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Objective:To investigate the effect of potassium sodium hydrogen citrate in the treatment of renal uric acid calculi with heavy load.Methods:The clinical data of 6 patients with intrarenal high-load uric acid calculi (long diameter >4 cm) treated with potassium sodium hydrogen citrate in our hospital from January 2018 to July 2020 were reviewed. All of the patients were male. Their ages ranged from 42 to 66 years, with an average age of 51.3 years old. The average length to diameter was 6.0(4.1-7.6) cm. The average density of stone was 475 (418-535) HU. The average blood uric acid was 453.3(258.7-570.0)μmol/L, and all patients had a urine pH ≤5.5. The blood uric acid level was higher than normal serum uric acid level before treatment, and 3 cases had a history of gout. Stone composition analysis revealed 100% uric acid stone in two patients before treatment. The remaining patients were more likely to have uric acid calculi before treatment. None of the patients had a history of urinary tract infection. All patients were treated with oral potassium sodium hydrogen citrate. During the treatment, the starting dose was 10g/ day, which was divided into 2.5 g after breakfast, 2.5 g after lunch and 5.0 g after dinner. The dose was adjusted according to the pH value of urine, and the urine pH was maintained between 6.5-7.0. CT plain scan was repeated every 2-3 months during the treatment period to evaluate the treatment effect.Result:After 2.5-8.0 months’ treatment, the stone load of all the patients was reduced to different degrees, and the average length diameter was shortened by 3.2cm, among which two patients’ stones disappeared. CT scan showed the stone edge changed from smooth to rough after the treatment, and there would be worm erosion defect and cavity on the surface and inside of the stone, showing obvious stone dissolution phenomenon.Conclusions:Potassium sodium hydrogen citrate has a good therapeutic effect on renal uric acid calculi with heavy load. Non-infected patients with uric acid calculi should be treated with potassium sodium hydrogen citrate.
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Objective To evaluate the feasibility and clinical effect of Argon plasma coagulator in simple enucleation for small renal cell carcinoma. Methods On the basis of successful performing the animal experience of coagulating therapy on the wound tissue during partial nephrectomy with Argon plasma coagulator in rabbit models, 10 cases of simple enucleation for small renal cell carcinoma with Argon plasma coagulator were accomplished. Results Both with the standard of stopping bleeding of wound tissue by Argon plasma coagulator and with the standard of re-spraying the wound tissue for 2 s after stopping bleeding using Argon plasma coagulator, the depth of wound tissue necrosis without blocking the renal pedicle is deeper than that with blocking the renal pedicle(P=0. 012 and P=0. 002, respectively).If the wound tissue was re-sprayed for 2 s after stopping bleeding by Argon plasma coagulator, the depth of the wound tissue necrosis without blocking the renal pedicle was deeper than that just with blocking the renal pedicle(P=0. 007 and P=0. 002,respectively). In the part of application in clinical, all procedures were successfully completed. The mean operative time was 163 min (range, 100-210 min) and mean blood loss was 230 ml (range, 100-400 ml). Drainage tube was pulled out 1 month after operation in 1 case for being allergic to absorbable hemostatic gauze, and the mean pulling drainage tube out time in others was 4. 2 d (range, 3-5 d). During a mean follow-up of 22 months (range, 10-38 months), no local tumor recurrence and distant metastasis was found. Conclusion Argon plasma coagulator can be used in simple enucleation for small renal cell carcinoma, and the clinical effectiveness is ideal.
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Objective To investigate the clinical characteristics and treatment method of pulmonary metastasis of transitional cell carcinoma of urinary tract.Methods The clinical data of 18 patients with pulmonary metastasis of transitional cell carcinoma of the urinary tract,who were admitted to the Second Hospital of Tianjin Medical University from July 2005 to March 2009 were analyzed.Results The primary sites of transitional cell carcinoma of these 18 patients were renal pelvis(8 cases),ureter(6 cases) and bladder(4 cases).Multiple metastases to both lungs were found in 14 cases,the chest X-ray showed dense nodular shadows in different size diffused in both lungs,and CT examination revealed the same picture.All the 14 patients were treated with systemic chemotherapy,and 13 of them underwent surgical operation after the discovery of local recurrence in their bladders.Isolated lung metastasis was found in 4 cases,in whom chest X-ray showed isolated dense nodular shadow in the lung,and CT examination revealed soft tissue shadows adjacent to the chest wall.All the 4 patients were treated with implantation of radioactive pellets and systemic chemotherapy,and one of them underwent surgical operation after the discovery of a local recurrence in the bladder.Follow-up was conducted for 6-36 months.Two patients died in 6-12 months,14 died in 12-24 months,and 2 survived for longer than 24 months.Conclusions The incidence of pulmonary metastasis of transitional cell carcinoma of urinary tract is low.Chest radiograph and CT are the main diagnostic means.Systemic chemotherapy should be used as the main treatment for diffuse pulmonary metastasis,radioactive pellet implantation and systemic chemotherapy should be used for a localized isolated pulmonary metastasis,and surgical operation should be done for the patient with local recurrence in the bladder.