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Objective To discuss the reasons and management of renal vein injury during percutaneous nephrostolithotomy (PCNL). Methods From 2007 to 2008 renal vein injury was caused in two patients by malposition of nephrostomic catheter in our hospital. The two patients were both males, aged 61 years old and 41 years old. They underwent PCNL due to left kidney stones. The percutaneous nephrostomy (PCN) catheters were malpositioned into the left kidney vein and vena cava, which was confirmed by prograde radiography and spiral CT scan after operation. The PCN catheter in the 41 years old patient was pulled back to renal collecting system on the 7th day, and was extracted on the 10th day under X-ray monitoring. The PCN catheter in the 61 years old patient was pulled back to the renal collecting system on the 14th day and wasstable extracted on the 18th day under X-ray monitoring. Results The bleeding was controlled and the hemodynamic status in the two cases after removal of PCN catheters. There was no renal arteriovenous fistula bleeding, surgical intervention, kidney infections or further damage of kidney function. Conclusion Renal vein injury during the PCNL can be managed by clamping the PCN catheter and gradual withdrawal. The method is safe and reliable, and it can avoid surgical intervention.
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Objective To evaluate the clinical value of the PolyScope™ endoscope system (F8 modular flexible ureteroscope) in treatment of upper urinary calculi less than 2 cm in diameter. Methods A total of 117 patients with upper urinary calculi, who were hospitalized in Xinhua Hospital from Nov. 2010 to Aug. 2012, were recruited in this study. The patients included 71 males and 46 females, aging from 20-86 (average age:49.7±13.9). Ninety-six patients had single calculi and the rest 21 had multiple calculi; 61 patients had left calculi and 56 had right calculi. The mean diameter of calculi was (1.19±0.34) cm. Twenty-two patients had been indwelled with D-J tube in advance under ureteroscope for 2-8 weeks, including 13 with ureteral stenosis, 7 with urinary tract infection and 2 with renal insufficiency. General or spinal anaesthesia were used and the patients were at cutting stone position. F8/9.8 rigid ureteroscope was inserted to the ureter for dilating the ureter, and the Holmium laser lithotripsy was performed for upper ureteral stone in situ. After dilating the ureter, the guide wire was inserted under the direct vision of F8/9.8 rigid ureteroscope, and then the F12/14 flexible ureteral access sheath was placed along the guide wire. Finally, further examination and Holmium laser lithotripsy were performed by F8 "PolyScope" modular flexible ureteroscope. The power of the laser was set at 1.0 J and the frequency was 10-20 Hz. F6 D-J tube was regularly indwelled for 4 weeks after operation and Forley urethral tube was indwelled for 1 to 7 days. KUB was performed 1 day after operation to detect the result of lithotropsy and the position of D-J tube. KUB was performed again 2-4 weeks after operation in some patients. Extracorporeal shock wave lithotripsy (ESWL) should be performed if the diameter of residual stones was larger than 6 mm. Results Lithotripsy was successfully performed in 103 patients, with the operation time being 25-85 min (mean time: [46±14] min) and with less bleeding. Four patients developed high fever after operation and were cured after anti-inflammatory treatment. There was no ureteral perforation or septicaemia. The single stone-free rate of single-pass lithotripsy was 88% (103/117); when combined with ESWL, the total stone-free rate was 95.7% (112/117).Conclusion F8 modular flexible ureteroscope is safe, convenient, and effective for the lithotripsy of the upper urinary calculi.
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Objective: To assess the efficacy and safety of the ureteroscopic lithotripsy in treatment of ureteral calculi in children. Methods, From March 2008 to May 2009, thirteen pediatric patients with ureteral stones were admitted to our department. There were six males and seven females, with an age range of 23 months to 11 years old. Six patients with stones located at the lower segments of the ureter, four at the middle segments, two at the upper segments, and one at pyelo-ureteral junction and lower ureter. The average diameter of the stones was (1.1 ± 0.47) cm (range 0.6 - 2.0 cm). The patients were placed in a lithotomy position; under general or venous anesthesia, ureteroscopy was performed using a semirigid ureteroscope (WOLF Fr 7.5/6), and the ureteral orifice was dilated to 10-12 Fr. Then holmium laser (1.5 J, 10 Hz) or pneumatic lithotripter was employed to fragment the stones (diameter of fragment less than 3 mm). Fr4. 7 double-J stent was placed after operation and was removed 4 weeks later. Results: Eleven of the 13 patient underwent successful lithotripsy, with the first time successful rate being 84.6%. The mean lithotripsy time was 8 min and the mean operation time was 21 min. There was slight bleeding during operation, but with no noticeable perforation of ureter or post operation fever, etc. Post-operation B ultrasound examination and X ray image revealed no residual stones with diameter > 3 mm in the 11 cases. Partial fragmentation was achieved in one patient with stone at upper ureter segment and one patient with stone at pyelo-ureteral junction and lower ureter, and the stones were excreted after extracorporreal shock wave lithotripy. Conclusion: Ureteroscopic lithotripsy is safe and effective in treatment of children with ureteral stones, which might become one of the first line treatment for children.
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Objective: To construct DNA vaccines expressing prostate-specific membrane antigen (PSMA) and/or granulocyte-macrophage colony-stimulating factor (GM-CSF) and to determine their immunoactivity. Methods: Recombinant plasmids pIRES-PS-MA-mGM-CSF, pIRES-PSMA, and pIRES-mGM-CSF were constructed with DNA vaccine vector pIRES. After identified by endonuclease digestion, the above 3 plasmids and blank pIRES vector were used to immunize C56BL/6 mice (n=15). LDH release assay was used to exam the cytotoxicity of cytolytic T lymphocytes in each group. Results: We successfully constructed the above mentioned recombinant plasmids. Mice in pIRES-PSMA-mGM-CSF immunized group had the highest specific cytotoxicity, followed by pIRES-PS-MA and pIRES-mGM-CSF immunized groups. The blank pIRES group had the lowest cytotoxicity (P<0.05). The cytotoxicity was the highest in all 4 groups at an effector/target ratio of 10/1. Conclusion: The bicistronic DNA vaccine expressing PSMA and mGM-CSF may have a promising therapeutic value in gene therapy of prostate cancer.
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<p><b>OBJECTIVES</b>To evaluate modified cystectomy with preservation of erectile and ejaculatory functions in men with nonmalignant bladder disease.</p><p><b>METHODS</b>Seven cases with average age of 27 years presented with bladder disease necessitating cystectomy, including 2 cases of tuberculous contractile bladder, 1 case of extensive polypoid cystitis glandularis, 4 cases of late stage of neurogenic bladder. All patients wished to maintain erectile and ejaculatory functions after the operation. We performed a modified simple cystectomy with preservation of the vasa deferens, seminal vesicles, prostate and neurovascular bundles, as well as construction of an Indiana pouch or ileal neobladder.</p><p><b>RESULTS</b>Average operative time was 5 h 45 min without perioperative complications in this group. Follow-up ranged from 9 to 60 months. Erectile and ejaculatory functions were normal in all cases. All patients remained completely continent and no dysuria in neobladder, and there was no difficulty in inserting catheter to empty pouch. Upper urinary tract was in good condition 3 and 24 months after operation.</p><p><b>CONCLUSIONS</b>Modified cystectomy with preservation of the vasa deferens, seminal vesicles, prostate and neurovascular bundles is an effective and reliable option for the patients who wish to maintain their fertility and erectile function after surgery.</p>