Analysis of stone composition and clinical characteristics of urinary calculi in infants in Xinjiang / 国际外科学杂志

Objective:To analyze the composition and clinical characteristics of urinary calculi in infants in Xinjiang.Methods:The clinical data of 75 infants with urinary calculi admitted to the People′s Hospital of Xinjiang Uygur Autonomous Region from January 2016 to December 2021 were retrospectively analyzed, including the general situation of the children, stone-related parameters, random urine pH value, urine culture and biochemical examination results. The serum uric acid, serum calcium, urine pH value, positive rate of urine culture, and stone length between infants with and without ammonium urate stones were compared. Measurement data conforming to normal distribution were expressed as mean ± standard deviation ( ± s), and independent sample t-test was used for inter-group comparison. Measurement data that did not conform to the normal distribution were expressed as the median (interquartile distance) [ M ( Q1, Q3)], and Mann-Whitney U test was used for comparison between groups. The Chi-square test, continuity-corrected Chi-square test or Fisher exact probability method were used for the comparison of count data. Results:The median age of infants with urinary calculi was 23.04 months, and the ratio of male to female was 3.2∶1. More than half of the infants (81.3%, 61/75) came from rural areas, 57.3% (43/75) were malnourished, 33.3% (25/75) were complicated with urinary tract infection, and 8.0% (6/75) were combined with urinary system congenital malformation. The calculi were found in 53 cases (70.67%) of kidney, 27 cases (36.0%) of ureter, 17 cases (22.67%) of urethra and 16 cases (21.33%) of bladder. The analysis of calculi composition showed that there were 44 cases (58.67%) of ammonium urate, 39 cases (52.0%) of calcium oxalate, 14 cases (18.67%) of apatite carbonate and 7 cases (9.33%) of uric acid. Kidney calculi was more common in female infants ( P=0.011). Compared with the infant group ( n=19), calcium oxalate stones were more common in the preschooler group ( n=56) ( P=0.039), but there were not statistical difference in the incidence of ammonium urate, apatite carbonate and uric acid stones. There were not statistical difference in gender, age, place of residence, nutritional status, serum uric acid, serum calcium, urine pH value, positive rate of urine culture, stone maximum diameter and incidence of bladder stones between ammonium urate group and non-ammonium urate group. Conclusions:The incidence of urinary calculi in infants is higher in boys, and the most common site of calculi is the upper urinary tract, especially in female kidney calculi. Ammonium urate is the main component of urinary calculi in infants. Calcium oxalate stones are more common in preschooler group. Infants with urinary calculi are mostly rural residents, and malnutrition and urinary tract infection are more common.

A single-center clinical study of 61 children with ammonium urate stones / 现代泌尿外科杂志

【Objective】 To analyze the clinical characteristics of children with ammonium urate stones in Xinjiang, so as to provide reference for the prevention and treatment of this disease. 【Methods】 The clinical data of all children with ammonium urate stones admitted to the People’s Hospital of Xinjiang Uygur Autonomous Region from 2016 to 2021 were retrospectively analyzed, including age, sex, body mass index, stone site, stone size, stone component, urine pH, urine culture and biochemical examination results. The serum total protein, albumin, sodium, potassium, calcium, magnesium, uric acid and urine pH were compared between the pure and mixed groups. 【Results】 A total of 61 children (31.6%) had ammonium urate stones, their average age was (4.05±3.37) years, and the male to female ratio was 2.21∶1. Among them, there were 37 cases (60.7%) of renal calculi and 50 cases (82.0%) of upper urinary calculi. The most common component of mixed ammonium urate stones was calcium oxalate, including calcium oxalate monohydrate, calcium oxalate monohydrate and calcium oxalate dihydrate. Compared with mixed type, children with pure stone type had a younger age (P=0.001) and a smaller stone size (P=0.003). Positive urine culture was detected in 14 cases (23.0%), 7 of which (50% were infected with Escherichia coli, and 11 (78.6%) with non-urease bacteria. 【Conclusion】 Non-urease bacteria are the main pathogens of urinary tract infection in children with ammonium urate stones. The incidence is higher in boys, and the most common stone location is upper urinary tract. Calcium oxalate is the most common mixed component. Pure type is more common in young children and the stones are relatively small.

Effects of electrophysiological technique combined with pelvic floor muscle training on the rapid recovery of urinary incontinence after electroresection of prostatic hyperplasia / 现代泌尿外科杂志

【Objective】 To investigate the clinical effects of electrophysiological technique combined with pelvic floor muscle training on urinary incontinence after electroresection of benign prostatic hyperplasia (BPH) based on the concept of enhanced recovery after surgery (ERAS). 【Methods】 A total of 86 patients with urinary incontinence treated with electroresection of BPH during Oct.2019 and Feb.2022 were randomly divided into control group and observation group, with 43 cases in either group. All patients received health education plus pelvic floor muscle training, and the observation group also received electrophysiological treatment. The differences in the indexes before and after treatment were compared between the two groups. 【Results】 There were no significant differences in the 1 h pad test, ICIQ-SF score, maximum urinary flow rate (Qmax), post void residual (PVR), International Prostate Symptom Score (IPSS), 24 h urinary incontinence frequency, and Urinary Incontinence Quality of Life Questionnaire Score (I-QoL) before treatment between the two groups (P>0.05). However, after treatment, Qmax and I-QoL score were significantly higher in the observation group than in the control group, while the other 5 indicators were significantly lower in the observation group than in the control group (all P<0.05). The total clinical effective rate was significantly higher in the observation group than in the control group (P<0.05). 【Conclusion】 Electrophysiological technique combined with pelvic floor muscle training can effectively improve the symptoms of urinary incontinence and promote the recovery of urinary control function, which is in line with the concept of ERAS and is worthy of further research and promotion.

Application value of dual-source CT in the component analysis of urinary calculi in children / 国际外科学杂志

Objective:To evaluate the application value of dual-source CT in detecting the components of urinary calculi in children.Methods:A retrospective analysis of 433 children treated for urinary calculi in the Urological Center, People′s Hospital of Xinjiang Uygur Autonomous Region from March 2018 to January 2021 was performed in parallel with dual-source CT examination. The data was processed by the post-processing workstation and the stone composition was analyzed. The analysis results were compared with the results of infrared spectroscopy, and the accuracy of dual-source CT analysis of stones and the predictive value of dual-source CT various measurement indexes for the types of stones were compared. The measurement data were expressed as mean±standard deviation ( Mean± SD), and the comparison of the measurement indexes of each stone type [average CT value, dual energy difference, dual energy ratio and dual energy index (DEI)] were compared by One-way Anova analysis of variance. Draw receiver operator characteristic curve and calculate the area under the curve (AVC), then evaluate the diagnostic efficacy of each index. Results:Dual-source CT detected 282 calcium oxalate stones, 238 calcium phosphate stones, 39 uric acid stones and 7 cystine stones. Compared with the results of infrared spectroscopy, the accuracy rates of dual-source for calcium oxalate stones and hydroxyapatite stones were 84.2% and 81.8%, respectively. Both uric acid stones and cystine stones were accurately detected. In addition, dual energy difference, dual energy ratio, and DEI have reliable predictive value for calcium oxalate stones and calcium phosphate stones, especially dual energy ratio and DEI, both AUC>0.75.Conclusion:Using advanced post-processing analysis methods, dual-source CT can reliably analyze the components of children′s urinary tract stones, and provide a reference for choosing personalized treatment plans.

Comparison of super-mini-percutaneous nephrolithotomy and flexible ureteroscopy for the management of upper urinary tract calculus in children / 中华泌尿外科杂志

Objective To evaluate the efficacy and safety of super-mini-percutaneous nephrolithotomy (SMP),retrograde intrarenal surge~(RIRS) for children with upper urinary tract calculus.Methods Clinical data of 85 children with upper urinary tract calculi treated by SMP or RIRS from April 2016 to June 2018 were retrospectively analyzed.Patients were divided into two groups according to operative method:group SMP and group RIRS.In group SMP:there were 38 male and 14 female patients;the mean age was (4.6 ± 2.7) years;the mean stone size was (15.2 ± 4.8) mm;17cases in left side,and 35 cases in right side;multiple stones were found in 18 cases and single stone was found in 34 cases.In group RIRS:there were 18 male and 15 female patients;the mean age was (4.6 ± 3.1) years;the mean stone size was (14.2 ±5.1)mm;9 cases in left side,and 24 cases in right side;multiple stones were found in 11 cases and single stone was found in 22 cases.No statistical significance was found between the two groups in sex,age,stone size,stone side (left/right),percentage of multiple calculi (P ＞ 0.05).Patients were evaluated with KUB radiography or CT after 1 month.The overall stone-free rate and complications of the two groups were compared.Results Group RIRS compared to group SMP showed longer operative time [(74.2 ± 31.8) min vs.(57.9±27.8)min,P =0.015],and hospital stay after operation [(4.8 ±2.8)days vs.(3.1 ±1.3) days,P =0.003].The overall stone-free rate was 90.4％ (47/52) for group SMP,and 48.5％ (16/33) for group RIRS(P ＜ 0.01).The re-treatment rate was significantly higher in group RIRS compared to group SMP[36.4％ (12/33) vs.1.9％ (1/52),P ＜ 0.01].The complication rate was 9.6 (3/52) and 27.3％ (9/33) for groups SMP and RIRS,respectively (P ＜0.05).Conclusions SMP was more effective than RIRS to obtain a better stone free rate,less complications and re-treatment rate in children with upper urinary tract renal calculus.

Clinical analysis of urine bacteria culture in children with urolithiasis / 国际外科学杂志

Objective To study the correlation between age,gender,stone size,bilateral or unilateral urinary calculi,anatomical location of calculi and the positive rate of urine culture,and to investigate the pathogenic bacteria and drug resistance in children with urolithiasis.Methods Files of patients from department of urology in People's Hospital of Xinjiang Uygur Autonomous Region from January 2013 to March 2017 were reviewed.The observed indexes included age,gender,stone size,bilateral or unilateral renal involvement,anatomical location of calculi,and the results of urine culture and drug susceptibility test.Only those patients with calculi and less than 12 years were studied.All files of patients with documented urological procedures prior to urinary tract infection occurrence were excluded from the study.CT technique was used to determine stone size and location.Collected urine samples were screened for urinary tract infection.Resets A total of 107 patients were studied.The mean age was (4.37 ±2.97) years.Seventy-four cases (69.2％) were males;33 cases(30.8％) were females.Urinary tract infection was found in 27 cases(25.2％).The most common pathogenic bacteria found on our culture plate of urinary tract infection positive patients was Escherichia coli (48.1％;13/27).Gram negative bacteria were most sensitive to imipenem (100.0％;24/24),cefoxitin (88.2％;15/17),and Piperacillin/Tazobactam (87.5％;21/24).Gram negative bacteria had a high resistance rate to ampicillin (84.2％;16/19),cefazolin (81.0％;17/21),cefuroxime (80.0％;16/20),TMP-SMX (77.3％;17/22) and ceftriaxone (73.9％;17/23) in our center.Conclusions There was no association between these parameters(age,sex,stone size,bilateral or unilateral renal involvement,and anatomical location of calculi) and positive rate of urine culture in children with urolithiasis.Escherichia coli was the most common causative agent of urinary tract infection in children with urolithiasis.Gram negative bacteria had a high resistance rate to ampicillin,cefazolin,and cefuroxime in our center.

Risk factors analysis for residual stones after MPCNL for the treatment of upper urinary calculi in pediatric patients / 重庆医学

Objective To investigate factors affecting residual stones in pediatric patients with the upper urinary calculi un ‐dergoing minimally invasive percutaneous nephrolithotomy (MPCNL ) and evaluate MPCNL curative effect before the operation . Methods A total of 240 children underwent MPCNL to remove the upper urinary calculi in People′s Hospital of Xinjiang Uygur Autonomous Region during the period of January 2009 to November 2014 were analyzed retrospectively .Pediatric patients were di‐vided into two groups by the stone‐free rate after the first operation :those who were stone‐free after the first operation (n= 202) as the control group and those who were residual stones (n= 38) as residual stones observation group .Then the clinical data were sta‐tistically analyzed and find out risk factors which lead to residual stone .Results The stone‐free rate after primary M PCNL was 84 . 2% (202/240) .Univariate analysis showed that stone size (P= 0 .001) ,stone location(P= 0 .014) and number of stones(P= 0 .005) were significant factors which could affect residual stones between the two groups ,while did not relate with gender ,age ,stone side , urinary irritation symptom ,hematuria ,renal colic ,preoperative infection and the degree of hydronephrosis (P > 0 .05) .Multivariate analysis showed that stone size(OR = 2 .593 ,95% CI :1 .228 - 5 .475) ,stone location(OR = 2 .674 ,95% CI :1 .290 - 5 .540)and num‐ber of stones(OR = 2 .397 ,95% CI :1 .145 - 5 .019)were independent predictors of the surgical outcome .Conclusion Stone size , stone location and number of stones are significant factors affecting residual stones in pediatric patients with the upper urinary cal ‐culi undergoing MPCNL .According to the the clinical features of pediatric patients ,we can chose suitable management of upper uri‐nary tract calculi .

Antibiotic prophylaxis for transrectal prostate biopsy:the value of rectal swab culture and targeted antimicrobial treatment / 国际外科学杂志

Objective To evaluate the targeted antimicrobial prophylaxis in men undergoing trans-rectal ultrasound guided prostate biopsy based on rectal swab culture results.Methods From July 2008 to April 2012 we studied differences in infectious complications in men who received targeted vs standard empirical ciprofloxacin prophylaxis before transrectal ultrasound guided prostate biopsy.All 344 patients were divided into 3 groups according to their hospital records,inculding group A:without antimicrobial prophylaxis(105 eases) ;group B:antimicrobial prophylaxis with fluoroquinolone(117 cases) ;group C:targeted prophylaxis used rectal swab cultures results(122eases).All cases received enema with diluted iodophors before biopsy.We identified men with infectious complications within 7 days after transrectal ultrasound guided prostate biopsy using the electronic medical record,following 3 conditions.Results In group A of 105 case,17 cases of fever were recorded,including prostatic abscess of 3 cases and septicemia of 1 case.Three cases of fever were occurred in group B,including 1 case of bacteremia and 1 case of prostatitis.No infectious complications were recorded in group C.Conclusions Targeted antimicrobial prophylaxis was associated with a notable decrease in the incidence of infections complications after transrectal ultrasound guided prostate biopsy,although fiuoroquinolone can provide good protective effets.

Advantage of color doppler ultrasonography guidence in mini percutaneous nephrolithotomy for pediatric patients / 国际外科学杂志

ObjectiveTo evaluate the advantages of color doppler ultrasonography guidence in mini-invasive percutaneous nephrostolithotripsy(mPCNL) for pediatric patients.MethodsFrom May 2006 to August 2011,a total of 165 pediatric cases with upper urinary stone,who were treated by mPCNL with F12-F16 access route,were respectively reviewed.All procedures were under the guidance of color doppler ultrasonography,and the pneumatic lithotripsy and/or EMS ultrasound lithotripsy were used to disintegrate the stones.ResultsIn one-stage mPCNL,The average length of the stones was ( 15.82 ±6.31 ) mm,all 165 cases were treated,during which percutaneous renal access was successfully established under color doppler ultrasound guidance and stones were fragmentated.The mean duration of renal access establishment was (11.7 ± 5.3 ) min.The one-stage stone free rate was 95.2％(157/165) with the operation time of (42.6 ± 20.1 ) min.The postoperative hemoglobin aud hematocrit decline were observed in 69.7 ％ ( 115/165 ) of the cases with the value of 2.67 g/L and 2.21％ respectively when compared with their preoperative counterpart. Infection rate related to operation was 23.03％ ( 38/165 ),which was demostrated by durative or iterative fever more than 48 hours.No perioperative bleeding was recorded,and no transfusion was required.No ease experienced perirenal organ injury.Conclusions Using color doppler ultrasound guidance during m-PCNL resulted in safe and effective therapeutic method for upper urinary stone,and can be considered as measures of choice for guidence of mPCNL in pediatric patients.