Clinical technical operation specification of kidney transplantation for autosomal dominant polycystic kidney disease (2022 edition) / 器官移植

Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited kidney disease and one of the most common causes for end-stage renal disease (ESRD). Kidney transplantation is the optimal renal replacement therapy for ADPKD patients complicated with ESRD. Currently, scholars at home and abroad have a certain controversy about whether polycystic kidney resection is necessary in ADPKD patients before kidney transplantation, and the criteria and methods for polycystic nephrectomy also differ. To further standardize the clinical technical operation of kidney transplantation in ADPKD patients, experts in organ transplantation organized by Branch of Organ Transplantation of Chinese Medical Association formulated this specification from the aspects of diagnosis of ADPKD, indications and contraindications of kidney transplantation for ADPKD, preoperative evaluation and treatment, polycystic nephrectomy, and postoperative management, etc.

Application of minimally invasive percutaneous nephroscopic plasma electrode decortication in the treatment of renal cysts / 现代泌尿外科杂志

Laparoscopic decortication is the standardized surgical treatment for simple renal cysts. With the continuous maturation of minimally invasive techniques, percutaneous nephroscopic decortication and decompression is gradually implemented, which has advantages of minimal invasiveness, fast recovery and good prognosis. Ureteroscopic plasma electrode is a modified procedure, which can achieve more exact intraoperative hemostasis and efficient cutting efficiency than traditional surgery. This article reviews the current treatments of simple renal cysts, and introduces our experience of using minimally invasive percutaneous nephroscopic plasma electrode decortication, its surgical procedures and technical points.

Clinical efficacy of flexible ureteroscopic holmium laser lithotripsy combined with cyst wall incision in the treatment of renal calculi with ipsilateral renal cyst / 现代泌尿外科杂志

【Objective】 To investigate the efficacy of flexible ureteroscopic holmium laser lithotripsy combined with cyst wall incision and drainage in the treatment of renal calculi with ipsilateral renal cyst. 【Methods】 A total of 70 patients with renal calculi complicated with ipsilateral renal cyst (cyst diameter >40 mm, maximum diameter of stone 0.05). 【Conclusion】 Flexible ureteroscopic holmium laser lithotripsy combined with cyst incision and drainage has the advantages of short operation time, small trauma, few adverse reactions, good stone clearance effect and satisfactory efficacy. It can be used as a preferred surgical method for renal calculi complicated with ipsilateral renal cyst.

Diagnostic value of double contrast-enhanced ultrasound in renal cystic lesions: a comparative study with enhanced magnetic resonance and intravenous pyelogram / 中华超声影像学杂志

Objective:To explore the application value of dual contrast-enhanced ultrasound in the differential diagnosis of renal cystic lesions.Methods:Eighty-four cases with renal cysts who were diagnosed by routine ultrasound in Zhejiang Cancer Hospital and Zhejiang Xiaoshan Hospital from January 2019 to October 2020 were included in the study. Intravenous contrast-enhanced ultrasound and enhanced MRI were performed to differentiate benign and malignant cysts. Patients with benign cysts underuent intravenous pyelography and intracapsular contrast-enhanced ultrasound. Before sclerotheraphy to exclude renal pelvic cysts. The diagnostic results of dual radiography were compared with MRI and intravenous pyelography.Results:Among 84 patients with suspected renal cysts, the diagnostic accuracy of enhanced MRI for cystic renal cancer was 97.62%, and the sensitivity was 97.62%. The diagnostic accuracy of intravenous contrast-enhanced ultrasound was 98.81, the sensitivity was 100%, and the specificity was 98.73%. There was no statistically significant difference between the two groups (all P>0.05). 77 cases were diagnosed as benign renal cysts, the detection rate of intravenous pyelography was 9.1% (7/77), the detection rate of renal pelvic cysts by intracystic ultrasonography was 6.5% (5/77). With intravenous pyelography as the gold standard, the diagnostic accuracy of intracapsular contrast-enhanced ultrasound was 97.4% (75/77), the sensitivity was 71.4% (5/7), and the specificity was 100% (70/70). Conclusions:Compared with enhanced magnetic resonance and intravenous pyelography before renal cyst sclerosing therapy, there is no difference in diagnostic efficiency of double contrast ultrasound for benign and malignant cysts. The diagnostic efficiency of renal pelvic cysts is high, and the operation is convenient. It can identify cystic renal cancer and cysts from the renal pelvis and improve the safety of sclerotherapy.

IgG4-related kidney disease presenting as a cystic renal mass: a case report and literature review / 中华泌尿外科杂志

Objective:To investigate the clinical characteristics, differential diagnosis and treatment of IgG4-related kidney disease (IgG4-RKD) presenting as a cystic renal mass.Methods:A 42-year-old male patient was found having a tumor in the left kidney in an annual physical examination. Subsequent CTU scan revealed a round shadow in the lower pole of the left kidney, with slightly lower, uneven density and obscure boundaries, which was slightly enhanced on contrast-enhanced CT imaging, suggesting a cystic mass (Bosniak category Ⅲ). Contrast-enhanced MRI showed a long T1, long T2 signal lesion in the lower pole of the left kidney, which was not obviously enhanced in the cortical phase but exhibited continuous and separated enhancement in parenchymal and delayed phases, suggesting a cystic renal cell carcinoma. A preoperative diagnosis of a left renal mass was made, for which the patient underwent a laparoscopic partial nephrectomy.Results:The resected cystic mass was grey white with obscured boundaries. Microscopically, the mass showed lymphoplasmacytic hyperplasia with lymphoid follicles, cystic formation, fibrosis hyperplasia and vascular obstruction. Immunohistochemistry revealed that the number of IgG4 (+ ) plasma cells was more than 50/HPF, and over 40% IgG (+ ) plasma cells were IgG4 (+ ). By virtue of the radiologic and pathologic findings, the patient was diagnosed with IgG4-RKD. At 2 weeks after operation, serum IgG level was 0.71g/L (reference: 0.03-2.01 g/L). Chest and abdominal CT scans performed 3 months after operation showed no evidence of other organ involvement and serum IgG4 level was within the normal range. Therefore no adjuvant therapy was prescribed.Conclusions:It is usually difficult to differentiate IgG4-RKD presenting as a cystic renal mass by radiography alone. The presence of other organ involvement, serum IgG4 test and renal biopsy can help the diagnosis and so as to avoid unnecessary surgery.

Massive retroperitoneal haematoma because of renal cyst rupture, report of a case / Hematoma retroperitoneal masivo por ruptura de quiste renal, reporte de caso

We report the case of an 86-year-old adult man who, as a pedestrian, is hit by a motorcycle, suffering polytrauma; in initial care, he refers to thoraco-abdominal pain and subsequently neurological deterioration. Assessed by a neurosurgeon and general surgeon, a right chest tube is placed and a laparoscopy is performed where there is little bleeding from the abdominal cavity. It shows deterioration of its general state and dies in respiratory failure. During the necropsy procedure there is subarachnoid hemorrhage and cerebral herniation, rib fractures and pneumonic consolidation, a massive retroperitoneal hematoma is observed due to rupture of simple renal cyst.

Reportamos el caso de un hombre de 86 años que, siendo peatón, es atropellado por una motocicleta, sufriendo politraumatismo. En la atención inicial refiere a dolor toracoabdominal y posteriormente deterioro neurológico. Evaluado por un neurocirujano y un cirujano general, se coloca un tubo torácico derecho y se realiza una laparoscopia y observándose poco sangrado de la cavidad abdominal. El paciente muestra deterioro de su estado general y muere por insuficiencia respiratoria. Durante el procedimiento de necropsia se determina hemorragia subaracnoidea y hernia cerebral, fracturas costales y consolidación neumónica, se observa un hematoma retroperitoneal masivo por rotura de quiste renal simple.

Liver transplantation for congenital hepatic fibrosis-induced liver function failure: A case report and literature review / 吉林大学学报(医学版)

Objective: To analyze the clinical characteristics, the typical pathological features and treatment methods of the patients with congenital hepatic fibrosis (CHF), and to improve the prognosis of the patients. Methods: The clinical data of a patient with CHF underwent liver transplantation for liver function failure were collected, and the relevant literatures were reviewed; the classification, clinical characteristics, diagnosis and treatment of CHF were analyzed. Results: The patient was a 39-year-old man and prensented with upper gastrointestinal bleeding. The results of gastroscope examination showed the severe varicose veins of the esophagus, which was marked by portal hypertension. The imaging examination after admission showed liver cirrhosis, splenomegaly and right renal cyst; the patient had mild liver function change, poor coagulation function, and liver function failure. After medical treatment, the condition was not improved, and the patient underwent allogeneic orthotopic liver transplantation. The postoperative liver pathology indicated CHF; all the laboratory indicators were normal after 1 month of transplantation. The patient recovered better 1 year after operation. Conclusion: CHF is characterized by liver fibrosis, portal hypertension and renal cystic lesions. Liver biopsy is the gold standard for its diagnosis, clinical treatment is mainly for the complications, and liver transplantation is the fundamental treatment.

Quiste renal simple / Simple Renal Cyst

Los quistes renales simples son poco frecuentes en recién nacidos, niños y adolescentes. Suelen ser únicos, y ocasionalmente múltiples. No existen evidencias de riesgo familiar. El objetivo de la presentación fue resaltar la importancia del diagnóstico precoz de malformaciones congénitas y/o defectos estructurales del feto, por ultrasonografía, en la atención primaria de salud. Presentamos las imágenes ecográficas de un caso de afectación fetal por un quiste renal simple a las 36 semanas, sin otros hallazgos ultrasonográficos. Previo asesoramiento genético y dado la avanzada edad gestacional y el buen pronòstico con que cursan estos casos además de no tener otro defecto genético asociado, la pareja decidió la continuación del embarazo. El caso fue confirmado por ecografía posnatal(AU)

Simple renal cysts are rare in newborns, children and adolescents. They tend to be unique, and occasionally multiple. There is no evidence of family risk. The objective of the presentation was to highlight the importance of early diagnosis of congenital malformations and / or structural defects of the fetus, by ultrasonography, in primary health care. We present the echography of a case of fetal involvement by a simple renal cyst at 36 weeks, with no other ultrasonography findings. The parents decided to continue the pregnancy previous genetic counseling, given the advanced gestational age and good prognosis with these cases, and considering there is no other genetic defect associated. The case was confirmed by postnatal ultrasound(AU)

Rapamycin in the treatment of renal diseases associated with tuberous sclerosis complex / 中华儿科杂志

Objective@#To investigate the efficacy and safety of rapamycin in children with tuberous sclerosis complex (TSC) associated renal disease.@*Methods@#A prospective self-control study was conducted. The clinical data of 92 children diagnosed with tuberous sclerosis complex associated kidney disease at the People′s Liberation Army General Hospital from January 2011 to January 2019 were collected. The long-term rapamycin treatment for all patients initiated at 1 mg/(m2·d), which was gradually adjusted to reach a blood concentration of 5-10 μg/L. The changes of the maximum diameter of renal lesions in children after rapamycin treatment were observed and analyzed with Wilcoxon test.@*Results@#Ninety-two children, including 52 males and 40 females, who met the criteria were analyzed. Sixty patients had only renal angiomyolipoma(RAML), while 24 patients had only multiple renal cysts(MRC), and 8 patients had both lesions. The age of TSC diagnosis was 16.0 (7.0, 42.0) months, and the age of initial treatment with rapamycin was 63.5 (21.0, 103.0) months. The follow-up lasted for 12.0 (4.0, 23.0) months. Sequencing of TSC1 and TSC2 genes was performed in 54 children with TSC, including 3 patients (6%) with mutations in TSC1 gene and 51 patients (94%) with mutations in TSC2 gene. The maximum RAML diameter before treatment was 7.0 (4.0, 9.0) mm. The best effect reached at 3 months of treatment, with the diameter of 4.0 (0,7.0) mm. The maximum diameters at 6 months, 1 year and 1-2 years were 5.0 (0,9.8) mm, 5.0 (1.5, 8.5) mm, 5.5 (3.0, 9.0) mm, respectively, and were significantly different from the baseline (Z=-2.404,-2.350,-2.750,P=0.016,0.019,0.006, respectively). The maximum diameter after 2-3 years, and ≥3 years were 5.0 (3.9,7.0) mm and 6.0 (1.0, 11.0) mm, without significant difference from the baseline (Z=-0.856,-0.102,P=0.393,0.919, respectively).The maximum diameters of MRC after 3 months, 6 months, 1 year,1-2 years, 2-3 years, and ≥3 years were 11.0 (5.0, 14.0) mm,3.0 (0.0,11.0) mm,5.0 (0,21.0) mm,0 (0,14.0) mm,0 (0,10.0) mm, and 0 (0,18.3) mm, respectively, but were not significantly different rom the baseline (7.0 (5.0, 15.7) mm)(Z=-0.944,-1.214,-1.035,-1.896,-1.603,-1.214,P=0.345,0.225,0.301,0.058,0.109,0.225, respectively).Twenty-nine patients (32%) had oral ulcers during the entire treatment period, and no serious adverse reactions were observed.@*Conclusions@#Rapamycin could decrease the diameter of TSC-related RAML, but could not inhibit the growth of cysts. It is well tolerated in the treatment of renal diseases associated with tuberous sclerosis complex.

The efficacy and safety of single flexible ureteroscope vs.flexible ureteroscope combined with intraoperative ultrasonography guided in the endogenous renal cyst incision and drainage / 中华泌尿外科杂志

Objective To evaluate the efficacy and safety of single flexible ureteroscope vs.flexible ureteroscope combined with intraoperative ultrasonography guided in the endogenous renal cyst incision and drainage.Methods Retrospective analysis of case data of 64 patients with endogenous renal cysts admitted from January 2015 to December 2017.All the patients undrwent contrast-enhanced CT,urinary tract imaging,ultrasound B to confirm bosniak classification Ⅰ and Ⅱ renal cyst.The patients (38 males,26 females) were divided into single flexible ureteroscope group [group A,32 cases of patients,average age (54.2 ±6.6) years,unilateral or bilateral cystic patients:19 cases/ 13cases,simple cyst of kidney or polycystic kidney:24 cases/8 cases,average maximum diameter of the renal cyst (5.4 ± 1.3) cm,combined with renal calculus:8 cases,combined with hydronephrosis:7 cases,1 case who had the history of laparoscopic renal cyst decapitation,1 case who had the history of percutaneous renal cyst puncture] and flexible ureteroscope group combined with intraoperative ultrasonography guided [group B,32 cases of patients,average age (52.3 ± 9.3) years,unilateral or bilateral cystic patients:21 cases/11 cases,simple cyst of kidney or polycystic kidney:25 cases/7 cases.Average maximum diameter of the renal cyst (5.3 ±1.2) cm,combined with renal calculus:9 cases,combined with hydronephrosis:8 cases,2 case who had the history of laparoscopic renal cyst decapitation,1 case who had the history of percutaneous renal cyst puncture].The double J stent was placed two weeks before the surgery into the body of patients.During the operation,the surgical procedure were used by the electronic flexible ureteroscope and holmium laser (0.8 J,20 Hz),combined with ultrasound B in the monitoring,to find the suitable incision position.It would be defined as the successful result if we could put the head of flexible ureteroscope into the inside of renal cyst and see the image of mist in the screen of ultrasound B.According to the standard,the result of operation wound be defined compared to before operation (success:shrink more than 80％ or maximum diameter was smaller than 1 cm;improvement:shrink about 50％-79％;ordinary result:shrink about 30％-49％;failure:shrink smaller than 30％).Effective rate =(success cases + improvement cases)/total cases.We compared the differences of two groups in the time,efficacy,safety and complication of surgery.Results Compared the results of single flexible ureteroscope groups vs flexible ureteroscope group combined with intraoperative ultrasonography guided in the success cases of surgery,after 8-30 months following-up,total operative complication rate was [8 cases(25％)vs.1 case(3.1％)],success rate of operation in 6 month later [(20 cases (62.5％) vs.28 cases (87.5％)].Flexible ureteroscope group combined with intraoperative ultrasonography guided had advantages statistically (P ＜ 0.05).However,there was no statistical difference for the two groups in the time of operation [(33.4 ± 6.7) min vs.(35.1 ± 8.6) min],single operative complication (intraoperative wounding bleeding:3 cases vs.1 case,postoperative urinary infection:3 cases vs.0 case,perinephric space effusion:2 cases vs.0 case,renal function impairment:1 case vs.0 case)(P ＞0.05).Conclusions Flexible ureteroscope combined with intraoperative ultrasonography guided can help the urologist can improve the success rate of surgery and reduce the chance of surgical injury intraoperatively.

Progress of diagnosis and treatment for cystic kidney disease in children / 中华实用儿科临床杂志

Cystic kidney disease is the main disease of cystic kidney change in children. It may be caused by non_genetic fetal malformations or genetic diseases,or may be acquired rarely. Most renal cysts are usually isolated oraspart of a syndrome. However,fatal renal cystic diseases can develop from these space occupying lesions. Although renalcystic diseases are similar in presentation,they possess distinct features and variable prognosis later in life. In order to correctly diagnose this kind of disease in the early stage,it claim to accurately grasp its pathogenesis,pathology,clini_cal characteristics and radiological findings. A comprehensive analysis of common cystic kidney disease in children is carried out to help clinicians to aid in early distinction and appropriate treatment.

Divertículo calicial y su diagnóstico incidental / Calyceal diverticulum and its incidental diagnosis

Introducción: El divérticulo calicial se detecta en 0,21 a 0.60 por ciento de los urogramas excretores. Objetivos: Describir una paciente con diagnóstico incidental de esta anomalía y su seguimiento durante 11 años. Presentación del caso: Durante la realización de un urograma excretor para el estudio de una hidronefrosis en una niña de siete años de edad, se detectó un divertículo calicial en el riñón contralateral y después de 11 años de seguimiento ultrasonográfico no se ha demostrado modificación ni complicación del divertículo. Conclusiones: El divertículo calicial es una anomalía congénita que puede mantenerse sin complicaciones durante años por lo que debe tratarse conservadoramente(AU)

ABSTRACT Introduction: Calyceal diverticulum is detected in 0,21 percent to 0.60 percent of excretory urogram. Objectives: To describe a patient with an incidental diagnosis of this anomaly and her follow up during 11 years. Case presentation: During the performance of an excretory urogram for studying a hydronefrosis in a seven years old girl, a calyceal diverticulum was detected in the contralateral kidney; and after 11 years of ultrasonographic follow-up there has been no modifications or complication related with the diverticulum. Conclusions: Calycial diverticulum is a congenital anomaly that can last years without presenting complications. That is why it must be treated conservatively(AU)

Collecting duct carcinoma kidney masquerading as hydatid cyst: A rare case report and review of literature

Cystic renal masses pose diagnostic challenge especially when they belong to Bosniak Type II and III. Septal and nodular enhancement on computed tomography (CT) is the strongest predictor of malignant process. A unilocular cyst with a calcified rim or a multilocular cystic lesion with heterogeneity on CT goes in favor of hydatid disease. We report a case in a 65-year-old female who presented with painless hematuria, was found to have a cystic mass in the right kidney. The mass turned out to be collecting duct carcinoma after histopathological examination though imaging studies were in favor of a hydatid cyst.

Clinical assessment of spectrum CT with material decomposition technique in overcoming renal cyst pseudoenhancement / 中国医学影像技术

Objective To evaluate the value of material decomposition imaging of spectrum CT in overcoming renal cyst pseudoenhaneement.Methods Totally 80 patients with renal cysts (total 75 cysts) who underwent CT imaging with GSI mode were collected.The renal cysts were divided into 3 groups according to diameters,group A (diameters 0.5-＜1.5 cm,n=25),B (1.5-＜2.5 cm,n=25) and C (2.5-＜3.5 cm,n=25) respectively.The iodine-water density imaging was reconstructed by using the GSI Viewer analysis software.The CT value and iodine-water concentration of the cysts were recorded.The difference of CT value,iodine-water concentration in unenhanced and enhanced dual phases in each group was compared.Results The difference of CT value between plain scan and parenchyma phase among the 3 groups had statistically significant difference (F=204.128,P＜0.001),and the differences comparing any two were statistically significant (all P＜0.05).The postcontrast attenuation increased more than 10 HU in group A and B,indicating renal cyst pseudoenhancement,and less than 10 HU in group C,which had no pseudoenhancement.There were statistical difference in iodine concentration of the cysts of the 3 groups in unenhance,cortical and parenchyma phases (all P＜0.001),but the difference value in unenhance,cortical and parenchyma phases were less than 10 (100 μg/cm3),and the difference value of the 3 group was group A＞group B＞group C (all P＜0.05).The water concentration of the cysts in group A descend in renal cortical and parenchyma phase with statistical difference (P＜0.001),but the difference value was less than 10 mg/cms.Conclusion The measurements of iodine-water concentration appear to drift as well,the smaller the greater,The degree of the iodine concentration shifting is more obvious than water concentration.

The Clinical Value of Ultrasound-Guided Percutaneous Lauromacrogol Injection Sclerotherapy for Simple Renal Cyst / 中国生化药物杂志

Objective To analyze the clinical value of ultrasound-guided percutaneous Lauromacrogol Injection sclerotherapy in the treatment of simple renal cyst. Methods A total of eighty patients with simple renal cyst, who were divided into 40 groups according to the random number table, were divided into two groups from February 2016 to April 2017. The traditional group used traditional open renal cyst unroofing decompression. Ultrasound guided ultrasound guided percutaneous Lauromacrogol Injection sclerotherapy was performed in the ultrasound guided group. The therapeutic effect, operation time and the rate of successful puncture were compared between two groups of simple renal cysts. It needs to compare the volume of the cyst and the quality of life before and after the intervention. Results Ultrasound guided group simple renal cyst treatment effect was higher than the traditional group (P<0.05). The operation time of the ultrasound guided group was shorter than that of the traditional group, and the success rate of the one shot puncture was higher than that of the traditional group(P<0.05). Before the intervention, the volume and quality of life of the two groups were similar. In the ultrasound guided group, the volume and quality of life in the ultrasound guided group were better than those in the traditional group(P<0.05). Conclusion Ultrasound guided percutaneous Lauromacrogol Injection sclerotherapy is of high clinical value in the treatment of simple renal cysts. The utility model can improve the success rate of one puncture, shorten the operation time, and the exact effect can speed up the regression of symptoms and reduce the volume of the cyst. Therefore, this method can improve the quality of life of patients.

Comparison of percutaneous resection and laparoscopic deroofing of renal cysts / 中华泌尿外科杂志

Objective To compare the short term clinical efficacy of percutaneous resection and laparoscopic deroofing of renal cysts.Methods From October 2013 to June 2016,the data from 39 cases with renal cysts were followed for approximately 22 months (ranging 5-36 months).Patients were randomized into two groups.In the resectoscopic group(17 pts),the mean age of those patients was 57 years (ranging 34-81 years).The mean size of these cysts was 6.4cm (ranging 5.4-8.2 cm).The mean preoperative creatinine was 66.5μmol/L (ranging 38.1-108.8μ mol/L).The mean preoperative sodium was 141.4μ mol/L(ranging 135.6-145.1μmol/L).The mean preoperative potassium was 4.0μmol/L (ranging 3.4-4.7 μmol/L).In the latter laparoscope (22pts),the mean age of these patients was 60 years (ranging 46-73 years).The mean size of these cysts was 6.8cm (ranging 4.3-8.9cm).The mean preoperative creatinine was 74.8μmol/L (ranging 48.6-141.9μmol/L).The mean preoperative sodium was 141.5μmol/L(ranging 135.0-146.1 μmol/L).The mean preoperative potassium was 4.0μmol/L (ranging 3.1-4.8μmol/L).The operative time,blood loss,days of drainage,hospital stay and complications were compared with the two groups.Results All of the 39 cases were accepted the procedure successfully without open conversion.Compared the resectoscopic group with Laparoscopic,the mean operative time was 29.7 min (ranging 15-50 min) and 63.0min (ranging 20-1 00 min),mean blood loss was 36.6ml(ranging 10-80 ml) and 60.4ml(ranging 10-200 ml),days of drainage was 2.3 days and 3.1 days,hospital stay was 3.7 days and 5.1 days,the mean postoperative creatinine was 67.4 μmol/L(ranging 43.8-95.5 μmol/L) and 68.9μmol/L(ranging 46.5-157.6 μmol/L),the mean postoperative sodium was 141.2μmol/L(ranging 136.0-147.2 μmol/L) and 141.6 μmol/L(ranging 136.0-147.2 μmol/L),the mean postoperative potassium was 3.8 μmol/L (ranging 3.2-4.3 μmol/L) and 3.8μmol/L (ranging 3.3-4.3 μmol/L).The overall postoperative pathology was renal cysts.All cases were followed for approximately 19 months (ranging 6-35 months) and 22 months (ranging 5-36 months) in reseetoscopic and laparoscopic group respectively.No cysts recurrence was found by ultrasound.Conclusions Compared with laparoscopic deroofing,use of resectoscopic technology significantly enhances the possibility of achieving better intraoperative results in all patients with renal cysts.Percutaneous resection of simple renal cysts is safe and feasible.

Collecting Duct Carcinoma (Bellini Duct Carcinoma) Presented as a Renal Cyst

Renal cysts are frequently seen in the general population. Most small simple renal cysts are managed by conservative treatment. A renal cell carcinoma (RCC) presenting as a renal cyst is extremely uncommon, and collecting duct carcinoma is a rare type of RCC. This report describes a collecting duct carcinoma initially presnted as a renal cyst. The patient was a 52-year-old man who had been diagnosed with a renal cyst in the left lower pole 8 years earlier but was not regularly follow-up. He presented with left flank pain and gross hematuria. Computed tomography revealed a heterogeneous enhanced mass in the left lower pole and multiple para-aortic lymph nodes. He underwent radical nephrectomy and lymph nodes dissection which confirmed collecting duct carcinoma with sarcomatoid differentiation.

An empirical study on medical selection of flying cadets with urinary system diseases between PLAAF and USAF / 军事医学

Objective To investigate the effect of different medical standards for the urinary system on the enlistment of pilots between PLAAF and USAF , and offer support to amendment .Methods Data on pilots′final enlistment between 2012 and 2015 were analyzed , and results of physical examinations of the urinary system were compared according to differ -ent medical standards .Results One hundred and twenty teenagers enrolled in this examination were disqualifiied due to defects of the urinary system while 97 applicants were qualified after comprehensive assessment of the urinary system .The main problems with the urinary system that affected results of pilots′enlistment were nephroptosia , renal cyst , microscopic hematuria , renal calcified foci and calculus .Conclusion Medical standards for the urinary system are different between PLAAF and USAF, especially those for nephroptosia , renal cyst and microscopic hematuria .The medical standards directo-ry about the urinary system approved by USAF can serve as a reference during our revision of current medical enlistment standards.

Diagnostic performance of contrast-enhanced ultrasound in the evaluation of renal masses in patients with renal impairment

Objective: To evaluate the performance of contrastenhanced ultrasound (CEUS) in the risk stratification of indeterminate renal lesions picked up incidentally on abdominal imaging, in patients with renal impairment. Methods: A retrospective study was performed of nonconsecutive patients who underwent CEUS at our tertiary care centre for indeterminate renal lesions between March 2010 and September 2014. A total of 63 patients with 74 nodules were assessed with CEUS and stratified into either benign (Bosniak I, II, IIF) or suspicious for malignancy (Bosniak III, IV or hypervascular solid lesions). Diagnostic accuracy was determined by comparing these findings to subsequent histological diagnoses, temporal change after at least 20 months follow-up or after a diagnostic computer tomography / magnetic resonance imaging study. Results: CEUS correctly identified 49/52 (94.2%) of benign lesions and 21/22 (95.5%) of malignant lesions, resulting in a sensitivity of 95.5% (95% CI 77.2-99.9%), specificity of 94.2% (95% CI 84.1-98.8%), positive predictive value (PPV) 87.5% (95% CI 67.6-97.3) and negative predictive value (NPV) 98.0% (95% CI 89.4-100%). Conclusion: CEUS has high diagnostic performance in predicting the benignity of a renal lesion in patients with renal impairment, showing sensitivity and NPV approaching 100%.

Clinical features and impact factors of simple renal cysts / 中国综合临床

Objective To analyze the main clinical features and impact factors of simple renal cyst (SRC), and to provide evidence for the future prevation and cure of simple renal cysts.Methods In this crosssectional study,a total number of 91 433 participants(aged 18-98 years old) were included who underwent health examinations during 2012-2014.The main life styles and clinical features of each participants were recored,and blood biochemistry test, urinanalysis and renal ultrasonography were performed.Results The prevalence of SRC was 2.70％ (2 465 subjects were diagnosed by ultrasonography).It was higher in men than women(2.95％ vs.1.68％, P =0.00), which was increased with the increasing of age (respectively 0.37％, 0.57％, 1.30％ ,2.69％ ,4.46％ and 6.91％ in the group of ≤29year,30-39 year,40-49 year,50-59 year,60 -69 year and ≥70 year,P＜0.01).The maximum diameter of simple renal cysts were (2.6±1.7) cm.Age,rate of men, body mass index, glucose, total cholesterol, creatinine, urea nitrogen, and urinary protein positive rate, kidney stone prevalence were higher in SRC group(respectively (61.11±11.24)year vs.(51.37±13.72) year, 87.59％ vs.79.88％, (25.27 ± 3.19) kg/m2 vs.(24.97 ± 3.35) kg/m2, (6.09 ± 2.08) mmol/L vs.(5.70 ± 1.85) mmol/L, (5.11 ± 1.54) mmol/L vs.(5.02 ± 1.37) mmol/L, (90.71 ± 34.84) μmol/L vs.(80.72 ±28.04) μmol/L, (6.03±3.60) mmol/L vs.(5.55±5.15) mmol/L,7.46％ vs.4.25％ ,7.06％ vs.1.28％ ,P ＜0.01) ,but glomerular filtration rate, triglycerides, rate of like salty, drink, smoke was lower than the group withoutSRC((79.01±19.89) ml/(min· 1.73 m2) vs.91.74±21.8 ml/(min · 1.73 m2),(1.57±1.48) mmol/L vs.(1.69± 1.82) mmol/L, 4.38％ vs.7.94％, 22.68％ vs.30.75％, 24.91％ vs.30.97％;P＜ 0.01).But,there was no difference between these two groups in serum uric acid ((309.16± 85.79) μmol/L vs.(312.38±91.22) μmol/L,P＞0.05).SRC as a dependent variable of multivariate log regression analysis.The result showed the OR of age, gender, fasting blood glucose, urea nitrogen, glomerular filtration rate, positive urine protein,kidney stone were respectively 1.040, 1.862, 1.035, 1.005,0.982, 1.254, 4.526, 95％ CI =1.037 -1.045,1.643-2.110,1.017-1.053,1.000-1.010, 0.980-0.984, 1.068-1.473,3.812-5.374;P ＜0.01).While the OR of multiple SRC was 0.43,95％ CI: 0.210-0.867 (P＜0.05) , when kidney stone as a dependent variable.Conclusion Old-age males are high risk population of catching SRC.Kidney stone and positive urine protein are important risk factors of SRC.Meanwhile kidney stone more easily induce single and small SRC.SRC is a key risk factor to induce renal function decrease.Therefore, GFR is a sensitive index of renal disfunction that induced by SRC.