膀胱癌是泌尿系统常见恶性肿瘤之一,其中约70％～80％膀胱癌为非肌层浸润性膀胱癌(non-muscle invasive bladder cancer, NMIBC)[1],经尿道膀胱肿瘤切除术辅以术后膀胱灌注化疗为NMIBC的临床首选治疗方案[2].吡柔比星(pirarubicin, THP)为蒽环类药物的半合成药物,通常用于膀胱灌注化疗.它能够嵌入肿瘤细胞 DNA 链中,抑制DNA聚合酶的活性,从而使肿瘤细胞死亡[3],但其最常见的不良反应为化学性膀胱炎,临床表现为尿频、尿急、尿痛等症状,甚至可能出现血尿.

Objective:To explore the feasibility, safety and short-term effect of the Hood technique in robotic-assisted radical prostatectomy (RARP).Methods:The data of 24 patients with localized prostate cancer underwent RARP with Hood technique From June 2020 to March 2021 were retrospectively reviewed. The mean age was 67.8 (57-76) years, and the mean body mass index was 25.17(18.31-32.54)kg/m 2. The mean tPSA value was 18.36(4.21-67.57)ng/ml and the mean biopsy Gleason score was 7.3 (6-8). In term of the clinical T stage, the 24 cases were composed of the T 1c stage in 1 case, T 2a stage in 5 cases, T 2b stage in 4 cases and T 2c stage in 14 cases. During Hood technique, the anterior bladder were limitedly isolated without exposing the outline of pelvis and prostate. Results:All the cases were completed robotically without conversion, transfusion or positive surgical margin. The average robot-assisted operation time was 84.5(63-110) mins. Estimated blood loss was 75.3(20-180) ml. The average time for maintaining the drain was 3.7(3-5) days. The mean postoperative hospital stay was 7.1(4-11) days. The mean catheterization time was 7.3(6-9) days after surgery. 23 patients achieved continence immediately after catheter removal, while 1 patient had continence full-recovery 2 weeks after surgery. The mean surgical Gleason score was 7.9 (6-9). In term of the surgical T stage, the 24 cases were composed of the pT 2a stage in 4 case, T 2b stage in 6 cases, T 2c stage in 14 cases.During 3-12 months’ follow-up, no biochemical recurrence was found. Conclusions:Hood technique were safe and valid in RARP with excellent immediate continence recovery. It facilitated Retzius sparing in a convenient approach with low positive surgical margin rate.

Benign prostatic hyperplasia (BPH) is highly prevalent among older men, impacting on their quality of life, sexual function, and genitourinary health, and has become an important global burden of disease. Transurethral plasmakinetic resection of prostate (TUPKP) is one of the foremost surgical procedures for the treatment of BPH. It has become well established in clinical practice with good efficacy and safety. In 2018, we issued the guideline “2018 Standard Edition”. However much new direct evidence has now emerged and this may change some of previous recommendations. The time is ripe to develop new evidence-based guidelines, so we formed a working group of clinical experts and methodologists. The steering group members posed 31 questions relevant to the management of TUPKP for BPH covering the following areas: questions relevant to the perioperative period (preoperative, intraoperative, and postoperative) of TUPKP in the treatment of BPH, postoperative complications and the level of surgeons’ surgical skill. We searched the literature for direct evidence on the management of TUPKP for BPH, and assessed its certainty generated recommendations using the grade criteria by the European Association of Urology. Recommendations were either strong or weak, or in the form of an ungraded consensus-based statement. Finally, we issued 36 statements. Among them, 23 carried strong recommendations, and 13 carried weak recommendations for the stated procedure. They covered questions relevant to the aforementioned three areas. The preoperative period for TUPKP in the treatment of BPH included indications and contraindications for TUPKP, precautions for preoperative preparation in patients with renal impairment and urinary tract infection due to urinary retention, and preoperative prophylactic use of antibiotics. Questions relevant to the intraoperative period incorporated surgical operation techniques and prevention and management of bladder explosion. The application to different populations incorporating the efficacy and safety of TUPKP in the treatment of normal volume (< 80 ml) and large-volume (≥ 80 ml) BPH compared with transurethral urethral resection prostate, transurethral plasmakinetic enucleation of prostate and open prostatectomy; the efficacy and safety of TUPKP in high-risk populations and among people taking anticoagulant (antithrombotic) drugs. Questions relevant to the postoperative period incorporated the time and speed of flushing, the time indwelling catheters are needed, principles of postoperative therapeutic use of antibiotics, follow-up time and follow-up content. Questions related to complications incorporated types of complications and their incidence, postoperative leukocyturia, the treatment measures for the perforation and extravasation of the capsule, transurethral resection syndrome, postoperative bleeding, urinary catheter blockage, bladder spasm, overactive bladder, urinary incontinence, urethral stricture, rectal injury during surgery, postoperative erectile dysfunction and retrograde ejaculation. Final questions were related to surgeons’ skills when performing TUPKP for the treatment of BPH. We hope these recommendations can help support healthcare workers caring for patients having TUPKP for the treatment of BPH.

良性前列腺增生(BPH)是中、老年男性的常见疾病,也是引起下尿路症状的常见原因.目前主要治疗方法是观察等待、药物治疗、外科手术治疗,其中手术干预能快速缓解下尿路症状,提高生活质量而成为治疗中、重度BPH最有效的手段.近年来,随着各种激光技术的飞速发展及临床应用,被认为是“金标准”的经尿道前列腺电切术因较多的手术并发症及治疗大体积前列腺的局限性而饱受争议;各种激光技术也因其明显的治疗效果、安全性及并发症较少的优势,逐渐获得临床医生的青睐.本文主要介绍半导体激光微创技术治疗BPH的临床研究进展,期望在一定程度上为医生的临床治疗提供相关的理论依据.

目的 探究经尿道前列腺钬激光剜除术与经尿道前列腺双极等离子电切术治疗老年、大体积良性前列腺增生症的临床效果及安全性.方法 回顾性分析华中科技大学同济医学院附属同济医院收治的76例年龄≥60岁,前列腺体积≥80 mL的良性前列腺增生症患者.根据手术方式的不同,将患者分为经尿道前列腺钬激光剜除术(holmium laser enucleation of prostate HoLEP)组和经尿道前列腺双极等离子电切术(bipolar plasmakinetic resection of prostate,BPRP)组,比较两种手术方式治疗老年、大体积良性前列腺增生症的临床效果和安全性.结果 所有符合纳入标准的76例患者手术均取得成功,其中50例患者接受了HoLEP术,26例患者接受了BPRP术.两组患者的平均年龄为(70.9±7.5)岁,平均前列腺体积为(100.2±24.2)mL.术前两组患者在年龄、体质量指数(BMI)、ASA分级、术前前列腺体积、国际前列腺症状评分(IPSS)、生活质量评分(QOL)、血清钠离子浓度等基线资料差异无统计学意义(均P＞0.05).与术前相比,两种手术方式均能明显地改善IPSS、QOL,并且无电切综合征和输血不良事件.两组患者虽然在术后血钠下降(P=0.60)以及术后并发症(P=0.75)方面差异没有统计学意义,但是HoLEP组在手术操作时间(P=0.03)、术后膀胱冲洗时间(P=0.04)、留置导尿时间(P＜0.01)、住院时间(P=0.04)等方面均更短,IPSS下降更明显(P=0.04)和QOL提高更显著(P=0.02).结论 HoLEP与BPRP治疗老年、大体积良性前列腺增生症均安全有效,但是HoLEP的手术时间更短、术后恢复更快,临床治疗效果更佳;同时,也需要更多的临床随机对照研究评价两种手术方式的临床效果和安全性.

Objective To evaluate the effect and mechanism of dihydromyricetin (DHM) on the proliferation of human bladder cancer cells.Methods UMUC3 cells were incubated with DHM at the concentrations of 0,5 and 20 μmol/L respectively,then the inhibitory effect were investigated by thiazole blue (MTT) assay and flow cytometry.The expression of Cyclin D1 and Cyclin E1 and cyclin-dependent kinases (CDK2 and CDK4) was detected using real-time fluorescence quantitativepolymerase chain reaction (FQ-PCR) and Western blotting.Statistical analysis was performed using SPSS 21.0 software and the results were expressed by mean value ± standard deviation (Mean ± SD).The statistical method was one-way analysis of variance incorporated with the least significant difference (LSD) method and Duncan multiple range test.Results DHM inhibited the proliferation of UMUC3 cells obviously.Compared with the control group [(48.4 ± 0.6)％],the percentage of G0/G1 phase cells in low concentration group [(55.2 ± 0.1) ％] and high concentration group [(60.5 ± 0.3) ％] increased,and the difference was statistically significant (F=417.668 in the low concentration group,P ＜0.01,F=401.652 in the high concentration group,P ＜ 0.01).The percentage of G0/G1 phase cells was higher in the high concentration group than in the low concentration group,and the difference was statistically significant (F =100.221,P ＜ 0.05).The results of RT-PCR and Western blotting showed that the expression of CDK2,CDK4,Cyclin D1 and Cyclin E1 decreased obviously.Conclusion DHM can effectively inhibit the proliferation of human bladder cancer cells,and its mechanism may be related to blocking the transition of cell cycle from G0/G1 phase to S phase.

Objectives: Pseudomonas aeruginosa-mannose sensitive hemagglutinin (PA-MSHA), a peritrichous P. aeruginosa strain with MSHA fimbriae, has been shown to be a valuable anticancer drug in many kinds of cancers. However, the effect of PA-MSHA on bladder cancer has not been elucidated. In this study, we focused on the antitumor activities and related mechanisms of PA-MSHA on bladder cancer in vitro and in vivo. Materials and methods: SV-40-immortalized normal uroepithelial cells (SV-HUC-1) and human bladder cancer cell lines (T24, 5637, and HT-1376) were treated with PA-MSHA or PA (heat-killed P. aeruginosa). At first, the effect of PA-MSHA on cancer cell proliferation was measured using Cell Counting Assay Kit-8 (CCK-8). whereas the changes of cell morphology were observed by transmission electron microscopy. The early apoptosis induced by PA-MSHA was evaluated by flow cytometry, and the expression level of apoptosis-related molecules was detected using Western blot assay. We then investigated the activation of the epidermal growth factor receptor signaling pathway stimulated by PA-MSHA; the expression and phosphorylation of several key regulators involved in the EGFR signaling pathway were detected. At last, xenograft tumor in nude mice was used to further investigate the antitumor effect of PA-MSHA in vivo. Results: Our results showed that PA-MSHA could efficiently inhibit proliferation and induce apoptosis in human bladder cancer cell lines. Furthermore, cells stimulated with PA-MSHA exhibited an inactivation of EGFR signaling. In vivo, PA-MSHA treatment significantly suppressed tumor growth and induced apoptosis in xenografts tumor in nude mice. Conclusions: PA-MSHA could efficiently inhibit proliferation and induce apoptosis in human bladder cancer cells in vitro and in vivo, which is associated with the inactivation of EGFR signaling pathway, and it might be used as a potential therapeutic agent for bladder cancer. (C) 2014 Elsevier Inc. All rights reserved.

Objective:To investigate the clinical application value of PSAD predict differences in Gleason score between biopsy and radical prostatectomy in prostate cancer patients.Method:We retrospectively analyzed the medical records of 133 patients who underwent a radical prostatectomy.The association between Gleason score changes and age,preoperative Gleason score,prostate-specific antigen(PSA),prostate volume and PSA density were analyzed.We also analyzed the factors that influence upgrading in patients with preoperative Gleason score ≤6 and downgrading in patients with Gleason score ≥7.Result:No difference in Gleason score was noted in 52 cases(39.1%),while a downgrade was noted in 13 cases(10.6%) and upgrade in 68 cases(51.1%).PSAD(P=0.002) was significantly correlated with upgrade,No significant characteristics were found for patients with Gleason score ≥7 who downgrade postoperatively.Based on the ROC analysis,a cut-off value of PSAD 0.2435 was associated with higher incidence of upgrade.Conclusion:Lower Gleason score and higher values of PSA are potential predictors for upgrade in patients who underwent TRUS guided prostate biopsy,influence therapeutic decision-making and prognosis.

目的探讨根治性改良式Bricker回肠膀胱术(BUD)早期并发症相关的手术危险因素。方法回顾总结52例行改良式BUD的膀胱癌患者的术后早期并发症(90 d),对并发症按照Clavien-Dindo手术并发症分级标准进行分级,采用Logistic回归分析术后早期并发症的危险因素。结果改良BUD术膀胱癌患者发生并发症共30例(57.7%),其中轻中度并发症发生率为36.5%(19/52),重度并发症发生率为21.2%(11/52)。Logistic回归分析显示年龄(P=0.023)、Charlson合并症指数(CCI)(P=0.015)、美国麻醉学评分(ASA)(P=0.017)、手术时间(P=0.033)和术后早期轻中度并发症显著相关;年龄(P=0.009)、CCI(P=0.015)、ASA(P=0.022)和重度术后早期并发症显著相关。结论 Clavien-Dindo并发症分级系统可作为根治性膀胱切除术尿流改道术后并发症的分析研究,年龄、CCI、ASA和重度术后早期并发症呈显著性相关。

BACKGROUND:Bladder urothelial cancer has been diagnosed at an increasing rate among young adults in China while the clinical outcomes remain highly controversial. To optimize the management of young patients with bladder cancer, we examined whether bladder urothelial cancer in young patients behaved differently from that in the elder patients.METHODS:From 1994 to 2008, a database of bladder urothelial cancer patients at a major tertiary medical center was retrospectively reviewed. The clinical and pathological parameters of patients who were less than 40 years of age and a series of patients older than 40 years of age as the control group during the same period were compared. A survival analysis was performed using the Kaplan-Meier method and log-rank test, and Cox regression was performed to identify clinical parameters that affected the clinic outcomes.RESULTS:Young bladder cancer patients had a lower male-to-female ratio and were less likely to have advanced stages and high-grade cancers at the initial diagnosis. Tumors in young bladder cancer patients tended to be less multifocal at diagnosis. In addition, young patients had a lower recurrence rate and longer recurrence interval than older patients. The Kaplan-Meier curve and Log-rank test showed that young patients had significantly better cancer specific survival than old patients. The univariate and multivariate Cox regression analysis revealed that tumor grade is the sole predictor for tumor recurrence in young patients.CONCLUSIONS:Young patients with bladder cancer have favorable pathological features and clinical outcomes than older patients. These findings argue for more conservative management approaches for young patients with bladder cancer.

Objective:To explore the expression of RUNX3 and EZH2 in renal clear cell carcinoma(RCC) in the purpose of illustrating their correlation to clinical phase and pathology grading.Methods:The expressions of RUNX3 and EZH2 in 55 samples of renal clear cell carcinoma and 15 samples of normal renal tissues were detected with immunohistochemical SP method.Results:① The expression levels of RUNX3 and EZH2 in renal clear cell carcinoma samples were no significant difference in age and sex(P>0.05);② The expression levels of EZH2 in renal clear cell carcinoma samples were significant higher than in the normal renal tissue samples(69.1%vs33.3%,P<0.05);the expression of EZH2 was significant higher in the higher clinical phase(60.0%vs85.0%,P<0.05)and pathology grading(47.4%vs80.6%,P<0.05);③ The expression levels of RUNX3 in renal clear cell carcinoma samples were significant lower than in the normal renal tissue samples(38.2%vs86.7%,P<0.05);the expression of RUNX3 was significant lower in the higher clinical phase(51.4%vs15.0%,P<0.05)and pathology grading(63.2%vs25.0%,P<0.05);④A negative correlation was found between RUNX3 and EZH2(r=-0.434 2,P<0.05).Conclusions:① the expression of RUNX3 is negatively correlated to the expression of EZH2 in renal clear cell carcinoma,they may play an important role in the occurrence,development,invasion and metastasis of renal clear cell carcinoma.② the expression of RUNX3 and EZH2 have significant values in distinguishing clinical stage of renal clear cell carcinoma and predicting the prognosis of the patients,and may provide a new approach for clinical treatment of renal clear cell carcinoma.

目的 探讨应用莫西沙星注射液治疗急重泌尿系感染的效果.方法 统计2010-11-2011-08使用莫西沙星治疗急重泌尿系感染的患者29例,均经临床、实验室和病原学检查确诊为泌尿道感染的成年患者,并对其治疗前后症状体征、体温变化、血液分析、肝肾功能电解质、尿液分析、尿液培养等指标进行比较,了解疗效及可能产生的对于肝肾功能的影响.结果 退热时间1～5 d,平均退热时间2.9d.疗程结束后,25例症状完全消失,4例7d内使用药物期间症状部分缓解,换用其他药物维持.结论 在治疗泌尿系感染方面,莫西沙星是一种高效、低耐药、退热快、不良反应少的药物.

Immunotherapy which has been in practice for more than 20 years proves effective for the treatment of metastatic renal cell carcinoma (mRCC). Anti-angiogenesis-targeted therapy has recently been identified as a promising therapeutic strategy for mRCC. This study was aimed to evaluate the effectiveness of vascular endothelial growth factor (VEGF) pathway-targeted therapy for mRCC by comparing its effectiveness with that of immunotherapy. The electronic databases were searched. Randomized controlled trials (RCTs) on comparison of VEGF inhibiting drugs (sorafenib, sunitinib and bevacizumab) with interferon (IFN) or placebo for mRCC treatment were included. Data were pooled to meta-analyze. A total of 7 RCTs with 3451 patients were involved. The results showed that anti-VEGF agents improved progression-free survival (PFS) and offered substantial clinical benefits to patients with mRCC. Among them, sunitinib had a higher overall response rate (ORR) than IFN (47% versus 12%, P<0.000001). Bevacizumab plus IFN produced a superior PFS [risk ratio (RR): 0.86, 95% confidence interval (CI): 0.76–0.97; P=0.01] and ORR (RR: 2.19; 95% CI: 1.72–2.78; P<0.00001) in patients with mRCC over IFN, but it yielded an increase by 31% in the risk of serious toxic effects (RR: 1.31; 95% CI: 1.20–1.43; P<0.00001) as compared with IFN. The overall survival (OS) was extended by sorafenib (17.8 months) and sunitinib (26.4 months) as compared with IFN (13 months). It was concluded that compared with IFN therapy, VEGF pathway-targeted therapies improved PFS and achieved significant therapeutic benefits in mRCC. However, the risk to benefit ratio of these agents needs to be further evaluated.

Objective To investigate the role of mTORC1 and mTORC2 in prostate cancer C4-2 cells. Methods The growth inhibition and apoptosis rate were examined by methyl thiazol tetrazolium ( MTT) assay and flow cytometry ( FCM) after knockouting raptor and rictor in prostate cancer C4-2 cells.The expression of androgen receptor ( AR) and Akt phosphorylation after transfection of siRNA raptor and rictor was detected by Western blotting. Results The growth inhibition of C4-2 cells had no significant change after transfecting siRNA raptor [(25. 37 ± 2. 63) % vs (27.49 ± 2. 96) % , P ＞ 0.05] , and the apoptosis rate was markedly increased [(11. 76 ± 1. 45) % vs (38. 23 ± 3. 71) % ,P ＜0. 01]. The inhibition of mTORC2 (rictor) markedly decreased the growth of C4-2 cells [(25.37 ±2.63)% vs (62.86 ±5.61)% ,P＜0.01] , and the apoptosis rate had no significant change [(11.76 ±1.45)% vs (14.25±1.68)%,P＞0.05]. The expression of AR [(0.21 ±0.04)% vs (0. 73 ±0. 12)% ,P＜0. 01] and Akt phosphorylation [(0. 23 ± 0. 06 ) % vs ( 0. 68 ± 0. 11 ) % , P ＜ 0. 01] were significantly increased after knocking down mTORC1 (raptor) in C4-2 cells, andt the inhibition of mTORC2 (rictor) markedly decreased the expression of AR [( 0. 21 ± 0. 04 ) % vs ( 0. 07 ± 0. 02 ) % , P ＜ 0. 01] and Akt phosphorylation [(0. 23 ± 0. 06) % vs ( 0. 06 ± 0. 03) % , P ＜ 0. 01]. Conclusion mTORC2 not only is required for the survival of prostate cancer, but also a promising therapic target.

294 Background: From 2000 to 2008, the incidence of bladder urothelial cancer in the young adults was diagnosed at an increasing trend at the Tongji Hospital, China. To investigate whether bladder urothelial cancer in patients under the age of 40 years behaves significantly differently from the bladder urothelial cancer in elder patients. Methods: From 1994 to 2008, the records of 4,568 patients with pathological diagnosis of bladder urothelial cancer presented to the Tongji Hospital were retrospectively reviewed. 82 patients were younger than 40 at the time of diagnosis. The clinicopathologic parameters were compared between this group and a serial of 164 older patients during the same time period. The Kaplan-Meier and Cox regression analyses were performed for the survival analysis. Results: 2.05% of patients with pathological diagnosis of bladder urothelial cancer presented to the Tongji Hospital were younger than 40 years (median age 32.93). Compared to the older group, young adults group had a lower sex ratio (male-to-female ratio, 3.4:1vs.6.5:1, p<0.05); much less likely with advanced stages (the percentage of invasive tumor, i.e., T1 or above, 28.1% vs. 52.4%, p<0.01); less with a high grade (the percentage of high grade tumor, 14.6% vs. 22.6%, p<0.05); lower recurrence rate (23.2% vs. 39.6%, p<0.05); less with big tumor size (the percent of tumor size greater than 3 cm, 18.3% vs. 22.0%, p<0.05); and less with multifocal (12.2% vs. 50.6%, p<0.01). Kaplan-Meier method and the log-rank test showed a significantly better cancer specific and overall survival for the group of young patients (p<0.01). The multivariate Cox regression analyses showed the following criteria were independent prognostic factors of overall survival: bladder tumor multiplicity, size greater than 3 cm, T2 or above stage, and high grade. Conclusions: Despite an increasing trend of diagnosis, both the pathologic features and clinical outcomes were significantly better in the young patients with bladder urothelial cancer when compared to their elderly counterparts. These findings suggested that more consevertive management approaches may be warranted for this group of patients even under the circumstances of extensive bladder involvement. No significant financial relationships to disclose.

Objective:To investigate the expression pattern and significance of DLL4 and VEGF in bladder transitional cell carcinoma(BTCC).Methods:The expression of DLL4 and VEGF in 50 patients with BTCC and 10 specimens of normal bladder tissue was analyzed by immunohistochemical method(Streptavidin/Peroxidase) and the expression level of DLL4 and VEGF was detected by computer graph analysis system.Compare the expressions of DLL4 and VEGF in different grades and pathological stages of BTCC.Results.DLL4 and VEGF were both positive expression in patients with BTCC,the rate of the positive expression were 90%(45/50) and 64%(32/ 50),but DLL4 was negatively expressed in all specimens of normal bladder tissue,only one specimen was VEGF positive(P<0.05).The expression of DLL4 had a negative correlation with pathological stage in patients with BTCC,the expression of VEGF had a positive correlation with pathological stage(P<0.05).The expression of DLL4 had a negative correlation with clinical grade in patients with BTCC,the expression of VEGF had a positive correlation with clinical grade(P<0.05).The positive expression of DLL4 and VEGF between the primary tumors and the recurrences were significantly different(P<0.05).Significant correlations were found among the expression of DLL4 and VEGF in patients with BTCC(r= -0.604,P = 0.035).Conclusions:In patients with bladder transitional cell carcinoma(BTCC),DLL4 and VEGF expressions were associated with tumor stage,grade and prognosis.Combining the both expression levels of DLL4 and VEGF can evaluate the prognosis of BTCC which contribute to optimize the treatment plan.Targeting DLL4 may be a novel treatment of anti - angiogenesis of tumors.

Objective:To investigate the expression and significance of EZH2 in renal cell carcinoma(RCC) and renal cell carcinoma cell lines.Methods:The expression of EZH2 was detected in 12 RCC and normal renal tissues by using western blot.We also evaluated two RCC cell lines for EZH2 protein expression using western blot.EZH2 protein expression was assessed by immunohistochemistry in 64 RCC and 12 normal renal tissues.Results:The expression level of EZH2 in human HK-2 cells was very low,but was high in two RCC cell lines.There were significant differences in EZH2 protein levels between normal renal and RCC tissues(P<0.05).Immunohistochemistry results revealed EZH2 protein was detectable in 16.7%and 78.1%of normal renal and RCC tissues,respectively (P<0.01).The positive expression rate of EZH2 was 63.9%and 92.9%in localized RCC and locally advanced RCC groups,respectively,and showed astatistically significant difference(P<0.01).The positive expression rates of EZH2 also showed astatistically significant difference in RCC groups with different pathological grades and lymph node metastasis profiles(P<0.05).Conclusions:The abnormal expression of EZH2 is associated with RCC clinical stage,pathologic grade and lymph node metastasis.The dysfunction of EZH2 may play an important role in the carcinogenesis and progression of RCC.

Objective:To evaluate the clinical effect of ureteroscopic Ho:YAG laser lithotripsy with simultaneous two double pigtail stents for ureteral calculi after failed ESWL and to investigate its influential factors. Methods:21 cases of ureteral calculi after failed ESWL were treated with ureteroscopic Ho:YAG laser lithotripsy with simultaneous two double pigtail stents.Of them 13 cases had ureteral polyps and they underwent Ho:YA-Glaser vaporization resection of the polyp.Two double-J stents were replaced 4 weeks after operation.Results: The overall success rate was 95.2%(20/21),and the operating time was(10-70) min with a mean of(40.4±10. 3)min.Two eases of the failure group underwent open operation and the other one were treated by PCNL.Hospital stay was l-7d with a mean of(3.1±1.2)d.Conclusions:Ureteroscopic Ho:YAG laser lithotripsy with simultaneous two double pigtail stents is an effective and safe management for after failed ESWL.

<正>患者,女,20岁。因"无痛性肉眼血尿4年余"为主诉入院。患者4年前因反复发作无痛性肉眼血尿,经影像学、膀胱镜检查排除肿瘤、结石等疾病,确诊为左肾静脉压迫综合征(胡桃夹综合征),后在我院行血管整形术,将左肾静脉下移后重新吻合于下腔静脉,手术经过顺利,术后1个月复查B超及CTA显示左肾静脉受压情况明显好转,肉眼血尿亦