Analysis of diagnosis and treatment of invasive renal parenchymal urothelial carcinoma / 中华泌尿外科杂志

Objective:To investigate the clinical features of diagnosis and treatment of renal parenchymal invasive urothelial carcinoma.Methods:The clinical data of 23 patients with renal parenchymal invasive urothelial carcinoma admitted to Beijing Chaoyang Hospital Affiliated to Capital Medical University from January 2014 to December 2020 were retrospectively analyzed. There were 12 males and 11 females. The mean age was (67.3±10.1) years old. Among them, 7 cases complained of painless hematuria and 9 cases were asymptomatic. Three cases underwent preoperative MRI examination, 19 patients underwent preoperative enhanced CT examination, and 1 patient underwent both MRI and enhanced CT examination. MRI examination showed renal lobulated and other T1 mixed with T2 signals, the boundary was not clear, and DWI showed obvious restricted diffusion. The tumor was located on the left side in 15 cases and on the right side in 8 cases. Preoperative diagnosis was made by fine needle aspiration biopsy in 1 patient, and specimens were obtained by flexible ureteroscope in 2 patients. No tumor was reported. The preoperative diagnosis of 22 patients was unclear and the nature of the tumor could not be determined. One patient was considered to have urothelial carcinoma by fine needle aspiration. All patients were treated by surgery, including 20 cases of laparoscopic radical nephrectomy and 3 cases of nephroureterectomy with bladder sleeve resection.Results:Postoperative pathological specimens showed yellow-white mass, high-grade invasive urothelial carcinoma invading renal parenchyma. Nine cases were T 3a stage, 14 cases were T 3b stage, and 5 cases were lymph node metastasis. The average postoperative follow-up time was (18.6±6.72)months, 2 patients were lost to follow-up, 8 patients died, and the overall mortality rate was 38.1%. Seven patients died of recurrence or metastasis. There were 3 cases of bladder recurrence and 5 cases of metastasis after operation. Conclusions:Renal parenchymal infiltrating urothelial carcinoma is difficult to diagnose in the early stage, with poor clinical biological behavior and poor overall prognosis. For patients diagnosed with renal parenchymal invasive urothelial carcinoma preoperatively, laparoscopic nephroureterectomy + bladder sleeve resection is recommended.

The treatment of renal calyceal diverticulum calculi with flexible ureteroscope combined with ultrasound guided puncture of diverticulum / 中华泌尿外科杂志

Objective To evaluate the efficacy of ultrasound guided diverticular puncture combined with flexible ureteroscope to treat calyceal diverticulum calculi, which is difficult in finding the diverticular orifice during ureteroscopic surgery.Methods From November 2012 to July 2015, Twenty-four cases suffered caliceal diverticulum calculi were treated with PCNL or flexible ureterorenoscopic methods.Twelve cases were treated with PCNL in Group PCNL, and 12 cases in Group FURS were all not found orifice or wall under flexible ureteroscope. For Group FURS, ultrasound guided nephrostomy needle puncturing into diverticular calvity were performed, saline-diluted methylthioninium chloride was injected through needle sheaths.The diverticular opening could be recognized in six cases.Guidewires were inserted through needle sheaths for identifying the wall of diverticular cavity in another six cases that could not find the orifice.The stenotic infundibulum or diverticular wall was incised with 200 micron holmium laser fiber for fragment or extraction of diverticular calculi.Results The time of operation, stone free and fragment success cases in Group FURS and PCNL were ( 91.8 ±24.2 ) min vs.( 86.3 ±18.7 ) min, 9 cases vs.10 cases, and 10 cases vs.11 cases, respectively ( P all >0.05 ) .Residual calculi with clinical significance in Group FURS and PCNL disappeared after the second FURS surgery.The VAS score in Group FURS was marked lower than that in Group PCNL [ ( 3.1 ±1.2 ) vs.( 5.3 ±0.9 ) , P﹤0.05 ] .There was no significant difference complication rate between two groups ( 2 cases vs.3 cases, P>0.05 ) .Hospital stay in Group FURS was dramaticly shorter than Group PCNL(3.4 ±0.8) d vs.(5.4 ±1.0) d,P﹤0.05).Diverticula disappeared in 6 cases and became smaller in 6 cases in Group FURS, disappeared in 10 cases and became smaller in 2 cases in Group PCNL.Conclusion Flexible ureteroscope combining with the ultrasound guided puncture of diverticular calvity for management of caliceal diverticula maybe a safe and effective option.

Retroperitoneal laparoendoscopic single-site ureterolithotomy versus conventional laparoscopic ureterolithotomy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Laparoendoscopic single-site (LESS) surgery through the retroperitoneal approach has been seldom reported. We aimed to evaluate the outcomes of LESS and conventional laparoscopic surgery via the retroperitoneal approach in the management of large, impacted ureteral calculi.</p><p><b>METHODS</b>Between November 2011 and July 2013, retroperitoneal LESS ureterolithotomy was performed in 12 patients using a homemade single-port device comprising a surgical glove and several strips of tape. Another 16 patients underwent conventional retroperitoneal laparoscopic ureterolithotomy. We compared the operative time, complications, and surgical outcomes, retrospectively.</p><p><b>RESULTS</b>All patients were completed without conversion to conventional laparoscopic or open surgery. The operative time of the LESS group and of the conventional laparoscopic group were (125.3 ± 12.8) minutes and (116.9 ± 14.4) minutes, respectively (P = 0.119). The intraoperative blood loss was (42.9 ± 8.9) and (43.4 ± 14.7) ml, respectively (P = 0.914). Postoperative radiologic evaluation revealed that the stones had been removed completely. Cosmetic results were superior in the LESS group (P = 0.001).</p><p><b>CONCLUSION</b>Retroperitoneal LESS ureterolithotomy using a homemade single-port device can be considered a feasible and safe alternative to conventional laparoscopic ureterolithotomy.</p>

Clinical diagnosis and management of Wunderlich's syndrome / 国际外科学杂志

Objective To investigate the cause, diagnosis and management of Wunderlich's syndrome.Methods Clinical data of 13 cases of Wunderlich's syndrome were reviewed retrospectively. Results There were nine cases of tumorous disease, 2 cases of non-tumorous disease and 2 cases of unknown causes in the group. The most common cause in this series was renal angiomyolipoma. Surgical management was performed in 8 cases. Conservative treatment was adopted in the rest 5 cases. Pathological study confirmed that there were 2 cases of renal cell carcinoma, 4 cases of angiolipoleiomyoma and 1 case of congenital polycystic kidney. Conclusions The cause of Wunderlich's syndrome is complicated, renal neoplastic origin disease appears to be the most common cause. Comprehensive analysis of multiple imaging examinations and clinical features is most important in the etiological diagnosis. The appropriate management depends on the underlying etiological diagnosis and the patient's hemodynamic status. Carefully watching is required for patients who have not been made a definite etiological diagnosis.

Safety and efficacy of intra-arterial infusion neoadjuvant chemotherapy for local advanced bladder cancer / 中华泌尿外科杂志

Objective To evaluate the safety and efficacy of intra-arterial infusion neoadiuvant chemotherapy in local advanced bladder cancer. Methods Nineteen cases with T2-T4a bladder cancer were enrolled in this study.Intra-arterial infusion chemotherapy with Gemcitabine and Cisplatin (GC)were performed for 1 to 3 cycles before radical cystectomy.Postoperative values of hematological parameters,maximum diameter of tumors,TNM(tumor,node and metastasis)stages and pathological grades were compared with preoperative parameters of the same case. Results Compared to the values before GC chemotherapy,WBC count showed no significant change post-operative,(6.63±2.58)×109/L vs(5.12±2.91)×109/L(P=0.13);RBC(4.41+0.52)×1012/L vs(3.92±0.42)×1012/L(P=0.00)and platelet count(220.50±59.86)×109/L vs(157.05±56.72)×109/L(P=0.001)showed significant decrease;ALT did not show significant decrease(20.00±8.31 vs 26.88±17.04 U/L,P=0.08);Creatltme also showed no significant change(95.82±14.57 vs 88.04±17.76μmol/L,P=0.06);Maximum diameter of tumors decreased significantly(3.72±1.23 vs 2.80±1.29 cm,P=0.02).Compared with clinical TNM stages,pathological TNM stages demonstrated significant decrease in 9 cases;While cell differentiation did not show decrease. Conclusions Intra-arterial infusion with GC regimen can reduce tumor size,decrease TNM stages,while not causing significant adverse impact to radical cystectomy.Bladder-spare treatment is an option for chemotherapy-sensitive cases.