ABSTRACT
Objective To evaluate the clinical efficacy of intracavitary holmium laser for ureter calculi combined with distal ureteral stricture.Methods Sixty-nine patients with ureteral calculi combined with distal ureteral stricture were selected.Nineteen patients with ureteral calculi above third lumbar vertebra inferior margin combined with distal ureteral stricture were given microchannel percutaneous nephroscope holmium laser lithotripsy + ureteral stricture dilatation and holmium laser incision,and 50 patients with ureteral calculi below third lumbar vertebra inferior margin combined with distal ureteral stricture were given ureteroscope holmium laser lithotripsy + ureteral stricture dilatation and holmium laser incision.The type-B ultrasonic,kidney-ureter-bladder plain film (KUB) + intravenous urography (IVU) were performed before operative and 3 months after removal of double J tube,and the degree of hydronephrosis and calculi removal condition were observed.Results The operations of all the patients were successful,and operation time was 42-85 (58 ± 13) min.Intraoperative hemorrhoea,ureteral rupture,ureteral avulsion,false passage formation did not occur.All patients had varying degrees of gross hematuria after operation,and 68 cases disappeared after 2-3 d.Thirteen cases had postoperative fever,and these patients were alleviated after the anti-infection and symptomatic treatment.The success rate of gravel was 95.7％ (66/69),and the success rate of ureteral stricture was 97.1％ (67/69).Three months after removal of double J tube,calculi had been discharged,with no residual calculi.The patients' hydronephrosis was obviously alleviated.The extension of renal collecting system was (22.0 ± 8.2) mm before operation,and was (12.0 ± 6.1) mm 3 months after extraction double J tube,and there was statistical difference (t =8.52,P ＜ 0.01).Conclusions The nicrochannel percutaneous nephroscope holmium laser lithotripsy or ureteroscope holmium laser lithotripsy + ureteral stricture dilatation and holmium laser incision for ureteral calculi combined with distal ureteral stricture patients has no serious intraoperative and postoperative complications,shorter operation time,low cost,operation safety,and satisfactory effect.It is a good method for ureteral calculi combined with distal ureteral stricture.
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Objective To investigate the effect and mechanism of hydrogen sulfide (H2S) on kidney injury induced by urinary-derived sepsis. Methods Rabbits were randomly divided into Control group, Sham group, Sepsis group, NaHS 2.8μmol/kg group and NaHS 8.4μmol/kg group. Upper urinary tract obstruction and acute infection was induced to estab-lish Sepsis model. At 24 h before surgery, and 24 h, 48 h, 72 h after surgery, blood was taken to examine white blood cell count (WBC), creatinine (Cr) and blood urea nitrogen (BUN). At 72 h after surgery, morphological changes were observed by HE staining and transmission electron microscopy. Immunohistochemical staining was used to detect TNF-α, IL-10 and NF-κB expression. Blood H2S concentration was measured by deproteinization and Cystathionine-γ-lyase (CSE) activity us-ing spectrophotometric methylene blue method. Results At 24 h, 48 h, and 72 h after surgery, Levels of WBC, Cr and BUN were all elevated in Sepsis group compared with the other four groups. Levels of WBC and BUN in NaHS 8.4μmol/kg group were lower than those in NaHS 2.8μmol/kg group. At 24 h, 48 h after surgery, there is no significant difference be-tween levels of Cr in NaHS 8.4 μmol/kg group and that in NaHS 2.8 μmol/kg group , but Cr level in NaHS 8.4 μmol/kg group was marked lower than that in NaHS 2.8μmol/kg group 72 hour after surgery. Pathological features of kidney injury were also alleviated by intravenous administration of NaHS. TNF-α, NF-κB expressions in NaHS 2.8μmol/kg group and NaHS 8.4 μmol/kg group were lower than those in Sepsis group, IL- 10 expression was higher than that in Sepsis group. TNF-α, NF-κB expressions in NaHS 8.4μmol/kg group were lower than that in NaHS 2.8μmol/kg group, whereas IL-10 expression in NaHS 8.4μmol/kg group was higher than that in NaHS 2.8μmol/kg group. Compared with Control group and Sham group, H2S content and CSE expression in kidney were decreased in Sepsis group. After intravenous administration of NaHS, H2S content increased, but the CSE activity has no obvious change. Conclusion Exogenous H2S reduced kidney in-jury induced by urinary-derived sepsis through inhibiting NF-κB, decreasing TNF-αand increasing IL-10.
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Objective By analyzing the urinary calculi ingredient and 24-hour urinary stone risk factors of urolithiasis patients in Hengyang area,to investigate the effects of diet intervention on recurrence rate in urolithiasis patients,and provide the measures for prevention and treatment.Methods Prospectively collected 692 patients that permanent residents in Hengyang area from September 2008 to September 2012,who had implementation of minimally invasive operation and taken stone specimens to analyze composition,and also collected 24 hours urine to analyze the urinary stone risk factors.They were divided into test group and control group by random number table method,346 cases in each,control group without diet intervention,and test group was given diet intervention according to the stone composition and urinary stonerisk factors.All patients were followed up for 1 year,the urinary stone recurrence rate in Hengyang area was observed.Results Among 692 urolithiasis patients,663 patients completed the study (test group of 341 cases and control group of 322 cases),the expulsion rate was 4.19％(29/692).The 24-hour urinary stone risk factors in control group before and after diet intervention had no significant difference(P ＞ 0.05).In test group after diet intervention,the excretion of ingredients in urine such as dietary calcium (t =3.412,P ＜ 0.05),oxalate(t =3.018,P ＜ 0.05) and uric acid(t =1.990,P ＜ 0.05) was obviously decreased,and urinary citrate (t =3.174,P ＜ 0.05) was increased,but the excretion of ingredients such as magnesium and phosphorus had no significant difference (P ＞ 0.05).After 1 year after diet intervention,the recurrence rate in test group was lower than that in control group [0.88％ (3/341) vs.7.76％ (25/322)],there was significant difference (P ＜ 0.01).Conclusion Diet intervention can effectively reduce the risk of urinary stone according to the stone composition and the 24 hours urine stone risk factors,plays an important role on reducing urinary stone recurrence,which is worth clinical promotion.
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Objective To summarize the experience of minimally invasive treatment in upper ureteral calculi complicated with urinary tract infection.Methods Retrospectively analyzed the clinical data of 40 cases with upper ureteral calculi complicated with urinary tract infection who were treated from December 2009 to December 2013.Results Twenty-one cases were performed with retrograde catheterization at cystoscopy and 11 cases were performed with percutaneous nephrostomy directed by B-ultrasound in the stage Ⅰ,the infection were controlled after operation 2-6 d.These patients were successfully cured by extracorporeal shock-wave lithotripsy (ESWL),ureterorenoscope lithotripsy (URL) or percutaneous nephrolithotomy (PCNL) in the stage Ⅱ].The remaining 8 cases were successfully cured by URL with antiinfection therapy in the stage Ⅰ.All patients had no ureteral perforation,laceration,urine derived sepsis and severe bleeding complications.All of ureteral calculi were drained after 2-10 weeks.The average hospital stay was 13.4 d.Patients were followed up for 1-12 months after the stone expulsion,the average was 6 months.There was 3 patients who with preoperative renal dysfunction had been improved after URL,and other patients' renal function returned to normal.Conclusions The therapy of retrograde catheterization at cystoscopy and percutaneous nephrostomy directed by B-ultrasound in the stage Ⅰ,combined with ESWL,URL or PCNL in the stage Ⅱ in treating upper ureteral calculi complicated with urinary tract infection have more advantage such as less complication,rapid control of infection and complete removal of stones.It is an ideal method.