Analysis of imaging and pathological features of renal neoplasms among different pathological types / 中华泌尿外科杂志

Objective To compare the different pathological type of renal tumor,clinical epidemiology,imaging and pathological features,summarize its value in the diagnosis of renal tumor.Methods The clinical data of 2198 patients who underwent surgical treatment in our hospital due to renal tumors from January 2010 to January 2019 were retrospectively analyzed.There were 1 404 males and 794 females with an average age of (56.5 ± 11.7) years old.The clinical epidemiology,image features and pathological features were compared.Results Among them,the pathological results concluded 1 891 cases of renal clear cell carcinoma (86.0％),112 cases of papillary renal cell carcinoma (5.1％),76 cases of chromophobe cell carcinoma (3.5％),23 cases of multilocular cystic renal tumors with low malignant potential (1.0％),13 cases of Xp11.2 translocation carcinoma (0.6％),4 cases of collecting duct carcinoma (0.2％),58 cases of anadipotic angiomyolipoma (2.6％),18 cases of acidophiloma (0.8％),and 3 cases of metanephric adenoma (0.1％).The overall differences in age and gender among patients with renal tumors of different pathological types were statistically significant (F =13.8,P ＜ 0.05;x2 =20.5,P ＜ 0.05),Xpl 1.2-translocated carcinoma had the lowest mean age of onset,which was (44.9 ± 17.1 years old).The percentage of women with anadipotic angiomyolipoma was higher (41,70.7％),and the percentage of men with clear cell carcinoma and papillary renal cell carcinoma was higher (1 253,66.3％) and(77,68.8％).There was no statistically significant difference in side sex and clinical manifestations among patients with different pathological types of renal tumors (x2 =16.27,P ＞ 0.05).No significant difference in the distribution of left and right side,the clinical manifestations were mainly sporadic (x2 =19.63,P ＞ 0.05).The results of renal tumors ultrasound ith different pathological types showed statistically significant difference (x2 =67.l,P ＜ 0.05).Hyperechoic (20,34.5％) and mixed echogenicity (16,27.6％) were the main manifestations of lipoma.Multilocular cystic renal tumors with low malignant potential were mostly cystic and solid mixed echogenicity (14,60.9％).CT values of renal tumors of different pathological types at all stages showed statistically significant differences (P ＜ 0.05).The CT values of clear cell carcinoma at the arterial phase of CT enhanced scan were significantly higher than those of other types of tumors (F =11.6,P ＜ 0.05),but decreased significantly in the parenchymal phase,showing the enhancement characteristics of "fast in and fast out".The CT values of papillary cell carcinoma in the third phase of enhanced scan were all lower than those of clear cell carcinoma and chromophobe cell carcinoma (P ＜ 0.05),showing a "progressive enhancement".The enhancement effect of chromophobe cell carcinoma is somewhere in between.The CT value on plain scan of anadipotic angiomyolipoma was higher than that of clear cell carcinoma,and the enhancement was followed by continuous enhancement,showing the characteristics of "fast in and slow out".The majority of clear cell carcinoma and papillary cell carcinoma were tan section (1 235,72.55％;51,52.13％).The grey-white section was the most common type of adipogenic angiomyolipoma (21,40.4％).Conclusions The epidemiological characteristics,imaging and pathological features of renal tumors of different pathological types have certain characteristics,especially the enhanced CT features of renal clear cell carcinoma,papillary renal cell carcinoma,chromophobe cell carcinoma and anadipotic angiomyolipoma,which are of certain value for the differential diagnosis of renal tumors of different pathological types.

Combination solifenacin and tamsulosin for the treatment of distal ureteral calculi after extracorporeal shock wave lithotripsy / 中华泌尿外科杂志

Objective To evaluate the efficacy of combination solifenacin and tamsulosin for the treatment of distal ureteral calculi after extracorporeal shock wave lithotripsy. Methods 120 patients (male:100 female:20 age:18-67 yrs) randomly assigned to 4 groups (each group 30) with the calculi diameter range from 0.5 to 1.1 cm.All patients performed extracorporeal shock wave lithotripsy (X ray oriented).The control group did not accept any medical treatment.The solifenacin group were administered solifenacin 5 mg,once per day.The tamsulosin group were administered tamsulosin 0.2 mg,once per day.The combination group were administered solifenacin 5mg,plus tamsulosin 0.2 mg,each per day.The observation duration was set at 2 weeks. Results The stone-free rate (according to KUB) within 2 weeks were 80.0％,83.3％,93.3％ and 96.7％ in the control group,solifenacin group,tamsulosin group and combination group respectively.Statistical differences were significant among the tamsulosin group,the combination group and the control group.The stone expulsion times were (7.6 + 3.7) d,(6.3 ± 2.5) d,(4.4 + 2.3) d and (3.5 ± 2.2) d in the 4 groups respectively.Statistical differences were significant among the tamsulosin group,the combination group and the control group.The uses of analgesics were 13,5,9 and 3 in the 4 groups respectively.The bladder irrtative symptoms were 12,6,4 and 4 in the 4 groups respectively.Statistical differences were also significant for the use of analgesics and relief of bladder irritation between the solifenacin group,the combination group and the control group. Conclusions Tamsulosin and solifenacin could be safe and effective for the treatment of distal ureteral calculi after extracorporeal shock wave lithotripsy.It could significantly improve the stone expulsion rate,relief the pain and improve bladder irrtative symptoms.

Operative treatment for ureteropelvic junction obstruction / 中华泌尿外科杂志

Objective To analyze the clinical features and summarize diagnosis and therapeutic efficacy for ureteropelvic junction obstruction(UPJO). Methods Two hundred and twenty-two patients with UPJO were treated from 2000 to 2008,including 155 males and 67 females:the age rangeed from 13 to 75 and mean age was 29 years.One hundred and seventy-three cases presented with back pain;19 cases with urine infection;12 cases with abdomen bump;7 cases with macroscopic hematuria;11 cases found by B-ultrasound examine.Etiological factors included 185 patients of ureteropelvic junction stenosis;18 cases of high location of the junction;19 cases which were diagnosed UPJO due to benign oppression,including fiber cords and peculiar vessels.A total of 222 cases of surgical procedures were conducted,of them Anderson-Hynes dismembered pyeloplasty was conducted for 191 cases,fiber cords and peculiar vessels were relieved for 19,nephrectomy for 12 cases because of nonfunction. Results One hundred and ninety-one cases who underwent Anderson-Hynes dismembered pyeloplasty were all succeeded with operation.They were followed up for 6 months to 8years with a mean of 38 months.B-ultrasound and IVU showed that hydronephrosis was obviously relieved.The clinical symptoms disappeared in all cases.The levels of serum creatinine of 7 cases who had higher ereatinine recovered. Conclusion Anderson-Hynes dismembered pyeloplasty could be a good choice and effective method for the treatment of UPJO.

Diagnosis and treatment on normotensive pheochromocytomas / 中华泌尿外科杂志

Objective To discuss the diagnosis and treatment of normotensive pheochromocyto-ma. Methods The clinical data of 22 patients with normotensive pheochromocytoma were reviewed. Inclusion criteria for normotensive pheochromocytoma were no previous history of hypertension and episode of symptoms suggesting high blood pressure. The blood pressure on admission was 90-130/ 60-90 mm Hg with an average of 113/72 mm Hg. Seven patients were found adrenal mass by routine ultrasonic examination. Twelve patients presented with superior abdominal or flank pain. Four pa-tients were present with fatigue, and 2 patients had fever. Headache and palpitation were found in 1 patient. Most of patients were present with large and round mass with low density area in the center of the tumor by uhrosonography and CT. Four patients had elevated level of plasma epinephrine and nor-epinephrine. 24 hours urine CA and VMA were elevated in 5 and 4 patients respectively. Seven pa-tients were prepared with infusion preoperatively to expand intravascular volume, and 2 patients were given prazosin 1.5 mg/d for 5 to 7 days. Results During the operation, seventeen patients had ele-vated blood pressure and 5 patients had no changed. One of seven patients with preoperative prepara-tion had obvious hypertension during operation, and 11 of 15 patients without preoperative preparation had obvious hypertension. The tumors were removed successfully in 21 patients. All the patients were diagnosed pheochromocytoma pathologically. Twenty-one patients had normal blood pressure with no recurrence during the follow-up from 1 month to 7 years. Conclusions The patients with normotensive pheochromocytomas may have lower catecholamine in their plasma and urine. The application of α-blockers and the expanding intravascular volume before operation could be important for the patients safe.

The affect of Smad_4 in bladder cancer / 中华泌尿外科杂志

Objective To evaluate the affect of Smad 4 in bladder cancer. Methods Immunohistochemical methods were used to study the Smad 4 expression in BBN induced bladder cancer in big rats. Results The positive expression rate of Smad 4 in the hyperplastic bladder mucosa was 24%(5/21),and in the bladder cancer 53%(17/32), P

Correlation between operative procedures for pelviureteral carcinoma and the postoperative occurrence of bladder carcinoma / 中华泌尿外科杂志

Objective To evaluate the correlation betwe en operative procedures for pelviureteral carcinoma and the occurrence of postop ertive occurrence of bladder carcinoma. Methods 94 cases of pelviureteral carcinoma with postopertive occurrence of bladder carcinoma we re retrospectively studied. Results With nephrouretectom y without cuff resection of the bladder,the postoperative occurrence of bladder carcinoma was 54.5%(6/11),being obviously higher than nephroureterectomy with pa rtial bladder resection (23.5%,12/51) or nephroureterectomy with bladder mucosal cuff resection (33.3%,3/9,P0.05).The lap between the primary ope ration and the occurrence of bladder carcinoma was usually short and the occurre nce was mostly on the same affected side.In pelviureteral carcinoma with multior gan involvement,the postopertive occurrence of bladder carcinoma was as high as 72.2%(13/15) in spite of nephroureterectomy with partial resection of the bladde r . Conclusions Cuff resection of the bladder on the same side is the key point to prevent postoperative occurrence of bladder carcinoma.T he improved bladder mucosa cuff technique is a sound procedure to prevent tumor cell implantation.