Objective:To investigate the long-term efficacy and complications of augmentation uretero-enterocystoplasty (AUEC).Methods:The clinical data of 262 patients with lower urinary tract dysfunction who underwent AUEC at our center from January 2003 to June 2022 were analyzed retrospectively. There were 193 males and 69 females, the median age was 24 (4, 67) years, the median disease duration was 12.0 (0.2, 56.0) years and the preoperative creatinine was 91.5 (68.1, 140.0) μmol/L. 320 ureters had high-grade UUTD, 216 ureters had VUR, 14 of which had low-pressure reflux.The number of low-grade VUR ureter was 22 (10.2%) and the number of high-grade VUR ureter was 194 (89.8%). Video-urodynamics showed that the maximum bladder capacity was 102 (47, 209) ml, the maximum detrusor pressure was 33.0 (15.5, 50.5) cmH 2O, and the bladder compliance was 6.4 (3.0, 12.3) ml/cmH 2O. All patients underwent AUEC. The surgical method is to cut a segment of sigmoid colon, open the sigmoid colon along the mesenteric margin, fold and suture it into " U" or " S" shaped intestinal mesh according to the principle of " detubulization" . At the same time, perform ureteroplasty and replanting, and then anastomosis the intestinal mesh with the opened bladder flap to form an expanded new bladder. Follow-up was performed via outpatient clinic or telephone. The creatinine, maximum bladder capacity, maximum detrusor pressure, bladder compliance, ureteral reflux and upper urinary tract dilatation were compared preoperatively and postoperatively. The postoperative complications were also evaluated. Results:The median follow-up time was 57.4 (4, 151) months after surgery. At 1-3 months after surgery, the maximum bladder capacity and bladder compliance increased to 303.9% and 189.9% of the preoperative level, and the maximum detrusor pressure decreased to 63.6% of the preoperative level. At 6-10 years after surgery, the maximum bladder capacity and bladder compliance increased to 490.2% and 627.9% and the maximum detrusor pressure decreased to 25.8% of the preoperative level. The UUTD of the patients was significantly reduced after surgery. The number of the high grade UUTD decreased to 116 (116/398, 29.2%) at 1-3 months and 51 (51/274, 18.6%) at 4-6 months. At 6-10 years, the number of the high-grade UUTD decreased to 4 (4/76, 5.3%) ( P<0.001), which was significantly lower than that before operation. The VUR was significantly relieved after operation, and 393 ureters had no VUR at 1-3 months, accounting for 97.8% (393/402) of the total ureters. Sustained remission of VUR was observed during follow-up. 73 ureters had no VUR at 6-10 years, accounting for 96.1% (73/76) of total ureters ( P<0.001). Patients' creatinine decreased to 79.0 (65.0-128.2) μmol/L at 1-3 months postoperatively, with a downward trend but no statistical difference, and creatinine levels were not significantly elevated at any postoperative time point compared with preoperative levels ( P>0.05). Postoperative complications included metabolic acidosis in 26 cases (9.9%), vesicoureteral anastomosis stenosis in 15 cases (5.7%), recurrent urinary tract infection in 16 cases (6.1%), and urinary calculi in 20 cases (7.6%), and intestinal obstruction requiring laparotomy in 8 cases (3.1%), all of them could be improved after treatments. Conclusions:AUEC is a safe and effective method for treating high-grade VUR or VUR with impaired anti-reflux mechanism, high-grade UUTD or UUTD with ureteral or vesicoureteral junction obstruction, and all of the complications can be improved after treatment. This technique can increase the bladder capacity and compliance, reconstruct the anti-reflux mechanism, and release upper urinary tract obstruction. It may play an important role in stabilizing and protecting the residual renal function from further deterioration.

Objective:To investigate the long term outcome of artificial urinary sphincter implantation for patients with stress urinary incontinence.Methods:The data of 46 patients who underwent artificial urethral sphincter implantation in China Rehabilitation Research Center from April 2002 to April 2022 were retrospectively analyzed.The patients’ age ranged from 19-80 years old (median 45.6 years). There were 45 males and 1 female. The history of illness was 8 months to 33 years. The patients category were urethral injuries associated urinary incontinence ( n=24), neurogenic urinary incontinence ( n=9) and post-prostatectomy incontinence ( n=13). Preoperative daily pad usage was 3.5±1.0. The impact of incontinence on the quality of life (QOL)measured by the visual analogue scale (VAS)was 7.1±1.2. All 46 patients underwent artificial urethral sphincter implantation, of which 20 patients were treated with anticholinergic drugs (5 cases) or urinary tract related surgery (urethral stenosis incision in 2 cases, sphincterectomy in 3 cases, urethral dilation in 5 cases, urethral calculus lithotripsy in 1 case, and augmentation cystoplasty in 4 cases) before artificial urethral sphincter implantation. Of the 45 male patients, 25 patients had the transperineal approach and 20 had the trans-scrotal approach. The female case had a trans-retropubic approach. Different cuffs size was used based on individual circumference of bulbar urethra (45 male cases: 4.5cm in 16 cases, 4.0cm in 29 cases; one female case: 8.0cm). Long-term surgical efficacy was evaluated. Assessments included postoperative urinary continence (socially continent: one pad per day or less; complete dry: wearing no pads), artificial urinary sphincter status and complications. The influences of patients of different etiologies, surgical approaches and cuff size on surgical results were compared. Results:The mean follow-up time was 7.1 years ranged from 6 months to 19 years. At the latest visit, 32 patients (69.6%) maintained the primary functional artificial urinary sphincter. Three patients (6.5%) had artificial urinary sphincter revisions and maintained continence with the new device. 11 patients (23.9%) removed the artificial urinary sphincter because of post-complications. Thirty-five patients were socially continent, of which 16 patients were totally dry, leading to the overall social continent rate as 76.1%(35/46). There was a significant reduction in pad usage to 1.2±0.6 diapers per day ( P<0.001). The impact of incontinence on the QOL measured by the VAS dropped to 2.6±1.9 ( P<0.001). The complication rate was 32.6%(15/46), including infections ( n=4), erosions ( n=5), mechanical failure ( n=3), dysurie ( n=2) and urethral atrophy ( n=1). There were no significant differences in social continent rate between patients with different etiologies[75.0%(18/24)vs. 66.7%(6/9) vs. 84.6%(11/13)], perioperative complications [37.5%(9/24)vs. 33.3%(3/9) vs. 23.1%(3/13)] and device re-intervention rate[37.5%(9/24) vs. 33.3%(3/9)vs. 15.4%(2/13)]. There were no statistically significant differences in postoperative complete dry rate [32%(8/25)vs. 40%(8/20), P=0.76] and postoperative device failure free rate [60%(15/25)vs. 80%(16/20), P=0.20] between trans-perineal group and trans-scrotal group. There was no statistically significant difference in postoperative social continent rate between 4.5cm cuff and 4.0 cuff[75%(12/16) vs. 65.5%(19/29), P=0.74]. Conclusions:Artificial urethral sphincter implantation is an effective treatment for stress urinary incontinence due to intrinsic sphincter deficiency. There was no difference in the continent rate and complication rate between patients of different etiologies, different surgical approaches and cuff size selection.

Objective To explore the technique, efficacy and complications of transurethral sphincterotomy with Holmium laser for the treatment of male patients with neurogenic bladder and examine its long-term outcome. Methods 20 male cases who received transurethral sphincterotomy with Holmium laser were included in this retrospective analysis, in which 7 cases injuried at cervical spinal cord, 6 at thoracic spinal cord, 3 at cauda equine; 1 was spinal meningocele, 1 was sacral crack, 1 was ependymoma, and 1 was myelitis sequel. The age was 20~64 years, averaged 45.1 years. They were followed up for 3~95 months (averaged 43.6 months) since the last sphincterotomy. Results The 20 patients significantly improved in symptoms, laboratory examination, imaging demonstration and urodynamic index after the operation.There were 3 patients who required repeated laser surgery during the follow- up. 17 patients were stable. Conclusion Transurethral sphincterotomy with Holmium laser is effective on neurogenic bladder with less bleeding for the appropriately selected patients.

Objective To assess clinical and urodynamic results of augmentation enterocystoplasty (AE) in patients with ncurogcnic hladdcr dysfunction (NBD).Methods Retrospectively reviewed our database between 2005-2011 to identify 77 patients who underwent AE ( sigmoid 74 patients,ileum 3 patients).Postoperativc complications,renal function,urodynamics parameters and quality of daily life were evaluated.Results The mean follow-up length was 24 months.Compared with pre-operative condition,the mean bladder capacity significantly increased from (160.6 ± 128.3) to (468.5 ± 60.6) ml (P ＜0.001 ) and the maximum detrusor pressure decreased from ( 31.1 ± 26.4) to ( 10.9 ± 4.5 ) cm H2O ( P =0.002 ).Serum creatinine level decreased from (270.3 ± 113.6 ) to ( 174.4 ± 81.3 ) μmol/(l) ( P =0.00 1 ).There were significant decrease on mean number of incontinence episodes and pads used per day ( P ＜0.01 ).Post-operative complications included metabolic acidosis in two patients (2.6％),adhesive intestinal obstruction in four patients (5.2％),deteriorating renal function in one patients ( 1.2％ ) and recurrence of vesicoureteral reflux in three patients (3.9％).Conclusions The results suggest that AE is safe and effective in treating patients with NBD.Concomitant URI is considerèd on patients with long illness history,vesicoureteral reflux at low intravesical pressures and upper urinary tract dilation.Patients with moderate and severe upper urinary tract deteriorations benefit from this procedure and the benefit can maintain a long time.

ObjectiveTo observe the effects of intravesical electric stimulation (IVES) on bladder sensation of neurogenic bladder.Methods28 patients with neurogenic bladder was evaluated, which all underwent intravesical bladder stimulation. Their bladder sensation were analyzed before and after the treatment.Results57.1% of the patients increased bladder sensation after treatment, 32.1% appeared the first sensation and urge sensation after treatment, 42.9% remained stable.ConclusionIntravesical bladder stimulation is effective to improve bladder sensation in a majority of the patients with neurogenic bladder.

ObjectiveTo study risk factors of urinary calculus formation in spinal cord injured patients. MethodsThe clinical data of 128 patients with spinal cord injury following urinary calculi were retrospectively reviewed.ResultsAmong the 128 cases, there were 32 cases receiving bladder stoma; 34 cases, regular replacement of indwelling catheter; 12 cases, intermittent catheterization; 19 cases, triggered reflex voiding; 11 cases, voiding by abdominal straining; 20 cases, condom catheters with urine collection devices. 120 cases presented with urinary tract infection, and 11 cases presented serum calcium increase. Video urodynamic suggested detrusor areflexia in 39 cases, detrusor overactivity in 63 cases, detrusor external sphincter dyssynergia in 41 cases, detrusor bladder neck dyssynergia in 11 cases, external urethral sphincter overactivity in 27 cases, and urethral sphincter deficiency in 11 cases. The pathology of several physiological conditions coexisted in some patients.ConclusionBladder management after spinal cord injury have a major impact on urinary stones formation. Low urinary tract infection, detrusor-urethral sphincter dyssynergia and other lower urinary tract dysfunction, long-term indwelling urinary catheter and cystostomy were main risk factors for urinary calculus formation. The abnormal calcium metabolism after spinal cord injury may be a risk factor for calculus formation.

Objective To evaluate the long-term outcome of reconstruction for urinary conti-nence function by using implantation of artificial urinary sphincter (AUS). Methods From 2002 to 2005,15 incontinent patients (14 men and 1 woman) with age range of 19-75 years treated with im-plantation of AUS were followed up. In 15 eases, there were 5 cases with traumatic urinary inconti-nence, 1 with neurogenic stress incontinence, 1 with neurogenic urgent incontinence,6 with postpros-tatectomy incontinence and 2 with neurogenie voiding dysfunction. Three eases had taken urethro-stenotomy, 3 had sphineterotomy and 1 had enterocystoplasty and ureterovesieostomy before the im-plantation for AUS. The patients were followed up for 13-55 months with mean of 37 months. The information about the continence status and pads usage, also the complications were collected. Results After implantation, 13 cases(87%)used AUS device normally, 12(92%)beeame dry and 1 (8%) got social continence. Eleven cases (85%) got continence depending on the original implanted AUS and 15% did continence by reoperation. There were 4 cases(27%) with complications including erosion of skin and urethral in 1, graft rejection in 1, urethral atrophy in 1, and voiding dysfunction in 1. Durability of 11 cases with original implanted devices was 13-55 months with mean of 38 months.Conclusion The implantation of AUS is a long-term reliable method in reconstruction for lower uri-nary tract function.

Objective To investigate the effect of Holmium laser urethrotomy under ureteroscopy on urethral stricture.Methods 30 men with urethral stricture who accepted urethrotomy with Holmium laser under ureteroscopy were observed.Results Operation was performed successfully in 21 cases;7 cases underwent 2～3 endoscopic surgical treatments.Endoscopic surgical treatment failed in 2 cases,and open surgery were performed on them.21 cases were followed up for 3～37 months,and 8 of them need urethral dilatation termly.Conclusion Endoscopic surgery with ureteroscopy and Holmium laser may be effective on urethral stricture with slight trauma.

Objective To evaluate the effectiveness and safety of Botulinum toxin-A (BTX-A) injection into detrusor to treat neurogenic detrusor overactivity in patients with spinal cord injury (SCI).Methods A total of 78 patients with SCI were treated with transurethral injection of BTX-A (300 IU dissolved in 15 ml of saline) into 30 different points of detrusor with 15 ml in every patients. Urodynamic parameters and voiding diary were assessed at baseline and 3 weeks and 3 months after the injections. Adverse events were recorded after the injection if present.Results After the first injection, 78 patients showed that the mean frequencies of incontinence decreased from 13.5 to 2.7 times per day, the mean volume of intermittent catheterization (IC) increased from 131 ml to 389 ml per time, the mean volume of incontinence decreased from 1 690 ml to 281 ml per day, the mean getting effect time was 7.6 days. 10 patients received second injection at 8.9 months after first injection, the results showed that the mean frequencies of incontinence decreased from 9.7 to 3.7 times per day, the mean IC volume increased from 108 ml to 387 ml. 6 patients received third injection at 5.8 months after second injection, the results showed that the mean frequencies of incontinence decreased from 9.2 to 3.9 times per day, the mean IC volume increased from 116 ml to 364 ml. No side effects were observed during the follow-up.Conclusion BTX-A injection into detrusor to treat neurogenic detrusor overactivity in patients with SCI seems to be an effective, safe and miniinvasive solution.

Objective To explore the technique,efficacy and complications of external sphincterotomy with Holmium laser for the treatment of detrusor external sphincter dyssynergia (DSD). Methods 7 male cases with neurogenic DSD who received the procedure were reported. Results All patients got significant improvement after the operation in symptoms,laboratory,imaging and urodynamic index. No one required transfusion. 1 case lost the erection. There was no need of re-operation during the follow-up. Conclusion External sphincterotomy with Holmium laser for the treatment of DSD shows the advantages of less bleeding,safety and good effectiveness for the well selected patients.