经尿道等离子整块切除术治疗直径<2 cm非肌层浸润性膀胱肿瘤

目的探讨经尿道等离子环状电极肿瘤整块切除术治疗直径2 cm的非肌层浸润性膀胱肿瘤的临床疗效。方法将2016年4月～2018年5月42例直径2 cm非肌层浸润性膀胱肿瘤随机分成2组各21例,分别行经尿道等离子肿瘤整块切除术(整块切除组)或经尿道膀胱肿瘤电切术(transurethral resection for bladder tumor,TURBT)(TURBT组),比较2组手术时间、术中出血量、手术并发症发生率及术后复发率。结果 2组手术时间、术中出血量、并发症发生率无统计学差异(P 0. 05),但在术后复发率方面整块切除组优于TURBT组[4. 8%(1/21) vs. 33. 3%(7/21),log-rankχ~2=4. 670,P=0. 031]。结论经尿道等离子环状电极肿瘤整块切除术治疗直径2 cm的非肌层浸润性膀胱肿瘤,复发率低,无膀胱穿孔及大出血等严重并发症,适合基层医院推广。     

两种经尿道膀胱肿瘤切除术治疗非肌层浸润性膀胱癌的疗效比较

目的：比较非肌层浸润性膀胱癌的两种经尿道膀胱肿瘤切除手术治疗效果。方法将71例非肌层浸润性膀胱癌患者随机分为两组,分别采用经尿道钬激光切除术（ HoLRBT,n ＝33例）和等离子电切术（ TURBT,n＝38例）治疗,比较两组疗效。结果两组患者手术时间、术后住院天数、复发率、治愈率比较,差异无统计学意义（ P ＞0．05）;但HoLRBT组术中出血量、闭孔神经反射、膀胱穿孔、术后低钠血症发生率明显低于TURBT组,差异有统计学意义（ P ＜0．05）。结论较之 TURBT,HoLRBT在治疗非肌层浸润性膀胱癌方面具有安全、有效、并发症少等特点,优势明显。     

经尿道钬激光切除术治疗非肌层浸润性膀胱癌的临床疗效的Meta分析

目的比较经尿道钬激光膀胱肿瘤切除术(HOLBT)与经尿道膀胱肿瘤电切术(TURBT)治疗非肌层浸润性膀胱癌的疗效以及安全性。方法检索PubMed、Cochrane图书馆、Web of Science、中国知网、维普数据库及万方数据库关于HOLBT和TURBT治疗非肌层浸润性膀胱癌的比较性研究文献。按Cochrane操作手册筛选文献、提取资料并评价文献质量后, 采用RevMan 5.2软件分析两种术式在手术时间、术中出血量、闭孔神经反射、膀胱穿孔和术后2年复发率方面是否存在差异。结果纳入9篇随机对照试验, 共1 338例患者, 其中HOLBT组621例, TURBT组717例。HOLBT组的手术时间较短, 术中出血量较少, 而闭孔反射和膀胱穿孔明显低于TURBT组, 差异均有统计学意义(均P<0.05)。两组术后2年复发率比较, 差异无统计学意义(P>0.05)。结论在治疗非肌层浸润性膀胱癌中, HOLBT与TURBT的疗效相当, 但安全性优于TURBT。     

膀胱肿瘤及前列腺增生同期经尿道切除的中期随访结果

目的 评估同时行经尿道膀胱肿瘤电切(TURBT)和前列腺汽化切除(TUVP)治疗非肌层浸润性膀胱肿瘤合并有严重下尿路症状前列腺增生患者的疗效.方法 对2004年至2008年期间45例行TURBT+TUVP和126例单纯行TURBT的非肌层浸润性膀胱肿瘤患者的肿瘤复发率、进展率和后尿道种植率进行比较.结果 TURBT+TUVP组的肿瘤复发率、进展率和后尿道种植率分别为26.7%、8.9%和4.4%;TURBT组分别为27.8%、8.7%和4.8%,两组比较差异无统计学意义(P>0.05).结论 同时行TURBT+TUVP治疗非肌层浸润性膀胱肿瘤合并有严重下尿路症状的前列腺增生患者是安全、有效的.     

经尿道等离子整块切除术在非肌层浸润性膀胱癌中的应用研究

目的探讨经尿道双极等离子肿瘤整块切除术(ERBT)治疗非肌层浸润性膀胱癌(NMIBC)的临床效果。方法回顾性分析2019年1月至2021年6月本院泌尿外科治疗的79例非肌层浸润性膀胱尿路上皮癌患者的临床资料, 其中观察组行经尿道双极等离子ERBT治疗(39例), 对照组行常规经尿道膀胱肿瘤电切术(cTURBT)治疗(40例)。所有患者术后规律行盐酸吡柔比星膀胱灌注化疗, 术后3、6、12、24个月行泌尿系彩超、膀胱镜检查。观察并分析比较两组患者的手术时间、术中出血量、留置尿管时间、术中不良事件发生情况及术后复发情况。结果 79例患者均成功完成手术, 无中转开放手术, 无输血病例。两组患者的手术时间、术中出血量、留置尿管时间及闭孔发射发生率比较, 差异均无统计学意义(均P>0.05)。观察组的逼尿肌可见率高于对照组[92.3% (36/39)vs. 52.5%(21/40), P<0.05]。两组患者均无围手术期大出血、膀胱穿孔发生。观察组肿瘤复发5例(12.8%), 对照组复发14例(35.0%), 两组2年内总复发率比较, 差异有统计学意义(P<0.05);对照组的...     

第二次经尿道膀胱肿瘤电切术预防高危非肌层浸润性膀胱癌术后肿瘤复发的临床研究

目的 探讨高危非肌层浸润性膀胱癌患者行二次经尿道膀胱肿瘤电切(TURBT)术的意义.方法 已行第一次TURBT的高危非肌层浸润性膀胱癌患者70例随机分为对照组和二次TURBT:对照组患者在电切术后行膀胱内化疗药物(丝裂霉素C)灌注治疗;二次TURBT组完成对照组治疗,术后3个月第一次复查时行第二次TURBT为实验组.两组患者随访2年,观察肿瘤复发的情况.结果 2年内实验组患者膀胱肿瘤的复发率相比对照组患者的复发率显著降低(P<0.05).结论 第二次TURBT术能有效降低高危非肌层浸润性膀胱癌患者术后肿瘤复发率.     

高频能量发生器经尿道膀胱肿瘤电切术治疗非肌层浸润性膀胱癌(附43例报道)

目的 探讨应用高频能量发生器(HFG)经尿道膀胱肿瘤电切术治疗非肌层浸润性膀胱癌的安全性和有效性.方法 采用HFG的能量助推双极等离子电切单元行经尿道膀胱肿瘤电切术(TURBT)治疗非肌层浸润性膀胱癌43例,能量助推混切电极切除肿瘤直达深肌层,同时扩大到电切距肿瘤基底边缘1cm范围的正常组织,术后个体化定期膀胱内灌注羟基喜树碱.结果 手术时间15 ～ 55min,平均30min.全组无膀胱穿孔病例,31例侧壁或伴发侧壁肿瘤者有15例发生不同程度的闭孔神经反射.全组随访6 ～18个月,复发4例,均行再次电切.结论 HFG经尿道膀胱肿瘤电切术治疗非肌层浸润性膀胱癌安全有效.     

GL-EBR术对NMIBC患者复发和进展的影响

目的探讨经尿道膀胱肿瘤电切术(TURBT)与经尿道膀胱肿瘤绿激光整块剜除术(GL-EBR)对非肌层浸润膀胱癌(NMIBC)患者复发及进展的影响。方法回顾性分析2018年1月至2020年7月于本院进行治疗的138例NMIBC患者的临床资料, 其中77例患者行TURBT治疗(对照组), 61例患者行GL-EBR治疗(观察组)。对比两组患者的一般资料、术中相关指标、术后复发率以及术后并发症情况。同时, 根据病理结果的肿瘤级别情况进一步将患者分为高级别TURBT组(A组, 17例)、高级别GL-EBR组(B组, 21例)、低级别TURBT组(C组, 60例)、低级别GL-EBR组(D组, 40例), 对比不同肿瘤级别亚组之间的术中相关指标、术后复发率以及术后并发症发生率等。结果两组患者的一般资料比较, 差异无统计学意义(P>0.05), 观察组与对照组的手术时间、膀胱穿孔例数比较, 差异均无统计学意义(均P>0.05), 观察组的术中出血量、闭孔神经反射例数少于对照组, 术后复发率低于对照组, 差异均有统计学意义(均P<0.05);观察组和对照组的术后并发症比较, 差异无统计...     

经尿道钬激光整块切除术治疗非肌层浸润性膀胱癌的疗效分析

目的:比较经尿道膀胱肿瘤钬激光整块切除术(HOL-ERBT)与传统经尿道膀胱肿瘤电切术(TURBT)治疗非肌层浸润性膀胱癌(NMIBC)的疗效及安全性。方法:回顾性分析接受HOL-ERBT的85例NMIBC患者和同期接受TURBT的62例NMIBC患者的临床资料。比较两组手术时间、病理肌层检出率、手术并发症、肿瘤复发率等指标。结果:两组患者性别、年龄、肿瘤大小、肿瘤多发性和肿瘤分级比较差异无统计学意义。HOL-ERBT组和TURBT组患者的手术时间分别为(48.92±5.89) min和(51.00±7.17) min,膀胱穿孔率分别为8.24%和8.06%,创缘外复发率分别为3.53%和3.22%,肿瘤进展率分别为5.88%和3.23%,差异均无统计学意义(P0.05)。两组病理肌层检出率分别为89.41%和54.84%,闭孔反射率分别为0和11.29%,原位复发率分别为23.53%和38.71%,差异均有统计学意义(P0.05)。结论:HOL-ERBT应用于NMIBC的治疗显示出切除组织相对完整、围术期并发症少、疗效确切的优点,可作为TURBT治疗NMIBC的有效补充,值得进一步研究并推广。     

经尿道双极等离子电切术与剜除术治疗非肌层浸润性膀胱癌的病例对照研究

目的对比经尿道膀胱肿瘤等离子电切术（TURBT）与经尿道膀胱肿瘤等离子剜除术（TUEBT）治疗非肌层浸润性膀胱肿瘤（NMIBT）的临床疗效。 方法回顾性分析中山大学附属第三医院粤东医院2013年8月至2017年8月的160例经尿道膀胱肿瘤切除的资料,所有患者术前临床分期均为T1N0M0,其中TURBT和TUEBT各80例,采用全麻或腰硬联合麻醉联合闭孔神经阻滞,行经尿道膀胱肿瘤电切或剜除术。 结果术前两组的临床资料差异无统计学意义,两组患者均顺利完成手术,无输血病例。无严重并发症（膀胱穿孔、严重闭孔神经反射）发生。TURBT组和TUEBT组在手术时间、膀胱穿孔率、术后肿瘤病理分级、术后病理T分期、术后随访时间上差异均无统计学意义,而在术中失血[（15±7）ml vs（6±2）ml,P<0.05],住院天数[（5.8±2.3）d vs（3.6±1.4）d,P<0.05],二次电切率（70.00%vs 36.25%,P<0.05）,二年内肿瘤复发率（47.50%vs 31.25%,P<0.05）差异有统计学意义。 结论TURBT与TUEBT均是安全、有效的处理NMIBT的手术方法,但TUEBT大多数标本含有肌层,有利于判断分期,减少了二次电切率,缩短住院时间,降低术后复发率。     

Automatic evaluation of ultrasonography-estimated bladder weight and bladder wall thickness in community-dwelling men with presumably normal bladder function

Study Type – Diagnostic (exploratory cohort) Level of Evidence 2b What's known on the subject? and What does the study add? The diagnostic potential of ultrasound derived measurements of bladder wall thickness and bladder weight in men with LUTS and varying degrees of BOO have been explored. However, there is a paucity of such measurements in the asymptomatic population with which to compare such patients. This study investigates these measurements in community‐dwelling men with presumably normal bladder function.

OBJECTIVE

• ? To identify measurements of ultrasonography (US)‐derived bladder wall thickness (BWT) and bladder weight in community‐dwelling men with presumably normal bladder function.

SUBJECTS AND METHODS

• ? A total of 100 male volunteers underwent transabdominal US measurements of BWT and bladder weight, using the BVM 9500 bladder scanner (Verathon Medical, Bothell, WA, USA), at a variety of bladder filling volumes.
• ? The data were explored for any correlation between measurements of BWT and US‐estimated bladder weight (UEBW) with subject age, height, weight, body mass index (BMI), International Consultation on Incontinence Questionnaire – Male Lower Urinary Tract Symptoms (ICIQ M‐LUTS) score, International Prostate Symptom Score (IPSS) and IPSS Quality of Life index (IPSS QoL).

RESULTS

• ? Several statistically significant but weak correlations were observed: BWT and weight (r= 0.216, P= 0.032); BWT and BMI (r= 0.246, P= 0.014); UEBW and weight (r= 0.304, P= 0.002); and UEBW and BMI (r= 0.260, P= 0.009).
• ? Bladder filling volume appeared to have a greater effect on BWT than on UEBW, although this could not be determined accurately.
• ? There was a substantial difference in measurements of BWT and UEBW in the assessment of inter‐ and intra‐observer reliability testing.

CONCLUSION

• ? Further studies are required to validate automated measurements of BWT and UEBW and to investigate such measurements in the symptomatic and asymptomatic male population.

     

Evaluation of urinary continence and voiding function: early results in men with neo-urethral modification of the Hautmann orthotopic neobladder

PURPOSE: At our institution we use the Hautmann orthotopic bladder replacement with a chimney and neo-urethral modification. A neo-urethral tube allows tension-free intestino-urethral anastomosis, thus providing application of this procedure for patients who may otherwise not qualify due to the inability of the small bowel to reach the urethra. However, this neo-urethral tube may also enhance continence by providing significant intra-abdominal urethral length. Conversely, such a modification may be associated with a higher degree of urinary retention. Early evaluation and reporting on the results of this procedure appear warranted. MATERIALS AND METHODS: From April 1996 to March 2000, 14 consecutive male patients underwent cystoprostatectomy and urinary reconstruction with Hautmann repair using chimney and neo-urethral modifications. We performed a retrospective analysis of urinary function and continence with data obtained from patient questionnaires completed preoperatively and at each postoperative office visit. The examining physician chart notes were reviewed for information about urinary retention. The American Urological Association symptom score and voiding bother index were used to assess urinary function and bother, respectively. Urinary continence was defined as the complete absence of any form of urinary leakage protection. RESULTS: Of the 14 patients 12 were completely continent day and night, with a median followup of 17 months. There were 2 patients who wore pads less than 7 months after surgery. Improvement of urinary continence appeared to continue up to 12 months postoperatively. Despite this encouraging effect, when our data were compared to the published literature, we noted a somewhat increased incidence of patients requiring clean intermittent catheterization to manage significant post-void urinary residuals. We had no patients with urethro-intestinal strictures who required clean intermittent catheterization. CONCLUSIONS: The neo-urethral tube modification appears to have a significant and favorable impact on urinary continence while seeming to be associated with a trend towards an increased rate of chronic urinary retention. Longer followup will be required to determine whether this higher rate of chronic urinary retention will remain stable or change with time.     

Urine based markers of urological malignancy

PURPOSE: A number of urine based markers have been and are being investigated for the diagnosis and prognostication of urological conditions. A majority of these markers have been evaluated in urological neoplasms, particularly bladder cancer. The diagnosis of bladder cancer currently relies on identifying malignant cells in the urine and subsequently visualizing the tumor on cystoscopy. This diagnosis is further confirmed by transurethral resection or biopsy. While urine cytology is specific, it is not sensitive, especially for detecting low grade disease. This characteristic has prompted the search for more accurate markers of bladder cancer. In this review we critically examine the results of studies evaluating various markers for bladder cancer. MATERIALS AND METHODS: The published literature on urine based markers for all urological diseases, particularly bladder cancer, was identified using a MEDLINE search and critically analyzed. The sensitivity, specificity, positive and negative predictive values of the various markers were compared. The benefit of using combined markers rather than a single marker was also analyzed from published reports. RESULTS: Most published literature on urine based markers for urological malignancies involve such markers for diagnosing and prognosticating bladder cancer. Hence, we focused mainly on urine based markers in bladder cancer. Most markers appear to have an advantage over urine cytology in terms of sensitivity, especially for detecting low grade, superficial tumors. However, most markers tend to be less specific than cytology, yielding more false-positive results. This scenario is more common in patients with concurrent bladder inflammation or other benign bladder conditions. However, there is reason to be optimistic about several new markers that appear to provide better specificity. Few urine based markers have been identified and investigated in other urological tumors. CONCLUSIONS: Detecting bladder cancer using diagnostic markers still presents a challenge. A number of new markers are currently available that appear to be significantly more accurate than cytology. However, further studies involving a larger number of patients are required to determine their accuracy and widespread applicability for diagnosing bladder cancer. Urine based markers do not appear to have a significant role in the diagnosis or prognosis of other urological malignancies, such as prostate, kidney or testicular cancer.     

两种膀胱扩大术治疗神经源性膀胱比较分析

目的:比较膀胱自扩大术和回肠膀胱扩大术治疗神经源性膀胱的临床效果。方法:回顾分析膀胱自扩大术10例,回肠膀胱扩大术13例患者临床资料,对两种术式的手术方法,手术前后患者膀胱容量,肾功能以及临床症状进行比较。结果:膀胱自扩大术和回肠膀胱扩大术的患者术后平均安全膀胱容量显著增多,分别为(178.2±31.8)vs(420.7±54.9)ml,(115.9±19.5)vs(517.4±48.3)ml(P<0.05),顺应性明显改善。前者尿失禁消失8例,明显改善1例;术后血清肌酐水平恢复正常6例,明显下降2例,肾积水明显缓解或消失,未发现膀胱输尿管反流现象;后者尿失禁消失9例,明显改善2例,血清肌酐水平6例恢复正常,1例明显下降,肾积水情况均较术前明显缓解或消失,膀胱输尿管反流消失;术后3例出现尿路感染;1例轻微漏尿;1例出现腹泻;3例出现肠梗阻;2例出现膀胱结石,均对症处理后好转。结论:膀胱自扩大术较为简单、安全,但其适应证把握应慎重。回肠膀胱扩大术是治疗神经源性膀胱有效的手术方式,其适应证相对广,但并发症较多。     

Toward a new classification of overactive bladders

Based on a large retrospective series, this study compares the International Continence Society's (ICS) classification of overactive bladders and a functional subtyping of our own, founded on clinical and urodynamic parameters. Functionally identical symptoms and urodynamic patterns were found within the Detrusor Hyperreflexia as well as the Unstable Detrusor categories. There are strong arguments for a revision of the current ICS classification system. © 1995 Wiley-Liss, Inc.     

经尿道膀胱肿瘤电切术后膀胱灌注吡柔比星治疗浅表性膀胱肿瘤42例报告

目的探讨吡柔比星膀胱灌注对治疗浅表性膀胱癌术后复发的预防效果。方法42例患者,在行经尿道膀胱肿瘤电切术（TURBt）术后定期经导尿管给予膀胱内灌注吡柔比星30mg／40ml,每周1次,每次膀胱内保留60min,共8次,术后3个月行1次膀胱镜检查。结果共有4例复发。42例患者有不同程度的膀胱区不适,3例症状较重。结论吡柔比星膀胱内灌注预防肿瘤术后复发疗效显著、安全、可靠。