Differences in standardized residency training system of urology between China and America / 中华医学教育探索杂志

Objective:To compare the features and advantages of the standardized residency training of urology in America and China, and to provide a reference for the improvement of the Chinese standardized residency training system.Methods:By studying the latest standardized training documents in China and the America, referring to the specific training rules of standardized training pilots (Shanghai and other cities), and the latest related researches, this article compares the differences between the Chinese and American standardized residency training systems from such five aspects as the source of urology training students, training objectives, training content, quality control and external environment, and tries to figure out the reasons for their formation.Results:There are many places in American standardized residency training system that can be referred, such as unifying the period of training system, strengthening the assessment of clinical capabilities of residents, focusing on the combination of clinical and scientific research, and improving the remuneration and practice environment of residents. At present, the quality and effectiveness of Chinese urology standardized residency training needs to be improved, especially the ability of independent diagnosis and surgical skills.Conclusion:By analyzing the differences of standardized residency training system between China and the United States, this article puts forward the following suggestions: a) to unify the educational system and establish a unified admission standard for urologists; b) to formulate a clear training goal and establish a national standardized assessment system; c) to improve the income level of urology residents, willing to establish a standardized residency training system that truly suits China's national conditions.

Bladder Acellular Matrix Grafts Seeded with Adipose-Derived Stem Cells and Incubated Intraperitoneally Promote the Regeneration of Bladder Smooth Muscle and Nerve in a Rat Model of Bladder Augmentation.

The objective of this study was to investigate the feasibility of bladder acellular matrix grafts (BAMGs) seeded with adipose-derived stem cells (ASCs) followed by intraperitoneal incubation for bladder reconstruction in a rat model of bladder augmentation, and to explore the underlying mechanism. Autologous CM-DiI-labeled ASC-seeded (experimental group) and unseeded (control group) BAMGs were incubated in the peritoneum of male rats for 2 weeks and then harvested for bladder augmentation. Histological analysis of the incubated BAMGs revealed numerous cells growing in homogeneous collagen bundles in both groups. In the control BAMGs, these cells were mesenchyme derived, while in the ASC-seeded BAMGs, myofibroblasts and mesothelial cells were found inside and on the surface of the scaffold, respectively. Immunofluorescence analysis demonstrated that some of the myofibroblasts were transdifferentiated from the ASCs after 2 weeks of intraperitoneal incubation. The greater bladder capacity was found in the experimental group than the control group both 4 and 14 weeks postoperatively. Histological analysis revealed that the entire urothelium regenerated well both in the experimental group and the control group without significant difference 4 weeks and 14 weeks postoperatively. From the quantitative data of immunohistochemical and immunofluorescence staining, the smooth muscle cells (SMCs) regenerated significantly better in the experimental group than the control group both 4 weeks and 14 weeks postoperatively. Also significantly more nerve cells were found in the experimental group 14 weeks postoperatively. At 4 weeks postoperatively, the immunofluorescence double staining revealed that some SMCs in the BAMG were transdifferentiated from the implanted ASCs, but no CM-DiI labeling of ASCs was detected 14 weeks postoperatively. Taken together, our results demonstrate that ASC-seeded and peritoneally incubated BAMGs promote not only the morphological regeneration of the bladder smooth muscle and nerve, but also the bladder capacity, which indicates their potential for bladder regeneration.

The application of S.T.O.N.E. nephrolithometry in pediatric patients with upper urinary tract calculi treated with mini-percutaneous nephrolithotomy.

The purpose of this study is to verify the applicability of S.T.O.N.E. nephrolithometry in pediatric patients. 103 cases of pediatric patients younger than 4 years old with upper urinary tract calculi treated with mini-percutaneous nephrolithotomy from January 2012 to March 2014 were retrospectively reviewed and evaluated using this scoring system. All procedures were performed under general anesthesia, using a 14-French nephroscope through a 16-French working access. All patients were divided into two groups according to the stages of the operations, Group A for one-stage operation and Group B for two-stage operation. 87 cases were male and 16 cases were female with the mean age of 26.5 months. The total operation time of group A was 45.89±5.43 min, and 54.62±5.58 min of group B (p=0.000). The hospitalization for group A and group B was 6.63±1.34 and 7.23±1.24 days, respectively (p=0.134). The total S.T.O.N.E. score was 5.93±0.67 for Group A, and 7.92±1.04 for Group B (p=0.000). On further dividing each group into low/moderate/high complexity according to the total score, more cases of low/moderate complexity in group A and more cases of moderate/high complexity in group B (χ2=38.096, p=0.000) were reported. Our data suggest that S.T.O.N.E. nephrolithometry is applicable in pediatric upper urinary tract calculi assessment and predictive for the complexity of the operation, hospitalization, and even complications after the operation. Yet modification may be necessary to make this scoring system more distinguishable for pediatric cases.

Long-term results of the surgical treatment of penile curvature with 16-dot plication : a retrospective analysis of 86 patients / 中华泌尿外科杂志

Objective To assess the long-term surgical outcomes,patient's satisfaction and functional results of correction for patients with penile curvature by 16-dot minimal tension plication.Methods Between August 2004 and December 2010,92 patients with penile curvature underwent surgical correction of penile curvature by 16-dot minimal tension plication.Of them,86 patients (53 patients with congenital penile curvature and 33 patients with Peyronie's disease (PD)) were reached for long-term follow-up.Indications for operation included patients with 30 to 90 degrees of penile curvature,penile length greater than 10 cm and patients who had one or more symptoms,such as difficulty or inability to vaginal penetration and partner discomfort during sexual intercourse.Patients were excluded from study if they had severe penile curvature (greater than 90 degrees),hourglass deformities or large plaques.Preoperative evaluation included international index of erectile function 5 (IIEF-5) questionnaire score,pain on erection and physical examination.Patients were recommended daily low dose phosphodiesterase type 5 (PDE-5) inhibitors 2 weeks after surgery and maintained for 2 to 3 months.At follow-up,recurrence rate,complications,erectile function,patients and partner's satisfaction with the surgery were assessed.Results The mean time of follow-up was 79 months (range,35-107 months).Of 86 patients who had been reached for long-term follow up,82 patients (95.3％) and 77 partners (89.5％) reported overall satisfaction after the surgery.Complete penile straightening was achieved in 79 patients (91.8％).Slight residual curvatures were observed in 7 patients,but did not affect their sexual intercourse.Postoperative penile length shortening (median penile length loss 1.3 cm) was noted in 35 patients (40.7％),which did not affect their sexual intercourse.In addition,no de novo erectile dysfunction was observed,and sexual function was significantly improved evidenced by the IIEF-5 scores,especially in the patients who had received PDE-5 inhibitors for 2 to 3 months.There were no surgery-related complications,such as hematoma,urethral injury,or infection.Conclusion The longterm results demonstrate that correction of penile curvature using 16-dot plication is a simple and safe method to achieve cosmetic and functional satisfaction in patients with mild to moderate penile curvature.

Approach to the patient with empty sella combined with adrenal adenoma / 中华内分泌代谢杂志

Clinical characteristics were analyzed retrospectively in a patient with empty sella and adrenal adenoma with regard to the elaborated diagnosis and treatment.Although empty sella syndrome alone was common,clinical combination with adrenal adenoma was rarely reported.It was difficult to diagnose due to complex symptoms and hormone levels.This case could help increase awareness of the disease and accumulate the experience in diagnosis and treatment.

Analysis and management of complications caused by holmium laser ureterolithotripsy / 国际外科学杂志

Objective To study the the causes, management and preventive measures for complications of holmium laser ureterolithotripsy. Methods Three hundred and seven cases of uteteral calculi from Jan. 2006 to Jan. 2010 were reported (203 men and 104 women, age ranged from 18-83 years,mean age 51.6 years). One hundred thirty-three patients had calculi in the lower ureter,94 in the middle part and 80in the upper ureter. Results The overall comminution rate was 89.9% (276/307 cases). sixteen cases (5.2%) were followed by ESWL due to the shift of the stones to the renal pelvis. The operation failed in 9 cases(2.9%), 3 cases(1%) had perforation,and recoveried after open operation. Deep infection was found in 3(1%)cases,which recoveried after anti-infective therapy. Conclusions Holmium laser ureterolithotripsy is an effective method for treating ureteral calculi, with advantage of high efficiacy,safety and minimal invasion. To master the operating induction, to raise operating technique and to take correct measure could reduce complications effectually.

The positive effect of sildenafil on LUTS from BPH while treating ED / 中华男科学杂志

<p><b>OBJECTIVE</b>To explore the possible relationship between erectile dysfunction (ED) and benign prostate hyperplasia (BPH) in men, and to assess the positive effect of Sildenafil on the lower urinary tract symptoms (LUTS) from BPH while treating ED.</p><p><b>METHODS</b>Thirty-two patients with ED and BPH were offered oral Sildenafil and reviewed before and six months after the administration of Sildenafil by the International Index of Erectile Function-5 (IIEF-5) and the International Prostate Symptom Score (IPSS) questionnaires. Scores were tested by chi-square.</p><p><b>RESULTS</b>IIEF-5 scores were increased by 42.36% and IPSS scores declined by 20.14%, with statistical significance (P < 0.01).</p><p><b>CONCLUSION</b>Treatment of ED with Sildenafil appears to improve urinary symptom scores. A lower IPSS at baseline seems to predict a better response to Sildenafil therapy for ED.</p>