Purpose The purpose of this study was to analyze long-term complications, urodynamics, and quality of life (QoL) of patients after orthotopic ileal neobladder with orthotopic ureteral reimplantation to enrich clinical data and provide a basis for clinical use of this surgery. Methods Between January 2007 and January 2013, 72 consecutive patients who underwent spiral ileal neobladder following radical cystectomy were enrolled. The neobladder was created using a modified Camey-II technique. Complications were reviewed and staged according to Clavien-Dindo classification and evaluated in long-term follow-up. Urodynamics were performed, and QoL was assessed by the Functional Assessment of Cancer Therapy for Bladder Cancer (FACT-BL) instrument. Results The total follow-up time was 60 months, and the total survival rates at 3 and 5 years after surgery were 76.4% (55/72) and 65.3% (47/72), respectively. There were 34 (47.2%) early complications in 23 (31.9%) patients and 42 (58.3%) late complications in 35 (48.6%) patients. The total satisfactory control rates were 69.1% and 66.0% at 3 and 5 years after the surgery, respectively. Urodynamic studies were performed in some patients, and the receiver operating characteristic curve analysis showed that pressure at maximum capacity, compliance, and post void residual urine had predictive value for mortality (P < 0.05). The total FACT-BL scores of patients at 1, 3, and 5 years postoperation were 125.0 ± 15.2, 127.0 ± 16.2, and 120.6 ± 13.5, respectively, and it decreased at 5 years postoperation (P < 0.05). Conclusion Spiral ileal neobladder with orthotopic ureteral reimplantation offers satisfactory long-term results, and urodynamic monitoring might have prognostic value.

Objective To investigate the expression intensity of carbonic anhydrase IX (CA-IX) in bladder urothelial carcinoma and its predictive value for the recurrence after transurethral resection of bladder tumor. Methods A retrospective analysis was made of 194 specimens who underwent transurethral resection of bladder tumors in our hospital from January 2014 to January 2016 and completed follow-up. The expression intensity of CA-IX and the clinical data of the patients were analyzed, and the subjects were divided into positive group and negative group according to the expression intensity of CA-IX. The age, gender, T stage, degree of differentiation, tumor number, tumor diameter, recurrence of each group was analyzed. Logistic univariate and multivariate analysis was used successively to find independent influencing factors for predicting the recurrence of bladder urothelial carcinoma after resection. The Kaplan–Meier survival curve was drawn according to the relationship between CA-IX expression intensity and postoperative recurrence. Results The positive expression rates of CA-IX in bladder urothelial carcinomas were 68.1% (132/194). The positive expression of CA-IX had no statistical significance with age, gender and tumor diameter (P > 0.05), while the positive expression of CA-IX had statistical significance with tumor T stage, tumor differentiation, tumor number and recurrence (P < 0.05); Logistic regression analysis showed that clinical T stage, tumor differentiation, tumor number, and CA-IX expression intensities were independent risk factors for predicting recurrence of bladder urothelial carcinoma after resection (P < 0.05); There were 59 cases of recurrence in the positive expression of CA-IX group, with a recurrence rate of 44.69% (59/132), and 17 cases of recurrence in the negative expression group, with a recurrence rate of 27.41% (17/62). The mean recurrence time of CA-IX positive group was 29.93 ± 9.86 (months), and the mean recurrence time of CA-IX negative group was 34.02 ± 12.44 (months). The Kaplan–Meier survival curve showed that the recurrence rate and recurrence time of patients with positive expression of CA-IX in bladder urothelial carcinomas were significantly higher than those of patients with negative expression of CA-IX. Conclusion CA-IX is highly expressed in bladder urothelial carcinoma, is a good tumor marker, and can be used as a good indicator for predicting the recurrence of bladder urothelial carcinoma after transurethral resection of bladder tumor.

Background: To explore the value of orthotopic spiral ileal bladder substitution (OSIBS) following radical cystectomy in treating bladder cancer patients by investigating the short-and long-term postoperative complications and assessing the quality of life in patients who had undergone OSIBS. Methods:The post-operative complications were retrospectively analyzed among bladder cancer patients who had undergone radical cystectomy + OSIBS in our center from January 2001 to January 2017. The quality of life was assessed by using the Function Assessment of Cancer Therapy-Bladder Cancer Form (FACT-BL). Patients were followed up by mails, telephone, and outpatient visits.Results: A total of 68 subjects were included in this study. All patients undergoing radical cystectomy + OSIBS were followed up for an extended period. The patients aged 39-68 years (mean: 60.34±9.43 years).The surgeries were completed, and all the patients were smoothly discharged after good postoperative recovery. Of the 68 patients who had completed the follow-up visits, 10 had early complications (14.71%), and 11 (17.64%) developed late complications. The blood urea nitrogen (BUN) (t=0.358, P=0.764) and serum creatinine (Cr) (t=1.305, P=0.196) levels showed no significant difference before and after surgery.The serum potassium (t=1.347, P=0.169), sodium (t=−1.748, P=0.144), and calcium (t=1.097, P=0.319) levels also showed no significant changes before and after surgery. However, the change in serum chlorine level was statistically significant (t=−4.701, P=0.000). To support urinary function, the patients were encouraged to take exercises During the 10-year follow-up period, the daytime urinary continence rate reached 94.1% (n=64) in the daytime, and the nighttime incontinence rate was 13.2% (n=9). Six months after the surgery, the neobladder capacity was (365.02±45.11) mL, the maximum flow rate was (14.36±1.41) mL/s, and the postvoiding residual (PVR) was (26.01±8.10) mL. The total FACT-BL score was (124.8±13.4) during the 10-year follow-up.Conclusions: After 10 years of follow-up, the early and late complications in patients who had undergone radical cystectomy + OSIBS were within acceptable range and the daily and nightly continence levels allowed normal daily life. OSIBS not only preserves the physical integrity of the body but also has normal physiological characteristics of the bladder. It remarkably improves the postoperative quality of life and can be easily accepted by patients. Therefore, it is an ideal surgical procedure.

Objectives Ureteral stenosis is a serious complication of flexible ureteroscopy. How to predict the possibility of stricture before surgery is an important topic. This research retrospectively studied the influence of preoperative hydronephrosis on ureteral stenosis after flexible ureteroscopy, to explore whether the preoperative hydronephrosis could predict postoperative ureteral stenosis. Methods We conducted a retrospective study on patients who received flexible ureteroscopy in our hospital for upper ureteral calculi from January 2015 to June 2018. Patients were followed-up for 36 months after surgery, and intraoperative and postoperative complications were recorded. We divided patients into the mild hydronephrosis group and moderate to severe hydronephrosis group. Preoperative clinical baseline data of the patients were adjusted by propensity matching score analysis. Differences of intraoperative ureteral injury, operative time, postoperative ureteral stricture, and SFR one month after surgery was statistically analyzed. Kaplan–Meier’s method and Log-rank test were used to compare the differences in the cumulative incidence of ureteral stenosis between the two groups. Cox regression was used to compare the hazard ratio of ureteral stenosis between the two groups. Results A total of 447 patients with 469 sides surgery were included, including 349 sides in the mild hydronephrosis group and 120 sides in the moderate to severe hydronephrosis group. Twenty-nine patients with 30 sides developed ureteral stenosis. Before and after propensity, the incidence of ureteral stricture matching analysis was 6.4% and 8%, respectively. There were statistical differences in ureteral stricture and injury, but the statistical differences in SFR and operation time were inconsistent. Kaplan–Meier showed a significant difference in the cumulative incidence of ureteral stenosis between the two groups. Conclusions Patients with moderate to severe hydronephrosis before surgery were more likely to have an intraoperative ureteral injury and postoperative ureteral stricture after FRUS. Preoperative hydronephrosis is an important predictor of ureteral stricture.