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ObjectiveSleep-related painful erections （SRPE） is a rare sleep disorder characterized by repeated awakening due to painful interruptions of penile erections during nighttime sleep， and its etiology is currently unclear. The purpose of this study is to explore the impact of potential risk factors on the incidence of SRPE. MethodsInformation was collected through questionnaires administered to patients who presented at the urology department and suffered from SRPE or did not suffer from SRPE. A total of 290 participants completed the study， including 145 controls and 145 cases. Logistic regression analysis was used to assess the impact of age， occupation， sleep initiation time per night， frequency of sexual intercourse per week， psychological status， erectile dysfunction， chronic prostatitis， prostate enlargement， lumbar spine disease， central nervous system disease， hypertension， diabetes and family history on the onset of SRPE. ResultsSingle-factor logistic regression analysis found that a history of chronic prostatitis， intellectual labor occupation， central nervous system disease， late sleep onset， frequency of sexual activity， and anxiety status might be related to the onset of SRPE. After incorporating these factors into a multivariate regression analysis model， it was found that having sexual activity ≥2 times/week （OR 95%CI = 0.326（0.179，0.592） and late sleep onset （after 24：00） （OR 95%CI = 0.494（0.265，0.918）might be protective factors for SRPE， while a history of chronic prostatitis（OR 95%CI = 3.779（2.082，6.859） might be a risk factor for SRPE. However， there was no significant statistical difference in the impact of central nervous system diseases and occupation on multivariate analysis. ConclusionChronic prostatitis and anxiety status may be independent risk factors for SRPE； having sexual activity ≥2 times/week and delaying sleep time appropriately may be independent protective factors.
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Objective:To explore the pathogenesis and treatment of severe hematuria after sexual activity in men.Methods:A retrospective analysis of 10 patients with severe hematuria after sexual activity who were admitted from January 2017 to January 2020, including 4 cases from Peking University People’s Hospital, 3 cases from Donghua Hospital Affiliated to Sun Yat-sen University, 2 cases from Second Hospital of Tianjin Medical University, and 1 case from Tianjin Jinnan Hospital. The average age of the patients was (33.5±7.6) years old. All 10 cases had severe hematuria and blood clots within 1 hour after sexual activity. The blood routine examination revealed that there were different degrees of hemorrhagic anemia after 24 hours of admission, and the average hemoglobin was(95.8±8.9)g/L. Ten patients underwent transurethral cystoscopy electrosurgical resection and / or electrocoagulation under subarachnoid anesthesia or epidural anesthesia. All patients were confirmed to be bleeding from posterior urethral lesions, including 4 cases located in the distal seminal caruncle, 5 cases in the prostate, and 1 case in proximal seminal caruncle. Three cases whose bleeding from varicose veins in the prostate urethra were treated with electrocoagulation in order to stop the bleeding, and lesions were removed in the other 7 cases for pathological examination. The F16 urinary catheter was indwelt after the operation.Results:All 10 operations in this group were successfully completed. Six cases of posterior urethral hemangioma rupture and 1 case of posterior urethral polyp were confirmed by the pathological examination in 7 cases. The urinary catheter was successfully removed 1 week after operation. Abstinence was required for 1 month after operation. There was no recurrence of hematuria after resuming sexual activity, and no complications such as dysuria or urinary incontinence.Conclusion:Severe hematuria after sexual activity is mostly caused by rupture or bleeding of abnormal blood vessels in the posterior urethra. Transurethral resection and/or electrocoagulation are the first choice for treatment. The effect is reliable and the prognosis is satisfactory.
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BACKGROUND: Infection following kidney transplantation has become one of the main reasons for graft failure and death of allograft recipients. However, there is not a standard therapeutic scheme for infection following kidney transplantation. OBJECTIVE: To investigate the clinical features and treatment measures of infection, additionally, to increase the cure rate of infection following kidney transplantation.DESIGN, TIME AND SETTING: A retrospectively analysis was performed at the Organ Transplantation Center, the First Affiliated Hospital of Kunming Medical College from February 2006 to February 2008.PARTClPANTS: Eighteen cases of infections in 84 kidney allograft recipients.METHODS: All cases were checked by chest X-ray. Patients who had no significant lung infection symptoms or obvious signs received lung CT scan. Pathogen detection was performed, including hemoculture, urine culture, sputum culture, nose swabs culture, throat swab culture, checking clinically important cytomegalovirus (CMV), EB-DNA and mycoplasma in blood, acid-fast bacilli and eumycete culture in sputum. All cases of pulmonary infection underwent a comprehensive treatment-antiviral drugs, antibiotics and antifungal. Depending on the individual condition and absolute values of lymphocytes and CD4+T cells, the immunosuppressant was adjusted individually. The occurrence time, clinical symptom, auxiliary examination and treatment strategies were analyzed.MAIN OUTCOME MEASURES: The occurrence time of infection and clinical symptoms; imaging manifestation and results of pathogenic detection; selection of antibiotics and immunosuppressant adjustment.RESULTS: Among 18 cases, 11 cases (61.2%) were deceased-donor kidney transplant recipients. Inflection following kidney transplantation occurred in 12 cases (66.7%) within 3 months, and increased to 15 cases (83.3%) within 3-6 months. Of the 18 infection cases, 14 cases (77.8%) had a main symptom of fever. There were 15 cases (83.3%) of respiratory tract infection, including 13 cases (72.2%) of pulmonary infection. Fungal cultivation, especially Monilia, was positive in 6 cases. Three out of the 18 cases (16.7%) died, two of whom had CMV infection. Mixed infection occurred in all cases.CONCLUSION: Infected patients following kidney transplantation present with diversity pathogens, which are dominated by bacteria, fungus and virus. Severe pneumonia combined with CMV infection demonstrates that poor prognosis, fungal and virus infection following kidney transplantation should be given more attention. Combined de-escalation therapy is the main method, and timely adjustment and even discontinuance of immunosupprassive agents is one of the key points in the treatment of infection following kidney transplantation