【Objective】 To improve the diagnosis and treatment of primary ureteral carcinoma.【Methods】 Data of 40 cases of primary ureteral carcinoma were reviewed to evaluate various kinds of diagnostic means and summarize the diagnostic and therapeutic experience.【Results】 The diagnosis was preoperatively confirmed in 38 cases using B-ultrasound,intravenous pyelogram(IVP),cystoscopy,retrograde pyeloureterography,urinary sediment,CT,MRI or ureteroscope.All cases were proved to be transitional cell carcinoma by pathological diagnosis after operation.【Conclusions】 The diagnostic accuracy of primary ureteral carcinoma might be improved by combined use of various kinds of the diagnostic means before open surgery.Cystoscopy and retrograde pyeloureterography are essential for the diagnosis.Operation is the chief treatment measure.The prognosis of primary ureteral carcinoma correlates well with the stage and grade of the tumor,the early diagnosis,treatment and severe postoperative follow-up are still the key to raise the survival rate of patients.

【Objrctive】To investigate the clinical efficacy of robot-assisted laparoscopic suprapubic prostatectomy. 【Methods】Twenty-one cases of benign prostatic hyperplasia (BPH) were treated by AESOP system (Computer Motion,USA) robot-assisted laparoscopic suprapubic prostatectomy. The average age was 65 years (range 60 ～ 79 years). The prostate calculated volume by TRUS preoperative was 90 mL (rage 68～160 mL). Mean value of residual urine was 110 mL (rage 60～300 mL). Eleven cases were in presence of bladder caculi.【Results】All procedures were completely performed by robot-assisted laparoscopic suprapubic prostatectomy. The operative time was range from 90 to 210 min (average 130 min). The average estimated blood loss was 200 mL (range 70～420 mL). The postoperative bladder irrigation was 2～6 days (average 3.5 days). The postoperative hospital time was 4 to 9 days (average 6.5 days) and urinary incontinence or retention was founded. During the follow up period (4～15 months),maximum flow rate was [preoperative vs postoperative (4.10±3.43) (0～7.3) vs (19.35±5.05) (15.2～26.8,P <0.05)].【Conclusion】The ZESOP system robot-assisted laparoscopic suprapubic prostatectomy is a more effective,more precise,more safe,and minimally invasive.

[Objective] To summary the experience of laparoscopic radical nephrectomy and open radical nephrectomy.[Methods]From Jan 2000 to May 2009, we performed 76 (group A) retroperitoneal laparoscopic radical nephrectomy and 48 (group B) open radical nephrectomy were retrospectively analyzed. Operating time, amount of bleeding during operation, recovery of intestinal function after operation, ambulation and normal activities after operation , total cost of hospitalization, the hospital stay,analgesics use after operation and complications were compared between group A and group B.[Results]In group A, the amount of bleeding during operation, the recovery of intestinal function after operation, ambulation after operation, the hospital stay, the resume of normal activities after operation,analgesics use after operation and the occurrence of complications were all better than those in group B (P 0.01), while in group B, the operation time, and the total cost of hospitalization were less than group A (P 0.05). Laparoscopic radical nephrectomy is superior to open radical nephrectomy with less blood loss, faster recovery and less pain and similar prognosis. [Conclusions]Laparoscopic radical nephrectomy has the advantages of rapid recovery and less pain. Laparoscopic radical nephrectomy is superior to open nephrectomy for renal tumor of T1～T2bN0M0.

Objective Compare the cost-effectiveness between sparfloxacin and gatifloxacin in the treatment of urinary system infection.Methods Principle of pharmacoeconomics were adopted to analyze cost-effectiveness of the 2 treatment schemes.Results The effective rates of sparfloxacin group and gatifloxacin group in the treatment of urinary system infection were 90.9% and 87.8% (P>0.05) respectively;the cost-effectiveness ratio(C/E) were 0.67 and 0.32 respectively.The cost for every one unit increment of effectiveness for sparfloxacin group was 10.70 yuan more than that of the gatifloxacin group.Conclusion There is no obvious difference between these two projects in clinical effective rate and cure rate of the treatment of urinary system infection,but cost-effectiveness ratio of the gatifloxacin group is superior to that of sparfloxacin group.

[Objective] To discuss the role of heme oxygenase-1(HO-1) in kidney transplantation. [Methods] Three study groups were set: kidney transplantation group (group A), ischemia/reperfusion group (group B) and sham-operation group (group C). Blood BUN, Cr and urine NAG/Cr were measured at 24 h post operatively. Lesions in kidney constitutions were detected by pathological examination. The protein expressions of HO-1 were inspected by immunohistochemistry, while HO-1 activity was determined simultaneously. [Results] Compared with sham-operation group, renal injuries were much more aggravated in group A and B. But there was no significant difference between A and B. At the same time, and the expression and activity of HO-1 were much higher in group A and B. [Conclusions] The HO-1 protein induced by kidney transplantation may contribute to the protection on kidney injury.

Objective To discuss the protective role of heme oxygenase-1(HO-1)on renal protection in kidney transplantation models.Methods Three study groups were set:kidney transplantation group(group A),induce of HO-1(hemin)pretreatment group(group B)and sham-operation group(group C).Blood Cr was measured at 4,12,24,48 h post operatively.At the same time,lesions in kidney constitutions were detected by pathological examination.The protein expressions of HO-1 were inspected by immunohistochemistry.Results Compared with group C,renal injuries were much more aggravated in group A and B,but in group B,injuries were more relieved than those in group A.Meanwhile,the protein expression of HO-1 was much higher in group B than that in group A.Conclusions HO-1 may play an important role in kidney transplantation,and induction of HO-1 may be used as a novel effective way for renal protection in kidney transplantation.

目的探讨持镜机器人辅助腹腔镜输尿管切开取石术的临床应用. 方法回顾性分析28例应用ZEUS机器人AESOP(USA)操作臂持镜机器人腹腔镜输尿管切开取石的临床资料,男15例, 女13例, 年龄18～72(平均42)岁.输尿管上段结石18例, 中段10例.结果本组患者手术全程为机器人持镜, 机器人辅助腹腔镜输尿管切开取石均成功.手术时间35～150(平均50)mim,术中出血20～50(平均30)ml.无术中中转手术, 术后住院3～5 d.无结石复发和输尿管吻合口狭窄.结论 AESOP机器人具有智能化,人性化的特点,机器人辅助下腹腔镜输尿管切开取石使手术效率提高,手术更安全, 手术视野更广泛,操作更精确.

[Objective] To evaluate the endourological technique in the treatment of ureteral calculi. [Methods] 789 cases with ureteral calculi were treated by endourological technique from October 1999 to July 2004. [Results] 738 cases were treated successfully in situ with the rate of 93.54% (70.58% in upper ureter, 95.78% in middle ureter, 97.65% in lower ureter) and the stone free rate with in 3 months was 93.00%. The complication rate was 3.55%. [Conclusions] The treatment of ureteral calculi using endourological technique is a safe, effective and easy handling. It should be the first therapeutic choice for the middle and lower ureteral calculus.

[Objective] To evaluate the efficacy and safety of Transureteroscopic lithotripsy with holmium. [Methods] 214 cases ureteral calculi treated with Transuteteroscopic laser lithotripsy from Feb. 2000 to Dec. 2003 were studied retrospectively. There were 134 male patients and 80 female with an average age of 35, 47 being upper ureteral stone, 63 middle and 104 lower ureteral stone. The stones were 0.5 to 2.6 cm (mean 1.2 cm) in diameter. [Results] The overall rate of successful fragmentation for all levels of utrteral stones in a single procedure achievevd 95% (203/214), The success rates of fragmentation in single procedure for the upper and mid-lower legels of ureteral stones were 87% (41/47) and 98% (164/167). The mean operative time was 30 min. No complications such as perforation occurred during the operation. The mean postoperative hospital stay was 2.5 days. In 197 patients, the postoperatve follow-up of 1 month to 3 months revealed that the stone-free rate was 98%. No ureteral stenosis occurred. [Conlusions] Treatment of ureteral calculi by transureteroscopic laser lithotripsy has geen safe and effective. It can be considered as the first choice of treatment.

探讨经尿道前列腺切除(TURP)治疗重度前列腺增生症(BPH)的可行性.方法:采用TURP治疗重度的BPH 378例.前列腺平均重量73.8g.膀胱灌洗压力50～60cmH2O,平均流量250～350ml/min.术中血电解质监测,血钠降低10mmol/L,肌注速尿20mg.结果:平均手术时间132min.前列腺组织的平均去除率75.3%.发生经尿道切除综合征(TURS)1例(0.26%).术后排尿通畅率为100%.3个月后最大尿流率由术前(5.9±2.5)ml/s升至(22.6±7.3)ml/s(P＜0.01).术后随访,生活质量(QOL)良好者95.6%.结论:术中低压、低流量膀胱灌洗,监测血电解质变化,及时治疗低钠血症,增加手术时间,TURP治疗重度BPH是安全、可行的.

我院1998年-2000年采用DSA超选择性肾动脉栓塞治疗肾脏急性大出血患者7例,临床疗效满意,现报告如下. 1临床资料 本组患者7例,均为男性,年龄24-62岁.2例因突发性大量肉眼血尿,其中1例伴左侧腰痛.起病后4-8h急诊入院.

目的:总结腔内泌尿外科技术治疗下尿路结石的疗效.方法:回顾性分析102例下尿路结石腔内技术的治疗.结果:102例下尿路结石腔内技术治疗.其中1例不成功, 改为开放性手术,成功率为98%.结论:腔内泌尿外科技术治疗下尿路结石疗效满意,比较传统开放手术时间短,痛苦少,术后恢复快,在门诊也可实行.

临床上肾动静脉瘘引起突发、难以控制的血尿者较为罕见,我们采用介入放射技术治疗2例,报告如下.

目的：提高内镜治疗创伤性后尿道狭窄和闭锁的远期疗效。方法：用窥视下尿道内切开及瘢痕组织电切除术治疗21例创伤性后尿道狭窄和闭锁的病人，对手术的可行性、手术要点和术后注意事项进行讨论。结果：17例1次手术治愈，2次和3次手术治愈各1例，治疗失败者2例(9.5%)。随访3～50个月(平均38.5个月)，18例(85.7%)排尿通畅，最大尿流率13.2～24.8ml/s(17.5±8.2)ml/s。结论：经尿道内切开及瘢痕电切术治疗创伤性后尿道狭窄和闭锁，比单纯的尿道内切开成功率高，明显提高内镜治疗尿道狭窄和闭锁的远期疗效。

临床上肾动静脉瘘引起的突发难以控制的严重血症较为罕见,我们收治2例,现报告如下. 1 临床资料

临床上肾动静脉瘘引起突发难以控制的严重血尿少见，临床相关检查缺乏特异性，致使发病原因一时难以明确，往往因为来势凶猛，危及生命而被迫采取患肾切除术。借助介入放射进行诊治，可取得良好效果，现报道如下。 男2例，女1例，以突发性全程内服血尿就诊，伴发患者腰痛或排尿困难，体查，肾无隆起，患肾区部压痛，HP 1．3～8．0 g，出凝血时间及凝血酶、血小板均正常，B超或CT显示患肾孟内及输尿管有血凝块声像，IVP患肾不显像，膀胱镜检示血尿来自一侧肾脏。采用Seldinger技术肾A造形显示异常血管外下方在一小团造形剂显示由淡变浓密，取明胶海绵颗粒与300#PVA微粒混合进行栓塞，取明胶海绵2条经导管注入，再取3 mm毛弹簧全塞该动脉。10 min进行肾动脉造形复查见该血管闭塞，无团状造形剂渗出。术后2 h患者血尿停止，随访5～12月复查镜下无血尿，IVP肾盂盏显影良好。我们认为对于一些原因不明的血尿，借助于介入放射技术结合B超、CT等检查，有助于明确出血部位及原因，给予及时有效的治疗，除非证实为肾脏恶性占位病变，应避免盲目行患肾切除。对其他肾血管良性病变引发的血尿也可借助于介入放射技术进行诊治。

近年来,分子生物学技术在各个领域得到广泛的应用,并在阐明一些疾病的病因及治疗方面取得了惊人的成果.

目的:探讨输尿管镜手术治疗输尿管狭窄的方法及疗效.方法:对32例33处输尿管狭窄患者分别采用输尿管镜硬性扩张、输尿管镜气囊扩张及输尿管镜冷刀内切开等方法进行治疗.结果:32例均获成功,无严重手术并发症发生.随访26例(81.2%),有效20例,好转3例,无效3例.结论:输尿管镜手术是治疗良性输尿管狭窄的有效方法,治疗效果良好,并发症少,手术创伤小.