Objective To study the efficacy and safety of transurethral plasmakinetic resection of prostate (PKRP) in treatment of benign prostate hyperplasia in elderly patients aged 80 years and over. Methods Retrospective clinical analysis of 180 case of high risk of benign prostate hyperplasia treated by PKRP in patients aged 80 years and over. Results All the 180 patients underwent the operation successfully. The average time for operation was (45.5±23.3) min and the resected prostate was in an average of (60.3±23.3) g. Neither of blood transfusion during the operation nor aductor reflex and transurethral resection syndrome occurred. International prostate symptom score,residual urine and quality of life decreased from (29.5±5.3) to (10.2±2.8),from (130.5±45.5) ml to (13.5±7.1)ml and from (7.2±1.1) to (1.0±0.5) respectively. The maximum flow rate elevated from (6.2±1.8) ml/s to (24.5±3.1) ml/s. The differences in the above indicators were statistically significant between pre- and post- operation (P＜0.05). Conclusions Transurethral plasmakinetic prostatectomy is a reliable and effective surgical method, especially for the aged patients with benign prostate hyperplasia.

Objective To investigate the expression of Twist,E-cadherin and N-cadherin in bladder urothelial carcinoma and evaluate their relationships with tumor.Methods From January 1998 to June 2007,the expression of Twist,E-cadherin and N-cadherin protein were detected in 180 bladder urothelial carcinoma tissue specimens in paraffin blocks and 60 normal bladder tissue specimens by tissue microarray and immunohistochemistry.Results Compared with normal hladder tissues,the expression of Twist and N-cadherin was up-regulated in bladder carcinoma tissues and the positive percentage was 63.9％ and 47.8％ respectively.The percentage of high E-cadherin expression in bladder carcinoma tissues was only 27.8％,which was significantly lower than that in normal bladder tissues.The expression of Twist was significantly related with age,tumor number,vessel invasion,distant metastasis and lymph node metastasis (P＜0.05).The expression of E-cadherin was significantly related with distant metastasis and lymph node metastasis (P＜ 0.05).The expression of N-cadherin was significantly related with distant metastasis and lymphnode metastasis (P＜0.05).There was significant positive correlation between Twist and E-cadherin expression (P＜ 0.05).There was significant positive correlation between Twist anl N-cadherin expression (P＜0.05).There was negative correlation between E-cadherin and N-cadherin expression.All the 180 bladder carcinoma patients were followed up after the surgery,and the mean follow-up time was (35.2±9.1) months.The 5-year survival rates of patients with low and high Twist expressions were 67.7％ and 46.1％ respectively,and there was significant difference between the two groups (P＜0.05).The multivariate analysis indicated that the Twist expression was an independent prognostic factor of bladder carcinoma.Conclusions The high expression of Twist,E-cadherin and N-cadherin are involved in the processes of invasion and metastasis of bladder urothelial carcinoma.The Twist expression was one of the independent prognostic factors of bladder urothelial carcinoma.

Objective To report the surgical methods and results of pure laparoscopic radical cystectomy with orthotopic U-shape ileal neobladder.Methods From August 2010 to April 2014,19 patients with locally advanced bladder cancer (cT2-3 N0-2 M0) underwent pure laparoscopic radical cystectomy and Endo-GIA assisted orthotopic U-shape ileal neobladder reconstruction.Perioperative and follow-up data were collected.Results The surgeries were successful in all 19 cases with the operating time ranging from 261 to 380 min,blood loss of 100 to 350 ml.Postoperative hospital stay was 21±4 (15-26) days,postoperative intestinal function recovery time at 1.9±0.4 (1.5-2.3) days.Surgical margins were all negative.Lymph node positive rate was 32％ (6/19).Complications were including 1 case of lymphatic leakage; 3 cases of new bladder and urethra anastomotic fistula.There were 17 cases of urinary incontinence,all these cases were improved after 3 months,but there were still 8 cases of night-time incontinence.Three cases had unilateral ureteral reflux,ureter mild hydrocephalus,1 of the cases had recurrent infections within 1 month after surgery.After the anti-inflammatory and catheterization treatment,the symptoms were improved.Two cases had unilateral ureteral anastomotic stricture,one underwent percutaneous nephrostomy and cystoscope-assisted double J tube placement,another underwent laparoscopic ureteral neobladder reimplantation.One case had bilateral ureteral stenosis due to recurrent infections,and underwent bilateral laparoscopic ureteral-new bladder reimplantation.Patients were followed up for 8-42 months,no recurrence or distant metastasis was found.Conclusion Pure laparoscopic radical cystectomy with endo-GIA assisted orthotopic U-shape ileal neobladder can reduce surgical trauma and help patient's postoperative recovery.

Single-docking robot-assisted laparoscopic radical nephroureterectomy is difficult to deal with the distal ureter and bladder. Thirty-two patients with ureter carcinoma underwent single-docking robot-assisted nephroureterectomy in rectus rectilinear cannula placement in our hospital. The advantages include lower surgical difficulty, shorter operation time, less surgical bleeding and damage. This surgical method is a safe and effective minimally invasive treatment for ureter carcinoma.

Objective:To explore the feasibility, safety and clinical efficacy of ileum augmentation cystoplasty assisted by Da Vinci robot for the treatment of neurogenic bladder.Methods:Retrospective analysis was performed on the data of 12 patients with neurogenic bladder admitted to Zhejiang Provincial People’s Hospital from March 2017 to November 2018, including 11 males and 1 female, with the mean age of 38(12-67). Preoperative symptoms were urinary incontinence, dysuria, decreased bladder capacity, or increased bladder pressure leading to ureteral reflux. All the 12 patients underwent preoperative intermittent catheterization, including 8 patients with spinal cord injury and 4 patients with spinal cord dysplasia. Preoperative serum creatinine(129.58±44.60)μmol/L and total glomerular filtration rate(61.63±18.04)ml/(min·m 2) were observed in 12 patients. Preoperative urodynamic examination showed the safe bladder volume of (95.67±39.10)ml, bladder internal pressure of(63.30±6.02)cmH 2O(1 cmH 2O=0.098 kPa)at the end of filling period, bladder compliance of(10.24±1.14)ml/cmH 2O, residual urine volume of(152.58±80.89)ml, and urine flow rate of(3.88±3.63)ml/s. Bladder contracture was evident on preoperative cystography. Ultrasound examination showed different degree of hydronephrosis and ureter expansion, in all cases, with ureteral reflux grading Ⅰin 2 cases, grade Ⅱ in 4 cases, grade Ⅲ in 4 cases, grade Ⅳ in 2 cases. All the 12 patients underwent robot-assisted ileum augmentation cystoplasty with 5-point puncture. Transverse incision of the bladder wall before full thickness, according to the amount of bladder and quality to decide 30 cm(normal), longitudinal cut back loops and one point after suture fixation in the bladder wall midpoint, fixed point as starting point, in turn, will be blind to the bladder stitching on both sides, the bilateral ureteral placing a single J tube respectively, evaluation of surgical success rate (including intraoperative bleeding, interception of bowel loops are no damage adjacent viscera, ureter openings with and without damage, impermeability, match insufflate whether unobstructed), postoperative complications, anastomotic fistula, intestinal obstruction, abdominal bleeding), urine dynamics test parameters, and patients’ quality of life. Patients were regularly given anticholinergic drugs(2 mg/d) for 6 months after surgery. Results:All the 12 cases in this group were successfully completed without any transfer to open surgery. The operation time was(120.8±12.0)min. Intraoperative blood loss(84.0±23.2)ml. Postoperative intestinal function recovery time(3.3±1.3) d. Postoperative hospital stay(12.1±3.1)d. Postoperative pelvic drainage tube indwelling time (3.8±1.2) d. Catheter and single J tube were removed 2 weeks after operation. Postoperative follow-up averaged 19.4(3-24) months. At 3, 12, 24 months after surgery, the bladder safety volume was rechecked(435.83±33.56), (450.90±31.09), (462.00±33.72)ml, the bladder internal pressure at the end of filling was(18.60±0.92), (15.70±1.42), (12.96±1.34)cmH 2O, the blood creatinine level was(81.43±21.10), (74.34±15.70), (72.90±15.90)μmol/L, and the bladder compliance was(37.94±4.22), (40.40±3.98), (43.42±4.20)ml/cmH 2O and the total glomerular filtration rate(91.52±9.49), (102.18±5.65), (112.41±6.50)ml/(min·m 2) were significantly improved compared with those before surgery( P<0.001). After 24 months of bladder urination training, 1 patient could basically urinate by herself. Three patients were treated with intermittent urinary catheterization supplemented by automatic urination. The remaining 8 patients were completely dependent on urinary catheter for intermittent catheterization. Postoperative complications such as anastomotic fistula, ileus and abdominal bleeding were not found in 12 patients. Conclusions:Ileum bladder enlargement assisted by robot can effectively expand bladder volume, reduce bladder internal pressure, improve bladder compliance, prevent ureteral reflux and protect renal function.

Objective: To analyze the main causes for unplanned re-operation of prostatic cancer. Methods: The clinical data of 4 patients with prostatic cancer who underwent an unplanned re-operation were analyzed retrospectively between September 2014 and July 2019 in our hospital.Preoperative data of patients was collected as follows: mean age of 65 years, ranged from 56 to 71 years.tPSA ranged from 5.17-13.20 ng/ml.Gleason score of 3+ 3 in 1 case, 3+ 4 in 2 cases, 4+ 4 in 1 case. pTNM pT_2a in 2 Cases, pT_2b in 2 cases. LRP(extraperitoneal approach) in 1 case, RARP(transperitoneal approach) in 3 cases. Results: The main causes for unplanned re-operation were as follows: perioperative hemodynamic instability(75%, 3/4), post-operative fever(25%, 1/4). All 4 re-operations were performed by urologists using Laparoscopic exploration of abdomen. Conclusions Inadequate and inappropriate surgical hemostasis are the key to lead a second-look surgery of prostatic cancer.A complete hemostasis could help to lower the re-operation rate.Laparoscopic exploration of abdomen could be one of the choices to deal with re-operation after minimally invasive radical prostatectomy.

Objective To compare the safety and efficacy between flexible ureteroseope lithtripsy (FURS) and super-mini-percutaneous Nephrolithotomy (SMP) in the treatment of lower calyx calculus.Methods From Mar 2015 to Apr 2017,120 male and 75 female patients were accepted FURS (n =112)or SMP(n =83) in our hospital.Their average age was 45 years old,ranged from 19 to 68 years old.The cumulative stone diameter ranged from 15-24 mm (mean 20.3 ± 3.9 mm) in FURS group and ranged from 15-28 mm (mean 20.7 ± 3.2mm) in SMP group.There were no significant differences between the groups FURS and SMP in the stone size (P ＞ 0.05).Operative duration,postoperative hospital stay,complication rate,and stone-free rate(one day or one month after procedure) were recorded and compared.Results The operative time ranged from 28 to 62 min (mean 55.3 ± 7.3min) in FURS group and ranged from 15 to 55 min (mean 40.5 ± 6.8 min) in SMP group (P ＜ 0.05).One day after the operation,CRP was 7.4-29.1 (mean 17.2 ± 7.1) mg/L in group SMP,which was lower than that in group FURS 6.9-37.8 (mean 26.4 ± 6.4) mg/L (P ＜ 0.05).And the procalcitonin and peripheral leukocyte count was 0.1-1.2 (mean 0.6± 0.3)ng/ml and 6.3-18.1(mean 12.6± 3.2) × 109/L respectively,which was lower than that in group FURS O.2-1.4 (mean 0.9 ± 0.4) ng/ml and 9.5-21.7 (mean 14.8 ± 2.9) × 109/L respectively (P ＜ 0.05).One day after the operation,the stone free rate was 80.4％ (90/112) in group FURS,which was lower than that in group SMP 89.2％ (74/83) (P ＜ 0.05).And one month after the operation,the stone free rate was 85.7％ (96/112) in group FURS,which was lower than that in group SMP 96.4％ (80/83) (P ＜ 0.05).Postoperative hospitalization stay ranged from 2 to 5 days (mean 2.3 ± 1.2 days) and ranged from 3 to 6 days (3.7 ± 1.6 days) in FURS and SMP group,respectively (P ＜ 0.05).The scores of Visual Analogue Scale (VAS) ranged from 0 to 3 (mean 2.1 ± 0.4) and ranged from 0 to 3 (mean 1.9 ± 0.5) in FURS and SMP group,respectively (P ＜ 0.05).And the scores of Bruggrmann comfort scale (BCS) ranged from2to4 (mean 3.2 ±0.7) and ranged from 2 to4 (2.8 ±0.5) in FURS and SMP group,respectively(P ＜ 0.05).Conclusions Both SMP and FURS are efficacy and safe surgical alteration for patients with renal and renal lower calyx calculus of CSD about 2cm.The SMP could have some advantages such as the better stone free rate and acceptable complieation rate.

Objective:To explore and compare the perioperative result and complications of robot-assisted radical cystectomy with intracorporeal and extracorporeal urinary diversion.Methods:Clinical data of bladder cancer patients undergoing robot-assisted radical cystectomy with ileal conduit in Zhejiang Provincial People's Hospital from January 2015 to March 2020 were retrospectively analyzed. Eighty-two patients underwent extracorporeal urinary diversion (ECUD group), and 122 underwent intracorporeal urinary diversion (ICUD group). In the ECUD group, the median age was 70(61, 76)years old, including 67 male (81.7%), the median BMI was 26.1(24.3, 28.5), 67 cases(81.7%) was ASA score 0-2, 15 cases (18.3%)was 3 or higher, 15 cases (18.3%) were high risk non-muscular invasive bladder cancer. 67 cases (81.7%) were muscular invasive bladder cancer. 16 cases (19.5%) received neoadjuvant chemotherapy. Past medical history included smoking in 35 cases (43.2%), hypertension in 31 cases (37.5%), diabetes in 17 cases (21.3%), heart disease in 13 cases (15.7%), and abdominal surgery in 15 cases (17.8%). In the ICUD group, the median age was 68 (62, 75), 95 male (77.9%), the median BMI was 25.6 (23.4, 27.8)kg/m 2, 105 cases(86.1%) was ASA score 0-2, 17 cases (13.9%)was 3 or higher, 29 cases (24.9%) were high risk non-muscular invasive bladder cancer, and 93 cases (75.1%) were muscular invasive bladder cancer. There were 22 cases (18.0%) undergoing neoadjuvant chemotherapy. Past medical history included smoking in 58 cases (47.3%), hypertension in 44 cases (32.6%), diabetes in 33 cases (22.8%), heart disease in 28 cases (26.7%), and abdominal surgery in 17 cases (14.2%). No significance was detected in characteristics between the two groups. For ileal bladder making and ureteral implantation method in ICUD group, 15 cm ileum was taken using stapler at the 15 cm from ileocecum to make ileal conduit and restore the continuity of the ileum. The proximal end of the ileal conduit was closed. The bilateral ureteral were implanted 3 cm apart on the ileal bladder. F6 single J tube was placed into both of the ureters to drain urine. For ECUD group, the subumbilical 5 cm incision was taken to enter the abdominal cavity. The ileocecum was found and the terminal ileum was taken out of the body. A segment of 15 cm in length ileocecum 15 cm away from the cecum was cut off with a linear cutting stapler and the blood vessels of arterial arch were ligated, then a small opening at the same ileum position was cut. The continuity of the ileocecum was restored. The ileal conduit was irrigated, and the bilateral ureters were placed into a single J tube and anastomosed to the ileal conduit 3 cm apart. The operation time, intraoperative blood loss, postoperative exhaust time, postoperative feeding time, postoperative hospital stay, postoperative incision pain score, postoperative readmission rate, peri-operative mortality, postoperative complications and pathology results were compared between the two groups. Results:All cases were successfully performed robotically without conversion or major intraoperative complications. There was no significant difference in operation time between ICUD group and ECUD group [260(230, 310) min and 235(220, 290) min, P=0.078]. The estimated blood loss in ECUD group was more than that in ICUD group [300(200, 400) ml and 150(100, 300), P=0.037], but there was no difference in blood transfusion rate between the two groups [7(8.6%) and 9(7.4%), P=0.196]. The exhaust time [4(2-6) days and 2(1, 3) days] and postoperative solid food feeding time [7(4, 9) days and 4(3, 5) days] in the ECUD group were longer than those in the ICUD group (all P<0 05). The exhaust time[4(2-6)day and 2(1, 3)day] and solid food feeding time[7(4, 9)day and 4(3, 5)day] in ECUD group were longer than those in ICUD group. There was no significant difference in postoperative hospital stay between ECUD group and ICUD group[8(5, 11)day and 6(5, 9)day, P=0.212]. Clavien-Dindo Ⅰ-Ⅱ grade was defined mild complication, Ⅲ grade or above was defined serious complication, early complication was defined within 30 days after operation, and late complication was defined 30-90 days after operation. The overall early postoperative complication rate were 19.6%(24) and 34.2%(28)(ICUD vs.ECUD), the mild complications rate were 13.9%(17) and 25.6%(21)(ICUD vs.ECUD), and the late severe complication rate were 4.1%(5)and 10.1%(8)(ICUD vs.ECUD). ICUD group were significantly lower than those of ECUD group (all P<0.05). There was no difference in the early severe complication rate [5.7%(7) and 8.5%(7)], the total late complication rate [15.6%(19) and 16.1%(13)], and the late mild complication rate [11.5% (14) and 6.0% (5)] (all P>0.05). There was no significant difference between ICUD group and ECUD group, in term of the number of lymph nodes dissected [21(14, 25) and 19(15, 24)], the positive rate of lymph nodes [10.7%(13) and 10.0%(8)], the positive rate of surgical margin [3.3%(4) and 4.8%(4)] and postoperative pathological stage T 1-T is [25(20.3%) and 14(17.1%)], and T 2-T 3 [97(79.7%) and 68(82.9%)]. The number of patients with postoperative incision pain (pain score >5) was 43 (35.6%) in ICUD and 46 (56.5%) in ECUD( P< 0.05). The 30-day and 90-day readmission rates were 1.6% (2/82) and 4.9% (6/82) in ICUD group, and 1.2% (1/122) and 9.8% (8/122) in ECUD group, respectively. There was no peri-operative mortality in both groups. Conclusions:Robot-assisted radical cystectomy with ileal conduit is a safe and repeatable method for the treatment of muscular invasive or high-risk non-muscular invasive bladder cancer. Complete intracorporeal bladder reconstruction is feasible and has the advantages of less intraoperative bleeding, faster postoperative intestinal function recovery and less complications.

Objective To investigate the outcome of patients underwent anatomic periurethral reconstruction during robotic assisted laparoscopic radical prostatectomy (RARP).Methods During August 2016 to May 2018,anatomic periurethral reconstruction was performed during RARP in 58 consecutive patients.The control group consists of another 50 patients had no anatomic periurethral reconstruction procedure during RARP.Perioperative data of these patients were collected retrospectively,including operation time,anastomosis timeintraoperative blood loss,duration of indwelling catheter,length of hospital stay,complications,postoperative pathology,and continence outcome at 1,3,6,12 months after surgery.Results All cases were successfully performed without conversion to open or laparoscopic surgery.There were no major intraoperative or postoperative complications.Operative time and anastomosis time was (145.3 ± 12.3)mins and (31.6 ± 8.2)mins in reconstruction group comparing to (122.4 ± 11.4)mins and (21.2 ± 4.4) in control group (both P ＜ 0.05).Duration of indwelling catheter was (7.0 ± 0.5) days in reconstruction group and (11.0 ± 0.6) days in control group (P ＜ 0.05).In reconstruction group,estimated blood loss was (108.1 ± 8.3) ml,duration of drainage tube was (3.0 ± 1.2) d,postoperative hospital stay was (8.0 ± 1.1) d,failure of leak test in 1 case,and postoperative complications in 4 cases (6.9％),comparing to (103.3 ± 10.4) ml,(4.0 ± 1.6) d,(10.0 ± 1.5) d,3 cases and 4 cases (8.0％) in control group with no significant difference (all P ＞ 0.05).Postoperative pathology confirmed 53 T2a-T2b diseases and 5 pT2c diseases in reconstruction group,in comparison with 46 T2a-T2b and 4 pT2c diseases in nonreconstruction group (P ＞ 0.05).There were 19 and 15 cases with a final Gleason score of 6,30 and 27 cases with Gleason 7,9 and 10 cases with Gleason 8,in reconstruction group and non-reconstruction group respectively(all P ＞ 0.05).There was no significant difference between the two groups regarding incidence of positive surgical margins (3 in reconstruction group and 2 in control group,P ＞ 0.05).The percentage of patients maintain continence in reconstruction group and non-reconstruction group:at 1 month [84.5 ％ (49/58) and 70.0％ (35/50)],at 3 months [89.7％ (52/58) and 78.0％ (39/50)],at 6 months [91.3 ％ (53/58)and 86.0％ (43/50)] and 1 year after surgery [100.0％ (58/58) and 96.0％ (48/50)].Reconstruction group showed better continence outcome at 1 and 3 month (P ＜ 0.05),with no statistical differences at 6 month and 1 year.The IPSS 1 year after surgery was 10.4 ± 1.6 and 12.1 ± 1.3,with anastomotic stricture in 0 and 2(4％) patients in reconstruction group and control group,respectively (both P ＞ 0.05).Conclusion Anatomic reconstruction of periurethral structure during RARP is safe and feasible with reduced duration of indwelling catheter and better continence outcome.

Objective:To investigate the perioperative and oncological outcomes in patients undergoing laparoscopic radical cystectomy with intracorporealorthotopic neobladder reconstruction.Methods:Clinical data of bladder cancer patients undergoing laparoscopic radical cystectomy(LRC) or robot-assisted radical cystectomy(RARC) with intracorporealorthotopic neobladder reconstruction in Zhejiang Provincial People's Hospital from March 2010 to December 2019 were retrospectively analyzed. There were 166 males and 52 females. The median age was 62 (52, 70) years old. The ASA score was 1-2 in 183 cases (83.9%) and 3 in 35 cases (16.1%). There were 61 cases of hypertension, 28 cases of diabetes, 26 cases of heart disease, 33 cases of history of abdominal surgery, and 3 cases received neoadjuvant chemotherapy. LRC was performed in 82 cases and RARC in 136 cases. The operation was performed by dissecting pelvic lymph nodes from right to left and then cystoprostatectomy. The periureteral blood supply and periperitoneal peritoneum were preserved, and the prostate was resected by intrafascial resection. The 30 cm terminal ileum was used to make a U-shaped new bladder, and then the urethral stump and both sides of the ureter were anastomosed on new bladder without tension. During the operation, two single J tubes were used as ureteral stent.The perioperative and pathological results results were evaluated.Results:The operations of 218 patients were completed successfully and there was no conversion to open operation. The median operation time was 281 (229, 400) ml. Intraoperative blood transfusion was performed in 24 cases (11.0%). Hospital stay was 15 (13, 22) days.Intraoperative complications happened in 11 cases (5.0%). Exhaust time was 2 (1, 3) days. Solid food intake time was 4 (3, 5) days. Total complications within 30 days after operation were 61 cases (28.0%), and total complications within 30-90 days after operation were 81 cases (37.2%). The number of median lymph node dissection in all patients was 19 (14, 24). Positive lymph nodes in 21 cases (9.6%). Positive margin in 6 cases (2.7%). Postoperative tumor pathological stages were T a/T 1/T is stage 48 cases, T 2 stage 134 cases, T 3 stage 36 cases. The median follow-up time of all patients was 33 (20.6, 48.2) months. There were 77 cases of tumor recurrence and 55 cases of death, of which 39 cases were tumor-specific death. The 5-year disease free survival, overall survival , and cancer-specific survival of all patients were 55.4%, 62.4% and 66.4%, respectively. Conclusions:Laparoscopic radical cystectomy and intracorporealorthotopic new bladder reconstruction can be well used in the treatment of muscle invasive or high-risk non-muscle invasive bladder cancer.Laparoscopic intracorporeal bladder reconstruction is feasible with few postoperative complications.