Analysis on the associated factors of adult urolithiasis in China based on two-level Logistic regression model / 中华疾病控制杂志

Objective To investigate the risk factors of adult urolithiasis in China. Methods 14 areas including 11 communities and 19 villages were randomly selected from 7 provinces of China by multi-stage stratified cluster sampling method during the period of May 2013 to July 2014. Individuals were investigated by a face-to-face questionnaire and a physical examination including urinary tract ultrasonographic examinations, routine blood and urine tests and blood biochemical examination ect. Results In total, 1 447 participants were found with the urolithiasis among 9 310 individuals and the overall prevalence was 15.5% (1 447/9 310). The prevalence of urolithiasis was significantly different among 14 areas ( 2=711.523，P<0.001), the lowest was the village in Shanxi (0.76%) and the highest was the village in Guangdong(35.99%). The intercept-only model further indicated the reginal aggregation for the individuals of urolithiasis (t=2.48, P=0.027) and the ICC was 48.74%. The two-level Logistic regression model showed that the gender (OR=1.235, 95% CI:1.082-1.411, P=0.005), age (OR=1.101, 95% CI:1.047-1.158, P=0.001), diabetes mellitus (OR=1.411，95%CI:1.192-1.670, P=0.001), family history of urinary calculi (OR=1.867, 95% CI:1.500-2.323, P<0.001), LDL (OR=1.150, 95% CI:1.050-1.260, P=0.006), drinking coffee (OR=1.352, 95% CI:1.065-1.716, P=0.017) and drinking sodas (OR=1.547, 95% CI:1.203-1.990, P=0.002) were the risk factors for urolithiasis. By contrast, consumed more fermented vinegar (OR=0.567, 95% CI:0.498-0.645, P<0.001) and had a amount of legume (OR=0.726, 95% CI:0.628-0.839, P<0.001) were protective factors of urolithiasis. Conclusion The prevalence of urolithiasis among adults reveal an aggregation in area-level, influenced by life environment and dietary habits of individual.

Platelet-derived growth factor-BB induces phenotypic transformation of corpus cavernosum smooth muscle cells in SD rats / 中华男科学杂志

<p><b>OBJECTIVE</b>To evaluate the effect of the platelet-derived growth factor-BB (PDGF-BB) on the phenotypic transformation of corpus cavernosum smooth muscle cells (CCSMC) in SD rats.</p><p><b>METHODS</b>CCSMCs were primarily cultured in the modified tissue sticking medium and subjected to immunofluorescence assay. The cells were divided into a blank control and four PDGF-BB groups, the latter exposed to 5, 10, 20, and 40 ng/ml of PDGF-BB, respectively, for 24 hours, and the cells in the 20 ng/ml PDGF-BB group treated for 24, 48, and 72 hours. The the relative expressions of α-SMA, SMMHC, calponin, and OPN mRNA were determined by real-time fluorescence quantitative RT-PCR (qRT-PCR).</p><p><b>RESULTS</b>The α-SMA positive rate of the CCSMCs was over 95%. Compared with the blank control group, the expression levels of α-SMA, SMMHC, and calponin mRNA were significantly decreased (P < 0.05) while that of OPN mRNA remarkably increased (P < 0.05) in the PDGF-BB groups. The 20 ng/ml PDGF-BB group also showed significantly downregulated expressions of α-SMA, SMMHC, and calponin mRNA (P < 0.05) and upregulated expression of OPN mRNA (P < 0.05) at 24, 48, and 72 hours.</p><p><b>CONCLUSION</b>PDGF-BB can induce the transformation of the phenotype of CCSMCs in SD rats from the contractile to the synthetic type.</p>

Treatment of urinary tract calculi in preschool children with endoscopy / 中华外科杂志

<p><b>OBJECTIVES</b>To investigate the safety and feasibility of endoscopy in treating urinary tract calculi in preschool children.</p><p><b>METHODS</b>From August 2004 to August 2008, 28 preschool children with urinary tract calculi were treated by endoscopy, 11 cases received ureterolithotripsy (URL) and 17 cases received minimally invasive percutaneous nephrolithotomy (MPCNL).</p><p><b>RESULTS</b>Of 11 cases with ureteric calculi, 5 cases were rendered stone free in the first session, the other 6 cases received passive dilation by indwelling of ureteric stents for 1 to 3 weeks and underwent successful ureteroscopy with a 8/9.8 Fr rigid ureteroscope. Seventeen cases with renal calculi received MPCNL and were rendered stone free.</p><p><b>CONCLUSION</b>Our study shows that endoscopy in treating urinary tract calculi is safe and feasible in preschool children.</p>

Complications of minimally-invasive percutaneous nephrolithotomy / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the occurrence and management of complications following minimally invasive percutaneous nephrolithotomy (MPCNL).</p><p><b>METHODS</b>The data of 4326 cases of MPCNL from January 2001 to February 2006 were reviewed, including 2451 male cases and 1875 female cases. Their age ranged from 4 to 82 years with a mean of 42 years. Of 4326 cases, 1221 cases had simple nephrolithiasis, 1735 staghorn nephrolithiasis, 386 upper ureterolithiasis, 90 serious stone street after extracorporeal shock wave lithotripsy, and 894 residual calculi after open surgery.</p><p><b>RESULTS</b>Among the 4326 cases of MPCNL, complications occurred in 445 cases (10.3%). Of the 445 cases, 20 had massive hemorrhage, 13 pleural injuries, 1 colonic perforation, 343 fever attacks (T > 38 degrees C), 13 septic shocks, 16 perinephric urinoma, 9 perinephric abscess, 26 renal perforating injuries, 1 guide wire misled into inferior vena cava, 3 died.</p><p><b>CONCLUSIONS</b>MPCNL is a minimally invasive operation. However, serious complications would occur if the procedure were ignored. The improvement in the prevention and management of complications can promote the application of this procedure.</p>

Endoluminal therapy for bilateral malignant ureteric obstruction / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the endourological technique in the treatment of bilateral malignant ureteric obstruction.</p><p><b>METHODS</b>The data of 43 patients (totally, 70 cases) with bilateral malignant ureteric obstruction treated with endoluminal therapy were reviewed retrospectively. Of 70 cases, 38 were treated by retrograde double-J stenting, 24 by minimally invasive percutaneous nephrotomy (MPCN) and 8 by antegrade double-J stenting.</p><p><b>RESULTS</b>All patients were followed up for an average of 12 months. The retrograde double-J stenting, MPCN and antegrade double-J stenting was successfully performed in 50.0% (19/38), 100.0% (24/24) and 62.5% (5/8), respectively. Technical failures in placing retrograde double-J stent were too difficult to identify the ureteric orifice (13/38) or failing to cross the obstruction site because of severe extraluminal compression (6/38). Failure in placing antegrade double-J stent was due to severe extraluminal compression (3/8). Dislodgment of nephrostomy tubes (11/19) was the major factor which limited the application of MPCN.</p><p><b>CONCLUSION</b>It is safe and effective to treat malignant ureteric obstruction with endourological technique, and suggested initially with retrograde double-J stenting. If malignant ureteric orifice occlusion or a severe extraluminal compression is showed in the imaging, MPCN or antegrade double-J stenting may be selected according to the site and the extent of obstruction.</p>

Surgical management of male infertility beyond assisted reproductive technology / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the role of urological surgery for male infertility which is beyond the help of assisted reproductive technology (ART).</p><p><b>METHODS</b>We retrospectively reviewed the records of 7 male infertility patients who, having failed to respond to ART, underwent urological surgery from 1999 to 2003. Of the 7 cases, 4 were varicocele, 2 were post-bilateral vasectomy and 1 was bilateral chronic epididymitis. For the 7 patients, 6 times we performed in vitro fertilization-embryo transfer (IVF-ET) and 5 times we attempted intracytoplasmic sperm injection (ICSI) , but all failed. After that, we resorted to surgical approaches, ligation of internal spermatic veins in 4 cases, bilateral vasovasostomy in 2, and unilateral epididymovasostomy in 1.</p><p><b>RESULTS</b>After surgical intervention, 2 cases fathered children, 1 achieved pregnancy and 3 cases improved in the quality and quantity of seminal fluid; only 1 failed to respond to the therapy.</p><p><b>CONCLUSION</b>In the treatment of male infertility, priority should be given to surgical intervention and, in case of failure, assisted reproductive technology could be considered.</p>

Treatment of renal lower caliceal calculi with minimally invasive percutaneous nephrolithotomy / 中华泌尿外科杂志

Objective To investigate the clinical outcomes of minimally invasive percutaneous nephrolithotomy(MPCNL)in the treatment of lower caliceal calculi.Methods We retrospectively re- viewed the clinical outcomes and complications of 33 patients who underwent MPCNL for lower caliceal cal- culi from March 2001 to April 2005.The average diameter of the calculi was 2.8 cm.Single tract nephrosto- my was performed in all 33 cases;among them renal access was obtained through a middle calyx in 10 cases and a lower calyx in 23.Nine cases had F14 renal access;and 24 cases,F16.Results Of 33 cases,28 (85%)achieved stone-free at 1 session.A second-look was needed in 3 cases due to intraoperative bleed- ing;ESWL,in 1 case with residual,calculi;no treatment,in 1 case with residual calculi＜4 ram.The mean operative time was 93 min;mean blood loss was 113 ml;mean hospital stay was 11 d.Blood transfusion was needed in 1 patient who suffered from hepatic cirrhosis preoperatively;another experienced severe bleeding 7 d after operation and was cured with hyperselective spongia gelatinosa embolization of the renal artery.Fol- low-up was available in 19 cases for 2-48 months,and no recurrence of renal calculi was noted.Conclu- sions Minimally invasive percutaneous nepbrolithotomy has advantages of safety,less invasion,and easy re- covery for the treatment of lower caliceal calculi.

Analysis of the cause of hemorrhage after MPCNL and its interventional treatment / 中华泌尿外科杂志

Objective To analyze the cause of delayed hemorrhage after minimally invasive percu- taneous nephrolithotomy(MPCNL),and to summarize the experience in the interventional treatment of severe bleeding after MPCNL by superselective arteriolar embolization.Methods The clinical data of 3812 cases of MPCNL from June 1998 to July 2004 were reviewed.Of them,12 patients(11 men and 1 woman;mean age,45 years)who developed severe hemorrhage after MPCNL were identified.The cause of hemorrhage and the treatment results were analyzed.Results The rate of delayed hemorrhage after MPCNL was 0.31% (12/3812).The mean time to onset of severe bleeding was 10 d after MPCNL.Renal arteriography was per- formed in all 12 patients,showing 5 arteriovenous fistulas and 7 false aneurysms.Superselective arteriolar em- bolization for hemostasis was performed in all 12 cases.All these vascular abnormalities were successfully treated by superselective embolization.Follow-up showed that the hematuria disappeared and renal function recovered well.Conclusions Severe hemorrhage following MPCNL is a rare complication,the incidence of which is significantly lower than that of conventional PCNL.The cause is mainly the arteriolar injury of re- nal puncture passage.Superselective embolization provides effective control of bleeding and currently consti- tutes the treatment of choice based on our experience.