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 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 observe the changes of number and proportion of CD4+CD25+FOXP3+ cells in peripheral blood of active rheumatoid arthritis patients (RA),and explore the function of recombinant human TNFR Ⅱ-Fc on the CD4+CD25-FOXP3+ Treg cells.Methods ① Forty severe RA patients were selected,who were divided into the combined treatment group (TNFR Ⅱ-Fc+MTX) and MTX only group according to the principle of randomized,double-blind,parallel and placebo-controlled study.All patients were treated for 12 weeks.Flow cytometry was used to analyze and compare the expression ratio of CD4+CD25+FOXP3 +Treg cells of RA patients' peripheral blood.Forty healthy controls were selected for parallel comparison.② VAS,DAS28,HAQ average of the two groups at different periods were compared.Matched t test was used to examine the quantity data between the groups.Results ① The proportion of CD4+CD25+FOXP3+ cells in the peripheral blood of active rheumatoid arthritis patients was significantly lower than healthy group [ (5.4±1.4)％ vs ( 7.5±1.5 )％,P＜0.01 ].The proportion of CD4+CD25+ FOXP3+ Treg cells in combined treatment group was significantly higher [(7.0+1.2)％ vs (5.2±1.6)％,P＜0.01 ] after TNFR Ⅱ-Fc and MTX combination therapy for 12 weeks.The increase rate of CD4+CD25+FOXP3+Treg cells in combined treatment group was evidently more remarkable than MTX only group [ (7.0 ± 1.2)％ vs (5.6 ±0.7 )％,P＜0.01].② After 12 weeks treatment,the arerage scores of VAS,DAS28 and HAQ of the combined treatment group were better than MTX only group,and the difference was statistically significant (P＜0.01).Conclusion This study has shown that the healing effect of TNFR Ⅱ -Fc combined with MTX is better than MTX only.TNFR Ⅱ -Fc can restore and improve the proportion of CD4+CD25+FOXP3+ Treg cells in active RA patients,which is likely to be an important mechanism for the treatment of RA patients.

Objective To investigate the expression of p53 up-regulated modulator of apoptosis (PUMA) and p53 protein and relationship with clinicopatbological parameters in human gastric cancers. Methods Primary gastric carcinoma and adjacent normal mucosa were obtained from 84 consecutively enrolled patients undergoing gastric cancer resection at Peking University People's Hospital during the period from April 2001 to May 2003. Immunohistochemistry staining was used to measure the expression of PUMA and p53 proteins both in normal and malignant tissues. Results PUMA expression is significantly weaker in primary gastric carcinoma compared to adjacent normal mucosa (P <0. 01 ). Weak PUMA expression in gastric cancer correlates with depth of tumor invasion ( P < 0. 01 ), advanced pTNM stage ( P < 0. 05 ) and poor overall survival of patients ( P < 0. 05 ). p53 protein expression in gastric carcinoma is significantly higher than adjacent normal mucosa ( P < 0. 01 ). There was a significant negative correlation between the expression of PUMA protein and p53 protein in gastric carcinoma (P < 0. 05 ). Conclusion PUMA expression in gastric carcinoma is significantly lower compared to adjacent normal mucosa. Weak PUMA expression in gastric cancer correlates with depth of tumor invasion, later pTNM stage and poor overall patient survival.

Objective To determine the efficacy of retrovirus-mediated HSV-TK gene transfer and GCV in a BALB/c mice model with urinary bladder transitional cell carcinoma. Methods A replication defective retroviral vector containing HSV-TK gene was used. In vivo experimental animals were divided into 3 groups.In group A,7 tumors were induced in BALB/c mice by subcutaneous injection of MBT-2 transitional cell carcinoma (TCC);the virus was directly injected into the tumor and the animals received intraperitoneal GCV.In group B, 6 tumors were induced in BALB/c mice by subcutaneous injection of transferred HSV-TK gene TCC and the animals received intraperitoneal GCV.In group C,6 tumors were induced in BALB/c mice by subcutaneous injection of MBT-2 TCC and the animals received intraperitoneal normal saline.Tumor-volume measurement was performed in these 3 groups 10 d and 20 d after treatment, and the volume changes were compared among the 3 groups. Results In vivo experiment indicated that the mean tumor volume of group A [MBT-2 group, (55.37?4.52) mm3] and group B [MBT-2/HSV-TK group,(49.77?4.15)mm3] was reduced significantly compared with that of group C [control group,(146.27?10.46)mm3](P0.05).At 20 d after treatment, the mean tumor volume of group A [(186.75?8.14)mm3] and group B [(72.50?6.70)mm3] was also reduced compared with that of group C [(441.76?41.80)mm3] (P

ObjectiveTo assess the safety and efficacy of retrograde ureteroscopy lithotomy (URSL)assisted antegrade percutaneous nephrolithotomy (PCNL) for complex upper ureteral calculi in semisupine-lithotomy position.MethodsFrom March 2007 to December 2010,a total of 95 patients with complex upper ureteral calculi underwent retrograde URSL assisted antegrade PCNL in semisupine-lithotomy position.Ureteral calculi size was 12 mm × 6 mm to 38 mm × 15 mm,24 cases combined with renal calculus.Firstly retrograde URSL was performed,once the stone fragments moved up to renal pelvis,a 16-22 F PCNL working channel was established under the ultrasound guidance through which lithotripsy was performed using an ureteroscope.Finally a 6-7 F double-J tube was indwelled.ResultsOperations were successfullycompleted in 93 patients.However,in it 2 patients were converted to open surgery because of significantureteral distortion due to previous open surgery.Operative time was(42.7 ± 14.9) min; estimated blood loss was(34.5 ± 26.1 ) ml.The ureteral calculi clearance rate was 100.0％,and renal calculus clearance rate inthose combined with renal calculus was 95.8％ (23/24).There were no major intraoperative and postoperative complications excepted early urinary leakage in 2 cases and fever ≥39℃ in 3 cases.ConclusionsRetrograde URSL assisted antegrade PCNL in semisupine-lithotomy position is safe and feasible for complex upperureteral calculi,especially non-opaque calculi,combined with renal calculus,easily ascending ureteral calculi and large calculi burden which has low calculi clearance rate after URSL.The outcomes are encouraging with fewer complications.It also avoids intraoperative change of patient's position.

BACKGROUND:Smooth muscle cells and transitional epithelial cells were traditionally used to construct tissue-engineered bladder and to perform double-sided implantation of scaffold.However,double-sided implantation is difficult to perform,because smooth muscle cells are difficult to isolate or culture in vitro and passage is limited.OBJECTIVE:To verify the feasibility of tissue-engineered bladder reconstruction with bone marrow mesenchymal stem cells(BMSCs)and bladder acellular matrix(BAM).DESIGN:A basic empirical study.SETTING:Linbaixin Medical Research Center,Second Affiliated Hospital,Sun Yat-sen University.MATERIALS:Experiments were performed at the Linbaixin Medical Research Center,Second Affiliated Hospital,Sun Yat-sen University from March 2006 to Mav 2007.The laboratory was the Opening Laboratory of Hospital Affiliated to Health Department of China.One-month old SD rats of either sex,weighting 80-100 g were provided by Animal Experimental Center of Sun Yat-sen University.Fresh porcine bladders were offered by Animal Experimental Center of Southern Medical University.METHODS:Whole bone marrow culture and successive adherence method was used to culture rat BMSCs in vitro.Flow cytometry was employed to detect surface antigen.Eradicator washing method was applied to prepare porcine BAM and measure its purity and characteristies.Third passage of BMSCs were inoculated in BAM and cultured in a medium containing vascular endothelial growth factor(VEGF165)(25 ng/L)in vive and in vitro to test compatibility.Cells cultured alone were considered to be controls for the in vivo trial,and materials non-implanted with cells were considered to be controls for in vitro trial.Suitable microenvironment was simulated to induce the differentiation of BMSCs.Four weeks and eight weeks later,compound materials were respectively removed to perform tissue section test.Simultaneously,immunohistochemistry keratin staining was conducted to examine regeneration of epithelial cells.MAIN OUTCOME MEASURE:Biocompatibility of BMSCs and BAM.RESULTS:①BMSCs were cultured by whole bone marrow method.Flow cytometry demonstrated that third passage of cells were positive for CD29(99.43%).②BAM had good biological characteristics.Homogen matrix and byssoid collagen appeared under a microscope.Compatibility trials showed good compatibility of BMSCs and BAM and well-growth cells.③Four weeks later,histological section test confirmed inflammatory cell infiltration,closely-arranged collagen and elastic fiber.Immunohistochemistry keratin staining showed lamellar and discontinuous simple epithelium.Eight weeks later,no inflammatory cell infiltration was found,and closely-arranged collagen and elastic fiber were detected.Immunohistochemistry keratin staining showed lamellar and continuous multiple epitheliums.CONCLUSIoN:With good compatibility,BMSCs and BAM appear to be an ideal material for bladder tissue engineering.