Objective:To investigate the feasibility and efficacy of treatment for 16 interstitial cystitis cases with transurethral intravesical nerve block injection.Methods:Between July 2010 and November 2011,16 interstitial cystitis cases who presented with urinary urgency and frequency or pelvic and perineal pain were analysed,the pathology was confirmed as interstitial cystitis with cystoscopy preoperatively,all cases had strong indication of surgery,using transurethral intravesical nerve block injection treatment with trigone injection of anesthetic and glucocorticoid drugs and comparative analysing the patients pain index score and interstitial cystitis symptoms and distress index score changes before and after surgery.Results:Two weeks after surgery,all patients' a 24-hour voiding and nocturia frequency decreased significantly,bladder capacity increased significantly compared with the preoperative,the pain scores and cystitis symptom index,interstitial cystitis plagued index decreased significantly compared with the preoperative,the differences were statistically significant(P<0.01).The postoperative patients were not seen a large number of hematuria,infection or other complications.Conclusions:Transurethral intravesical nerve block injection may be a new method treating for interstitial cystitis,which is effective and feasible,but its long-term safety and efficacy remains to be further confirmed.

目的探讨氩氦刀冷冻联合经尿道前列腺电切术（TURP）治疗中叶明显突入膀胱的前列腺癌的安全性和近期疗效。方法采用经直肠超声引导下经会阴前列腺癌氩氦刀冷冻联合经尿道前列腺中叶切除术治疗中叶明显突入膀胱的初诊前列腺癌患者2例。术后2个月复查血前列腺特异抗原（PSA）,以及盆腔CT或MRI。结果 2例患者手术均顺利完成,手术时间、冷冻复温时间、术中出血量分别为115min、50min、20ml,110min、52min、15ml。术后无明显血尿及导尿管堵塞等,2周后顺利拔除导尿管,未出现尿潴留及尿失禁。患者术前、术后2个月盆腔CT或MRI对比显示:前列腺明显缩小,突入膀胱的中叶已消失。2例患者术后2个月复查PSA分别为0.909、0.26ng/ml。结论氩氦刀冷冻联合TURP治疗中叶明显突入膀胱的前列腺癌安全可行,近期疗效确切。

Objective To present the first clinical case of transumbilical laparoendoscopicsingle-site (LESS) renal cryoablation in the mainland of China and assess its safety and feasibility.Methods One patient with an enchancing radiographic small renal mass underwent transumbilicallaparoendoscopic single-site renal cryoablation on 15-Sep-2012 in our institution. The salient patientdemographics and tumor characteristics, including age, gender, body mass index, tumor laterality, diameter(cm), and preoperative left and right GFR were: 59 years, male, 24.5 kg/m2, left, 2.1 cm, 37.2 ml/min and34 ml/min. A 2 cm longitudinal transumbilical skin incision was made. With the renal mass fully dissectedand exposed, a 2 mm cryoprobe was introduced percutaneously and placed into the tumor underlaparoscopic visualization. Two freeze-thaw cryoablation cycles were performed according to the instructionsof EndoCare Cryo-Care Surgery System. Results The procedure was smoothly completed without any extraskin incision. Operation time, cyroablation time and estimated blood loss was 120 min, 30 min and 30 mlrespectively. Postoperative pain measured by the visual analog pain scale (VAPS) at day1, day2 and day3was 1, 1 and 0 respectively. The patient was discharged 5 days after surgery. Pathologic examinationrevealed renal clear cell carcinoma with Fuhrman grade Ⅱ . The left and right GFR tested at 4-weekfollow-up was 36.1 ml/min and 34.8 ml/min respectively. No evidence of contrast-enhancing at thecyroablative region by contrasted renal CT scan performed 1 week and 4 weeks after surgery was observed,indicating no tumor remnant or recurrence. Conclusions The initial experience shows the transumbilicallaparoendoscopic single-site renal cryoablation is a safe, feasible and effective procedure. It may exhibitclinical benefits for patients in terms of pain control, preservation of renal function, convalescence and cosmesis.

Objective To assess the safety,feasibility and efficacy of retroperitoneal laparoscopic-assisted mini-incision partial nephrectomy in treatment of R.E.N.A.L.tumors with R.E.N.A.L.score ≥7,and to evaluate its clinical significance. Methods Between January 2011 and November 2012,retroperitoneal laparoscopic-assisted mini-incision partial nephrectomy was performed in 19 R.E.N.A.L.tumor patients with R.E.N.A.L.score ≥7 at our institution.The information of patients was: male/female,10/9;age(48.5±14.0) years old;body mass index(24.0±2.6) kg/m2;ASA score(1.9±0.4);Charlson co-morbidity index(age-weighted) 0.6±0.2;tumor laterality(L/R) 11/8;maximal diameter(3.3±1.2) cm;R.E.N.A.L.nephrometry score 8.6±0.9;and preoperative estimated glomerular filtration rate(eGFR)([104.8±24.0] mL/[min·1.73 m2]).The R.E.N.A.L.pedicle,involved kidney and tumors were exposed by retroperitoneal laparoscopic techniques.A mini-incision was made along the line between the two original subcostal trocar sites.The R.E.N.A.L.pedicle was clamped and ice-slush surface cooling of the kidney was given,by then the tumor resection and R.E.N.A.L.defect reconstruction was finished.Results All the 19 cases were smoothly finished without any intraoperative complications or blood transfusion.The operative time was(220.2±57.5) min,estimated blood loss was(252.6±182.9) mL,R.E.N.A.L.ischemia time was (25.2±6.6) min,and all surgical margin was negative.The recovery was smooth,with a mean postoperative hospital stay of (11.4±3.4) days.Pathological examination revealed 15 cases of R.E.N.A.L.carcinoma,2 angiomyolipoma,and 2 others.All the patients were alive after a mean follow-up of(13.1±6.7) months,without local recurrence or distant metastasis.Nevertheless,the eGFR was significantly decreased from(104.8±24.0) to(90.4±17.0) mL/(min·1.73 m2) after operation(Z=-3.099,P=0.002).Conclusion Retroperitoneal laparoscopic-assisted mini-incision partial nephrectomy is a safe,feasible and effective alternative for surgical management of complex localized R.E.N.A.L.tumors.It has the combined advantages of open operation and conventional laparoscopic partial nephrectomy,with less surgical demanding and lower cost,and is therefore deserve further popularization.

Objective To summarize the clinical features,diagnosis and treatment of autologous urologic neoplasms in renal transplant recipients.Methods A retrospective analysis on the clinical data of 25 renal transplant recipients was done in our center.The onset time of new neoplasms was between 29 to 72 months after transplantation,with an average of 48.2 months.Intermittent hematuria was the first symptom in 23 patients,and the rest two cases were diagnosed through routine examination. The pathological diagnoses of thee cases were renal carcinoma,which were treated by transperitoneal laparoscopic radical nephrectomy.Eight cases were diagnosed as having renal pelvic tumor,which was treated by radical resection for the renal pelvic carcinoma.Fourteen cases were diagnosed as having bladder cancer,which was treated by transurethral resection of bladder tumor (13 cases) or radical cystectomy (one case).All patients were subjected to surgical treatment.The dosage of MMF,CSA/Tacrolimus was decreased to 1/2-2/3 of their original dosage. Sirolimus was used in place of calcineurin inhibitors in four patients.Immunosuppressive regimes and adjuvant therapy were given after surgery treatment.Results Twenty-five patients were followed up for 12-84 months.Contralateral renal carcinoma combined with lung and chest multiple metastases occurred in one case after radical nephrectomy,who died after targeted therapy 6 months later.Two patients with lymph node metastasis died 14 months and 20 months after surgery respectively.The rest 22 patients were closely followed up,whose creatinine remained 98-163μmol/L.Conclusion More attention should be paid to patients with hematuria after renal transplantation to screen the autologous urinary neoplasms.Patients should be treated with surgical procedures,and immunosuppressive regimens should be adjusted postoperatively.

Objective To summarize the surgical experience in robotic-assisted laparoscopic partial nephrectomy,and to investigate the efficacy and safety of this surgery.Methods The clinical data of 12 patients who underwent robot-assisted laparoscopic partial nephrectomy in Changhai Hospital from March to July in 2012 were analyzed.All the patients were male and the age range was 43-66 years.In 4 cases the tumors were in the left kidney,and 8 in the right.In 7 cases the tumors were in the dorsal part of the kidney,and 2 in the ventral part.There were 3,5 and 4 cases in the upper,middle and lower pole of the kidney respectively.Preoperative GFR test was normal in all cases.Kidney CT scan showed the maximum diameters of the tumors were 2.0-5.8 cm,with an average of 3.3 cm.The pre-operative stages in all cases were T1N0M0.Results The surgery was successfully completed in all cases.The mean duration of the surgery was 160-310 min,with an average of 242 min.The blood loss was 30-300 ml,with an average of 135 ml,and the intraoperative blood transfusion was unnecessary.The warm ischemia time was 20-49 min,with an average of 31 min.There was no intraoperative morbidity,and no conversion to open surgery.The postoperative length of hospitalization was 9-31 d,with an average of 14 d.Gross hematuria arose in 1 patient at 1 week after the surgery.The post-operative pathology showed renal clear cell carcinoma with Furhman Grade Ⅱ in 11 cases,and renal angiomyolipoma in 1 case.The maximum diameters of the tumors were 2.0-5.0 cm,with an average of 3.5 cm.The tumor resection margin was negative in all cases.Conclusions Robot-assisted laparoscopic partial nephrectomy is safe and effective for local renal tumors.This surgery has significant advantage over traditional laparoscopic partial nephrectomy,in terms of the resection of the renal tumors and the reconstruction of the kidney.

目的完善相关术前评估并取得患者知情同意后,在国内首次尝试进行单孔多通道后腹腔镜下肾脏肿瘤冷冻消融术,探讨该手术的可行性和安全性,总结操作经验。方法 2012年3月14日和19日我科先后完成单孔多通道（TriPort TM）后腹腔镜下肾肿瘤冷冻消融术2例。例1为79岁男性,Charlson合并症指数（Age-weighted）为4,肿瘤最大径2.7cm,R.E.N.A.L.评分为2+2+3+p+3=10p,术前eGFR为61.5ml/（min.1.73m2）;例2为43岁女性,Charlson合并症指数（Age-weighted）为3,肿瘤最大径2.6cm,R.E.N.A.L.评分为1+1+1+a+2=5a,术前eGFR为187.8ml/（min.1.73m2）。手术方法:于腋中线水平,髂嵴最高点与第12肋下缘连线中点处取一2cm纵行皮肤切口,充分游离暴露肿瘤表面,腹腔镜监视下将两把2mm直角冷刀经皮穿刺后置入瘤体内,按照EndoCare冷刀手术操作系统完成两个循环后退出冷冻刀头。结果 2例手术均顺利完成,手术时间、冷冻时间、术中出血分别为:185/170min,30/30min,50/30ml;术后第1、2、3天患者视觉疼痛模拟评分分别为:2/1,1/1,0/0;术后住院时间分别为:6/5d;无任何术中、术后并发症。术后病理组织学评估2例均为透明细胞癌,Furhman分级分别为Ⅱ和Ⅰ。术后1个月复查肾功能分别为:60.2和144.3ml/（min.1.73m2）;术后1周、1个月复查肾脏增强CT提示肿瘤已完全消退,无局部复发。结论初步经验表明单孔多通道后腹腔镜下肾脏肿瘤冷冻消融术切口小、肾功能损害小,术后患者疼痛轻、恢复快,肿瘤治疗近期疗效确切,但需严格把握临床适应证。远期疗效有待前瞻性大样本的长期随访对照研究。