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Objective To study the constituents of urinary stones in patients in Zhejiang,and analyze the composition difference between patients from northern Zhejiang province and southern Zhejiang province.Methods From October 2012 to October 2018,clinical data of 4 423 urinary stone patients treated in Sir Run Run Shaw Hospital,the Second Affiliated Hospital of Wenzhou Medical University,and Huzhou First People's Hospital was retrospectively analyzed.Infrared spectrum was used to analyze urinary calculi constituents.Among 4 423 patients,there were 3 041 males and 1 382 females,male to female ratio was 2.2∶ 1,and the mean age was (51.2 ±16.5) years.There were 2 974 northern Zhejiang patients and 1 449 southern Zhejiang patients.High incidence age group was 41-60 years [48.2％ (2 136/4 423)].The distribution characteristics of urinary calculi constituents in different groups of sex,age,and region were analyzed.Results Among the 4 423 cases,the mixed urinary stones were dominant in the urinary calculus [73.1％ (3 235/4 423)],in which,the most component was the calcium oxalate monohydrate + calcium oxalate dehydrate + carbonated apatite [36.2％ (1 604/4 423)];among the pure stones,the most component was the calcium oxalate monohydrate [16.3 ％ (719/4 423)].Carbonated apatite stones [70.1％ (970/1 382) vs.61.0％ (1 856/3 041),P ＜0.05] and magnesium ammonium phosphate stones [12.7％ (176/1 382) vs.4.9％ (150/3 041),P ＜ 0.05] were both more prevalent in females than males,but uric acid stones[10.6％ (325/3 041) vs.5.8％ (81/1 382),P ＜0.05] were more common in males than females.The proportions of calcium oxalate stones[90.6％ (961/1 060) vs.76.2％ (935/1 227),P ＜0.05],carbonated apatite stones [77.6％ (823/1 060) vs.50.7％ (623/1 227),P ＜ 0.05],and magnesium ammonium phosphate stones[9.1％ (97/1 060) vs.6.5％ (80/1 227),P ＜0.05] of 0-40 years group were all higher than ＞ 60 years group,however,uric acid stones were more frequent in ＞ 60 years group [3.5％ (38/1 060) vs.17.0％ (209/1 227),P ＜ 0.05].The proportion of calcium oxalate stones in southern Zhejiang was lower than northern Zhejiang [79.0％ (1 145/1 449) vs.89.4％ (2 661/ 2 974),P ＜ 0.05].However,carbonated apatite stones [71.5％ (1 037/1 449) vs.60.1％ (1 789/2 974),P ＜ 0.05],magnesium ammonium phosphate stones [15.1％ (220/1 449) vs.3.5％ (106/ 2 974),P ＜ 0.05],and uric acid stones [10.7％ (156/1 449) vs.8.4％ (250/2 974),P ＜ 0.05] were more prevalent in southern Zhejiang than northern Zhejiang.Conclusions The distribution of constituents of urinary stones in Zhejiang was different in genders,age,and regions.Carbonated apatite stones and magnesium ammonium phosphate stones were more prevalent in females and young people,and uric acid stones were more common in males and old people.Calcium oxalate stones were more common in youths.Moreover,calcium oxalate stones were more frequent in northern Zhejiang,and carbonated apatite stones,magnesium ammonium phosphate stones and uric acid stones were common in southern Zhejiang.
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Objective To discuss the diagnosis and surgical management of multilocular cystic renal cell carcinoma (MCRCC) and to evaluate the gene function of the mutation of von Hippel-Lindau (VHL) gene in MCRCC. Methods Seventeen MCRCC cases (11 men and 6 women) out of 512 cases of renal cell carcinoma from 2000 to 2010 were retrospectively analyzed. The mean age of the 17 patients was 46 years (37-61 years). Ultrasonography and CT were available in all 17 cases, and 1 case was misdiagnosed as parapelvic renal cyst. The mutation of VHL gene was detected by PCR in the specimens of can-cerous tissue and adjacent normal tissue from 11 cases of MCRCC. Results Three of 17 cases underwent nephron sparing surgery, the others underwent radical nephrectomy. One case underwent unroofing of parapelvic renal cyst, but the rapid frozen pathology of the cyst wall showed renal cell carcinoma of clear type. As a result, radical nephrectomy was eventually performed. All 17 cases were confirmed as MCRCC by eva-luating pathological characteristics, such as the cyst wall lined by single or several layers of clear tumor cells and the nuclei which were small and anachromasis. Clinical stages of all cases were T1N0M0, in which there were 14 cases with pathological T1G1 and 3 cases with pathological T1G2. All patients underwent a follow-up of 9 to 36 months (mean, 12 months) without recurrence or metastasis. Mutation of VHL gene was detected in 7 of 11 cases (64%), but all adjacent normal tissues were negative. Conclusions As a rare subtype of renal cell carcinoma, MCRCC is difficult to diagnose. CT is an essential measure in diagnosis of MCRCC preoperatively. Because of the good prognosis of reported cases, nephron sparing surgery for the treatment of MCRCC is recommended. VHL gene mutations may play an important role in the carcinogenesis of MCRCC.
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Objective To evaluate the feasibility and clinical results of laparoseopic reoperation for patients with history of previous ipsilateral urology laparoscopic surgeries. Methods Thirteen patients that underwent second ipsilateral urology laparoscopic surgeries were retrospectively ana-lysed. The reasons for a second operation included nonfunctional kidney after pyeloplasty, ure-terolithotomy or pyelolithotomy in 4 cases, recurrence of urinary calculi in 3 cases, pelviureteric june-tional stenosis after pyeloplasty in 1 case, recurrence of renal cyst in 1 case, recurrence of adrenal tumor in 1 case, residual adrenal tumor in 1 case, progression of polycystic kidney in 1 case and renal carcinoma after laparoscopic surgery for renal cyst in 1 case. Transperitoneal laparoscopie surgeries were performed in all cases and the first trocar was placed with open incision to avoid puncture injury. The adhesion between intestines and retroperitoneal space was dissected to expose the operative field. The lateral peritoneum and perirenal fascia were sutured after surgery in all cases except nephrectomy cases. Results For the first operation, the mean operative time was 93 min, the mean estimated blood loss was 70 ml and the average postoperative hospital stay was 4.8 d. The second operations on the 13 cases were successfully performed with mean operative time of 97 rain, mean estimated blood loss of 62 ml and average postoperative hospital stay of 5.0 d which were not significantly different from the first operation parameters(P＞0.05). During the secondary operations, adhesions and abnor-mal anatomic structure observed increased the difficulty of surgery. All patients after secondary opera-tions were followed up for 2--24 months and no major complication was observed. Conclusion La-paroscopic reoperation on patients with history of ipsilateral urology laparoscopic surgery is feasible in skilled and experienced hands and in properly selected cases.
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<p><b>OBJECTIVE</b>To evaluate spiral CT urography (SCTU) and CT virtual endoscopy (CTVE) in detecting urologic diseases.</p><p><b>METHODS</b>SCTU was performed in 46 patients with urological diseases including renal neoplasms (2), paropelvic cysts (2), ureteral calculi (6), ureteral stenosis (4), ureteral neoplasms (2), double kidneys and ureter malformation (1), bladder neoplasms (28) and bladder endometreosis (1). The 6 patients with ureteral diseases and 29 patients with bladder diseases underwent CTVE based on spiral CT scan. All CTVE findings were compared with those of B-mode ultrosonography, intravenous urography (IVU), retrograde pyelography (RGP), conventional CT or cystoscopy.</p><p><b>RESULTS</b>All upper urinary tract diseases and bladder diseases (28 cases) were detected by SCTU and CTVE scans and they were confirmed operatively or pathologically except one case of bladder neoplasm (diameter less than 5 mm) was missed.</p><p><b>CONCLUSION</b>SCTU and CTVE have proved to be non-invasive and reliable in the diagnosis of urological diseases and are superior to IVU or conventional CT. CTVE can serve as a supplementary method to fiberoptic cystoscopy or ureteroscopy.</p>
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Diagnostic Techniques and Procedures , Endoscopy , Tomography, X-Ray Computed , Urography , Urologic Diseases , DiagnosisABSTRACT
Objective To introduce the new technique of transperitoneal laparoscopic ureterovesical reimplantation and to evaluate its feasibility and clinical significance. Methods Overall,17 cases (5 men and 12 women) of ureterovesical obstruction (left,7 and right,10) were included.Of them,10 cases were diagnosed with simple congenital ureter outlet stricture;1 had calculi and polyp formation at right ureter outlet;2 had recurrent ureter outlet stricture after open ureterovesical reimplantation (1 of them had 2 calculi at lower part of the ureter);1 had double nephroureteral upper unit ureter outlet stricture with 2 calculi;2 had recurrent ureter outlet stricture after holmium laser section;1 with urinary TB had right ureter outlet stricture after left nephrectomy.Among the 17 cases,severe hydronephrosis occurred in 12,and moderate,in 5.Transperitoneal laparoscopic ureterovesical reimplantation was performed in the 17 cases (ureterovesical anastomosis in 15 and bladder flap ureterovesical reimplantation in 2). Results The operations were all successful in 17 cases with operating time of 90～160 min (mean, 112 min) and blood loss of 60～100 ml.The drainage tubes were removed 1～3 days after surgery without urine leakage.The urinary catheters were removed 1 week after surgery and double J stents,1 month after surgery. Six months after surgery cystography showed Ⅲ?urine reflux in 6 cases, Ⅰ?-Ⅱ? urine reflux in 5 and no reflux in 6.One year after surgery cystography showed Ⅲ? urine reflux in 3 cases, Ⅰ?～Ⅱ? urine reflux in 4 and no reflux in 10.During 3～24 months' follow-up, ultrasound B and IVU showed moderate hydronephrosis in 4 cases,mild,in 5 and no obvious hydronephrosis in 8. Conclusions Laparoscopic ureterovesical reimplantation is a feasible,less painful and minimally invasive alternative method for treatment of ureterovesical diseases.By comparison,bladder flap ureterovesical reimplantation has better anti-urine reflux effect but more complicated than ureterovesical anastomosis does.Long term efficacies of the methods need further observation.
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Objective To describe the new technique of transperitoneal laparoscopic dismembered pyeloplasty and to evaluate its clinical effect. Methods Of the 18 cases of ureteropelvic junction (UPJ) obstruction who underwent transperitoneal laparoscopic dismembered pyeloplasty,8 cases had severe hydronephrosis;7,intermediate;3,mild. Results Operations were all successful in 18 cases with the operating time being 100 to 210 min (mean,142 min) and the blood loss,40 to 200 ml.All the pores of puncture healed at phase 1;mean hospitalization was 7.4 d.Only 1 case had postoperative urine leakage.Follow-up of 3 to 12 months showed there was no stricture at UPJ and hydronephrosis was remitted (intermediate hydrops in 4 cases,mild in 7 and resolution in 7).The renal functions were improved. Conclusions Laparoscopic dismembered pyeloplasty is an effective and minimally invasive approach and can be used as an alternative to open surgery for UPJ obstruction.
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Objective To introduce a better and quicker technique of transperitoneal laparoscopic ureterolithotomy. Methods 42 cases of ureterolithiasis (23 males and 19 females;mean age of 42.4 years,range from 16 to 63 years) were included.Of them 26 cases had calculi on the left side and 16 cases,on the right side.All the cases underwent laparoscopy through 3-port technique. Results The operations were successful in all of 42 cases.The mean operative time was 43 min (range,33 to 56 min).Blood loss was 20 to 50 ml.The postoperative hospital stay was 3 to 5 days.None experienced urinary leakage.During the follow-up of 12～18 months no ureteral stricture was found.The renal functions were improved. Conclusions Our experience indicates that appropriate trocar location,exactly checking of calculi,good D-J tube drainage and skillful intra-abdomenal suturing are the keys to perform laparoscopic ureterolithotomy quickly.
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Objective To evaluate the clinical effect of Ho:YAG laser lithotripsy in management of ureteral calculi and to investigate its influential factors. Methods The data of 137 cases of ureteral calculi (66 males and 71 females;aged 19-71 years with a mean of [(45.0?10.4)years;disease course from 4 days to 10 years with a mean of (1.50?0.65)years] treated via ureteroscope with Ho:YAG laser lithotripsy were analyzed retrospectively.Of them 112 cases had 1 stone,and 25 had more than one.Fifty five cases had stones on the left side,71,on the right side;11,on both sides;107 cases had stones in the lower ureter and 30,in the middle or upper ureter.The size of the stones were 0.6-2.0 cm in diameter with a mean of ( 1.1? 0.3) cm.Of them 23 cases had ureteral polyp and they underwent Ho:YAG laser vaporization resection of the polyp;11 cases had ureteral stricture and they underwent ureter dilatation or Ho:YAG laser incision of the stricture and lithotripsy.Double J tube was placed after operation. Results The overall stone fragmentation rate was 94.9%(130/137) with a single procedure.Stone free time was 5-56 d with a mean of ( 21.5 ?13.4) d.Operating time was (20-120)min with a mean of (60.4?18.3)min.Post operative hospital stay was 1～10 d with a mean of (2.4?1.1)d.In the successful operation group (130/137),the mean stone size was (1.03?0.24)cm in diameter, while in the failure group it was (1.47?0.51) cm. Four cases of the failure group had ureteral stricture;2 of them underwent shift to open operation, the other 2 experienced failure because of difficulty of placing D J tube. Three cases also experienced failure because of stone shift in the operation;of them 1 underwent shift to open operation,the other 2 were treated by ESWL.The differences of the stone size,concomitant ureteral stricture, stone shift in operation between success group and failure group were statistically significant ( P