INTRODUCTION:Intrarenal pressure (IRP) is challenging to measure during retrograde intrarenal surgery (RIRS). Distal end-mounted pressure sensors in flexible ureteroscope (fURS) or ureteral access sheath (UAS) offer real-time pressure measurement, which may address this issue. Pyelorenal reflux occurs in the renal calyces, particularly at the fornices. No study has yet investigated whether there is a pressure differential between the renal pelvis and the calyces. This research aims to examine this topic using the porcine kidney model developed at our institution. MATERIALS AND METHODS:Twelve adult porcine kidneys were used. Three pressure measuring catheters were inserted into upper, middle, and lower calyces. IRPs were studied using either conventional UAS (cUAS) or vacuum-assisted UAS (vaUAS) with a fourth measure monitor catheter inside and level with the tip of UAS and a 7.5F fURS. Incremental rate of irrigation was delivered through the fURS and IRPs were measured and recorded. RESULT:In cUAS, there were statistically significant reductions in pressure, ranging from small to moderate, observed in both the upper and lower calyces compared to the renal pelvis. These pressure differences disappeared when irrigation reached >90 c.c./minute. In vaUAS with vent closed: The IRP remained negligible even with irrigation up to 140 c.c./minute. Interestingly, there were very small but significantly less pressures in all three calyces as compared to the real pelvises when irrigation rate was ≧90 c.c./minute. There were no differences in pressure with irrigation below 90 c.c./minute. CONCLUSION:Real-time IRP measurement during RIRS with cUAS can provide valuable clinical insights. Porcine kidney studies show slightly less pressure in the calyces than the renal pelvis. vaUAS reduces high IRP and pressure gradients, potentially making real-time IRP measurement unnecessary.

精囊结石在泌尿系疾病中较少见，患者常因血精或射精疼痛来院就诊而发现，精囊结石体积普遍较小，桓台县人民医院接诊一例膀胱结石合并精囊多发结石的患者，成功进行手术治疗，效果良好，现报道如下。

INTRODUCTION:7.5F digital fURS and 9.5/11.5F ureteral access sheaths (UAS), both conventional (cUAS) and vacuum-assisted (vaUAS), are commercially available. Irrigation increases intrarenal pressure (IRP). This study analyzes the IRP with various irrigation rates using 7.5F fURS without UAS or with either cUAS or vaUAS in an ex-vivo porcine model. Pyelo-tubular backflow was also studied during these experiments. MATERIALS AND METHODS:11 porcine kidneys were used. 7.5F digital fURS was tested without UAS and with 9.5/11.5F cUAS and vaUAS. 6F pressure monitor catheters were placed into the upper and lower calyces. IRPs were recorded under different irrigation rates. When vaUAS was used, the air vent was either open or closed. 300 mmHg aspiration pressure was chosen. Lastly, contrasted irrigation fluid was delivered until IRP reached above 30 mmHg. Fluoroscopy images were obtained at 5 mmHg intervals over this threshold to study the pyelo-tubular backflow. RESULTS:Using cUAS, IRP reached 30 mmHg with irrigation rates between 60 and 70 cc/min. Using vaUAS with vent closed, IRP never exceeded 10 mmHg with irrigation up to 120 cc/min. vaUAS with vent open performed marginally better than cUAS. fURS without UAS performed better than cUAS. Pyelo-tubular backflow became prominent at 40 mmHg. CONCLUSION:In an ex-vivo porcine model, 7.5F fURS could be used safely without UAS with irrigation rates up to 120 cc/min. The safety margin dropped to 60-70 cc/min with cUAS. vaUAS with vent closed maintained IRP < 10 mmHg with irrigation rates up to 120 cc/min. Pyelo-tubular backflow was observed with IRP > 35 mmHg.

OBJECTIVE:This study aimed to prove the vacuum-assisted ureteral access sheath (vaUAS) is more effective in maintaining a lower IRP than conventional ureteral access sheath (cUAS). MATERIALS:The model consisted of 12 freshly harvested adult porcine kidneys. METHODS:Either a 12/14F cUAS or vaUAS was alternately inserted into the ureter to one cm below the renal pelvis. Upper, middle, and lower calyces were punctured, and 6F pressure monitor catheters were introduced. IRP with cUAS was monitored using various irrigation rates. IRP with vaUAS was monitored with the same irrigation rates; various aspiration pressures; and vent fully closed, 50% closed, and fully open. RESULTS:cUAS with irrigation rate of 50 cc/min resulted in IRP < 30 mmHg. 50 to 100 cc/min should be used with caution. When irrigation rate exceeded 100 cc/min, IRP rose to ≥ 30 mmHg in most instances. With vent closed, vaUAS with vacuum pressure ≥ 150 mmHg and irrigation rate of 50 cc, 100 cc, and 150 cc/min generally resulted in IRPs < 5 mmHg. With vent half closed, vaUAS with vacuum pressure ≥ 300 mmHg and irrigation rate of ≤ 100 cc/min avoided IRP > 30 mmHg. vaUAS with vent open showed limited advantages over cUAS. CONCLUSION:vaUAS maintains lower IRP than cUAS under same parameters. Both vaUAS and cUAS can be used when irrigation is ≤ 50 cc/min vaUAS showed clear advantages over cUAS in maintaining lower pressure when irrigation rate is ≥ 100 cc/min.

临床上肾良性肿瘤以血管平滑肌脂肪瘤较为多见,肾血管瘤较为少见,而吻合状血管瘤更为少见,现将我科去年收治的1例吻合状血管瘤汇报如下. 临床资料 患者张某某,男,67岁,因检查发现肝肾间低回声结节3周入院,无发热,无腰腹部疼痛,无恶心、呕吐,无肉眼血尿,无尿频、尿急、尿痛等不适;入院后彩超示肝肾之间探及一低回声结节,大小1.9 cm×1.5 cm,边界清,形态规则,未见明显血流信号.腹部强化CT检查示肝肾间隙见一15 mm结节灶,与右肾分界不清,增强扫描病灶可见明显不均匀强化,并可见细小血管影通入(图1 a～d).

目的 探究肾结石通过输尿管软镜联合钬激光治疗的临床疗效.方法 随机从2016年5月～2018年5月期间在本院治疗的孤立肾肾结石患者中选择24例,随机分为两组对照组和观察组,对照组患者给予输尿管软镜治疗,观察组给予输尿管软镜联合钬激光治疗,对比两组患者手术治疗的情况.结果 对照组和观察组患者的结石清除率分别为83.33％、91.67％,差异显著(P<0.05).对照组和观察组患者并发症地发病率分别为25％、8.33％,差异显著(P<0.05).结论 输尿管软镜联合钬激光治疗效果更明显,结石清除率高,同时治疗费用低,能够减轻患者的经济压力,对于患者而言是较为理想的治疗方案,具有较高的技术价值.

目的探讨巨大肾上腺嗜铬细胞瘤术前介入栓塞治疗的利弊。方法选取同一天手术、瘤体相差不大且手术方式相同的2例巨大左侧肾上腺嗜铬细胞瘤患者，其中1例术前做血管介入栓塞治疗；术中锁骨下静脉穿刺检测中心静脉压(CVP)，桡动脉穿刺置管检测平均动脉压(MAP)，记录术中出入量。结果术前行介入栓塞患者在手术过程中血压在70~199 mmHg/40~140 mmHg范围内波动，术中出血<150 ml；未行介入栓塞治疗患者手术过程中血压在40~330 mmHg/35~170 mmHg范围内波动，术中出血<350 ml。结论巨大肾上腺嗜铬细胞瘤术前血管介入栓塞治疗能减少术中出血，降低术中血压波动；而术前介入治疗易诱发巨大血压波动，增加患者的额外风险。

目的观察帕罗西汀联合索利那新治疗女性膀胱过度活动症(OAB)的临床疗效。方法将80例女性OAB患者随机分为观察组43例和对照组37例。观察组采用帕罗西汀联合索利那新治疗,对照组单用索利那新治疗,治疗4周后检测并比较2组尿动力学参数。结果 2组治疗后平均24h排尿次数、平均24h尿失禁次数低于治疗前,初始尿意容量(FDV)、最大膀胱压容量(MCBC)、最大尿流率(Qmax)检测值高于治疗前,且观察组优于对照组,差异均有统计学意义(P<0.05)。结论联合应用帕罗西汀和索利那新能有效提高OAB临床疗效。

目的评价双氯芬酸钾联合安定治疗良性前列腺增生术后膀胱痉挛的效果。方法选取笔者所在医院84例前列腺增生术后发生膀胱痉挛患者,随机分为治疗组和对照组,治疗组给予双氯芬酸钾片50mg,2次/d,联合安定5mg,2次/d,对照组给予杜冷丁50mg,肌注对症治疗,拔除导尿管后停药。结果治疗组患者膀胱痉挛次数及程度明显优于对照组,开放手术后出现膀胱痉挛的比例明显高于TURP。结论双氯芬酸钾联合安定治疗前列腺术后膀胱痉挛效果显著。