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Objective To compare the clinical characters and hemodynamic data of the prone position and supine position percutaneous nephrolithotomy. Methods Patients with kidney stones in 100 cases were randomly assigned into the supine position group and prone position group.There were 50 cases in each group.The following data were recorded at preoperative,intraoperative,change position:the blood pressure,heart rate,respiration,saturation of blood oxygen and blood gas analysis results.The VAS score was recorded in patients for postural comfort,dyspnea and pain score. Results The systolic blood pressure in the preoperative,intraoperative,postoperative on supine position and prone position were as follows:(137±12),(119±15),(115±17) mm Hg and (137±10),(110±18),(104±16) mmHg.The diastalic blood pressure was as follows:( 81 ± 9 ),(74 ± 8 ),(63 ± 14 ) mm Hg and ( 84 ± 8 ),(63 ± 9 ),(60 ± 15) mm Hg.Compared with preoperative,there was a blood pressure decreased in both groups.The blood pH at preoperative,intraoperative,postoperative in supine position and prone position:7.4 ± 0,7.3 ± 0,7.3 ± 0 and 7.4 ± 0,7.3 ± 0,7.3 ± 0.The bass excess (BE) of two groups were:(2.1 ± 0.5),(-2.7 ±0.5),( -1.5 ±0.5) mmol/L and (3.2 ±0.5),(-3.8 ±0.5),(-2.5 ±0.5) mmol/L.Compared with preoperative data,the pH and BE declined in both groups.The prone position had more pronounced decrease in serum sodium,serum potassium; but with no significant difference.Supine group in postural comfort and breathing difficulties were 1.6 ± 0.4 and 7.1 4± 05,while prone group were 7.5 ± 0.2 and 1.4 ± 0.3.The supine position showed better in postural comfort and breathing difficulties with statistical significance. Conclusions Compared with the prone position,the supine positioned percutaneous nephrolithotomy could have less influence on hemodynamics,blood gas analysis.It could have better postural comfort.
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Objective To investigate the safety and efficacy of percutaneous nephrolithotomy (PCNL) in a new operative position, flank suspended supine position. Methods The new position hold affected flank suspended by raising the ipsilateral shoulder and haunch with two 3-liter saline bags, and set up waist bridge simultaneously. From March 2010 to October 2010, a series of 173 patients underwent PCNL with the new supine position under epidural anesthesia. The average age was (50± 11) years, and the average bulk of the stone was (2. 9±1.0) cm. All patients were placed in the new supine position. Under ultrasound guidance, the desired calix or pelvis was punctured near the posterior axillary line, then dilating the tract and establishing the 16 F or 20 F tract for PCNL. Results The pelvicaliceal system could be successfully approached in all patients. The procedure was well tolerated in all patients. Mean operation time was (86 ± 34) min. 80. 3% of the patients were rendered free of stones by the initial PCNL. Thirty-four cases had residual stones, and a second PCNL was performed in 16 cases to clear the residual stones. Only 1 patient required blood transfusion.None of the patients suffered visceral injury. Conclusion The new supine position is safe and effective for PCNL.
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Objective To compare the health related quality of life (HRQoL) of ileal conduit versus orthotopic ileal neobladder using the FACT-BL scale.Methods One hundred and thirty patients underwent radical cystectomy and urinary diversion for invasive bladder cancer from Jan 2006 to Dec 2010 at our hospital.According to different urinary diversions,patients were divided into ileal conduit (IC) and orthotopic ileal neobladder (NB).HRQoL was assessed using FACT-BL.The following scores calculated from the FACT-BL questionnaire and list:physical well-being ( PWB ),social/family well-being ( SWB ),emotional well-being(EWB),functional well-being( FWB),overall bladder-special subscale and total FACT-BL were included.A high FACT score indicated a high level of HRQoL.The medical records of each patient were then reviewed.Clinical parameters including age,sex,type of diversion and pathological status were recorded and analyzed.Results A total of 94 questionnaires were collected,of these patients 50 had an IC and 44 had an NB.Among the respondents,the age at surgery was significantly younger in NB group than IC group (P =0.014 ).While the percent of males,follow-up years and pathological stage T3 or greater revealed no significant difference.The NB group got significantly higher scores in PWB,SWB,EWB and FACT-BL than the IC group.Which indicated that the HRQoL was higher in patients following orthotopic ileal neobladder.Conclusions The HRQoL was better in patients who followed orthotopic ileal neobladder than those who followed ileal conduit.This may indicate that orthotopic ileal neobladder should be considered first when making a decision about which urinary diversion should be used.
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Objective To explore the curative effect of combined use of minimally invasive percutaneous nephrolithotomy (MPCNL) and extracorporeal shockwave lithotripsy (ESWL) for the treatment of solitary renal staghorn calculi in patients with renal insufficiency. Methods Eight cases of solitary renal staghorn calculi associated with renal insufficiency were treated by a combination of MPCNL and ESWL. Results Stones were completely cleared away in 5 cases, while residual stones were found in 3 cases. No blood transfusion was required and no severe surgery-related complications were encountered. After surgery variable degrees of improvement in renal functions was observed. The serum creatinine (Cr) decreased from 289?166 ?mol/L pre-operation to 155?33 ?mol/L post-operation (t=4.69, P=0.004), and the blood urea nitrogen (BUN) decreased from 15.1?7.9 mmol/L to 8.3?1.9 mmol/L (t=4.00, P=0.005). The emission computed tomography (ECT) examinations showed the glomerular filtration rate (GFR) was elevated from 48.8?12.4 ml/s before operation to 63.0?8.4 ml/s after operation (t=4.68, P=0.003). Post-renal obstruction disappeared after operation. Follow-up for 0.5~4.5 years (mean, 2.8 years) in the 8 cases revealed no obvious changes in renal functions. Conclusions Combination of MPCNL and ESWL for solitary renal staghorn calculi associated with renal insufficiency is safe and effective.
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Objective To evaluate and compare the therapeutic effects of suprapubic transvesical prostatectomy (SPPC), Madigan prostatectomy (MPC) and transurethral electrovaporization ablation prostatectomy (TUVP) for the treatments of symptomatic BPH. Methods 216 symptomatic BPH patients randomly underwent SPPC(n=87), MPC(n=45) or TUVP(n=84) respectively and their therapeutic effects were evaluated. Results There are significant improvements in symptoms and physical signs in each group after operation. The morbidity rates of post-operative complications in SPPC,MPC and TUVP were 31 0%,11 1%,13 1% respectvely. SPPC group showed the longest average operative time and the most blood loss, both of which were the least in TUVP group. Conclusions SPPC was the most effective among the three procedures, but the trauma of SPPC to the patient was the most. Complication of MPC was the least. TUVP was the safest procedure with the least injury.
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Objective To study the pathologic changes of nephrotoxicity with CsA and to give advice on clinic drug administration. Methods Thirty two cases of renal allografts were biopsied.Histological changes of the biopsy specimens were examined by light microscopy. Results Twenty five cases of the 32 cases were identified having CsA nephrotoxicity.Of them 23 demonstrated acute nephrotoxicity.The main pathologic changes were vacuole's degenerations of glomerular tubular epithelial cells.The other 2 had chronic nephrotoxicity,and were histologically characterized by striped tubular interstitial fibrosis and hyalinization of the afferent arteriole. Conclusions Major histopathologic changes of CsA nephrotoxicity are tubular vaculation and vessel hyalinization,which are the main indicators for detection of CsA nephrotoxicity.