Objective To study the diagnosis accuracy and the treatment sequelae of adenocarcinoma of urinary bladder. Methods 41 cases of urinary bladder adenocarcinoma have been encountered from 1980 to 2000,all of them had undergone operation and the diagnosis being assessed on histopathology studies.There are 18 cases of primary bladder adenocarcinoma,among which 8 had undergone radical cystectomy and 10 partial cystectomy.Among 12 cases of urachal adenocarcinoma extending to the bladder,11 received extended resection.All the 11 patitents with metastatic focus in the bladder underwent local ablation. Results Urinary bladder adenocarcinoma comprised 3.2% of the bladder cancer.Thirty seven patients have been followed up for five months to ten years.The 1 year survival rate was 51.3%(19 cases),the 2 year survival rate 43.2%(16 cases) and the 5 year survival rate 21.6%(8 cases). Conclusions Radical total cystectomy is the treatment of choice for primary adenocarcinoma of bladder and extended partial cystectomy seems to be the best for urachal adenocarcinoma. Comprehension therapy should be undertaken for patients with metastatic adenocarcinoma or tumor recurrence so as to improve the survival rate.

Objective To evaluate the modified Stamey bladder neck suspension for female stress urinary incontinence. Methods 52 cases with an average age of 46 and an average stress incontinence history of 7.5 years underwent the modified Stamey procedure,18 cases being degree Ⅰ,21 degree Ⅱ and the other 13 degree Ⅲ. Results 32 cases were treated before 1994 and the outcome was evaluate at 3.6 years and 9.6 years postoperatively.There were 3 failures because of operative complication.The cure rates and failure rates at 3.6 and 9.6 years were 87.5%,68.8% and 6.2%, 21.9%,respectively.20 cases were treated after 1994 with a follow up of 4.3 years.The cure rate has been 90.0%. Conclusions The Stamey procedure yields high initial cure rates yet the latter declines with time.

We report the results of nephrectomy under laparoscopy for 3 patients. Three patients were subjected to laparoscopy for the treatment of hydronephrosis of no function under general aneshesia. Succesiful operation was performed in the 3 patients without complication, the average operation time being 240 minutes, and hospitelization duration averaging 4.5 days.

Objective To explore the effectiveness of tension-free vaginal tape (TVT) for female stress urinary incontinence. Methods Thirteen cases of stress urinary incontinence confirmed by urodynamics examinations underwent treatment with tension-free vaginal tape through the anterior vaginal wall under an epidural anesthesia. The patients were positioned in the lithotomy position. Dissection was performed alongside the urethra bilaterally by way of the anterior vaginal wall. A TVT suprapubic tape was passed through the lower abdominal wall and was positioned and adjusted. Results The operation time was 15~45 min (mean, 35 min). Follow-up observations for 6~24 months (mean, 13 months) in 13 cases revealed 12 cases of cure and 1 case of improvement. No recurrent urinary incontinence or dysuria was noted. Conclusions Treatment with TVT is a simple, effective and minimally invasive procedure for stress urinary incontinence, with a short operative time and a quick postoperative recovery.

Objective To highlight the diagnostic and t herapeutic procedures for extra-adrenal pheochromocytoma. Methods Thirty-eight cases of extra-adrenal pheochromocytoma proven patholo gically from 1998 to 2002 were reviewed and studied.Hypertension was observed in 34 cases and intermittent macrohematuria in 4 patients.Another 2 cases were adm itted to hospital with abdomen masses through routinely physical examination.Uri nary VMA,serum and urinary catecholamine were measured in 33 cases.38 cases had B-model ultrasound examination and 34 cases took CT scan.The level of urine VMA elevated in 30 cases(91%) and serum or urinary catecholamine were elevated in 2 8 (85%).The positive rates of localization of B-ultrasound and CT were 92% and 100%,respectively.29 cases took ?-receptor blocker for at least 2 weeks preope ratively.There were 6 cases operated under epidural anesthesia and 32 general an esthesia.Six cases were operated transvesical.10 cases with lumber incision and 19 with abdominal incision.The other 3 cases operated laparoscopically. Results Tumor location,6 cases in bladder wall,7 in renal hilum, 9 in upper pole of kidney,4 in low pole,10 in anterio-lateral to the adrenal gl and,and 2 cases of multifoci.The specimens were from 2 to 9 cm in size.Among 34 cases with hypertension,the blood pressure of 26 patients return to normal and 2 cases were still hypertensive.10 cases were assayed as malignant pheochromocyto ma.There were 9 cases of recurrence or metastases and 5 patients died during fol lowed-up from 13 months to 10 years. Conclusions Urine VMA level is a useful marker to detect extra-adrenal pheochromocytoma and CT sc an is the most reliable in localizing the lesions. 131I-MIBG scintigra phy is of great value for the localization and quantitative for extra-renal phe ochromocytoma with high sensitivity and accuracy.It may be also used as a therap eutic method.Surgical manipulation of the tumor is the best management and metic ulous perioperative management is extremely important.Measuring the level of uri nary catecholamine can monitor the recurrence or metastasis of the tumor.

Objective To assess the efficacy and safety of interventional combine with surgical therapy of symptomatic portal vein thrombosis (PVT). Methods Seven patients with PVT were treated by surgical thrombectomy, regional medical thrombolysis, and angioplasty or stenting. Resection of part of the small intestine was performed in 2 cases due to enteric necrosis and in 1 case because of enteric stenosis. Results The procedure was successful in all the 7 patients. The preoperative symptoms (abdominal pain, distention, and ascites) were alleviated apparently. Follow-up observations for 3~24 months (mean, 16 months) showed no death. No alimentary tract hemorrhage occurred. Re-examinations with Doppler ultrasonography revealed patent blood flow in the portal vein. Conclusions Interventional combined with surgical therapy is safe and effective in the treatment of symptomatic portal venous thrombosis.

Objective To evaluate the surgical and interventional therapy in patients with acute superior mesenteric vein thrombosis.Methods In this series,31 acute superior mesenteric vein thrombosis(SMVT) cases were reviewed from Oct 2006 to Feb 2012.According to varied clinical presence,patients received superior mesenteric vein thrombectomy with necrotic bowel resection or indirected catheter thrombolysis through superior mesenteric artery.Results 6 of 9 cases undergoing surgery were cured and other 3 still complained abdominal distension when discharged for not being able to bear anticoagulation and thrombolysis after operation due to alimentary tract hemorrhage,and residual thrombus was shown in superior veins by venography.17 of 22 treated by interventional therapy gained obvious relief within 72 hours after intervention,others gained symptomatic relief in 5-7 days.Indirected catheter thrombolysis were interrupted in 2 due to alimentary tract hemorrhage.One patient was shifted to surgery 48 hours after catheter thrombolysis due to deterioration.Mean duration of follow-up after hospital discharge was (19 ± 5) months in 25 cases,20 had no abdominal distension and pain,3 with postcibal abdominal distension.Conclusions Indirected thrombolytic therapy by way of the superior mesenteric artery is a technically simple,safe and effective therapy for patients with acute SMVT.

ObjectiveTo evaluate interventional therapy for Buddi-Chiari syndrome with occlusive hepatic veins.MethodsIn this study,37 Budd-Chiari syndrome cases with occlusive hepatic vein undergoing abdominal ultrasonography, CT scan, and liver vascular reconstruction before operation.Interventional procedures included recanalization of occlusive hepatic veins through transjugular,transfemoral vein or both. ResultsProcedures were successful in 34 patients (success rate 34/37,92％ ),with 38 hepatic veins opened. After hepatic vein was opened,nine patients were treated with PTA alone.27 stents were placed in 25 patients,with 2 cases receiving stent placement in both the right hepatic vein and accessory hepatic vein.7 home-made Z-stent were placed after the opening of occluded inferior vena cara.After the procedures hepatic vein pressure dropped from ( 36.0 ± 3.4) cm to ( 21.0 ± 2.3 ) cm H20.Recurrence of stenosis or oclusion was found in 4 out of 9 receiving PTA only after a follow-up of (23.0 ± 2.0) months.In the other 23 patients with stent implantation there were 6 eases of restenosis or occlusion (6/23,26％ ). ConclusionsAccording to the hepatic vein and intrahepatic collateral venous occlusion conditions,correct selection of interventional methods can significantly decrease the hepatic and portal vein pressure,improve clinical symptoms.

ObjectiveTo explore the causes of recurrence of Budd Chiari syndrome after radical resection and the key points of second surgery. Methods Venography was performed in 11 relapsing cases. The diseased IVC segment was resected and replaced with artificial vascular graft in 4 cases, membranectomy and thrombectomy were performed in 2 cases. Thrombectomy with artificial vascular patch cavoplasty in 4 cases, incision of the stenotic IVC and right hepatic venoplasty and IVC venoplasty with artificial vascular patch repairing was performed in 1 case. Result The mortality rate was zero. Acute heart failure occurred in 2 cases and thoracic hemorrhea in 2 cases. Symptoms disappeared or improved in all cases. Patients were followed up from 6 to 68 months, with excellent results in 9 cases and fair in 2 cases. Conclusion There were some factors influcing the long term results of the surgery including distal free length from diseased IVC, thrombus clearance, material and size of the patch used for venoplasty.

Objective To evaluate a combination of interventional treatment and surgical exploration for acute lower limb ischemic disease.Methods We reviewed 42 cases admitted from July 2007 to January 2010,all patients complained pain,paralysis,pulselessness,pallor and paresthesia.After Fogarty thrombectomy angiography was taken in DSA room.Patients with angiostenosis greater than 50％ were then managed by interventional treatment(CDT,PTA,Stenting).Results Lives were saved in all patients,40 lower limbs were saved,and 2 patients received below knee amputation.The amputation rate was 4.76％.Dorsal or(and)posterior tibial artery of foot was felt in 33 patients,symptoms significantly improved.The other 7 patients still had painful and paralysis on the diseased limb.Conclusions The interventional treatment and surgical operation in acute lower limb ischemic disease is safe and result is satisfactory,which can improve the long-term patency and salvage rate of the lower limb.