The aim of this study was to report the experience and long-term efficacy of a novel surgical treatment for pelvic lipomatosis (PL) using a combination of pelvic fat mass extirpation and ureteral reimplantation. Data of 8 patients with PL who underwent pelvic fat mass extirpation and ureteral reimplantation at our hospital from September 2010 to March 2018 were retrospectively reviewed. Demographics, serum creatinine level, radiographic changes, perioperative complications, and patient-reported outcomes were evaluated. Surgeries were performed successfully without severe perioperative complications in all 8 patients. Median operating time was 150 minutes with a median estimated blood loss of 75 mL. Patients were discharged after a median of 8.5 postoperative days. Imaging studies at the first follow-up revealed varying extents of alleviation of hydronephrosis and 3 patients’ urinary symptoms were gradually relieved after surgery. During a median follow-up of 48.5 months (range, 10–100 months), all patients exhibited excellent surgical outcomes without evidence of disease progression, except 1 patient who underwent radical cystectomy with Bricker ileal conduit surgery due to hydronephrosis recurrence in the 49th postoperative month. Based on these cases, pelvic fat mass extirpation and ureteral reimplantation is a safe and effective surgical treatment for PL.
The particle size plays an important role in the mechanical behavior of granular geomaterials. With respect to the crushable granular soils, the particle breakage under different pressures leads to the variation of the particle size distribution of soils. Therefore, it is essential to accurately model the particle fracture process to reproduce the key response of granular soils in the simulation. In this study, two simulated approaches, cluster method and replacement method, were performed to investigate the particle size effect for the crushable granular soils by three-dimensional (3D) discrete element method (DEM). DEM simulations were validated through the available results of diametric and oedometric compression tests with the help of the Weibull statistics. Based on the evaluation at particle and assemble-scale, it is found that both the cluster method and replacement method could simulate the particle strength and size dependence of sample failure with a good agreement with experimental results. The particle breakage phenomenon is also successfully modeled in DEM simulation and analyzed by the breakage index. Meanwhile, the computational efficiency was analyzed compared with two simulated methods. The findings in this study can provide a viable approach to investigate the particle breakage effect of the crushable geomaterials.
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