Summarizing the evidence for robotic-assisted bladder neck reconstruction: Systematic review of patency and incontinence outcomes

Objective:Bladder neck contracture and vesicourethral anastomotic stenosis are difficult to manage endoscopically,and open repair is associated with high rates of incontinence.In recent years,there have been increasing reports of robotic-assisted bladder neck reconstruction in the literature.However,existing studies are small,heterogeneous case series.The objective of this study was to perform a systematic review of robotic-assisted bladder neck reconstruction to better evaluate patency and incontinence outcomes.Methods:We performed a systematic review of PubMed from first available date to May 2023 for all studies evaluating robotic-assisted reconstructive surgery of the bladder neck in adult men.Articles in non-English,author replies,editorials,pediatric-based studies,and reviews were excluded.Outcomes of interest were patency and incontinence rates,which were pooled when appropriate.Results:After identifying 158 articles on initial search,we included only ten studies that fit all aforementioned criteria for robotic-assisted bladder neck reconstruction.All were case series published from March 2018 to March 2022 ranging from six to 32 men,with the median follow-up of 5e23 months.A total of 119 patients were included in our analysis.A variety of etiologies and surgical techniques were described.Patency rates ranged from 50%to 100%,and pooled patency was 80%(95/119).De novo incontinence rates ranged from 0%to 33%,and pooled incontinence was 17%(8/47).Our findings were limited by small sample sizes,relatively short follow-ups,and heterogeneity between studies.

A review of the development and current status of wound ostomy continence nurses in the mainland of China

Wound ostomy continence nurses(WOC nurses),developed as an important part of clinical nurse specialists play an indispensable role in the management of ostomy,all kinds of chronic wounds and incontinent dermatitis.However,there exists a gap compared with developed countries and regions.This paper provides an overview of WOC nurses in China including origin and development,training and accreditation system,roles,values and management,in order to provide references for the development of WOC nurses in China.

Excisional hemorrhoidal surgery and its effect on anal continence

AIM:To investigate the role of anal cushions in hemorrhoidectomy and its effect on anal continence of the patients.METHODS:Seventy-six consecutive patients(33 men and 43 women) with a mean age of 44 years were included.They underwent Milligan-Morgan hemorrhoidectomy because of symptomatic third-and fourth-degree hemorrhoids and failure in conservative treatment for years.Wexner score was recorded and liquid continence test was performed for each patient before and two months after operation using the techniques described in our previous work.The speed-constant rectal lavage apparatus was prepared in our laboratory.The device could output a pulsed and speed-constant saline stream with a high pressure,which is capable of overcoming any rectal resistance change.The patients were divided into three groups,group A(< 900 mL),group B(900-1200 mL) and group C(> 1200 mL) according to the results of the preoperative liquid continence test.RESULTS:All the patients completed the study.The average number of hemorrhoidal masses excised was 2.4.Most patients presented with hemorrhoidal symptoms for more than one year,including a mean duration of incontinence of 5.2 years.The most common symptoms before surgery were anal bleeding(n = 55),prolapsed lesion(n = 34),anal pain(n = 12) and constipation(n = 17).There were grade Ⅲ hemorrhoids in 39(51.3%) patients,and grade Ⅳ in 37(48.7%) patients according to Goligher classification.Five patients had experienced hemorrhoid surgery at least once.Compared with postoperative results,the retained volume in the preoperative liquid continence test was higher in 40 patients,lower in 27 patients,and similar in the other 9 patients.The overall preoperative retained volume in the liquid continence test was 1130.61 ± 78.35 mL,and postoperative volume was slightly decreased(991.27 ± 42.77 mL),but there was no significant difference(P = 0.057).Difference was significant in the test value before and after hemorrhoidectomy in group A(858.24 ± 32.01 mL vs 574.18 ± 60.28 mL,P = 0.011),but no obvious difference was noted in group B or group C.There was no significant difference in Wexner score before and after operation(1.68 ± 0.13 vs 2.10 ± 0.17,P = 0.064).By further stratified analysis,there was significant difference before and 2 months after operation in group A(2.71 ± 0.30 vs 3.58 ± 0.40,P = 0.003).In contrast,there were no significant differences in group B or group C(1.89 ± 0.15 vs 2.11 ± 0.19,P = 0.179;0.98 ± 0.11 vs 1.34 ± 0.19,P = 0.123).CONCLUSION:There is no difference in the continence status of patients before and after Milligan-Morgan hemorrhoidectomy.However,patients with preoperative compromised continence may have further deterioration of their continence,hence Milligan-Morgan hemorrhoidectomy should be avoided in such patients.

The therapeutic effect of pelvic floor muscle exercise on urinary incontinence after radical prostatectomy:a meta-analysis

Pelvic floor muscle exercise(PFME)is the most common con servative manageme nt for urinary incon tine nee(Ul)after radical prostatectomy(RP).However,whether the PFME guided by a therapist(G-PFME)can contribute to the recovery of urinary continenee for patients after RP is still controversial.We performed this meta-analysis to investigate the effectiveness of G-PFME on Ul after RP and to explore whether the additional preoperative G-PFME is superior to postoperative G-PFME alone.Literature search was con ducted on Cochra ne Library,Embase,Web of Scie nee,and PubMed,to obtai n all re leva nt randomized controlled trials published before March 1,2018.Outcome data were pooled and an a lyzed with Review Man ager 5.3 to compare the conti nence rates of G-PFME with control and to compare additional preoperative G-PFME with postoperative G-PFME.Twenty-two articles with 2647 patients were included.The conti nence rates of G?PFME were all superior to con trol at d iff ere nt follow-up time points,with the odds ratio(OR)(95%confidence interval[Cl])of 2.79(1.53-5.07),2.80(1.87-4.19),2.93(1.19-7.22),4.11(2.24-7.55),and 2.41(1.33-4.36)at 1 mon th,3 months,4 months,6 months,and 12 months after surgery,respectively.However,there was no difference between additional preoperative G-PFME and postoperative G-PFME,with the OR(95%Cl)of 1.70(0.56-5.11)and 1.35(0.41-4.40)at 1 month and 3 months after RP,respectively.G-PFME could improve the recovery of urinary continence at both early and Iong-term stages.Starting the PFME preoperatively might not produce extra benefits for patients at early stage,compared with postoperative PFME.

The antegrade continence enema procedure and total anorectal reconstruction

Patients may present with anal incontinence(AI)following repair of a congenital anorectal anomaly years previously,or require total anorectal reconstruction(TAR)following radical rectal extirpation,most commonly for rectal cancer.Others may require removal of their colostomy following sphincter excision for Fournier’s gangrene,or in cases of severe perineal trauma.Most of the data pertaining to antegrade continence enema(the ACE or Malone procedure)comes from the pediatric literature in the management of children with AI,but also with supervening chronic constipation,where the quality of life and compliance with this technique appears superior to retrograde colonic washouts.Total anorectal reconstruction requires an anatomical or physical supplement to the performance of a perineal colostomy,which may include an extrinsic muscle interposition(which may or may not be‘dynamized’),construction of a neorectal reservoir,implantation of an incremental artificial bowel sphincter or creation of a terminal,smooth-muscle neosphincter.The advantages and disadvantages of these techniques and their outcome are presented here.

Preservation of the continence function after intersphincteric resection using a prolapsing technique in the patients with low rectal cancer and its clinical prognosis

Background The technique of intersphincteric resection of tumors combined with coloanal anastomosis has been used to avoid permanent colostomy for patients with a rectal cancer located 〈5 cm from the anal verge. This study aimed at assessing the preservation of continence function of the residual rectum and the clinical prognosis of patients with lower rectal cancer after intersphincteric resection using a prolapsing technique. Methods This study included patients with the following inclusion criteria： （1） pathological evidence of rectal cancer and the tumors within distal margins located 5 cm or less from the anus by preoperative endoscopic examination; （2） no evidence by MRI of infiltration of either the external sphincter, puborectalis or the levator muscle; （3） the patients are eligible for intersphincteric resection and lower coloanal anastomosis with a preoperative biopsy showing the tumors with well-to-moderate differentiation. From January 2000 to June 2004, 23 patients with low rectal cancer were included in this study. We used the standard abdominoperineal approach to perform radical resection of tumors with excision of the mesorectum and total or part of the internal sphincters. The patients were followed for assessment of the function of the residual rectum and of cancer recurrence after the operations. Results The median tumor distance from the anal margin was 4.5 （range 3.5-5.0） cm and the mean distal surgical margin 1.6 （range 1.0-2.0） cm. Cancer was classified into Stage Ⅰ （30.4%）, Stage Ⅱ （47.8%）, and Stage Ⅲ （21.7%） according to the TNM classification. Two patients developed anastomotic fistula after the surgical resection and 2 patients （8.7%） developed later stages of anastomotic stricture at the site of coloanal anastomosis. The median follow-up period was 31.5 months （range 12-54） and 2 patients （8.7%） developed local recurrence. Three deaths were associated with distal organ metastasis. Twenty patients （87.0%） have maintained competence to control solid or liquid stool and the capacity of flatus continence after the surgery. Among these patients, 2 patients were able to control solid stool and occasionally lose continence of liquid stool. And only 1 patient （4.4%） has retained partial rectum function with good continence of solid stool but not liquid after the operations. Average times of defecation per day of 3, 6, 12, 24 and 36 months after the surgery were 13.1, 4.7, 3.1, 2.9, and 3.2 times/day. Anal manometer measurements showed a decrease of pressure during the resting time after intersphincteric resection and this change remained during the period of follow-up. The maximum squeeze pressure was improved after an initial decrease after the surgery. Conclusions More residual rectum function after the surgery may be preserved by intersphincteric resection of low rectum cancer. At the same time this technique is safe with few postoperative complication and low tumor recurrence after the surgery.

The Continental Scale USMTArray:Lessons Learned and Synergies with SinoProbe-Ⅱ

The USMTArray was completed on June 27,2024,comprising a network of 1779 transportable long-period magnetotelluric(MT)stations(Fig.1)with nominal 70-km grid spacing spanning the conterminous United States,an area of 8.1×10^(6)km^(2).Each station operated for weeksto-months,as required to meet data quality standards over the period band of 10–10000 s.The USMTArray shares similarities with the planned SinoProbe-II MT Array,with its 1-degree station spacing(~111 km in the latitudinal direction)spanning an area of 9.6×10^(6)km^(2).

Distinct Interannual Variability and Physical Mechanisms of Snowfall Frequency over the Eurasian Continent during Autumn and Winter

This study investigates the dominant modes of interannual variability of snowfall frequency over the Eurasian continent during autumn and winter,and explores the underlying physical mechanisms.The first EOF mode(EOF1)of snowfall frequency during autumn is mainly characterized by positive anomalies over the Central Siberian Plateau(CSP)and Europe,with opposite anomalies over Central Asia(CA).EOF1 during winter is characterized by positive anomalies in Siberia and negative anomalies in Europe and East Asia(EA).During autumn,EOF1 is associated with the anomalous sea ice in the Kara–Laptev seas(KLS)and sea surface temperature(SST)over the North Atlantic.Increased sea ice in the KLS may cause an increase in the meridional air temperature gradient,resulting in increased synoptic-scale wave activity,thereby inducing increased snowfall frequency over Europe and the CSP.Anomalous increases of both sea ice in the KLS and SST in the North Atlantic may stimulate downstream propagation of Rossby waves and induce an anomalous high in CA corresponding to decreased snowfall frequency.In contrast,EOF1 is mainly affected by the anomalous atmospheric circulation during winter.In the positive phase of the North Atlantic Oscillation(NAO),an anomalous deep cold low(warm high)occurs over Siberia(Europe)leading to increased(decreased)snowfall frequency over Siberia(Europe).The synoptic-scale wave activity excited by the positive NAO can induce downstream Rossby wave propagation and contribute to an anomalous high and descending motion over EA,which may inhibit snowfall.The NAO in winter may be modulated by the Indian Ocean dipole and sea ice in the Barents-Kara-Laptev Seas in autumn.

DEEP-2024 Expanded Abstract Volume

Deep Earth exploration is a multi-disciplinary, complex activity aimed at understanding the structure, dynamics and evolution of the continents and their margins. Interaction between Earth's tectonic plates created the continents and oceans that characterise our planet, while forming the mineral and other resources that support our living lives in modern society. Active tectonic processes are also responsible for devastating hazards such as earthquakes and volcanic eruptions, and control Earth's surface topography which fundamentally affects the climate and environment. Therefore, it is of common interest to society worldwide to study the interior of the Earth and to gain fundamental insight into how our planet operates.

The Introduction of the Idea of the Hypothetical Magellanica Continent into China during the Seventeenth Century

The idea of the hypothetical Magellanica Continent(Terra Australis Incognita)was introduced into China by the Jesuit missionaries during the seventeenth century.While not accepted by the Chinese government,it was affirmed and transmitted to the public by a few Chinese scholars,including Feng Yingjing,Cheng Bai'er,Zhang Huang,Xiong Mingyu,Xiong Renlin,You Yi,Zhou Yuqi,Jie Xuan,Wang Honghan,and Ye Zipei.Most of them communicated closely with the Jesuit missionaries,and several even helped the missionaries compose the maps.The concept was updated progressively by Matteo Ricci,Giulio Aleni,Johann Adam Schall von Bell,Francesco Sambiasi,and Ferdinand Verbiest.Chinese scholars copied the missionaries'relevant maps and textual introductions without much modification.However,they paid little attention to advancements in the idea,and many of them circulated outdated knowledge.It was not until the middle-and late-nineteenth century that Chinese scholars reexamined the correctness of this hypothetical continent.

Application of Thermodynamic Database to Corrosion of ZrO_(2) Containing Submerged Entry Nozzle in Steel Continuous Casting Process

The CALPHAD thermodynamic databases are very useful to analyze the complex chemical reactions happening in high temperature material process.The FactSage thermodynamic database can be used to calculate complex phase diagrams and equilibrium phases involving refractories in industrial process.In this study,the FactSage thermodynamic database relevant to ZrO_(2)-based refractories was reviewed and the application of the database to understanding the corrosion of continuous casting nozzle refractories in steelmaking was presented.

The Dynamic Impact of Ocean on Continent

Around 71% of the Earth’s surface is covered by oceans with depths that exceed several kilometers, while continents are geographically enclosed by these vast bodies of water. The principle of fluid mechanics stipulates that water yields pressure everywhere in the container that holds it, and the water pressure against the wall of container generates force. Ocean basins are naturally gigantic containers of water, in which continents form the walls of the containers. In this study, we present that the ocean water pressure against the walls of continents generates enormous force, and determine the distribution of this force around continents and estimate its amplitude to be of the order of 1017 N per kilometer of continent width. Our modelling suggests that the stresses yielded by this force are mostly concentrated on the upper part of the continental crust, and their magnitudes reach up to 2.0 - 6.0 MPa. Our results suggest that the force may have significantly impacted the dynamics of continent (lithospheric plate) and its evolution.

Penile prosthesis implant in the special populations:diabetics,neurogenic conditions,fibrotic cases,concurrent urinary continence surgery,and salvage implants

Penile prosthesis implant(PPI)remains an effective and safe treatment option for men with erectile dysfunction(ED).However,PPI surgery can be associated with a higher risk of complications in certain populations.This article provides a critical review of relevant publications pertaining to PPI in men with diabetes,significant corporal fibrosis,spinal cord injury,concurrent continence surgery,and complex salvage cases.The discussion of each category of special populations includes a brief review of the surgical challenges and a practical action-based set of recommendations.While specific patient populations posed considerable challenges in PPI surgery,strict pre-and postoperative management coupled with safe surgical practice is a prerequisite to achieving excellent clinical outcomes and high patient satisfaction rate.

Mapping International Student Mobility Between Africa and China

This book delves into an emerging trend in international student mobility specifically focusing on students from across the African continent enrolled in degree programmes at Chinese universities.While China stands out as a highly sought-after destination for African students,there has been limited research to date on this growing mobility pattern.

Intermediate-term oncological and functional outcomes in prostate cancer patients treated with perineal robot-assisted radical prostatectomy:A single center analysis

Objective:In the last 10 years,robotic platforms allowed to resume of some alternative surgical approaches,including perineal robot-assisted radical prostatectomy(p-RARP).Herein,we present in detail the oncological and functional outcomes of patients who underwent p-RARP with a median follow-up of 30 months.Methods:Patients presenting low-or intermediate-risk prostate cancer and prostate volume up to 60 mL who underwent p-RARP between November 2018 and November 2022 were selected.Baseline,intraoperative,pathological,and postoperative data were collected and then analyzed.Results:Thirty-seven p-RARP cases were included.Such patients presented mean age of 62 years and a mean Charlson comorbidity index of 4.Body mass index of≥25 kg/m^(2)was reported by 24(64.9%)patients,as well as 7(18.9%)patients reported a past surgical history.Mean prostate volume and median prostate-specific antigen were 41 mL and 6.2 ng/mL,respectively.The median operative time was 242 min.The positive surgical margin rate was 45.9%.In terms of postoperative complications,10 patients reported complications with any grade;however,a single case(2.7%)of major(Clavien-Dindo grade≥3)complication was observed.No patient with biochemical recurrence or distant metastasis was reported at 2 years of follow-up.Recovery of continence rates were 67.6%,75.7%,and 92.9%,at 6 months,12 months,and 24 months after surgery,respectively.

Robotic-assisted proctosigmoidectomy for Hirschsprung’s disease:A multicenter prospective study

BACKGROUND Robotic surgery is a cutting-edge minimally invasive technique that overcomes many shortcomings of laparoscopic techniques,yet few studies have evaluated the use of robotic surgery to treat Hirschsprung’s disease(HSCR).AIM To analyze the feasibility and medium-term outcomes of robotic-assisted proctosigmoidectomy(RAPS)with sphincter-and nerve-sparing surgery in HSCR patients.METHODS From July 2015 to January 2022,156 rectosigmoid HSCR patients were enrolled in this multicenter prospective study.Their sphincters and nerves were spared by dissecting the rectum completely from the pelvic cavity outside the longitudinal muscle of the rectum and then performing transanal Soave pull-through procedures.Surgical outcomes and continence function were analyzed.RESULTS No conversions or intraoperative complications occurred.The median age at surgery was 9.50 months,and the length of the removed bowel was 15.50±5.23 cm.The total operation time,console time,and anal traction time were 155.22±16.77,58.01±7.71,and 45.28±8.15 min.There were 25 complications within 30 d and 48 post-30-d complications.For children aged≥4 years,the bowel function score(BFS)was 17.32±2.63,and 90.91%of patients showed moderate-to-good bowel function.The postoperative fecal continence(POFC)score was 10.95±1.04 at 4 years of age,11.48±0.72 at 5 years of age,and 11.94±0.81 at 6 years of age,showing a promising annual trend.There were no significant differences in postoperative complications,BFS,and POFC scores related to age at surgery being≤3 mo or>3 mo.CONCLUSION RAPS is a safe and effective alternative for treating HSCR in children of all ages;it offers the advantage of further minimizing damage to sphincters and perirectal nerves and thus providing better continence function.

Randomized controlled trial comparing open anterograde anatomic radical retropubic prostatectomy with retrograde technique

Objective:Radical prostatectomy is the recommended treatment for localized prostate cancer;however,it is an invasive procedure that can leave serious morbidity.Robot-assisted radical prostatectomy was introduced with the aim of reducing postoperative morbidity and facilitating rapid recovery compared to the traditional Walsh’s open radical retropubic prostatectomy.Therefore,a protocol was developed to perform an open prostatectomy comparable to that performed by robotics,but without involving novel instrumentation.Methods:A total of 220 patients diagnosed with localized prostate cancer underwent radical prostatectomy.They were divided into two groups:anterograde technique(115 patients)and the retrograde method(105 patients).The study outcomes were observed 3 months after surgery.Results:No differences were found in terms of surgical time,hospital stay,and suction drainage.However,reduced bleeding was observed in the anterograde technique(p=0.0003),with rapid anastomosis duration(p=0.005).Among the patients,60.9% undergoing the anterograde technique were continent 3 months after surgery compared to 42.9%treated by the retrograde method(p=0.007).Additionally,fewer complications in terms of the number(p=0.007)and severity(p=0.0006)were observed in the anterograde technique.Conclusion:The anterograde method displayed increased efficiency in reducing complications,compared to the retrograde technique.

Intersphincteric resection and coloanal anastomosis in the treatment of distal rectal cancers

Objective:In the evolving era of minimal access surgery,low rectal cancers still pose a challenge to laparoscopic or robotic surgeons.Hence,at our institute we intended to demonstrate the oncological efficacy of intersphincteric resection and coloanal anastomosis in the treatment of distal rectal cancers,performing the abdominal part of the procedure which includes rectal mobilization,laparoscopically.Methods:From February 2017 to March 2021,125 patients who had undergone intersphincteric resection and coloanal anastomosis via the perineal approach at Galaxy Care Laparoscopic Institute,Pune,were included in this study.Transabdominal mobilization of the rectum was performed laparoscopically.All patients had a diversion ileostomy and a pelvic drain.Patients were followed-up for a period of 18 months post-surgery.Data on clinical and oncological outcomes were collected and analysed.The pre-operative and post-operative Wexner incontinence scores were compared.Results:The mean time taken for surgery was 181.57±30.00 min.The mean blood loss was 119.76±42.53 mL.Most patients(103,82.4%)had their tumour at a distance of 1e2 cm from the anal verge.A loco-regional recurrence rate of 12.8%(16/125)was noted in our study.For the post-surgery Wexner score,74.4% of patients(93/125)had a score of 5 or less,depicting that three-quarters of the study population had satisfactory continence.Overall,81.6%of patients were satisfied with the functional results of surgery.Conclusion:Intersphincteric resection and coloanal anastomosis,with a 12.8%recurrence rate,can now be considered an oncological and technically feasible procedure with sphincter salvage and good continence.

Renewable and Green Energy, Africa’s Pathway to Sustainable Development;Harnessing the Continent’s Natural Energy Sources

Renewable energy includes all forms of energy produced from renewable sources in a sustainable manner, including bioenergy, geothermal energy, hydropower, ocean energy, solar energy, and wind energy. Less than one quarter of Africa’s renewable power generation potential is utilized. Africa’s natural endowments are enormous, yet the continent experiences high energy shortage. Amongst the classifications of energy sources, renewable and green energy sources are increasingly gaining popularity due to their sustainable nature and environmental concerns. This paper explores the continent’s natural energy sources and identifies pathways to sustainable development. The paper also narrows the renewable and green energy sources obtainable on the continent and presents their contribution to the development of the continent. The awareness level of Africans towards renewable energy is discussed and the challenges of renewable and green energy sources are highlighted. Finally, the roles to be played by the government and private organizations in the development of renewable and green energy sources in Africa are discussed.

带上狗狗环游世界

汤姆·图奇在七年多的时间里,带着他的狗萨凡纳横跨六大洲38个国家。主题语境:环游世界篇幅:305词建议用时:6分钟1Tom Turcich of New Jersey became the 10th person to walk around the world on May 21, 2022.Over seven years, he walked 48,000 kilometers across six continents and 38 countries—most of it with his dog Savannah.