The role of lymphography in diagnosis and treatment of chyluria / 中华泌尿外科杂志

Objective To evaluate the use of unilateral pedicle lymphography (PLG) in preoperative localization and treatment of chyluria.Methods From October 2010 to March 2017,25 cases with severe chyluria and undergoing cystoscopy and unilateral PLG before renal pedicle lymphatic disconnection were reviewed.There were 11 males and 14 females,aged 44-71 years,with an average of 58.5 years.The course of the disease was 6 months to 30 years,with an average of 8.3 years.Of them,18 cases had undergone unilateral PLG and spiral CT angiography preoperatively.Surgical treatment was performed according to PLG imaging.Results Unilateral ureteral chyluria was discovered in 16 out of the 19 cases through cystoscopy,with the sensitivity of 84.2％ (16/19).In contrast,unilateral chyluria was only detected in 4 of the other 6 patients with bilateral chyluria.Albiduria were found in the remaining 5 cases in bladder,without ureteral excreted chyle.The sensitivity for chyluria positioning by cystoscopy was 64.5％ (20/31).The location of lesion in 19 patients with unilateral chyuria and 6 patients with bilateral chyluria could be correctly displayed by PLG and the sensitivity was 100％ (31/31).There was no significant difference in location between cystoscopy and PLG in 19 patients with unilateral chyluria (P =0.2482).But in total lesion location,the sensitivity of PLG was higher than cystoscopy(P =0.0026).Eighteen patients who had undergone PLG combined with spiral CT angiography,could not only locate the chylous fistula,but also determine the number of renal vessels as well as their relationship with diseased lymphatic vessels.Chyluria had disappeared immediately after unilateral renal pedicle lymphatic exfoliation in 23 patients.However,it still presented in the other 2 patients who were confirmed contralateral pyeloymphatic fistulas by PLG 3 months after surgery and cured by reoperation.Chyluria recurred in 6 cases during follow-up of 6 to 58 months,and 4 were confirmed bilateral pyelolymphatic fistulas by PLG.Two of these 4 cases were cured by laparoscopic surgery or open surgery,respectively.The other 2 patients were cured by conservative treatment.Moreover,2 patients with unilateral chyluria recurred in situ after the first laparoscopic surgery,which was confirmed by PLG.Notably,all these patients were cured by ESWL finally.Conclusions This study suggested that PLG displays remarkable advantage in terms of localization sensitivity.PLG combined with spiral CT angiography preoperatively can not only locate the chylous fistula,but also determine the number of renal vessels as well as their relationship with diseased lymphatic vessels.Depending on PLG and spiral CT angiography,renal pedicle lymphatic disconnection can effectively protect renal vessel.In addition,it can avoid the omission of ligation for perivascular lymphatic vessels.Furthermore,PLG plays a key role in temporarily obstructing the leakage of pyelolymphatic fistulas to some extent.

Transurethral holmium laser resection for adult ureterocele / 中国基层医药

Objective To explore the curative effect and security of transurethral holmium laser resection for adult ureterocele.Methods 22 cases with adult ureterocele were retrospectively studied.Eight adult ureterocele cases were male and 14 cases were female.The mean age was 36.5 years (ranged from 20 to 67years).All of the patients were unilateral onset,15 cases on the left side and 7 cases on the right side.The mean course of the disease was 31 months (ranged from 15d to 12 years).The clinical presentations were varied.All 22 cases were treated by tran-surethral holmium laser resection.About one -third of cyst wall were left in order to avoid vesicoureteral reflux and hydronephrosis.Results All 22 cases succeeded uneventfully.The pathologic study confirmed that 22 cases were ure-terocele.The mean hospital stay was 8days (ranged from 6 to 12days).Mean follow -up time was 17 months (12 -26 months),while 2 cases were lost.All 20 cases urine alalysis was normal.Five patients showed no hydronephrosis, while 10 cases showed less hydronephrosis.Cystoscopy showed all 20 cases ureteral healing was smooth,and none showed recurrence of ureterocele.Voiding cystourethrography showed none of vesicoureteral reflux.Conclusion Transurethral holmium laser resection would be a good choice for adult ureterocele,because the treatment has the advantages of simple operation,low requirement of equipment,safety and reliability.Especially for the primary level hospital,transurethral holmium laser resection is worth further clinical promotion.

Establishment of making cystoscope training model with rapid prototyping technology and research on its train-ing method / 局解手术学杂志

Objective To explore the feasibility of making cystoscope training model with rapid prototyping technology and its training method in cystoscope operation. Methods Constructed a cystoscope training model, and designed a set of corresponding training methods ac-cording to the process and behavioral essentials of cystoscope operation. Selected 20 students who have never learned cystoscope operation and trained them with the new designed cystoscope training mode and training methods, and the training results were verified. Results Compared before and after the training, the operation time of all the trainees were significantly shortened, and their operation steps and skills were more proficient. Conclusion Cystoscope training model can help beginners to grasp the theoretical basis of cystoscopy, operation steps, and behavioral essentials, so as to shorten the learning curve of the cystoscope operation.

Clinical analysis of percutaneous nephrolithotomy combined with flexible cystoscope in the treatment of complex renal calculi / 中华泌尿外科杂志

Objective To evaluate the clnical value of percutaneous nephrolithotomy combined with flexible cystoscope in the treatment of complicated renal calculi.Methods Data of 53 cases of complex renal calculi treated with single channel percutaneous nephrolithotomy combined with flexible cystoscope from July 2011 to September 2013 were analyzed retrospectively.There were 31 males and 22 females.Their age ranged from 26 to 74 years with a mean age of 49 years.Thirty-two cases were located on the left side,19 cases right,2 cases bilateral,21 cases of staghorn calculi and 32 cases of multiple stones.All the stones were filled in 2 or more calyces,with 7 cases in upper ureteral stones at the same time and 2 cases in solitary kidney.The longest diameter of stones was between 2.5 cm to 4.6 cm,with an average of 3.7 cm.There were 39 cases with hydronephrosis and the separation of the collection system was 2.0-5.1 cm with an average of 3.8cm.The period which patients suffered from stones was from 1 month to 6 years.Fourteen cases underwent ESWL and 6 cases underwent open operation before percutaneous nephrolithotomy.All patients underwent single channel percutaneous nephrolithotomy under the guidance of color Doppler ultrasound,and the channel of puncture was expanded to 24 F.Results Fifty-three cases (55 sides) were performed successfully in one-stage sugery and the operation time was between 85 to 170 min,with an average of 119 min.Thestone clearance rate was 89％ (49/55) and postoperative hemoglobin decreased 3.9-9.2 g/L with an average of 6.1 g/L.The hospitalization time was 8 to 12 days with an average of 9.2 days.Two cases had hemorrhage of about 500 ml after surgery and the renal hemorrhage stopped after clamping of renal fistula without blood transfusion.Two patients suffered from fever on surgery day and 1 patient on one day after surgery,and the body temperature returned to normal level after anti-infection treatment for 2 or 3 days.No renal perforation,fluid pneumothorax or damaged surrounding organs occurred.6 patients had residual stones,among which 2 were treated by two-stage operation and 4 were treated with extracorporeal shock wave lithotripsy.Conclusion Percutaneous nephrolithotomy combined with flexible cystoscope has little trauma and high stone clearance rate in the treatment of complex renal calculi with high clinical value.

A novel continuous irrigation sheath for flexible cystoscope for diagnosis under hematuria / 第二军医大学学报

Objective To evaluate the efficacy and safety of a novel continuous irrigation sheath for flexible cystoscope in improving the vision and patient compliance of flexible cystoscopy under hematuria. Methods A total of 32 male patients, who received flexible cystoscopy for hematuria in our hospital, were evenly randomized into two groups. Patients in group A received flexible cystoscopy with the help of the novel continuous irrigation sheath; while patients in group B received traditional flexible cystoscopy. The vision score of flexible cystoscopy and visual analog pain score were recorded in the two groups. Results The flexible cystoscopy was smoothly conducted in the two groups. The operation time in group A was significantly shorter than that ingroup B ([7.50 ± 1.59] min vs [9.81 ± 2.56] min, P0.05). Conclusion The novel continuous irrigation sheath can effectively improve the vision of flexible cystoscopy without increasing discomfort to patients.

"Flexible ultrasonic cystoscopy" can be used for preoperative staging of primary bladder cancer i an initial experience / 第二军医大学学报

Objective To access the feasibility of ueing "flexible Uitrasonic cystoscopy (FUCS)" (Uitrasonic bronchoscope Olympus BF-UC260F-OL8 as a subslitute) for staging of bladder cancet Methods From Jun 2010 to Nov. 2010,36 patierrts with piiimary bladder urotheiial carcinoma were examined by "FUCS" before operation and were rttaged by "FUCS" findings. All patients rectived IVP and enhanced pdvc CT Non-muscle-invasive bladder cancer patierrts rem-ved TURBT, and the tumor base was routinely bopied for pathology Pathological results, traditional imaging eraliiaiton, and "FUCS" evaluation were compared. Visual analog scores (VAS) were also compared between patierrts reccing "FUCS" and rcmime cystoscopy. Results Compared with conventional cyrtoscopy, the VAS of patients receiving intraoperative "FUCS" was significantly tower (1 3 ± 0. 5 vs 4. 3 ± 0. 9, P<0. 01). Of the 36 patierrts, 28 were diagrosed as non-muscle-invasive bladder cancer (Ta + T1) and 8 were diagrosed as muscle-invasive bladder career (T2 + T3). Based on the postoperative pathologic results, "FUCS" had a 100% accuracy in diagnoeing norem Uselelinvaeive and muscle-invasive bladder cancer. Conclution "FUCS" is painless and feasible in clinical practice; it can display the depth of bladder wall invaded by tumor, and can be used for preoperative staging of primary bladder tumor.

Treatment of upper urinary tract calculi with flexible cystoscope conducted holmium laser lithotripsy via percutaneous nephrostomy / 中华泌尿外科杂志

Objective To assess the efficacy and safety of flexible cystoscope conducted holmium laser lithotripsy via percutaneous nephrostomy in the treatment of upper urinary tract calculi.Methods The flexible cystoscope conducted holmium laser lithotripsy via percutaneous nephrostomy was performed on 26 patients from Jul 2005 to Jan 2007. Among these patients, 8 had bilateral renal calculi and ureteral calculi, 5 had multiple renal calculi, 4 had renal calyx calculi and 9 had ureteral calculi. The average diameter of the calculus was 2.2 cm (range from 1.0-3.2 cm). Four patients had mild hydronephrosis, others had moderate or severe hydronephrosis. Insufficient renal function was noted in 13 cases. The procedure was performed via a single tract through the middle calyx under the ultrasonic guidance in all cases.Results Twenty-two cases achieved stone free at primary procedure, secondary procedure was needed in 4 cases. A 18 F tract was used in 18 cases and 24 F tract was used in the left 8 cases. The average operation time was 72 min, stone-free rate was 96.2%(25/26),and there was no blood transfusion. One patient had fever after the procedure and recovered 2 days after the administration of antibiotics. No other complication was recorded. In an average 11 month follow-up in 22 patients, hydronephrosis reduction was significant observed by ultrasound scan. No calculus relapse was found.Conclusions Flexible cystoscope conducted holmium laser lithotripsy via percutaneous nephrostomy is an effective and minimally invasive technique for the treatment of upper urinary tract calculus. It has the advantages in dealing with the calyx and ureteral calculus located in the proximal or middle segment as well.

Comparison of different ways of pulling out ureter double-J stent in females / 重庆医科大学学报

Objective:To compare the different ways of pulling out ureter double-J stent in females.Methods:172 female patients requiring urter double-J stent for different cases were chosen,including upper urinary calculus(150 cases),hydronephrosis with urterostenosis(14 cases),Ormond’s syndrome(3 cases) and postradiotherapy of uterine cervix cancer(5 cases).These cases were divided into three groups with different ways of pulling out the urter double-J stent.Results:The achievement ratio of cystoscope(100%) and rat-tooth forceps(98.1%) were higher than the blood vessel forceps(92.1%).Conclusion:The cystoscope operation requires the special equipment and cost more money and time.Compared to the blood vessel forceps,using the rat-tooth forceps to pull out the female ureter double-J stent is safe and more effective.

The Experience of Modified Flexible Cystoscopy in Male Patients / 대한비뇨기과학회지

PURPOSE: A flexible cystoscopic examination is well tolerated compared to a rigid cystoscopic examination in male patients. A modified flexible cystoscope was designed, and its discomfort and efficacy evaluated compared with a rigid cystoscope. MATERIALS AND METHODS: 104 patients underwent a cystoscopic examination, of which 37 underwent both rigid and modified flexible cystoscopic examinations, and 37 and 30 only a modified flexible cystoscopic or rigid cystoscopic examination, respectively. An observer visual analog pain scale was applied after the procedure, and the rating of discomfort recorded. RESULTS: In the group that underwent both examination types, the mean pain scores were 1.8 and 6.4 after the modified flexible cystoscopic and rigid cystoscopic examinations, respectively (p<0.001). In the individual cystoscopic groups, the mean pain scores were 2.6 and 6.0 after the modified flexible and rigid cystoscopic examinations, respectively (p<0.001). The vision of modified flexible and rigid cystoscopes was the same. CONCLUSIONS: A modified flexible cystoscopic examination was well tolerated by patients, and can be routinely used in place of the rigid counterpart for follow-up of bladder tumors and as a diagnostic procedure for a gross hematuria. Some modifications, such as a more ample working channel and an integral video camera, will be needed.

Flexible cystoscope:an adjuvant device to help the surgical management of complex renal calculi / 中华泌尿外科杂志

Objective To evaluate the use of flexible cystoscope in the surgical management of complex renal calculi. Methods Flexible cystoscope and a set of stone baskets were used to help the surgical of complex renal calculi via the renal pelvis incision or the dilated ureter during operation.A pyelostomy with the use of a Foley's catheter was carried out if necessary and the residual stones could be removed via the pyelostomy tract later on. Results 31 cases of complex renal stones have been surgically treated.Flexible cystostomy was used intraoperatively in 11,postoperatively for the removal of residual stones in 16 and being used both intra and postoperatively in 4.A total of 106 stones have been removed.26 patients ( 83.9 %) have been free from any stone.2(6.4%) have undergone ESWL followed by flexible cystoscopy to remove the residual stones.3 patients (9.7%),however,still had residual stones in spite of the above procedure. Conclusions Flexible cystoscopy as an adjuvant procedure is an effective means in the surgical treatment of complex renal calculi especially for the removal of residual stones.The procedure is simple,safe and less expansive.