[Laparoscopic pyeloplasty combined with ultrasonic lithotripsy via nephroscope for treatment of ureteropelvic junction obstruction with renal calculi].

OBJECTIVE: To investigate the efficacy and safety of laparoscopic pyeloplasty combined with ultrasonic lithotripsy via nephroscope in the treatment of ureteropelvic junction obstruction (UPJO) with renal calculi. METHODS: From June 2016 to January 2022, eight patients including five males and three females underwent laparoscopic pyeloplasty combined with ultrasonic lithotripsy via 19.5F(1F≈0.33 mm) nephroscope in Peking University People' s Hospital. The age ranged from 23-51 years (mean: 40.5 years) and the body mass index (BMI) ranged from 18.8-32.4 kg/m2 (mean 27.0 kg/m2). The lesion located on the left side in all of the eight patients. Two patients had solitary kidney and one patient had horseshoe kidney. Solitary stone was seen in one patient and the other seven patients suffered multiple stones, with two patients had staghorn stones. The largest diameter of stones ranged from 0.6-2.5 cm (mean: 1.5 cm). CT or ultrasound showed that moderate nephrosis was seen in five patients and severe nephrosis was seen in three patients. During surgery, after exposure of renal pelvis and proximal ureter, a small incision of 1.5 cm was performed in the anterior wall of the renal pelvis, and a 19.5F nephroscope was introduced into renal pelvis through laparoscopic trocar and renal pelvis incision. Stones were fragmented and sucked out by 3.3 mm ultrasonic probe placed through nephroscope. After stones were removed, modified laparoscopic pyeloplasty was performed. RESULTS: Surgery was successfully completed in all of the eight patients without conversion to open surgery. The operation time ranged from 160-254 min (mean 213 min) and the time of nephroscopic management time was 25-40 min (mean: 33 min). The hemoglobin was decreased by 3-21 g/L (mean: 10.3 g/L). The stone-free rate was 75% (6/8 cases), stones were incompletely removed in two patients due to abnormal intrarenal structure. The modified Clavien classification system (MCCS) grade ⅢA complication occurred in one patient postoperatively, which was nephrosis due to intrarenal bleeding, and nephrostomy was performed. With the mean follow-up of 30 months (ranged from 2-68 months), there was no evidence of obstruction in all the patients, and one patient underwent percutaneous nephrolithotomy to treat residual calculi. CONCLUSION: Laparoscopic pyeloplasty combined with ultrasonic lithotripsy via 19.5F nephroscope is feasible and safe, and could be a complementary method to treat UPJO and renal calculi.

[Endoscopic treatment for ureterovesical junction stenosis in patients with kidney transplantation: 13 cases report].

OBJECTIVE: To evaluate the safety and efficacy of endoscopic treatment for ureterovesical junction (UVJ) stenosis in patients with kidney transplantation. METHODS: A retrospective study was conducted among the patients with kidney transplantation diagnosed as UVJ stenosis from 2012 March to 2018 July in Urology and Lithotripsy Center, Peking University People's Hospital. Only the patients who received endoscopic treatment were included, with staged or same-session nephrostomy followed by a retrograde ureteroscopy to evaluate the ureteral stenosis. Incisions with laser, mono- or bipolar energy, or balloon dilation were used to manage the stenosis depending on different situations. Demographic characteristics and clinical data were gathered and analyzed, including age, gender, preoperative serum creatinine, hemoglobin, operation time, success rate, postoperative serum creatinine, hemoglobin, postoperative complications rate, and long-term stenosis recurrence rate. RESULTS: In this study, 13 patients were included (9 males and 4 females). All the UVJ stenoses were diagnosed with preoperative ultrasound, CT scan, MRI, or urethrography. The mean age was 45 years (range 34-57 years). The mean preoperative serum creatinine was 243 µmol/L. Four patients developed UVJ stenosis 1 month after kidney transplantation, while the rest developed long-term stenosis. Fifteen operations were performed in all, of which 14 cases were successful while one failed. The first 8 cases received first-stage nephrostomy and second-stage endoscopic management of the stenosis, while the last 7 cases received the same session surgery. The mean operation time was 95.4 min vs. 68.9 min, and the immediate success rate was 87.5% vs. 100.0% in the first 8 cases and last 7 cases, respectively. The mean decrease of postoperative hemoglobin was 0.6 g/L and mean postoperative serum creatinine was 105 µmol/L. No postoperative fever, severe hematuria, and urine leak were observed. The mean postoperative hospital stay was 2.8 days. Three patients were able to remove ureteral stents and no recurrence was found with a follow-up time of 9, 17, and 82 months. The long-term stenosis recurrence rate was 76.9% (10/13). CONCLUSION: Endoscopic approach for the treatment of UVJ stenosis in patients with kidney transplantation was safe and efficient in our study cohort. However, long term stenosis recurrence rate was high and needed to be paid attention to.

[Treatment of crossing vessels in laparoscopic pyeloplasty].

OBJECTIVE: To investigate the management of crossing vessels compression in laparoscopic pyeloplasty. METHODS: From January 2016 to June 2018, a total of 21 patients who were admitted to Peking University People's Hospital with ureteropelvic junction obstruction (UPJO) associated with crossing vascular compression were reviewed. There were 15 males and 6 females who formed this group, with a mean age of (33.9±15.0) years. There were 4 cases of mild hydronephrosis, 12 cases of moderate hydronephrosis and 5 cases of severe hydronephrosis before operation. All the patients underwent laparoscopic pyeloplasty in our hospital, including 13 on the left and 8 on the right. Laparoscopic pyeloplasty (Anderson-Hynes) were performed in all the patients. Hem-o-lok suspension (14 cases in the suspension group) or translocation of the crossing vessels (7 cases in the translocation group) were used for the intraoperative management of the crossing vessels. Double J tubes were removed 8 weeks postoperatively. The patient demographic data were collected (including operation time, treatment time of crossing vessels, intraoperative blood loss, time of drainage tube removal after operation, and average length of hospital stay), postoperative outcomes were evaluated and the patients were followed up regularly. RESULTS: In all the patients, the crossing vessels were successfully reserved, and none of them were ligated intra-operatively. Mean operative times were (202.2±57.0) min. The duration of intraoperative treatment of crossing vessels was (10.5±3.2) min, (6.1±2.0) min in the suspension group, and (13.7±5.2) min in the translocation group, respectively. Intraoperative blood loss was (47.8±25.6) mL, postoperative drainage time was (4.8±2.6) d, and length of hospital stay was (11.5±3.3) d. Postoperative slight urinary leakage occurred in 1 case. Preoperative pyelectasis of the affected side of all the patients was (3.4±1.7) cm, compared with postoperative pyelectasis of (1.9±1.3) cm. The difference was statistically significant (P<0.05). Postoperative follow-up of all the patients was carried out until December 2018. There was no significant difference in kidney size in all the patients before or after the operations, and hydronephrosis was alleviated compared with that before surgery. CONCLUSION: For UPJO patients with crossing vascular compression, according to the location of the crossing vessels, Hem-o-lok suspension or vessel transposition can be adopted to relieve the crossing vascular compression and improve the success rate of the surgery.

[Effects of percutaneous nephrolithotomy in the treatment of medullary sponge kidney with calculi].

Objective: To evaluate the effects of percutaneous nephrolithotomy (PNL) in the treatment of medullary sponge kidney with calculi. Methods: A total of 77 patients (91 renal units) of medullary sponge kidney with calculi (MSK group) and 77 patients (77 renal units) with common kidney stone (control group) received PNL at Department of Urology in Peking University People's Hospital from September 2006 to February 2016 were analyzed retrospectively. The MSK group included 33 males and 44 females with a mean age of (42.1±13.2) years, the mean stone burden was (3.9±1.8) cm. The control group included 36 males and 41 females with a mean age of (45.3±13.0) years, the mean stone burden was (3.6±1.5) cm. The numbers of tracts, the time of operation, the drop of hemoglobin, the change of creatine, the time of hospitalization, the stone free rate and major complications were compared between the two groups. The measurement data and numeration data were compared with t test and χ(2) test. Results: There were no significant differences in sex, age, preoperative urinary tract infection, stone type, and stone burden between the two groups (all P>0.05). The proportion of bilateral renal calculus in MSK group was higher (18.2% vs. 0, χ(2)=15.400, P=0.000). There were 159 percutaneous channels were established in MSK group while 90 percutaneous channels were established in control group. Compared with the control group, the operation time ((88.1±37.5) minutes vs. (68.5±30.1) minutes, t=3.543, P=0.000) and hospitalization time ((15.1±8.3) days vs. (10.1±3.6) days, t=4.816, P=0.000) were longer, the creatinine level increased ((101.2±62.6) µmol/L vs. (71.3±23.6) µmol/L, t=3.777, P=0.000), the rate of stone free decreased (27.5% vs. 83.1%, χ(2)=51.840, P=0.000) and the rate of complications increased (29.9% vs. 11.7%, χ(2)=8.114, P=0.004) in MSK group. There was no statistically difference in hemoglobin drop ((12.5±13.2) g/L vs. (13.0±10.9) g/L, t=-0.260, P=0.795). Conclusions: Using PNL for patients of MSK with calculi has a lower stone free rate and a higher complications. It is an effective method for patients of MSK with large and complex calculi.

[Risk factor analysis of systemic inflammatory response syndrome in type 2 diabetics after percutaneous nephrolithotomy].

OBJECTIVE: To evaluate the risk factors of systemic inflammatory response syndrome (SIRS) in the patients with type 2 diabetes diagnosed with kidney stone after percutaneous nephrolithotomy (PCNL). METHODS: In this study, 461 patients with type 2 diabetes who received PCNL in Peking University People's Hospital from June 2006 to December 2015 were reviewed. There were 281 males and 180 females with an average age of 57 years were included, of whom, 137 were diagnosed with SIRS after PCNL. The demographic data, clinical features, and test results were compared between the patients with SIRS and without SIRS, trying to identify the correlation between their clinical characters and the occurrence of SIRS. RESULTS: The SIRS was significantly correlated with the patients' preoperative white blood cell counting (×10(9)/L) [7.76 (4.00-17.96) vs. 6.31 (2.00-17.40), P<0.001], preoperational blood glucose level (mmol/L) [7.30 (3.08-19.90) vs. 6.40 (3.42-16.78), P<0.001], operative time (min) [75 (20-270) vs. 60 (20-200), P<0.001], length of stay (d) [12 (2-46) vs. 11 (3-29), P=0.019], staghorn stones [38.8% (33/85) vs. 27.7% (104/376), P=0.042], and preoperational urinary tract infection [36.8% (50/136) vs. 26.6% (81/304), P=0.032]. There was no significant correlation between the SIRS and the patients' age, body mass index, preoperative hemoglobin level, preoperative serum creatinine, and transfusion. In multivariate analysis, abnormal preoperative white blood cell counting (OR=3.194, 95% CI: 1.531-6.666, P=0.002), operative time longer than 60 min (OR=1.635, 95% CI: 1.088-2.456, P=0.018), and preoperational blood glucose level higher than normal 7.1 mmol/L were significantly correlated with the presence of SIRS. CONCLUSION: The high level of preoperational blood glucose, abnormal preoperative white blood cell counting, and long operative time were significantly correlated with the presence of SIRS in patients with type 2 diabetes after PCNL.

[Risk factor analysis of systemic inflammatory response syndrome in type 2 diabetics after percutaneous nephrolithotomy].

OBJECTIVE: To evaluate the risk factors of systemic inflammatory response syndrome (SIRS) in the patients with type 2 diabetes diagnosed with kidney stone after percutaneous nephrolithotomy (PCNL). METHODS: In this study, 461 patients with type 2 diabetes who received PCNL in Peking University People's Hospital from June 2006 to December 2015 were reviewed. There were 281 males and 180 females with an average age of 57 years were included, of whom, 137 were diagnosed with SIRS after PCNL. The demographic data, clinical features, and test results were compared between the patients with SIRS and without SIRS, trying to identify the correlation between their clinical characters and the occurrence of SIRS. RESULTS: The SIRS was significantly correlated with the patients' preoperative white blood cell counting (×109/L) [7.76 (4.00-17.96) vs. 6.31 (2.00-17.40), P<0.001], preoperational blood glucose level (mmol/L) [7.30 (3.08-19.90) vs. 6.40 (3.42-16.78), P<0.001], operative time (min) [75 (20-270) vs. 60 (20-200), P<0.001], length of stay (d) [12 (2-46) vs. 11 (3-29), P=0.019], staghorn stones [38.8% (33/85) vs. 27.7% (104/376), P=0.042], and preoperational urinary tract infection [36.8% (50/136) vs. 26.6% (81/304), P=0.032]. There was no significant correlation between the SIRS and the patients' age, body mass index, preoperative hemoglobin level, preoperative serum creatinine, and transfusion. In multivariate analysis, abnormal preoperative white blood cell counting (OR=3.194, 95% CI: 1.531-6.666, P=0.002), operative time longer than 60 min (OR=1.635, 95% CI: 1.088-2.456, P=0.018), and preoperational blood glucose level higher than normal 7.1 mmol/L were significantly correlated with the presence of SIRS. CONCLUSION: The high level of preoperational blood glucose, abnormal preoperative white blood cell counting, and long operative time were significantly correlated with the presence of SIRS in patients with type 2 diabetes after PCNL.

Phylogenetic and physiological diversity of bacteria isolated from Puruogangri ice core.

The microbial abundance, the percentage of viable bacteria, and the diversity of bacterial isolates from different regions of a 83.45-m ice core from the Puruogangri glacier on the Tibetan Plateau (China) have been investigated. Small subunit 16S rRNA sequences and phylogenetic relationships have been studied for 108 bacterial isolates recovered under aerobic growth conditions from different regions of the ice core. The genomic fingerprints based on ERIC (enterobacterial repetitive intergenic consensus)-polymerase chain reaction and physiological heterogeneity of the closely evolutionary related bacterial strains isolated from different ice core depths were analyzed as well. The results showed that the total microbial cell, percentages of live cells, and the bacterial CFU ranged from 10(4) to 10(5) cell ml(-1) (Mean, 9.47 x 10(4); SD, 5.7 x 10(4), n = 20), 25-81%, and 0-760 cfu ml(-1), respectively. The majority of the isolates had 16S rRNA sequences similar to previously determined sequences, ranging from 92 to 99% identical to database sequences. Based on their 16S rRNA sequences, 42.6% of the isolates were high-G + C-content (HGC) gram-positive bacteria, 35.2% were low-G + C (LGC) gram-positive bacteria, 16.6% were Proteobacteria, and 5.6% were CFB group. There were clear differences in the depth distribution of the bacterial isolates. The isolates tested exhibited unique phenotypic properties and high genetic heterogeneity, which showed no clear correlation with depths of bacterial isolation. This layered distribution and high heterogeneity of bacterial isolates presumably reflect the diverse bacterial sources and the differences in bacteria inhabiting the glacier's surface under different past climate conditions.

Association of gastric cancer with tyrosine hydroxylase gene polymorphism in a northwestern Chinese population.

Gastric cancer (GC) is a common and complex disease caused by multifactors. The aim of our study was to investigate the association of the common polymorphisms detected in insulin-like growth factor (IGF)-II, IGF-1 receptor, insulin-like growth factor binding protein 1 (IGFBP1), insulin (INS) and tyrosine hydroxylase (TH) with susceptibility to GC in a northwestern Chinese population. One hundred and fifty-four GC patients and 166 healthy controls were investigated in our study. The genotypes were determined by polymerase chain reaction-restriction fragment length polymorphism. The frequencies of CC and CT genotypes of TH were significantly higher in GC patients than in controls, as the odds ratios were 3.03 (95%CI 1.438-6.362, P=0.003) and 1.97 (95%CI 1.218-3.167, P=0.005), respectively. No association was found between the polymorphisms of IGF-II ApaI, insulin-like growth factor-1 receptor MnlI, IGFBP1 Bgl II and INS-23HphI and the development of GC. The presence of CC and CT genotypes of TH was associated with a significantly increased risk of GC. But the polymorphisms of other genes detected did not indicate an increased risk of GC in the investigated population.

Association of ACE, ACE2 and UTS2 polymorphisms with essential hypertension in Han and Dongxiang populations from north-western China.

To assess the significance of polymorphisms of the genes for angiotensin-converting enzyme (ACE), angiotensin-converting enzyme 2 (ACE2) and urotensin II (UTS2) as risk factors for essential hypertension in two populations from north-western China, we enrolled 198 patients with essential hypertension and 131 healthy controls from the Han population and 120 patients with essential hypertension and 102 healthy controls from the Dongxiang population. Polymerase chain reaction (PCR) and PCR-restriction fragment length polymorphism were used to analyse gene polymorphisms. The results provided evidence that genetic variants of UTS2 and ACE2 may play a role in the development of essential hypertension in these populations. Polymorphisms of ACE were not associated with essential hypertension in either population. This is the first report showing that the S89N single-nucleotide polymorphism of the UTS2 gene is associated with essential hypertension.

Bacterial diversity in Malan ice core from the Tibetan Plateau.

Three ice core samples were collected from the Malan ice core drilled from the Tibetan Plateau, and three 16S rDNA clone libraries by direct amplification from the ice-melted water were established. Ninety-four clones containing bacterial 16S rDNA inserts were selected. According to restriction fragment-length polymorphism analysis, 11 clones were unique in the library from which they were obtained and used for partial sequence and phylogenetic analysis, and compared with 8 reported sequences from the same ice core at depth 70 m. Differences among the samples were apparent in clone libraries. The phylotypes were dominated by the Proteobacteria group, Acinetobacter sp. and Cytophaga-Flavobacterium-Bacteroides (CFB) group. They accounted for 92.5% (Proteobacteria), 100% (Acinetobacter sp.), 34.4% (CFB) and 100% (beta-Proteobacteria) in the clone libraries from the samples at ice depths 35, 64, 70, and 82 m, respectively. The Acinetobacter sp. was only found in the deposition at ice depth 82 m and closely clustered with gamma-Proteobateria. Two members (Malan A-21 and 101) of alpha-Proteobacteria from the sample of 35 m and two (Malan B-26 and 48) of beta-Proteobacteria of 64 m were loosely clustered (< 95% similarity) with known bacteria, represented new genera in ice bacteria.