Objective:To evaluate the morphological characteristics of transrectal ultrasound(TRUS) on seminal vesicle of the patients with initial diagnosis of premature ejaculation.Methods:Between July 2017 and Dec 2018, the morphological characteristics of TRUS on the seminal vesicle, such as the size, echo and structure of the seminal vesicle, were evaluated on 60 patiets, including 36 cases with initial diagnosis of premature ejaculation and 24 cases with premarital rountine examination. The mean age of the patients in two groups was 24 years (range 22 to 27 years). The details about the length of masturbation and the frequency of masturbation in the presence or absence of masturbation about all the subjects during their puberty were recorded.Results:The size, echo and structure of the seminal vesicle, the rate of the length of masturbation (>6 months) and the frequency of masturbation (>twice per week) during the puberty on the patients with initial diagnosis of premature ejaculation and the other with premarital rountine examination were (31.0±9.7) mm and (26.6±7.3) mm (P<0.001), obscore and clear,echo enhancement and echo normalment, 80.6%(29/36) and 45.8%(11/24) (P=0.011), 75%(27/36) and 33.3%(8/24) (P=0.003), respectively.Conclusion:The morphological characteristics of TRUS on seminal vesicle of the patients with initial diagnosis of premature ejaculation include reduction, the obscure structure and echo enhancement of the seminal vesicle.

Objective:To analyze the value of 68Ga-Prostate-specific membrane antigen (PSMA)-11 PET/CT delayed imaging in the detection of pelvic recurrence after radical prostatectomy.Methods:Twenty-four patients who underwent radical prostatectomy at our institution were retrospectively enrolled in the study. The patients received 68Ga-PSMA-11 PET/CT whole-body standard imaging at 60 min and pelvic delayed imaging at 180 min after intravenous injection of radiopharmaceutical. The number, size, maximum standard uptake (SUVmax) and target-to-background ratio (T/B) of pelvic recurrent lesions were compared between standard imaging and delayed imaging.Results:Pelvic recurrence occurred in 17 of the 24 patients. Of the recurrent patients, standard imaging was positive in 15 cases and delayed imaging was positive in 17 cases. There were 7 cases without recurrence, and both standard imaging and delayed imaging were negative. There was no statistical difference (χ2=2.125, P=0.145) in the sensitivity of detecting pelvic recurrence between standard imaging (82.24%, 15/17) and delayed imaging (100.00%, 17/17). Delayed imaging detected 10 more pelvic positive lesions than standard imaging. The diameter 4(3, 8) mm of additional pelvic lesion detected by delayed imaging was smaller than that 8(7, 12) mm of pelvic lesion detected by standard imaging (U=94, P=0.004). The SUVmax 10.08(6.58, 15.50) of delayed imaging was similar to that of standard imaging 7.89(4.87, 15.26) (U=1204, P=0.234), however the T/B value of delayed imaging 55.90(30.45, 109.27) was significantly higher than that of standard imaging 32.89(21.67, 55.07) (U=840, P=0.0005).Conclusion:68Ga-PSMA-11 PET/CT delayed imaging can detect more and smaller pelvic recurrent lesions after radical prostatectomy.

目的 探讨1470 nm激光剜除治疗高危前列腺增生的手术技巧及临床效果.方法 回顾分析2018年6月至2018年9月中山大学附属第三医院泌尿外科采用1470 nm激光治疗共89例高危前列腺增生患者的临床资料,年龄平均(68±3)岁,前列腺体积(57.4±2.6)ml.所有患者均采用"寻找层面,先易后难,剜切结合"的层面递进法思路行激光腔内前列腺剜除术,比较患者术中及术后情况.结果 89例均顺利完成手术,与术前相比,术后3个月患者最大尿流率明显增加,[(6.9±2.1)ml/s vs(19.8±3.6)ml/s].国际前列腺症状评分显著好转,[(24.6±1.7)vs(8.0±1.2)].术中无输血、无电切综合征、无直肠和膀胱穿孔病例,无输尿管损伤、大出血、心脑血管意外等严重并发症发生.结论 层面递进法激光剜除技术构想对于高危前列腺增生外科包膜层面的寻找、减少术后并发症有独到优势,且易于掌握,或可为业界同行提供一个新的思路.

High-volume metastatic hormone-sensitive prostate cancer refers to primarily patients with a high burden of disease including the presence of visceral metastases or at least 4 bone metastases and at least one bone metastasis outside the spine or pelvis. In this case, on the basis of docetaxel combined with endocrine therapy, cytoreductive prostatectomy was performed after bone metastases were effectively controlled. Comparing preoperative puncture pathology and postoperative pathology, the primary lesions were considered to achieve pathological complete response.

Objective:To investigate the role of Smad4 as a target gene regulated by microRNA (miRNA, miR)-301a and the mediating effect of high glucose in promoting the proliferation of prostate cancer cells.Methods:Real-time PCR was used to examine the expression of miR-301 in prostate cancer cells. Bioinformatics prediction by using software of TargetScan and PicTar and luciferase reporter gene assay was utilized for the identification of the target genes of miR-301. The expression of Smad4 was detected by real-time PCR and Western bloting [25 μg, 10% sodium dodecyl sulfate polyacrylamide gel electropheresis (SDS-PAGE)] after the miR-301 mimic was transfected 24 h later. After miR-301 mimics were transfected or co-transfected with Smad4 over-expression plasmid for 24 h, the proliferation and cell cycle of prostate cancer cells (PC-3 and DUl45) were examined by cell counting kit-8 (CCK-8) and flow cytometry, respectively.Results:Bioinformatics prediction and luciferase reporter gene assay demonstrated that Smad4 was the target of miR-301a. After up-regulating miR-301a, the expression of Smad4 mRNA and protein was significantly reduced. The cell proliferation ability increased by 160% ( P<0.05) after up-regulating the expression of both miR-301a and Smad4 for 96 h. MiR-301a could inhibit the expression of Smad4, thereby promoting the cell transition from the G 1 phase to the S phase. In PC-3 cells, before overexpression of miR-301a, the percentages of different phases were G 0/G 1 62.60%, S 28.00%, G 2/M 9.40%; after overexpression, the percentages were G 0/G 1 49.97%, S 41.04%, G 2/M 8.99%, the differences in the phases of G0 and S were significant ( P<0.05). In DU-145cells, before overexpression of miR-301a, the percentages of different phases were G 0/G 1 65.16%, S 24.54%, G 2/M 10.30%; after overexpression, the percentages were G 0/G 1 53.34%, S 36.67%, G 2/M 10.00%, the differences in the phases of G 0 and S were significant ( P<0.05). In addition, knockdown of Smad4 shortened the G 1 phase and prolonged the S phase, which was consistent with the results of miR-301a overexpression. Overexpression of Smad4 could block the effect of miR-301a inducing transformation of G 1/S phase. Conclusion:MiR-301 can regulate the proliferation of prostate cancer cells by targeting Smad4 gene. Smad4 plays an important role in the regulation of hyperglycemia associated prostate cancer.

Objective To compare the efficacy of extended pelvic lymph node dissection (ePLND)and oncological outcome by fluorescence laparoscopic radical prostatectomy (FLRP) versus high-definition laparoscopic radical prostatectomy (HD-LRP) for men with locally advanced prostate cancer (LAPCa).Methods In a prospective trial,we recruited 51 patients with T3a-bNxM0 prostate cancer from July 2015 to April 2018.Patients were assigned to study group or control group according to random number method,and were underwent either FLRP + ePLND or HD-LRP + ePLND.21 in the study group were injected with 5 mg of indocyanine green (ICG) into the bilateral lobes of the prostate transperineally guiled by transrectal ultrasound 30 min before surgery for lymphography.During the surgical procedure a fluorescence laparoscope,optimized for detection in the near infrared range,was used to visualize the lymph nodes (green fluorescent) in the dissection region in the study group while a common laparoscopy introduced in control one.Lymph nodes were removed in the external iliac vessiles,internal iliac artery,obturator fossa regions,common iliac regions and presacral regions in both groups.Radical prostatectomy was completed in the both groups by similar steps.The operation time,blood loss,number of removed lymph nodes and positive lymph nodes,complication rate,biochemical recurrence (BCR) and metastasis free survival rates in 2 years were recorded and compared in the two groups.Results 51 eligible patients were selected,including 21 in the study group and 30 in the control group.The mean age of biopsy of study group and control one were (66.4 ± 7.7) and (66.8 ± 7.4),the mean age PSA (23.5 ± 16.8) ng/ml and (26.0 ± 20.1) ng/ml,the mean Gleason score of biopsy (8.1 ± 1.0) and (7.9 ± 0.9) respectively,and there was no statistical significant difference between two groups.The mean operation time of study group and control one were (45.9 ± 4.6) min and (56.4 ± 3.2) min,the mean removed lymph nodes were (27.7 ± 5.6) and (22.1 ±5.6) respectively,and there was statistical significant difference between two groups (all P ＜ 0.05).Lymph nodes invasion in pathology were reported in 8 cases(38.1％)in the study groups while 9 (30.0 ％) in the control one;the proportion of positive lymph node (metastasis) were 3.2％ (19/583) and 3.4％ (23/663) in the two groups respectively and no statistically significant difference was noted between the two groups.Lymphorrhagia occurred in 4 cases in the control group,and there was no serious complications in both groups.The median follow-up time was 20 (7-33) month and during this time,BCR observed of 1 (4.7％) in the study group and 8 (26.7％) in the control;meanwhile,the MFSR was recorded of 100.0％ (0)in the study group and 86.7％ (4)in the control one,showing a statistically significant difference between the two groups(P =0.04).Conclusions Comparing with LRP,FLRP achieved better results of LN dissection,which will improve oncological outcomes.

目的 探讨羟考酮联合托烷司琼用于1470 nm半导体激光前列腺剜除术(DiLEP)后镇痛疗效及安全性.方法 收集择期行1470 nm DiLEP的102例BPH患者,根据患者术后镇痛药物分为单用羟考酮50例(A组),羟考酮联合托烷司琼52例(B组).比较术后不同时间段2组患者的疼痛视觉模拟评分(VAS)、Ramsay麻醉程度评分和镇痛满意率,观察2组患者术后躁动、恶心呕吐、头晕、嗜睡、皮肤瘙痒等不良反应发生情况.结果 2组BPH患者的1470 nm DiLEP均取得成功,无中转开放手术者,2组患者在术后各时间点的VAS、Ramsay评分及镇痛满意率组间比较差异均无统计学意义(P均>0.05).术后48 h内,B组BPH患者的恶心呕吐发生率低于A组(P<0.05),2组其他不良反应发生率比较均无统计学意义(P均>0.05).结论 羟考酮用于1470 nm DiLEP术后镇痛的效果良好、安全性高,联合使用托烷司琼可减少术后恶心呕吐的发生.

目的 探讨学习曲线内1 470 nm激光层面递进前列腺剜除法的临床应用体会.方法 回顾分析2018年6月至2018年10月初学者采用层面递进法剜除治疗共93例前列腺增生患者的临床资料,主要观察的内容有:移交高年资熟练医师的中转发生率与手术例数的关系、移交高级熟练医师的中转发生率与前列腺体积的关系、剜除效率与手术例数的关系、国际前列腺症状评分、最大尿流率等,并予评估初学者的学习曲线.结果 学习曲线中的93例前列腺汽化剜除全部顺利完成,没有中转开放及输血病例.术前与术后相比,最大尿流率、术后国际前列腺症状评分均有明显改善.在学习曲线中,前列腺体积对初学者手术病例的选择较有参考性,前列腺体积在50～70 mL时外科包膜层面较容易显露,中转熟练医师的发生率最低,剜除效率也较高.随着手术例数及手术经验的累加,20余例后中转熟练医师的发生率明显下降,手术剜除效率也有明显的改善,40余例后逐渐进入稳定期.结论 学习曲线内的术者可优先选择前列腺大小在50～70 mL的病例,20余例后初学者可独立完成大部分的剜除手术,40余例后剜除技术成熟并进入稳定期.1 470 nm激光层面递进剜除法术后并发症较少,术后尿控良好,可较安全、有效的应用在前列腺增生的治疗中.

Objective To evaluate the value of semi-quantitative indices of 68Ga-prostate specific membrane antigen (PSMA)-11 PET/CT in differentiating malignant and benign prostate lesions.Methods From November 2017 to June 2018,30 patients (age:52-86 years) who underwent 68Ga-PSMA-11 PET/CT imaging in the Third Affiliated Hospital of Sun Yat-sen University were retrospectively analyzed,and the serum total prostate specific antigen (tPSA) and free prostate specific antigen (fPSA) were examined within 1 week before PET/CT imaging.Semi-quantitative indices of 68Ga-PSMA-11 PET/CT on prostate lesions were measured by automatic segmentation algorithm method,including PSMA-related lesion volume (VPSMA),maximum standardized uptake value (SUVmax),mean standardized uptake value (SUVmean),peak standardized uptake value (SUVpeak) and total lesion uptake value of PSMA (TLUPSMA).The indices were compared between malignant and benign prostate lesions,and the optimal cut-off values for differentiating malignant and benign prostate lesions were obtained by receiver operating characteristic (ROC) curve analysis.Results According to the pathological results,19 patients had malignant lesions and 11 were with benign diseases.The differences of tPSA,SUVmax,SUVmean SUVpeak and TLUPSMA between malignant and benign prostate lesions were statistically significant (u values:17.00-48.00,all P＜0.05),but there were no significant differences of fPSA,fPSA/tPSA and VPSMA between 2 groups (u values:64.00-99.00,all P＞0.05).The optimal cut-off value of tPSA was 18.30 μg/L for differentiating malignant and benign prostate lesions,with sensitivity of 13/17 (PSA of 2 patients were missing),specificity of 9/11 and area under curve (AUC) of 0.743.The optimal cut-off values of SUVmax,SUVmean and SUVpeak were 5.50,3.09 and 3.56,respectively,with all corresponding sensitivity of 18/19,all specificity of 9/11,and AUC of 0.902,0.907 and 0.919,respectively.The optimal cut-off value of TLUPSMA was 54.81 cm3,with sensitivity of 14/19,specificity of 9/11 and AUC of 0.804.Conclusion The semi-quantitative indices of 68Ga-PSMA-11 PET/CT are valuable for differentiating malignant and benign prostate lesions,in which SUVpeak is superior to other indices.

Objective To explore the surgical techniques and clinical efficacy of adrenalectomy through the extraperitoneal approach of perirenal fat. Methods Clinical data of 136 patients with adrenal tumors undergoing adrenalectomy in the Third Affiliated Hospital of Sun Yat-sen University and Southern University of Science & Technology School of Medicine from January 2018 to December 2018 were retrospectively analyzed. Among them, 97 cases were treated via the extraperitoneal approach of perirenal fat and 39 patients via the retroperitoneal approach. The intraoperative and postoperative conditions of the patients were compared between two groups. Results All 136 patients successfully completed the surgery. In the extraperitoneal approach of perirenal fat group, the average operation time was (47±13) min and the average intraoperative blood loss was (32±9) ml, and (66±19) min and (35±11) ml in the other group. Three patients were switched to open surgery, 1 case of intraoperative blood transfusion, and 1 case of postoperative hypertensive crisis. During adrenalectomy through the extraperitoneal approach of perirenal fat, the operation time and blood loss were better compared with those in the retroperitoneal group. The trans-abdominal technique was advantageous to the retroperitoneal approach for patients with large diameter of adrenal tumors and obesity. No statistical difference was observed in surgical complications and postoperative recovery between two groups. Conclusion Laparoscopic adrenalectomy through the trans-abdominal and retroperitoneal approach of perirenal fat can achieve safe and satisfactory clinical efficacy. Key words: Adrenalectomy; Anatomical plane; Laparoscopy

Objective To study of using E.coli Nissle1917 which can express FCoAT (EcN-Frc) as probiotic treatment to reduce urine oxalate in a rat model. Methods Thirty male SD rats were randomly divided into 6 groups (A to F). 1% oxalate was added to the diet for rats in group B, C, D, E, F; while rats in group A received regular diet. Furthermore, 30 minutes before each feeding, each rats in group B received 1 ml suspension, while those in group C, D, E, F was given 1 ml EcN-Frc suspension (103 viable bacteria). Rats in group C, D, E, F were feeding bacteria every day, once every three days, once a week, respectively. 24-hour urine specimens were obtained on days 0, 3, 6, 9, 14 by placing the rats in metabolic cages. Results Hyperoxaluria rats due to high dietary oxalate were treated by EcN-Frc. It can effectively reduce the high urinary oxalate level in rat model since day 3 after supplementation. The effect of the decrease proved directly proportional to the dose of EcN-Frc.But, one dose of EcN-Frc (103 viable bacteria) can still effectively reduce urinary oxalate in a 2 weeks period. It showed that EcN-Frc had the ability to stay stable in rat’s intestine and grew well. In addition, during 2 weeks period, all rats kept health with no signs of toxicity. Conclusions Probiotic administration of low dose EcN-Frc can effectively reduce the high urinary oxalate in hyperoxaluria rats. EcN-Frc can stay stable in rat’s intestine and play a role in degrading oxalate. This approach appears to be safe and good tolerance. Key words: FCoAT; E.coli; Oxalate; Treatment; Rat; Random

Objective:To compare the short-term efficacy and safety between 1 470 nm diode laser enucleation of the prostate (DiLEP) and plasmakinetic enucleation of the prostate (PKEP) in treating benign prostatic hyperplasia (BPH).Method:From August 2016 to July 2017,a total of 180 consecutive BPH patients with lower urinary tract obstruction were randomly assigned to either 1 470 nm DiLEP group (n=90) or PKEP group (n=90)respectively in our institution.All patients enrolled in the present study have been evaluated preoperatively and followed-up at 1 and 3 months postoperatively.Preoperative characteristics,intraoperative data and postoperative outcomes of all patients were recorded and compared.Result:There was no statistical difference in the preoperative characteristics between the DiLEP and PKEP group (P＞0.05).Compared with PKEP,the DiLEP group had significantly shorter operative time,postoperative bladder irrigation time,postoperative catheterization time and less drop in postoperative serum hemoglobin and sodium levels (all P＜0.001).No severe intraoperative complications such as bladder perforation,excessive haemorrhage or transurethral resection syndrome occurred.DiLEP group was equivalent to PKEP group in International Prostate Symptom Score,quality of life scores,Qmax and post-voiding residual volume before and after surgery (all P＞0.05).The overall follow-up period ranged from 3-14 months,and the mean follow-up period (mean±SD) was (7.2±2.4) months.During the follow-up period,no incontinence or urethral stricture was observed in the DiLEP group.Only one patient had hematuresis one week after surgery and was cured by symptomatic treatment.Whereas,two patients (2.2％) suffered from incontinence in PKEP group.Conclusion:The present study verified the advantages of 1 470 nm DiLEP in treating patients with symptomatic BPH,as the efficacy of DiLEP and PKEP were similar while the former technique provides less risk of perioperative complications,shorter operative time and reduced bladder irrigation and catheterization time.

Objective To evaluate the clinical efficacy and safety ofureteroscopy or percutaneous nephrolithotomy using 24 F balloon dilation for benign ureteral stenosis.Methods The clinical data of 40 cases of benign ureteral stenosis treated with ureteroscopy or percutaneous nephrolithotomy with 24 F (20 cases) and 18 F (20 cases) balloon dilatation were retrospectively analyzed from January 2014 to January 2016.Results In the 24 F group,20 cases had access to the correct channel by ureteroscopy or percutaneous nephrolithotomy to perform balloon dilatation.There were 10 cases indwelling 6 F ureteral stent and 10 cases indwelling 4.7 F ureteral stent.In addition,the double J reteral stents were indwelled for 6 to 12 months.After the follow-up for 6～30 months,the overall effective rate was 90％ (18/20).Fourteen cases were effectively dilated by one operation,and the overall effective rate of 18 F balloon dilatation was 65％ (13/20),and the overall effective rate between the two groups was statistically significant (P＜0.05).No severe hemorrhage or ureteral injury occurred in these two types of balloon dilation.Conclusion 24 F balloon dilation is a safe and effective method for the treatment of benign ureteral stenosis by ureteroscopy or percutaneous nephrolithotomy,the total effective rate was higher than those of 18F balloon dilation.So 24 F balloon dilation should be the preferred option for cases of benign ureteral stenosis with narrow moderate to moderate damage unilateral renal function within a narrow range of 1 cm.

Objective To report the clinical application of negative pressure of ureteral access sheath (NPUAS) in retrograde intrarenal surgery (RIRS).Methods The data of 25 kidney stones cases who was treated with flexible ureteroscopic lithotripsy in the Fifth Affiliated Hospital,Guangzhou Medical University between August 2016 and February 2017 were analyzed retrospectively.The operation time,stone-free rate and complications were evaluated.Results All patients were successfully treated with RIRS in one stage.The mean stone diameter was (2.3 ±0.3) cm,range from 2 to 3 cm.The mean operative time was (64±16) min.The average postoperative hospital stay was (4.1 ±1.7) days.The stone clearance rate was 92.0％ (23/25) in the postoperative period of 1 month.The overall complication rate was 8％ (2/25).After the operation,2 cases suffered fever with body temperature ＜38.5 ℃.They were recovered after antiinfection treatment.There were no serious complications such as massive haemorrhage,ureteral steinstrasse,avulsion and perforation occured.Conclusion Retrograde intrarenal surgery with NPUAS is an effective method in the treatment of moderate-size kidney stone.

目的 探讨经尿道膀胱肿瘤整块切除术(TUERBT)对初发膀胱肿瘤的精准分期与切除疗效.方法 回顾性分析2011年10月至2015年12月由单一术者(庞俊)收治的初发膀胱肿瘤患者42例.采用珠海司迈(SM)等离子电切镜杆状电极行经尿道膀胱肿瘤整块切除术.保留完整的膀胱肿瘤基底送病理检查.术后辅以即刻灌注表柔吡星和常规灌注化疗.结果 42例患者(男性28例,女14例),中位年龄57(26～84)岁,手术均获成功,肿瘤数目平均1.5个(1～5个),大小2.2 cm(0.8～5 cm).未出现膀胱穿孔及闭孔反射.肿瘤基底组织均可见肌层.术后病理分期Ta 5例,Tis 7例,T1期20例,T2期9例(其中3例患者因高龄术后行髂内动脉灌注化疗,6例行二期膀胱癌根治术),T3期1例(行二期膀胱癌根治术).32例T1期及以下患者行膀胱肿瘤整块剜除术后仅l例行二次电切术后病理报告显示膀胱尿路上皮癌,术后辅以规范的膀胱灌注化疗,术后随访中位时间16个月(6～40个月),仅l例患者复发.10例T2期及以上患者中7例行根治术后无复发,3例行整块剜除和髂内动脉灌注化疗,随访中位时间8个月(6～12月)未见复发.结论 经尿道膀胱肿瘤整块剜除术有利于膀胱肿瘤术后精准分期,肿瘤基底切除更彻底,可安全有效的应用于初发膀胱癌的诊治.

目的 探讨侧入路4步法经尿道前列腺等离子解剖性剜除术治疗大体积前列腺增生的疗效及安全性.方法 2013年1月至2015年5月中山大学附属第三医院泌尿外科采用侧入路4步法经尿道前列腺等离子解剖性剜除术治疗体积＞80 ml的前列腺增生患者90例,记录术中出血量,切除腺体体积,手术时间,对比术前术后残余尿量,最大尿流率.结果 90例均顺利完成手术.术中出血量30～120ml,平均(56±21) ml;手术时间30～100min,平均(60±23)min;切除腺体50～120 g,平均(69±29)g.与术前经直肠前列腺超声比较,平均切除率68.6％ (62.5％～76.3％).与术前相比,术后3个月患者残余尿量明显减少[(83.4±25.6) ml vs (7.2±2.5) ml,P=0.017],最大尿流率明显增加[(7.4±3.2) ml/svs (21.3±5.6) ml/s,P=0.019],IPSS评分明显好转[(25.6±4.3)分vs (7.3±3.6)分,P=0.012].结论 侧入路4步法经尿道前列腺等离子解剖性剜除术治疗大体积前列腺增生的疗效确切,并发症少,尤其对于外科包膜的寻找有独到优势,易于掌握,值得临床推广.

目的 探讨输尿管软镜碎石取石术(RIRS)治疗孤立肾鹿角状结石的安全性和有效性.方法 回顾性分析2014年10月至2015年10月广州医科大学附属第五医院用RIRS治疗30例孤立肾鹿角状结石患者的临床资料,分析术后1个月结石清除率及并发症情况.残留结石则采取再次RIRS、体外冲击波碎石或经皮肾镜碎石取石术(PCNL).结果 平均结石负荷:(628±27) mm2.其中16例(53.3％)行一期RIRS,12例(40％)需行二期RIRS,2例(6.7％)二期行PCNL.平均手术时间(84±21)min.术后住院时间4～14 d,中位数6d.术后1个月一期结石清除率53.3％(16/30),总结石清除率86.7％ (26/30).1例术后因输尿管石街出现感染性休克和急性肾功能衰竭,1例术后肾周尿源性脓肿,均治愈.术后发热5例.无输血、输尿管穿孔、撕脱等并发症.总并发症发生率23.3％(7/30).结论 对于孤立肾鹿角状结石,RIRS是一种可选的可靠和有效的手术方式.分期结合PCNL有利于提高结石清除率和安全性.

Objective To study changes of bladder's structure and functions,changes of distribution and expression of α1-adrenoceptor subtypes,and pathological changes of diabetes mellitus cystipathy in SD rats with diabetes mellitus(DM).Methods Animal models of DM were made in SD rats by injecting 1% streptozotocin into abdomen.The rats were divided into normal control groups and DM groups in 2,4 and 6 weeks by random allocation.Successively after 2,4 and 6 weeks' time,rats underwent filling cystometry to estimate the bladder function,Western blot and immunofluorescence of bladder tissue sample were conducted to observe pathological and histological changes in detrusor of bladder,and expression changes of Alpha receptor subtype(α1D-AR and α1A-AR).Results Urine volume and bladder wet weight of DM rats increased with weight decreased compared with control groups.The results of filling cystometry in DM rats showed that bladder capacity,compliance,peak detrusor pressure and residual urine all increased distinctly,with decreased micturition efficiency.The routine HE staining under light microscopy showed there were progressively loose and disorder muscle bundles,even fracture ones in detrusor of DM rats.Western blot results showed α1A-AR and α1D-AR expressed decreasingly in detrusor in DM rats.Immunofluorescence results showed the grey value of α1A-AR and α1D-AR positive cells in DM groups progressively reduced and were less than that of control groups.Conclusion Morphological and functional changes of detrusor of bladder occurred in early stage of DM rats.There was negative correlation between expression of α1-AR and DM disease,indicating DM may decrease expression of α1-AR in bladder,of which the decreased expression may be one of factors to cause increased bladder compliance and residual urine in DM disease.