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Objective:To investigate the safety and efficacy of one-stage transurethral prostatectomy for prostatic hyperplasia accompanied by non-neurogenic detrusor acontractility.Methods:The clinical data of 35 patients with benign prostatic hyperplasia accompanied by non-neurogenic detrusor acontractility admitted to The Second Affiliated Hospital of Zhengzhou University from January 2015 to Octorber 2021 were analyzed.The average age was (74.0±7.9) years old. The average volume of prostate was (77.8±44.5)cm 3. The average total prostate specific antigen(tPSA)was(8.9±8.7)ng/ml. The preoperative international prostate symptom score(IPSS) was (19.1±4.3) and the preoperative quality of life score(QOL)was 5(5, 5). All the patients were treated with one-stage transurethral prostatectomy and suprapubic cystostomy. After removing the cystostomy tube, the post-void resident volume(PVR), the maximum urine flow rate(Q max), IPSS, QOL were recorded, and complications were followed up. Successful treatment is defined as the removal of the cystostomy tube without worsening of upper urinary tract hydronephrosis. Results:All the operations were successfully completed. The success rate of treatment was 85.7%(30/35), and the median time to resume spontaneous urination was 4.0(3.3, 4.5) weeks. The average postoperative Q max was (12.6±2.3)ml/s, and the average PVR was(27.7±9.5)ml. The postoperative IPSS was (5.5±2.4), which was significantly improved compared to preoperative( P<0.001). The postoperative QOL score was 1(1, 2) points, which was significantly lower than preoperative( P<0.001). The patients voiding spontaneously were followed up for 3-69 months, and no complications such as urinary retention, recurrent urinary tract infection and hydronephrosis occurred. Conclusions:One-stage transurethral prostatectomy for patients with benign prostatic hyperplasia accompanied by non-neurogenic detrusor acontractility has a high success rate and few complications, which greatly improves the quality of life of patients.
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【Objective】 To establish a nomogram model for predicting the risk of positive prostate biopsy in MRI-negative patients, and to perform the internal validation. 【Methods】 We retrospectively analyzed the clinical data of 197 MRI-negative patients who underwent prostate biopsy at our hospital, analyzed the independent predictors of positive prostate biopsy with univariate and multivariate logistic regression analysis, constructed the nomogram model and conducted internal validation. 【Results】 Multivariate logistic regression analysis showed age (P=0.003), digital rectal examination (DRE)(P=0.005), total prostate-specific antigen (tPSA) (P=0.001) and prostate volume (PV)(P<0.001) were independent risk factors of MRI-negative but prostate biopsy-positive results. The nomogram model based on all variables was established. The area under the receiver operating characteristic (ROC) curve (AUC) was 0.862, which was greater than that of tPSA (AUC=0.739), PV(AUC=0.711) and DRE(AUC=0.666) (all P<0.05). The average absolute error of the model was 1.1% after 500 internal resampling, indicating that the prediction of positive prostate biopsy was consistent with the actual situation. 【Conclusion】 The age, DRE, tPSA and PV were independent predictors of positive prostate biopsy in MRI-negative patients. The nomogram model has a good prediction performance.
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Objective:To explore risk factors for the efficacy and complications of surgery for infectious kidney stones.Methods:The clinical data of 75 patients with infection kidney stones from January 2015 to May 2022 were retrospectively analyzed. This group of 75 patients, were 23 to 74 of age, with mean of (49.3±10.4) years old. Among them, 25 were male and 50 were female. The mean diameter of the stones was (5.4±2.7)cm. There were 29 cases of staghorn stones, 25 cases of multiple kidney stones, and 21 cases of single kidney stones. Preoperative renal function measuring by creatinine was 68 (51, 68)μmol/L. Twenty-five patients (33.3%) were combined with comorbidities, including diabetes mellitus, neurogenic bladder, spinal cord injury, cerebrovascular disease, or urinary anatomical malformation. All the patients underwent surgical treatment, including percutaneous nephrolithotomy, flexible ureteroscopy, and combined endoscopy. Postoperatively, urosepsis was diagnosed according to the SOFA score. One month after the operation, CT or KUB were re-examined to evaluate the efficacy of the operation. Multivariate logistic regression was used to analyze the risk factors for surgical efficacy, complications and sepsis.Results:All 75 patients undewent successful surgery. The overall stone clearance rate was 64%, and the single-factor analysis showed that the stone diameter ( P=0.001) and stone type ( P=0.002) were the impacting factors of the surgical efficacy of infectious kidney stone. Multivariate analysis showed that stone type ( OR=2.55, 95% CI 1.00-6.51, P=0.049) was an independent risk factor influencing the efficacy of surgery for infectious kidney stones. A total of 24 cases experienced surgical complications after surgery, including 18 cases of infection, 3 cases of bleeding, and 3 cases of subcapsular hemorrhage, and the complication rate was 32.0%(24/75). Univariate analysis showed that hydronephrosis ( P=0.039), comorbidities ( P=0.009), and preoperative renal function ( P=0.008) were risk factors for postoperative complications of infectious nephrolithiasis, and multivariate analysis showed that comorbidities ( OR=0.21, 95% CI 0.05-0.90, P=0.029) were independent risk factors for postoperative complications. The incidence of postoperative urosepsis was 6.7%, and univariate analysis did not find any risk factors for sepsis. Conclusions:Stone type is a factor that affects the efficacy of surgery for infectious kidney stones, and comorbidities are factors that affect surgical complications.
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Vagus nerve reflex is a rare complication of percutaneous renal decompression. It is often induced by excessively rapid decompression of severe hydronephrosis and traction of the main nerves innervating the kidney. The clinical manifestations are irritability, sweating, clammy skin, hiccups, slow heart rate. It is easy to misdiagnose. In this study, 4 patients with vagus nerve excitement after percutaneous renal decompression were treated. After monitoring the patient’s vital signs and giving treatment such as expanding blood volume and raising blood pressure, the symptoms gradually disappeared.
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Objective To evaluate the effect of one step flexible ureteroscopic lithotripsy for incarcerated upper ureteral calculi.Methods The clinical data of 80 cases of incarcerated upper ureteral calculi were retrospectively analyzed between August 2015 and September 2016.Theone step flexible ureteroscopic lithotripsy was used in 40 cases (one step group),including 22 male cases and 18 female cases.The average age was (40.0 ± 9.5) years.The maximal stone diameter was (i.8 ± 0.5) cm.The widest width of the ureter above the stone was (2.5 ± 1.1) cm.The CT value of stone was (1 089.0 ± 111.3) HU.Two step method was used in 40 cases (two step group),including 21 male cases and 19 female cases.The average age was (41.0 ± 10.7).The maximal stone diameter was (1.7 ± 0.6)cm.The widest width of the ureter above the stone was (2.3 ± 0.9) cm.The CT value of stone was (1 002.0 ± 97.2) HU.During the one step flexible ureteroscopic lithotripsy,only flexible ureteroscope was used to crush the stone,no matter whether the stone located in the ureter or return to the renal pelvis.During two stepmethod,the rigid ureteroscopy was firstly used for crushing the stone in the ureter.When the stone return to the renal pelvis,the rigid ureteroscopy was change into flexible ureteroscope for continuous crushing the stone.Compared two groups' operating time,2 weeks stone clearance rate and the cases of fever after operation.Results The mean operative time in the one step group was (37.45 ± 11.34) min.The mean operative time in the two step group was (55.07 ± 13.57) min.The difference was statistically significant (P ＜ 0.05).The number of infection 2 cases in one step group and 9 cases in two step group.The difference was statistically significant (P ＜ 0.05).2 weeks stone clearance rate was 87.5％ (35/40) in one step group and 82.5％ (33/40)in two step group.There was no significant difference between two groups.Conclusions Flexible ureteroscope one step method is a safe and effective alternation for incarcerated upper ureteral calculi.
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Objective To monitor intraluminal renal pelvic pressure during retrograde intrarenal surgery ( RIRS ) with syringe irrigation and to investigate the safety of this irrigation method.Methods Seven patients admitted for the flexible ureteroscopic lithoripsy with indwelling nephrostomy tube were enrolled.Two males and 5 femals, with the age from 29 to 58 years (median 48 years).The renal pelvic pressure was measured by the pressure transducer during RIRS.Results In the 7 cases, the mean intra-pelvic pressure( IPP) ranged from 5.1 to 54.8 cm H2 O,the maximum intra-pelvic pressure( IPPmax) ranged from 12 to 158 cmH2O, the time of lithotripsy ranged from 8.25 to 54.73 min (median 23.12 min),the water consumption ranged from 250 to 2300 ml( median water consumption 640 ml) ,and the mean irrigation rate ranged from 27.19 to 40.02 ml/min ( median irrigation rate 31.14 ml/min) , respectively.Conclusions The intraluminal renal pelvic pressure during retrograde intrarenal surgery ( RIRS) with syringe irrigation can be controlled at a low level.The cooperation of pushing water during RIRS by the assistant is crucial.The syringe irrigation method has the advantages of controllable pressure, a rapid adjustment, negative pressure suction in necessity and short duration of high pressure.
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Objective To observe the curative effect of external physical vibration lithecbole (EPVL) therapy after extracorporeal shock-wave lithotripsy (ESWL) in upper urinary calculi.Methods A total of 133 patients of upper urinary calculi with randomly divided into 2 groups after ESWL therapy during the period of 2012 October to 2013 February.The EPVL group (66 cases) used the physical vibration lithecbole treatment,and the natural lithecbole group (67 cases) used the method by drinking water,adding exercise and other natural lithecbole method.Of the EPVL group,6 of the stones were located in the upper or middle calyx,13 in renal pelvis,16 in lower renal calyx and 31 in ureter,the stone diameter was 10-15 mm.Of the natural lithecbole group,8 of the stones were located in the upper or middle calyx,17 in renal pelvis,15 in lower renal calyx and 27 in ureter,the stone diameter was 10-15 mm.The clinical data of the curative effect,side-effect,and complications were collected and analyzed systematically.Results In the EPVL group,the average times of lithagogue treatment was 2.6 times,51 patients (77％) expelled stones on the day of lithecbole,and the stone free rate in a week was 79％ (52/66).Especially,81％ (13/16) of the lower renal calyx expelled stones on the day of lithecbole,and the stone free rate in a week was 88％ (14/16).Whereas,30 patients (45％) in the natural lithecbole group expelled stones on the day of ESWL,and the stone free rate in a week was 49％ (33/67) ; the lower renal calyx stone expulsion rate on the day of ESWL was 33％ (5/15),and the stone free rate in a week was 40％ (6/15).The curative effects were significantly different between the 2 groups (P＜ 0.05).There were no serious complications in both groups.Conclusions EPVL machine can significantly promote the stone expulsion after ESWL.Compared with traditional methods,EPVL therapy has a better curative effect,especially on lower renal calyx stones.EPVL is a safe and noninvasive treatment.