to nephroureterctomy with ureterectomy and bladder cuff excision by complete laparascopy through a transperitoneal approach. Immunosuppressive protocol conversion from calcineurin inhibitors to sirolimus was performed on all cases. Results In the 9 patients,11 LUNTs were performed successfully without conversion to open surgery.The follow-up period was from 6 to 48 months. One patient died of lung metastasis at 8th month after tumor excision,and 1 patient displayed ductal cancer of the left breast at 7th month after LNUT.Another seven patients showed no evidence of disease during the follow-up period with normal renal function.ConclusionOur present clinical experience suggested that LNUT for the native upper tract cancer in renal transplant recipients is feasible,safe,and effective.

ObjectiveTo evaluate the efficacy and safety of domestic taerolimus in the manage-ment of acute rejection in renal transplantation reeipienta.MethodsA multieeneter, open and com-parative study for domestic Taerolimua and Prograf was performed. Eighty reeipienta of first allogenie renal transplantation were randomized into 2 groups: ①Experimental group (accepting Fumeixin ad-ministration, n=58) included 23 males and 35 females with the mean age of(39.1±9.6)years. ②Control group(accepting Prograf administration, n=22) included 12 males and 10 females with the mean age of(41.34±8.5)years. There was no significant difference in the volume, warm and cold is-chemia time of donor renal, age and sex of donor. All of the 80 cases accepted tacrolimus (domestic or foreign made, at the dose of 0. 10～0. 15 mg·kg-1·d-1 , q 12 h) treatment that combined with MMF and prednisone posttransplantation. Tacrolimus CO was aimed to 8-12 ng/ml in the first 60 days and 5-10 ng/ml later. The dose of MMF was according to the rule of each transplantation center based on the following recommendation: 1.5-2.0 g/d for the weight above 70 kg, 1.5 g/d for the weight 50-69 kg, and 1.0 g/d for the weight below 49 kg, in two divided doses. Prednisone was ad- ministrated as per ruler of each center. ResultsObservation termination was 3 months. Morbility of actue rejection was 3.40% (2/58)and 13.6% (3/22) in experimental and control group(P>0.05). Ad-verse events including hypertension, hyperlipemia, hyperglycemia and slight abnormality of liver func-tion occurred in 36. 2%(21/58) and 36. 4% (8/22) cases of experimental and control group(P> 0. 05). The survival rate in the 2 groups was 100%. The dose of tacrolimus in experimental group was significantly lower than that in the control group at 8 and 12 weeks posttransplant, while drug valley concentration in serum was proximal in 2 groups during the whole observation period.Conclusion Domestic tacrolimus capsules can be used effectively and safely in the management of acute rejection in renal transplantation.

Objective To evaluate the operative techniques and the methods of the renal function protection in laparoscopic nephron sparing surgery for the treatment of renal tumors.Methods Thirty-six renal tumor patients accepted transperitoneal laparoscopic partial nephrectomy at the 70 degree lateral decubitus position.There were 17 tumors in the upper pole,13 in the lower pole and 6 in the center of kindey.The mean tumor diameter was 2.6 cm(from 0.8 to 4.0 cm).Peke forceps were used to clamp the renal artery and achieve warm ischemia.Cold scissors was used to resect tumors and Hem-o-lok was used to clamp and control the artery bleeding in surgical bed instead of ligature when suturing the kidney parenchyma.Ulinastatin was used to prevent and relieve the ischemical reperfusion injury.The operative time,estimated blood loss,warm ischemia time,intraoperative and postoperative complications and the operative efficacy were recorded.Results All operations were completed successfully,no case was converted to open surgery.The mean operative time was 128 min(95 to 186 min),mean estimated blood loss was 130 ml (40 to 600 ml),mean warm ischemia time was 21 min(16to 28 min).There was no hemorrhage and urinary leakage after surgery.The post-operative renal function was normal in all the cases.The histopathological examination showed that 36 cases were renal cell carcinoma including 31 pT1a,cases and 5 pT1b cases.There was no positive surgical margin.The mean follow-up time was 16 months (from 6 to 30 months).There was no recurrence and metastasis found and renal function was normal in all cases during the follow-up.Conclusions Laparoscopic nephron sparing surgery for renal tumors is a safe and feasible treatment option.This procedure can resect tumor safely and preserve renal function efficiently.The use of Hem-o-lok instead of ligature can significantly reduce the operative time.Ulinastatin can help reducing the ischemical reperfusion injury and thus preserve renal function.

PURPOSE: We performed a meta-analysis to evaluate the efficacy and safety of mirabegron add-on therapy to solifenacin for patients with overactive bladder (OAB). METHODS: We conducted a systematic literature review to identify all randomized, double-blind, controlled trials (RCTs) of this combination (mirabegron and solifenacin) for OAB. Embase, MEDLINE, and the Cochrane Central Register of Controlled Trials were searched. A manual search was also performed to investigate relevant references from the retrieved studies. RESULTS: Four publications describing 5 RCTs that compared combination therapy with solifenacin, including a total of 3,309 patients, were analyzed. The mean number of micturitions per 24 hours (mean difference [MD], -0.45; 95% confidence interval [CI], -0.65 to -0.26; P < 0.00001), number of episodes of incontinence per 24 hours (MD, -0.71; 95% CI, -0.14 to -0.02; P=0.04), volume voided per micturition, and number of urgency episodes per 24 hours demonstrated that combination therapy was more effective than solifenacin therapy alone. Safety assessments, including common treatment-emergent adverse events (odds ratio, 1.09; 95% CI, 0.95–1.27; P=0.23) and discontinuations due to adverse events (P=0.30), demonstrated that the combination therapy was well tolerated. CONCLUSIONS: This meta-analysis suggests that mirabegron therapy as an add-on to solifenacin provides a satisfactory therapeutic effect for OAB symptoms with a low occurrence of side effects.
Humans ; Solifenacin Succinate* ; Urinary Bladder, Overactive* ; Urination