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Objective:To evaluate the clinical value of nanopore targeted sequencing (NTS) in pathogens detection in urinary tract by comparing the results of different tests performed on the same urine sample.Methods:The results of NTS and urine culture test collected from 326 patients in the Department of Urology of People's Hospital of Wuhan University from July 2020 to June 2021 were retrospectively analyzed. There were 224 males and 102 females. The average age was (56.88 ± 14.58)years old. χ 2 test and Student’s test and Wilcoxon's sign rank test were used to analyze the differences of the pathogen detection rate, pathogen types results and detection time consuming between NTS and urine culture. The clinical value of the NTS in rapid detection of urinary pathogens was evaluated. Results:Among 326 hospitalized patients, the urinary tract microbes’ detecting rate of NTS was significantly higher than that of urine culture[67.80%(221/326)vs. 23.93%(78/326), χ2=130.25, P<0.01]. The uropathogens detecting rate of NTS was significantly higher than that of urine culture[54.29%(177/326)vs. 23.31%(76/326), χ2=38.95, P<0.01]. The number of urinary tract microbes detected by NTS was significantly higher than that of urine culture ( Z=11.49, P<0.01), the number of uropathogens was significantly higher than that of urine culture ( Z=9.67, P<0.01). The detection time of NTS and urine culture positive samples was (24.29±2.65) h and (49.28±11.30) h, the difference was statistically significant ( t =39.48, P<0.01). The results obtained by using NTS and urine culture were consistent in 135 (41.41%) samples. In 150 (46.01%) samples, NTS could detect the urinary tract microbes while urine culture cannot find, of which 112 cases (34.36%) were uropathogenic. In 27 cases (8.28%), more pathogens were detected by NTS except those from urine culture. In 6 cases (1.84%) re-detecting NTS after antibiotic therapy, the number of reads of primary uropathogen decreased gradually with the growth of colonizing bacteria or opportunistic pathogens appeared in the end. Re-examinations of urine culture could verify the results of NTS detection on admission in 5 cases (1.53%). NTS in 2 cases (0.61%) could cover the uropathogens of subsequent several urine cultures. Conclusions:NTS has the advantages of rapid, sensitive and comprehensive detection of urinary tract infection pathogens. When urine culture is not yet reported or even negative, NTS already has a certain clinical reference value and can be used as an effective supplement to urine culture, which is conducive to the comprehensive judgment of the patient's condition.
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Objective:To investigate the availability and safety of a domestic disposable digital flexible cystoscope compared with a reusable Olympus digital flexible cystoscope in cystoscopy and removal of double J stent.Methods:From August 2018 to March 2019, patients were enrolled in this prospective, open, multicenter, randomized, parallel positive controlled clinical trial study, which were from department of Urology in Renmin Hospital of Wuhan University, the First Affiliated Hospital of Xiamen University and the First Affiliated Hospital of Guangzhou Medical University. The experimental group and control group were assigned into a 1∶1 ratio by random table method. Inclusion criteria included age≥18 years and have indications for cystoscopy or removal of double J stent. Exclusion criteria included patients having acute genitourinary tract infection, having tuberculous bladder contracture, bladder capacity less than 50ml, having urethrostenosis, female menstrual period, pregnancy and lactation, having difficulty for lithotomy position, having serious cardio-cerebrovascular disease and liver or kidney dysfunction. A domestic disposable digital flexible cystoscope was adopted in the experimental group, whereas a reusable Olympus digital flexible cystoscope was used in the control group. Acceptability of image was defined as primary availability indicator, while success rate of working and performance score were defined as secondary availability indicators and mean operating time was calculated for cystoscopy only and cystoscopy plus removal of double J stent respectively, yet rate of adverse event as well as rate of equipment defects were sorted as safety indicators.Results:A total of 188 cases which were listed in per protocol set completed the clinical trial study successfully. There were 95 cases in the experimental group and 93 cases in the control group. Acceptability of image was 93.68%(89/95) and 96.77%(90/93) respectively in two groups( P=0.52). Success rate of working was 100.00%(95/95) and 98.92%(92/93) respectively in two groups ( P=0.49). Performance score was 14.41±0.93 and 14.56±0.84 respectively in two groups ( P=0.23). Mean operating time (MOT) only for cystoscopy was (15.3±2.6) min and (15.4±3.3)min respectively in two groups ( P=0.93), while MOT for cystoscopy plus removal of double J stent was (21.0±3.2) min and (21.7±3.9) min respectively in two groups ( P=0.69). Rate of adverse event was 8.42%(8/95) and 9.68%(9/93) respectively in two groups( P=0.76). There was no equipment defects in both groups. Conclusions:There is no statistical difference in acceptability of image, success rate of working, performance score, mean operating time for cystoscopy or removal of double J stent, rate of adverse events and rate of equipment defects. A domestic disposable digital flexible cystoscope has shown non-inferiority in the availability and safety compared with a reusable Olympus digital flexible cystoscope.
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Objective:To explore optimum surgical treatment of ureteral strictures after ureteroscopic holmium laser lithotripsy.Methods:The clinical data of 113 patients with ureteral stricture after ureteroscopic holmium laser lithotripsy from December 2014 to December 2019 were analyzed retrospectively. Of all the patients, there were 73 males and 40 females(aged from 31 to 68) with the mean age of 49 years. The mean length of ureteral stricture was 15mm (from 5mm to 25mm). The mean time since the last holmium laser lithotripsy was 6 months (from 3months to 10 months). According to the different treatment of stenosis, 113 patients were divided into endourological treatment group (34 patients) and reconstruction group(79 patients). According to the different surgical methods, endourological treatment group was divided into ureteral balloon dilatation (18 patients) and ureterotomy (16 patients). Reconstruction group was divided into laparoscopic surgery and open surgery, whose were ureteral stenosis resection and anastomosis. Patients were followed up closely postoperatively. Therapeutic success was defined as disappeared hydronephrosis, and unobstructed anastomosis. Success rate, operation time, postoperative changes of hemoglobin, hospital stay and the incidence of postoperative complications were measured.Results:The follow-up time ranged from 5 months to 53 months, with a median time of 18 months. There was no significant difference in age, sex, BMI, location of ureteral stricture, side of stricture and degree of hydronephrosis between endourological treatment group and reconstruction group( P>0.05). The length of ureteral stricture in reconstruction group was significantly longer than that in endourological treatment group (10.3±4.2 mm vs. 17.2±7.8mm, P<0.001). Although the operation time, postoperative changes of hemoglobin, hospital stay and the incidence of postoperative complications were lower in the endourological treatment group compared to reconstruction group ( P<0.001), the overall success rate of the reconstruction operation was significantly higher than that in endourological treatment group (96.2% vs. 61.8%, P<0.001). Furthermore, there was no significant difference in the success rate between laparoscopic surgery group and open surgery group (95.3% vs.97.2%, P<0.05), and there was no significant difference between the balloon dilatation group and the stenosis internal ureterotomy group (66.7% vs.56.3%, P<0.05).113 cases were followed up for an average of 18 (5-53) months. Conclusions:For the treatment of ureteral stricture after ureteroscopic holmium laser lithotripsy, the success rate of reconstruction group (laparoscopic surgery and open surgery)was significantly higher than that of endourological surgery (balloon dilatation and internal ureterotomy). Reconstruction surgery is the optimum surgical treatment to treat ureteral stricture after ureteroscopic holmium laser lithotripsy.
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Objective To evaluate if the flexible ureteroscopy could treat stones located in lower calyx with the infundibulopelvic angle (IPA) less than 30°.Methods Thirty-six patients with inferior caliceal calculi on whom flexible ureteroscopic procedures were performed between November 2009 and June 2015 were reviewed.The mean age of the patients was 52.1 years (34-71),with the mean stone diameter of (1.5 ± 0.8) cm (1.2-2.6 cm).IPA was smaller than 30° in all 36 cases,which confirmed by CTU examination.IPA was less than 10° in 15 patients,between 11 ° and 20° in 13 patients and between 21 ° and 30° in 8 patients.Results The success rate was 63.9％ (23/36 patients) in patients with IPA smaller than 30° after first session of procedure,and the stone free rate reached 100％ after the second session of procedure.The mean operation duration was (95.5 ± 31.4) min(51-127 min).The mean hospital stay after operation was(4.1 ± 1.2)days (3-5 days).No major complications were recorded and no patients needed to convert to open surgery.Double J tube was removed after 4 weeks postoperatively.Patients were followed up for 4-12 months,during which ultrasound and CT scan were used for stone detection.Conclusions The small IPA (＜30°) negatively affected the SFR in the first session operation.However,its negative effect was solvable by using modern endoscopes.A complete stone clearance was achievable even in case of unfavorable anatomic conditions in experienced hand.
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Objective To monitor the renal pelvic pressure and to investigate its clinical significance during retrograde flexible ureteroscopic lithotripsy (RFUL).Methods The data of renal pelvic pressure measured in 60 cases of RFUL with the mean irrigation pump speed and pressure of 30 ml/min and 30 mmHg were analyzed retrospectively.The influence factors of renal pelvic pressure and its correlation with postoperative fever were analyzed.Renal pelvic pressure was measured by baroceptor,which was connected to PHILIP-MP4 monitor IBP channel and ureteric catheter positioned in renal pelvis through a dual channel ureteral access sheath (UAS).The renal pelvic pressure data was collected and analyzed in every 2 seconds by computer.The 60 cases were divided into 3 groups according to their intra-pelvic pressure situations:normal pressure group(NP,IPPmax ≤30 mmHg),high pressure group(HP,IPPmax＞30 mmHg,but high pressure duration≤ 10 min),and backflow pressure group(BP,IPPmax＞30 mmHg and high pressure duration＞ 10 min).Results The baseline intra-pelvic pressure (IPP0) and max imum intra-pelvic pressure (IPPmax) were (13.2±5.6) mmHg and (95.6±2.3) mmHg respectively.IPP levels during the RFUL were significantly higher than the IPP0(P＜0.001).There were 32,17 and 11 cases in NP,HP and BP groups,respectively.There were 6 cases with fever higher than 38.5 ℃ (10％),in which there were 1 case in NP,1 case in HP group and 4 cases in BP group.The postoperative fever rate in NP,HP and BP group were 3％,6％ and 36％ respectively,which were significantly different between groups(P＜0.01).There were 12 cases with procalcitonin ＞0.1 ng/ml and 8 cases with procalcitonin ＞0.5 ng/ml,in which 2 cases in HP group and 6 cases in BP group.Conclusions RFUL would result in a temporal elevated intrapelvic pressure greater than 30 mmHg.Postoperative fever is relevant with renal perfusion pressure and perfusion time.It's necessary for the surgeons to adjust the perfusion pressure during operation.
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Objective To compare the therapeutic effect of retrograde ureteroscopic Ho:YAG laser lithotripsy (UHL) and percutaneous nephrolithotripsy (PCNL) in treating patients with renal calculi of ≤3 cm.Methods From Feb.2008 to Apr.2011,a total of 109 cases (117 renal calculi in total) treated by either PCNL (50) or UHL (67) were retrospectively analyzed.Operative time,stone free rate,postoperative hospital stay,hospitalization expenses and complications were compared in the 2 groups.Results The mean stone burden of the UHL group and PCNL group was 2.5 cm (1.5-3.0) cm and 2.4 cm (1.3-3.0) cm,respectively.There was no significant difference in two groups.In UHL group,operations were performed successfully in all 67 calculi,of whom,43 patients needed combination of flexible ureteroscopy to break the stone fragments falling into the renal calices.No serious complication was recorded except postoperative fever in 3 cases.In PCNL group,all patients had been successful operated.Postoperative fever occurred in 2 cases.Obvious intraoperative and postoperative haemorrhage appeared in 1 case,and cured by selective renal artery embolization.The operation time of the UHL group and PCNL group was (117.0±36.5) min and (90.0±18.3) min respectively,and had no significant difference in two groups (P＞0.05).The stone free rate of the UHL group and PCNL group was 94％ (63/67) and 92％ (46/50) respectively,and had no significant difference in two groups (P＞0.05).Hemoglobin decline of the UHL group and PCNL group was (0.3±0.1) g/L and (20.6±8.1) g/L,and had significant difference in two groups (P＜0.05).Postoperative hospital stay of the UHL group and PCNL group was (5.0±2.4) day and (7.0±3.7) day,and had statistical difference in two groups (P＜ 0.05).Hospitalization expenses of the UHL group and PCNL group was (15 477.0±754.3) RMB and (27 453.0± 1763.5) RMB,and had statistical difference in two groups (P＜0.05).Conclusions Although UHL and PCNL have similar curative effect in treating renal stones of less than 3 cm,UHL have the advantages of lcss trauma and complication,lower expenses and fewer hospital stay.In treating renal stones of smaller than 3 cm,especially in the contraindication of PCNL,UHL may be a better choice.
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Objective To study the efficacy of hypo responsiveness of allogenic T cells induced by curcumin (Cur)-treated dendritic cells (DCs) and influence on survival time of renal allografts in rats.Methods DCs were generated from Wistar rat bone marrow and treated with Cur. The costimulatory molecules (CDl1c, CD80, CD86 and major histocompability complex Ⅱ ) were determined by using flow cytometry,and the production of IL-12 in DCs culture supernatant was examined by using ELISA.The probability of Cur treated DCs to stimulate the proliferation of Lewis rat T cells was detected by using mixed leukocyte reaction (MLR),and the antigen specific T cell hypo responsiveness was analyzed by using secondary MLR. Allograft renal transplantation animal models were established by using Wistar rats as donors,and Lewis rats as recipients.At 7th day before allograft renal transplantation,Cur-treated DCs from donors were injected into recipients through tail vein, meanwhile the non-treated control group and immature DCs control group (immature DCs from donors were injected into recipients through tail vein) were set up.The allograft survival time and allograft pathology after transplantation were assayed.Reaction of T cells from the recipients to mature DCs of donors was analyzed at 14th day.Results Cur restrained the expression of DCs phcnotypc and production of IL-12 (P＜0.05). Cur treated DCs displayed poor ability to stimulate T cells proliferation,and potential to induce antigen specific T cell hypo-responsiveness.The survival time of the renal allograft in Cur-treatcd CDs group [(31.5 ± 6.9) days] was significantly longer (P＜0.05) than in control group [(8.6± 2.1) days] and immature DCs control group [(22.4± 7.4) days],and the pathological lesions in the renal allografts in Cur treated CDs group were milder than in the control group and immature DCs control group.T cells from the recipients injected with Cur-treated DCs showed significant hypo-responsiveness to mature DCs from donors (P＜0.05),but higher proliferation ability to the stimulation of third party independent antigen.Conclusion Cur can suppress the maturation and function of DCs,and induce immune suppression of allogeneic T cells,while infusion of Cur-treated immature DCs can prolong the survival of renal allograft remarkably.
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ObjectiveTo investigate the effects of using spiral pedunculated bladder muscle flap ureteroplasty in the treatment of long ureteral segment defects ( ＞ 20 cm).MethodsA retrospective analysis was conducted on the clinical effects of five patients who encountered long ureteral segment defects caused during ureteroscopic lithotripsy.The five patients included three males and two females with an age range from 37 to 59 yrs ( average age 48 ).Four of the cases had defects on the left and one case on the right.Two cases had whole ureteral mucosal avulsion and three cases had whole ureteral ruptur from the pelvis to the bladder junction.Defect lengths measured from 21 to 25 cm( mean length 22.5 cm).All five patients underwent emergency surgery using spiral pedunculated bladder muscle flap ureteroplasty and 7 F double J stent placement in the repaired ureters which was fixed on psoas muscles.The average length of the new ureters using spiral pedunculated bladder muscle flap was 22.5 cm.ResultsAll the operations were successful and the operation time was 1 -2 hrs (average 1.5 hrs).Drainage tubes for four patients were removed three days after operation.IN the remaining case the drainage tube was removed 10 days after surgery due to urine leakage.All wounds healed uneventfully.Serum creatinine and blood urea nitrogen were normal two weeks after surgery.Double-J tubes were removed safely under cystoscope eight weeks after surgery.In following-up,one case was found to have mild hydronephrosis and ipsilateral ureter slight expansion six months after surgery,but renal function was normal.There was no abnomality found in the remaining four patients after 2 -4 years of follow-up.The IVU showed normal morphology and good developments in the ipsilateral ureter.ConclusionsSpiral pedunculated bladder muscle flap ureteroplasty is an ideal treatment method in repairing long ureteral segment defects.
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Objective To explore the effects of different initial treatment protocols on the prognosis of pneumonia in the kidney transplant recipients. Methods Sixty-seven cases of pneumonia following kidney transplantation were divided into case group (34 cases) and control group (33 cases).The patients in case group were treated with Imipenem and Cilastatin, SMX/TMP and ganciclovir,and those in control group received routine treatments. Mortality and length of stay in hospital (LOS)were analyzed. Results Mortality (5.9 % ) and LOS (15 days) in case group were reduced as compared with those in control group ( 18. 2 %, 23 days, respectively) (P＜ 0. 05). Among the patients without severe pneumonia, the mortality and incidence of LOS beyond 21 days in case group (3. 4 %, 1/29; 3. 4 %, 1/29) were lower than those in control group (17. 2 %, 5/29; 37. 9 %, 11/29, respectively) (P＜0. 05). Whether the patients were admitted to hospital sooner or later, the incidence of LOS beyond 21 days in case group was lower than that in control group (P＜0. 05).Whether the etiologies were determined or undetermined, the incidence of LOS beyond 21 days in case group was lower than that in control group (P＜0. 05). The incidence of LOS beyond 21 days in case group was lower than that in control group among the patients with cardiopulmonary disease (P＜0. 05). Conclusion The initial appropriate treatment would improve the prognosis of pneumonia in the kidney transplant recipients.
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Percutaneous nephrostomy was applied in some other urologic diseases and the efficacy was evaluated. Percutaneous nephrostomy for percutaneous nephrolithotomy (PNL) was performed in patients with various renal, perinephric and bladder diseases (n=79). The tract establishment, operation duration and complications were observed and the efficacy was assessed. The results showed that the tracts were successfully established in 79 cases. The operation lasted 4-20 min. 12F-16F single tract was established in nephrohydrop patients and 16F-20F single or multiple tracts were established in patients with pyonephrosis, renal cortical abscess, renal cyst and perinephric abscess. During dilation, no leakage of liquor puris was noted. Establishment of 18F single tract was achieved in one urinoma patient. In two patients with foreign body in kidney, the foreign bodies were removed via established 14F single tract. 18F tracts were established in 2 patients with bladder contracture, which was followed by the placement of 16F balloon urethral catheter for drainage. No complications, such as massive bleeding, intestinal injury and spreading of infection took place in our series. All the patients were followed up for 2-12 months. No long-term complications such as dropping of drainage tube occurred. It is concluded that as a minimally invasive technique, percutaneous nephrostomy has the advantages of convenience, simplicity and causing less complications and can be used for various urologic diseases.
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Objective To discuss the etiology of male pseudohermaphroditism. Methods The clinical data of 42 male pseudohermaphroditisms were retrospectively analyzed.Among the 42 cases (mean age of 10 years,range from 8 to 19 years),39 caseg social gender were female sex and 3 were male.Physical examination indicated abnormal external genitalia,cryptorchidism,hypospadias and mass of pelvis or inguinal.Chromosome examination showed that 39 cases were 46,XY,2 cases of 45,X/46.XY and 1 case of 45,X/47,XXY.Etiology analyses were established in 42 cases by eytogeneties,endocrinology,B-ultrasound or CT examination,celiac exploration and pathology examination.Results All the 42 cases received operation.All cases were treated by hormone replacement according to the social gender which they selected.Thirty-three cases were followed up for 7 to 10 years. Conclmion The etiology of male pseudohermaphroditism includes anti-androgen syndrome,testosterone synthetase deficiency,resistant LH/hCG by testis,simple gonadal dysgenesis,mixed gonadal dysgenesis and resistant mullerian duct syndrome.
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Objective To investigate the morphology change of transplants of adrenocortical cells using poly-? -hybroxybutyric acid (PHB) as a cell carrier. Methods Adrenocortical cells were seeded on PHB and then implanted into rats bearing bilateral adrenalectomy. Histological changes and CD3 expression by using immunohistochemical staining were observed in local area of transplants on the postoperative week 2, 4, 8. Results Histological study showed inflaming cells were decreased as time passed, fibrous tissue disappeared step by step, PHB degraded gradually and adrenocortical cells tended to be organized; Ultrastratural observation revealed these cells maintained identical secreting function; Immunohistochemical assay indicated the expression of CD3 in the transplanted was similar to that in the normal adrenal cells. Conclusion The transplanted cells seeded in PHB can not only be survival, but also organized to the same tissue structure and ultrastructure as normal adrenal tissue.
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<p><b>OBJECTIVE</b>To study the effects of prostadyn sabale capsules on chronic prostatitis (CP).</p><p><b>METHODS</b>One hundred and twenty-five CP cases were divided into three categories according to National Institutes of Health (NIH) concensus definition and classification of CP:31 of category II. 75 of category IIIA and 19 of category IIIB. All the cases were treated with prostadyn sabale capsules at the dosage of 320 mg twice a day. NIH chronic prostatitis symptom index (NIH-CPSI), routine examination and culture of expressed prostatic secretions (EPS) were prospectively evaluated before and after treatment.</p><p><b>RESULTS</b>The cure rates of category II, category IIIA and category IIIB were 25.8%, 16.0%, and 21.1% respectively, the general cure rate being 19.2%. The alleviation rate was 63.5% and the total effectivity rate was 82.7%. No side effects were observed.</p><p><b>CONCLUSIONS</b>Prostadyn sabale capsules have good effects on CP.</p>
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Adult , Humans , Male , Middle Aged , Capsules , Chronic Disease , Phytotherapy , Prostatitis , Drug Therapy , SerenoaABSTRACT
Objective To investigate the possibility of transplantation of adrenocortical cells to treat insufficiency of adrenocortical function using poly-?-hybroxybutyric acid (PHB) as cell carrier.Methods Adrenocortical cells were seeded to PHB and then implanted into rats bearing bilateral adrenalectomy, while adenocortical cells implanted into the similar rats as a contrast. The changes of blood corticosterone and aldostenone and local histological changes in these rats were observed.Results The blood corticosterone and aldostenone were elevated after transplantation. The levels of blood corticosterone and aldostenone in PHB group were higher than that of control group. Histological study showed that adenocortical cells in PHB grew well.Conclusion The implanted adrenocortical cells within PHB can not only survive in rat body but also secrete corticostenone and aldostenrone which can satisfy the need of adrenalectomized rats. It is more effective to use PHB in adrenocortical cell transplantation than that cell implanted singly.
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Objective To investigate the long-term therapeutic effectiveness of transplantation of adrenals for the treatment of Addison's disease in the past 15 years. Methods Nine cases subject to adrenal transplantation were followed up for a long-term and the outcome after 15 years was evaluated. Results Seven cases of graft adrenal survived. In 6 patients, urine 17-OHCS, urine 17-KS and serum cortisol were normal. The remaining two grafts out of the 9 cases didn't survive and they had abnormal levels of urine 17-OHCS, urine 17-KS and serum cortisol. Conclusion The transplantation of adrenals for the treatment of Addison's disease had a good long-term effectiveness.
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Leydig cells derived from a SD rat aged one month were transplanted to the hind leg subcutaneous of a 2 week-castrated outbred rat. At 1, 3, 4, 6 months after implantation, the grafts were removed and taken to have a histochemical staining for 3?-hydroxygsteroid dehydrogenase (3b-HSD), light and electron microscopy. The results indicated that there were a lots of 3b-HSD positive leying cells in the grafts. The well revascularized and no lymphocytic infiltration were seen around the implanted cells with 4 months after transplantation. Electron microscopy displayed that the implanted cells had abundant mitochondria and smooth endoplasm reticulum, suggesting that the implanted ceils could survive and had better secretary testosterone function for 4 months.