Comparison of ultrasound-guided transrectal and transperineal prostate biopsies in clinical application / 中华男科学杂志

<p><b>OBJECTIVE</b>To compare the positive rates and complications of ultrasound-guided transrectal and transperineal prostate biopsies.</p><p><b>METHODS</b>We retrospectively analyzed 156 cases of ultrasound-guided transrectal (n = 97) and transperineal (n = 59) prostate biopsy, and compared the positive rate and post-biopsy complications between the two approaches.</p><p><b>RESULTS</b>The positive rates in the transrectal and transperineal groups were 48.4% and 44.1%, respectively, with no significant difference between the two approaches according to different PSA levels (P >0.05). No statistically significant differences were observed between the transrectal and transperineal groups in the post-biopsy incidence rates of such complications as hematuria (54.6% vs 42.4%, P >0.05), lower urinary tract symptoms (17.5% vs 22.0%, P >0.05), dysuria (9.3% vs 6.8%, P >0.05), and acute urinary retention (7.2% vs 6.8%, P >0.05). However, the incidence rates of post-biopsy infection and rectal bleeding were remarkably higher (15.5% vs 3.4%, P<0.05 and 50.5% vs 3.4%, P >0.01) while that of perineal swelling markedly lower in the former than in the latter (3.1% vs 13.6%, P <0.05).</p><p><b>CONCLUSION</b>Transrectal and transperineal biopsies are both effective for the diagnosis of prostate cancer. Since their complications vary, the choice between the two methods depends on the specific condition of the patient.</p>

Transperitoneal laparoscopic pyelolithotomy(report of 19 cases) / 中华泌尿外科杂志

Objective To evaluate the feasibility and initial experience of laparoscopic pyelolithoto- my within renal sinus.Methods A total of 19 patients(14 men and 5 women)of nephrolithiasis on 21 sides underwent laparoscopic pyelolithotomy within renal sinus.Of them,9 cases with other upper urinary tract diseases were treated by laparoseopic pyelolithotomy at the same time.The patient age ranged from 16 to 67 years(mean,41 years).The calculi were 1.2 to 3.5 cm in diameter,and were found on the right side in 11 cases,left side in 6,and both sides in 2.Five cases concomitantly had ureteral calculi;of them,1 had bi- lateral ureter calculi with ipsilateral steinstrasse,2 had pyelic polyp(1 with giant hydronephrosis after open ureterolithotomy),and 1 had giant bydronephrosis with pyelolithiasis during pregnancy with double-J tube drainage.Twelve cases(13 sides)had experienced unsuccessful extracorporeal shock wave lithotripsy,and 1 failed with minimally invasive percutaneous nephrolithotomy.Results The procedure was successful in all the 19 cases.The operative time ranged from 75 to 240 rain(mean,115 rain).The intraoperative blood loss ranged from 30 to 100ml(mean,50 ml).One case experienced 5-d urine leakage,and was spontaneously cured.The hospital stay was 5-9 d(mean,6 d).Double-J tube drainage was 4-6 weeks.During the follow- up(3-36 months),KUB and IVU showed no upper urinary tract stricture and no residual stones except for 1 stone of 0.7 cm in the renal lower calyx in 1 case.The kidney function was improved in all cases.Con- clusions Laparoscopic pyelolithotomy is new and minimally invasive alternative approach for renal calculi. With this procedure the urinary tract complications can be treated concomitantly,thus it can partially replace open surgery.

The application of laparoscopy in kidney preserving surgery for the treatment of savage giant hydro-nephrosis / 中华泌尿外科杂志

Objective To evaluate the application and initial experience of laparoscopy in kidneypreserving surgery for savage giant hydronephrosis. Methods This series included 6 cases of savage gianthydronephrosis (2 men and 4 women;age range,15 -57 years;mean age,28 years).Of them 5 cases weredetected when visiting doctors due to flank pain,abdominal mass,and the rest one by B-ultrasound duringpregnancy.Four cases had hydronephrosis on the left;and 2 cases,on the right.The quantity of hydronephro-sis was 2250 -8300 ml,respectively.None had development on IVU examination.Of them,3 cases had con-genital ureteropelvic junction (UPJ) obstruction;2 had multiple stones in infracalices secondary to UPJ ob-struction;1 had stones in pelvis with polyp formation.Relieving obstruction,pyeloplasty,nephroplication andnephropexy were performed via laparoscope. Results All the operations were successful.The operativetime was 2.5 -5.0 h;the blood loss was 50 -150 ml,and the mean postoperative hospital stay was 7.2 d.The postoperative follow-up ranged from 3 to 24 months. Three months after operation,B-ultrasound showedthat giant hydronephrosis was markedly relieved in 5 cases (the renal sinus separation was 1.8 m,2.0 cm,2.5 cm,2.5 cm and 2.8cm,respectively),and in the rest 1 case the kidney was slightly smaller than nor-mal.IVU examination was performed every 3 months after operation, and different degrees of developmentappeared in all cases.During the follow-up,no obvious ureteropelvic anastomotic stricture was found on retro-grade pyelography (RGP). Conclusions The protective renal treatment via laparoscopy for savage gianthydronephrosis is a feasible and minimally invasive technique that provides the same clinical and radiograph-ic results as open operation.