Objective:To evaluate the safety and efficacy of resectoscope and ureteroscope in the treatment of middle-lower ureteral calculi accompanied with difficulty in entering ureteral opening.Methods:Forty cases of middle-lower ureteral calculi with difficulty in entering ureteral opening patients were admitted in General Hospital of Southern Theatre Command of China People's Liberation Army from March 2008 to December 2019. All patients underwent transurethral resection of the ureter opening, under the guidance of the guide wire, the ureteroscope entered the ureter, and then holmium laser lithotripsy under ureteroscope was performed.Results:All patients were completed the operations successfully. The average operative time was (27±6) min, intraoperative blood loss was (7.0±1.4) ml, the duration of hospitalization postoperative was (3.6±0.9) d. The abdominal plain film was examined and D-J stent was in good position one week after operation, the stone clearance rate was 97.5%. All patients were followed up (4.3±1.0) months after the operations, and intravenous urography and cystourethrography examination showed no ureteral stenosis and reflux.Conclusions:Resectoscope and ureteroscope is safe and effective in the treatment of middle- lower ureteral calculi accompanied with difficulty in entering ureteral opening, it can increase the success rate of endoscopic surgeries and worthy of promotion.

膀胱癌(BC)是男性泌尿生殖系统肿瘤中最重要的恶性肿瘤之一,具有很高的发病率,主要包括非肌层浸润性膀胱癌(NMIBC)和肌层浸润性膀胱癌(MIBC).膀胱镜检查结合病理活检为诊断BC的金标准,其他诊断方法还包括尿液细胞学检查和影像学检查.由于组织病理学特征的不同,NMIBC和MIBC的治疗及预后有极大的差异.文章就目前BC的分型、诊断方法及治疗手段进行归纳、总结,并对BC未来更为精准的诊疗提出展望.

Objective:To determine the efficacy and safety of sacral neuromodulation (SNM) in incomplete spinal cord injured (SCI) subjects affected by neurogenic lower urinary tract symptoms.Methods:Clinical data of 36 patients with incomplete spinal cord injury who underwent SNM from February 2015 to April 2019 were retrospectively analyzed and were divided into group NUR (16 cases neurogenic urinary retention group) and group NOAB (20 cases of neurogenic bladder overactive group). If at least 50% clinical improvement occurred, the patient would undergo a permanent SNM procedure. The patients were evaluated by using bladder diary, postvoid residual volume measurement, frequency of clean catheterization and urodynamic parameters before and during the test, and after the permanent SNM.Results:Among the 36 patients, 21 cases (58.3%) were tested effectively and received permanent stimulator implantation, 7(19.4%) in NUR group and 14(38.9%) in NOAB group. The residual urine volume of bladder, the average number of catheterization and the average number of urination in NUR group were improved in different degrees. After operation, the symptoms of frequent urination, urgency of urination and incontinence in NOAB group were relieved to varying degrees. During the follow-up, 2 patients with urinary retention failed the treatment. After the Ⅰ phase of the contralateral S3, the curative effect was recovered. A patient were infected after operation, and the wound healed after removal of the infection.Conclusions:The SNM is safe and effective in the treatment of neurogenic lower urinary tract symptoms in some incomplete spinal cord injury patients, and is helpful to protect renal function in patients with spinal cord injury. SNM can not improve all symptoms at times, but the SNM can be considered in patients with ineffective or intolerant traditional treatment.

目的 探讨膀胱内水扩张、肝素-碱化利多卡因膀胱内灌注及心理干预3种方式综合治疗间质性膀胱炎(IC)的临床效果.方法 收集接受水扩张、肝素-碱化利多卡因膀胱内灌注联合心理干预治疗的23例IC患者,分别于术前和术后1、6、12个月.采用间质性膀胱炎指数(ICSI)评价患者症状(如尿频、尿急、膀胱/盆腔疼痛或不适情况)的变化,使用尿流动力学检查了解患者膀胱潴尿期的感觉、顺应性、容量及稳定性变化,应用焦虑自评量表(SAS)、抑郁自评量表(SDS)评估患者的心理状态变化.结果 与治疗前比较,综合治疗1、6、12个月后,23例IC患者的SAS、SDS及ICSI评分均降低(P均<0.008),排尿次数减少(P均>0.008),初尿感、最大膀胱容量均增加(P均<0.017),且疗效一直维持(治疗后各时点间两两比较P>0.008或0.017).1例膀胱顺应性下降的患者恢复其顺应性,1例膀胱过度活动的患者未检出膀胱过度活动.结论 膀胱内水扩张、肝素-碱化利多卡因膀胱内灌注联合心理干预综合治疗IC的临床效果明显,患者生理及心理状态均有好转.

目的:研究分析本地区近年来泌尿系结石患者性别、年龄、结石部位、成分等情况,为本地区的结石控制预防提供依据.方法:搜集广东医科大学附属医院2013年6月—2017年7月在我院行手术治疗的尿石症患者共2527例,并对相关临床资料进行统计分析.结果:2527例患者中男性的结石发生率明显高于女性,男女之比约为2.25:1;尿石症患者中40～79岁为高发年龄,其中50～59为最高发年龄段,男性最高发年龄为60～69岁,女性为50～59岁,肾结石1327例(52.51％)、输尿管结石545例(21.57％)、膀胱结石652例(25.80％)、精囊结石3例(0.12％).2527例患者结石中1929例为混合成分结石,599例为单一成分结石,混合结石中常见的成分一水草酸钙和二水草酸钙占30.19％,无水尿酸和一水草酸钙占27.11％,一水草酸钙、二水草酸钙和碳酸磷灰石占9.34％,单一结石常见的为一水草酸钙,约占15.16％,无水尿酸约占7.91％.结论:湛江地区尿石症住院患者的年龄、性别、部位、成分具有差异性,这对不同成分类型结石的防治提供了一定的依据.

Objective The clinical effect and prognosis of greenlight photoselective laser vaporization combined with intraoperative submucosa multi-point injection of gemcitabin for the treatment of non muscle-invasive bladder tumors(NMIBC).Methods Selected 105 cases of NMIBC Confirmed by pathology from Mar.2012 to Nov.2013 in Guangzhou General Hosptial of Guangzhou Military Command of PLA urology.Put the patients into three groups randomly.Greenlight photoselective laser vaporization for bladder tumors (PVBT) combined with intraoperative submucosal injection of gemcitabine (PVBT group) 38 cases,Transurethral resection of bladder tumor(TURBT) combined with intraoperative submucosal injection of gemcitabine 25 cases (TURBT group),TURBT combined with immediate postoperative bladder perfusion chemotherapy (Control group)42 cases.Maintain the bladder perfusion chemotherapy after surgery,follow-up of 2 years.To compare and analysis the effect and the prognosis of three ways of operation method,And evaluate the quality of life of three groups of patients after treatment.Results The operation of 105 cases were successful,a total of 31 cases of recurrence,included PVBT group 7 cases (18.4％),TURBT group 6 cases (24％),contrlol group 18 cases (42.9％).Tumor progression of time were 12、10、6 month for the first time.The body function,psychological function,social function and material life of four dimensions scores have no obvious difference Three groups (P ＞ 0.05).Conclusions PVBT combined with intraoperative submucosal multi-point injection of gemcitabine is a kind of simple operation,and reduce the complications and the recurrence of the operation,especially suitable for the lateral wall of superficial tumor and intolerance to TURBT surgery for high-risk patients.It is a new better method of expansion clinical application.

目的：探讨八宝丹胶囊联合α1肾上腺素能受体阻滞剂治疗ⅢB型慢性非细菌性前列腺炎疗效。方法选择符合美国国立卫生研究院（ NIH）诊断标准的ⅢB型慢性前列腺炎患者136例，按照就诊顺序随机分为治疗组和对照组，每组68例，治疗组给予口服八宝丹胶囊0．6 g／次，3次／d，甲磺酸多沙唑嗪缓释片4 mg，1次／d。对照组给予口服甲磺酸多沙唑嗪缓释片4 mg，1次／d。2组疗程均为12周。评价2组NIH－慢性前列腺炎症状指数（ NIH－CP-SI），比较2组疗效。结果2组治疗后NIH－CPSI总评分较治疗前明显降低（P均＜0．05），且治疗组较对照组降低更明显（P均＜0．05）。2组有效率比较差异有统计学意义（P均＜0．05）。2组均未见肝肾功能异常及不良事件发生。结论八宝丹胶囊联合α1肾上腺素能受体阻滞剂治疗ⅢB型慢性非细菌性前列腺炎较单一用药疗效明显，且无明显不良反应。

目的:探讨输尿管镜下钬激光治疗输尿管嵌顿性结石术后引起输尿管狭窄的相关风险因素,为临床提供参考指导.方法:选取195例2012～2015年间广州军区广州总医院泌尿外科经相关检查明确诊断为输尿管嵌顿性结石的患者,行输尿管镜下钬激光碎石治疗,术后根据患者不同情况留置输尿管支架管4～8周,拔管后1、3个月行静脉尿路造影(IVU)和泌尿系彩超重新评估,如造影和彩超提示肾脏积液未减轻,则进一步行CT增强+三维重建(CTU)及逆行尿路造影证实输尿管狭窄诊断.结果:190例患者被纳入随访研究,10例发生输尿管狭窄,总的狭窄发生率为5.3.导致术后发生输尿管狭窄的风险因素主要为输尿管穿孔、输尿管黏膜损伤.结论:应重视引起输尿管狭窄的术中风险因素,提高输尿管镜下处理嵌顿性结石的手术技巧,术后拔除输尿管支架管后1、3个月应常规行静脉尿路造影和泌尿系彩超检查.

目的 评价人工尿道括约肌植入术(AUS)治疗骶髓损伤后压力性尿失禁的临床效果.方法 2010年3月至2012年10月,广州军区广州总医院泌尿外科全军泌尿外科中心收治了2例男性骶髓损伤后压力性尿失禁患者,术前采用影像尿流动力学检查、自由尿流率、脊髓磁共振、静脉肾盂造影检查、中段尿细菌培养、尿常规进行评估.行经会阴尿道球部人工尿道括约肌(AMS 800)植入术,并从术前开始口服抗胆碱能药物;术后第3、6个月行尿常规、超声、残余尿和尿流率检查.结果 2例患者随访9～12个月,术后完全控尿,未出现感染、侵蚀、尿道萎缩、装置机械故障等并发症.结论 AUS治疗骶髓损伤后压力性尿失禁,需要精确评估其膀胱及尿道功能,严格选择手术适应证,术后可获得满意控尿效果,同时需要长期密切随访.

Objective To improve the understanding of comprehensive treatment for high risk of localized prostate cancer.Methods One case high risk of localized prostate cancer of our hospital clinical, The clinical data and the results of the patients followed-up were retrospectively reviewed. experienced the maximum androgen blockade therapy, high intensity focused ultrasound ablation of the prostate, intensity modulated radiation therapy, transrectal prostate125I seeds implantation, docetaxel combined with prednisoney, oral estramustine and abiraterone comprehensive treatment.Results In September 2006, the patients admitted to hospital check PSA158.69 ng/mL, pathologic diagnosis of poorly differentiated adenocarcinoma of the prostate, Gleason score 5+4= 9 points, the patient has now been progress for castration resistant prostate cancer, with multiple bone metastases, docetaxel combined with prednisoney 3 weeks scheme chemotherapy again, PSA reduced significantly than before treatment, bone pain symptoms improved significantly.Conclusion Individualized comprehensive treatment strategies for high-risk patients with localized prostate cancer can delay the progress of the tumor, and improve the patient's survival quality. It is worthy of clinical attention.

多导联尿流动力学是一项综合性检查，能够同时记录膀胱压、逼尿肌压和腹内压等，它能判断尿液输送、储存和排出等过程中的异常情况，是客观评估膀胱及尿道功能状态的金标准[1]。目前我国进入老龄化阶段，有数据显示，超过50%的60岁以上老年男性患有良性前列腺增生（Benign prostatic hyperplasia, BPH），70岁以后这个比例达到60%~70%。BPH已成为我国泌尿外科医生研究的重点课题。在临床实际工作中，BPH伴发其他相关疾病具有普遍性。当BPH合并其他相关疾病时，尿流动力学检测结果往往与单纯BPH不一致，此时尿流动力学检查不仅能提供膀胱逼尿肌以及膀胱出口梗阻等信息，更重要的是能为及时手术干预提供重要依据。本文就尿流动力学在BPH合并糖尿病（Diabetes mellitus DM）、膀胱过度活动综合征（Over active bladder OAB）、神经源性膀胱（Neurogenic bladder NB）、脑卒中以及高血压疾病的诊治价值上做一简要综述。

Objective To detect the relationship of pathological grade and stage of bladder cancer with common chromosomal aberrations of urine exfoliated cells by FISH. Methods A total of 99 urine samples were detected by FISH with probes of chromosomes 3,7,17 and 9p21 to collect pathological grade and stage information of bladder tumor tissues. Results (1) The aberrations of chromosome 3 and 17 had significant correlation with pathological grade and stage (P<0.05) but that of chromosome 7 had no correlation with pathological stage (P>0.05), but had correlation with grade (P < 0.05). The aberration of 9p21 had no correlations with pathological grade or stage (P > 0.05). (2)The polysomic chromosomal aberrations of chromosomes 3, 7 and 17 assessed correlated with high-grade and high-stage bladder carcinoma. The 9p21 deletion was found at a significant frequency in low-grade and low-stage lesions, when, 9p21 amplification was found at a significant frequency in high-grade and high-stage lesions. Conclusions Aberrations of the four chromosomes, especially polysomic chromosomal aberrations of the bladder cancer cases could present a possible trend toward greater chromosome increased with tumor grades and progressive stages of invasion.

目的 比较围手术期应用度他雄胺和非那雄胺对经尿道前列腺电切术出血量的影响,为临床提供指导意义.方法 将确诊的90例前列腺增生患者随机分成度他雄安组、非那雄胺组、对照组3组.度他雄安组、非那雄胺组术前及术后均口服药物1周,剂量为安福达0.5 mg/次;非那雄胺组术前及术后均口服非那雄胺1周,5 mg/次;对照组术前术后未给予任何药物,患者均经同一手术组医师使用等离子电切系统进行手术.对3组患者术中出血量、手术时间、术后膀胱冲洗液的量等进行比较.结果 所有患者均顺利完成手术,效果满意,围手术期间均未发现药物副作用.3组患者术前、术后血红蛋白差值分别为(-1.29±0.81、-1.25±0.68、-1.83±1.25)g/L;血细胞压积差值分别为(-5.67±2.58、-6.34±2.89、-6.50±2.40)L/L;3组手术时间两者分别为(58.4±19.5、57.62±21.33、55.62±23.76)min;术后膀胱冲洗液量分别为(18.33±2.35、19.25±3.20、25.35±1.98)L,均有统计学差异(P＜0.05).度他雄安组术后膀胱冲洗液量少于非那雄胺组(P＜0.05),但在手术出血量、手术时间两者比较无明显差异(P＞0.05).结论 围手术期应采用非那雄胺或度他雄胺均可减少前列腺增生患者术中及术后出血量,缩短手术时间、减少术后膀胱冲洗液量,是有效、安全的,值得临床推广应用.

Objective To evaluate the application value of multicolor fluorescence in situ hybridization ( M-FISH) in postoperative follow-up monitoring of bladder cancer patients with negative urine cytology .Methods A total of 78 patients with urothelial cancer who were treated by transurethral resection of the bladder were included in this study .All of them had negative urine cytology .The cystoscopy and M-FISH were used to monitor the recurrence of the disease , and the results were compared.Results In 76 patients, 14 cases recurred (18.4%).M-FISH only detected 3 cases of recurrence (4%), and 11 cases of missed diagnosis (14.5%).Cystoscopy showed 54 cases with negative results , 1 case of recur-rence (low level), and the M-FISH showed positive results.Cystoscopy showed 12 cases were suspicious and 4 cases of re-currence (2 cases of low level, 2 cases of high level), and M-FISH showed 1 case with positive results (low level).Cysto-scopy showed 10 cases with positive results , 9 cases of recurrence ( 5 cases of low level , 4 cases of high level ) , and M-FISH showed 1 case with positive results ( high level ) .For that cystoscopy showed negative results , M-FISH showed posi-tive results, the sensitivity of predicting recurrence was 100%, the specificity was 94.3%, the positive predictive value was 25%, and the negative predictive value was 100%.For that cystoscopy showed suspicious results , M-FISH showed positive results, the sensitivity of predicting recurrence was 25%, the specificity was 87.5%, the positive predictive value was 50%, and the negative predictive value was 70%.For that cystoscopy showed positive results , M-FISH showed posi-tive results, the sensitivity of predicting recurrence was 11.1%, the specificity was 100%, the positive predictive value was 100%, and the negative predictive value was 11.1%.Conclusions M-FISH assay in postoperative follow-up monito-ring of bladder cancer patients with negative urine cytology had a low detection rate and low economic benefits .It was not considered as a follow-up routine monitoring project in bladder cancer surveillance after transurethral resection .

Objective To evaluate the efficacy and safety of InVance bulbourethral sling for stress urinary incontinence after radical prostatectomy.Methods Six male patients with stress urinary incontinence after radical prostatectomy were treated with perineal sling (InVance) from March 2005 to March 2011,and the clinical data were analyzed.Results The operation time was 80-120 min and intra-operative blood loss was 20-50 ml.The catheter was removed at the second day after surgery.In a follow-up of 12 to 29 months,4 patients were dry,1 patient was improved,and 1 patient suffered treatment failure.There were 2 patients transient acute urinary retention and 1 patient short-term perineal pain in the main post-operative complication.In six months after the operation,urodynamic examination showed (15.9 ± 7.7) ml/s at Qmax and 0-20 ml/s at postvoid residual.Conclusion InVance bulbourethral sling for the treatment of stress urinary incontinence after radical prostatectomy appears to be safe,simple in the procedure and good effect to mild and middle incontinence.

目的:探讨我院1例罕见胃印戒细胞癌睾丸转移的临床病理特点,免疫组织化学在睾丸转移瘤与原发肿瘤鉴别诊断中的应用.方法:回顾分析了我院收治1例睾丸肿瘤患者,1年前曾行胃贲门癌根治性全胃切除术,术后病理报告提示低分化印戒细胞癌,术后未予以放化疗,此次外院睾丸穿刺活检病理报告为低分化腺癌浸润或转移,考虑患者的病情及预后,行患侧根治性睾丸切除术.结果:术中见睾丸略增大,约4 cm×3 cm×2 cm,质地硬,颜色呈淡红色,附睾大小、质地无异常.术后病理证实胃低分化腺癌合并印戒细胞癌转移.随访半年,临床症状好转.结论:胃印戒细胞癌睾丸转移非常罕见,特定的免疫组织化学指标可以有助于诊断.

Objective To investigate a non-invative , sensitive and specific method to diagnose bladder cancer, and evaluate the value of the combination of FISH with NMP22 in the diagnosis of bladder cancer. Methods Urine from 68 patients suspected suffering from bladder cancer were used by FISH, NMP22 expression and cytologi-cal examination, respectively. The results of above detections were compared to the subsequent histopathology as-say to analyze the specicficity, sensitivity of diagnosis for bladder cancer. Results The sensitivity of FISH, NMP22 expression and the cytological examination was 81.4%,86.0% and 39.5% respectively, and the specifici-ty of FISH, NMP22 expression and the cytological examination was 84.0%, 72.0% and 96.0%, respectively. The sensitivity and specificity of the combination of FISH with NMP22 was 79.1% and 92.0%. Conclusions The combined diagnosis of FISH and NMP22 for bladder cancer showed greater sensitivity than that of the conventional cytology, with similar specificity as the conventional cytology. The combination of FISH with NMP22 test shows more value for the diagnosis of bladder cancer than any single assay.

目的 探讨原发性肾脏弥漫性大B细胞淋巴瘤(DLBCL)的临床、病理特点及诊治方法.方法 回顾分析1例原发性肾脏DLBCL患者的临床资料,结合国内外文献对DLBCL进行讨论.结果 患者为22岁女性,无临床症状,无意中发现左上腹部肿块,术前诊断为左肾癌,行左肾根治性切除术,术后病理诊断为左肾DLBCL,行R-CHOP方案治疗6次,患者一般状态良好,病情稳定.结论 原发性肾脏DLBCL临床罕见,不易与肾癌鉴别,根据术后病理检查可确诊,患者预后较差,需联合化疗并长期随访.

Male genital lichen sclerosus (MGLSc) is a chronically relapsing disease characterized by a long course, gradual aggravation, and a tendency towards malignancy. Once called balanitis xerotica obliterans, MGLSc has a distinct predilection for the prepuce and glans, involving the urethra when aggravating, forming scarring tissues, and causing urethral stricture, which may seriously affect the patients'quality of life with such symptoms as urinary stream narrowing, dysuria, and painful penile erection. The etiology and pathogenesis of MGLSc have not yet been adequately explained though it is generally thought to be associated with autoimmune mechanism, genetic factors, infections, local trauma, and chronic urinary irritation. MGLSc can be fairly easily diagnosed according to its clinical manifestations and histopathological results, but can be hardly cured. Early diagnosis and prompt treatment are the most important approaches, which may relieve its symptoms, check its progression, and prevent its long-term sequelae. Ultrapotent topical corticosteroids are the choice for the treatment of MGLSc. For those who fail to respond to expectant medication or have dysuria due to urethral stricture and painful erection, rational surgery may be resorted to, with importance attached to long-term follow-up. This article presents an update of the diagnosis and treatment of MGLSc and MGLSc-induced urethral stricture.

Objective To comparatively analyze the effects of plastic meatotomy and buccal mucosa graft(BMG) urethroplasty in the treatment of glanular urethral strictures caused by Male Genital Lichen Sclerosus(MGLSc). Methods Clinical data of 28 patients with glanular urethral strictures caused by Male Genital Lichen Sclerosus(MGLSc) who received operation between August 2008 and September 2012 were retrospectively reviewed and evaluated including medical history, physical examination, uroflowmetry and cystourethrography (VCUG). Stricture was destributed at the glanular urethra (≤2 cm.) of the patients. All patients were divided into two groups, 12 patients in group A were performed with plastic meatotomy and 16 patients in group B with BMG urethroplasty.Voiding symptoms, uroflowmetric parameters and cosmesis were assessed at 1,3,6,12,and 18 months after surgery, and yearly thereafter were comparatively analyzed. Results During a follow-up of 23.57±10.50 months, 10 (83.3%) patients were cured and 2 (16.7%) recurred in group A, while 6 (37.5%) and 10 (62.5%) in group B. Mean Qmax (mL/s) was 17.71±3.06 and 14.03±3.85 respectively in group A and group B at the month of 12 after surgery (P=0.011). The recovery rate was 83.3% and 37.5% respectively in group A and group B(P=0.023). Conclusion These results suggest that BMG urethroplasty is superior to plastic meatotomy due to lower recurrence rate and beautiful appearance. BMG urethroplasty may be an ideal approach in the treatment of glanular urethral strictures caused by MGLSc.