Percutaneous nephrolithotomy through the upper pole calix access for complicated renal calculi: report of 581 cases / 南方医科大学学报

<p><b>OBJECTIVE</b>To discuss the optimal approach of percutaneous nephrolithotomy (PCNL) for treatment of complicated renal calculi.</p><p><b>METHODS</b>A total of 581 patients with complicated renal calculus were treated by PCNL through the upper pole calix access. Of the 581 patients, 55 had multiple upper pole calculi, 136 had staghorn stones, 145 had partial staghorn stones, and 245 had multiple renal calculi.</p><p><b>RESULTS</b>PCNL through the upper pole calix access was completed successfully in all the cases. Of these patients, 90.3% (525/581) were stone-free after a single access, with a total stone-free rate of 94.6% (550/581). Thirty-five patients needed two accesses, 10 needed 3 accesses, 2 required 4 accesses, and 1 patients had 5 accesses. The operative time ranged from 30 to 150 min (mean 45 min). The successful rate of puncture was 100% without occurrence of severe injury of the pleura, intestine, peritoneum or other adjacent organs.</p><p><b>CONCLUSIONS</b>Percutaneous nephrolithotomy through the upper pole calix access allows greater stone clearance rate due to its easy access into the intrarenal collecting system and can be an ideal approach for PCNL for complicated renal calculi.</p>

Laparoscopic radical cystectomy and detenial sigmoid colon orthotopic neobladder reconstruction for bladder tumor in a 3-year-old boy / 南方医科大学学报

<p><b>OBJECTIVE</b>To present a case of laparoscopic radical cystectomy and detenial sigmoid colon orthotopic neobladder reconstruction for bladder tumor in a child.</p><p><b>METHODS</b>A 3-year-old boy with bladder rhabdomyosarcoma underwent laparoscopic radical cystectomy and detenial sigmoid colon orthotopic neobladder reconstruction. The bilateral pelvic lymphadenectomy and cystectomy were performed laparoscopically, and removal of the mobilized specimens and urinary diversion operation were managed through enlarged abdomen incision. The urinary diversion procedure included construction of the detenial sigmoid pouch, bilateral stented antiflux implantation of the ureters in the pouch and orthotopic anastomosis of the neobladder with the urethra.</p><p><b>RESULTS</b>The total operative time was 6 h, and the laparoscopic procedure lasted for about 3.5 h. The intraoperative blood loss was 50 ml, and 200 ml concentrated red blood cell transfusion was used for the safety of the patient. Six dissected lymph nodes in each pelvic side and the surgical margins of the ureter and urethra were all free of tumor invasion. Bowel peristalsis recovered 3 days after the operation, and the pelvic drainage and the neobladder drainage tubes were removed on day 7 and 14, respectively. The urethral catheter and ureteral stents were removed 25 days after the operation. The daytime urine control and micturition recovered 1 week after the operation. The neobladder capacity was about 110 ml, with residual urine volume of 10 ml and peak flow rate of 12 ml/s after 5 months. No perioperative complications occurred such as water-electrolyte and metabolic acid-base balance disorders, urinary leakage, reflux or bowel obstruction.</p><p><b>CONCLUSION</b>Laparoscopic radical cystectomy is minimally invasive, reduces intraoperative blood loss and allows rapid postoperative recovery, and can be a promising approach to management of bladder rhabdomyosarcoma in children.</p>

Application of silk fibroin film for repairing rabbit urethral defect / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the effect of silk fibroin film for repairing urethral defect in rabbits.</p><p><b>METHODS</b>Twenty-four male New Zealand rabbits were randomized into experimental group, control group I and control group II. In the experimental group, a urethral defect of 1.5 cm was induced in the 12 rabbits and repaired with silk fibroin film. The 6 rabbits in control group I without the surgically induced defect served as the sham operation group, and in control group II consisting of 6 rabbits the urethral defect of 1.5 cm was induced without repair. Histological observation and immunohistochemistry were conducted to examine the regenerative segments of the urethra at regular time points between 2 and 16 weeks postoperatively.</p><p><b>RESULTS</b>The 12 rabbits in the experimental group did not show signs of urethral stricture following the surgery. The implanted silk fibroin film for defect repair was degraded completely at 16 weeks and the defect was repaired with smooth urethral mucous membrane lining and orderly arranged smooth muscle cells. Immunohistochemistry identified the cells lining the defect area as the urethral epithelial cells.</p><p><b>CONCLUSION</b>Silk fibroin film can promote the repair of urethral defect by inducing the growth of the urethral epithelial cells and smooth muscle cells.</p>