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Objective To evaluate the safety and effectiveness of retroperitoneal laparoscopic nephroureterectomy combined with transurethral resection of the ureteral orifice for the treatment of upper urinary urothelial carcinoma (UTUC). Methods We retrospectively analyzed the clinical data of 59 UTUC cases treated in our hospital from July 2013 to July 2019, who underwent retroperitoneal laparoscopic nephroureterectomy combined with transurethral resection of the ureteral orifice (n=20) or abdominal incision(n=39). Blood loss volume, time of incision drainage, recovery time of postoperative intestinal function, postoperative hospitalization time, postoperative complications and local recurrence, and distant metastasis were compared between the 2 groups. Results The transurethral resection group had significantly longer operative time (219.1±54.2 vs 178.7±60.8 min, P < 0.05), but shorter time of incision drainage, recovery time of postoperative intestinal function and postoperative hospitalization time (P < 0.05) when compared with the abdominal incision group. There were 4 cases having operative complications in the abdominal incision group, including 2 cases of pulmonary infection, 1 case of retroperitoneal effusion, and 1 case of lymphorrhagia. In the transurethral resection group, there was 1 case of postoperative bladder bleeding, and cystoscopic electrocision was performed for hemostasis. No significant differences were found in other evaluated indicators between the 2 groups. Conclusion Retroperitoneal laparoscopic nephroureterectomy combined with resection of the ureteral orifice is safe and effective for the treatment of UTUC. Compared with abdominal incision, transurethral approach has the advantage of less trauma and rapider recovery.

Objective To assess the efficacy of bundle care for improving postoperative urinary control in patients receiving radical cystectomy and orthotopic ileal neobladder reconstruction. Methods Between January, 2014 and December, 2016, 60 patients with bladder cancer undergoing radical cystectomy and orthotopic ileal neobladder reconstruction in our department were randomly assigned into control group and bundle care group (n=30). In the control group, the patients were provided with routine instructions and training at discharge, and those in the bundle care group received additional interventions including training of the pelvic floor muscles and trainings for changing the manner of urination, increasing abdominal pressure by Valsalva breathing during urination, and keeping the voiding diary. The patients were followed up regularly and at 3, 6, and 12 months after the surgery, the urine dynamics, maximum and mean urinary flow rate, neobladder capacity and residual urine volume, renal functions and patient's satisfaction with urination were assessed and compared between the two groups. Results At 3, 6, and 12 months after the surgery, the patients in the bundle care group showed significantly greater maximum and mean urinary flow rate and neobladder capacity (P < 0.01) with smaller residual urine volume (P < 0.01) and better satisfaction with urination both in daytime and at night (P < 0.05) than those in the control group. Conclusion Bundle care interventions can effectively improve postoperative urinary control and promote functional recovery of the neobladder in patients receiving radical cystectomy and orthotopic ileal neobladder reconstruction for bladder cancer.