Objective To outline the diagnosis and treatment of a through-and-through urinary bladder to rectum-anal canal injury. Methods To review and summary 13 cases of through-and-through urinary bladder to rectum-anal canal injury.All patients were male and average age of 37 years old.Among them 4 cases reached hospital in 6 hours after injury,5 cases during 6～12 hours and 4 cases over 12 hours.Debridment and suture of urinary bladder to rectum-anal canal injure,effective revolution of urine and stools and full drainage in anterior sacrum space were performed.All of the 13 cases experienced operation of bladder exploration and drainage.1 among them underwent prostate gland cuting off because of the prostate gland injury.Another received the operation of urethra anastomoses.Both of them keep on catheterizing after operation.The management of anus and rectum hurt:3 cases received clearing and sewing up the wounnd of anus sphincter.8 cases received the repair of rectum passing through the anus.4 cases were not given remedy.7 patients received placing double thimble in the gap before sacrum.4 patients recieved placing eduction tube in the original wound.12 patients were given the operation of making sigmoid flexure fistula. Results All the 13 cases were cured.2 cases had postoperative infection in anterior sacrum space and were cured by full drainage.1 case was cured by secondary repairment after anal spincter repaired unsucessfully.1 case with rectovesical fistula was cured by conservative treatment.None suffered from dysuria,importence or anal stenosis.12 cases were visited and 1 was lost.Follow up was conducted from 10 months to 6 years.1 case with mild bowels incontinence recovered after training of lifting the anus for half a year.1 patient suffered from bladder calculi after a year and healed through lithotrity under cystoscope.The remaining 10 urinate and defecate normally,amonmg them 1 experienced urethra extends 6 times. Conclusions It was the key of improving treatment effect to master the clinical feature of a through-and -through urinary bladder to rectum-anal canal injury and diagnose correctly in the early stage and select reasonable operative procedure.

Objective To study the effect of pelvic autonomic nerve preservation(PANP)on urination and sexual function in total mesorectal excision(TME). Methods Two hundred and forty cases of male rectal cancer patients,divided into the PANP who accept the pelvic autonomic nerve preservation in TME,and the control group of 120 patients who do not.The urination and sexual function were observed and compared.3-year-survival rate,local recurrence rates of the two groups were recorded. Results The urinary disorder rates,erective disorder rates and ejaculation disorder rates of PANP group were 30.8%,28.3%and 34.2%,while values of control group were 55.0%、60.0%and 62.5%.The difference between them had statistical significance(P<0.05).The 3-year-survival rate and local recurrence rate of PANP group were 9.4%and 75.0%.The 3-year-survival rate and local recurrence rate of control group were 9.0%and 65.0%.There was no significant difference between them(P>0.05). Conclusion The PANP technique in TME could improve the urinary and sexual function of male patients without affect the prognosis.

Objective To evaluate the clinical efficacy of radical cystectomy with orthotopic ileal neobled-der. Methods 28 cases of bladder tumor treated with radical cystectomy with ileal orthotopic neobladder were studiedretrospectively. Results All patients achieved excellent continence,whereas possessory patients needed time-lapse e-mietion at nighttime. The mean bladder capacity for the entire group was 330 ml. Residual urine was less than 70 ml.All of these patients have been followed up for 4～58 months with a mean of 18 months. They were survival with no re-currences except 1 case. Good urinary stream was reported. A little operative complications occurred. ConclusionThe operation of radical cystectomy with orthotopic ileal neobladder might be an ideal way of bladder replacement,characterized by large capacity,low pressure, orthotopie continent urination.