Publications by authors named "Kunlin Yang"

37 Publications

The Whitaker Test in the Follow-up of Complex Upper Urinary Tract Reconstruction: Is It Clinical Useful or Not.

Urol J 2021 May 22. Epub 2021 May 22.

Department of Urology, Peking University First Hospital. Institute of Urology, Peking University. National Urological Cancer Center, Beijing, P.R. China.

Purpose: To evaluate the feasibility and guiding significance in postoperative management of the Whitaker test after complex reconstruction of the upper urinary tract.

Materials And Methods: Patients who underwent complex ureteral reconstruction and received the Whitaker test after surgery between December 2018 and December 2019 were included. We judged it abnormal that the renal pelvis pressure was higher than 22 cmH2O or the pressure difference was greater than 15 cmH2O. The results were used as a reference for removing the nephrostomy tube. Based on whether the renal pelvic pressure was higher than 22 cmH2O, the patients were divided into the elevated pelvis pressure group and the normal group. Follow ups at 1 month and every 3 months were collected.

Results: A total of 19 patients were included. Fifteen patients did not present obvious abnormalities. One patient suffered from contrast infiltrating into the renal parenchyma, and the pressure was higher than 15 cmH2O. Ureteral stent implantation was performed. The other 3 patients had either elevated pelvis pressure or insufficient image, 2 of which prolonged the duration of nephrostomy tubes. The median follow-up time was 12.6 months. CTU/MRU after removing nephrostomy tubes indicated improved/stable hydronephrosis in all patients. The creatinine in the elevated pelvis pressure group was higher than that in the normal group (91.4 ± 27.6 vs 86.7 ± 16.5 μmol/L, P = .782), and the eGFR was lower (76.0 ± 14.0 vs 81.8 ± 24.1 mL/min/1.73m2, P = .695), but without significant difference. The change in creatinine during follow-up in the elevated renal pelvic pressure group was significantly different from that in the normal group (-13.6 ± 1.0 vs -0.2 ± 10.6 umol/L, P = .047).

Conclusion: Postoperative Whitaker test can help judge whether nephrostomy could be removed. Elevated pressure in upper urinary tract after reconstruction suggests the need to prolong the time of the nephrostomy tube or even re-intervene. Proper management for patients with elevated renal pelvis pressure can help restore the renal function.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.22037/uj.v18i.6277DOI Listing
May 2021

Clinical characteristics and surgical treatment of ureteral endometriosis: our experience with 40 cases.

BMC Womens Health 2021 05 17;21(1):206. Epub 2021 May 17.

Department of Urology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.

Background: To present the experience with the surgical management of ureteral endometriosis (UE) in our single center.

Methods: To present the experience with the surgical management of ureteral endometriosis (UE) in our single center. A retrospective analysis of 40 patients with UE who presented with intraoperative surgical findings of endometriosis involving the ureter and pathology-proven UE was performed.

Results: Forty patients (median age, 42.5 years) with histological evidence of UE were included. Six (15%) patients had a history of endometriosis. Twenty-one (52%) patients had urological symptoms, and 19 (48%) patients were asymptomatic. All patients had hydronephrosis. The mean glomerular filtration rate (GFR) of the ipsilateral kidney was significantly worse than that of the contralateral kidney (23.4 vs 54.9 ml/min; P < 0.001). Twelve (30%) patients were treated with ureteroureterostomy (11 open approaches and 1 robotic approach). Twenty-two (55%) patients underwent ureteroneocystostomy (17 open approaches, 4 laparoscopic approaches and 1 robotic approach). Five patients underwent nephroureterectomy. One patient refused aggressive surgery and received ureteroscopic biopsy and ureteral stent placement. Thirteen (33%) patients required gynecological operations. Three (8%) patients in the open group suffered from major surgical complications. Nine (24%) patients received postoperative endocrine therapy. Twenty-eight (70%) patients were followed up (median follow-up time, 71 months). Twenty-four patients received kidney-sparing surgeries. The success rate for these 24 patients was 21/24 (87.5%). The success rates of ureteroneocystostomy and ureteroureterostomy were 15/16 (93.8%) and 5/7 (71.4%), respectively.

Conclusions: Although UE is rare, we should remain vigilant for the disease among female patients with silent hydronephrosis. Typically, a multidisciplinary surgical team is necessary. For patients with severe UE, segmental ureteral resection with ureteroureterostomy (UU) or ureteroneocystostomy may be a preferred choice.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12905-021-01349-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8130255PMC
May 2021

Re: Eduard Roussel, Giovanni Tasso, Riccardo Campi, et al. Surgical Management and Outcomes of Renal Tumors Arising from Horseshoe Kidneys: Results from an International Multicenter Collaboration. Eur Urol 2021;79:133-40.

Eur Urol 2021 Jul 30;80(1):e30-e31. Epub 2021 Apr 30.

Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.eururo.2021.04.016DOI Listing
July 2021

Indocyanine green fluorescence imaging for laparoscopic complex upper urinary tract reconstructions: a comparative study.

Transl Androl Urol 2021 Mar;10(3):1071-1079

Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China.

Background: To describe our technique for using an intraureteral injection of indocyanine green (ICG) and visualization under near-infrared fluorescence (NIRF) to facilitate challenging upper urinary tract reconstructions (UUTRs) and to present the comparative outcomes.

Methods: We collected 36 patients who underwent laparoscopic UUTRs between April 2019 and March 2020, and we divided the patients into two groups based on the use of ICG (ICG group and non-ICG group). Demographic characteristics, perioperative outcomes, and functional outcomes were compared between the two groups.

Results: There were 18 cases in the ICG group and 18 cases in the non-ICG group, respectively. There were no differences in the baseline characteristics between the two groups. The intraoperative time to identification of the ureter (TIU; 20.9±11.7 30.0±14.6 min, P=0.03) and length of postoperative hospital stay (LPHS; 11.1±3.0 16.6±10.0 days, P=0.03) were significantly shorter in the ICG group. There was also a trend for lesser time for locating the stricture (43.0±27.9 55.4±18.6 min, P=0.14) and lower estimated blood loss (EBL) in the ICG group patients (88.3±75.4 91.7±46.2 mL, P=0.22). During the mean 3.8-month follow-up for the ICG group and the 6.2-month for the non-ICG group, there was a trend for more severe complications in the non-ICG group.

Conclusions: Visualizing intraureteral ICG under NIRF is useful in challenging UUTRs, allows for rapid ureteral identification and accurate real-time delineation of the ureteral stricture margins, and provides encouraging follow-up outcomes compared with those in the non-ICG group.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.21037/tau-20-1261DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8039610PMC
March 2021

Lingual mucosa graft ureteroplasty for ureteral stricture: a narrative review of the current literature.

Ann Palliat Med 2021 Apr 23;10(4):4840-4845. Epub 2021 Mar 23.

Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China.

Long proximal or middle ureteral strictures remain challenging conditions. Although ileal replacement of the ureter or renal autotransplantation are possible solutions for these problems, both present complexities and considerable morbidity. In recent years, many urologists have tended to use oral mucosal grafts to repair complex proximal or middle ureteral strictures and thereby avoid ileal replacement and renal autotransplantation. A comprehensive search of oral mucosa graft ureteroplasty and lingual mucosa graft (LMG) ureteroplasty was performed. All literatures must be in English language. Most reports related to oral mucosa graft ureteroplasty focus on buccal mucosa grafts (BMGs). The available data about LMG ureteroplasty are limited. Both LMG and BMG are oral mucosa grafts that have similar histological structures. The success rates of urethroplasty with LMG and BMG are similar. Although there is still no comparative study between LMG and BMG for ureteroplasty, the limited reports show that LMG ureteroplasty is safe and effective for the management of ureteral strictures. This method provides one more option for the management of long proximal and/or middle ureteral strictures. However, the current studies on LMG ureteroplasty have a small sample size and are retrospective. More prospective, multicenter and large sample studies with long-term follow-up results that can further prove the efficacy of LMG ureteroplasty are still needed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.21037/apm-20-2339DOI Listing
April 2021

Robot-assisted pyeloplasty using a new robotic system, the KangDuo-Surgical Robot-01: a prospective, single-centre, single-arm clinical study.

BJU Int 2021 Mar 16. Epub 2021 Mar 16.

Department of Urology, Peking University First Hospital, Institute of Urology Peking University, National Urological Cancer Center, Peking University, Beijing, China.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/bju.15396DOI Listing
March 2021

Social behavior of musk deer during the mating season potentially influences the diversity of their gut microbiome.

PeerJ 2021 3;9:e10860. Epub 2021 Feb 3.

Biology, Nanjing Norma University, Nanjing, China.

An increasing body of research has revealed that social behavior shapes the animal gut microbiome community and leads to the similarity among the same social group. However, some additional factors (e.g., diet and habitat within each social group) may also contribute to this similarity within the social group and dissimilarity between social groups. Here, we investigated the potential correlation between social behavior and the gut microbiome community in 179 musk deer from four breeding regions in the Maerkang Captive Center, Sichuan. The dominant gut microbiome phyla in the musk deer in this study were Firmicutes, Bacteroidetes, and Proteobacteria. We found significant effects on the alpha and beta diversity of the gut microbiome due to the breeding regions. The similarity within breeding regions was higher than that between the breeding regions. Due to their solitary lifestyle, captive musk deer are raised in single cages with no direct social contact most of the time. Deer in all of the breeding regions have the same diet and similar living conditions. However, during each mating season from November to January, in each region, one adult male and about six adult females will be put together into a large cage. Social behavior happens during cohabitation, including mating behavior, grooming within the same sex or between different sexes, and other social contact. Therefore, we speculated that high similarity within the breeding region might be associated with the social behavior during the mating season. This was a simple and straightforward example of the relationship between animal social behavior and the gut microbiome.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7717/peerj.10860DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7866896PMC
February 2021

Modified Laparoscopic and Robotic Flap Pyeloplasty for Recurrent Ureteropelvic Junction Obstruction with a Long Proximal Ureteral Stricture: The "Wishbone" Anastomosis and the "Ureteral Plate" Technique.

Urol Int 2021 Feb 10:1-8. Epub 2021 Feb 10.

Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China.

Objectives: The aim of the study was to present our modified flap pyeloplasty techniques for recurrent ureteropelvic junction obstruction (UPJO) with a long proximal ureteral stricture and compare outcomes of laparoscopic and robotic procedures.

Materials And Methods: Between March 2018 and January 2020, 21 patients underwent modified laparoscopic or robotic flap pyeloplasty for recurrent UPJO with a long proximal ureteral stricture. Our surgical modifications included the "wishbone" anastomosis and "ureteral plate" technique. Demographic, perioperative, and follow-up data were recorded and compared retrospectively between the groups. Success was defined as subjective pain alleviation and hydronephrosis improvement.

Results: Thirteen modified laparoscopic flap pyeloplasty (mLFP) and 8 modified robotic flap pyeloplasty (mRFP) were performed successfully without conversion. mRFP tended to have shorter overall operative time (142.4 vs. 179.1 min, p = 0.122) and anastomosis time (43.1 vs. 61.0 min, p = 0.093) than mLFP. No difference was found in estimated blood loss (p = 0.723) and pararenal draining time (p = 0.175) between the groups. The mean postoperative hospital stay of mRFP was significantly shorter than that of mLFP (5.0 vs. 8.2 days, p = 0.015). No major complications occurred. During the mean follow-up of 17.9 months, the overall success rate was 90.5%, and there was no significant difference between 2 groups.

Conclusions: The modified flap pyeloplasty could be considered a practical and effective treatment option with a high success rate for recurrent UPJO with a long proximal ureteral stricture, and the robotic procedures showed advantages of higher efficiency and faster recovery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000512994DOI Listing
February 2021

Minimally invasive ileal ureter replacement: Comparative analysis of robot-assisted laparoscopic versus conventional laparoscopic surgery.

Int J Med Robot 2021 Jun 24;17(3):e2230. Epub 2021 Feb 24.

Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China.

Background: This study is an initial comparative analysis of perioperative and intermediate-term functional outcomes between patients who underwent robot-assisted laparoscopic (RALS) or conventional laparoscopic surgery (LS).

Materials And Methods: A total of 25 patients who underwent ileal ureter replacement (10 RALS and 15 LS) were followed by functional cine magnetic resonance urography (MRU) combined with a modified Whitaker test. Also, the characteristics, perioperative data and functional outcomes of the patients were compared.

Results: The estimated blood loss, postoperative hospital stay and time to oral intake were significantly lower in the RALS group. At the median 14-month follow-up, all the patients showed improved renal function and were symptom-free, with no signs of leakage or stenosis observed by cine MRU combined with a modified Whitaker test.

Conclusions: RALS with an extracorporeal bowel resection is feasible and appears to be safe, with quick postoperative recovery and encouraging outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/rcs.2230DOI Listing
June 2021

A "bridge" technique to replace the obstructed single-J stent in the patient with ileal conduit urinary diversion: a case report.

Transl Androl Urol 2021 Jan;10(1):532-535

Department of Urology, Peking University First Hospital, Beijing, China.

The ureteroileal anastomotic stricture is a complication of ileal conduit urinary diversion. To prevent the hydronephrosis and protect the renal function, a single-J ureteral stent may be needed. However, the most common complication of these patients is single-J stent obstruction. To solve this problem, we describe an easy, useful and low-cost technique to replace the obstructed ureteral stent under radiographic guidance without intervention by flexible cystoscopy or percutaneous nephrostomy. The key steps of our procedure are to identify the location of the stricture, to place the super smooth guide wire into pinhole of the obstructed single-J stent and to get the super smooth guide wire and 5-Fr ureteral catheter across the stricture. Our case was a 40-year-old male patient who was diagnosed as pelvic lipomatosis and received ileal conduit urinary diversion 3 years ago. The left-side ureteroileal anastomotic stricture occurred 1 year after surgery. He refused to repair the stricture by open or other minimal invasive surgery. He regularly changed his ureteral stent with intervals of three months. As the stent was obstructed by the stone, the guide wire couldn't be inserted through the primary ureteral stent. We used our "bridge" technique to solve his problem successfully. No bleeding and no urinary tract infection were observed after intervention. The urine from the ureteral stent was fluent. We think that this "bridge" technique may be a good choice for the replacement of the obstructed single-J stent in the patients of ileal conduit urinary diversion.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.21037/tau-20-1186DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7844502PMC
January 2021

Experience managing distal ureteral strictures with Boari flap-psoas hitch and comparison of open and laparoscopic procedures.

Transl Androl Urol 2021 Jan;10(1):56-65

Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China.

Background: To summarize our experience with the Boari flap-psoas hitch and compare the indications, perioperative data and outcomes between open and laparoscopic procedures.

Methods: This study retrospectively reviewed 35 patients with complex distal ureteral stricture between January 2015 and April 2019. All patients were treated with Boari flap-psoas hitch by either an open or a laparoscopic procedure. Selection criteria were based on the etiology, comorbidities, medical history, and patient preference.

Results: All surgeries were performed successfully. The median operation time was 201 min (range, 120 to 300 min), and the median estimated blood loss was 50 mL (range, 20 to 400 mL). The median postoperative hospitalization was 9 days (range, 3 to 46 days). Nineteen patients were treated by the open procedure, and 16 were treated by the transperitoneal laparoscopic procedure. The surgical indication of open surgery was broader than that for laparoscopic surgery. For patients experiencing iatrogenic injury and ureterovesical reimplantation failure, no significant differences in sex, laterality, operative time, ASA score or postoperative hospitalization stay were observed between the two groups. The median estimated blood loss was lower in the laparoscopic group than in the open group (P=0.047). Patients in the open group had more surgical complications than patients in the laparoscopic group (P=0.049). The postoperative follow-up showed the radiological resolution of hydronephrosis in 33 patients.

Conclusions: With the appropriate surgical considerations, Boari flap-psoas hitch is a valid method to bridge distal ureteral defects. For select patients, laparoscopic surgery had advantages being a minimal invasive surgery with less estimated blood loss and fewer surgical complications.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.21037/tau-20-789DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7844529PMC
January 2021

P4HB: A novel diagnostic and prognostic biomarker for bladder carcinoma.

Oncol Lett 2021 Feb 6;21(2):95. Epub 2020 Dec 6.

Department of Urology, Peking University First Hospital, Xicheng, Beijing 100034, P.R. China.

Prolyl 4-hydroxylase, beta polypeptide (P4HB) protein is an endoplasmic reticulum (ER) molecular chaperone protein and has been reported to be overexpressed in multiple tumor types. However, the role of P4HB in bladder cancer (BLCA) has not yet been elucidated. The aim of the present study was to investigate the prognostic value of P4HB and the association between clinicopathological characteristics and P4HB in BLCA. P4HB expression levels were assessed through The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) databases, and validated by reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and western blot analysis in BLCA tissues and cells. A total of 69 pairs of tumor and normal samples were used to analyze the expression of P4HB via immunohistochemical staining. A co-expression network and functional enrichment analyses were conducted to investigate the biological function of P4HB in BLCA. The protein-protein interaction (PPI) network was constructed by Search Tool for the Retrieval of Interacting Genes. The results showed that P4HB was highly expressed in BLCA cells and tissues. The area under the curve value for P4HB expression to discriminate between tumor and normal tissues was up to 0.888 (95% CI: 0.801-0.975; P<0.001) and 0.881 (95% CI: 0.825-0.937; P<0.001) in TCGA database and our database, respectively. Furthermore, the expression level of P4HB was an independent risk factor for overall survival (OS) and recurrence-free survival (RFS) by univariate and multivariate analyses. Kaplan-Meier survival analysis demonstrated that high P4HB expression was associated with low OS and RFS. Pathway enrichment analysis suggested that P4HB was involved in protein processing in the endoplasmic reticulum (ER), including N-glycan modification and protein metabolic processes responding to ER stress. PPI analysis revealed that the potential targets of P4HB were mainly involved in posttranslational protein modification and response to ER stress. In conclusion, the expression level of P4HB aid in identifying patients with early-stage BLCA and predicting the prognosis of BLCA. Therefore, P4HB may be a novel diagnostic and prognostic biomarker for BLCA.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3892/ol.2020.12356DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7751343PMC
February 2021

Identification of immune-related LncRNA for predicting prognosis and immunotherapeutic response in bladder cancer.

Aging (Albany NY) 2020 11 18;12(22):23306-23325. Epub 2020 Nov 18.

Department of Urology, Peking University First Hospital, Beijing, China.

Long noncoding RNAs (lncRNAs) have multiple functions in the cancer immunity response and the tumor microenvironment. To investigate the immune-related lncRNA (IRlncRNA) signature for predicting prognosis and immunotherapeutic response in bladder cancer (BLCA), we extracted BLCA data from The Cancer Genome Atlas (TCGA) database. Finally, a total of 405 cases were enrolled and 8 prognostic IRlncRNAs (, , , were identified in the training set. Risk scores were calculated to divide patients into high-risk and low-risk groups, and the high-risk patients tended to have a poor overall survival (OS). Multivariate Cox regression analysis confirmed that the IRlncRNA signature could be an independent prognostic factor. The results were subsequently confirmed in the validating set. Additionally, this 8-IRlncRNA classifier was related to recurrence free survival (RFS) of BLCA. Functional characterization revealed this signature mediated immune-related phenotype. This signature was also associated with immune cell infiltration (i.e., macrophages M0, M2, Tregs, CD8 T cells, and neutrophils) and immune checkpoint inhibitors (ICIs) immunotherapy-related biomarkers [mismatch repair (MMR) genes, tumor mutation burden (TMB) and immune checkpoint genes]. The present study highlighted the value of the 8-IRlncRNA signature as a predictor of prognosis and immunotherapeutic response in BLCA.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.18632/aging.104115DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7746369PMC
November 2020

Re: Ureteral Reimplantation Via Robotic Non-Transecting Side-to-Side Anastomosis for Distal Ureteral Stricture by Slawin et al.

J Endourol 2020 Dec 3. Epub 2020 Dec 3.

Department of Urology, Peking University First Hospital, Beijing, China.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/end.2020.0931DOI Listing
December 2020

Comparison of KD-SR-01 robotic partial nephrectomy and 3D-laparoscopic partial nephrectomy from an operative and ergonomic perspective: A prospective randomized controlled study in porcine models.

Int J Med Robot 2021 Apr 24;17(2):e2187. Epub 2020 Nov 24.

Department of Urology, Peking University First Hospital, Beijing, China.

Background: To investigate the feasibility, validity and security of a new robot platform called KD-SR-01 and compare relative merits of KD-SR-01 robotic partial nephrectomy (KD-RPN) and 3D-Laparoscopic Partial Nephrectomy (3D-LPN).

Methods: Twelve porcine models were randomly and equally divided for KD-RPN and 3D-LPN. The perioperative outcomes, physical and mental workload of the surgeon were compared. Physical workload was evaluated with surface electromyography. Mental workload was evaluated with National Aeronautics and Space Administration Task Load Index (NASA-TLX).

Results: All surgeries were performed successfully. The average docking time of KD-RPN was 6 min. The estimated blood loss was lower in KD-RPN (p < 0.05). There were no differences in all the other operative variables (p > 0.05). KD-RPN showed advantages in physical workload and was significantly superior in mental workload (p < 0.05).

Conclusions: KD-RPN is technically feasible, valid and safe in porcine models. It's comparable from operative perspective while KD-RPN had advantages over 3D-LPN from ergonomic perspective.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/rcs.2187DOI Listing
April 2021

Laparoscopic and robotic ureteroplasty using onlay flap or graft for the management of long proximal or middle ureteral strictures: our experience and strategy.

Int Urol Nephrol 2021 Mar 10;53(3):479-488. Epub 2020 Oct 10.

Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.

Purpose: To present our experience of laparoscopic and robotic ureteroplasty using onlay flap or graft for the management of long proximal or middle ureteral strictures and summarize our treatment strategies for these challenging scenarios.

Methods: From March 2018 to January 2020, 53 patients with long proximal/middle ureteral strictures (2-6 cm) who underwent laparoscopic or robotic onlay flap/graft ureteroplasty were retrospectively enrolled. Different reconstruction techniques were chosen based on our management strategy: pelvic flap (PF) was the first choice for proximal stricture if pelvic tissue was sufficient for repair, while appendiceal flap (AF) was preferred over oral mucosa graft for both proximal and middle strictures.

Results: A total of 28 PFs, 9 AFs and 16 lingual mucosa grafts (LMGs) onlay ureteroplasty were performed successfully, with 33 laparoscopic procedures and 20 robotic procedures being undertaken. No intraoperative complications or conversion occurred. The median stricture length was 4 cm (range 2-6 cm). Compared with laparoscopic procedures, robotic procedures showed significantly shorter operative time (P = 0.008), shorter postoperative hospital stay (P = 0.011) but higher hospital cost (P < 0.001). At a mean follow-up of 12.8 months, the overall success rate was 94.3%. There was no difference in postoperative complications or the success rate between the approaches.

Conclusion: Laparoscopic and robotic onlay flap/graft ureteroplasty can be safe and feasible to repair long proximal/middle ureteral strictures while robotic procedures showed higher efficiency, faster recovery but higher cost. Our algorithmic strategies may provide beneficial references for their standardization and dissemination into clinical care.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11255-020-02679-5DOI Listing
March 2021

Posteriorly Augmented Anastomotic Ureteroplasty with Lingual Mucosal Onlay Grafts for Long Proximal Ureteral Strictures: 10 Cases of Experience.

J Endourol 2021 02;35(2):192-199

Department of Urology, National Urological Cancer Center, The Institute of Urology, Peking University First Hospital, Peking University, Beijing, China.

To share the technique of posteriorly augmented anastomotic ureteroplasty with lingual mucosal onlay grafts for long proximal ureteral strictures as well as our initial experience with the technique. From October 2018 to September 2019, 10 cases of robotic and laparoscopic posteriorly augmented anastomotic ureteroplasty with lingual mucosal onlay grafts for long proximal ureteral strictures were recruited from our database of Reconstruction of Urinary Tract: Technology, Epidemiology and Result (RECUTTER). The perioperative and follow-up data were recorded. Complete success was defined as the absence of clinical symptoms, relieved stenosis on imaging, and a stable estimated glomerular filtration rate without serious complications. All surgeries were completed without serious complications. There were eight laparoscopic surgeries and two robotic surgeries. The median length of defect after posteriorly augmented anastomosis was 3 cm (range, 3-5 cm). The median length of the lingual mucosa graft was 4 cm (range, 3-5 cm). The median operative time was 237 minutes (range, 189-310 minutes). The median estimated blood loss was 40 mL (range, 10-100 mL). The median postoperative length of stay was 7.5 days (range, 5-22 days). The Double-J stent was removed median 3.5 months (range, 2-7 months) after the surgery. At the median follow-up of 11 months (range, 7-20 months), all patients achieved the successful criteria of treatment. The posteriorly augmented anastomotic ureteroplasty with lingual mucosal onlay grafts for long proximal ureteral strictures is a feasible and safe technique, which may be an option especially for strictures marginally longer than those that can be safely repaired via end-to-end anastomosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/end.2020.0686DOI Listing
February 2021

Onlay Repair Technique for the Management of Ureteral Strictures: A Comprehensive Review.

Biomed Res Int 2020 27;2020:6178286. Epub 2020 Jul 27.

Department of Urology, Temple University School of Medicine, 255S 17th Street, 7th Floor Medical Tower, Philadelphia, PA 19103, USA.

Ureteroplasty using onlay grafts or flaps emerged as an innovative procedure for the management of proximal and midureteral strictures. Autologous grafts or flaps used commonly in ureteroplasty include the oral mucosae, bladder mucosae, ileal mucosae, and appendiceal mucosae. Oral mucosa grafts, especially buccal mucosa grafts (BMGs), have gained wide acceptance as a graft choice for ureteroplasty. The reported length of BMG ureteroplasty ranged from 1.5 to 11 cm with success rates of 71.4%-100%. However, several studies have demonstrated that ureteroplasty using lingual mucosa grafts yields better recipient site outcomes and fewer donor site complications than that using BMGs. In addition, there is no essential difference in the efficacy and complication rates of BMG ureteroplasty using an anterior approach or a posterior approach. Intestinal graft or flap ureteroplasty was also reported. And the reported length of ileal or appendiceal flap ureteroplasty ranged from 1 to 8 cm with success rates of 75%-100%. Moreover, the bladder mucosa, renal pelvis wall, and penile/preputial skin have also been reported to be used for ureteroplasty and have achieved satisfactory outcomes, but each graft or flap has unique advantages and potential problems. Tissue engineering-based ureteroplasty through the implantation of patched scaffolds, such as the small intestine submucosa, with or without cell seeding, has induced successful ureteral regeneration structurally close to that of the native ureter and has resulted in good functional outcomes in animal models.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2020/6178286DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7407031PMC
April 2021

Management of Migrated or Residual Stones Following Laparoscopic Pyelolithotomy and Ureterolithotomy in Abnormal Kidneys: A Prospective and Randomized Comparison.

J Endourol 2020 11 27;34(11):1155-1160. Epub 2020 Jul 27.

Department of Urology, National Urological Cancer Center, Peking University First Hospital, The Institute of Urology, Peking University, Beijing, China.

To conduct a prospective and randomized controlled trial comparing contemporaneous transabdominal rigid ureteroscopy (TRU) with postoperative extracorporeal shockwave lithotripsy (SWL) in the management of migrated or residual stones during laparoscopic pyelolithotomy and ureterolithotomy in kidneys with either intrinsic or extrinsic abnormalities. From February 2016 to December 2019, 45 patients with migrated or residual stones following laparoscopic pyelolithotomy and ureterolithotomy were accrued and randomly divided into two groups. These patients all had either urinary tract obstruction distal to the stone or concomitant ipsilateral intrinsic or extrinsic pathology requiring laparoscopic intervention. Twenty-three patients underwent contemporaneous TRU, and 22 patients underwent postoperative SWL. Patients' demographics, perioperative variables, and follow-up data were collected. The primary outcome was the final stone-free rate (SFR) at the 2-month follow-up. Secondary outcomes included blood loss, operative time, change in serum creatinine, complications per Clavien-Dindo grading system, renal colic occurrence rate (RCOR), and postoperative hospitalization. There was no significant difference in gender, age, body mass index, location, or stone burden between the two groups ( > 0.05). At the 2-month follow-ups, the SFR was higher in the TRU than the SWL group ( = 0.002), and the RCOR was lower in the TRU than the SWL group ( = 0.005). Postoperative hospitalization was also shorter for the TRU group. No significant difference was noted in the operative time, blood loss, change in serum creatinine, or perioperative complications ( > 0.05). Contemporaneous TRU is more effective and equally safe compared to postoperative SWL in the management of residual or migrated stones during laparoscopic pyelolithotomy and ureterolithotomy in kidneys with either intrinsic or extrinsic abnormalities.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/end.2020.0296DOI Listing
November 2020

Pattern and risk factors of local recurrence after nephroureterectomy for upper tract urothelial carcinoma.

World J Surg Oncol 2020 May 30;18(1):114. Epub 2020 May 30.

Department of Radiation Oncology, Rush University Medical Center , Chicago, USA.

Purpose: This study aims to identify predictive local recurrence risk factors and site-specific local recurrence pattern of upper tract urothelial carcinoma (UTUC) with different primary tumor locations.

Methods: Three hundred and eighty-nine UTUC patients with radical nephroureterectomy were included in this study. Univariate and multivariate Cox proportional hazards regressions were performed to measure the risk of local recurrence. We also mapped the position of local recurrence sites stratified by primary tumor locations.

Results: A total of 73 patients (18.7%) developed local recurrence within a median follow-up of 41 months (range, 3-80 months). For patients with local recurrence, the median interval of local recurrence was 9 months. Ureter tumor, multifocality, T stage, G grade, lymph node metastasis (LNM), lymph node dissection (LND), and lymph vascular invasion (LVI) were all significantly associated with increased local recurrence by univariable analyses (P < 0.05). Only multifocality, T3-4, G3, and LNM remained independent predictors of increased local recurrence by multivariable analyses. Adjuvant radiotherapy could reduce the local recurrence (HR = 0.177; 95% CI 0.064-0.493, P = 0.001). Patients with local recurrence had poorer cancer-specific survival (4-year cancer-specific survival rate 36 ± 7.5% vs 88.4 ± 2.2%, P = 0.000). We evaluated local recurrence pattern stratified by tumor locations. Para-aortic lymph node region was the most common recurrence area for all the patients. Left-sided UTUC had more than 70% recurrent lymph nodes in the left para-aortic region (LPA). For right-sided UTUC patients, recurrent para-aortic lymph nodes distributed in the LPA (33.3%), aortocaval (AC) (41.5%), and right paracaval (RPC) (25.2%) regions. Recurrence in the internal and external iliac regions was only found in the distal ureter group (P < 0.05). Renal pelvic fossa recurrence was only found in renal pelvic tumor (22.2%, P = 0.007). The ureter tumor bed recurrence rate was higher for ureter patients (P = 0.001).

Conclusions: Multifocality, T3-4, G3, and LNM are predictors of higher local recurrence rate of UTUC. Adjuvant radiotherapy can reduce local recurrence rate. Local recurrence patterns are different according to primary tumor locations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12957-020-01877-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7261378PMC
May 2020

Appendiceal Onlay Flap Ureteroplasty for the Treatment of Complex Ureteral Strictures: Initial Experience of Nine Patients.

J Endourol 2020 Aug 25;34(8):874-881. Epub 2020 Jun 25.

Department of Urology, National Urological Cancer Center, Institute of Urology, Peking University First Hospital, Peking University, Beijing, China.

To evaluate the onlay technique using the appendix for ureteral reconstruction and describe the initial experience of nine operations performed by one surgeon. Nine patients with complex ureteral strictures who underwent appendiceal onlay flap ureteroplasty since May 2019 were recruited from our RECUTTER database. There were seven men and two women, with a mean age of 38.9 years; four patients underwent robot-assisted laparoscopic surgery, and five patients underwent traditional laparoscopic surgery. All patients had iatrogenic injuries of the ureter after treatment of stone disease. Seven patients had proximal ureteral strictures, and two had midureteral strictures. The mean stricture length of the nine patients was 3.9 (range 3-4.5) cm. Nephrostomy was performed in seven patients before they presented to our center, and the other two patients had indwelling Double-J ureteral stents. All nine operations were effectively completed without open conversion. The mean operation time was 182 (range 135-220) minutes, the mean estimated blood loss was 71 (range 20-100) mL, and the mean length of postoperative hospital stay was 9 (range 6-12) days. No postoperative complications of high grade (Clavien-Dindo III and IV) occurred within 30 days of surgery. All the patients had their Double-J ureteral stents and nephrostomy tubes removed after complete ureteroscopy and upper urinary tract urodynamic examination or CTU, which showed that the anastomosis healed well and that the urinary tract was unobstructed, respectively. The objective success rate was 100% (all the patients had endoscopic and radiographic resolution of their ureteral strictures). The subjective success rate was 88.9% (one patient developed recurrent back discomfort and a 0.5 cm calculus was found in her renal pelvis). Appendiceal onlay flap ureteroplasty is a viable and effective technique for treating complex proximal and middle ureteral strictures at the right side.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/end.2020.0176DOI Listing
August 2020

Successful penile replantation after macroscopic repair using vein blood-letting therapy.

Urol Case Rep 2020 Jan 5;28:101069. Epub 2019 Nov 5.

Department of Urology, Peking University First Hospital, Beijing, China.

Although penile amputation is a rare injury, it may occur caused by self-mutilation with psychiatric disturbances and sexual need, or due to accidents, iatrogenic injuries or revenge and marriage breakdown. A case of successful penile glans replantation by macroscopic repair using vein blood-letting therapy is presented. This case report shows the surgical procedure and postoperative care which may be critical for successful replantation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.eucr.2019.101069DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6864311PMC
January 2020

Prognostic performance of the 1973 and 2004 WHO grading classification in upper tract urothelial carcinoma.

Urol Oncol 2019 08 30;37(8):529.e19-529.e25. Epub 2019 May 30.

Department of Urology, Peking University First Hospital, Xicheng, Beijing, China; Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China. Electronic address:

Background: Grading of upper tract urothelial carcinoma (UTUC) is routinely used in clinical practice; however, reports concerning prognostic performance of different grading systems are contradictory. We aim to assess the clinical reliability of the 1973 and 2004 World Health Organization (WHO) grading classification systems in UTUC.

Patients And Methods: We retrospectively evaluated 458 consecutive patients with UTUC from 2008 to 2013. The postoperative tumor grades were evaluated by a single uropathologist using the 1973 and 2004 WHO grade classification systems. The Kaplan-Meier method was used to estimate cancer-specific survival (CSS) and overall survival (OS). Univariate and multivariate analyses were used to test the association between clinical variables and the CSS and OS rates.

Results: There were 133 (29.0%) low-grade patients and 325 (71.0%) high-grade patients. The 3-year CSS rates were 87.0% and 76.0% for G2 and G3 disease and 89.0% and 80.0% for low- and high-grade disease according to the 2004 system, respectively. For all UTUC patients, there were significant differences in the CSS and OS rates between G2 and G3 cases, as well as between the low- and high-grade groups. The CSS and OS rates were significantly different between the G2 and G3 cases for the overall high-grade population (CSS: P = 0.003; OS: P = 0.009), while no significant difference emerged between low- and high-grade tumors in G2 UTUC patients (CSS: P = 0.717; OS: P = 0.280). In the subgroup of high-grade non-muscle-invasive tumors, the 1973 WHO grading system was an independent predictor of CSS (P = 0.045).

Conclusions: The results support the hypothesis that the 1973 WHO system is superior to the 2004 system for predicting clinical outcomes in patients with non-muscle-invasive UTUC.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.urolonc.2019.01.013DOI Listing
August 2019

Technical considerations and outcomes for ileal ureter replacement: a retrospective study in China.

BMC Surg 2019 Jan 18;19(1). Epub 2019 Jan 18.

Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Center, Peking University, No.8 Xishiku St, Xicheng District, Beijing, 100034, China.

Background: Ileal ureter replacement is an alternative treatment for various length ureter defects. We present our experience and outcome of ileal ureter replacement in China.

Methods: We retrospectively collected data of patients who underwent ileal ureter replacement between January 2010 and January 2015. We reviewed the medical history, indications for surgery, operative data, perioperative data, and outcomes. Besides, follow-up data included symptom, urine routine test, serum creatinine, serum electrolyte status, and radiographic test.

Results: There were 23 patients who underwent ileal ureter replacement by the same surgeon. Twenty patients were performed unilateral ileal ureter replacement, two patients underwent a combination of ileal ureter replacement and Boari flap-psoas hitch, and one received bilateral ileal ureter replacement. Among these patients, the main cause leading to surgical treatment was iatrogenic injuries (n = 15), especially urinary surgery procedure (n = 11). The median follow-up time was 45 months. There were 6 early complications and 6 late complications after operation. Only one patient suffered from small bowel-related complication and was cured by conservative treatment. Only the patient who underwent bilateral ileal ureter replacement had metabolic acidosis. And 22 patients (95.7%) had a good renal function.

Conclusions: Ileal ureter replacement is an efficacious and safe procedure for the therapy of long ureteral defects. With appropriate technical considerations, the complication rate may decrease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12893-019-0472-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6339271PMC
January 2019

A Simple Modification for the Usage of Flexible Cystoscope in Modified Laparoscopic Pyeloplasty for Ureteropelvic Junction Obstruction with Renal Calculi: A Flexible Guiding Tube.

Urol Int 2019 10;102(3):262-268. Epub 2019 Jan 10.

Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China.

Objective: To present our technique of laparoscopic pyeloplasty (LP) with concomitant pyelolithotomy in ureteropelvic junction obstruction (UPJO) complicated by renal calculi and compare outcome with a group of UPJO patients undergoing modified LP without coexistent calculi.

Materials And Methods: We retrospectively reviewed the charts of 51 UPJO patients undergoing modified LP from January 2013 to November 2016 at our institution. Sixteen patients were diagnosed as UPJO with coexistent ipsilateral renal calculi and underwent pyelolithotomy using our modified technique at the time of modified LP. The outcome data of this group were compared with those of 16 matched patients undergoing modified LP without calculi.

Results: No conversion to open surgery occurred. The mean operative time for modified LP and pyelolithotomy was 151.6 min, while the mean operative time for modified LP was 137.6 min (p = 0.21). Additionally, no differences in estimated blood loss (p = 0.96) or postoperative complications (p = 1.00) were observed between the 2 groups. The stone-free rate was 100%. During a mean follow-up of 27.1 months, there were no recurrent calculi or secondary UPJO.

Conclusions: The combination of our novel flexible guiding tube and modified suture technique provides a practical and economic approach with satisfying outcome in the treating of UPJO with concomitant renal calculi.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000495569DOI Listing
December 2019

Modified Laparoscopic Partial Ureterectomy for Adult Ureteral Fibroepithelial Polyp: Technique and Initial Experience.

Urol Int 2019 16;102(1):13-19. Epub 2018 Nov 16.

Department of Urology, Peking University First Hospital. Institute of Urology, Peking University. National Urological Cancer Center, Beijing, China.

Objectives: To present our modified laparoscopic partial ureterectomy technique for adult ureteral fibroepithelial polyp (FEP) and initial experience.

Methods: Between August 2009 and October 2017, 22 patients with ureteral FEP underwent modified laparoscopic partial ureterectomy by an experienced surgeon. In our method, a stay suture passing through the upper ureter was fixed to the abdominal wall to keep the ureter from twisting. The ureter was not completely dismembered until the first stitch, which was placed between the lowest points of the upper ureter and lower ureter end faces, was finished. Besides, we used a 3-step method to locate the polyp. Surgical success was defined as improved hydronephrosis and alleviated symptoms.

Results: The mean operative time was 152.18 min. The mean estimated blood loss was 22.73 mL. One patient complained of urinary tract infection postoperatively. The mean times to remove the drainage tube and catheter were 2.64 and 3.73 days respectively. The double-J tube was removed at 1-3 months after surgery. At a mean follow-up of 47.04 months, no patient experienced disease recurrence, and the operative success rate was 100%.

Conclusions: Modified laparoscopic partial ureterectomy, with a high success rate, could be considered a safe and efficient treatment option for ureteral FEP.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000494804DOI Listing
March 2019

Head-to-Head Comparison of Modified Laparoscopic Pyeloplasty and Robot-Assisted Pyeloplasty for Ureteropelvic Junction Obstruction in China.

Urol Int 2018 19;101(3):337-344. Epub 2018 Sep 19.

Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China.

Objective: To compare the outcomes of modified laparoscopic pyeloplasty (LP) and robot-assisted pyeloplasty (RLP) for ureteropelvic junction obstruction (UPJO) in China patients.

Materials And Methods: We retrospectively reviewed the medical records of patients who underwent modified LP and RLP using a transperitoneal laparoscopic approach at 2 different medical institutions between October 2009 and November 2017.

Results: Seventy-six patients underwent modified LP and 140 patients underwent RLP. No open conversion occurred. The mean operative time of RLP was shorter than that of modified LP (p = 0.042). For UPJO concomitant with renal calculi, there was no difference in operative time between 2 groups (p = 0.656). With RLP, the operative time for UPJO concomitant with horseshoe was shorter (p = 0.011). In terms of complication rate, there was no significant difference between 2 groups (p = 0.596). The postoperative hospital stay for modified LP was shorter than that for RLP (p < 0.05). The mean follow-up time for modified LP and RLP was 31.79 months and 10.85 months respectively (p < 0.05). The success rate was 96.05 and 97.86% for modified LP and RLP, respectively (p = 0.736).

Conclusions: Modified LP and RLP are safe and efficient treatment for UPJO with similar success rates.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000492337DOI Listing
April 2019

Analysis of Factors Influencing Mayo Adhesive Probability Score in Partial Nephrectomy.

Med Sci Monit 2017 Dec 20;23:6026-6032. Epub 2017 Dec 20.

Department of Urology, Peking University First Hospital, Beijing, China (mainland).

BACKGROUND To retrospectively explore the factors influencing Mayo Adhesive Probability (MAP) score in the setting of partial nephrectomy. MATERIAL AND METHODS Data of 93 consecutive patients who underwent laparoscopic and open partial nephrectomy from September 2015 to June 2016 were collected and analyzed retrospectively. Preoperative radiological elements were independently assessed by 2 readers. Ordinal logistic regression analyses were performed to evaluate radiological and clinicopathologic influencing factors of MAP score. RESULTS On univariate analysis, MAP score was associated with male sex, older age, higher body mass index (BMI), history of hypertension and diabetes mellitus, and perirenal fat thickness (posterolateral, lateral, anterior, anterolateral, and medial). On multivariate analysis, only posterolateral perirenal fat thickness (odds ratio [OR]=0.88 [0.82-0.95], p=0.001), medial perirenal fat thickness (OR=0.90 [0.83-0.98], p=0.01), and history of diabetes mellitus (OR=5.42 [1.74-16.86], p=0.004) remained statistically significant. Tumor type (malignant vs. benign) was not statistically different. In patients with renal cell carcinoma (RCC), there was no difference in tumor stage or grade. CONCLUSIONS MAP score is significantly correlated with some preoperative factors such as posterolateral and medial perirenal fat thickness and diabetes mellitus. A new radioclinical scoring system including these patient-specific factors may become a better predictive tool than MAP score alone.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5747148PMC
http://dx.doi.org/10.12659/msm.907938DOI Listing
December 2017

Genetic evidence for a novel variant of the pilus island 1 backbone protein in group B Streptococcus.

J Med Microbiol 2017 Oct 19;66(10):1409-1415. Epub 2017 Sep 19.

Public Health Ontario, Toronto, ON, Canada.

Purpose: Pili contribute significantly to the pathogenesis of infection of group B Streptococcus (GBS) by facilitating adhesion and invasion of host cells. GBS pilin subunits (the backbone pilin protein, BP, and the ancillary pilin proteins, AP) as well as the specific enzymes required for pilus assembly are encoded by genes located in two separate genomic regions, known as pilus island 1 (PI-1) and PI-2. Our aim was to characterize the pilus profile of a collection of GBS isolates from metropolitan Toronto, Canada.

Methodology: The pilus profile of 1332 invasive and colonizing GBS isolates was determined by PCR and, in selected cases, by whole genome sequencing.

Results: While investigating the pilus profile of a collection of GBS organisms, we discovered that 51 isolates possessed a novel variant of the PI-1 BP, which we named BP-1b. The predicted translated sequences of archetypical GBS BP-1 and novel BP-1b variants shared only 63 % amino acid sequence homology. The novel BP-1b variant was most common among strains of serotype Ib and VI, but was also found among strains of serotypes Ia, II, III and VIII.

Conclusion: We describe a relatively frequent occurrence of a novel PI-1 BP that cannot be detected by a commonly used multiplex PCR scheme, which could lead to strains being mistyped as PI-1 negative. We present PCR primers that can easily be incorporated into the multiplex PCR assay to identify strains with novel BP-1b variant.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1099/jmm.0.000588DOI Listing
October 2017

Laparoscopic ureteral reimplantation with extracorporeal tailoring and direct nipple ureteroneocystostomy for adult obstructive megaureter: long-term outcomes and comparison to open procedure.

Int Urol Nephrol 2017 Nov 29;49(11):1973-1978. Epub 2017 Aug 29.

Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.

Purpose: To evaluate the long-term outcomes of laparoscopic ureteral reimplantation with extracorporeal tailoring and direct nipple ureteroneocystostomy for adult obstructive megaureter and compare the results with the open procedure.

Methods: From January 2007 to July 2013, 22 patients underwent laparoscopic and 28 patients underwent open ureteral reimplantation for adult obstructive megaureter. For laparoscopic group, the dilated ureter was delivered out of through a 12-mm port and the distal end was tailored and formed into an antireflux nipple extracorporeally. The ureteral nipple was intracorporeally reimplanted into the posterolateral wall of the bladder. Demographics, complications and follow-up data were analyzed and compared retrospectively between the groups.

Results: Baseline characteristics including age, gender, body mass index, affected side, age at diagnosis and follow-up time were statistically similar for the groups. All of the surgeries were performed successfully, and no major complications occurred. Comparing with the open group, the use of our novel laparoscopic procedure resulted in less estimated blood loss (50.0 vs. 71.0 ml; P = 0.001), less narcotic analgesic (3.0 vs. 18.0 mg; P = 0.01) and shorter hospital stay (5.1 vs. 7.9 days; P < 0.001). Long-term outcomes including rates of recurrent ureteral stricture (4.5 vs. 0%; P = 0.25), rates of vesicoureteral reflux (9.1 vs. 3.6%, P = 0.42) and success rates (86.4 vs. 96.9%; P = 0.45) did not significantly differ between the two groups.

Conclusion: Laparoscopic ureteral reimplantation with extracorporeal tailoring and direct nipple ureteroneocystostomy is a safe and equally effective as the open surgery for the long-term outcomes of adult obstructive megaureter.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11255-017-1687-7DOI Listing
November 2017