Application and prospect of common laparoscopic technique evaluation tools in urology / 国际外科学杂志

Laparoscopy technology is widely used in urology. The mastery of laparoscopic surgery by urologists is very important to improve the quality of surgery and improve the prognosis of patients. However, there is no evaluation system for the maturity of laparoscopic technology of urologists. Based on this situation, in recent years, some evaluation criteria or evaluation elements have emerged to try to evaluate the laparoscopic skills of urologists. This article mainly summarizes the common evaluation tools, application scenarios, and limitations of laparoscopic technology in urology, and made an idea to establish a laparoscopic technology evaluation system in urology, providing a certain reference for the application and development of training and evaluation tools of laparoscopic technologyin urology.

Testicular decompression and tunica vaginalis flap in human acute testicular torsion: modified step-by-step technique description and preliminary outcomes

ABSTRACT Objective To report the effects of a tunica vagina flap on testicular compartment syndrome. Methods This single-arm clinical trial was conducted from September 2020 to October 2021. Consecutive patients with suspected testicular torsion within 24 hours of pain onset were included. Patients with past testicular torsion, bilateral torsion, or previous atrophy were excluded. The tunica vaginalis was opened, and the intratesticular pressure was measured before testicular retrieval from the scrotum and detorsion (P1), after detorsion (P2), and after transverse incision (P3). A tunica vaginalis flap was performed and a new intratesticular pressure was recorded (P4). The contralateral testicular pressure was recorded before fixation (Pc). The minimum follow-up period was 6 months. Results Fifteen patients were recruited from September 2020 to October 2021. Nine patients completed the follow-up. The median age (range) was 15 years (9-19). The mean P1, P2, P3, P4, and Pc (range) were 43, 60, 23, 20, and 14mmHg, respectively. The atrophy rate was 66.3% and the viability was 88.9%. No major complications were observed. Conclusion The modified tunica vaginalis flap in acute testicular torsion decreased intratesticular pressure. Furthermore, normal testicular pressure can improve testicular preservation. It can also decrease testicular pressure to normal levels and preserve the testicular parenchyma.

The learning curve of bilateral laparoscopic varicocelectomy: a prospective study / A curva de aprendizado da varicocelectomia laparoscópica bilateral: um estudo prospectivo

ABSTRACT Varicocele occurs in 15% of general male population and in 35% of infertile men. Since 1992, surgical correction with laparoscopic varicocelectomy is the gold standard for treatment of symptomatic patients or patients with abnormal seminal analysis. The learning curve for this frequently performed procedure has not yet been described. In the present study, we investigated the learning curve of a single urologist in training performing his first 21 laparoscopic varicocelectomies using qualitative and quantitative tools to evaluate his performance during the process. Our results show that 14 bilateral laparoscopic varicocelectomies are enough to achieve the plateau of the learning curve.

RESUMO Varicocele ocorre em 15% dos homens e em 35% dos homens inférteis. Desde 1992, a correção cirúrgica com varicocelectomia laparoscópica é o padrão ouro para o tratamento de pacientes sintomáticos ou com análise seminal anormal. A curva de aprendizado para esse procedimento frequentemente realizado ainda não foi descrita. No presente estudo, investigamos a curva de aprendizado de um único urologista em treinamento realizando suas primeiras 21 varicocelectomias laparoscópicas usando ferramentas qualitativas e quantitativas para avaliar seu desempenho durante o processo. Nossos resultados mostram que 14 varicocelectomias laparoscópicas bilaterais são suficientes para atingir o platô da curva de aprendizado.

Tratamento cirúrgico de linfedema penoescrotal em um paciente com doença de Milroy: relato de caso / Surgical treatment of penoscrotal lymphedema in a patient with Milroy's disease: case report

Introdução: A doença de Milroy manifesta-se como linfedema de membros inferiores e região genital, o que provoca prejuízos físicos e sociais. Relato de Caso: Reporta-se um caso de linfedema penoescrotal severo em um paciente com doença de Milroy. Foi realizada a ressecção cirúrgica do tecido afetado e a reconstrução com retalhos locais e enxerto de pele. Discussão: A doença de Milroy é rara, de caráter autossômico dominante. Sua apresentação clínica é progressiva e decorre da hipoplasia dos vasos linfáticos dos membros inferiores. O tratamento em casos avançados é iminentemente cirúrgico. Conclusão: No caso apresentado, o tratamento cirúrgico é uma boa opção. O uso de retalho paraescrotal para escrotoplastia associado ao enxerto para cobertura do pênis proporciona bom resultado funcional.

Introduction: Milroy disease manifests itself as lymphedema of the lower limbs and genital region, which causes physical and social damage. Case Report: A case of severe-scrotal lymphedema in a patient with Milroy disease. Surgical resection of the affected tissue and reconstruction with local flaps and skin graft were performed. Discussion: Milroy disease is a rare autosomal dominant disease. The clinical presentation is progressive and results from hypoplasia of the lymphatic vessels of the lower limbs. Treatment in advanced cases is mainly surgical. Conclusion: In the case of a patient with Milroy disease and severe penoscrotal lymphedema, surgical treatment is a good option. The use of parascrotal flaps for scrotoplasty associated with a graft to recover the penis provides a good functional result.

Learning curve of semi-rigid ureteroscopy for small calculi: how many cases are necessary? / Curva de aprendizado em ureteroscopia semi-rígida em cálculos de pequenas dimensões: quantos casos são necessários?

ABSTRACT Introduction: semi-rigid ureteroscopy is the procedure of choice for the treatment of ureterolithiasis, but it requires a learning curve to be performed safely. Objective: To describe an estimate of the learning curve for performing semi-rigid ureterorenolithotripsy in patients with small-sized ureterolithiasis and to estimate the minimum number of procedures necessary to safely perform the surgical procedure. Methods: this is a prospective study evaluating the learning curve of a resident of urology in the first 60 semirigid ureteroscopies in patients with ureterolithiasis up to 1cm. The patients were divided into three groups: Group I one to twenty surgeries, Group II twenty one to forty surgeries and Group III forty one to sixty surgeries. The surgeries were recorded and analyzed by two urologists experienced in endourology. A qualitative analysis was performed based on a previously validated tool and a quantitative analysis. Results: all qualitative variables had significant variation between Groups I and II (p<0.001), and between Groups I and III (p<0.001). There was a difference in time to access the ureter, passage of a double J catheter and total operative time between Groups I and II (p<0.001) and Groups I and III (p<0.001). Conclusion: after 40 cases there seems to be little increase in both quantitative as well as qualitative evaluation in surgical performance for performing semi-rigid ureterolithotripsy safely in calculations up to 1cm.

RESUMO Introdução: ureteroscopia semi-rígida é o procedimento de escolha para o tratamento da ureterolitíase, mas necessita de uma curva de aprendizado para ser executada com segurança. Objetivo: descrever uma estimativa da curva de aprendizado para realização da ureterorrenolitotripsia semi-rígida em pacientes com ureterolitíase de pequena dimensão e estimar o número mínimo de procedimentos necessários para realizar o procedimento cirúrgico com segurança. Métodos: trata-se de um estudo prospectivo avaliando a curva de aprendizado de um residente de urologia nas primeiras 60 ureteroscopias semi-rígidas em pacientes com ureterolitíase até 1cm. Os pacientes foram divididos em três grupos: Grupo I uma a vinte cirurgias, Grupo II vinte e uma a quarenta cirurgias e Grupo III quarenta e uma a sessenta cirurgias. As cirurgias foram gravadas e analisadas por dois urologistas experientes em endourologia. Foi feita uma análise qualitativa baseada em uma ferramenta previamente validada e uma análise quantitativa. Resultados: todas as variáveis qualitativas tiveram variação significativa entre os Grupos I e II (p<0.001), e entre os Grupos I e III (p<0.001). Houve diferença no tempo para acesso ao ureter, passagem de cateter duplo J e tempo operatório total entre os Grupos I e II (p<0.001) e nos Grupos I e III (p<0.001). Conclusão: após 40 casos parece haver pouco incremento tanto na avaliação quantitativa bem como na avaliação qualitativa em performance cirúrgica para a realização de ureterolitotripsia semi-rígida com segurança em cálculos de até 1cm.

Creation of a Pilot Surgical Program for the Comprehensive Management of Patients with Congenital Urological Malformations / Creación de un programa quirúrgico piloto para el manejo integral de pacientes con malformaciones urológicas congénitas

Objectives Congenital malformations constitute the first cause of morbidity and mortality in childhood in Latin America. That is why, since 2001, a surveillance system for congenital malformations has been implemented in Bogota - Colombia. However, despite the increase in detection, an impact on treatment has not been achieved. The present study describes our experience with a novel social program focused on congenital urologic disorders. Methods The present manuscript is a retrospective observational study. We reviewed two national databases containing patients with congenital malformations. Patients were actively contacted to verify the status of the malformations. Children in whom the malformation was confirmed were offered a free consultation with a multidisciplinary group. After screening for surgical indications, patients were scheduled for surgery. Results Between November 2018 and December 2019, 60 patients were identified. In total 44, attended the consultation; the remaining did not attend due to financial or travel limitations. The most common condition assessed was hypospadias. In total, 29 patients underwent surgery. The total cost of care was of US$ 5,800. Conclusions Active search improves attention times and reduces the burden of disease. The limitations to be resolved include optimizing the transportation of patients and their families, which is a frequent limitation to access health care.

Objetivos Las malformaciones congénitas corresponden a la principal causa de morbimortalidad en la infancia en América Latina, motivo por el cual desde el 2001 se viene implementando un sistema de vigilancia epidemiológica de malformaciones congénitas en Bogotá, Colombia. Sin embargo, a pesar del aumento en la cobertura del reporte obligatorio, no se ha logrado un impacto sobre su tratamiento. Este estudio busca mostrar nuestra experiencia con un programa integral de pacientes con malformaciones urológicas congénitas. Métodos El presente es un estudio observacional retrospectivo. Los menores con malformaciones congénitas fueron identificados en dos bases de datos nacionales que incluyen pacientes con malformaciones congénitas. Los pacientes reportados fueron contactados telefónicamente para verificar el estado actual de la malformación. A aquellos niños en quienes se les confirmó la malformación, se les ofreció de manera gratuita una consulta con un grupo multidisciplinario. Una vez confirmadas las indicaciones quirúrgicas, fueron llevados a cirugía. Resultados Se identificaron 60 pacientes entre noviembre del 2018 y diciembre de 2019. De los pacientes identificados, 44 acudieron a consulta. Los demás no asistieron por limitaciones económicas. La principal condición valorada fue hipospadias. En total, 29 pacientes fueron llevados a cirugía. El costo total de la atención de estos pacientes fue de 22 millones de pesos colombianos. Conclusiones La búsqueda activa mejora los tiempos de atención y reduce la carga de la enfermedad. Una de las limitaciones aun por resolver es optimizar el transporte de los pacientes y sus familias, que resulta una limitación frecuente para el acceso a la salud.

Effect of Antibiotic Prophylaxis on Infectious Complications in Patients with Asymptomatic Bacteriuria Undergoing Urologic Surgery / Efecto de la profilaxis antibiótica sobre las complicaciones infecciosas en pacientes con bacteriuria asintomática programados a cirugía urológica

Objectives To identify the effect of duration of surgical antibiotic prophylaxis (SAP) and other variables on infectious postsurgical complications in patients with asymptomatic bacteriuria (ASB) undergoing urological surgery. Methods We conducted an observational study of a cohort of patients with ASB scheduled for urologic surgery at three health service providers in Colombia. The study population comprised all patients with planned urologic surgery who had ASB prior to surgery from April 2018 to January 2019. The intervention evaluated was the duration of preoperative SAP, and the outcome variable was the development of any postoperative infectious complications for up to 30 days after the procedure. Results The present study included 184 patients with ASB scheduled for urologic surgery. The median duration of preoperative SAP (p = 0.49) or of 1 dose SAP (risk ratio [RR] = 1.24; 95% confidence interval [CI]: 0.45­3.39) were not statistically different in patients with postsurgical infectious complications. Infectious complications were more frequent among patients with benign prostatic hyperplasia (RR = 6.57; 95%CI: 1.98­21.76) and hospitalization in the preceding 3 months (RR = 8.32; 95%CI: 2.69­25.71). Conclusion One dose of antimicrobial therapy is sufficient to avoid infectious complications in patients with ASB. There were other factors associated with postsurgical infectious complications, such as benign prostatic hyperplasia and hospitalization in the preceding 3 months.

Objetivos Identificar el efecto de la duración de la profilaxis antibiótica quirúrgica (PAQ) y otras variables sobre las complicaciones infecciosas posquirúrgicas en pacientes con bacteriuria asintomática (BA) sometidos a cirugía urológica. Métodos Se realizó un estudio observacional de una cohorte de pacientes con BA programados para cirugía urológica en tres instituciones de salud en Colombia. La población de estudio comprendió a todos los pacientes programados para cirugía urológica y con BA en el periodo de Abril del 2018 a Enero 2019. La intervención evaluada fue la duración de la PAQ preoperatoria, y la variable de resultado fue el desarrollo de cualquier complicación infecciosa posoperatoria hasta 30 días después del procedimiento. Resultados El estudio incluyó a 184 pacientes con BA programados para cirugía urológica. La mediana de duración de la PAQ preoperatoria (p = 0,49) o 1 dosis de PAQ (razón de riesgo [RR]: 1,24; intervalo de confianza [IC] del 95%: 0,45 a 3,39) no fueron estadísticamente diferentes en pacientes con complicaciones infecciosas posquirúrgicas. Las complicaciones infecciosas fueron más frecuentes entre los pacientes con hiperplasia prostática benigna (RR: 6,57; IC del 95%: 1,98 a 21,76) y hospitalización en los 3 meses anteriores (RR: 8,32; IC del 95%: 2,69 a 25,71). Conclusión Una dosis de terapia antimicrobiana es suficiente para evitar complicaciones infecciosas en pacientes con BA. Hubo otros factores asociados con complicaciones infecciosas posquirúrgicas, como hiperplasia prostática benigna y hospitalización en los tres meses anteriores.

Urological Cancer Treatment by a Multidisciplinary Teamthroughout the Covid-19 Pandemic: What Have We Learned? / Tratamiento del cáncer urológico por un equipo multidisciplinario durante la pandemia de Covid-19: ¿Qué hemos aprendido?

Introduction It is known that cancer care is best approached by a multidisciplinary team (MDT). This became specifically true in the Covid-19 pandemic in which choices for urological cancer treatment are influenced by many factors. In some cases, delayed treatment may have consequences regarding the patient's oncological outcomes. The aim of the present article is to report our experience throughout the Covid-19 pandemic treating patients with urological neoplasms at a high-volume center. Methods We used a convenience sampling method. Cases were evaluated and discussed on an individual basis at the MDT meetings, and, after a consensus regarding delaying or scheduling treatment, patients were scheduled according to the risk of postponing the procedures. The Medically Necessary, Time-Sensitive (MeNTS) scoring system was measured in each patient; all patients answered the Centers for Disease Control and Prevention (CDC) Covid-19 self-screening questionnaire prior to surgery. The Covid-19-free survival rate was estimated. Results A total of 194 patients were assessed by themultidisciplinary team and finally treated, with median follow-up of 4 (interquartile range [IQR]: 2.75 to 6) months. Only two patients had Covid-19 confirmed by real-time polymerase chain reaction (RT-PCR). In total, 54 patients underwent oncological surgery, 129 were treated with radiotherapy, and 11 were treated with intravenous chemotherapy. Themedian age was 66 years (IQR: 59 to 94 years), and the median MeNTS score in the surgically-treated cohort was 35 points (IQR: 31 to 47 points). Conclusions The evaluation and treatment of urological cancer should be conducted by an MDT; this is of utmost importance, especially during the Covid-19 pandemic. The data collected in our institution showed that most patients could be safely treated by taking all necessary precautions and discussing each case individually in the MDT meetings and performing a close follow-up.

Introduccion La atención del cáncer se aborda mejor con un equipo multidisciplinario (EMD), aspecto que se tornó más importante en la pandemia por Covid-19, en que las opciones para tratar el cáncer urológico están influenciadas por muchos factores. En algunos casos, el tratamiento retrasado puede tener consecuencias en los resultados oncológicos del paciente. El objetivo de este estudio es describir nuestra experiencia en un centro de referencia y de alto volumen para el tratamiento de neoplasias urológicas durante la pandemia por Covid-19. Métodos Realizamos un muestreo por conveniencia. Posteriormente, los casos fueron evaluados y discutidos de forma individual en las reuniones del EMD. Posterior a la obtención de un consenso sobre el tratamiento del paciente, los pacientes fueron programados según el riesgo individual de posponer el manejo. Se midió la puntuación de cada paciente en el sistema Medically Necessary Time-Sensitive (MeNTS, "Médicamente necesario, sensibles al tiempo"). Todos los pacientes respondieron el cuestionario de autoevaluación del Centers for Disease Control and Prevention (CDC) COVID-19 antes de la cirugía. Se estimó la tasa de supervivencia libre de Covid-19. Resultados Un total de 194 pacientes fueron evaluados por el EMD y finalmente tratados, con una mediana de seguimiento de 4 (rango intercuartil [RIC]: 2,75 a 6) meses. Solo dos tenían Covid-19 confirmado por reacción en cadena de la polimerasa en tiempo real (RCP-TR). Un total de 54 pacientes fueron sometidos a cirugía oncológica, 129 fueron tratados con radioterapia, y 11 fueron tratados con quimioterapia intravenosa. La mediana de edad fue de 66 años (RIC: 59 a 94 años), la puntuación mediana en el MeNTS de la cohorte tratada quirúrgicamente fue de 35 puntos (RIC: 31 a 47 puntos). Conclusiones La evaluación y el tratamiento del cáncer urológico debe ser realizado por un EMD durante la pandemia de Covid-19. Los datos recopilados en nuestra institución mostraron que la mayoría de los pacientes podrían ser tratados de manera segura, discutiendo cada caso individualmente y haciendo un seguimiento cercano.

Application of robot-assisted laparoscopic technique in urology: The latest 15-year data in China / 第二军医大学学报

Da Vinci robotic surgical system has many unique advantages, including 3D high-definition vision system, simulation wrist with high degree of freedom, automatically removing the physiologic hand tremor and allowing sitting position for the operators. It was introduced into Chinese mainland in 2006, and has been widely applied in many fields, especially in urology (accounting for 46% of all clinical fields). In this paper, we analyzed the latest 15 years' application data of robot-assisted laparoscopic technique in urology in China and discussed the application characteristics and existing problems.

Image-guided study of swine anatomy as a tool for urologic surgery research and training

Abstract Purpose: To describe the anatomy of the swine urinary system using computed tomography and to discuss the role of this animal as an experimental model for urological procedures. Methods: Three male Landrace pigs underwent computed tomography and the anatomy of the urinary system and renal circulation was analyzed and described. Results: In all animals, 2 kidneys, 2 ureters and one bladder were identified. Each kidney presented a single renal artery vascularization, with a mean diameter on the right of 4.45 and 5.31 mm on the left (p < 0.0001) and single renal vein drainage, with a mean diameter on the right of 5.78 and 5.82 mm on the left (p = 0.0336). The average renal length was 9.85 cm on the right and 10.30 cm on the left (p < 0.0001). The average renal volume was 113.70 cm3 on the right and 109.70 cm3 on the left (p < 0.0001). The average length of the ureter was 19.78 cm on the right and 22.08 cm on the left (p < 0.0001). The average bladder volume was 423.70 cm3. Conclusions: The data obtained show similarities with human anatomy, suggesting the viability of the swine model for planning preclinical trials, basic research, refinement in experimental surgery and surgical training for urological procedures.

Perspectivas do homem submetido à penectomia / Perspectives of man submitted to penectomy / Perspectivas del hombre sometido a la penectomía

Objetivo: o presente artigo objetiva descrever as perspectivas do paciente submetido à penectomia e conhecer as perspectivas deste paciente após a penectomia. Métodos: trata-se de um estudo de caso realizado em um hospital federal na cidade do Rio de Janeiro com dois pacientes que estiveram internados no ano de 2017 e foram submetidos a penectomia. A coleta de dados foi realizada no ano de 2018 através de uma entrevista semiestruturada. Os participantes foram amparados pelos princípios éticos estabelecidos pela resolução 466/ 2012 do Conselho Nacional de Saúde, sendo que este estudo foi aprovado sob o número 2.769.381. Resultados: constatou-se que a penectomia nestes estudos de caso era a única terapêutica. Com isso, o desejo de estar com a família e prolongar a vida foram determinantes na adesão ao tratamento. Conclusão: concluiu-se que mesmo com as mudanças no corpo, a penectomia foi realizada na perspectiva de prolongar a vida

Objective: this article aims to describe the perspectives of patient submitted submitted to penectomy and to know the perspectives of this patient after the penectomy. Methods: its a case study realized in a federal hospital of Rio de Janeiro city with two patients who were admitted to the hospital during 2017 and underwent to penectomy surgery. The data collection was realized during 2018 with a semi-structured interview. The participants were protected by the ethics principles established by the resolution 466/ 2012 of the National Health Council and this study was approved under the number 2.769.381. Results: it was found that penectomy in this case studies was the only therapy. Thereby, the desire of being among their family and to extend their life was determinants to adhere the therapy. Conclusion: it was concluded that even with the changes in their body, the penectomy was realized to extend the life

Objetivo: el presente artículo objetiva describir las perspectivas del paciente sometido a la penectomía y conocer las perspectivas de este paciente después de la penectomía. Métodos: se trata de un estudio de caso realizado en un hospital federal en la ciudad de Río de Janeiro con dos pacientes que estuvieron internados en el año 2017 y fueron sometidos a penectomía. La recolección de datos se realizó en el año 2018 através de una entrevista semiestructurada. Los participantes fueron amparados por los principios éticos establecidos por la resolución 466/2012 del Consejo Nacional de Salud, siendo que este estudio fue aprobado bajo el número 2.769.381. Resultados: se constató que la penectomía en estos estudios de caso era la única terapéutica. Con ello, el deseo de estar con la familia y prolongar la vida fueron determinantes en la adhesión al tratamiento. Conclusión: se concluyó que incluso con los cambios en el cuerpo, la penectomía se realizó en la perspectiva de prolongar la vida

Is neutrophil to lymphocyte ratio a predictive factor for recurrence of urethral stricture?

SUMMARY INTRODUCTION Due to spongiofibrosis and inflammatory processes underlying the pathogenesis of urethral stricture, it is possible that the neutrophil-lymphocyte ratio (NLR) may give essential information about the course of the disease and recurrence possibilities. Our study aims to evaluate the correlation between NLR and recurrence rates. METHODS A total of 512 patients who underwent direct visual internal urethrotomy (DVIU) due to urethral stricture in our clinic between February 2010 and January 2018 were evaluated retrospectively. RESULTS The median follow up for non-recurrent and recurrent groups after DVIU was 30 and 36 months, respectively. During the follow-up, 280 (54.7%) of the patients had recurrences, and 232 (45,3%) had no recurrences. The mean time for recurrence after DVIU was 6,5±1,4 months, with a range of 1-36 months. The mean NLR in the non-recurrence group was 2,02±0,87, with a median of 1.9, and 3,66±2,30, with a median of 3 in the recurrence group. A highly significant statistical difference was observed between two groups in terms of neutrophil count and NLR (p: 0.000 - both). The area under curve value for NLR was 0.767, with a standard error of 0.021 (95% CI 0.727-0.808). The cut-off value of NLR was determined as 2.25, with a 70% sensitivity and 67,7% specificity. CONCLUSION By using NLR, the inflammatory features of the urethral tissue can be predicted, and possible recurrences after surgery can be estimated. Consequently, open urethroplasty techniques can be used in cases with a significant NLR value instead of the recurrent endoscopic procedure.

RESUMO INTRODUÇÃO Devido à espongiofibrose e processos inflamatórios subjacentes à patogênese da estenose uretral, pode-se pensar que a relação de linfócitos neutrofílicos (NLR) pode fornecer informações essenciais sobre o curso da doença e as possibilidades de recorrência. O objetivo do nosso estudo é avaliar a correlação entre NLR e taxas de recorrência. MÉTODOS Quinhentos e doze pacientes submetidos à uretrotomia interna visual direta (DVIU) devido à estenose uretral em nossa clínica entre as datas de fevereiro de 2010 e janeiro de 2018 foram avaliados retrospectivamente. RESULTADOS A mediana de acompanhamento para os grupos não recorrentes e recorrentes após a DVIU foi de 30 e 36 meses, respectivamente. Durante o seguimento, 280 (54,7%) dos pacientes tiveram recidivas e 232 (45,3%) não tiveram recidivas. O tempo médio de recorrência após a DVIU foi de 6,5±1,4 mês, com variação de 1-36 meses. A média da RNL no grupo sem recorrência foi de 2,02±0,87 com mediana de 1,9 e 3,66±2,30 com mediana de 3 no grupo com recidiva. Uma diferença estatística altamente significativa foi observada entre dois grupos em termos de contagem de neutrófilos e NLR (p: 0,000 - ambos). A área sob o valor da curva para NLR foi de 0,767 com um erro padrão de 0,021 (IC 95% 0,727-0,808). Valor de corte de NLR determinado como 2,25 com uma sensibilidade de 70%, especificidade de 67,7%. CONCLUSÃO Ao utilizar a RNL, as características inflamatórias do tecido uretral podem ser previstas e possíveis recidivas após a cirurgia podem ser estimadas. Dessa forma, técnicas de uretroplastia aberta podem ser usadas em casos com valor significativo de NLR em vez de procedimento endoscópico recorrente.

Design and implementation of optimal puncture pathway for percutaneous nephroscopy in 86 cases of complex renal calculi / 中国基层医药

Objective@#To investigate the safety and effectiveness of percutaneous nephrolithotomy(PCNL) with X-ray and ultrasound in the design and implementation of the best percutaneous puncture pathway for complex renal calculi.@*Methods@#Eighty-six patients with complex renal calculi treated in Shengjing Hospital Affiliated to China Medical University from May 2015 to May 2018 were collected.Before operation, CT/IVP was used to design the best percutaneous puncture pathway and selected the calices to be punctured.The intersection of the central axis of the calyx fornix, the neck of the calyx and the body surface were regarded as the puncture point on the body surface, and the connection between the central axis of the calyx fornix and the center of the calyx fornix was the puncture line.The ultrasound probe was placed slightly below the planned puncture point.According to the order of echolocation of hydronephrosis or hump-like calculi, two-step puncture was adopted to puncture the calyx along the central axis of the calyx dome and the calyx neck.The guide wire was retained and the channel was gradually expanded to F24 standard channel for ballistic or ultrasonic lithotripsy.@*Results@#Percutaneous puncture pathways were successfully established in 86 cases, 65 cases were single-channel and 21 cases were double-channel.The operation time(from puncture to indwelling nephrostomy) was (65.3±17.2)min, and the hemoglobin decreased in (10.1±4.5)g/L.The hospitalization time of the patients was (7.2±5.2)d.The first stage stone clearance rate was 74.4%(64/86), and the second stage stone clearance rate was 95.3%(82/86).@*Conclusion@#Combined with the advantages of X-ray and ultrasound, the puncture route shoud be designed by CT/IVP before operation, and puncture shoud be carried out under the guidance of ultrasound during operation.The best percutaneous puncture pathway can be established to complete the treatment of complex renal calculi.

Effect of accelerated rehabilitation surgery management combined with thymalfasin on rehabilitation quality of patients undergoing laparoscopic radical nephrectomy / 中国基层医药

Objective@#To investigate the effect of enhanced recovery after surgery program with thymalfasin in patients undergoing laparoscopic radical nephrectomy in the perioperative period to enhance the quality of rehabilitation and reduce the risk of surgical complications.@*Methods@#Retrospective analysis of the clinical data of 156 patients undergoing radical laparoscopic radical nephrectomy in the People's Hospital of Renshou County from August 2013 to June 2018 was conducted.According to the perioperative management plan, 74 patients were divided into control group(74cases) and observation group(82cases). Laparoscopic surgery was performed in both two groups.The perioperative period of the observation group was accelerated surgical rehabilitation, and thymalfasin was given before and after surgery.The control group used a traditional perioperative management program.The blood loss, postoperative recovery time and complications were compared between the two groups.@*Results@#The loss of hemoglobin during operation[(11.90±5.61)g/L]in the accelerated rehabilitation group was slightly lower than that of the control group[(17.47±5.31)g/L], and the indwelling time of plasma drainage tube, anal exhaust time and hospitalization time in the accelerated rehabilitation group were (35.96±4.47)h, (12.61±4.05)h, (121.45±4.30)h, respectively, which were significantly shorter than those in the control group[(46.81±4.55)h, (15.34±4.45)h, (193.69±5.48)h], the differences were statistically significant (t=6.351, 15.011, 4.012, 92.043, all P<0.05).@*Conclusion@#Enhanced recovery after surgery program with thymalfasin in patients undergoing laparoscopic radical nephrectomy is a safe and effective treatment.The use of thymalfasin method can accelerate the recovery of patients' immune function, and the accelerated rehabilitation program with thymalfasin can effectively reduce the probability of infection during surgery, which can effectively reduce the possibility of infection during operation, accelerate the recovery of physiological function, shorten the hospital stay of patients and improve the quality of rehabilitation of patients.

Effect of accelerated rehabilitation surgery management combined with thymalfasin on rehabilitation quality of patients undergoing laparoscopic radical nephrectomy / 中国基层医药

Objective To investigate the effect of enhanced recovery after surgery program with thymalfasin in patients undergoing laparoscopic radical nephrectomy in the perioperative period to enhance the quality of rehabilitation and reduce the risk of surgical complications.Methods Retrospective analysis of the clinical data of 156 patients undergoing radical laparoscopic radical nephrectomy in the People＇s Hospital of Renshou County from August 2013 to June 2018 was conducted.According to the perioperative management plan ,74 patients were divided into control group (74cases) and observation group(82cases).Laparoscopic surgery was performed in both two groups.The perioperative period of the observation group was accelerated surgical rehabilitation ,and thymalfasin was given before and after surgery.The control group used a traditional perioperative management program.The blood loss,postoperative recovery time and complications were compared between the two groups.Results The loss of hemoglobin during operation [(11.90 ±5.61)g／L]in the accelerated rehabilitation group was slightly lower than that of the control group [(17.47 ± 5.31) g／L], and the indwelling time of plasma drainage tube , anal exhaust time and hospitalization time in the accelerated rehabilitation group were (35.96 ±4.47) h,(12.61 ±4.05) h,(121.45 ±4.30) h,respectively,which were significantly shorter than those in the control group [(46.81 ±4.55)h,(15.34 ±4.45)h,(193.69 ±5.48)h], the differences were statistically significant ( t ＝6.351, 15.011, 4.012, 92.043, all P ＜0.05 ).Conclusion Enhanced recovery after surgery program with thymalfasin in patients undergoing laparoscopic radical nephrectomy is a safe and effective treatment.The use of thymalfasin method can accelerate the recovery of patients ＇immune function, and the accelerated rehabilitation program with thymalfasin can effectively reduce the probability of infection during surgery,which can effectively reduce the possibility of infection during operation ,accelerate the recovery of physiological function,shorten the hospital stay of patients and improve the quality of rehabilitation of patients .

Design and implementation of optimal puncture pathway for percutaneous nephroscopy in 86 cases of complex renal calculi / 中国基层医药

Objective To investigate the safety and effectiveness of percutaneous nephrolithotomy (PCNL)with X-ray and ultrasound in the design and implementation of the best percutaneous puncture pathway for complex renal calculi.Methods Eighty-six patients with complex renal calculi treated in Shengjing Hospital Affiliated to China Medical University from May 2015 to May 2018 were collected.Before operation,CT/IVP was used to design the best percutaneous puncture pathway and selected the calices to be punctured.The intersection of the central axis of the calyx fornix,the neck of the calyx and the body surface were regarded as the puncture point on the body surface,and the connection between the central axis of the calyx fornix and the center of the calyx fornix was the puncture line.The ultrasound probe was placed slightly below the planned puncture point.According to the order of echolocation of hydronephrosis or hump-like calculi,two-step puncture was adopted to puncture the calyx along the central axis of the calyx dome and the calyx neck.The guide wire was retained and the channel was gradually expanded to F24 standard channel for ballistic or ultrasonic lithotripsy.Results Percutaneous puncture pathways were successfully established in 86 cases,65 cases were single-channel and 21 cases were double-channel.The operation time(from puncture to indwelling nephrostomy) was (65.3 ± 17.2)min,and the hemoglobin decreased in (10.1 ± 4.5)g/L.The hospitalization time of the patients was (7.2 ± 5.2) d.The first stage stone clearance rate was 74.4％ (64/86),and the second stage stone clearance rate was 95.3％ (82/86).Conclusion Combined with the advantages of X-ray and ultrasound,the puncture route shoud be designed by CT/IVP before operation,and puncture shoud be carried out under the guidance of ultrasound during operation.The best percutaneous puncture pathway can be established to complete the treatment of complex renal calculi.

Simulated training of a laparoscopic vesicourethral anastomosis

Abstract Purpose: To develop a model and curriculum for simulated training of an effective and well accepted laparoscopic vesicourethral anastomosis (VUA). Methods: Experimental longitudinal study of quantitative character. The sample consisted of 12 general surgery residents and 6 urology residents (R3). The training consisted of making twelve VUAs on synthetic organs. The training was divided into four sessions and accompanied by an instructor who performed positive feedback. The evaluation of the anastomoses considered the time and the analysis of the operative technique through the global evaluation scale Objective Structured Assessment of Technical Skills (OSATS). Results: Residents showed a reduction in operative time and evolution in the surgical technique statistically significant (p<0.01). The best-rated items were the facilitator positive feedback and the fact that the training was carried out at the teaching hospital premises. Conclusions: The proposed training model was well accepted and proved to be effective in reducing operative time and improving laparoscopic skills. The training should be fractionated (4 sessions in 3 weeks), repetitive (12 anastomoses) and have positive feedback.

Comparison of the effects of remifentanil and fentanyl in the urology endoscopic anesthesia / 中国基层医药

Objective To compare the effects of remifentanil and fentanyl in urologic surgery under endoscopic anesthesia and the incidence of adverse reactions in patients.Methods A total of 170 patients undergoing urological surgery admitted to the Second People 's Hospital of Jinzhong from February 2015 to April 2016 were randomly divided into the study group and control group according to the digital table ,with 85cases in each group. Remifentanil and fentanyl was used in the study group and control group respectively .The preoperative anesthesia was performed in the patients who received anesthesia before and after tracheal intubation and before and after tracheal intubation,and the time of induction of anesthesia ,the operation time and the time of postoperative wakefulness were compared between the two groups.Pressure and heart rate changes ,the incidence of adverse reactions were recorded and compared between the two groups.The amount of anesthesia ,anesthesia surgery costs and the amount of bleeding during surgery were compared.Results The induction time of anesthesia in the study group was significantly shorter than that in the control group (9.8min vs.6.9min,t＝12.029,P＜0.05).The mean arterial pressure and heart rate in the study group were significantly larger than those in the control group ( all P＜0.05).The incidence rate of adverse reactions in the study group was significantly lower than that in the control group (5.9% vs.12.9%,χ2＝7.935,P＜0.05).The cost and blood loss of the study group were significantly lower than those of the control group (2 871.4 CNY vs.3 014.9 CNY;23.4mL vs.32.7mL,t＝20.391,17.907,all P＜0.05).Conclusion The application of remifentanil in preoperative anesthesia of urologic surgery can save time ,reduce the economic burden of patients and the incidence of adverse reactions in patients.It is worthy of widely recommended in clinic.

Late secondary urological reconstruction of separated ischiopagus twins with exstrophic bladder and urinary incontinence / Reconstrução urológica tardia de gêmeos isquiópagos com extrofia de bexiga e incontinência urinária

ABSTRACT We report a case of secondary urinary reconstruction of previously separated conjoined twins with exstrophic bladder and urinary incontinence. Patients were male and aged 13-year-old. Twin one had a history of failed enterocystoplasty that extruded and was visible like an exstrophic neobladder. He underwent a procedure to close bladder neck and reconfigure abdominal wall. After the procedure the patient developed a fistula that was treated, but it persisted and, for this reason, a catheterizable pouch was constructed and native bladder was discarded. Twin two required the immediately construction of catheterizable pouch using the Macedo's technique. Currently, both patients are continent at 4 hour intervals. The mean follow-up was 8 months. Modern continent urinary diversion techniques offer new perspectives and hope for such complex population.

RESUMO Relata-se caso de reconstrução urinária em gêmeos siameses previamente separados com apresentação clínica de bexiga extrófica e incontinência urinária. Os dois pacientes eram do sexo masculino com idade de 13 anos. O primeiro gêmeo apresentava falha da enterocistoplastia com extrusão e visualização da neobexiga extrófica, tendo sido submetido ao fechamento do colo vesical e à reconfiguração da parede abdominal. Após o procedimento, o paciente desenvolveu fístula, que foi tratada, mas persistiu. Posteriormente, optamos por bolsa cateterizável, descartando a bexiga nativa. O segundo gêmeo foi submetido à construção imediata de bolsa cateterizável, por meio da técnica de Macedo. Atualmente, ambos os pacientes estão continentes em intervalos de 4 horas. O seguimento médio foi de 8 meses. As atuais técnicas de derivação urinária oferecem novas perspectivas e esperança para esta população complexa.

Application effect of single port laparoscopic techniques in urology grassroots / 中国基层医药

Objective To explore the application effect of single port laparoscopic techniques in urology grassroots.Methods 60 patients with upper ureteral stones were randomly divided into observation group(using single port laparoscopic technique lithotripsy) and control group (30 cases with open surgery).The surgery time,blood loss,hospital stay,postoperative complications were compared between the two groups and the patients were followed up for three months,the clearance rate of stones and patients' satisfaction were observed.Results The operative time between the two groups had no significant difference(t=1.559,P>0.05).The blood loss of the observation group was significantly less than that of the control group[(128.3±10.32)mL vs.(76.4±9.65)mL],the difference was statistically significant(t=20.003,P<0.01),and the hospitalization time was shorter than that of the control group[(5.86±1.47)d vs.(7.95±1.53)d],the difference was statistically significant(t=5.395,P<0.01).The incidence rate of postoperative complications of the observation group was lower than that of the control group(6.7% vs.30.0%),the difference was statistically significant(x2=5.454,P<0.05).Followed up for 3 months,the ESWL rate(73.3% vs.96.7%) and satisfaction rate (100.0% vs.80.0%) in the observation group and the control group had statistically significant differences (x2=4.705,4.629,all P<0.05).Conclusion The single port laparoscopic technique lithotripsy in the treatment of upper ureteral stones has precise effect,less invasion,high ESWL rate,low complication rate and other advantages,and it is worthy of wide promotion.