Objective To evaluate the clinical efficacy and safety of anterograde flexible ureteroscopic lithotripsy in the management of ureterointestinal anastomotic calculus after Bricker procedure by a retrospective analysis of 11 cases. Methods From March 2006 to July 2009,11 patients with ureterointestinal anastomotic calculus after Bricker procedure were enrolled in this study. The average age of the patients was (62±9) years old. The first clinic presentation was averagely (8.2±3.2) months after the Bricker procedure (5-16 months). There were 7 cases with left side calculi and 4 cases with right side ones. The urinary tract ultrasound and the multiplanar CT reconstruction were carried out to identify the obstructive portion of the ureter. Seven cases without complications underwent percutaneous nephrostomy and simultaneous anterograde flexible ureteroscopic lithotripsy. Simple nephrostomic drainage was carried out for 3 cases with obstructive upper urinary tract infection and a second time anterograde flexible ureteroscopic lithotripsy was done 3 weeks after the antibiotics, nearly the same as the patients with right unique kidney and acute renal failure due to the ureterointestinal anastomotic calculus. The 7F soft mono J ureteral stent was indwelled for 4 weeks. The intravenous antibiotics were administered during the first 2 days after the surgery. A kidney ureter and bladder X-Ray (KUB) or a CT scan was performed 4 weeks after the procedure to evaluate the clinical outcomes. Any residual calculus larger than 4 mm was taken as significant. Results The nephrostomic procedure was successful in all the cases. The upper urinary tract infection was well controlled in all the 3 cases and the serum creatinine decreased in the case with acute renal failure. The flexible ureteroscopic lithotripsy was carried out smoothly in all the 11 cases. The mean operative time was (40±9.3) min (25-55 mins). The nephrostomic catheter was removed 72 hours after the surgery. The mean hospital stay was (3.3±0.9) days. The average blood loss was less than 50ml. No residual calculus was found during the 4 weeks’ follow-up. The average follow-up was 19 months. One case had recurrent calculus 13 months after the first procedure, which was successfully managed by the flexible ureteroscopy again. Two cases had ureteral stricture at the lower ureter at 3 and 8 months after the first intervention. In these 2 cases, an exploration by the anterograde flexible ureteroscopy combined with the balloon dilation was done and an indwelling soft mono J stent was changed every 6 months. Conclusion The anterograde flexible ureteroscopic lithotripsy is safe and effective for ureterointestinal anastomotic calculus after Bricker procedure, with less complications, low recurrence rate, and a high calculus removing rate. Four week stenting of mono J ureteral stent after operation can help to prevent ureterointestinal anastomotic stricture.

Objective:To summarize the characteristics of MSCT of the upper urinary tract fungal bezoars and to evaluate the feasibility and clinical value of MSCT in the diagnosis and treatment of obstructing renal fungal ball. Methods: A retrospective study of 4 cases with upper urinary collecting system fungal bezoars complicating urinary tract obstruction from April 2007 to December 2009. 2 males and 2 females were enrolled in this study and in all the cases, the obstruction was unilateral. Case 1:female,37-year-old, came to the emergency room for high fever and pyonephrosis with a surgical history of percutaneous nephrostomic lithotomy in the right kidney 6 months ago. The patient had a medical history of dermatomyositis treated by corticosteroid. Case 2:Female, 42- year-old with DM, came to the clinic for right ureteropelvic junction obstruction and hydronephrosis. Case 3: Male, 57-year-old, came to the clinic for left ureteral stone and left hydronephrosis. Case 4:Male, 52-year-old, consult in the ER for anuria with right unique kidney. The MSCT without enhancement was realized in all the 4 cases. The GE Light Speed 16 CT was used in these cases with the following parameters: 120 kV, 280 mA, 1. 25 mm reconstruction slice, 1. 375: 1, window width 360 HU, window site 60 HU. Results:In all the 4 cases, MSCT showed that the infected kidney was enlarged with a hydronephrosis. The perinephretic fascia was thick and some high density lines could be found in the perinephretic fat tissue. Some high density mass could be recognized in the collecting system as well as the UPJ junction with a CT value of 180-235. There was no parenchymal necrosis or abscess found in the kidney. The PCN drainage and local irrigation of anti-fungal medication was realized in all the cases to control the severe infection and the fungal bezoars were extracted by the percutaneous access. The urine fungal culture was positive in all the cases. These were no systemic fungal infection or massive haemorrhage during the peri-operative phase. No medication-related kidney or liver impairment was found. Conclusions:The MSCT was widely available and almost suitable for all the cases except for the pregnant women. The CT value could help to make the right diagnosis of fungal bezoars, which makes the managements of such patients more correct, suitable and safe.

To evaluate the feasibility and successful rate of a new visualized puncture system for the percutaneous nephrolithotomy (PNL) procedure.

To evaluate the feasibility and the clinical outcome of the transurethral resection of prostate by plasmakinetic TUR system in the BPH patients with high surgical risk pretreated by short-term (3 months) subcutaneous administration of goserelin acetate.

To investigate the feasibility and the efficacy of endoscopic management of ureterointestinal anastomotic stricture of the STUDER neobladder by the flexible ureteroscope.

To study the pathological basis of the iatrogenic ureteric lesion complicating upper tract obstruction, to evaluate the efficacy of different surgical strategies in these cases.