Clinical features and optimal treatment of primary urethral carcinoma / 现代泌尿外科杂志

【Objective】 To explore the clinical features and treatment outcomes of female urethral carcinoma so as to improve the awareness and prognosis of this rare malignant disease. 【Methods】 Clinical data of 8 cases of female urethral carcinoma treated during Jan. 2012 to Dec.2022 at the Department of Urology of Peking University People’s Hospital were retrospectively analyzed. The patients underwent urodynamic tests, cystourethroscopy and pathological biopsy to confirm the diagnosis. Traditional radical surgery was performed in 5 cases, and radical surgery for lower urethral cancer with bladder preservation was performed in 3 cases. 【Results】 The patients aged 36 to 68 years, with a mean of 53.75 years. Urinary obstruction, lower urinary tract symptoms and urethral masses were common manifestations. Urodynamic tests indicated bladder outlet obstruction. After surgical treatment, radical surgery for lower urethral cancer with bladder preservation showed advantages over traditional radical surgery in terms of intraoperative bleeding, operation time and postoperative hospital stay. 【Conclusion】 Female primary urethral carcinoma is rare but invasive. Early diagnosis and radical surgery are crucial for improving the prognosis. Radical surgery for lower urethral cancer with bladder preservation has better treatment outcomes and postoperative quality of life compared to traditional radical surgery. For such patients, symptoms should be closely monitored and timely diagnosis and treatment should be performed.

Clinical Observation of Compound Sabal Berry Tablet Combined with Tamsulosin in the Treatment of Benign Prostatic Hyperplasia Complicated with Urinary Obstruction / 中国药房

OBJECTIVE:To observe the efficacy and safety of Compound sabal berry tablet combined with tamsulosin in the treatment of benign prostatic hyperplasia complicated with urinary obstruction. METHODS:86 patients with benign prostatic hyper-plasia complicated with urinary obstruction were randomly divided into control group(43 cases)and observation group(43 cases). Control group orally received 0.2 mg Tamsulosin hydrochloride orally disintegrating sustained-release tablet,once every evening. Observation group additionally received 500 mg Compound sabal berry tablet before a meal,3 times a day. 4-week was regarded as 1 treatment course,and it lasted 3 courses. During the treatment,all patients in the two groups ate light food,avoiding spicy and bland food. The clinical efficacy,TCM symptom scores,interleukin-8 (IL-8),interleukin-10 (IL-10),tumor necrosis factor α(TNF-α),maximum flow rate(Qmax),post-void residual(PVR),the International Prostate Symptom Score(IPSS)scores before and after treatment and the incidence of adverse reactions in the 2 groups were observed. RESULTS:The total effective rate in ob-servation group was significantly higher than control group,the difference was statistically significant(P0.05). After treatment,TCM symptom scores,IPSS scores,IL-8,IL-10,TNF-α and PVR in 2 groups were signifi-cantly lower than before,and observation group was lower than control group,Qmax was significantly higher than before,and obser-vation group was higher than control group,the differences were statistically significant (P<0.05). And there were no severe ad-verse reactions during treatment. CONCLUSIONS:The efficacy of Compound sabal berry tablet combined with tamsulosin is superi-or to tamsulosin alone in the treatment of benign prostatic hyperplasia complicated with urinary obstruction,it can reduce the in-flammatory reactions and residual urine,with good safety.

Dual contrast-enhanced ultrasound for diagnosis of obstructive diseases in upper urinary tracts / 第二军医大学学报

Objective To establish a dual contrast-enhanced ultrasonography (DCEUS) method for diagnosing the upper urinary tract obstructive diseases, and to discuss the diagnosis criterion and value. Methods A total of 147 patients with upper urinary tract obstructive diseases underwent dual contrast-enhanced ultrasound examination. A dose of SonoVue solution was directly injected into the renal pelvis via the puncture tube, and the antegrade contrast agent movement within the upper urinary tract was continuously monitored under CPS mode. Meanwhile, intravenous contrast-enhanced ultrasound was performed to observe the capillary filling of the urinary tract and surrounding structures, that is what we called DCEUS. And all the patient received magnetic resonance urography (MRU) and urinary contrast-enhanced CT within one week. With the operative findings and/or postoperative pathology taken as the golden standard, the accuracies of DCEUS and MRU in diagnosing the obstructive levels and severity of upper urinary tract obstruction were compared, and the accuracies of DCEUS and contrast-enhanced CT in diagnosing causes of the obstruction were compared. Results (1)The accuracy of DCEUS in revealing the obstructive levels were 100%, showing no significant difference with MRU(98. 6%)(P>0. 05). (2)The accuracy of DCEUS in evaluating the severity of upper urinary tract obstruction was 98. 6%, which was significantly better than that of MRU(89. 8%, P0. 05). (4) No complications were found during renal pelvis puncture or administration of SonoVue in the 147 patients,and no late complications were noticed during 1-6 months ultrasound follow-up in the 143 patients whowere followed up. Conclusion DCEUS is a safe, effective method; it can accurately locate the upper urinary tract obstruction and help to make qualitative diagnosis, and combination with percutaneous nephrostomy can yield even better clinical values.

Uretrostomia pré-púbica emergencial por necrose de uretra peniana em felino / Emergency uretrostomy prepubic by necrosis of the penile urethra in feline

Foi atendido no Hospital de Clínicas Veterinárias (HCV) da UFRGS um felino, macho, sem raça definida, dois anos de idade, com histórico de duas obstruções urinárias anteriores. No dia anterior foram realizadas inúmeras tentativas de sondagem, sem sucesso, em outro estabelecimento veterinário e o paciente foi, portanto, encaminhado para o HCV. No momento da consulta o paciente apresentava hiporexia, disúria e incontinência urinária. Ao exame clínico, observou-se aumento de volume em região perineal de consistência firme. Foi iniciada fluidoterapia e o animal foi anestesiado para nova tentativa de sondagem uretral. Verificou-se que não era possível a sondagem, pois a uretra peniana apresentava-se com estenose severa.

Treatment of septic shock from upper urinary obstruction / 中华泌尿外科杂志

Objective To investigate the treatment of septic shock(SS) from upper urinary obstruction(UUO). Methods Continuous veno-venous haemofiltration(CVVH) combined with surgical method was applied to 42 SS patients from UUO. Their general conditions, liver and kidney functions, APACHE Ⅱ, therapeutic intervention scorisystem(TISS), multiple organ dysfunction syndrome (MODS), complication rate and main outcomes were analysed comparing with traditional therapies groups(n=30). Results Compared with those traditional therapies, the APACHEⅡ , MODS and TISS score decreased (P＜0.05). Thirty-seven out of 42 patients survived and the survival rate was 88.0% during ICU. Conclusion CVVH combined with surgical methods may effectively decrease the incidence of complications and mortality of SS from UUO, and the mechanism may be related to the remove of mediators of inflammation.

Cistite glandular evoluindo com uropatia obstrutiva / Cystitis glandularis evolving with obstructive uropathy

Introdução: Cistite glandular é um processo proliferativo benigno e infrequente da mucosa vesical, caracterizado por proliferação do epitélio e, em alguns casos, formação de glândulas intestinais. Alterações metaplásticas na cistite glandular são bem documentadas na literatura, embora sua etiologia não seja totalmente esclarecida. Relato do caso: Relatamos um caso de cistite glandular em um paciente de 55 anos, apresentando sintomas miccionais irritativos e obstrutivos persistentes sem resposta à terapia com alfabloqueadores. Ultrassonografia evidenciou lesão vegetante no trígono vesical e o paciente foi submetido à ressecção endoscópica por duas vezes e evoluiu com ureterohidronefrose bilateral. Dado o extenso acometimento vesical e a persistência dos sintomas, o paciente foi submetido a cistoprostatectomia e neobexiga ileal com boa evolução pós-operatória. Discussão: Há duas formas de cistite glandular: típica e intestinal. A forma típica é a mais comum e a intestinal é marcada pela produção de mucina, mais frequentemente associada ao adenocarcinoma de bexiga. A maioria dos casos de cistite glandular é assintomática, sendo que os pacientes sitomáticos normalmente apresentam hematúria, sintomas urinários irritativos e típicos de cistite crônica. Há controvérsias sobre o tratamento precoce agressivo, sendo que vários estudos propõem a ressecção transuretral e o acompanhamento com biópsias.

Introduction: glandular cystitis is a benign proliferative process and infrequent mucosal bladder, characterized by proliferation of the epithelium and in some cases, formation of intestinal glands. Metaplásticas changes in glandular cystitis are well documented in the literature, although its etiology is not fully understood. Case report: A case of glandular cystitis in one patient of 55 years, with irritative and obstructive urinary symptoms persisted without response to therapy with alpha blockers. Ultrasonography revealed a vegetative lesion in the trigonal and the patient underwent endoscopic resection and twice progressed to bilateral ureterohidronefrose. Given the extensive bladder involvement and persistence of symptoms, the patient underwent ileal neobladder cistoprostatectomia and with good postoperative evolution. Discussion: There are two types of glandular cystitis: typical and intestinal tract. The typical form is the most common and is characterized by intestinal mucin production, most often associated with adenocarcinoma of the bladder. Most cases of glandular cystitis is asymptomatic, and patients usually present sitomáticos hematuria, urinary symptoms and typical of chronic cystitis. There is controversy over early aggressive treatment, and several studies suggest transurethral resection and follow-up biopsies.

Application of 16-Slice CT Urography in Upper Urinary Tract Obstructive Disorder / 医疗卫生装备

Objective To assess the application value of MSCTU(multi-slice computed tomography) in upper urinary obstructive disorders. Methods MSCTU was performed in 38 patients with upper urinary obstructive patients, and we reconstituted all abscissa axis images with 3D-reconstitution technology according obstructive level to select suitable delay scan time and got CTU post-processing images. Results Among 38 patients with upper urinary tract disorders, 13 cases were urolithiasis, 5 cases congenital urinary malformations, 8 cases upper urinary tract Obstruction caused by urinary neoplasm, 5 cases were stricture of ureter caused by inflammation or tuberculosis, and 7 cases by non-uretery derived tumor. The most early of delay scan time were 8 minutes and the most late were 2 hours. Conclusion MSCTU gets advantages such as high speed scan, excellent discrimination, and aplenty post-process technique, and is of great value in application of upper urinary obstructive.

The application of spiral computer tomography in the diagnosis of upper urinary obstruction / 中国微创外科杂志

Objective To evaluate the diagnostic value of 3-dimentional spiral computer tomography (3 D- sCT) in patients with upper urinary tract obstruction. Methods 113 patients with upper urinary tract obstruction were subjected to 3D-sCT. Results The site of urinary tract obstruction and hydronephrosis were distinctly shown in all patients by 3D-sCT. 112 of them were confirmed by ESWL, pathological or operative findings. Conclusions 3D-sCT can exactly show the location, cause and interaction of the upper urinary obstruction, and is especially applied to patients with resultless IVP and unable to retrograde pyelography.

Minimally Invasive Management for Acute Ureteral Obstruction and Severe Infection Caused by Calculi / 中国微创外科杂志

Objective To evaluate the efficacy and technique of minimally invasive management for acute ureteral obstruction and severe infection caused by calculi.Methods A total of 51 patients with acute upper urinary tract obstruction and severe infection caused by calculi were enrolled in this study.When infection,sepsis,and electrolyte disorders were corrected,emergent drainage by retrograde ureteral catheterization using cystoscopy or B-ultrasonography-guided percutaneous nephrostomy were carried out.Ureteroscopic lithotripsy or extracorporeal shock wave lithotripsy(ESWL)were performed after the infection was controlled.Results Cystoscopic retrograde ureteral catheterization was completed in 8 cases,and the other 43 patients were treated successfully by B-ultrasonography-guided percutaneous nephrostomy.During the operations,purulent urine spurted out from the drainage tube.Ten patients had transient hematuria and lumbar pain postoperation.None of the patients developed pneumothorax,urinary extravasation,perirenal hematoma,or abdominal organ injuries,etc.In 3 cases,recauterization was done because the catheter dropped out.In all the patients,the body temperature and blood white blood cell counts returned to a normal range 3 to 7 days after the drainage.Among the cases,8 were treated with ESWL,35 received ureteroscopic lithotripsy,and 8 underwent ESWL after the ureteral stone being pushed upwards to the renal pelvis.No severe complications,such as ureteral perforation or tears,massive hemorrhage,or high fever occurred after lithotripsy.The stones were completely removed in all the cases in 3 weeks postoperation(in 1 week for 34 cases).The patients were followed up for 3 to 6 months,during which the renal function recovered to a normal level.Conclusions Retrograde ureteral catheterization using cystoscopy or B-ultrasonography-guided percutaneous nephrostomy combined with ureteroscopic lithotripsy or ESWL is efficient for patients with acute ureteral obstruction and severe infection caused by calculi.By using the method,ureteral infection can be controlled quickly without causing severe complications.

Implante uretero-vesical em ratos

Apresentar os resultados obtidos com técnica de implante ureterovesical em ratos após obstrução ureteral ipsilateral. Treze ratos foram submetidos à obstrução ureteral distal à direita e, após uma semana, realizou-se o implante desse ureter na bexiga seguido da nefrectomia contralateral. No período de observação de 4 semanas foram estudados os níveis séricos semanais de uréia e creatinina e, na quarta semana, foi realizada cistografia para pesquisa de refluxo vésico-ureteral. Nove animais sobreviveram ao período de obstrução ureteral. Observou-se aumento significativo dos valores de uréia e creatinina sérica no segundo dia pós-operatório, que regrediram para níveis semelhantes aos basais já na terceira semana de seguimento. Não foi observado refluxo vésico-ureteral à cistografia. Após o sacrifício, a avaliação da junção uretero-vesical não mostrava sinais de obstrução, havendo regressão da hidronefrose presente antes do implante ureteral. A técnica de reimplante ureteral utilizada é eficaz em proporcionar adequada drenagem do trato urinário, evitando refluxovésico-ureteral, sendo adequada para ser utilizada no estudo da recuperação da função renal após período de obstrução ureteral.

A Case of Congenital Megacalyces

Congenital megacalyces is a congenital renal disease characterized by hypoplasia of the medulla and a non-obstructive dilatation of the calyces. More than 100 cases have been reported in the literature after first described by Puigvert in 1963, but it has been reported only three cases (two cases of adults and one case of child) in the literatures in Korea. The etiology of the congenital megacalyces is unknown. Renal pelvis and ureter are mostly normal in size and there is no urinary obstruction or reflux. Renal medulla of congenital megacalyces is thinner than that of normal kidney but renal cortex retains its normal thickness and function. This is features that help to distinguish megacalyces from obstructive atropy. The calyces are polygonal in shape and the majority of kidney with megacalyces have increased number of calyces. Since congenital megacalyces is a non-progressive lesion, it is important to recognize the clinical entity and avoid unnecessary surgery. We report one case of congenital megacalyces without urinary obstruction or reflux with a brief review of related literatures.

Interventional therapy for congenital urinary obstruction in children / 介入放射学杂志

Objective To investigate the interventional therapy in children's congenital urinary obstruction and its efficacy. Methods Thirty-three children with congenital obstruction of ureteropelvic junction were treated through percutaneous dilation and/or stent placement, and 42 cases with posterior urethral valves were treated through trans-urethra dilation. Results Thirty-three cases with upper urinary obstruction were improved with symptoms disappeared and stable efficacy on long-term follow-up of 1-7 years. Another 2 cases with the upper urethral obstruction had not been relieved of symptoms and resorted to surgical operation. For patients with posterior urethral valves, the lower urethral obstruction was totally got rid of after interventional therapy with stable efficacy on long-term follow-up of 1-10 years. Conclusions Interventional therapy is safe, micro-invasive and efficient in treating congenital urinary obstruction with stable efficacy on long-term follow-up.

Management of 24 Lower Ureteral Obstruction -Especially Internal Stent Indwelling- / 대한비뇨기과학회지

The lower ureter is not so frequent site of the urinary tract obstruction. In lower ureteral obstruction, the obstruction should be relieved by any method for maintaining renal parenchyme. A clinical studies were made on the 24 ureters of the lower ureteral obstruction. This studies were mainly focused on the method of management by internal stent indwelling. The following results were obtained. 1. In etiology, acquired lower ureteral strictures were most common ; tuberculosis in 10 ureters, radiation in 6 ureters, pelvic lymphadenopathy in 4 ureters, and iatrogenic stricture in 3 ureters. Congenital UVJ stricture was only one ureter. 2. In the method of management, open surgeries were done in 10 ureters and endourologic methods in 14 ureters. 3. In 5 failures of the first management, open surgeries were done in 3 ureters and endourologic methods in 2ureters. The tuberculosis was the most of their etiology. 4. Complications in internal stent indwelled cases were flank pain, severe vesical irritation, migration into the bladder and the obstruction of the lumen of stent.