Diagnosis and treatment of kidney stones complicated with emphysema pyelonephritis (report of 8 cases) / 中华泌尿外科杂志

Objective To discusse the diagnosis and treatment of kidney stones with emphysema pyelonephritis.Methods The clinical data of 8 patients with kidney stones complicated with emphysema pyelonephritis diagnosed in our hospital from January 2015 to October 2018 were retrospectively analyzed.There were 5 males and 3 females.The average age was 50 years old.The clinical manifestations including chills fever in 6 cases,low back pain in 5 cases,nausea and vomiting in 3 cases.Six patients had diabetes,one had thalassemia,and two had contralateral kidney stones.The maximum cross-sectional area of stones was 737.6 mm2.Among the 8 cases,there were 7 cases which number of white blood cells and procalcitonin were higher than normal reference value.4 cases of hemoglobin ＜ 110 g/L,2 cases of platelet count ＜ 125 × 109/L.The patient was cultured with urine and/or blood and drainage fluid.5 cases were Escherichia coli,2 cases were infected with Proteus mirabilis,and 1 case was infected with Pseudomonas aeruginosa.According to the CT findings of emphysematous pyelonephritis reported in the literature,it was divided into type Ⅰ-Ⅳ:There were 2 cases of type Ⅰ,2 cases of type Ⅱ,3 cases of type Ⅲ,and 1 case of type Ⅳ.Results 4 cases of type [and type Ⅱ patients,2 cases without SIRS were given positive medical treatment to control infection then performed PCNL.2 cases with SIRS,first treated with percutaneous nephrolithotomy and active medical,after control infection the PCNL was performed.None of the 4 patients were treated with ICU and recovered well after surgery.Three patients with type Ⅲ and one patient with type Ⅳ were complicated with SIRS.Two of them underwent percutaneous nephrolithotomy in the emergency department.They were transferred to the ICU after surgery.After the infection and general condition improved,PCNL was performed.The postoperative recovery was satisfied.One patient percutaneous nephrolithotomy,due to poor drainage,secondary percutaneous nephrolithotomy,large intrachannel,low pressure perfusion in the operation of partial obstruction of renal pelvis stones,dredge obstruction,after ICU control infection PCNL was performed,postoperative recovery was good.One patient with type Ⅲ also had poor peritoneal drainage for the first time.Secondary percutaneous nephrolithotomy was performed.After the infection was controlled by ICU,PCNL was performed to remove the stones.However,because the patient had contralateral kidney stones and thalassemia,an epileptic-like reaction occurred during the anti-infection with imipenem,and a serious infection occurred again after the operation,and eventually the patient died.Conclusions Patients with type Ⅰ and Ⅱ emphysematous pyelonephritis with renal calculi treated with conservative medical treatment alone or combined with percutaneous renal puncture drainage with SIRS can achieve better therapeutic effects after PCNL surgery.Type Ⅲ,Ⅳ emphysema pyelonephritis with renal calculus patients need to be actively anti-infective accompany with percutaneous renal puncture drainage.When the stone leads to multiple renal pelvic obstruction,large channels,low-pressure perfusion can be used to crush stones,dredge obstruction.PCNL was performed after infection control.

Distribution of vascular endothelial growth factor gene polymorphism in Uyghur Ethnic patients with urolithiasis in south Xinjiang / 中华泌尿外科杂志

Objective To determine vascular endothelial growth factor(VEGF)-460 gene polymorphism in Uyghurs and its relationship to urolithiasis in south Xinjiang. Methods Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP),gene sequencing and genetic analysis methods were used in 200 urolithiasis patients of Uyghurs, and 200 healthy Uyghurs. Results The distribution of genotype and allele had no significant difference between urolithiasis patients and normal controls (P＞0. 05). The frequencies for the CC,TT and CT genotypes in patients with urolithiasis and normal controls were 1.5 %, 29.0 %, 69.5 % and 0. 5 %, 27.5 %, 72.0 %, respectively. The frequencies for C and T allele were 36.2%,63.7% and 36.9% ,63.1%, respectively. Conclusions The results of VEGF-460 gene polymorphisms indicate no significant relationship between patients with turolithiasis and normal controls in Uyghurs in south Xinjiang,which may not be urolithiasis susceptibility genetic locus.

Clinical analysis of 100 cases of relative living kidney transplantation in the minorities / 中华器官移植杂志

Objective To summarize the experiences of 5-year relative living kidney transplantation in the minorities. Methods The clinical data of HLA matching, rejection, survival and causes of death were retrospectively analyzed from 2004 to July 2009. There were 97 blood relative donations, including 1 case of father → son, 1 case of daughter → father, 1 case of mother → son, 24 cases of donation between brother and sister, 2 cases of non-blood relative donors (husband and wife),1 case of inter-ethnics, and the remaining were collateral relative donors. All the donations were voluntary, and all the recipients were minorities and all donors were their blood relatives. There were no mismatch of gene matching of 6 antigenic sites (0 MM) in 1 patient, 1 mismatch point (1 MM) in 2 patients, 2 mismatch points (2 MM) in 5 patients, 3 mismatch points (3 MM) in 10 patients, 4 mismatch points (4 MM) in 21 patients, 5 mismatch points (5 MM) in 39 patients and complete mismatch in 22 patients. Results All donors were discharged after 1 week and followed up for 3-6 months. Blood creatinine was normal and urine protein was negative. Up to July 2009, the conditions of the recipients were as follows: (1) Ninety-one receptors survived after transplantation. The longest survival time was up to 5 years. Among 9 deaths, 1 case died from myocardial infarction, 1 case from hemorrhagic shock and the others from respiratory failure (7 %) ; (2) Two renal grafts lost their functions and the patients restarted dialysis, in whom the preoperative panel reactive antibodies (PRA) of 1 patient was high and the patient had postoperative acute rejection, and the other patient stopped immunosuppressive agents on his own, leading to renal function loss; (3) After transplantation 10 patients had acute rejection, of which 2 cases received methylprednisolone plus OKT3, and the remaining 9 patients were treated with methylprednisolone. All rejections were reversed; (4) Urethral fistula occurred in one case and was improved after 45 days. Three patients had vesicoureteral anastomotic stenosis and were cured surgically. lyrnph leakage occurred in one case and was improved after 2 months. Fourteen patients had lung infection, including 7 mild lung infections which were improved after treatment, and 7 severe lung infections which died from respiratory failure.Other complications included secondary diabetes mellitus (4 cases), urinary tract infection (2 cases),acute renal failure (2 cases), deep venous thrombosis (3 cases), drug-induced liver damage (5 cases),polycythemia (5 cases), hepatitis C (3 cases), chronic allograft nephropathy (3 cases), and all were improved after treatment. Conclusion Comprehensive assessments of the donors and receptors before transplantation are guarantee to successful living kidney transplantation from relative donors; Living kidney transplantation from relative donors has the advantages of good matching, short ischemia period of donated kidney, less rejections and high survival rate of transplanted kidneys.

PCNL Combined with TURP for Benign Prostatic Hyperplasia Complicated with Bladder Stones / 中国微创外科杂志

Objective To explore an effective treatment for benign prostatic hyperplasia complicated with bladder stones.Methods Swiss LithoClast Master and transurethral resection of the prostate(TURP)were performed on 33 patients with benign prostatic hyperplasia complicated with bladder stones.Results The operations were completed successfully in all the cases with a mean lithoclasty time of 35 min(15-65 min),and mean TURP time of 85 min(50-110 min).No blood transfusion,TUR syndrome,bladder perforation,or residual stone occurred during and after the operations.Urethral catheter was withdrawn 5 days postoperation,none of the patients had urinary incontinence or dysuria.The diagnosis of benign prostatic hyperplasia was confirmed by pathology examination.Three months after the operations,IPSS decreased from 23.4?5.2 to 7.4?1.2(t=3.732,P=0.000);maximum urinary flow rate increased from(5.4?1.5)ml/s to(18.6?3.2)ml/s(t=2.491,P=0.015);and QOL decreased from 3.9?1.2 to 2.0?0.7(t=2.454,P=0.014).Conclusions EMS LithoClast Master combined with TURP is an effective treatment for benign prostatic hyperplasia complicated with bladder stones.