BACKGROUND: Myelodysplasia induced by spina bifida is one of the common developmental malformations of the nervous system in children, and neurogenic urinary incontinence induced by it can affect the children' s quality of life.OBJECTIVE: To observe the effects of surgical therapy and rehabilitation training for children with hyper-reflexic neuropathic urinary incontinence.DESIGN: A controlled follow-up observation.SETTING: Department of Pediatric Surgery, First Hospital Affiliated to Zhengzhou University.PARTICIPANTS: A total of 81 children(54 males and 27 females), aged 4 to 14 years treated for hyper-reflexic neuropathic urinary incontinence between January 1992 and October 2000 were selected. All the cases were confirmed loose pelvic floor muscle and smaller bladder capaeity before operation. Moreover, all cases with neuropathic urinary incontinence were proved to be hyper-reflexic neurogenic bladder by urodynamic examination.METHODS: Pelvic muscles of the 81 patients were strengthened with bilateral iliopsoas and the bladder was augmented on the basis of ileocystoplasty. Five patients had an additional bladder neck suspension. Wound healing was satisfactory after 3 weeks; therefore, rehabilitative exercise for coordination was performed. The improvements in symptoms and urodynamic results were followed up.RESULTS: Urinary catheters were removed in the 81 patients 2 weeks after operation. Forty patients had voiding desire before micturition, with linear urine current, more than 60 minutes' interval between micturitions, and almost normal or normal maximal bladder capacity and pressure and residual urine volume, which was regarded as significantly improved. Twenty-three patients had voiding desire before micturition, with linear urine current, more than 40 minutes' interval between micturitions, and reduced maximal bladder capacity and residual urine volume, but increased bladder pressure, which was regarded as improved. However, 18 patients were improved after regular bladder training. The postoperative urodynamic results in 9 patients showed that the average bladder pressure, average urethra pressure, residual urine volume and maximal bladder capacity were 1.2 kPa, 1.15 kPa, 30 - 50 mL and 300 -600 mL, respectively. Of the 81 cases, 63 cases were followed up completely for 6 months whereas the others had no complete follow-up data. The follow-up results showed significant outcomes in 56 cases, improvement in 5 and no effect in 2, with the total effective rate of 97%.CONCLUSION: Satisfactory results can be obtained by combined augmentative ileocystoplasty with strengthening of pelvic floor by iliopsoas for children with hyer-reflexic neuropathic urinary incontinence. The combination of micturition reflex and control training after operation produces obvious therapeutic effects.

BACKGROUND: There are various surgical treatments to neurogenic urinary incontinence, and the curative effects differ a lot. The present research was to study the effect of surgical treatment of neurogenic urinary incontinence.OBJECTIVE: To evaluate the therapeutic effect of cystectasy using a demucosalized ileoseromuscular layer patch containing neurovascular pedicle for the patients with overactive neurogenic urinary incontinence to suggest for improvement in operations.DESIGN: A retrospective case analysis based on the study of the patients.SETTING: Department of pediatric surgery of a university hospital.PARTICIPANTS: A follow-up study was conducted to 68 patients who were treated at the Department of Pediatric Surgery of the First Affiliated Hospital of Zhengzhou University from April 1998 to January 2004 for neurogenic urinary incontinence. There were 38 cases with full follow-up data.METHODS: All the 38 patients with overactive neurogenic urinary incotinence underwent bladder augmentation using a demucosalized ileoseromuscalar layer patch containing neurovascular pedicle and were followed up for 4to 69 months, and 17.2 months in average. Among the patients, 34 with pelvic diaphragm ptosis were treated with pelvic diaphragm strengthening at the same time.MAIN OUTCOME MEASURES: The preoperative and postoperative symptoms, bladder compliance and maximum bladder capacity and the relative safe bladder capacity were studied.RESULTS: Thirty of 38 patients showed improvement in the symptoms of urinary incontinence(micturition interval ＞ 1 hour) after the operation. The results of urodynamics showed that the all patients with bladder augmentation using a demucosalized ileoseromuscular layer patch containing neurovascular pedicle urinated under abdominal pressure, and no active contraction of detrusor urinae was detected. The compliance, the maximum bladder capacity and the relative safe bladder capacity were increased by(27.43 ± 24.78) mL/kPa (P ＜0.01), (122. 18±79.99) mL(P ＜0.01) and(98.63 ±86.78) mL ( P ＜ 0.01 ) respectively. No aggravation of upper urinary function injury was observed after the operation.CONCLUSION: The bladder augmentation using a demucosalized ileoseromuscular layer patch ontaining neurovascular pedicle can protect the upper urinary function, and it is an effective approach to treating overactive neurogenic urinary incontinence.

Constriction, Pathologic ; Humans ; Vascular Diseases

Connective Tissue Growth Factor ; Humans ; Myocardial Infarction ; physiopathology ; Ventricular Remodeling

BACKGROUND: How to solve the source of material substitute for repair of urethral dcfoct and improve the blood supply of new urethra has become a critical problem in the urethral repair and reconstruction.OBJECTIVE: To investigate the effects of endothelial progenitor cells (EPCs) on improving blood circulation in the new urethra following urethral defect repair.DESIGN,TIME AND SETTING: In vivo tissue engineering experiment,performed at the Laboratory of Deparanent of Surgery,First Affiliated Hospital of Zhengzhou University between January 2006 and February 2008.MATERIALS: Thirteen 3-5-month-old male Japanese rabbits were included for this study.Of them,one was used for preparation of bone marrow mononuclear cells,and the remaining twelve rabbits were divided into EPC repair group (n=8) and model group (n=4).METHODS: Under the aseptic condition,bone marrow was taken from the rabbit bilateral anterior superior lilac spine.Mononuclear cells isolated by Percoll method were induced in vitro using medium supplemented with vascular endothelial growth factors (VEGFs) and bovine basic fihroblast growth factors.When covering the whole bottom of culture flask,the mononuclear cells were digested with trypsin for passage.Animal models of urethral defect were developed in the two groups.One piece of aseptic fresh acellular human amnion (1 cm2) was sutured to each defected urethra using 0/6 DG suture for forming urethra.In the EPC repair group,1010/L passage 3 rabbit bone marrow mononuclear cell suspension was injected to two anastomotic stomas of the new urethra,0.1 mL for each stoma.The subcutaneous tissue was interruptedly sutured to the formed urethra using 0/6 DG suture.In addition,0.5 mL bone marrow mononuclear cell suspension was added to the region between each anastomotic stroma and newly repaired urethra.The same procedure was performed in the model group except that bone marrow mononuclear cell suspension was replaced by cell-free medium.At weeks 4 and 12 after surgery,paraffin sections of urethral tissue were made.MAIN OUTCOME MEASURES: Identification of cellular morphology; vascular regeneration of urethral tissue after urethral defect repair.RESULTS: After surgery,rabbit bone marrow mononuclear cells adhesively grew in vitro.Four days later,these cells exhibited rapid clone-like growth.Ten days later,they had typical slabstone-like change,presenting with strip-shaped and bundle-shaped growth.The phenotype of cultured cells gradually turned from CD34+/CD 133+/CD31+ to CD34+/CD 1337CD31+.At weeks 4 and 12 after surgery,the number of regenerate,d blood capillaries in the urethral tissue was significantly greater in the EPC repair group than in the model group (t=-9.034 to 5.985,P ＜ 0.01).CONCLUSION: Rabbit bone marrow mononuclear cells-differentiated EPCs can apparently improve local blood circulation in the urethral defect repair.

Objective To explore the determination of urinary angiotensinogen (uAGT) in the urine of children with obstructive hydronephrosis and its relationship with impaired renal function, to provide a new and rapid reference index for the preoperative evaluation and postoperative follow-up of the children with hydronephrosis.Methods The data were collected from 48 children who were diagnosed as unilateral congenital renal pelvis and ureter obstruction in the outpatient or inpatient Department of Pediatric Surgery of the First Affiliated Hospital of Zhengzhou University,which were divided into operation group and non-operation group.There were 28 children in operation group(who were all severe hydronephrosis) ,who were all operated with dismembered pyeloplasty.There were 20 children in the non-operation group (who were all mild and moderate hydronephrosis).They temporarily had no surgery signs and hydronephrosis did not become increasingly serious for assuring the regular outpatient follow-up after being diagnosed as hydronephrosis;there were 20 children in the control group, 10 of which were male, and 10 female.The males were hospitalized children with hydrocele and the females were with inguinal hernia.Gender composition among the 3 groups, and the average age difference was not statistically significant.The clean urina of children in 3 groups was collected,3 times for operation group, once before operation and once in 6 weeks and once in 12 weeks after operation;3 times for non-operation group and control group with interval of 6 weeks in outpatient clinic.The children in operation group and non-operation group were all scanned for glomerular filtration rate (GFR) of diseased renal with radionuclide;enzyme-linked immunosorbent assay (ELISA) was adopted to determine the content of uAGT in the urine of the 3 groups of children, and automatic biochemical analyzer was used to measure the amount of urine creatinine (uCr).Results Before operation, in 6 weeks and 12 weeks after operation, uAGT / uCr average water of non-operation group and control group was significantly lower than the operation group, all the differences were statistically significant (F =34.360,14.683,5.035, all P ＜ 0.05).Preoperative and postoperative uAGT / uCr and GFR of diseased renal were of negative correlation(r =-0.647,-0.786, all P ＜ 0.05).In operation group, the preoperative and postoperative GFR average of diseased renal was 37.18 ± 7.31 and 45.27 ± 8.18.The difference of GFR changes was statistically significant before and after treatment (t =-3.971, P =0.000).Conclusions uAGT/uCr increased evidently in congenital renal pelvis and ureter obstruction patients who needed operation, so increase of uAGT might be the indicator of impaired renal function caused by obstructive hydronephrosis of children.

Objective:To study the curative efficacy of transabdominal ultrasound-guided Lauromacrogol combined with radiofrequency ablation in the treatment of fibroid and its effects on the serum estradiol (E2),luteinizing hormone (LH),follicle stimulating hormone (FSH) levels.Methods:90 patients of fibroid who were treated from June 2014 to June 2015 in our hospital were selected as the research objects.According to random number table,those patients were divided into the observation group (n=45) and the control group (n=45).Both groups were routinely examined before operation,the control group was treated with transabdominal ultrasound radiofrequency ablation,while the observation group was treated with transabdominal ultrasound-guided percutaneous radiofrequency ablation combined with radiofrequency ablation,Then visual analogue scale (VAS),menstrual volume,uterine fibroid volume,uterine volume,E2,LH,FSH levels,myoma symptoms and quality of life score,curative effect were compared between two groups.Results:After treatment,the total effective rate of observation group was significantly higher than that of the control group [95.55％(43/45)vs75.55％(34/45)] (P＜0.05);the VAS score,menstrual volume were significantly lower than those of the control group[(1.05± 0.23)score vs.(3.62± 0.50)score,(192.35± 22.10)mL 1 vs.(236.54± 24.57)mL](P＜0.05);The myoma volume,uterine volume were significantly lower than those of the control group[(32.13± 13.20)cm3 vs(40.81± 14.11)cm3,(101.93± 9.89)cm3 vs(118.36±11.20)cm3](p＜0.05);the serum E2,LH,FSH levels were significantly lower than those before treatment,but there was no difference between the two groups (P ＞0.05);the fibroid symptoms score was significantly lower than that of the control group [(4.50 ± 1.02)score vs.(10.34± 2.21)score] (P＜0.05),the quality of life score was significantly higher than that of the control group [(95.36± 14.29)score vs.(80.84 ±14.06)score] (P ＜ 0.05).Conclusion:Transabdominal ultrasound-guided lauromacrogol combined with radiofrequency ablation could enhance the efficacy of fibroid,which might be related to the decrease of serum levels of E2,LH,and FSH.

Objective To test the differential proteomics by using proteomic technology of children diagnosed with nephroblastoma and healthy children,thereby for screening non-stress-related protein markers of Wilms' tumor.Methods The serum of children with Wilms' tumor,children with trauma in 1-3 hours and healthy children were collected in the First Affiliated Hospital of Zhengzhou University from May 2010 to May 2014.Then,the differential proteomics were screened and the interference of traumatic stress proteins in the process were eliminated by using proteomic technology of surfaced enhanced laser desorption/ionization time of flight mass spectroscopy (SELDI-TOF-MS),matrix-assisted laser desorption/ionization time-of-flight mass spectroscopy (MALDI-TOF-MS),high performance liquid chromatography(HPLC),and two dimensions-liquid chromatography-linear trap quadrupole-mass spectrometer(2D-LC-LTQ-MS),therefore the non-stress-related protein biomarkers of Wilms' tumor were determined.Results A mass-to-charge ratio 6630.58 Da protein or peptide was selected as tumor-specific marker.And there were no same or similar proteins in mass spectrometry of children with traumatic stress by SELDI-TOF-MS.Finally,by purification through HPLC and identification through MALDI-TOF-MS and 2D-LC-LTQ-MS,apolipoprotein CI(APO CI) was found to be the non-stress-related serum protein of Wilms' tumor.Conclusions It is identified that APO CI is an important serum protein biomarker of Wilms' tumor by using proteomic technology in eliminating the influences of interference factors of stress.Therefore,the results provide possibilities of further studies and investigating the mechanisms of the protein expression changes and early diagnosing the Wilms' tumor.

Objective To evaluate the efficacy and safety of solifenacin in the treatment of bladder spasm after surgical operation of chlidren hypospadias.Methods From January 2014 to May 2015,60 cases of children more than 4 years old after surgical operation of hypospadias who had symptom of bladder spasm on the day of surgery were assigned into the study group (n =30) and control group (n =30),based on simple randomization.On the first day,the frequency of spasm,the duration of spasm and the incidence of urine extravasation were recorded regarded as the first day condition of bladder spasm.Patients in the study group were treated with solifenacin (5 mg once daily) for a nine days period from l th day postoperation.Patients in the control group were not treated with solifenacin.The frequency of spasm,the duration of spasm and the incidence of urine extravasation of the two groups were recorded and compared on the 3th and 9th day.Adverse events with solifenacin of two groups were recorded.The function of liver and kidney in the study group were recorded and compared.Results There were statistically significant differences(P ＜0.01) in favor of the study group over the control group in the aspect of the frequency of spasm,the duration of spasm and the incidence of urine extravasation on the 3th and 9th day.In the study group,the data compared among l th,3th and 9th was statistically significantly different,opposite to the control group.There was no statistically significant difference between the liver and kidney function of preoperation and the 9th day in the study group.The frequency of adverse events between two groups had no statistically significant difference.Conclusions Solifenacin is effective and safe in the treatment of bladder spasm after surgical operation of chlidren hypospadias

Objective:To investigate the efficacy of robot-assisted laparoscopic surgery in heminephrectomy in children.Methods:The clinical data of 54 children with heminephrectomy in the First Affiliated Hospital of Zhengzhou University from January 2017 to December 2019 was analyzed retrospectively, of which 42 cases underwent laparoscopic heminephrectomy (LH group) and 12 cases underwent robot-assisted laparoscopic heminephrectomy (RALH group). In LH group, there were 17 males and 25 females, with an average age of (71.74±34.57)months, 29 on the left and 13 on the right. In RALH group, there were 4 males and 8 females, with an average age of (76.83±37.33) months, 9 on the left and 3 on the right. There was no significant difference in age, sex composition and deformity side between the two groups ( P > 0.05). The clinical indexes such as operation time, intraoperative blood loss, postoperative drainage time, hospital stay and postoperative complications were compared between the two groups. Results:There were significant differences in operation time[(196.48±21.92)min vs.(171.50±24.91)min], intraoperative blood loss[(34.14±8.63)ml vs.(18.50±5.92)ml], postoperative drainage time[6.0(5.0, 7.0)d vs. 4.5(3.0, 6.5)d] and postoperative hospital stay[(8.93±1.70)d vs.(7.33±1.37)d] between LH and RALH groups ( P < 0.05). During the follow-up from 3 months to 2 years, the lower kidneys of the two groups developed well and the symptoms before operation such as urinary tract infection, intermittent voiding leakage and dysuria caused by ureterocele were gradually relieved and disappeared after operation. In the LH group, 2 cases were complicated with the symptoms as ureteral stump effusion, cyst formation and recurrent ureteral stump infection after operation, which were cured after reoperation. There was no case of ureteral stump effusion and cyst formation in the RALH group. Conclusions:Robot-assisted laparoscopic heminephrectomy in children has shorter intraoperative blood loss, postoperative drainage time and hospital stay, lower incidence of postoperative complications, and has better efficacy and safety.