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Objective:To analyze the clinical features of ureteral calculi in elderly patients with type 2 diabetes mellitus in order to improve the diagnosis and treatment level.Methods:The clinical data of 34 ureteral calculi elderly patients with type 2 diabetes mellitus in the Second People's Hospital of Lianyungang from October 2014 to December 2018 were studied retrospectively.Insulin therapy or oral glucose-lowering drugs was accepted.The patients received one-stage treatment according to the guidelines, while the patients with severe infection received two-stage treatment.In the stage I, cystoscopic retrograde double J tube was accomplished.In the stage II, the patients received surgical treatment according to the guidelines.Results:Of the 34 cases, 15 cases were male and 19 cases were female, and the female to male ratio was 1.3.Five cases with infection were female and had long disease duration.One case with mild infection received one-stage treatment through strictly controlling the infection, 1 case with severe infection refused treatment and requested discharge from the hospital, 2 cases with severe infection received two-stage treatment, 1 case suffered infection after ureteroscopic lithotripsy(URL). Of the 12 patients received medical expulsive therapy, 9 cases were cured, while 3 cases failed.Nine patients were successfully cured by extracorporeal shock-wave lithotripsy(ESWL), 7 patients with middle-lower ureteral calculi by URL, 5 patients with upper ureteral calculi by percutaneous nephrolithotripsy(PCNL). Septicemia occurred in 1 case after URL, the others had no serious complications.Conclusion:The incidence of ureteral calculi in elderly patients with type 2 diabetes mellitus in female is gradually rising.Female and long disease duration are the risk factors for urinary tract infection.Medical expulsive therapy and surgery are safe and effective for the treatment of ureteral calculi in elderly patients with type 2 diabetes mellitus through strictly controlling the infection and blood glucose.
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Objective:To investigate the clinical features, diagnosis, treatment and prognosis of primary testicular diffuse large B-cell lymphoma (PT-DLBCL).Methods:The clinical data of 2 patients with PT-DLBCL in the Second People's Hospital of Lianyungang treated in May 2013 and April 2018 was retrospectively analyzed. The clinical features, diagnosis, treatment and prognosis of PT-DLBCL were summarized with review of these 2 cases combining with other 42 cases reported in domestic literature.Results:Case 1, a 71 years old man, complained of bilateral scrotal enlargement with pain and discomfort for 2 months. Case 2, an 85 years old man, presented with left scrotal mass for 3 months. All 2 patients underwent orchiectomy. Both of the 2 patients were diagnosed as PT-DLBCL and non-germinal center B-cell (non-GCB) subtype and had Ann Arbor stage Ⅰ E after operation. Case 1 received only 2 cycles of CHOP (cyclophosphamide, epirubicin, vincristine, prednisone) due to lack of financial support. Case 2 refused chemotherapy and right testis irradiation because of advanced age. They were followed up for 71 months and 12 months, respectively. They were both alive without recurrence at last time of the follow-up. The median age of 44 patients (2 cases in this study and 42 cases reported in the domestic literature) was 64 years old (range 45-87 years old). The most common symptom was unilateral painless testicular swelling (left testis 17 cases and right testis 24 cases). Twenty-one patients were Ann Arbor stage Ⅰ, 6 patients were stage Ⅱ, 6 patients were stage Ⅲ, and 11 patients were stage Ⅳ. Thirty-one patients were non-GCB subtype. Twelve patients were international prognostic index (IPI) score ≥3. Serum lactate dehydrogenase (LDH) level was elevated in 13 patients. All patients underwent orchiectomy. CHOP/R-CHOP chemotherapy was given to 40 patients and prophylactic radiation to contralateral testis was given to 12 patients. Twenty-two patients received prophylactic intrathecal chemotherapy. After a median follow-up of 17 months (range 3-135 months), 14 patients died and the median overall survival time was 13 months (range 3-96 months). Conclusions:PT-DLBCL is rare. Its diagnosis mainly depends on pathology, with the majority of patients diagnosed in early Ann Arbor clinical stage and non-GCB subtype. The radical orchiectomy and R-CHOP chemotherapy is recommended due to local relapse and systemic dissemination. It is curable in the early stage while patients with advanced stage have a very poor prognosis. Prophylactic radiation to contralateral testis and intrathecal chemotherapy can decrease the risk of recurrence.
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Objective@#To explore comprehensive treatment for severe infection caused by ureteral calculus.@*Methods@#The clinical data of 12 patients with severe infection caused by ureteral calculus in the Second People's Hospital of Lianyungang from January 2016 to December 2017 were reviewed.The patients cured by anti-infective therapy received one-stage surgical treatment.The patients with ineffective anti-infective therapy received one-stage cystoscopic retrograde double J tube or B ultrasound-guided percutaneous nephrostomy first, then ureteral calculus was treated.@*Results@#Two patients were cured by empirical antimicrobial agents.One patient was successfully cured by extracorporeal shock wave lithotripsy (ESWL) and the other by retroperitoneoscopic ureterolithotomy.Ten patients were not responsive to empirical antimicrobial agents.Two patients refused treatment and requested discharge from the hospital.The other 8 patients received two-stage treatment.In the stage I, cystoscopic retrograde double J tube was accomplished in 3 patients, and 5 patients were treated successfully by percutaneous nephrostomy guided by B ultrasound.In the stage II, one patient with ureter stone-street was cured by lithagogue drugs, 2 patients were successfully cured by ESWL, one patient by holmium laser lithotripsy under ureteroscope, 2 patients by ureterolithotomy and 2 patients by percutaneous nephrolithotomy by endoscopy and holmium laser.@*Conclusion@#The therapy of retrograde double J tube at cystoscopy or percutaneous nephrostomy guided by B ultrasound combined with empirical antimicrobial agents in the satae I, combined with lithotripsy according to guidelines in the stage II in treating severe infection caused by ureteral calculus have more advantage such as simple, less injury, rapid control of infection, less complication and satisfactory effect.It is an ideal method.
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Objective@#To explore the clinical features of chromophobe renal cell carcinoma(chRCC) in order to improve its diagnosis and treatment.@*Methods@#Clinical data of 8 patients with chRCC treated from July 2012 to February 2019 in the Second People′s Hospital of Lianyungang were retrospectively analyzed. There were 3 males and 5 females. Their age ranged from 34 to 71 years, with a mean age of (52.1 ± 11.2) years. All tumors were located unilaterally, with 3 cases in left kidney and 5 cases in right kidney. Five patients were asymptomatic and back pain occurred in other 3 patients. The maximum diameter of the tumor was 2.0 to 8.5 cm and the mean value was (5.6 ± 2.2) cm. Ultrasonography and CT scan were performed on all patients. Ultrasonography was mainly characterized by low echo renal mass with intact capsule and low blood flow signals. The CT appearances were typically well circumscribed and homogeneous solid mass, with mild enhanced. One case had calcification, 1 case had necrosis and cystic degeneration, and 1 case had central scar 1 case had significant enhancement. All patients underwent surgery. Five cases underwent retroperitoneal laparoscopic radical nephrectomy, 2 cases underwent open radical nephrectomy and 1 case underwent retroperitoneal laparoscopic partial nephrectomy.@*Results@#Postoperative pathologic findings confirmed the diagnosis of chRCC. The cross section of the tumors was grossly homogeneous, gray and yellow or gray and red. Immunohistochemical assay was positive of CK7 and CD117. The pathologic TNM stage of chRCC was as follows: pT1aN0M0 in 2 cases, pT1bN0M0 in 2 cases, pT1bN0M1(with bone metastasis) in 1 case and pT2N0M0 in 3 cases. All cases were followed-up. The follow-up time was 3 to 79 months, and the mean time was (26.8 ± 24.1) months. One case with bone metastasis was treated with apatinib and had pulmonary metastasis 9 months after operation and died 19 months after operation. One case had pulmonary metastasis 24 months after operation and survived up to March 2019 refusing to accept targeted therapy. Other 6 patients were followed-up without local recurrence and metastasis.@*Conclusions@#chRCC is rare and its diagnosis mainly depends on pathology without obvious clinical and preoperative imaging presentation. Nephrectomy is the common treatment for chRCC and should follow the treatment principles of renal cell carcinoma, with a favorable prognosis owing to a relatively indolent clinical behavior.
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Objective To explore the clinical features of chromophobe renal cell carcinoma (chRCC) in order to improve its diagnosis and treatment. Methods Clinical data of 8 patients with chRCC treated from July 2012 to February 2019 in the Second People′s Hospital of Lianyungang were retrospectively analyzed. There were 3 males and 5 females. Their age ranged from 34 to 71 years, with a mean age of (52.1 ± 11.2) years. All tumors were located unilaterally, with 3 cases in left kidney and 5 cases in right kidney. Five patients were asymptomatic and back pain occurred in other 3 patients. The maximum diameter of the tumor was 2.0 to 8.5 cm and the mean value was (5.6 ± 2.2) cm. Ultrasonography and CT scan were performed on all patients. Ultrasonography was mainly characterized by low echo renal mass with intact capsule and low blood flow signals. The CT appearances were typically well circumscribed and homogeneous solid mass, with mild enhanced. One case had calcification, 1 case had necrosis and cystic degeneration, and 1 case had central scar 1 case had significant enhancement. All patients underwent surgery. Five cases underwent retroperitoneal laparoscopic radical nephrectomy, 2 cases underwent open radical nephrectomy and 1 case underwent retroperitoneal laparoscopic partial nephrectomy. Results Postoperative pathologic findings confirmed the diagnosis of chRCC. The cross section of the tumors was grossly homogeneous, gray and yellow or gray and red. Immunohistochemical assay was positive of CK7 and CD117. The pathologic TNM stage of chRCC was as follows: pT1aN0M0 in 2 cases, pT1bN0M0 in 2 cases, pT1bN0M1(with bone metastasis) in 1 case and pT2N0M0 in 3 cases. All cases were followed-up. The follow-up time was 3 to 79 months, and the mean time was (26.8 ± 24.1) months. One case with bone metastasis was treated with apatinib and had pulmonary metastasis 9 months after operation and died 19 months after operation. One case had pulmonary metastasis 24 months after operation and survived up to March 2019 refusing to accept targeted therapy. Other 6 patients were followed-up without local recurrence and metastasis. Conclusions chRCC is rare and its diagnosis mainly depends on pathology without obvious clinical and preoperative imaging presentation. Nephrectomy is the common treatment for chRCC and should follow the treatment principles of renal cell carcinoma, with a favorable prognosis owing to a relatively indolent clinical behavior.
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Objective To explore comprehensive treatment for severe infection caused by ureteral calculus.Methods The clinical data of 12 patients with severe infection caused by ureteral calculus in the Second People's Hospital of Lianyungang from January 2016 to December 2017 were reviewed.The patients cured by anti-infective therapy received one-stage surgical treatment.The patients with ineffective anti-infective therapy received one-stage cystoscopic retrograde double J tube or B ultrasound-guided percutaneous nephrostomy first,then ureteral calculus was treated.Results Two patients were cured by empirical antimicrobial agents.One patient was successfully cured by extracorporeal shock wave lithotripsy (ESWL) and the other by retroperitoneoscopic ureterolithotomy.Ten patients were not responsive to emnpirical antimicrobial agents.Two patients refused treatment and requested discharge from the hospital.The other 8 patients received two-stage treatment.In the stage Ⅰ,cystoscopic retrograde double J tube was accomplished in 3 patients,and 5 patients were treated successfully by percutaneous nephrostomy guided by B ultrasound.In the stage Ⅱ,one patient with ureter stone-street was cured by lithagogue drugs,2 patients were successfully cured by ESWL,one patient by holmium laser lithotripsy under ureteroscope,2 patients by ureterolithotomy and 2 patients by percutaneous nephrolithotomy by endoscopy and holmium laser.Conclusion The therapy of retrograde double J tube at cystoscopy or percutaneous nephrostomy guided by B ultrasound combined with empirical antimicrobial agents in the satae Ⅰ,combined with lithotripsy according to guidelines in the stage Ⅱ in treating severe infection caused by ureteral calculus have more advantage such as simple,less injury,rapid control of infection,less complication and satisfactory effect.It is an ideal method.
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Objective To evaluate the clinical and pathological characteristics and treatment of penile schwannoma.Methods One case of penile schwannoma was reported,and the relevant literature was reviewed to investigate the histogenesis,diagnosis and treatment of this disease.Related literature from PubMed and Wanfang databases to date(up to April 2017)with"penis" or"penile" combined with "schwannoma" or"neurilemmoma" as search terms was reviewed.Results One 40-year-old male presented in October 2015 with a tumor at the root of the dorsal penis for 1 year.Physical examination revealed a non-tender,easily movable without adhesion to the skin,1.2cm ×0.8cm nodule at the root of the dorsal penis,the overlying skin was smooth and intact.No evidence of neurofibromatosis was found.Hypoechoic well-defined nodule(1.7cm ×0.4cm)located between the superficial skin and corpus cavernosum was showed on ultrasound without blood flow signal.Simple excision of the tumor was performed under local anesthesia.Grossly,the tumor was a well-defined,white,soft 1.5cm ×1cm ×0.7cm nodule.Microscopically,the tumor was composed of Antoni A area with hypercellular and nuclear palisading.Immunohistochemical staining showed S-100(+++),SMA(-),Act(-).The pathological diagnosis was penile schwannoma.Postoperatively,the patient recovered well without erectile dysfunction.During a follow-up 18 months,the patient had no recurrence.By literature review,we found 14 cases in Chinese articles with one malignant case,while 33 cases in English articles with six malignant cases.The average age of onset was 39.2 years.Most of the tumors are benign and located in the dorsal side of the penis.Penile schwannoma can be diagnosed properly based on pathological examination,owing to the lack of typical clinical and imaging manifestation.The tumor resection was the treatment of choice for benign penile schwannoma without postoperative complications.Conclusion Penile schwannoma is extreme rarity,but can be diagnosed properly based on postoperative pathological examination,owing to the lack of typical clinical and imaging manifestation.S-100 is a useful marker for the diagnosis of schwannoma.The tumor resection is the treatment of choice for benign penile schwannoma without erectile dysfunction or recurrence ;for the malignant,the final diagnosis relies on postoperative pathological examination after the secondary operation with local recurrence.The tumor resection combined with radiotherapy and chemotherapy is reliable treatment,but the prognosis is poor.
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Objective To evaluate the diagnosis and treatment of duplication of the renal pelvis and ureter. Methods The clinical data of 9 patients with duplication of the renal pelvis and ureter who were treated from May 2014 to January 2018 in the Second People′s Hospital of Lianyungang were retrospectively analyzed. Of the 9 cases, 1 case was male, and 8 cases were female. The age range from 6 to 68(40.4 ± 20.6) years. Three cases of duplex kidneys were on the left side, 4 cases on the right side, and 2 cases on the both side. 6 cases had imcomplete duplex systems and 3 cases had complete duplex systems. The diagnosis rate of ultrasound, intravenous urography (IVU), CT scan, magnetic resonance urography (MRU), retrograde pyelography (RPG) was 3/9, 7/8, 5/9, 0/1 and 2/2 respectively. Results One case with simple urinary tract infection was cured by antimicrobial agents, and 1 case with lower ureteral calculus was cured by lithagogue drugs. One case with renal calculus and pyonephrosis in upper moiety of duplex kidney underwent retroperitoneoscopic nephrectomy, 1 case with ureteropelvic junction obstruction and horseshoe kidney underwent division of the isthmus and pyeloplasty, and 2 cases with ureterocele underwent transurethral incision. The clinical symptoms of patients who underwent surgery were cured in all cases. Three cases without complications underwent conservative treatment, and follow-up observation showed no complications. Conclusions Duplication of the renal pelvis and ureter can be diagnosed properly based on imaging data. IVU has a significant advantage, while RPG has high specificity in difficult cases. Treatment should be individualized according to clinical symptoms, complications and other urinary tract congenital anomaly.
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Objective To compare the safety and efficacy of 1 470 nm diode laser vaporization of the prostate with transurethral resection of the prostate (TURP) in patients with benign prostatic hyperplasia (BPH).Methods From July 2014 to July 2015,82 patients diagnosed as BPH were randomly divided into two groups.Forty cases of them underwent 1 470 nm diode laser vaporization and 42 cases for TURP.The operation time,hemoglobin decrease,serum sodium decrease,bladder irrigation time,duration of bladder catheterization and postoperative complications were recorded.The international prostate symptom score (IPSS),maximum flow rate (Qmax) and post-voiding residual volume (PVR) before and after operation were compared.Results No differences were found between the two groups in basic preoperative characteristics,such as:age,prostate volume,IPSS,PVR and Qmax(P＞0.05).The mean operative time in the diode laser group was (64.8±14.6) min,slightly longer than tin he TURP group ((59.3 ± 14.5) min,P＞0.05).The hemoglobin decrease,the serum sodium decrease,the time of bladder irrigating and the time of catheterization of 1470 nm diode laser group were all less than that in TURP group,the differences were significant between the two groups((2.06±1.43) g/L vs.(6.07±1.68) g/L,(1.16±0.67) mmol/L vs.(4.09±3.78) mmol/L,(5.08±2.80) h vs.(25.8±12.7) h,(3.38±1.17) d vs.(4.88± 1.42) d,respectively;t =-11.615,-4.845,-10.337,-5.232;P＜0.001).The complications in 1470nm diode laser group were less than that in TURP group,but the differences were not significant between the two groups(P＞0.05).All patients were followed up for 3-12 months,the IPSS,PVR and Qmax of 3 months after surgery in 1 470 nm diode laser group and TURP group were all improved significantly compared with that of preoperative in both groups,but no statistical differences could be found between the two groups(IPSS:F inner grouP=527.65,P＜0.001;F between groups=0.099,P=0.753;F across groups=0.040,P=0.843,PVR:F inner grouP =509.57,P＜ 0.001;F between groups =2.817,P =0.097;F across groups =1.02,P=0.315;Qmax:inner grouP=60.06,P＜0.001;F between groups =0.30,P=0.585;F across groups =0.394,P=0.532).Conclusion 1 470 nm diode laser vaporization of the prostate can significantly improve the patient's lower urinary tract obstruction symptoms,which show similar short-term effects with TURP.It also has advantages of less bleeding,shorter catheter indwelling time and rapid postoperative recovery compared with TURP,suggesting that it is a safe and effective operation for BPH treatment.