Treatment of intravesical instillation with fulguration-hydrodistention on female interstitial cystitis / 北京大学学报(医学版)

OBJECTIVE@#To investigate the efficacy and safety of intravesical instillation of heparin/alkalized lidocaine (lidocaine mixed with sodium bicarbonate) combined with hydrodistension and transurethral fulguration in the treatment of female interstitial cystitis (IC).@*METHODS@#Female patients who attended the Department of Urology at the First Hospital of China Medical University between January 2012 and December 2020 and met the diagnostic criteria proposed in the guidelines of the American Urological Association with a new diagnosis of IC were selected for retrospective analysis. Cystoscopy and biopsy of suspicious lesions were performed at the time of diagnosis. All the patients were treated with an intravesical instillation regimen of 2% lidocaine 10 mL + 5% sodium bicarbonate 5 mL + heparin 25 000 IU for a continuous period of 12 months, with or without water dilatation and transurethral electrocautery according to the patient's preference, categorized as hydrodistension and transurethral fulguration (HD/TF) group and non-HD/TF group. The patients were evaluated before and 1, 6, and 12 months after treatment for O'Leary-Sant interstitial cystitis patient symptom index scores (ICSI), interstitial cystitis patient problem index scores (ICPI), visual analog scale (VAS) of suprapubic pain, and functional bladder capacity (FBC) changes.@*RESULTS@#A total of 79 patients were collected in this study. Four (5.1%) of these patients underwent cystectomy due to pathological diagnosis of cancer or treatment failure. The remaining patients were followed up 1, 6 and 12 months after treatment. Repeated-measures ANOVA showed a significant decrease in ICPI, ICSI and VAS and an increase in FBC after treatment compared with before treatment (P < 0.05). FBC continued to decrease during the 1, 6 and 12 months' post-treatment follow-ups, with statistically significant differences; ICSI continued to decrease during the 1 and 6 months post-treatment follow-ups, with statistically significant differences, while the difference between ICSI at 6 months post-treatment and at 12 months' post-treatment was not statistically significant. In the HD/TF group, ICPI continued to decrease in the follow-up from 1 and 6 months after treatment, and the difference was statistically significant, while the difference between ICPI 6 months after treatment and 12 months after treatment was not statistically significant. There was no statistically significant difference between the remaining indicators 1, 6 and 12 months after treatment. ICPI, ICSI, VAS and FBC improved earlier and the changes in VAS and FBC were more significant in the HD/TF group compared with the non-HD/TF group (P < 0.05).@*CONCLUSION@#Heparin/alkalized lidocaine combination of intravesical instillation with hydrodistension and transurethral fulguration for IC is an effective treatment option. Heparin/alkalized lidocaine combination of intravesical instillation may be the first choice of treatment, which can significantly reduce the economic burden of patients and medical insurance system. If patients can accept it, transurethral fulguration with hydrodistension may be considered.

A study proposal on short term outcome and prognosis of primary and delayed fulguration in posterior urethral valve

Background: Posterior urethral valve (PUV) is the most common cause of lower urinary tract obstruction in male neonates. The incidence is 1 in 4000, 1 in 7500 births PUV occur exclusively in males. This disease has a broad spectrum of presentations. They may present at any age during childhood and may vary from ascites in the neonate to renal failure in infants and only minor voiding dysfunction in an older child. Urinary tract infection is common at all ages. The objectives of the study were to assess the impact of primary impaction on short term outcomes and to assess the outcome of diversion and delayed fulguration.Methods: This retrospective study was conducted at the Pediatric Urology outpatient department (OPD) at the Institute of Child Health and Hospital for Children, Madras Medical College, Chennai including the patients who attended the pediatric surgery from August 2008 to December 2011.Results: In the current series, the incidence of renal insufficiency in patients with urosepsis was 45%. Recurrent urosepsis >3 episodes in a year (fever with urine culture showing infection) primarily due to poor patient compliance lead to progressing pyelonephritis and nephron damage and plays an important role in the outcome of these children.Conclusions: The incidence of renal insufficiency in children with posterior urethral valves in this series was 38% (30-45%) with an average follow up 3 years. Several factors were important in prognosticating the progression towards renal insufficiency and bladder dysfunction. Urodynamics is of immense help in cases having symptoms despite good stream. The use of anticholinergic for abnormal urodynamics gives encouraging results.

Therapeutic Endoscopic Treatment Plus Maintenance Dimethyl Sulfoxide Therapy Prolongs Recurrence-Free Time in Patients With Hunner Type Interstitial Cystitis: A Pilot Study / 대한배뇨장애요실금학회지

PURPOSE: To evaluate whether hydrodistention with fulguration of Hunner lesions (HD/FUL) plus maintenance dimethyl sulfoxide (DMSO) therapy prolongs the recurrence-free time in patients with Hunner type interstitial cystitis (IC).METHODS: The study enrolled patients with Hunner type IC who required repeat HD/FUL due to recurrence of IC symptoms after the first HD/FUL at our institution. All patients received a second HD/FUL plus maintenance DMSO therapy. The maintenance DMSO therapy was performed every 2 weeks for a total of 8 instillations, and then once every 4 weeks thereafter. The recurrencefree time from HD/FUL to therapeutic failure was estimated using the Kaplan-Meier method. The recurrence-free time between the first HD/FUL and second HD/FUL plus maintenance DMSO therapy was statistically compared using the log-rank test.RESULTS: A total of 21 patients (mean age, 66.3±10.8 years) with Hunner type IC were evaluated. The recurrence-free time for the second HD/FUL plus maintenance DMSO therapy was significantly longer than that for the first HD/FUL (P<0.0001). The median recurrence-free time for the first HD/FUL was 10.1 months, while that for the second HD/FUL plus maintenance DMSO therapy has yet to be reached. The recurrence-free rate for the first HD/FUL was 81.0% at 6 months, 38.1% at 1 year, 9.5% at 2 years, and 4.8% at 3 years. In contrast, the rate for the second HD/FUL plus maintenance DMSO therapy was 100% at 6 months, 94.7% at 1 year, 82.6% at 2 years, and 82.6% at 3 years. There were no significant differences in efficacy between the first and second HD/FUL.CONCLUSIONS: HD/FUL plus maintenance DMSO therapy clearly prolongs the recurrence-free time compared with HD/FUL alone in Hunner type IC.

Which mode and potency of electrocoagulation yields the Smallest Unobstructed Area of the Fallopian Tubes? / Qual modo e potência produzem a menor área de nãoobstrução nas tubas de Falópio?

Abstract Objective To determine which mode and potency of electrocoagulation, using a modern electrosurgical generator, yields the smallest unobstructed area of the Fallopian tubes. Methods In an experimental study, tubes from 48 hysterectomies or tubal ligation were evaluated. Tubes were randomly allocated to one of the following groups: group A) 25 W x 5 seconds (n = 17); group B) 30 W x 5 seconds (n = 17); group C) 35 W x 5 seconds (n = 18), group D) 40 W x 5 seconds (n = 20); group E) 40 W x 5 seconds with visual inspection (blanch, swells, collapse) (n = 16); group F) 50 W x 5 seconds (n = 8). Bipolar electrocoagulation was performed in groups A to E, and monopolar electrocoagulation was performed in group F. Coagulation mode was used in all groups. Digital photomicrography of the transversal histological sections of the isthmic segment of the Fallopian tube were taken, and themedian percentage of unobstructed luminal area (mm2) was measured with ImageJ software (ImageJ, National Institutes of Health, Bethesda, MD, USA). The Kruskal-Wallis test or analysis of variance (ANOVA) was used for statistical analysis. Results Ninety-six Fallopian tube sections were analyzed. The smallest median occluded area (%; range) of the Fallopian tube was obtained in the group with 40 W with visual inspection (8.3%; 0.9-40%), followed by the groups 25 W (9.1%; 0-35.9%), 40 W (14.2; 0.9-43.2%), 30 W (14.2; 0.9-49.7%), 35 W (15.1; 3-46.4%) and 50 W (38.2; 3.1-51%). No statistically significant difference was found among groups (p = 0.09, Kruskal-Wallis test). Conclusion The smallest unobstructed area was obtained with power setting at 40 W with visual inspection using a modern electrosurgical generator. However, no statistically significant difference in the unobstructed area was observed among the groups using these different modes and potencies.

Resumo Objetivo Determinar em qual modo e potência, usando unidades geradoras modernas de eletrocoagulação, produz a menor área de não-obstrução das tubas de Falópio. Métodos Num estudo experimental, tubas uterinas derivadas de 48 histerectomias ou ligadura tubária foram avaliadas. As tubas foram alocadas aleatoriamente para um dos seguintes grupos: grupo A) 25 W x 5 segundos (n = 17); grupo B) 30 W x 5 segundos (n = 17); grupo C) 35 Wx 5 segundos (n = 18), grupo D) 40 W, 5 segundos (n = 20); grupo E) 40 W x 5 segundos inspeção visual (branqueia, incha e colapsa) (n = 16); grupo F) 50 Wx 5 segundos (n = 8). A eletrocoagulação bipolar foi usada nos grupos de A a E, e a eletrocoagulação monopolar, no grupo F. O modo de coagulação foi utilizado em todos os grupos. Cortes histológicos transversais do segmento ístmico das tubas de Falópio foram corados e fotografados digitalmente, e a percentagem da área luminal (mm2) não-obstruída foi medida com o software ImageJ (ImageJ, National Institutes of Health, Bethesda, MD, USA). O teste de Kruskal-Wallis ou ANOVA foram usados para a análise estatística. Resultados Noventa e seis cortes histológicos de tubas de Falópio foram analisados. A mediana da menor área não-obstruída (%; amplitude) da tuba de Falópio foi obtida no grupo 40 W com inspeção visual (8,3%; 0,9-40%), seguido do grupo 25 W (9,1%; 0- 35,9%), 40W(14,2; 0,9-43,2%), 30 W(14.2; 0,9-49,7%), 35 W(15,1; 3-46,4%) e 50 W (38,2; 3.1-51%). Não houve diferença significativa entre os grupos (p = 0,09, teste de Kruskal-Wallis). Conclusão A menor área não-obstruída foi obtida com a potência de 40 W com inspeção visual usando um gerador moderno de eletrocirurgia. Contudo, nenhuma diferença significativa na área não-obstruída foi observada entre os grupos usando esses modos e potências.

Experience and modification of percutaneous nephrolithotomy for caliceal diverticular calculi / 中华泌尿外科杂志

Objective To summary our experiences in percutaneous nephrolithotomy for treating the caliceal diverticular calculi and postoperative outcome with technical modification.Methods A retrospective review was performed on 34 patients with caliceal diverticular calculi who underwent percutaneous nephrolithotomy between January 2009 and June 2013.The patients were divided into 2 groups.In group A (1 1patients),stones were removed and diverticular neck was incised.In group B (23 patients),fulguration of diverticular wall was performed after the stone removal and diverticular neck incision.Group A had 11 cases including 4 male and 7 female with average age (36.7± 16.0) years.Mean size of stone was (1.8±0.4) cm.Mean maximum diameter of diverticulum was (2.3±0.5) cm.Group B had 23 cases including 10 male and 13 female with average age (40.1±12.0) years.Mean size of stone was (1.9±0.6) cm.Mean maximum diameter of diverticulum was (2.3±0.8) cm.There were no significant difference in stone size and maximum diameter of diverticulum within two groups (P＞0.05).The following parameters such as operative time,drop in hemoglobin,stone clearance,complication rate and ablation rate of diverticulum were compared between two groups.Results In group A,average operative time was (62.7±11.7) min.Mean hemoglobin dropping was (12.0t9.7) g/L.Stone clearance rate was 90.9％ (10/11) and overall complications rate was 18.2％ (2/11).The ablation rate of diverticulum was 63.6％ (7/11).In group B,average operative time was (76.3±21.6) min.Mean Hemoglobin reducing was (12.9±16.7) g/L.Stone clearance rate was 91.3％(21/23) and overall complication rate was 21.7％.The ablation rate of diverticulum was 91.3％ (21/23).There was no significant difference in stone clearance and complication rate between two groups.It seemed that the operativc timc in group B was longer than that in group A.However,no significant difference was found (P＞0.05).The ablation rate of diverticulum in group B was significantly higher than that in group A (P＜0.05).Conclusion In percutaneous nephrolithotomy treatment for caliceal diverticular calculi,fulguration to diverticular wall is an effective method to achieve diverticular obliteration and reduce possibility of stone recurrence.

Observation of the effects of 5-aminolevulinic acid photodynamic therapy combined with fulguration in treating perianal condyloma / 中国基层医药

Objective To evaluate the relapse rate and the effect of 5-aminolevulinic acid photodynamic therapy(ALA-PDT) combined with fulguration in the treatment of perianal genital warts.Methods 67 patients with perianal genital warts were randomly divided into the three groups.22 cases in the fulguration and ALA-PDT treatment group performed the ALA-PDT treatment immediately after removal of dominant wart by fulguration,once a week,treatment for 3-4 times.22 cases in the ALA-PDT treatment group only underwent ALA-PDT treatment,once a week,treatment for one month.23 cases in the fulguration group were given the traditional fulguration methods one by one electrocautery fulguration gasification treatment for all skin lesions,a weekly batch treatment,treatment for a month.Follow-up six months after the last treatment to determine efficacy and recurrence rate.Results The cure rate of combined treatment group was 90.9％ (20/22),and recurrence rate was 9.1％ (2/22) ;cure rate of photodynamic group was 54.5％ (12/22),and its recurrence rate was 22.7％ (5/22) ; cure rate of fulguration group was 39.1％ (9/23),and the recurrence rate was 43.5％ (10/23).There were statistically significant differences in the cure rate and relapse rate between combination therapy group and electrocautery treatment group (P =0.000,P =0.017).Conclusion The fulguration combined with ALA-PDT in the treatment of perianal genital warts has high cure rate,low recurrence rate,and less side effects.

Combined laparoscopic technique for superficial bladder neoplasms involved orifice / 中华泌尿外科杂志

Objective To assess clinical efficacy of the combined laparoscopic technique for superficial bladder neoplasms involved uretetic orifice. Methods A totsl of 12 patients with bladder neoplasms involved ureteric orifice were treated and reviewed.The clinieal tumor stage was Tis in 6,T1 in 6.During the procedure,the transurethral resection of bladder neoplasms was performed firstlythe extent including 0.5-1.0 cm formal bladder tissue around ureteric orifice,deep to superficial muscle of bladder,then ureteroneocystostomy was done with transperitoneal laparoscopic technique.Results The operations were successfully in all 12 cases.The average procedure time was 2.2 h.The average volume of hemorrhage was 25 ml.The double J stents were removed 3 months postoperatively.Six months after surgery intravenous pyelography(IVU)and cystography showed no ureter obstruction in all cases,Ⅰ-Ⅱ degree vesicle-ureteral reflux in 2 cases.One year after surgery custography showed Ⅰ-Ⅱdegree vesicle-ureteral reflux in 4 cases,Ⅱdegree relux in 3 cases.During 324 months' follow-up,B type ultrasound and IVU showed moderate hydronephrosis in 1 case,mild in 5. Conclusion The treatment of combining laparoscopic technique for superficial bladder neoplasms involved ureterie orifice might be an effective and safe method.

Resultados tardios da fulguraçäo da junçäo atrioventricular em pacientes com taquicardias supraventriculares utilizando choques de alta energia / Long Term Follow -up After Direct Current Catheter Ablation (High Energy) of the Atrioventricular Junction in Patients with Supraventricular Tachycardias

Purpose - To evaluate the long term efficacy and safety at long term after atrioventricular junction fulguration (complete AV block induction, using high energy shocks, to control drug-resistant supraventricular tachyarrythmias. Methods - Twenty-eigth patients, 17 (60,7%) men, with mean age 48,1 years, were submitted to one up to six ablation sessions with high energy shocks. The total delivered energy per patient was 1304 ± 868 J. Each shock ranged from 100 to 400J. Results - After 12 months, at least, 60,6% of patients were in complete atrioventricular block; three (10,8%) were assymptomatics without complete AV block, and infive (17,8%) the ablation was unsuccessful. Conclusion - AV junction ablation with high energy shocks is safe and efficient in long term follow-up

Objetivo - Avaliar a eficácia a longo prazo da fulguração da junção AV (indução de BAVT), utilizando choques de alta energia, para controle de arritmias supraventriculares refratárias a drogas. Métodos - Vinte e oito pacientes, 17 (60,7%) do sexo masculino, com média etária de 48,1 anos, foram submetidos a uma até seis sessões de fulquração da junção AV, com choques de alta energia. Cada paciente recebeu em média de um a dez choques. A energia total aplicada por paciente variou de 100 a 3200 J (1304 ± 868 J); cada choque foi de 100 a 400J. Resultados - No mínimo após 12 meses, 60,6% dos pacientes permaneceram em BAVT; 3 (10,8%) pacientes apresentam-se assintomáticos, com alterações na condução AV, sem apresentar BAVT. Em 5 (17,8%) pacientes o procedimento foi ineficaz. Conclusão - A fulguração da junção AV (indução de BA VT) com choques de alta energia é procedimento seguro e eficaz a longo prazo

80 cases of hemorrhagic radiation cystitis / 대한비뇨기과학회지

We reviewed 80 cases of hemorrhagic radiation cystitis(HRC) treated in the Department of Urology, Korea Cancer Center Hospital from March, 1985 to July, 1990. The results were obtained as follows. 1. Primary underlying diseases were 1 bladder tumor and 79 cervix cancers. Main presenting symptoms and signs on hospitalization were gross hematuria, passage of blood clots and vesical irritability symptoms. 2. The range of radiation doses to the bladder was from 5,000 to 11,086 cGy and the ratio of cases receiving irradiation over 7,000 cGy was 56.3 %(45 among 80 cases). Time elapsing between termination of radiation therapy and occurrence of HRC was ranged from 1 month to 14.5 years. 3. We performed histopathologic examination in 22 cases. Microscopically, diffuse mucosal edema and ulceration, vascular telangiectasia, submucosal hemorrhage were observed. The areas of ulceration contained acute inflammatory cells at their base and the lamina propria was hyalinized with enlarged atypical fibroblasts and endothelial cells. Of 22 cases, 4 cases of the secondary neoplasia (1 case of transitional cell papilloma, 2 cases of transitional cell carcinoma(TCC) and 1 case of adenocarcinoma), 1 case of TCC of recurrent bladder tumor and 1 case of recurrent cervix cancer invading bladder were observed. 4. Hematuria was controlled in 57 cases receiving transurethral fulguration(TUF), but repeated TUF (2-4 times) was performed for recurrent severe gross hematuria in 7 cases and the ratio of cases requiring re-hospitalization due to recurrent severe gross hematuria after TUF was 16.4%. Of complications due to treatment of HRC, no significant complication was found after TUF, but incontinence due to contracted bladder was occurred in 1 case of 3% formalin instillation.

Fulguraçäo endocavitária de vias acessórias no tratamento da síndrome de Wolff-Parkinson-White / Endocavitary fulguration of accessory pathways in the treatment of Wolff-Parkinson-White syndrome

Apresentar nossa experiência inicial no tratamento definitivo da síndrome de Wolff-Parkinson-White, através de fulguraçäo endocavitária de vias acessórias. Quatorze sessöes de fulguraçäo endocavitária realizadas em 9 portadores de síndrome de Wolff-Parkinson-White. Cinco eram do sexo masculino e a média de idade foi de 35 anos. Obteve-se completa interrupçäo da conduçäo pela via anômala em 7 pacientes: 4 através de uma e 3 de duas sessöes. Um paciente (1§ da série) foi submetido a três sessöes, näo se conseguindo a interrupçäo definitiva da conduçäo pela via acessória, e encaminhado a cirurgia. O restante, näo responsivo à primeira tentativa, aguarda nova sessäo. Näo foram observadas complicaçöes cardiológicas inerentes ao procedimento. A fulguraçäo endocavitária de vias acessórias mostrou-se método seguro, eficaz e portanto passível de ser cogitado como primeira opçäo quando da indicaçäo de ablaçäo desses feixes anômalos

COMPARATIVE OBSERVATION OF TWO METHODS TREATING THE VERRUCA ACUMINATE / 重庆医科大学学报

This paper reports the treatment of 65 cases with Verruca Acuminate, 35 cases with the fulguration while 30 cases with the combined fulguration with injection poly i:c and both were compared. The results showed that the cure rate of the fulguration group was 68.6%, and that of the combined therapy group was 96,5%. The cure rate of the latter group revealed higher (P