Endoscopic treatment for ureterovesical junction stenosis in patients with kidney transplantation: 13 cases report / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the safety and efficacy of endoscopic treatment for ureterovesical junction (UVJ) stenosis in patients with kidney transplantation.@*METHODS@#A retrospective study was conducted among the patients with kidney transplantation diagnosed as UVJ stenosis from 2012 March to 2018 July in Urology and Lithotripsy Center, Peking University People's Hospital. Only the patients who received endoscopic treatment were included, with staged or same-session nephrostomy followed by a retrograde ureteroscopy to evaluate the ureteral stenosis. Incisions with laser, mono- or bipolar energy, or balloon dilation were used to manage the stenosis depending on different situations. Demographic characteristics and clinical data were gathered and analyzed, including age, gender, preoperative serum creatinine, hemoglobin, operation time, success rate, postoperative serum creatinine, hemoglobin, postoperative complications rate, and long-term stenosis recurrence rate.@*RESULTS@#In this study, 13 patients were included (9 males and 4 females). All the UVJ stenoses were diagnosed with preoperative ultrasound, CT scan, MRI, or urethrography. The mean age was 45 years (range 34-57 years). The mean preoperative serum creatinine was 243 μmol/L. Four patients developed UVJ stenosis 1 month after kidney transplantation, while the rest developed long-term stenosis. Fifteen operations were performed in all, of which 14 cases were successful while one failed. The first 8 cases received first-stage nephrostomy and second-stage endoscopic management of the stenosis, while the last 7 cases received the same session surgery. The mean operation time was 95.4 min vs. 68.9 min, and the immediate success rate was 87.5% vs. 100.0% in the first 8 cases and last 7 cases, respectively. The mean decrease of postoperative hemoglobin was 0.6 g/L and mean postoperative serum creatinine was 105 μmol/L. No postoperative fever, severe hematuria, and urine leak were observed. The mean postoperative hospital stay was 2.8 days. Three patients were able to remove ureteral stents and no recurrence was found with a follow-up time of 9, 17, and 82 months. The long-term stenosis recurrence rate was 76.9% (10/13).@*CONCLUSION@#Endoscopic approach for the treatment of UVJ stenosis in patients with kidney transplantation was safe and efficient in our study cohort. However, long term stenosis recurrence rate was high and needed to be paid attention to.

Treatment of crossing vessels in laparoscopic pyeloplasty / 北京大学学报(医学版)

OBJECTIVE@#To investigate the management of crossing vessels compression in laparoscopic pyeloplasty.@*METHODS@#From January 2016 to June 2018, a total of 21 patients who were admitted to Peking University People's Hospital with ureteropelvic junction obstruction (UPJO) associated with crossing vascular compression were reviewed. There were 15 males and 6 females who formed this group, with a mean age of (33.9±15.0) years. There were 4 cases of mild hydronephrosis, 12 cases of moderate hydronephrosis and 5 cases of severe hydronephrosis before operation. All the patients underwent laparoscopic pyeloplasty in our hospital, including 13 on the left and 8 on the right. Laparoscopic pyeloplasty (Anderson-Hynes) were performed in all the patients. Hem-o-lok suspension (14 cases in the suspension group) or translocation of the crossing vessels (7 cases in the translocation group) were used for the intraoperative management of the crossing vessels. Double J tubes were removed 8 weeks postoperatively. The patient demographic data were collected (including operation time, treatment time of crossing vessels, intraoperative blood loss, time of drainage tube removal after operation, and average length of hospital stay), postoperative outcomes were evaluated and the patients were followed up regularly.@*RESULTS@#In all the patients, the crossing vessels were successfully reserved, and none of them were ligated intra-operatively. Mean operative times were (202.2±57.0) min. The duration of intraoperative treatment of crossing vessels was (10.5±3.2) min, (6.1±2.0) min in the suspension group, and (13.7±5.2) min in the translocation group, respectively. Intraoperative blood loss was (47.8±25.6) mL, postoperative drainage time was (4.8±2.6) d, and length of hospital stay was (11.5±3.3) d. Postoperative slight urinary leakage occurred in 1 case. Preoperative pyelectasis of the affected side of all the patients was (3.4±1.7) cm, compared with postoperative pyelectasis of (1.9±1.3) cm. The difference was statistically significant (P<0.05). Postoperative follow-up of all the patients was carried out until December 2018. There was no significant difference in kidney size in all the patients before or after the operations, and hydronephrosis was alleviated compared with that before surgery.@*CONCLUSION@#For UPJO patients with crossing vascular compression, according to the location of the crossing vessels, Hem-o-lok suspension or vessel transposition can be adopted to relieve the crossing vascular compression and improve the success rate of the surgery.

Assessment of injury to the pancreas,the abdominal tissues and organs of swine in vivo by high intensity focused ultrasound combined with radiotherapy / 中华医学超声杂志（电子版）

Objective To observe the injury of high intensity focused ultrasound combined with radiotherapy (RT) to the pancreas,the unintended abdominal tissues and organs of swine in vivo.MethodsAccording to the criterion to grade the gross and histological injury of the pancreas and the unintended tissue,the scores of injury between the groups to get the data of safety and feasibility of high intensity focused ultrasound(HIFU)combined with RT were compared.Results There was a better tolerance in each group and no fatal complication was observed.For the pancreas there was significant difference for the combined group compared with the other groups.For the unintended target tissue there was no significance difference except the control group with the other groups.Conclusion HIFU combined with RT can increase the injury to the pancreas of the swine compared with HIFU alone; while there was no increase for the injury to the unintended target tissue.The main toxicity of combination treatment is the toxicity of RT and can be tolerated by the animals.If the HIFU treatment is strictly controlled,the combination of HIFU and RT is safe and feasible.

Analysis and clinical implication of upper urinary tract stone's bacterial spectrum / 中华外科杂志

<p><b>OBJECTIVES</b>To analyze the pathogenic bacterial's distribution and the drug resistance in the upper urinary tract stones, and to provide the information for choosing suitable antibiotics.</p><p><b>METHODS</b>Stone samples were taken for culture and for drug sensitivity test in 146 patients undergoing percutaneous nephrolithotomy between April 2007 and October 2008, and the results were analyzed.</p><p><b>RESULTS</b>Pathogens presented in 72 (49.3%) patients. There were 70 (86.4%) Gram-negative bacteria strains. Escherichia coli, Pseudomonas aeruginosa and Enterobacter cloacae were the predominant bacteria, accounted for 30.9%(25 strains), 23.5% (19 strains) and 12.3% (10 strains), respectively. There were 10 (12.3%) Gram-positive bacteria strains, the predominant bacteria was Staphylococcus epidermidis (6 strains), accounting for 7.4%. And there was 1 fungi strain (1.2%). Resistance to ampicillin/sulbactam (88.7%), ceftriaxone (81.3%) and ciprofloxacin (67.5%) was most commonly found in pathogen, and the rate of resistance to amikacin, imipenem and piperacillin/tazobactam were 8.6%, 10.0%, 10.0%, respectively. Erythromycylamine, teicoplanin, SMZ-TMP, nitrofurantoin were sensitive to Gram-positive bacteria.</p><p><b>CONCLUSIONS</b>Bacterial's distribution of upper urinary tract stones are multiple, and the majority pathogen is Gram-negative bacteria. A big variant resistance is found among different bacterium. The suitable antibiotics should be chosen according to the different bacterium in the patients who underwent percutaneous nephrolithotomy.</p>