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Objective To establish computer assisted virtual ureteroscopy (VU) through data from computerized tomography urography (CTU) of patients with renal stones and make validation of effectiveness.Methods From June of 2015 to January of 2016,23 cases of renal stones cases was selected by 5 experts in 3 different centers.There were 21 unbilateral cases and 2 bilateral cases.The age ranged from 31 to 79(54.7 ± 12.5).Mean stone burden was (19.0 ± 6.2) mm.Stone number ranged from 1 to 5 (2.7 ± 1.2).VU generation was accomplished by specialized software (Crusher) with incorporating CTU data.After patientspecific VUs were presented to the experts,and the FURS surgeries were all finished successfully,face and content validations about VU using modified Likert questionnaire ordinal 10-point rating scales were made.20 trainee were selected to do the flexible ureteroscopy lithotripsy with assistance of VU.After observation of CTU and VU,the numbers of renal calyces and stones found by the experts and trainees were recorded.The statistical analysis were made before and after observation of VU between the experts and trainees.Result Face and content validation of VU:overall usefulness 7.6 ± 0.5,graphics 7.6 ± 0.5,intrarenal collecting system 8.4 ± 0.5,stone details 8.4 ± 0.5,usefulness in surgical planning and training 8.0 ± 0.7.Significant improvement was found when the trainees doing the surgery with the help of VU.Compared with using CTU only,VU could help the trainees had better understanding of intrarenal structure and stone information [the number of calyces (16.7 ±3.7)vs.(24.6 ± 1.8),P ＜0.001;the number of stones (4.9 ± 1.4)vs.(8.2 ± 1.3),P ＜0.001].Before observation of VU,trainees found much fewer calyces and stones compared with experts (P =0.004 and P ＜ 0.001 respectively).However,this gap disappeared after VU observation (P =0.327 and 0.292 respectively).Conclusions Establishing computer assisted VU through CTU data from renal stone patients is feasible and rapid.VU can significantly improve trainee's view of intrarenal collecting system and stone information before practicing FURS.
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Objective To investigate the safety and efficacy of same session ureteroscopical lithotripsy as a valuable treatment for the bilateral upper urinary stones.Methods 32 cases with bilateral upper urinary stones were enrolled into this study from Jan 2013 to Dec,including 19 male and 13 female.The age ranged from 19 to 79 years old [mean (53.2 ± 14.2) years old].Ultrasound,CT and IVU were used to evaluate the details about the stone burden,number and location.The total stone burden was (23.7± 7.6)mm,ranged from 14 to 40mm.The kidney stone burden ranged from 0 to 37mm [mean (15.4 ±9.7)mm].and ureter stone burden ranged from 0 to 34 mm [mean (8.2 ±7.2)mm].Total stone number was 109,including 78 stones in kidney and 31 stones in ureter.23 (71.9％) patients had stents placed before the surgery.All the patients were treated with FURL and(or) URL by the same surgeon under general anesthesia,and C arm was used routinely to monitor the position of the guide wire,sheath and residual stones.The stents were placed for 2 to 4 weeks post-operatively.The ureteral catheters were placed for 24 to 48 hours.Stone-free rates(SFRs) were judged by KUB and(or)NCCT on the first day after the surgery and one month after withdraw the stent.The number of procedures,operative duration,hospital stay,SFRs in different time phase,serum creatinine,stone composition and complications were evaluated.All patients were divided into low burden group and high burden group,based on the borderline of stone burden (20mm).The SFR and complication was compared among those group.Results Among 32 cases,30 cases underwent the one stage procedure and 2 cases underwent two stage procedure.Operative time was (99.2 ± 32.5) mins.There was no significant difference of serum creatinines before and after the surgery.[(78.3 ± 15.0) μmoL/L vs.(77.9 ± 15.3) μmol/L,P =0.711].The overall SFRs aftcr 1,2 procedures were 84.0％ (27/32) and 91.0％ (29/32),respectively.The immediate SFRs for patients with a preoperative stone burden ≤20 and ＞20 mm showed significant difference(100％ vs.50％,P =0.002).Only 5 minor postoperative complications,including fever in 4 patients,hematuria in 1 were recorded.Longterm complication,such as ureteral stricture,was not noticed.Conclusions For selected cases with bilateral upper urinary stones,bilateral same-session ureteroscopy is effective and safe with little influence on the kidney function.For those whose stone burden less than 20mm,the immediate SFRs are much higher.
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Objective To investigate the efficacy of using three-dimensional (3D) printing technique on surgical planning and its function in enhancing the physician-patient rapport before surgery.Methods From June 2013 to January 2014,10 patients with T1 renal tumors,who were received laparoscopic partial nephrectomy,were selected in study.Left renal tumor was found in 3 cases and right renal tumor was found in 7 cases.The location of tumor included upper part of kidney in 5 cases,lower part of kidney in 3 cases and renal hilum in 2 cases,4 cases were diagnosed as T1a stage and 6 cases were diagnosed as T1b stage.64-slice enhanced CT scan was performed preoperatively.Data of DICOM format was sent for post processing.The final data was then output to 3 d printer for generating kidney models using thermoplastic plastics.After generating the model,different colors were put on the model,including pink in kidney,yellow in pelvis and ureter,red in renal artery and blue in renal vein.Plotted questionnaires were designed for medical professionals and patients,respectively.4 urological experts make the scores by this questionnaire in order to evaluate the efficacy and fidelity of the model.2 surgeons evaluated the efficacy of model after operation by comparing the actual tumor size with that measured on the models.Meanwhile,the model was used for conversation before operation.The questionnaires were also used for evaluating the effectiveness of conversion.Results 10 kidney models fabricated successfully with 3D-printing.The tumor size,position,renal vascular and collecting system could be clearly presented.Being evaluated by 4 experts and 2 performing urologists,and the mean scores was 7.8 ± 0.7.Intraoperative correlation was advocated by the performing urologists.The mean evaluation score was 7.5.The bias between real diameter of renal carcinoma and that of 3 d model was 3.4± 1.3 mm.Patients and family members preferred the demonstration of the disease and the procedure with a visual and tactilediseased organ.The scores of satisfactory were 9.0 ± 0.8.Conclusions The 3d printed model could exhibit the relationship between tumor and renal,clearly.It can help the urologists in making surgical plan,effectively.Patients' Understandings from patients and family members of the disease and the procedure to be used can be upgraded with this novel technology.
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Objective To compare the safety and clinical efficiency between minimally invasive percutaneous nephrolithotomy(MPCNL)in supine position and flexible ureteroscopy(FURS)in management of proximal ureteral calculi.Methods From Oct.2010 to May.2012,76 patients with single proximal ureteral calculus between 10-20 mm failed in SWL or other conservative therapy accepted MPCNL (32 cases)or FURS(44 cases).There was no significant difference between the groups in base-line parameters.Stone sizes were(15.6±2.5)mm and(14.9±2.3)mm,P＞0.05.Procedural time,post-operative hospitalization stay,complication rates(Clavien degree Ⅱ or over)and stone free rates were compared.Results In these two groups,procedural time was(49.3± 11.7)and(67.2± 17.3)min,P＜0.05,postoperative hospitalization stay were(4.2±1.1)and(1.8±0.8)days,P＜0.05,complication rates were 12.5％ and 6.8％,P＞0.05 and stone free rates(residual fragments≤3 mm)were 93.7％ and 84.1％,P＞0.05.Conclusions For patients with surgically indicated proximal ureteral calculi,both minimally invasive percutaneous nephrolithotomy in supine position and flexible ureteroscopy are effective and safe therapeutic modalities.Patients treated with flexible ureteroscopy have faster postoperative recovery.
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Objective To assess the face and construct validity of a full procedural transurethral prostate resection simulator (TURPSimTM) in the training of transurethral resection of the prostate. Methods Ten experienced and thirteen inexperienced urologists (TURP experience ≥ 30 and ≤ 3 respectively) were included for TURP training on TURPSimTM. Each participant filled out a questionnaire regarding their previous experience and opinion of the usefulness of the simulator before and after performing six full procedures at level-2 difficulty. Performance was evaluated between the two groups and pre- /post-training, including GRS and objective parameters recorded on the simulator. Results The experienced group had higher GRS scores (16.3±2.6 vs 12.9±4.0, P=0.024) and prostate resection rate [(94.6±2.8)% vs (89.8±4.4)%, P=0.006]. Less blood loss [(78 ml vs 115 ml, P=0.208) and less capsule resection rate [(27.6±5.4)% vs (29.1±6.2)%, P=0.558] were detected in the experienced group than in the inexperienced group with no significant differences. After training, GRS and coagulation precision increased (14.4±3.8 vs 20.0±3.4, P<0.001; 93% vs 100%, P=0.001) ,while capsule resection rate [(28.4±5.8)% vs (20.8±3.9)%, P<0.001), blood loss (86 ml vs 76 ml, P=0.039) and injury of sphincter (5.5±2.2 vs 3.2±1.7, P<0.001) decreased in both groups. Conclusions Proof of face and construct validity is shown for this full procedural simulator to simulate the skills necessary to perform TURP. The surgical skills of urologists may be enhanced after training on the simulator.
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ObjectiveTo assess the validity of virtual-reality simulator UroMentorTM in skill training of ureteroscopy. MethodsThirty urologists were included and divided into groups A (n =18) and B (n =12 ) based on former ureteroscopy experience ( ≥ 20 or ＜ 20).Participants were assessed on their ability to perform cystoscopy,gnidewire insertion,semirigid ureteroscope advancement and basket extraction of a distal ureteric stone on the simulator.A blinded examiner assessed the subjects' performance using global rating scale (GRS).In addition,computer-generated parameters including time to complete the task,endoscope and instrument trauma,and the number of attempts to insert a guidewire were recorded as pretest.After 2 days of simulator training,they were retested with the same task. ResultsAll participants had reduced time to completion (333 ± 32 s & 228 ± 18 s,P =0.001 ) and improved GRS (24.4 ± 2.1 & 28.1 ±1.2,P =0.010).Differences were significant between the two groups in the time to completion (before 405 ±40 s & 262 ±22 s,P =0.014; after 276 ± 12 s & 179 ±9 s,P =0.000),and GRS (before 19.6 ±2.5 & 29.2 ± 1.3,P =0.009 ; after 25.0 ± 1.1 & 31.2 ± 0.7,P =0.002).Previous ureteroscopy experience was correlated to GRS (before r=0.705,after r=0.756). ConclusionThe UroMentor virtual-reality simulator is an appropriate and useful tool in training and assessing the skills of ureteroscopy.
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Objective To evaluate the efficacy and safety of standard percutaneous nephrolithot-omy (PCNL) for patients with deformity of spine. Methods Between Aug 2003 and May 2009, 35 patients of upper urinary tract calculi with scoliosis and kyphosis had undergone PCNL accessed by two steps dilation to 24F tract with ultrasound guidance. Clinical data were analyzed retrospectively. Results The pereutaneous renal access was successfully established in 35 patients under ultrasound guidance and immediate lithotripsy was performed. Prone position 9 units,lateral position 14 units,and other unconventional position 14 units. 34 (91.9 %) units were operated by single access and 3 (8.1%) by double in one session. The mean first accessing time was (8. 5±1.7)min, and stone management time was (39.3±14.6)min. The stone-free rate after the first operation was 86.5%, 2 kidneys ac-cepted another PCNL to remove the residual calculi, and the last stone-free rate was 91.9%. 2 cases needed transfusion. No injury of adjacent organs or urosepsis occurred. No severe complications oc-curred. Conclusions Standard PCNL for calculi in patients with deformity of spine accessed by two steps dilation to 24 F tract with ultrasound-guided puncture could be effective and safe. Special indi-vidual operative position and experienced clinical technique are needed.
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Objective:To study the damage of nanobacteria on HK-2 cells,the possible principles,the effect of crystals(COM) adhering to HK-2 cells after the damage.Methods:Four groups were chosen for the study:control group,NB group,nHAP group and COM group.Morphological changes of the HK-2 cells were observed after HE stain and with TEM after 12 hours and 24 hours.Meanwhile,the levels of H2O2,LDH,MDA and ATPases were surveyed after 6 hours,12 hours and 24 hours,respectively.And 6,12,and 24 hours later,COM crystals were mixed into the culture fluids of each group.Then phalloidin-FITC was used to finish fluorescent staining of the cells.At last,the adhering effects of each group with the laser scanning confocal fluorescence microscope were observed and contrasted.Results:After HE stain and with TEM:in NB and nHAP group,the shape of the cells changed,brush borders were arranged in disorder,vacuoles formed in the kytoplasms,the mitochondria became swelled up,the karyotheca dissolved and the nucleolus disappeared in some cells.After 24 hours,in NB group,the number of the cells in which the karyotheca dissolved was more than that in nHAP group.After 12 and 24 hours,the level of H2O2 in NB group was higher than that in control group and nHAP group;After 6 and 24 hours,the level of MDA in NB group was higher than that in control group and nHAP group;At each time point,there was no significant difference in the level of LDH between control group,nHAP group and NB group;After 12 hours,the activities of Na+/K+ ATPases in NB group and nHAP group were lower than those in control group.And after 24 hours,the activity of Na+/K+ ATPases in NB group was lower than that in control group;After 12 and 24 hours,the activities of Ca2+ /Mg2+ ATPases in NB group was lower than those in control group.After 12 hours,the activity of Ca2+/Mg2+ ATPases in nHAP group was lower than that in control group.The observation with the laser scanning confocal fluorescence microscope:after 12 hours,showed that the number of the crystals adhering to the cells in NB group and COM group increased,and in COM group,some crystals had entered the cells;after 24 hours,the adhering effects of the crystals in NB and COM group were similar to those after 12 hours,but the number of adhered crystals was more than that after 12 hours;At each time point,there was no significant change in control and nHAP groups.Conclusion:Nanobacteria has a damage effect on HK-2 cells,the damage increases with the acting time expanding.The damage is more severe than that of nHAP.In the damage process of nanobacteria,the lipid peroxidation may play an important role.After the damage of nanobacteria,the adhering effect of the COM crystals to the cells increases observably,and the number of crystals adhering to the cells becomes more and more with the acting time expanding.Although nHAP also has a damage effect on HK-2 cells,it does not effect the adhering process.
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Objective To evaluate the clinical effect of uterine arterial embolization (UAE) as a treatment of symptomatic uterine fibroids(UF).Methods Twenty-six patients with clinic symptoms(menorrhagia, pelvic pain, bulk-related symptoms and anemia)caused by uterine fibroids underwent UAE.The embolization with a single catheter using the single-femoral artery approach to bilateral uterine artery was performed, injection of PVA 355～500 ?m and silk particles were used in 20 and 6 cases respectively.Results All cases were followed up for 6 to 18 months after treatment.The symptoma were noticeable improvement in 24 cases but 2 cases whom with injection silk particles.The tumors were marked diminution in size(45%～75%) sonographically after 2～6 months in 13 cases.No severe complication were discovered in all cases.Conclusion Uterine artery embolization is a safe and effective method for the management of symptomatic UF.Longer follow up is needed to evaluate the long term effects.