The clinical study of laparoscopic radical cystectomy for bladder cancer aftar partial cystectomy / 中华泌尿外科杂志

Objective:To discuss the clinical efficacy of laparoscopic radical cystectomy in the treatment of bladder cancer after partial cystectomy.Methods:The clinical data of 30 patients who underwent laparoscopic radical cystectomy after PC in Sichuan Provincial People's Hospital from March 2016 to August 2020 were retrospectively analyzed. Including 24 males and 6 females with an average age was 62.5 (45.5-82.5)years.6 out of 30 cases underwent pelvic lymph node dissection during PC. All patients had definite pathological diagnosis for the high-grade urothelial carcinoma after PC, and the tumor staging was pT 2-3bN 0M 0.5 patients received postoperative adjuvant chemotherapy with gemcitabine and cisplatin, 6 received postoperative adjuvant radiotherapy, 13 received postoperative adjuvant radiotherapy and chemotherapy, and all patients were received maintenance intravesical instillation. Median time for local tumor recurrence after PC was 9(5-29) months, all patients had pathological diagnosis for the high-grade papillary urothelial carcinoma, cT 2-4N 0M 0 stage.The average tumor diameter was 3.5(2.5-4.5)cm, an average number of tumors was 2(1-3). Laparoscopic salvage cystectomy was performed after recurrence.General anesthesia, supine position, 5 ports were inserted through the abdominal approach. Standard pelvic lymph node dissection (PLND) was used to clean the pelvic lymph nodes. Those who had underwent PLND no longer clean the obturator and peripheral iliac vessels, but including the common iliac vessel and the bifurcation of the abdominal aorta and lymphatic tissues around the inferior vena cava, as well as the presacral lymph nodes. Results:All 30surgeries were successfully performed. The average operative time was 270(240-310)min, average estimated intraoperative blood loss was 180(50-300)ml, and there was no blood transfusion during the perioperative period.The average number of lymph nodes dissected was 18 (10-27). There were 4 cases with positive lymph nodes, of which 3 cases were positive for 2 obturator lymph nodes, and 1 case was positive for 3 obturator and external iliac lymph nodes. No serious intraoperative complications occurred.No lymphatic leakage occurred. The average drainage duration was 4(3-7) d, and postoperative hospital stays was 9(7-20)d. The postoperative pathology was invasive high-grade papillary urothelial carcinoma, and pathological TNM stage was pT 2-4aN 0-2M 0.13 patients received postoperative adjuvant chemotherapy. The average postoperative follow-up time was 23(3-31) months. There were 2 cases of pelvic recurrence and 1 case of retroperitoneal lymph node metastasis. These 3 cases received adjuvant chemotherapy and radiotherapy. Conclusions:Radical cystectomy should be the primary treatment for recurrence of bladder cancer after partial cystectomy.

Safety of enzalutamide in patients with mCRPC with hepatic dysfunction / 中华泌尿外科杂志

In March 2019, a patient with advanced prostate cancer was diagnosed in Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, and the disease progressed to the stage of mCRPC after traditional endocrinotherapy. Serious adverse event occurred after 1 month of treatment with abiraterone, which result in drug withdrawal, and replaced therapy by enzalutamide, the effect was good.

Effects of individualized testosterone replacement therapy on serum total testosterone and sex hormone levels in male patients with late-onset hypogonadism / 实用医学杂志

Objective To observe the effects of individualized testosterone replacement therapy on serum total testosterone(TT)and sex hormone in males with late-onset hypogonadism(LOH). Methods A total of 78 cases with LOH males were divided into group A(TT<8 nmol/L)and group B(8≤TT<11.5 nmol/L)according to the serum TT level,and the B group was randomly divided into the B1 group and the B2 group.They were given the individualized testosterone replacement therapy,and the treatment effect was compared among the 3 groups. Results After treatment,the SHBG level in the 3 groups was significantly reduced(P<0.05)whereas the serum TT level was significantly higher(P<0.05). The TT level in the B1 group was significantly higher than that in the B2 group(P ＜0.05). The levels of E2and FSH in the 3 groups were significantly lower(P ＜0.05)whereas the level of P was significantly higher(P ＜0.05). The ADAM scores in the 3 groups were significantly better than those before treatment(P<0.05),and there was no significant difference between the B1 group and the B2 group (P ＞0.05). There was no significant difference in the total incidence rate of adverse reactions between the group A and the other two groups(P ＞0.05),and the rate in the B2 group was lower than that in the B1 group(P <0.05). Conclusions In supplementary treatment of LOH,TT ＜8 nmol/L recommended to choose conventional dose,and 8≤TT<11.5 nmol/L can choose a small dose of testosterone.

A study of clinical characteristics and prognosis of infradiaphragmatic craniopharyngioma / 中国神经精神疾病杂志

Objective To summarize clinical characteristics of infradiaphragmatic craniopharyngioma and explore its prognosis factors. Methods The clinical date, imaging and follow-up findings were analyzed retrospectively in 58 pa?tients with infradiaphragmatic craniopharyngioma who underwent surgical operation in our hospital. Factors related to the postoperative quality of life of patients were analyzed using multi-factors Logistic regression analysis. Results There were 45 minor cases with infradiaphragmatic craniopharyngioma, of which forty cases (88.9%) had preoperative visual im?pairment. Preoperative endocrine examination revealed that 21 cases (46.7%) had pan-hypopituitarism and 24 cases (53.3%) had pari-hypopituitarism. In addition, preoperative MRI showed that 38 cases (84.4%) had tumor involvement in/on the saddle and the average tumor size was(4.53 ± 1.71)cm. There were 13 adult cases, of which 8 cases (61.5%) had preoperative visual impairment. Only 1 case (15.4%) had pan-hypopituitarism, 7 cases had pari-hypopituitarism and 5 cases had normal pituitary function. Ten cases (76.9%) had tumor involvement in/on the saddle and average tumor size was(2.92 ±1.18)cm. Multi-factors Logistic regression analysis revealed the patient's age (OR=0.090, P=0.090) and tu?mor size (OR=8.350, P=8.350), preoperative vision loss (OR=0.086, P=0.086), preoperative hypopituitarism (OR=0.198, P=0.198) were the relative factors affecting the quality of life. Conclusion Infradiaphragmatic craniopharyngioma is more common in minor patients. The clinical features and prognosis are significantly different between minor patients and adult patients. Age, size of tumors, preoperative vision loss and hypopituitarism of patients are associated with poor prog?nosis.

Chinese patent of anti-infective urinary catheter / 中国组织工程研究

BACKGROUND:Catheter associated urinary tract infection is a difficult problem for clinical practice management, and its key pathogenesis is the bacterial biofilm formation on the surface of the catheter material. Therefore, developing a new anti-infective urinary catheter has become an area of interest in the current studies of anti-infective biological materials. OBJECTIVE:To review the research literatures on anti-infective urinary catheter, and provide a direction for further study and clinical application. METHODS:Al related Chinese patent papers of anti-infective urinary catheters were retrieved by Google’s proprietary search platform (http://www.google.com/advanced_patent_search) until the deadline of March 26, 2014, with the search strategy of‘Return the patents with the fol owing proprietary name:urinary catheter’. RESULTS AND CONCLUSION:According to the predefined search strategy, 949 potential y relevant patent papers were screened out for further identification, and 23 papers referred to anti-infective catheters that were obviously eligible were included. The analyses showed that:(1) The antibacterial coating agents of the majority of papers were antibacterial agents of nano-inorganic metal cations, only four papers used antibiotic coated. (2) The drug-eluting catheters were mainly composite-coated. (3) The drug release modes from coating were mainly extended-release but release mechanism was not clarified. (4) The preparation process was chemical bond or ionic bond in one paper, blending methods in one paper, repeated electroplating in one paper, electrospinning technology in one paper, and physical impregnation methods in 12 papers (52.17%). (5) The antimicrobial mode was ultrasonic-antibacterial method in two patent papers, sterile sleeve in one paper, hydrophilic coating in one paper, catheter made by blending polymer material and anti-infective agents in one paper, drug coated films made by coating with antimicrobial drug liquid and drying process in 20 papers (82.61%). In conclusion, there have been no translational and applied clinical researches about the anti-infective urinary catheter, and the relevant researches were only at the laboratory level. The research methods of Chinese patent for anti-infective urinary catheter were limited, and need to be further improved.

Comparative Analysis of Four Different Operation Methods for Treatment of Complex Upper Ureteral Calculi / 昆明医科大学学报

Objective To compare the effects of ureteroscopic lithotripsy (URL), minimally invasive percutaneous nephrolithotomy ( MPCNL) , retroperitoneal laparoscopic ureterolithotomy ( RLU) and open ureterolithotomy (UL) for the treatment of complex upper ureteral calculi. Methods The data of 281 patients with complex upper ureteral calculi from January 2005 to January 2013 were retrospectively reviewed. 48 patients of them received treatment of URL, 113 patients received MPCNL, 67 patients received RLU and other 53 patients received UL. Results Success rates of treatment at the first time were:URL 62.5% (30/48), MPCNL 92.9%(105/113),RLU 100%(67/67) and UL 100%(53/53) . The mean blood losses during the operation were:URL (9.2 ± 1.4) mL,MPCNL (72.5 ± 5.8) mL,RLU (43.1 ± 8.5) mL and UL (100.5 ± 9.2) mL. The average operation time of URL group was shorter than three other groups, and the difference was statistically significant (P0.05) . Conclusion Clinical characteristics of patients and individual require ment should be considered comprehensively before an individual treatment choice is made for the treatment of complex upper ureteral calculi.

Image examination of renal injuries and analysis of renal explorative indications / 中华创伤杂志

Objective To study the image examination of renal injuries and discuss renal explorative indications so as to spare the kidney or nephron as much as possible and improve curative rate of diagnosis and treatment. Methods An analysis was done on 286 cases that included 231 cases with close injury, 54 with open injuries, one with iatrogenic injury and 91 with combined injuries. Of all, 212 cases were examined by B-ultrasonography, 163 by CT and 132 by intravenous urography(IVU) and 6 by digital subtraction angiography(DSA); 202 cases were treated with conservative treatment and 84 with operation. Results The diagnostic positive rates of IVU, B-ultrasonography and CT were 67.4%, 72.2% and 87.7%, respectively. Among the operation cases, 42 cases were treated by renal repair, 12 by partial nephrectomy and 30 by nephrectomy. The operation rate was 29.4% and the nephrectomy rate 35.5%. Interventional treatment of the kidney was carried out in three cases. Conclusions For renal injury cases, the first and most important step is to evaluate the injury condition so as to correctly determine whether an operation exploration is needed. The injury conditions and severity are mainly determined by the image examinations that change according to injury cause, injury type and clinical symptoms. Renal exploration or not, and the operation time exert great influence on renal reservation rate and complication rate.