Objective:In recent years, the super mini-PCNL (SMP) technique has developed rapidly and matured gradually. However, the operation time may be prolonged when manage the large burden renal calculi with 14 F tract. On the basis of SMP, the suction sheath was increased to 18 F, in the aim to improve the lithotripsy efficiency and keep a low renal pelvic pressure, which was called enhanced-SMP (eSMP). In the present study, eSMP and mini-PCNL was compared to analyze the intra-operative renal pelvic pressure and stone removal efficiency when managed the 2-5 cm renal calculi, and to verify the safety and efficiency of eSMP technique.Methods:From January 2017 to December 2019, 100 patients with 2-5 cm renal calculi in our hospital were randomly divided into eSMP group and mPCNL group. 18 Fpercutaneous tract was established, suction sheath with 11 F mini nephroscope and peel-away sheath with 8/9.8 F ureteroscope was used in eSMP and mPCNL, respectively. Ho:YAG laser and pneumatic lithotriptor was used for lithotripsy. During the operation, renal pelvic pressure was measured, operation time, lithotripsy time, removed stone volume and complications were recorded and analyzed statistically.Results:There was no significant difference in the stone volume removed between mPCNL group and eSMP group, but the lithotripsy time in mPCNL was significantly longer than eSMP group [(50.1±19.6) min vs (35.3±14.3)min, t=4.314, P<0.001], thus the stone removal effectiveness was higher in eSMP group [(13.66±1.17) mm3/h vs (9.78±1.23) mm3/h, t=16.150, P<0.001], and the total operation time in mPCNL group was longer than eSMP group [(67.3±19.5) min vs (52.1±14.4) min, t=4.429, P<0.001]. The intra-operative renal pelvic pressure in mPCNL group was higher than eSMP group [(17.88±3.28) mmHg vs (12.01±2.45) mmHg, t=10.140, P<0.001], and also the accumulated time of renal pelvic pressure >30 mmHg in mPCNL group was longer than eSMP group [(23.2±16.6) s vs (3.8±4.3) s, t=8.012, P<0.001]. The postoperative decreased hemoglobin in mPCNL group was more than eSMP group [(17.1±6.8) g/L vs (14.0±7.5) g/L, t=2.182, P=0.032]. There was no significant difference in the postoperative fever rate and stone clearance rate, while the hospital stay in mPCNL group was longer than eSMP group [(2.98±0.87) d vs (2.60±0.78) d, t=2.298, P<0.001].Conclusion:Enhanced SMP (eSMP) was safe and effective in the management of 2-5 cm renal calculi. On the basis of irrigation-suction sheath, eSMP can keep a lower renal pelvic pressure and higher lithotripsy efficiency when compared to traditional mPCNL.
Objective To evaluate the diagnostic value of 320 slice CT urography in ureteral obstruction. Methods 320 slice CTU was performed in 92 cases with ureteral diseases. The volume data of all patients were reconstructed by 3D reconstruction techniques including maximum intensity projection,multiple plane reformation, curve plane reformation and volume rendering technique. Results Among the 92 cases, there were 65 cases of ureteral calculus, 4 ureteral carcinomas, 5 bladder carcinomas, 1malignan interstitialoma, 3 inflammatory stenosis, 2 renal and ureteral tuberculosis stenosis, 4 malformation with congenital huge ureter, 4 malformation with double renal pelvis and ureter, 3 retrocaval ureter and 1genitical gland vein and ureter juncture oppression. All cases were confirmed by surgery or cilinical data. On CTU, the location, shape and diameter of the lesions, enlargement of renal pelvis and ureter were clearly displayed. Conclusion 320 slice CTU has an unique advantage in the diagnosis of ureteral obstruction diseases for its high spatial resolution and the high quality of reconstructions.
Objective To evaluate the significance of intravesical prostatic protrusion(IPP) in predicting postoperative outcomes in patients with benign prostatic hyperplasia. Methods The parameters of265 patients with a follow-up of 6 months who were treated with bipolar transurethral plasma kinetic prostatectomy(TUPKP) were analyzed. We divided the patients into two groups on the basis of the degree of IPP: the significant IPP group(IPP≥5 mm, n=105) and the no significant IPP group(IPP5 mm, n=160).Preoperative and postoperative changes in parameters, such as the International Prostate Symptom Score(IPSS), quality-of-life(QOL) score, maximum urinary flow rate(Qmax), and postvoid residual urine(PVR)were analyzed. Results The preoperative characteristics had no significant difference between two groups.Postoperative changes in IPSS and QOL score were higher in the significant IPP group than in the group with no significant IPP and there were significant differences(P=0.038 and P=0.000, respectively). Changes in Qmax and PVR were not significantly different between the two groups. Conclusion IPP is an independent factor for predicting postoperative outcomes of IPSS and QOL.
Objective To evaluate the diagnosis values of multi-slice CT angiography(CTA) in patients with ureteropelvic junction obstruction(UPJO) caused by aberrant crossing vessels. Methods 16 patients with surgically proved UPJO caused by aberrant crossing vessels were included. Their CTA findings were retrorespectively analyzed to observe the variants of renal vessels, presence, origin and size of crossing vessels surrounding ureteropelvic junction. Results Of 16 patients, 12 had variants of renal artery and 3 had variants of renal veins. A total of 19 aberrant crossing vessels were found in 16 patients. 15 of these vessels were arteries and 4 were veins. Solitary vessel was found in 13 patients and 2 vessels were found in 3patients. Of the 19 vessels, 12 were accessory renal arteries, 3 were aberrant arteries, 2 were gonadal veins,and 2 were accessory renal veins. CTA findings of 16 cases were corresponded to their surgical pathology.Conclusion Multi-slice CTA not only reveals the anatomy of the renal vessels and its vascular variants, but also plays vital roles in the diagnosis and preoperative assessment of patients with UPJO caused by aberrant crossing vessels.
Objective To summarize the CT findings and to enhance the understanding of renal、 pancreatic and adrenal involvement in Von Hippel-Lindau syndrome.Methods Collect 9 cases of patients who were clinically consistent with VHL syndrome diagnostic criteria and abdominal involvement,and the clinical,pathological data and multi slice spiral CT(MSCT) performance were analyzed retrospeclively.All underwent MSCT scan and enhance the inspection.Results Multiple bilateral renal lesions were detected in 9 patients.The renal lesions were classified as cystic,cystic with solid components and solid.Multiple combined renal lesions were found in 6 patients,and multiple simple cysts in 3 patients.Renal tumor resection was performed in 3 patients,and the renal masses were diagnosed as clear cell carcinoma by pathology.Pancreatic cysts were found in 7 patients,calcifications were detected in 4 patients,and pancreatic islet cell tumor was detected in 1 patient.Adrenal pheochromocytomas were found in 3 patients,including 2 bilateral cases.Five patients have family history.Conclusions Multiple abdominal organs can be involved in VHL syndrome,familiarity with the CT imaging features of VHL will be helpful to the early and comprehensive diagnosis.
Objective To compare the safety,feasibility and application value of the single hole method and the three holes method in retroperitoneal laparoscopic ureterolithotomy.Methods Retrospective of the clinical data of single hole method group and three holes method group were analyzed retrospectively.Retroperitoneal laparoscopic ureterolithotomy was performed,comparing the trocar leakage rate,operation time,intraoperative bleeding,peritoneal wear out rate,additional operation hole rate,stone clearance and complications.Results In two groups,the trocar leakage rate,stone clearance,postoperative complications and postoperative hospital stay were not statistically different(P 0.05).There were more advantages on the intraoperative bleeding,operation time,peritoneal wear out rate and the additional trocar rate in the three holes method groups(P 0.05).Conclusions The single hole method has the advantages of minimally invasion cosmetic.Rich clinical experience should be the basis of the technology of the potential and the scope of application,so as to reduce surgical trauma and cosmetic effect.
Objective To introduce a new technique and evaluate the effect of pneumatic ballistic lithotripsy via outer sheath of resectoscope by optimized water flow in the treatment of bladder calculi. Methods Thirty-one patients with bladder calculi were enrolled into the study from June 2009 to September 2011. By improving the way of water flow, they were treated with pneumatic ballistic lithotripsy via outer sheath of resectoscope. Results All the bladder calculi were removed by one session. No severe postoperative complications such as bladder perforation and water intoxication occurred. No recurrance or urethral stricture was observed after 6-20 months follow-up. Conclusions Treatment of bladder calculi with pneumatic ballistic lithotripsy via outer sheath of resectoscope is safe and effective with few complications and worths recommendation in clinical practise.
Objective To compare the efficacy of transurethral electroresection combined with onlyone time intravesical instillation of pirarubicin (THP) and with postoperative repeatedly THP intravesicalinstillation in the treatment of cystitis glandularis in women. Methods A total of 120 patients withcystitis glandularis were randomly divided into two groups. Sixty patients underwent transurethralelectroresection combined with postoperative repeatedly intravesical instillation of pirarubicin and 60received same resection combined with single THP bladder perfusion. Remission rate, relapse rate the rateof cancer, and the incidence of complication were statistically analyzed during 12 -18 months follow-up.Results The remission rate of urinary frequency and urgency, lower abdominal pain, hematuria and rate ofcancer, relapse rate in two groups were similar (P 0.05). However, the complication rate was statisticallydifferent in two groups (P0.05). Conclusions The two treatment effects were similar for symptoms relief,prevention of recurrence and cancer. However, the transurethral resection combined with intraoperativesingle THP bladder instillation for the treatment of women with cystitis glandularis had the advantages: lightpain, well tolerated, low cost and low complication rate.
Objective To compare the survival rate of lung cancer patients with single adrenlmetastasis who underwent adrenalectomy or conservative management, and to analyze prognositic impactfactors. Methods Between January 2001 and December 2010, 26 patients were diagnosed with singleadrenal metastasis from lung cancer. Sixteen patients underwent adrenalectomy. The reasons fornonoperative procedures included: poor performance status, melting mediastinal lymph nodes metastasesand unwilling to accept operation. Four patients(25%) treated surgically had ipsilateral tumor to the primarysites and 8 (50% ) had synchronous metastases. Results Three-year survival was 52% for operativepatients and 10% for nonoperative ones (P =0.02). Among operative patients, 3-year survival rate foripsilateral adrenal metastasis was 75% compared with 15% for contralateral ones (P=0.015). Patients withmediastinal nodal metastasis had 3-year survival rate of 0% compared with 40% for patients without lymphnode disease (P =0.001). There was no significant survival difference between patients who underwentadrenalectomy for synchronous and metachronous metastases. Conclusions Adrenalectomy of singlemetastasis from lung cancer provides a better survival compared with nonoperative procedures. Contalateralmetastasis and mediastinal lymph nodes metastases are adverse impact factors. Synchronous ormetachronous metastases did not significantly affect survival rate.
Objective To compare the efficacy of three approaches of laparoscopic ligation of internal ring (IR) in the treatment for patent processus vaginalis (PPV) in children. Methods Between January 2008 and December 2011, 142 children with patent processus vaginalis who underwent laparoscopic operations by three different technique (three-port technique, TPT; two-port or single-port technique) were enrolled into this study. Operation time, complications, post-operative stay, cosmetic effects, recurrences and hospitalization costs were studied retrospectively. Results IR was ligated in 203 sides of 142 patients. During 12 months, follow-up (3-36 months), single-port group acquired better cosmetic effect, two-port group or single-port group needed shorter operation time than TPT group (unilateral, P0.005; bilateral, P=0.017). One patient in two-port group recurred postopertatively, and 1 cases of single-port group developed contralateral metachronous hernia during the study period. Wide rings (1 cm) were found intra-operation, including 9 cases in TPT group, 7 cases in two-port group, and 13 cases in single-port group, while recurrences were found in 0, 1, and 0 case respectively. The complications, hospital stay and hospital cost were not significanly different among the three groups(P0.05). Conclusions Laparoscopic ligation of IR are safe and efficacious procedures. Single-port laparoscopic surgery, on the basis of the success of operation, can save the time of surgery, reduce complications, and get excellent cosmetic outcomes.
Objective To explore the effect and the feasibility of our homemade triport withcircumcision device in laparoendoscopic single-site surgery for varicocele. Methods Thirteen patientswith varicocele on the left side underwent laparoendoscopic single-site surgery. The single-site port wasmade in our institution. The data were analyzed retrospectively. Results All the operations weresuccessful. The operative time was 20-60 min, cost of hospitalization was 6453-7464 yuan, duration ofhospitalization was 5-7 days. Conclusions The homemade triport with circumcision device in thetransperitoneal single-site surgeries is feasible.
Objective To investigate the diagnosis and treatment of adrenal ganglioneuroma.Methods Five cases of adrenal neoplasm diagnosed by preoperative B-ultrasound, CT and MRI andconfirmed as adrenal ganglioneuroma by pathological immunohistochemistry were reviewed. Four casesunderwent open surgery and 1 case underwent laparoscopic excision of adrenal ganglioneuroma. ResultsAll operations were completed successfully. The pathological reports showed adrenal ganglioneuroma. Allpatients recovered without complication. No recurrence was observed after 2 years’ follow-up.Conclusions The clinical diagnosis of adrenal ganglioneuroma is depended on preoperative B-ultrasound,CT and MRI, while the final diagnosis is depended on pathological and immunohistochemistry after surgicalresection of the mass.
Objective To improve the diagnosis and treatment of primary ureteral polyp and to explore the experience of retroperitoneal laparoscopic surgery. Methods The clinical data of 8 cases with primary ureteral polyps from 2007 to 2011 aging from 15 to 48 years, including 5 male and 3 female, 5 cases in right side, 2 cases in left cases and 1 bilateral case were retrospectively analyzed. Results Five cases underwent segmental resection with ureteral anastomosis, while other 3 cases underwent local resection with pyeloplasty. All operations were successful without complication such as hemorrhage, infection or leakage of urine. Diagnoses were confirmed by pathology and no recurrence or canceration was observed in 3-12 months’ follow-up. Conclusions Retroperitoneal laparoscopic surgery is feasible for treatment of primary ureteral polyp that is local, multiple and difficult to treat by ureteroscopy and can be applied in clinical practice.
Objective To evaluate the value of transrectal real-time tissue elastography (TRTE) in transrectal prostate gland biopsy. Methods Totally 125 male patients with elevated prostate specific antigen were chosen for transrectal prostate gland biopsy. Eight points as well as two points that TRTE shown as hard tissue were punctured for each patients. According to the TRTE results, all the punctured points were divided into hard tissue or soft tissue. The pathologic results between the hard tissue and soft tissue were compared . Results Eighty-seven patients ( 67 . 9 % ) were diagnosed as benign prostatic hyperplasia and 38 (32.1%)as prostate cancer. Altogether 1250 biopsy tissues were taken and the time spent for TRTE in each patient was 10-16 min (13.2±2.8 min in average). Biopsy tissues shown 437 and 813 in hard and soft group, the case with the prastate cancer was 131 and 162 respectively. The hard tissue group had higher prastate cancer rate than the soft tissue group (P =0.00). Conclusions Transrectal real-time tissue elastography could be a new method to improve the transrectal prostate gland biopsy for cancer.
Objective To summarize the experience of laparoscopic radical cystectomy and sigmoid colon orthotopic neobladder reconstruction for invasive bladder cancer. Methods The clinical data of 18 patients with invasive bladder cancer were analyzed retrospectively. These patients underwent prostatectomy or hysterectomy depending on the gender. Radical cystectomies and pelvic lymphadenectomies were performed with laparoscopic technique. The resected specimens were removed via enlarged incision and the detenial sigmoid neobladder was reconstructed. Results All operations were completed successfully. Laparoscopic operation time was 240 to 360 minutes and blood lost was 300 to 500 ml. Open neobladder reconstruction time was 180 to 300 minutes and blood lost was 200 to 400 ml. Oral intake was allowed in 5 to 7 days after operation. Pelvic drainages were removed in 2 weeks and bladder fistula was removed in 3 to 4 weeks. Bilateral urteral stents and the pouch catheter were removed in 4 to 6 weeks postoperatively. Conclusions Laparoscopic radical cystectomy and sigmoid colon orthotopic neobladder reconstruction takes advantages in less trauma, faster recovery, better therapeutic effects and less complications. It is a safe and effective surgical method for invasive bladder cancer.
Objective To investigate the effects of etoposide(ETOP) and TAXOL on growth and cell apoptosis of human prostate cancer cell line.Methods After prostate cancer cells were cultured with ETOP,TAXOL,or the combination of both chemicals,cell survival was assessed by MTT assay.Cell chromatin morphologic changes were observed under fluorescence microscope,and cell apoptosis were determined by DNA ladder assay.Results ETOP and TAXOL,used alone or in combination,inhibited the growth of prostate cancer cells in a time-and dose-dependent manner.The inhibition was more obvious in the combination group than ETOP group and TAXOL group(P0.05).Typical changes of apoptotic cells in morphology can be observed in ETOP and TAXOL and combination group.The number of cell in combination group is lowest in all three groups.In all groups,a continual diffusive tailed tape and DNA-tailed tape were observed,especially for combination group.Conclusions ETOP and TAXOL can inhibit the growth and induce apoptosis of prostate cancer cells.Furthermore,the combination of ETOP and TAXOL can exert synergistic inhibitory effect on the growth of prostate cancer cells.
Objective To explore the relationship of level of IL-2, IL-6, TNF-α, with reactiveoxygen species (ROS) and malondialdehyde in different seminal plasma. Methods 41 male patients withnormal fertility, 65 patients with oligospermia and asthenospermia and 21 patients with azoospermia wereenrolled. After the removal of seminal by centrifugation, levels of IL-2, IL-6, TNF-α were detected byELISA, level of ROS by chemiluminescence and level of MDA by biochemical colorimetric method. Theconcerntration of cytokines above and oxidative stress related index was analysed. Results The level ofIL-2 was highest in patients with oligospermia and asthenospermia, but no difference was detected inpatients with normal fertility and azoospermia. Levels of IL-6, TNF-α were higher in patients witholigospermia, asthenospermia and asthenospermia than in normal male, but no difference was detected inpatients with oligospermia, asthenospermia and asthenospermia. Levels of ROS and MDA were highest inpatients with oligospermia and asthenospermia, but no difference was detected in patients with normalfertility and azoospermia. Level of ROS and MDA was correlated with level of IL-2 in different semen.Conclusions Seminal cytokines was closely related with male infertility. The level of cytokines increasedobviously in abnormal semen, and low male reproduction resulted from oligospermia and asthenospermia iscorrelated to oxidative stress.
Objective To compare the effect of laparoscopic partial nephrectomy (LPN) with open partial nephrectomy (OPN) in the treatment of local renal cell carcinoma. Methods We retrospectively analysed the data of 68 cases of partial nephrectomy in our hospital from October 2007 to September 2011, including 31 cases of laparoscopic partial nephrectomies and 37 cases of open partial nephrectomies. Variables compared included operation time, warm ischemic time, blood loss, amount and time of drainage, time of anal exsufflation, postoperative hospital stay, postoperative complication and creatinine levels before and after partial nephrectomy. Letters, telephone and postoperative table were used in follow-up. Results There was no significant difference in postoperative complication, amount and time of drainage(P0.05). LPN group was obviously superior to OPN group in blood loss, time of anal exsufflation, and postoperative hospital stay(P0.05). But in the operation time, warm ischemia time, LPN group was obviously inferior to OPN group (P0.01). There was no significant difference between the two groups in creatinine increased after operation. Conclusions Though the laparoscopic approach is associated with longer operation time and warm renal ischemic time, laparoscopic partial nephrectomy for the treatment of localized renal tumor has the advantages of minimal invasion and efficiency.
Objective Compare the effects of transurethral prostate electrocision to the body temperature and occurrence of shivering in patients after assisted with rinsing fluid at two different temperatures.Methods The patients of two groups were using bladder rinsing fluid at different temperatures.Without warming group:20 ℃-23 ℃; Warming group:32 ℃-35 ℃.Rinsing rate is 100-110 drops /min.Results During the 8 hours of rinse,the body temperature changes of patients in two groups has no significant difference between each other(P0.05).However,along with the extension of rinse time and increasing quantity of rinse fluid,there were significant differences between body temperature changes(P0.01).Patients′ occurrence of shivering:in warming group 2 cases(5.7%),without warming group 8 cases(25%),There were significant differences between the two groups(P0.05).Conclusions It is beneficial to reduce the occurrence of body temperatures and shivering in patients when given continuing bladder rinse time for more than 8 hours after surgery,as well as warming the washing liquid.
Objectives To evaluate the effect of ketamine-associated cystitis treated with intravesical instillation of sodium hyaluronate.Methods From July 2010 to December 2012,a total of 30 patients who suffered from ketamine-associated cystitis were recruited into the study.Analyzed the clinical symptoms and laboratory results,withdrawal the ketamine abuse and treated with intravesical instillation of sodium hyaluronate for 8 weeks.Results After the treatments,21 cases(70%) totally got rid of the lower urinary tract symptoms,6 cases(20%) were partially relieved and 3 cases had no effect.Conclusions For the treatment of ketamine-associated cystitis,withdrawal the ketamine abuse and treated with intravesical instillation of sodium hyaluronate could have a good effect.
