Predictive value of dual-source stone energy spectrum CT for uric acid stones / 中华泌尿外科杂志

Objective:To investigate the predictive value of stone composition prediction method based on dual-source stone energy spectrum CT for uric acid stones.Methods:The clinical data of 204 patients with urinary stones, 159 males and 45 females, admitted to Shanghai Sixth People's Hospital from July 2020 to July 2022 were retrospectively analyzed. The average age was (50.7±14.3) years. There were 187 cases of upper urinary tract (kidney, ureter) stones and 17 cases of lower urinary tract (bladder, urethra) stones. All patients underwent preoperative dual-source stone energy spectroscopy CT, measuring CT values at 150 kV and 100 kV, respectively, and the calculated dual energy ratio (Ratio) was used to predict stone composition. Of the 204 cases in this group, 33 cases underwent percutaneous nephrolithotomy and 171 cases underwent ureteroscopic lithotripsy. Postoperative stone specimens were analyzed for stone composition by infrared spectroscopy. Subject work characteristic (ROC) curves were used to analyze the efficacy of preoperative dual-source stone energy spectrum CT to predict uric acid stones.Results:In 204 patients, preoperative CT predicted 28 cases of uric acid stones and 176 cases of non-uric acid stones, including 136 cases of calcium oxalate stones, 38 cases of hydroxyapatite, and 2 cases of cystine stones. Postoperative IR spectral analysis detected 26 cases of uric acid stones and 178 cases of non-uric acid stones, including 129 cases of calcium oxalate stones, 47 cases of hydroxyapatite, and 2 cases of cystine stones. Compared with the preoperative CT results, there were 2 false positives and no false negatives in the classification of uric acid stones. The ROC curve showed that the sensitivity of the CT value for predicting uric acid stones at 100 kV was 96.2%, the specificity was 99.5%, and the area under the ROC curve (AUC) was 0.995, with the best prediction value of 620 HU.The sensitivity of the CT value for predicting uric acid stones at 150 kV was 96.2%, specificity was 85.5%, AUC was 0.916, and the best predictive value was 597.5 HU. The sensitivity of using Ratio values for predicting uric acid stones was 100.0%, specificity was 97.9%, AUC was 0.996, and the best predictive value was 1.14. The CT values for uric acid stones at 100 kV and 150 kV were (558.58±77.07) HU and (521.12±83.54) HU, CT values for calcium oxalate stones were (1 335.26±301.82) HU and (878.21±200.21) HU, CT values for hydroxyapatite were (1 104.09±203.61) HU and (710.38±178.44) HU, respectively.The CT values of cystine stones were (684.5±67.18) HU and (573.5±67.10) HU, respectively, and the differences between uric acid stones and other components were statistically significant ( P<0.01). The Ratio values of uric acid stones, calcium oxalate stones, hydroxyapatite, and cystine stones were 1.08±0.06, 1.52±0.08, 1.62±0.40, and 1.19±0.02, respectively, and the differences were statistically significant ( P<0.01) when comparing uric acid stones with other components. Conclusion:The CT and Ratio values of dual-source stone energy spectrum CT can effectively distinguish uric acid stones from other types of stones, and the accuracy, sensitivity, and specificity of this method for predicting uric acid stones are high.

Long-term follow-up outcomes of modified transobturator bulbourethral sling suspension for post-prostatectomy incontinence / 现代泌尿外科杂志

【Objective】 To evaluate the safety and efficacy of transobturator bulbourethral suspension with modified four-armed pelvic sling for post-prostatectomy incontinence (PPI). 【Methods】 The clinical data of 78 male PPI patients treated during Jan.2012 and Dec.2017 in our hospital were collected. The incontinence quality of life (I-QOL) score, daily use of urine pad, 1-hour urine pad test, residual urine volume (RUV), and maximum flow rate (Qmax) were assessed before and after surgery. 【Results】 The total success rate was 79.5%, of which the cure rate was 56.4% and the improvement rate was 23.1%. The preoperative I-QOL score was (54.6±3.9), daily use of urinary pad was (3.6±0.7), and increase in weight of the 1-hour urine pad test was (33.6±5.0) g. Three years after surgery, the I-QOL score was (80.4±5.7), daily use of a urinary pad was (1.9±0.4), and increase in weight of the 1-hour urine pad test was (7.4±1.3) g. Compared to preoperative status, the I-QOL score, daily use of urine pad, and increase in weight of the 1-hour urine pad test 3 years after surgery improved significantly (P<0.05). During the mean follow-up of (61.4±20.5) months, no significant changes in the I-QOL score, daily use of a urinary pad, 1-hour urinary pad test, RUV or Qmax were observed, and no complications occurred. 【Conclusion】 Transobturator bulbourethral suspension with modified four-armed pelvic sling is an effective and safe procedure to treat post-prostatectomy incontinence. The long-term efficacy is satisfactory.

Analysis of laparoscopic repair of traumatic bladder neck obliteration / 中华泌尿外科杂志

There are few reports on laparoscopic repair of traumatic atresia of bladder neck. In this study, three patients with traumatic atresia of bladder neck were repaired by laparoscopic surgery, and the surgery was successfully completed. During postoperative follow-up, the patients had smooth urination, no urinary incontinence and sexual function damage, and laparoscopic surgery was effective in repairing traumatic atresia of bladder neck.

Oral mucosal grafts urethroplasty for the treatment of anterior urethral strictures: a ten-year clinicalexperience / 中华泌尿外科杂志

ObjectiveTo evaluate the efficacy of using oral mucosal grafts (buccal mucosa and lingual mucosa) for urethroplasty in the treatment of anterior urethral strictures. Methods Between Jan 2001 and Dec 2010,255 patients with urethral strictures (length ranging from 3 cm to 18 cm,mean 6 cm)underwent one-stage onlay oral mucosal grafts urethroplasty.Two different techniques were used for urethral reconstruction.The first technique involved tubularized dorsal lingual mucosa graft (LMG) augmentation of urethral plate ; the second technique used dorsal patch graft urethroplasty.Of the 255 patients,49 patients with long-segment urethral strictures ( ≥ 8 cm) underwent dual buccal mucosal graft ( BMG),dual LMG,combined LMG and BMG or long-strip LMG urethroplasty. ResultsThe patients were followed up for 8 -120 months postoperatively ( mean 37 months).Of the 255 cases,230 cases voided well and the urinary peak flows ranged from 16 to 51 ml/s (mean 26 ml/s).The overall success rate was 90.2％.Seventeen cases developed a recurrence of urethral stricture.Among these patients,15 underwent BMG urethroplasty again and 2 underwent direct vision internal urethrotomy,after which the patients voided well.Eight cases presented with urethrocutaneous fistula,these patients underwent a second operation,after which,the urethrocutaneous fistulas were cured. Conclusions The buccal mucosa and lingual mucosa are excellent sources of graft materials for the repair of anterior urethral strictures.Combined two oral mucosal grafts substitution urethroplasty is an effective technique for the treatment of long-segment urethral strictures.

Application of 3-dimensional CT reconstruction in the diagnosis of posterior urethral strictures or ankylurethria / 中华泌尿外科杂志

Objective To study the diagnostic value of 3-dimensional CT reconstruction in posterior urethral strictures or ankylurethria.Methods Thirty patients with strictures or ankylurethria of posterior urethra caused by pelvic fracture underwent helical CT scan and 3-dimensional reconstruction of the urethral canal as well as radiographic urethrography before and post open urethral reconstruction to observe the urethral anatomy,the length and position of the urethral strictures,the depth of periurethral scar.Results The mean stricture or ankylurethria length measured by radiographic urethrography was 4.0 cm (range from 1.0 cm to 7.0 cm),and the correlation coefficient of stricture or ankylurethria length was 0.92,21 (70%) patients were diagnosed accurately by radiographic urethrography.The mean stricture or ankylurethria length measured by 3-dimensional CT reconstruction was 4.3 cm (range from 1.2 cm to 7.6 cm),and the correlation coefficient of stricture or ankylurethria length was 0.96,there were 28(93%) patients diagnosed accurately by 3-dimensional CT reconstruction.The mean stricture or ankylurethria length measured by open urethral reconstruction was 4.2 cm (range from 1.5 cm to 7.5 cm).Five patients with urethrorectal fistula were also diagnosed accurately by 3-dimensional CT reconstruction rather than by radiographic urethrography.Conclusions 3-dimensional CT reconstruction of the urethral canal can accurately evaluate the urethral anatomy,the length and position of the urethral strictures,as well as the depth of periurethral scar after crush injury and provide useful information for operation that may not be provided by radiographic urethrography.3-dimensional CT reconstruction may become the most valuable means for detecting posterior urethra strictures or ankylurethria with urethrorectal fistula.

Inhibition of bladder activity by 5-HT1 subtype-selective serotonin receptor agonists in cats with chronic spinal cord injury / 中华泌尿外科杂志

Objective To investigate the effect of bladder activity by 5-hydroxytryptamine serotonin receptor agonists with chronic spinal cord injury(SCI). Methods Intact cats and SCI cats were catheterized through the bladder dome for saline-filling cystometry.Dose-response curves for i.v.8-OH-DPAT and GR-46611 were followed in three cases each by WAY-100635.Threshold volume,capacity,residual volume,micturition volume,and arterial pressure were measured. Results Intact cats showed few significant changes in cystometric variable.SCI cats responded to both 8-OH-DPAT and GR-46611 with dose-dependent increases in threshold volume,capacity,and residual volume.Effects of 8-OH-DPAT but not GR-46611 were largely reversed by WAY-100635. Conclusions Both 5-HT_ 1A and 5-HT_ 1B/1D agonists may offer a promising means of reducing bladder hyperactivity and increasing bldder capacity in patients with chronic SCI.

Bulbourethral suspension in treatment of male incontinence / 中华外科杂志

<p><b>OBJECTIVE</b>To explore whether bulbourethral suspension procedure is effective for the treatment of male urinary incontinence of post-prostatectomy and posterior urethroplasty.</p><p><b>METHODS</b>Twelve male patients with urinary incontinence undergone bulbourethral suspensive operation were reviewed and analyzed with regard to the operation method, postoperative urinary dynamics and clinical results.</p><p><b>RESULTS</b>Ten patients resumed complete control of urination and 1 was improved. In one patient, postoperative difficulty occurred in voiding but corrected by transurethral bladder neck revision for free passage of urine and continence. Urodynamic study showed that the maximum urethral pressure ranged from 85 to 115 cm H(2)O (mean 98 cm H(2)O, 1 cm H(2)O = 0.098 kPa). The functional urethral length ranged from 3.5 to 4.5 cm (mean 3.75 cm).</p><p><b>CONCLUSION</b>Bulbourethral suspension procedure is effective in the treatment of male urinary incontinence after prostatectomy and posterior urethroplasty.</p>

Urethral reconstruction with colonic mucosa in treatment of complex urethral stricture / 中华预防医学杂志

<p><b>OBJECTIVE</b>To investigate the possibility of urethral reconstruction with colonic mucosa for the treatment of complex longer urethral stricture (>/= 10 cm).</p><p><b>METHODS</b>From October 2000 to September 2001, 6 patients with complex longer urethral stricture were treated with colonic mucosal graft urethroplasty. They had under gone 3 previous unsuccessful urethral repairs on average. Urethral reconstruction with a free graft of colonic mucosa ranged from 10 to 15 cm (mean 12.17 cm). Follow-up included retrograde urethrography, urethroscopy, and uroflowmetry.</p><p><b>RESULTS</b>The patients were followed up 3 - 14 months postoperatively (mean 7.8 months). Meatal stenosis developed in one patient 3 months after operation needed reoperation. The patient voided very well with urinary peak flow 28.7 ml per second duing follow-up for 12 months postoperatively. The other patients voided well with urinary peak flow greater than 15 ml per second. At urethroscopy, colonic mucosa was macroscopically difficult to distinguish from normal original urethral mucosa in 4 patients over 6 months after the operation.</p><p><b>CONCLUSIONS</b>Colonic mucosa graft urethroplasty is feasible for the treatment of complex longer anterior urethral stricture. The technique is useful for urethral reconstruction when penial skin and bladder mucosa are not available.</p>

A comparative evaluation of laparoscopic and open surgical unroofing of renal cysts / 中华泌尿外科杂志

0.01). There was no recurrence in both groups. Mean hospitalization stay was 8.1 days in the laparoscopy group, whereas it was 11.8 days in the open surgical group. Post- operative fever lasted a mean of 4.1 and 5.4 days in the two groups respectively ( P