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Objective:To compare the efficacy and safety of three minimally invasive methods, transurethral rigid ureteroscopic holmium laser lithotripsy (URL), transurethral flexible ureteroscopic holmium laser lithotripsy (FURS), and percutaneous nephroscopic holmium laser lithotripsy (PCNL), in the treatment of complicated upper ureteral calculi.Methods:The clinical data of 60 patients with complex upper ureteral calculi admitted to the urology department of the Second People's Hospital of Wuhu from January 2016 to December 2018 were retrospectively analyzed.All patients were divided into three groups according to treatment methods: URL group (20 cases), FURS group (20 cases) and PCNL group (20 cases). The efficacy of the three methods was compared in terms of stone removal rate, operation time, intraoperative and postoperative bleeding, length of hospital stay and other indicators.Results:The success rate of one-time lithotripsy in the URL group was significantly lower than that in the FURS group and the PCNL group(FURS vs.URL, χ 2=5.83, P<0.05, URL vs.PCNL, χ 2=8.03, P<0.05). The operative time(FURS vs.PCNL, t=2.436, P<0.05, URL vs.PCNL, t=2.634, P<0.05), hospital stay, intraoperative and postoperative bleeding in the URL group and FURS group were significantly less than those in the PCNL group(FURS vs.PCNL, t=2.243, P<0.05, URL vs.PCNL, t=2.320, P<0.05). There were no statistically significant differences among intraoperative, postoperative infection, fever, renal colic and other complications (all P>0.05). Conclusion:FURS in the treatment of complicated upper ureteral calculi, the one-time stone removal rate is better than URL operation, compared with PCNL, the intraoperative and postoperative bleeding is significantly less than the latter, and the operative time and hospital stay are shorter than PCNL.It is suggested that FURS operation should be given priority in the treatment of complicated upper ureteral calculi.
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Objective To analyze the serious complications of transurethral resection of the prostate (TURP).Methods A retrospective study was conducted to summarize the clinical data of 1950 patients with benign prostatic hyperplasia from January 2005 to December 2014.All patients received TURP.The mean patient Age,disease course,IPSS score,PV and Qmax of 1 950 eligible patients were 71 years (54 to 87 years),7.6 years(0.5 to 15.0 years),(65.1 ±33.4)ml,25.5 ±3.9 and (8.1 ±2.6)ml/s,respectively.Intraoperative and postoperative complications were graded according to the CLASSIC and modified Clavien classifications,respectively.Serious complications were defined as grade Ⅲ or higher.Results Among the TURP procedures,99 serious complications occurred,resulting in a serious complication rate of 5.1％,Serious intraoperative and postoperative complication rates were 1.2％ (24 cases) and 3.9％ (75 cases),respectively.Serious intraoperative complications included ureteral orifice injury (3 cases),bladder explosion (4 cases),and transurethral resection syndrome (17 cases).Serious postoperative complications included massive hemorrhage (26 cases),severe dysuria (18 cases),permanent urinary incontinence (4 cases),cardio-cerebral vascular accident (5 cases),pulmonary thrombosis (3 cases),severe infection(18 cases),and death (1 case).Conclusions Serious complications may occur at any stages during TURP.Understanding the causes and characteristics of complications,strengthening the prevention and effective treatment is the key measure to reduce the incidence rates.
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Objective To investigate the clinical application value of retroperitoneal laparoscopic nephrectomy for nonfunctioning kidney.Methods Fifty-four cases of retroperitoneal laparoscopic nephrectomy for nonfunctioning kidney were reviewed,including 9 cases with nonfunctioning tuberculosis pyonephrosis,18 cases with infection nonfunctioning pyonephrosis and 27 cases of nonfunctioning hydronephrosis.Fifty-four cases were received retroperitoneal laparoscopic nephrectomy,tuberculous and infection pyonephrosis underwent laparoscopic resection surrounding adipose capsule,nonfunctioning hydronephrosis underwent laparoscopic resection by pumping water to increase the peritoneal space.Results The operation of 54 cases were perfomed successfully.None of the patient required conversion to open surgery.During the surgery,1 case showed mild extravasation of cheese-like pus induced by laceration of the kidney capsule;2 cases had injuried on the peritoneum.The mean operation time was 125 (95-230) min,the mean blood loss was 84 (50-420) ml.All patients showed primary healing of the wound,the patients were discharged from the hospital in 6 to 11 d (mean 7.5 d).After followed up for 5-27 months,none of them had long-term complication.Conclusions Retroperitoneal laparscopic nephrectomy for nonfunctioning kidney has advantages of minimal invasion,less blood loss and quicker recovery,so it is a fairly safe and effective procedure for nonfunctioning kidney.
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<p><b>OBJECTIVE</b>To study the characteristics, diagnosis,treatment and prognosis of incidental renal cell carcinoma(RCC).</p><p><b>METHODS</b>109 cases of incidental RCC treated in 20 years were analyzed retrospectively and compared with 247 cases of non-incidental RCC.</p><p><b>RESULTS</b>The age, sex and side between incidental RCC and non-incidental RCC were not significant (P > 0.05). Compared to the non-incidental RCC,the diameter of incidental RCC [(4.1 +/- 1.7) cm] was smaller and its stage was lower (P < 0.01). Ultrasonography and CT can improve the detection rate of incidental RCC significantly, and operation is more effective for incidental RCC than for non-incidental RCC (P < 0.01). The 3 and 5 year cancer specific survival rates in patients with incidental RCC were higher than those of non-incidental RCC(P < 0.01). The detection rate of incidental RCC was higher from 1990 to 1999 (39.3%) than from 1980 to 1989 (15.6%) (P < 0.01).</p><p><b>CONCLUSIONS</b>Incidental RCC is not another type of RCC, but a developing stage of RCC without appearance of a symptoms. Ultrasonography and CT are important to diagnose incidental RCC. Low pathological stage, small size, early diagnosis, and radical nephrectomy indicate better prognosis of incidental RCC.</p>