A retrospective monocenter review of simultaneous pancreas-kidney transplantation with bladder drainage in China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Simultaneous pancreas-kidney transplantation (SPKT) frees the diabetic patient with end-stage nephropathy from dialysis and daily insulin injections. Herein, we review consecutive cases of SPKT with bladder drainage performed at our institution over an 8-year period.</p><p><b>METHODS</b>The study population included 21 patients (16 males and 5 females) who underwent SPKT between September 2001 and September 2009. Seven patients had type-1 diabetes and 14 had type-2 diabetes. Nineteen patients were on dialysis at the time of transplantation. Donation after cardiac death donors were selected for SPKT. The mean human leukocyte antigen match was 2 (range 0 - 4). SPKT was always performed using bladder drainage and vascular anastomoses to the systemic circulation. Immunosuppressive treatment consisted of anti-lymphocyte globulin induction followed by tacrolimus, mycophenolate mofetil, and prednisone.</p><p><b>RESULTS</b>The mean hospital stay was 45.43 days. After a mean follow-up of 39.4 months, survival rates for patient, kidney, and pancreas were 76.2%, 76.2%, and 66.7% at 1 year; 76.2%, 59.3%, and 55.6% at 5 years; and 57.1%, 39.5%, and 41.7% at 8 years, respectively. Major complications included anastomotic leaks, reflux pancreatitis, and rejection. Six patients died from septic shock (n = 3), duodenal stump leak (1), cardiac arrest (1), or renal failure (1). Eight kidney grafts were lost due to acute rejection (n = 2), chronic rejection (3), and death with a functioning graft (3). Pancreatic graft failure (9) was caused by thrombosis (n = 1), rejection (2), duodenal stump leak (1), and death with a functioning graft (5).</p><p><b>CONCLUSIONS</b>SPKT is a valid therapeutic option for uremic diabetics although few hospitals in China can undertake SPKT.</p>

Interns' knowledge on male reproductive health: a comparison between pre- and post-training in the department of urology / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate whether training in the department of urology will help interns acquire more knowledge on male reproductive health in such aspects as male erectile dysfunction (ED), premature ejaculation, male infertility (PE), male contraception, and so on.</p><p><b>METHODS</b>Sixty interns receiving rotatory training in the Department of Urology of the Peking University Third Hospital were recruited to complete a questionnaire designed by ourselves. A comparison was made of their knowledge on male reproductive health before and after their training in the department by using the chi-square statistical test in SPSS 11.0 software.</p><p><b>RESULTS</b>With regard to ED in such questions as "Do you regard ED as a disease affecting the aging male?" and "Do you regard ED as a local symptom of some male systemic disease?", all the interns knew significantly better after trained in the department of urology. Concerning the definition of ED and the effect of sildenafil citrate on ED, no significant difference was found in their knowledge between pre-training and post-training. As to patients' questions about ED, most of them showed interest but rarely made any initiative inquiries, which was not significantly changed after the training. Regarding PE, most of them knew very little even after trained, but they all thought of it as a disease affecting life quality. As regards male infertility, although some knew something about its definition and the normal parameters of semen routine analyses, others remained quite ignorant. As for male contraception, most of them knew little even after trained in the department.</p><p><b>CONCLUSION</b>Interns generally acquire more knowledge on male reproductive health after trained in the department of urology. However, in regard to male infertility and male contraception, their knowledge is quite insufficient, which implies the need for strengthening the training in the related aspects.</p>

Treatment of multiple condyloma acuminatum of the coronary sulcus with sleeve circumcision of prepuce and coronary sulcus skin (a report of 35 cases) / 中华男科学杂志

<p><b>OBJECTIVE</b>To evaluate the effectiveness of sleeve circumcision of prepuce and coronary sulcus skin in the treatment of patients with multiple condyloma acuminatum (CA) of coronary sulcus of penis.</p><p><b>METHODS</b>In a randomized clinical control study, 35 patients were randomized to the treatment group and received sleeve circumcision of prepuce and coronary sulcus skin. 34 patients were randomized to the control group, received electric cauterization of verrucae plus the general circumcision. The recurrence of CA was evaluated in follow-up visit within three months after the treatment.</p><p><b>RESULTS</b>The stitches were taken out 10.2 days after operation in the treatment group, and 8.1 days in the control group. There were no complication in the treatment group, the average healing time of electric cauterization wound was 19.4 days in the control group. There was a statistically significant difference in the recurrence rate of CA between the treatment group and the control group (5.7% vs 26.5% , P <0.05).</p><p><b>CONCLUSIONS</b>The sleeve circumcision of prepuce and coronary sulcus skin is more effective than electric cauterization of verrucae plus the general circumcision in the treatment of patients with multiple condyloma acuminatum of coronary sulcus of penis.</p>

Retroperitoneoscopic nephroureterectomy with bladder-cuff excision for renal pelvic and ureteral tumors(report of 35 cases) / 中华泌尿外科杂志

Objective To report our experience with retroperitoneoscopic nephroureterectomy with excision of a bladder-cuff for renal pelvic and ureteral tumors.Methods Thirty-five patients (21 women and 14 men;mean age,67 years;age range,49 -82 years) with upper urinary tract tumors underwent retro- peritoneal laparoscopic nephrourcterectomy with excision of a bladder-cuff.Of the 35 cases,15 had pelvic tumors and 20 had ureteral tumors;19 cases had the tumors on the right side and 16 on the left.Two cases had ureteral tumors combined with bladder tumors.One case had bilateral ureteral tumors then concomitantly had bladder tumors.The needle electrode was used to circleround incise the bladder thoroughly 0.5 cm away from the ureterostoma.Three trocars in the waist were used for dissecting the kidney;and the ureter was dis- sected as far distally downward.Then an incision of 5-9 cm was created in the lower abdomen to allow dis- section of the distal ureter and bladder-cuff and intact specimen extraction.Results The operation was successful in all 35 patients.The mean operative time was 3.1 h ( range,1.5-6.0h).The mean estimated blood loss was 166 ml (range,20-1600 ml).Four cases received blood transfusion.The patient's activity re- covered in 20-32 h after operation.Postoperative pathology showed transitional cell carcinoma in 30 cases, poorly differentiated adenocareinoma in 2 (ureter),squamous cell carcinoma in 1 (ureter),leiomyosarcoma in 1 (ureter),xanthogranulomatous pyelonephritis in 1.Duodenal leakage occurred in 1 patient who had had dialysis a drainage catheter was placed on the third d after operation,and the patient died of heart failure af- ter 2 months.Postoperative vesical irrigation was performed to prevent tumor recurrence.The mean hospital stay was 11 d.During a mean follow-up of 14 months(range,1-32 months),1 patient developed pelvic me- tastasis and was alive with the tumor.The other 33 patients survived free of tumor to date.No patient had re- current transitional cell carcinoma of the bladder.Conclusions Our data demonstrate that retroperitoneo- scopic nephroureterectomy for renal pelvic and ureteral tumors has shorter incision and more rapid postopera- tive recovery compared with open surgery.Using resectoscope to resect the termination of ureter allows more complete excision of the ureter.