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Purpose@#Transcutaneous electrical neural stimulation (TENS), as a non-invasive modality, has been clinically used as an alternative treatment for children with overactive bladder (OAB). We conducted a pooled analysis to explore the effect of TENS on OAB. @*Methods@#The Preferred Reporting Items for Systematic Reviews and Meta-analysis guideline was followed in this study. The MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases, as well as the reference lists of the retrieved studies, were used to find trials relevant for assessing the use of TENS to treat OAB. @*Results@#Of the 246 records identified, 8 publications were analyzed in our study. Our analysis found that TENS resulted in a greater decrease of wet days/wk, daily voiding frequency, daily incontinence episodes, and daily number of voids than was observed in the control group. Furthermore, TENS-treated patients showed similar visual analogue scale (VAS) scores to patients in the control group, demonstrating that the application of TENS did not increase patients’ discomfort and pain. TENS had a relative advantage in the number of partial responses, but no clear differences were found in frequency of no response or a full response compared to the control group. In urodynamic testing, TENS led to obvious improvements in average voided volume and maximum voided volume in children with OAB. @*Conclusions@#TENS had a remarkable effect on the improvement of urodynamic indexes and objective OAB symptoms without a significant increase in VAS scores for children with OAB.
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Objective To explore the feasibility and clinical significance of individualized formular administration of tacrolimus after renal transplantation based on the CYP3A5 and MDR1 gene polymorphism.Methods Total 129 renal transplantation recipients from Oct.1,2015 to July 30,2016 were included in this study and divided into 2 groups.In experimental group,tacrolimus was administrated by the individualized formula based on CYP3A5 and MDR1 gene polymorphism;in control group,tacrolimus was administrated by doctors' experience based on patient's body weight.The blood trough level of tacrolimus was determined 3 days after administration.The first blood trough level of tacrolimus,plasma creatinine level,acute rejection rate,and necessity for dialysis were compared between two groups.Results The first blood trough levels of tacrolimus in experimental and control groups were 9.24 ± 2.32 and 9.39 ± 3.47μg/L respectively (P＞0.05).The tacrolimus levels of 7 cases in experimental group and 18 cases in control group were not in normal range (P＜0.05).The plasma creatinine level at day 7 after surgery was 157.36 ± 110.55 μg/L in experimental group,and 174.01 ± 130.68μg/L in control group (P＞0.05).Acute rejection was found in both two groups:2 in experimental group and 5 in control group (P ＞ 0.05).There was significant difference in necessity for dialysis between two groups:4 in experimental group and 10 in control group (P＜0.05).Conclusion The individualized formular administration of tacrolimus based on the CYP3A5 and MDR1 gene polymorphism is more feasible and reasonable than experimental administration,which is more easier to come to an appropriate blood level and would benefit the early recovery of renal function.
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PURPOSE: We performed a meta-analysis to evaluate the efficacy and safety of mirabegron add-on therapy to solifenacin for patients with overactive bladder (OAB). METHODS: We conducted a systematic literature review to identify all randomized, double-blind, controlled trials (RCTs) of this combination (mirabegron and solifenacin) for OAB. Embase, MEDLINE, and the Cochrane Central Register of Controlled Trials were searched. A manual search was also performed to investigate relevant references from the retrieved studies. RESULTS: Four publications describing 5 RCTs that compared combination therapy with solifenacin, including a total of 3,309 patients, were analyzed. The mean number of micturitions per 24 hours (mean difference [MD], -0.45; 95% confidence interval [CI], -0.65 to -0.26; P < 0.00001), number of episodes of incontinence per 24 hours (MD, -0.71; 95% CI, -0.14 to -0.02; P=0.04), volume voided per micturition, and number of urgency episodes per 24 hours demonstrated that combination therapy was more effective than solifenacin therapy alone. Safety assessments, including common treatment-emergent adverse events (odds ratio, 1.09; 95% CI, 0.95–1.27; P=0.23) and discontinuations due to adverse events (P=0.30), demonstrated that the combination therapy was well tolerated. CONCLUSIONS: This meta-analysis suggests that mirabegron therapy as an add-on to solifenacin provides a satisfactory therapeutic effect for OAB symptoms with a low occurrence of side effects.
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Humans , Solifenacin Succinate , Urinary Bladder, Overactive , UrinationABSTRACT
PURPOSE: OnabotulinumtoxinA is used widely for the treatment of neurogenic detrusor overactivity. We conducted a systematic review and meta-analysis to assess its efficacy and safety for neurogenic detrusor overactivity treatment. METHODS: A systematic literature review was performed to identify all published randomized double-blind, placebo-controlled trials of onabotulinumtoxinA for neurogenic detrusor overactivity treatment. MEDLINE, Embase, and the CENTRAL were employed. Reference lists of retrieved studies were reviewed carefully. RESULTS: Six publications involving 871 patients, which compared onabotulinumtoxinA with a placebo were analyzed. Efficacy of onabotulinumtoxinA treatment was shown as a reduction of the mean number of urinary incontinence episodes per day (mean difference, -1.41; 95% confidence interval [CI], -1.70 to -1.12; P<0.00001), maximum cystometric capacity (135.48; 95% CI, 118.22–152.75; P<0.00001), and maximum detrusor pressure (-32.98; 95% CI, -37.33 to -28.62; P<0.00001). Assessment of adverse events revealed that complications due to onabotulinumtoxinA injection were localized primarily to the urinary tract. CONCLUSIONS: This meta-analysis suggests that onabotulinumtoxinA is an effective treatment for neurogenic detrusor overactivity with localized advent events.
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Humans , Urinary Incontinence , Urinary TractABSTRACT
Objective To investigate the clinical features of multiple primary malignancies ( MPM) in patients with kidney malignancy .Methods The clinical data of 111 patients suffered from MPM associated with kidney malignant tumor in Yantai Yuhuangding Hospital and Affiliated Yantai Hospital of Binzhou Medical College from April 1984 to December 2014 were retrospectively analyzed .Results Among the 111 cases,there were 100 cases with two primary malignancies ,9 with three cancers and 2 cases with four or five cancers.Synchronous MPM were 37 cases,and metachronous 74 cases.The interval between the first and the second primary malignancy was between 0 and 348 months,with average of 46 months and median of 16 months.One hundred and seventy-two cases were treated by operation , and 64 cases by conservative therapy.The proportion of operation from the first to the fifth cancers were 89.2%(99/111),59.5%(66/111),54.5%(6/11),50.0%(1/2),0%(0/1),respectively,with the trend of declining.Finally 95 cases (85.6%) were followed up ,with 53 cases survived and 42 cases died.From the diagnostic date of the first primary cancer,overall survival in 1 year,3 years,5 years,10 years were 97.2%,77.2%,67.8%,48.4%, respectively.Median survival time was 120 months.From the diagnostic date of the last primary cancer , overall survival in 1 year,3 years,5 years were 81.4%,53.4%,48.2%,respectively.Median survival was only 48 months.Univariate analysis showed that the cumulative survival rate was higher in patients with operation than conservative therapy ( P =0.000 ) , in metachronous group than synchronous group ( P =0.009).COX proportional hazard model showed metachronous MPM (OR=3.870,95%CI 1.702-8.801,P=0.001),aggressive operation of the first primary cancer (OR=0.107,95%CI 0.018-0.647,P=0.015) and the second cancer (OR=0.313,95%CI 0.131 -0.750, P=0.009) were independent prognostic factors. Conclusions The main treatment of MPM associated with kidney malignancy is aggressive operation, radiotherapy, chemotherapy and biological therapy are adjuvant .Early detection and early operation for MPM are beneficial for increasing the survival of the patients .
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Objective To evaluate the clinical efficacy of retroperitoneal laparoscopic nephroureterectomy (RLNU) combined with transurethral electric coagulation on upper urinary tract urothelial carcinoma (UUTUC).Methods Sixty UUTUC patients were enrolled from Jun.2012 to Apr.2013.The prospective clinical controlled analysis method was adopted in this study.All patients were divided into test group and control group according to the order of admission.Thirty cases (test group) underwent RLNU combined with electric coagulation,and 30 cases (control group) underwent RLNU combined with electric resection.The differences in operation time,blood loss,hospital stay and tumor recurrence rate between the 2 groups were compared.Results All the 60 operations for UUTUC were successful without conversion to open surgery.No intraoperative complications such as great vessels or surrounding organs damage occurred.There were 2 cases loss to follow-up in test group and 3 cases in control group.There were no significant differences in operation time,blood loss,follow-up time,tumor stage and tumor grade between the 2 groups.The hospital stay in the test group was shorter (5.5±2.0 d versus 7.1±2.2 d),the tumor recurrence rate was lower [4％ (1/28) versus 30％ (8/27)],and the differences were significant (P＜0.05).Conclusion Compared with RLNU combined with transurethral electric resection,RLNU combined with electric coagulation has advantages of shorter hospital stay and lower tumor recurrence rate.
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Objective To evaluate the application of inguinal incision in retroperitoneal laparoscopic nephroureterectomy(LNU)in the treatment of upper urinary urothelial carcinoma(UUUC).Methods From Mar.2007 to Jan.2012,186 retroperitoneal LNU procedures on 115 males and 71 females for the treatment of UUUC were performed in our institute.All cases were grouped as inguinal incision group(n =112)and lumbar incision group(n =74)according to specimen retrieval incision.Operative time,estimated blood loss,postoperative analgesia,hospital stay,incision complications,cosmetic satisfaction and tumor recurrence were compared between the 2 groups.Results All the 186 cases of operation were successfully accomplished.There were no differences in tumor stage,tumor grade,mean operative time,blood loss between the 2 groups.In inguinal incision group,the incidence of incision fat liquefaction,incision hernia,incision bulging,lumboabdominal unsymmetry and postoperative analgesia was less than that of lumbar incision group.In inguinal incision group,the mean hospital stay was shorter,cosmetic satisfaction(Ⅰ/Ⅱ/Ⅲ)was better(7/24/81 versus 22/18/34,P ＜ 0.01).Recurrence rate of UUUC in middle and inferior segment of ureter was fewer than that of lumbar incision group(5.3％ versus 35.0％,P ＜0.01).Conclusion Retroperitoneal LNU for UUUC combined with inguinal incision offers advantage of less trauma,less complications,higher cosmetic satisfaction and lower tumor recurrence.
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ObjectiveTo investigate the clinical outcome of laparoscopic nephroureterectomy (LUNT) for native upper tract urothelial carcinoma (UC) in renal transplant (RT) recipients.Methods We conducted a retrospective analysis on 1130 RT recipients,and 9 patients (0.8％,9/1130) with native upper tract UC were identified. UC was confirmed pathologically in the 9 patients,including 3 cases of unilateral ureter tumor (2 on the right,and 1 on the left),4 cases of unilateral renal pelvis tumor (2 on the right,2 on the left),1 case of bilateral ureter tumor and 1 case of tumor in the right ureter and left kidney.Females predominated (8/9) in the 9 patients with upper tract UC.The patients with left upper urinary tract cancer underwent LUNT using a retroperitoneal approach with a technique of transurethral circumcision of the ureteral orifice.The patients with right upper urinary tract cancer were subjected to nephroureterctomy with ureterectomy and bladder cuff excision by complete laparascopy through a transperitoneal approach. Immunosuppressive protocol conversion from calcineurin inhibitors to sirolimus was performed on all cases. Results In the 9 patients,11 LUNTs were performed successfully without conversion to open surgery.The follow-up period was from 6 to 48 months. One patient died of lung metastasis at 8th month after tumor excision,and 1 patient displayed ductal cancer of the left breast at 7th month after LNUT.Another seven patients showed no evidence of disease during the follow-up period with normal renal function.ConclusionOur present clinical experience suggested that LNUT for the native upper tract cancer in renal transplant recipients is feasible,safe,and effective.
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Objective To demonstrate the efficacy and safety of Hangzhou tacrolimus capsule(Saishi Tac capsule, Hangzhou Zhongmei Huadong Pharmaceutical Co. Ltd, China) in Chinese kidney transplant recipients. Methods Multicenter, randomized open-labeled, prospective controlled clinical trial was performed in de novo Chinese kidney transplant recipients. According to including and excluding criterions, 65 kidney recipients from 9 transplant centers were enrolled. The mean age of recipients was (36.53 ± 5.71 ) years, and 8 received living donor transplantion. The time of cold ischemia and warm ischemia was (4.08 ± 5.43) h and (3.90 ± 2.15) min respectively. The number of mismatched HLA was (2.1 ± 0.8). The recipients accepted Saishi Tac capsule + mycophenolate steroid 60 days, followed by 5-10 μg/L until the terminal observation time point (12 weeks after transplantation). The efficacy and safety were estimated during the period. The primary efficacy endpoint of the study was the incidence of biopsy-confirmed acute rejection. Graft survival and renal function (evaluated by serum creatinine) were the secondary endpoints. Safety was assessed by monitoring laboratory parameters and adverse events reported over the course of the study, such as infection, hepatic damage, hypertension, hyperlipema, diabetes mellitus and other adverse affairs.Results The dose of Tac at 1 st, 2nd, 4th and 8th week postoperation was (6.54 ± 1.69), (6.39 ±1.45),(6.73± 1.25), (6.25 ± 1.02) and (6.03 ± 1.16) mg, corresponding values to the C0 were (8.24±2.09),(9.39± 1.35),(9.93± 1.87),(7.23± 1.16) and (6.43± 1.26) μg/L. During 12weeks of follow-up, the incidence of biopsy-confirmed acute rejection was 12.3% (8/65), among which 6 cases were reversed by implosive therapy. The survival rate of graft kidney was 96.9% (63/65). The incidence of hypertension and hepatic damage was both 7.7% and morbidity of lung infection was 7.6%. There were 3 patients (4.6%) complicated with hyperlipema and diabetes mellitus respectively. Conclusion During the first 3 months of treatment Saishi Tac capsule was safe and effective to Chinese kidney transplant recipients.
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Objective To evaluate the operative techniques and the methods of the renal function protection in laparoscopic nephron sparing surgery for the treatment of renal tumors.Methods Thirty-six renal tumor patients accepted transperitoneal laparoscopic partial nephrectomy at the 70 degree lateral decubitus position.There were 17 tumors in the upper pole,13 in the lower pole and 6 in the center of kindey.The mean tumor diameter was 2.6 cm(from 0.8 to 4.0 cm).Peke forceps were used to clamp the renal artery and achieve warm ischemia.Cold scissors was used to resect tumors and Hem-o-lok was used to clamp and control the artery bleeding in surgical bed instead of ligature when suturing the kidney parenchyma.Ulinastatin was used to prevent and relieve the ischemical reperfusion injury.The operative time,estimated blood loss,warm ischemia time,intraoperative and postoperative complications and the operative efficacy were recorded.Results All operations were completed successfully,no case was converted to open surgery.The mean operative time was 128 min(95 to 186 min),mean estimated blood loss was 130 ml (40 to 600 ml),mean warm ischemia time was 21 min(16to 28 min).There was no hemorrhage and urinary leakage after surgery.The post-operative renal function was normal in all the cases.The histopathological examination showed that 36 cases were renal cell carcinoma including 31 pT1a,cases and 5 pT1b cases.There was no positive surgical margin.The mean follow-up time was 16 months (from 6 to 30 months).There was no recurrence and metastasis found and renal function was normal in all cases during the follow-up.Conclusions Laparoscopic nephron sparing surgery for renal tumors is a safe and feasible treatment option.This procedure can resect tumor safely and preserve renal function efficiently.The use of Hem-o-lok instead of ligature can significantly reduce the operative time.Ulinastatin can help reducing the ischemical reperfusion injury and thus preserve renal function.
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Objective To evaluate the efficacy and safety of percutaneous nephrolithotomy (PCNL) under ultrasonic guidance for the treatment of upper urinary calculus. Methods From June 2004 to July 2009, 1289 patients with upper urinary tract calculi were treated with PCNL under ultrasonic guidance, 386 cases of them were upper ureteral calculi, 463 cases were single renal calculi,355 cases were multiple renal caculi, 85 cases were staghorn calculi. Calculus size was 0.8 cm× 1.2cm-9.0 cm× 5.3 cm,mean 2. 1 cm× 3.1 cm. Nine hunderd and thirty-five cases were with hydronephrosis. Results All patients were performed PCNL successfully, without conversion to open surgery or death. Mean operation time was 90(55-220)min, mean operative blood loss was 175(60-800)ml. Thirty-one cases were given blood transfusion during operation or post operation, 14 cases were given super-selective renal artery embolism for bleeding control. 1105 cases were treated with single tract, 108 cases with double tracts, 76 cases with three tracts. Calculus clearance rate of onestage PCNL was 85.03%(1096/1289);193 cases were found with residual calculi, 67 of them were given extracorporeal shock-wave lithotripsy, 126 of them were given two-stage PCNL, calculi were removed complelety in 85 cases. Total calculus clearance rate was 91.62%(1181/1289). Conclusions PCNL under ultrasonic guidance is an effective and safe method for the treatment of upper urinary calculus with advantages of accurate positioning, high calculus clearance rate, minimal trauma, and fewer complications. The key of successful PCNL is selection of patients, grasp of operation technique, and availability of other equipements.
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ObjectiveTo evaluate the efficacy and safety of domestic taerolimus in the manage-ment of acute rejection in renal transplantation reeipienta.MethodsA multieeneter, open and com-parative study for domestic Taerolimua and Prograf was performed. Eighty reeipienta of first allogenie renal transplantation were randomized into 2 groups: ①Experimental group (accepting Fumeixin ad-ministration, n=58) included 23 males and 35 females with the mean age of(39.1±9.6)years. ②Control group(accepting Prograf administration, n=22) included 12 males and 10 females with the mean age of(41.34±8.5)years. There was no significant difference in the volume, warm and cold is-chemia time of donor renal, age and sex of donor. All of the 80 cases accepted tacrolimus (domestic or foreign made, at the dose of 0. 10～0. 15 mg·kg-1·d-1 , q 12 h) treatment that combined with MMF and prednisone posttransplantation. Tacrolimus CO was aimed to 8-12 ng/ml in the first 60 days and 5-10 ng/ml later. The dose of MMF was according to the rule of each transplantation center based on the following recommendation: 1.5-2.0 g/d for the weight above 70 kg, 1.5 g/d for the weight 50-69 kg, and 1.0 g/d for the weight below 49 kg, in two divided doses. Prednisone was ad- ministrated as per ruler of each center. ResultsObservation termination was 3 months. Morbility of actue rejection was 3.40% (2/58)and 13.6% (3/22) in experimental and control group(P>0.05). Ad-verse events including hypertension, hyperlipemia, hyperglycemia and slight abnormality of liver func-tion occurred in 36. 2%(21/58) and 36. 4% (8/22) cases of experimental and control group(P> 0. 05). The survival rate in the 2 groups was 100%. The dose of tacrolimus in experimental group was significantly lower than that in the control group at 8 and 12 weeks posttransplant, while drug valley concentration in serum was proximal in 2 groups during the whole observation period.Conclusion Domestic tacrolimus capsules can be used effectively and safely in the management of acute rejection in renal transplantation.
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Objective To compare the safety of laparoscopic live donor nephreetomy(LDN) and open live donor nephrectomy(ODN), evaluate the kidney function and blood pressure of living donors during 1 year follow-up. Methods Thirty cases of LDN and 30 eases of ODN were retrospectively reviewed. The operation time, warm ischemia time, operative blood loss, time to post-operative intake and time to ambulation of the 2 grouups were compared. According to the modified Clavien classifica-tion system procedure-related complications were described and compared. Serum creatinine(SCr) le-vels, blood pressure and 24-h urine protein excretion were measured before nephreetomy and 1 d, 7 d, 3 months, 6 and 12 months after nephrectomy. Glomerular filtration rate (GFR) were measured preo-pratively and at 6 and 12 months postoperatively. These data were statistically analyzed. Results The operation time was (98. 6+13. 6)rain and (96.3+19. 5)rain in the LDN and ODN groups, re- spectively. Warm ischemia time in the LDN group was (90.6±15.1)s, in the ODN group was (86.4±12.3)s. Operative blood loss was (105.2±634.8)ml and (206.3±126.4)ml in the LDN and ODN groups(P<0.01). For the time to post-operative intake and time to ambulation, LDN group was (28.5±2.9)h and (25.8±63.8)h, ODN group was (38.6±63.3)h and (36.5±65.3)h(P<0.01). Perioperative complications rates were 6.6%(2/30) and 23.3%(7/30) for LDN and ODN, respective-ly. SCr was (109.1±7.5), (105.4±69.5), (96.6±10.7), (89.4±11.5), (91.6±69.3)/zmol/L in the LDN group and (107.3±69.6), (103.3±68.4), (95.4±69.1), (90.5±13.6), (90.3±11.7)μmol/L in the ODN group 1 day, 7 days, 3 months, 6 months and 12 months after nephrectomy. The mean GFR of LDN and ODN was 64.7 and 65.8 ml/min at 6 months after nephrectomy, 65.9 and 67.5 ml/min at 12 months postoperatively, which were significantly different comparing with preoperative mean GFR in each group(P<0.05) but no significant difference was found between 6 months and 12 months after nephrectomy and between the 2 groups at the same time point respectively(P>0.05). Mean 24 h protein excretion was elevated after either LDN or ODN during 1 year followup, but was not significantly different either between predonation and 1 year after nephrectomy or between the 2 groups at the same period. Blood pressure increased or decreased slightly with the duration of follow-up,no significant blood presure changes were found before and after nephrectomy or between the two groups at the same period postoperatively. Conclusions LDN has the advantages of minimal trauma, less operative blood loss and quicker convalescence. It is safe and and has no adverse effects regarding kidney function and blood pressure during the first year after living kidney donation comparing to ODN.
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Objective To analyze the different approaches and their indications in the laparo-scopic treatment of upper urinary tract transitional cell carcinoma. Methods 94 patients with upper urinary tract transitional cell carcinoma were divided to two groups. Group A (63 cases) with renal pelvic and ugper ureteral carcinoma were treated with retroperitoneal approach laparoscopic surgery and transurethral reseetoscope surgery. Group B (31 cases) with middle ureteral carcinoma including 6 cases with ureteral local infiltration were treated through 70° recumbent position transperitoneal ap-proach laparoscopic surgery combined with bladder cuff resection. The operative time, blood loss, the intestinal functional recovery time and post-operative complications were recorded. Results All 94 procedures were successfully completed, with no complication during the surgery. The mean operation time of A and B group was 156.5 and 160.8 min;the mean blood loss was 80 and 86 ml; the mean hos-pital stay was 8 and 8. 5 d; the time of bowel functional recovery of group A and group B was 24-48 and 24-72 h, respectively. 84 cases were followed-up with mean follow-up time of 23 months. Three eases and 5 cases were found having bladder tumor in the group A and group B. The incision and port metastasis was not found. Conclusions It is safe and feasible to treat the upper urinary tract transi-tional cell carcinoma laparoscopically. The selection of operating approach is mainly based on the loca-tion and local infiltration status of the tumor.
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Objective To evaluate the outcome and the feasibility of retroperitoneal laparoscopic total nephroureterectomy with resectoscopic excision of bladder cuff for upper urinary tract transitional cell carcinoma.Methods A total of 83 patients with upper urinary tract transitional cell carcinoma underwent retroperitoneal laparoscopic total nephroureterectomy with resectoscopic excision of bladder cuff from March 2003 to July 2006.The bladder cuff was transurethrally resected for 1.5 cm in circumference from the ureteric orifice.Then the total nephroureterectomy was performed laparoscopically through retroperitoneal approach.Intraurethral catheter was indwelled for 7 days postoperatively.Adjuvant radiotherapy was given in 11 patients.Results The operation was successfully completed in all the 83 patients.The operation time was 115-205 min(mean,156 min),the intraoperative estimated blood loss was 50-150 ml(mean,80 ml),and the postoperative hospital stay was 7-11 d(mean,8.5 d).Follow-up examinations were conducted for 3-38 months(mean,10.8 months).Pathological findings revealed transitional cell carcinoma in 82 patients and moderate-to-severe atypical hyperplasia of the renal pelvis epithelium in 1 patient.Cystoscopic examinations within 12 months postoperatively found bladder tumors in 6 patients,5 of whom underwent transurethral resection of tumor and 1 of whom was given laparoscopic en bloc cystectomy with left cutaneous ureterostomy.Liver metastasis was found in 2 patients with tumor of renal pelvis(pT3G3 and pT2G3)3 months after operation.Local recurrence and lung metastasis was found in 2 patients with tumor in middle segment of the ureter(pT3G3 and pT3G2-3)6 months after operation.Bone metastasis was found in 1 patient with tumor in lower segment of the ureter(pT3G3)6 months after operation.There was 1 case of loss to follow-up,while in the remaining 71 cases no recurrence or metastasis was seen.Conclusions Retroperitoneal laparoscopic total nephroureterectomy with resectoscopic excision of bladder cuff appears to be a technically feasible operation for upper urinary tract transitional cell carcinoma,which is worthy of clinical application.
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Objective To discuss a modified laparoscopic pyeloplasty. Methods A total of 32 patients presenting ureteropelvic junction obstruction underwent a modified laparoscopic pyeloplasty which included the dissection of the ureteropelvic junction under laparoscope and the pyeloplasty through an extended trocar-incision 2.5~3 cm in length as open surgery did. Results The operation was successfully completed in all the 32 patients.Intraoperative findings demonstrated renal inferior polar compression by ectopic blood vessels in 1 patient and primary ureteropelvic stricture in 31 patients.The operative time was 40~70 min(mean,52 min) and the intraoperative blood loss was 20~30 ml(mean,23 ml).No surgery-related complications were observed.Follow-up checkups in 27 patients for 7~15 months(mean,9.6 months) showed disappearance of lumbar distending pain.Intravenous pyelography revealed no anastomotic obstruction.In 17 patients presenting the separation of the renal collective system,(B-ultrasonography) revealed a decrease from 2.0~4.2 cm(mean,2.8 cm) preoperatively to 1.0~2.3 cm(mean,1.5 cm) postoperatively.Conclusions The modified laparoscopic pyeloplasty simplifies the operation performance and shortens the operation time.
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Objective To investigate the techniques and effects of percutaneous nephroscopic pneumatic and ultrasoud lithotripsy for complicated renal calculi.Methods Under the guidance of B-ultrasonography,a F_(24) working channel for percutaneous nephroscopy was established.Renal stones were fragmented and extracted under a F_(20.8) nephroscope by using the LithoClast Master(EMS,Switzerland).Results The time for unilateral complete stone clearance was 5~115 min(mean,35 min).All the stones were successfully fragmented and the stone clearance rate was 91.8%(45/49).The renal fistulization tube was removed at 4~6 days after operation and the urethral catheter was removed 2 days afterwards.The double-J tube was removed at 1 month after operation.The postoperative hospital stay was 4~6 days(mean,8 days).Residual stones
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To investigate the expression of CD151 in human atherosclerosed artery and explore its clinical implications, Western blot and immunohistochemical techniques were used to determine the protein expression of CD151 in arterial tissues with atherosclerosis taken from 36 patients, including 26 cases who received bypass operation for peripheral artery atherosclerosis and 6 cases who died from coronary heart disease. The expression of CD151 in normal artery tissues from 15 healthy organ donators were also measured to serve as control. The results showed that expression of CD151 protein in atherosclerotic arteries was significantly higher than that in normal artery. In ath erosclerotic arteries, CD151 expression was localized in vascular smooth muscle cells (VSMCs) in all tunica media and in partial subintima, while in normal artery, sparse expression was found in tunica media near adventitia. It is concluded that high CD151 protein expression in artery is associated with atherosclerosis and CD151 plays an important role in the atherosclerosis related to VSMC. The expression of CD151 in human atherosclerotic artery depends on the extent of atherosclerotic dam age, it's independent of risk factors.
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5 cm in diameter)were enrolled in this study.Aomong the patients,17 underwent RLRN,and 14 patients received open radical nephrectomy(ORN).The outcomes of the two groups were compared.Results In both the groups,the operations were completed.The blood loss in RLRN group was less than that in ORN group [(245.9?75.5)ml vs(640.5?174.8)ml,t=-8.425,P=0.000].No significant difference was found between the two groups in operation time [(164.8?44.6)min vs(182.7?30.3)min,t=-1.277,P=0.212],postoperative hospital stay [(7.1?3.2)d vs(9.6?5.7)d,t=-1.541,P=0.134],and survival rate(Log-rank test,?2=0.243,P=0.622).Conclusion The efficacy of RLRN is similar to that of ORN.RLRN is safe and induce less blood loss.
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Objective To investigate the value of transurethral electrocision of the ureteric orifice in total nephroureterectomy. Methods Transurethral electrocision in combination with lumbar incision was employed in total nephroureterectomy for treating 28 cases of transitional cell carcinoma of the renal pelvis or the upper ureter from January 2002 to September 2003 in this hospital. Transurethral electrocision of the ureteric orifice on the diseased side was performed, and then the kidney and the whole ureter were excised through a lumbar incision. A catheter was placed for 7 days postoperatively. Results The operation time was 70~95 min (mean, 81 min). No urinary leakage, severe hematuria or wound infection occurred. The length of postoperative hospitalization was 7~9 days (mean, 7.4 days). Follow-up for 8~15 months (mean, 12 months) in 28 cases found no recurrence. Conclusions Total nephroureterectomy through transurethral electrocision in combination with lumbar incision is proved to be minimally invasive and safe, with a quick recovery.