Clinical features of testicular torsion and its misdiagnosis:analysis of 274 cases / 南方医科大学学报

OBJECTIVE@#To summarize the clinical characteristics of testicular torsion and explore the relationship between its incidence and temperature, the value of supplementary examinations, and the factors causing misdiagnosis and testicular lesions.@*METHODS@#We retrospectively analyzed the clinical data of the patients with testicular torsion diagnosed in 9 hospitals in Hunan Province from May 1, 2009 to November 1, 2018. The temperature at onset and WBC value after onset were analyzed. The misdiagnosis rate and testicular lesion rate in the first-visit hospitals were compared between the large general hospitals and local hospitals. The factors that affected the diagnosis and treatment of testicular torsion were analyzed.@*RESULTS@#A total of 274 cases were included in this study, and misdiagnoses occurred in 151 cases (61.9%). The initial diagnosis was made in large general hospitals in 59 cases; misdiagnosis occurred in 30.5% of the cases and the rate of testicular lesions was 57.6%. Of the 215 cases first diagnosed in local hospitals, only 82 cases were diagnosed correctly, and the misdiagnosis rate was as high as 61.9%; the rate of testicular lesion was 85.6% in these cases. There were significant differences in the misdiagnosis rate and testicular lesion rate between the two groups ( < 0.05).@*CONCLUSIONS@#The first-visit misdiagnosis rate of testicular torsion is much lower and the probability of testicle preservation is significantly higher in large general hospitals than in the local hospitals, suggesting the importance of health education for testicular torsion, enhancing the awareness of this condition and training of the surgeons in primary hospitals.

Exploration of hematuria in urinary system integrated courses for eight-year medical educa-tion program / 中华医学教育探索杂志

Organ system based integrated teaching model has been adopted in several medical schools, and these schools face some challenges in this teaching process. In order to provide new sights for organ system based integrated teaching reform in eight-year medical education program, ex-ploration of setting up three-staged-dimensional integrated teaching models was conducted in urinary system by hematuria, and designing related teaching objectives, teaching programs and assessment form to optimize teaching quality in this teaching methods, according to characteristics of the urinary systemic diseases, cultivating objectives of eight-year medical education program and teaching experi-ence of Xiangya School of Medicine.

Bladder interstitial cells and pathophysiology / 中南大学学报(医学版)

Bladder interstitial cell (IC) is a cell, which lacks thick filaments and dense bodies but with incomplete basement membrane, rough endoplasmic reticulum and golgi apparatus. IC is divided into 4 subtypes: lamina propria IC, intramuscular IC, IC between the detrusor bundles and perivascular IC. There are different ion currents and related activation pathways in the lamina propria IC and intramuscular IC. Ca2+ signaling pathways play an important role in the communication between IC and detrusor. Any bladder lesions affecting the ion current and Ca2+ signaling pathways can lead to bladder dysfunction. The bladder lesions include bladder outlet obstruction, bladder pain syndrome, interstitial cystitis, neurogenic bladder and diabetes. Imatinib mesylate is currently an available treatment target in IC, and electrical stimulation of acupuncture therapy is a new direction.

Renal transplantation with kidneys procured from cardiac deceased post-liver transplantation donor: 2 cases report and literature review / 中南大学学报(医学版)

OBJECTIVE@#To better understand the pre-operation evaluation of donor kidneys from extended criteria donation after cardiac death and to improve the management during and after renal transplantation.@*METHODS@#Both of the donor kidneys were from the donor who underwent liver transplantation 5 years ago in the Center of Organ Transplantation of Central South University. The donor was admitted because of liver function deterioration which led to hepatic coma, brain death, hepatorenal syndrome and cardiac death sequentially. Deceased donor score (DDS) and "zero point" kidney biopsy were applied to evaluate the donor kidney. After thorough examination of the donor and the renal function, renal transplantation was performed on 2 recipients.@*RESULTS@#The recipients were followed up by 6 months, both of whom developed pulmonary infection and relieved after treatments. The kidney grafts functioned well and no surgical complication and no acute rejection occurred during the follow-up.@*CONCLUSION@#Proper evaluation of the donor organs ensures the safety of renal transplantation with kidneys from cardiac death donors who underwent liver transplantation, which is an important way to increase the number of organs for transplantation, yet the long-term effects need further observation.

Diagnosis and treatment of three cases of adrenocortical oncocytoma and a literature review / 中南大学学报(医学版)

To investigate the diagnosis and surgical treatment of adrenocortical oncocytoma. The clinical data from three cases of adrenocortical oncocytomas (ACOs) were retrospectively analyzed and discussed in light of the relevant literature. In these three cases, one presented with virilization, while the other two cases had no typical clinical features. The tumor was completely encapsulated and was non-invasive. Microscopically, the tumor cells showed neither mitosis nor necrosis, with abundant eosinophilic cytoplasm. No recurrence or metastasis was discovered after close follow-up observation for 12-24 months. Adrenocortical ACOs are rather rare, and most of them are benign. It was hard to make a confirmed diagnosis of ACOs before surgery. Resection of tumor is the best choice, and close follow-up observation is essential.

BPH combined with prostatitis:differences in clinical characters / 中华泌尿外科杂志

Objective To analysis the differences of age, prostate volume, serum PSA and PSAD, IPSS between the BPH and BPH with prostatitis. Methods Clinical data of 100 patients whom received surgical treatments with a pathologic diagnosis of BPH were retrospectively analyzed. The occurrence of prostatitis was determined by pathology. The differences of age, prostate volume, serum PSA and PSAD, IPSS between the BPH cases and BPH with prostatitis cases were analyzed. The capability of B-ultrasound in diagnosis of the prostatitis combined with BPH was evaluated. Re-suits 66% BPH patients were found combined with prostatitis. There was a significant correlation between inflammatory infiltration grade and aggressiveness grade (r= 0. 772, P<0. 001). There was a moderate correlation between prostate volume and patient age(r= 0. 420, P<0. 001). There was a low correlation between serum PSA and patient age (r= 0. 258, P<0. 01) while no significant correla-tion between PSAD and age. The patient age of BPH combined with prostatitis group was significantly higher than BPH group (P<0. 05). Average prostate volume of combined with prostatitis group was significantly higher than BPH group (P<0. 05). There was a significant correlation between prostate volume and inflammatory infiltration grade(r=0. 292, P=0. 003), PSA and aggressiveness grade(r=0. 254, P=0.007). Both average PSA and PSAD of BPH combined with prostatitis group were signif-icantly higher than the BPH group (P<0. 05). When the factor of difference in age distribution was considered, the conclusion were still valid (P<0.05). On α= 0.05 level, relatively low correlations were found between PSA and inflammatory infiltration grade(r=0. 319, P=0. 001), PSA and aggres-siveness grade(r=0. 214, P=0. 032), PSAD and inflammatory infiltration grade ( r=0. 212, P=0. 034). There was no significant correlation between PSAD and aggressiveness grade(r=0.081 ,P=0.425). Average IPSS of combined with prostatitis group were significantly higher than BPH group. On diagnosis of the combined prostatitis in BPH, the sensitivity of ultrasonic was 21.2% with a speci-ficity of 82.4%. Conclusions Prostatitis is often found in more than half BPH samples. The BPH with prostatitis usually has bigger prostate volume, higher PSA, PSAD and may present relatively se-verer clinic syndromes.

Effect of extracorporeal shock-wave lithotripsy on residual stones after different methods of surgery / 中南大学学报(医学版)

Objective To observe the effect of extraeorporeal shock wave lithotripsy (ESWL) on residual stones after different methods of surgery. Methods Clinical resources of 100 patients with residual stones after different methods of surgery treated with extracorporeal shock wave lithotripsy from May 2006 to May 2008 were retrospeetively studied. Of the 100 patients, ureteroscopic laser lithotripsy was used for 15 patients (Group Ⅰ) , ureteroscopic pneumatic lithotripsy was used for 25 (Group Ⅱ), mini-percutaneous nephrolithotomy (MPCNL) with holmium laser for 11 (Group Ⅲ), mini-percutaneous nephrolithotomy (MPCNL) with airpressure path lithotripterfor 12 (Group Ⅳ) , open surgery for the other 37 (Group Ⅴ). Results About 94% of the residual stones were shattered, and 86 % of the residual stones were cleared successfully. The clearance rate of residual stones from Group Ⅰ to Ⅴ was 100% , 100% , 81.8% , 83.3% , and 73.0% , respectively. The clearance rate of residual stones in Group Ⅰ + Ⅱ was higher than that of Group Ⅲ + Ⅳ and Group V (P<0.05). Conclusion Extracorporeal shock wave lithotripsy is good for the treatmentof residual stones after different methods of surgery, especially the management of residual stones after trans-urethral ureteroscope technique.

Clinical diagnosis and treatment in 230 cases of cryptorchidism / 中华泌尿外科杂志

Objective To evaluate the diagnosis and treatment of cryptorchidism and its complications,and to emphasize the appropriate surgical treatment age of cryptorchidism. Methods The data of diagnosis and treatment of 230 cases of cryptorchidism (a total of 299 undescended testicles) were reviewed.Their ages varied from 1 to 59 years and the mean age was (9.5?9.0)years.88 cases had cryptorchidism on the left side;73 cases on the right side;and 69 cases on both sides.Cryptorchidism was complicated by hypospadias in 11 cases and by latent penis in 2 cases. Results In these series only 25 cases (10.9%) underwent surgical treatment within 2 years of age.Surgical operations were performed in these cases (289 sides) and the locations of the undescended testicles were determined.Of them 273 ones underwent primary descending and fixation,15 ones underwent resection and histopathological examinations for mahgnant or shrinked tendency 1 was absent during the detection,and they were followed up for 4 months to 5 years with the success rate being 98.9 %.Of these cases 260 ones(90.0%) were external abdominal;25 ones (8.7%) were intra-abdominal;4 ones were missing (1.4%).For external abdominal testicles the positive ratio of detections by B-ultrasonography was 86.3%(126/146) and that of physical examination was 63.0% (92/146),which showed statistically significant difference ( P

Expressed prostatic secretion leukocyte count in the diagnosis of chronic prostatitis / 中华泌尿外科杂志

Objective To investigate the value of expressed prostatic secretion (EPS) leukocyte count in the diagnosis of chronic prostatitis. Methods EPS was obtained from 75 out patients with chronic prostatitis,pH and WBC per high power microscopic field being studied.Transabdominal prostatic ultrasonography was performed. Results Mean pH of the EPS was 6.9?0.4.pH of the EPS and the frequency of ultrasound abnomalities were significanly correlated to the leukocyte count in EPS.There was no correlation between age of symptom duration and the pH of EPS, frequency of ultrasound abnormalities or white blood cell counts in EPS. Conclusions In chronic prostatitis,the leukocyte count in EPS was positively correlated with the ultrasound abnomalities and the pH elevation of EPS.There was no correlation between age or symptom duration and pH of the EPS,frequency of ultrasound abnormalities or leukocyte count in the EPS.

Diagnosis and treatment of bladder outlet obstruction caused by bladder neck fibrosis (report of 30 cases) / 中华泌尿外科杂志

Objective To present experience on the diagnosis and treatment of bladder outlet obstruction (BOO) caused by bladder neck fibrosis. Methods 30 cases of BOO caused by bladder neck fibrosis were studied. All the patients were treated by transurethral partial resection or incision of the cervix vesicae combined with alpha 1 adrenoceptor antagonists such as tamsulosin and terazosin or parazosin. Results Urination has been improved in all.The patients have been followed up for 3 to 30 months.On repeated uroflowmetry,the 30 patients showed the urine flow rates have been more than 15ml/s. IPSS scores was 5.3?1.7(25.4?4.2 preoperative) and quality of life scores was 1.4?0.6(4.1?0.8 preoperative).Fibroblast proliferation was noted in all the 30 and obvious chronic inflammation in 18. Conclusions Clinical symptoms, pressure rate measurement and cystoscopy are the reliable diagnostic methods.Transurethral partial resection or incision of cervix vesicae combined with alpha 1 adrenoceptor antagonists is effective.