中华泌尿外科杂志最新文献

{"title":"Effect and mechanism of atorvastatin on cellular inflammatory response induced by calcium oxalate crystals","authors":"Yan Sun, Z. Tao, Juening Kang, Quan Liu, Xiang Wang, Shibin Long, Derong Li, Yao-liang Deng","doi":"10.3760/CMA.J.ISSN.1000-6702.2019.10.012","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1000-6702.2019.10.012","url":null,"abstract":"Objective \u0000To investigate the effect and mechanism of atorvastatin (ATV) on the inflammatory response of human renal tubular epithelial cells (HK-2 cells) induced by calcium oxalate crystals. \u0000 \u0000 \u0000Methods \u0000HK-2 cells were divided into control group (normal medium), ATV group (after 3 h pretreatment with 40 μmol/L ATV, replaced with normal medium), calcium oxalate crystal stimulation group (4 mmol/L calcium oxalate crystal) and ATV treatment group (after 3 h pretreatment with 40 μmol/L ATV, replaced with 4 mmol/L calcium oxalate crystals). After 12 h, the cells were collected, and the expression levels of NLRP3 and Cleaved caspase-1 were detected by immunohistochemical staining and Western blotting. The expression level of NF-κB was detected by immunofluorescence and Western blotting. The cell culture supernatant was collected to detecte the concentrations of interleukin-1β (IL-1β) and interleukin-18 (IL-18) by enzyme linked immunosorbent assay (ELISA). \u0000 \u0000 \u0000Results \u0000Western blot analysis showed that the relative expression of NLRP3 (0.125±0.013 vs. 0.135±0.007) and Cleaved caspase-1 (0.090±0.014 vs. 0.095±0.006) was decreased in the ATV group compared with the control group, but the difference was not statistically significant (P>0.05). The relative expression of NLRP3 (0.315±0.021 vs. 0.135±0.007, P 0.05] and IL-18 [(176.50±24.12)pg/ml vs.(182.50±20.51)pg/ml, P>0.05] in the ATV group was lower than that in the control group, but the difference were not statistically significant (P>0.05). The concentrations of IL-1β[(850.50±48.79)pg/ml vs. (183.50±7.78)pg/ml, P 0.05). The relative expression of NF-κB (0.295±0.035 vs. 0.100±0.014, P<0.001) in the calcium oxalate crystal stimulation group was significantly increased compared with the control group. While the relative expression of NF-κB (0.160±0.012 vs. 0.295±0.035, P<0.05) in the ATV treatment group was significantly lower than that in the calcium oxalate crystal stimulation group. The expression of NF-κB by immunofluorescence staining was consistent with the results of Western blotting. \u0000 \u0000 \u0000Conclusions \u0000Calcium oxalate crystals can induce the inflammatory response of HK-2 cells, while ATV can exert anti-inflammatory effects by inhibiting the activation of NLRP3 inflammasome and decreasing the secretion of inflammatory factors IL-1β, IL-18 and the expression of NF-κB. \u0000 \u0000 \u0000Key words: \u0000Inflammation; Cytokines; Atorvastatin; Calcium oxalate; Human renal tubular epithelial cells","PeriodicalId":10343,"journal":{"name":"Chinese Journal of Urology","volume":"40 1","pages":"780-785"},"PeriodicalIF":0.0,"publicationDate":"2019-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49016815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Individualized prediction of recurrence-free survival after operation in patients with papillary renal cell carcinoma","authors":"G. Hou, Zibao Xing, Yu Zheng, Ming-Chun Gao, Fuli Wang, F. Guo, Pengfei Liu","doi":"10.3760/CMA.J.ISSN.1000-6702.2019.10.004","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1000-6702.2019.10.004","url":null,"abstract":"Objective \u0000To explore the independent predictors for recurrence-free survival (RFS) in patients with papillary renal cell carcinoma (PRCC), and establish a nomogram to predict individual 2-year RFS. \u0000 \u0000 \u0000Methods \u0000The data of patients diagnosed in Xijing Hospital of the Air Force Medical University from June 2009 to May 2018 were retrospectively analyzed. A total of 71 patients with primary T1-4N0M0 unilateral tumor were included in this study. The median age was 54 (range from 25 to 83) years. There were 51 males and 20 females. There were 27 cases of typeⅠ, 44 cases of type Ⅱ, 36 cases of left tumor and 35 cases of right tumor. Patients with clinical Ⅰ, Ⅱ, Ⅲ, Ⅳ stage were 47 cases, 12 cases, 9 cases and 3 cases, respectively. Tumor necrosis occurred in 15 cases (21.1%). The average preoperative alkaline phosphatase (ALP) was 89.0(43.0-217.0) U/L, the average preoperative hemoglobin (Hb) was (132.5±19.9) g/L, with 20 cases (28.2%) of Hb<120 g/L before surgery; the average of preoperative Hb was (132.5±19.9) g/L, among which 20 cases (28.2%) had Hb<120 g/L before surgery; the average of preoperative neutrophils/lymphocytes (NLR) was 2.40 (1.03-6.77); radical nephrectomy was performed in 43 patients and nephrectomy was performed in 28 patients. The 1-, 2-, and 3-year RFS were calculated using Kaplan-Meier method and the differences among different subgroups were assessed using Log-rank test. Univariate and multivariate Cox regression analysis were used to identify the independent predictors for RFS, and the nomogram was developed using R software according to the results of multivariate Cox regression analysis. Furthermore, the predictive ability of the nomogram was internally validated using the Bootstrap method by calculating the C-index and drawing the calibration plot. \u0000 \u0000 \u0000Results \u0000After a median follow-up of 41 ( range from 25 to 83) months, 16 (22.5%) recurrence occurred, including 4 local recurrence and 12 distant recurrence, and 11 (68.8%) patients relapsed within 2 years after surgery. The 1, 2, and 3-year RFS were 88.6%, 80.4%, and 78.7%, respectively. Clinical stage Ⅱ (HR=3.655, 95%CI 1.036-12.890, P=0.044) and stage ≥Ⅲ(HR=3.654, 95%CI 1.008-13.248, P=0.049), preoperative ALP≥90U/L(HR=3.274, 95%CI 1.044-10.267, P=0.042), preoperative Hb<120 g/L (HR=4.771, 95%CI 1.553-14.660, P=0.006), and preoperative NLR≥2.40(HR=4.701, 95%CI 1.238-17.849, P=0.023) were identified as independent risk factors for RFS. On internal validation, the nomogram which integrates the four predictors of clinical stage, preoperative ALP, preoperative HB and preoperative NLR, has a good predictive performance (C-index =0.829, 95%CI 0.819-0.839). \u0000 \u0000 \u0000Conclusions \u0000In the present study based on single center data, clinical stage Ⅱ and ≥Ⅲ, preoperative ALP≥90 U/L, preoperative Hb<120 g/L and preoperative NLR ≥2.40 were independent predictors for postoperative RFS in patients with PRCC, and a new preoperative nomogram for predicting individual postoperative 2-year RFS w","PeriodicalId":10343,"journal":{"name":"Chinese Journal of Urology","volume":"40 1","pages":"737-741"},"PeriodicalIF":0.0,"publicationDate":"2019-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43790257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic value of biparameter magnetic resonance imaging of PI-RADS and PSA related markers in first prostate biopsy","authors":"Zhen Liang, Jun Zhu, Jiaqi Kang, Rui Hu, W. Zhang, Ningjing Ou","doi":"10.3760/CMA.J.ISSN.1000-6702.2019.10.010","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1000-6702.2019.10.010","url":null,"abstract":"Objective \u0000To evaluate the value of Prostate Imaging Reporting and Data System Version 2 (PI-RADS ) based biparametric magnetic resonance imaging (bpMRI) for predicting prostate biopsy results in patients with elevated prostate specific antigen (PSA). \u0000 \u0000 \u0000Methods \u0000The bpMRI from 539 patients who took transperineal template saturate biopsy from January 2015 to October 2017 were assessed retrospectively. The average age was 69.5 years old (44-88 years), with tPSA level of 7.23 ng/ml (4-10 ng/ml), f/t PSA of 0.183( 0.016-0.504), PSAD of 0.126 ng/ml2 ( 0.025-0.534 ng/ml2) , PV of 72.42 ml ( 18.71-199.51 ml). The age, PSA level, free/total PSA ratio, PSA density, prostate volume, and PI-RADS score of enrolled patients were analyzed for univariate analysis and their difference was compared by chi-square test, t-test. The multivariate logistic regression analysis was also performed through SPSS to select the independent risk factors for prostate cancer (PCa) and clinically significant cancer (csPCa). The receiver operating characteristic curves were also constructed to analyze the sensitivity and specificity of PI-RADS in PCa to explore the best cut-off value for the diagnosis of PCa and csPCa. \u0000 \u0000 \u0000Results \u0000A total of 539 patients were included in our study with 244 cases being positive and 295 cases being negative. In patients with positive results, 59 patients were diagnosed csPCa. According to univariate analysis results, the age(P<0.001) and PI-RADS score (P<0.001) of the positive patients were higher than the negative patients, and the difference was statistically significant. The age of the csPCa patients (P=0.023), PSAD (P=0.048) and PI-RADS scores (P<0.001) were higher than those of InsPCa patients, and f/t PSA (P=0.027) was lower than that of InsPCa patients with statistically significance. Multivariate logistic regression analysis demonstrated that f /t PSA (OR=2.283, P=0.049) and PI-RADS score (OR=9.046, P<0.001) were independent risk factors for positive biopsy results, while PSAD (OR=4.54, P=0.038) and PI-RADS score (OR=8.254, P<0.001) were independent risk factor for csPCa. The Yoden index analysis of different thresholds for prostate cancer detection indicated that PI-RADS 3 was the optimal threshold for the diagnosis of PCa, and PI-RADS 4 was the optimal threshold for the diagnosis of csPCa. Based on the combination of the above factors, the positive rate of prostate cancer was relatively high in patients with PI-RADS score ≥3 and f/t PSA<0.2 , which accounted for 86.6%(181/209). In contrast, the positive rate in patients with a PI-RADS score of ≤2 and f/t PSA≥0.2 was low, which accounted for 10.7%(6/56). The positive rate of csPCa was relatively high in patients with PI-RADS score≥4 and PSAD≥0.15 ng/ml2, which accounted for 76.0%(38/50). The positive rate of csPCa detected in patients with ≤3 and PSAD<0.15 ng/ml2 was low, which accounted for 0(0/359). \u0000 \u0000 \u0000Conclusions \u0000PI-RADS score could be used to reduce the unnecessary prostate bio","PeriodicalId":10343,"journal":{"name":"Chinese Journal of Urology","volume":"40 1","pages":"768-773"},"PeriodicalIF":0.0,"publicationDate":"2019-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47990525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical treatment of renal angiomyolipoma with inferior vena cava tumor thrombus: case report and literature review","authors":"Hong-xian Zhang, Xun Zhao, Zhuo Liu, Guo-liang Wang, Lei Zhao, X. Tian, Min Lu, W. He, H. Ge, Lulin Ma","doi":"10.3760/CMA.J.ISSN.1000-6702.2019.10.003","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1000-6702.2019.10.003","url":null,"abstract":"Objective \u0000To explore the clinical characteristics of renal angiomyolipoma (AML) with inferior vena cava (IVC) tumor thrombus and to improve the diagnosis and treatment of the disease. \u0000 \u0000 \u0000Methods \u0000The clinical data of 3 patients with renal AML and inferior vena cava tumor thrombus was retrospectively reviewed. The patients were all female, aged 19 to 70 years. Among them, 2 patients presented with lumbago on the right side, and the other one was diagnosed by physical examination. The body mass index ranged from 18.4 to 24.6 kg/m2, with a median value of 20.4 kg/m2. According to the American Society of Anesthesiologists (ASA), they were classified as grade Ⅱ. Color doppler ultrasound examination of the kidney and IVC was performed in all the 3 patients, all of which showed hyperechoic solid mass in the right kidney. Color doppler ultrasound of IVC showed hyperechoic band in the IVC, indicating blood flow signals and the tumor thrombus. All the 3 cases showed irregular fat density or mixed density in the right kidney and multiple irregular fat density were observed in the right renal vein and inferior vena cava on CT. Two of them received MRI examination of IVC, which showed irregular lesions in the right kidney, short T1 and long T2 signals, low lipids, and no definite limited diffusion on DWI. Irregular fat signal were seen in the right renal vein and inferior vena cava. All 3 patients were diagnosed with right renal mass with IVC tumor thrombus, with 1 patient of Mayo grade Ⅲ tumor thrombus and the other 2 of Mayo gradeⅡtumor thrombus. One underwent laparoscopic radical nephrectomy and inferior vena cava tumor thrombectomy, another one underwent open right partial nephrectomy and tumor thrombectomy, and the third one suffered preoperative AML rupture, undergoing open radical nephrectomy and tumor thrombectomy. \u0000 \u0000 \u0000Results \u0000The operation time was 168 to 659 min, with median of 220 min. Intraoperative blood loss ranged from 50 to 300 ml, with the median of 50 ml. Postoperative indwelling time of drainage tube was 5 to 11 days, with the median of 6 days. Postoperative hospital stay ranged from 7 to 14 days, with a median of 8 days. Postoperative follow-up ranged from 12 to 16 months, with a median follow-up of 13 months. All the three patients underwent operation without postoperative complications. Postoperative pathology proved to be right renal angiomyolipoma. After 3 months of follow-up, the patients showed no tumor recurrence or metastasis. \u0000 \u0000 \u0000Conclusions \u0000Renal AML is a benign lesion, which is rarely concurrent with inferior vena cava cancer thrombus. Enhanced CT examination is the main diagnostic method, surgical resection of the lesion is the preferred treatment, partial nephrectomy combined with thrombectomy can be performed in patients with AML, if permitted, and postoperative prognosis turns out to be propitious. \u0000 \u0000 \u0000Key words: \u0000Inferior vena cava; Renal angiomyolipoma; Tumor thrombus","PeriodicalId":10343,"journal":{"name":"Chinese Journal of Urology","volume":"40 1","pages":"732-736"},"PeriodicalIF":0.0,"publicationDate":"2019-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41566457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The manufacture and application of novel evaluating tool for renal vascular anatomy: the system of individualized reno-vasculature evaluation for nephrectomy","authors":"Dongwen Wang, Bin Zhang, Xiaobin Yuan, Xuhui Zhang, Caoyang Hu, Qiang Jing, Bowei Wu, Yanhong Luo","doi":"10.3760/CMA.J.ISSN.1000-6702.2019.10.002","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1000-6702.2019.10.002","url":null,"abstract":"Objective \u0000To explore the clinical feasibility and effectiveness of novel preoperative evaluating tool to achieve accurate and quantitative evaluation of renal vascular anatomy for retroperitoneoscopic radical nephrectomy (RLRN). \u0000 \u0000 \u0000Methods \u0000Two-hundred and fifty one consecutive patients who underwent RLRN for renal tumours from September 2016 to March 2018 were enrolled prospectively, including 154 males (61.4%) and 97 females (38.6%), aged 26 to 84 years with the mean age of 58.7 and mean BMI of 25.8 kg/m2. The tumors were all isolated with the mean size of 5.4 cm. According to presence or absence of vascular correlation events (VCE) and nephrectomy times under endoscope (NTE), all the cases were divided into two groups: the common group (VCE, NTE <60 min) and the difficult group (no VCE, NTE ≥60 min). With the help of preoperative three-dimensional reconstruction, the specific and crucial arteriovenous anatomical features were recorded, which consist of side, count, spatial configuration and density of the vessel to be processed. After univariable analysis, multivariable analysis with logistic regression was performed for the selected risk factors. Individualized reno-vasculature evaluation for nephrectomy were established, when the value of risk factors were assigned separately according to its correlation and clinical practice. \u0000 \u0000 \u0000Results \u0000There was no statistical significance between common group and difficult group in the aspects of gender, age, BMI, maximum diameter of the tumor, R. E.N.A.L. score and PADUA score. There were statistical significance between common group and difficult group in the aspects of N (number of total vessels), D (vascular anomalies density), C (3D conformation), S (sides) of pending renal vessels (χ2=125.700, 102.014, 97.090, 12.603, P 0.05). SIREN was preliminarily established as a preoperative evaluating tool to achieve accurate and quantitative evaluation of renal vascular anatomy. Of the 5 components of SIREN, N, D were scored on 1 to 3 points, C was scored on 0 to 3 points, E was scored on 0 to 1 point, and S was not scored but showed in terms of L or R. All of these constitute the assessment content with a full score of 10 points except S suffixed by L or R instead of scores. There was a statistically significant difference during low (2-3 points), middle (4-6 points), and high (7-10 points) groups (χ2=126.927, P<0.05) according to the comparisons between low and middle, low and high, as well as middle and high (χ2=90.997, 7.195, 91.679, P<0.05). \u0000 \u0000 \u0000Conclusions \u0000In virtue of the renal vascular scoring system named after SIREN by 3d reconstructing, the spatial structure information of the renal vascular system can be obtained accurately and expressed directly before operation, the difficulty of vascular treatment can be predicted, the preoperative planning can be optimized, and the accurate quantitative evaluation of renal vascular anatomical structure can be achieved to further improve the surgical sa","PeriodicalId":10343,"journal":{"name":"Chinese Journal of Urology","volume":"40 1","pages":"726-731"},"PeriodicalIF":0.0,"publicationDate":"2019-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49290459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extraperitoneal approach robotic-assisted urethra-sparing simple prostatectomy for large-gland benign prostatic hyperplasia: initial experience","authors":"F. Qu, Gu-tian Zhang, Yongming Deng, Jing Liang, Ning Liu, Rong Yang, Linfeng Xu, Xiaogong Li, W. Gan","doi":"10.3760/CMA.J.ISSN.1000-6702.2019.10.008","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1000-6702.2019.10.008","url":null,"abstract":"Objective \u0000To report our initial experience with extraperitoneal approach Robotic-Assisted Urethra-sparing simple prostatectomy(US-RASP)on large-gland (>100 ml) benign prostatic hyperplasia(BPH). \u0000 \u0000 \u0000Methods \u0000From August 2015 to April 2018, 32 patients with large volume prostate underwent US-RASP performed by single surgical team were retrospectively reviewed. The patient's median age was 73 (range 59-80) years, and median BMI was 24.9 (19.3-34.8 ) kg/m2, The estimated prostate volume(V), postvoid residual volume(PV) by transrectal ultrasonography and PSA were 152.0(119.0-223.1)ml, 145(0-280)ml and 13.7(5.2-27.3)ng/ml, respectively. Four of 32 patients underwent preoperative urinary catheterization. The perioperative functional parameters including international prostate symptom score (IPSS) questionnaire, maximum flow rate (Qmax), maximum voided volume(Vmax), quality of life questionnaires (QOL) and International Index of erectile function-erectile function (IIEF-EF) were 27(23-33), 5.9 (2.5-7.8) ml/s, 110 (80-210)ml, 5(3-6), and 27(26-29), respectively. Functional parameters including IPSS, QOL, Qmax, Vmax, PV and IIEF-EF were compared and analyzed at 3 and 12 months postoperatively during the following-up. \u0000 \u0000 \u0000Results \u0000The US-RASP was completed in all 32 patients and no open conversion. Median operation time was 180 (115-240) min, the estimated blood loss was 300(range 100 to 400)ml, Hemoglobin loss was 17(5-38)g/L. The median Foley catheterization time was 7 (5-12) days and drainage was removed after a median of 5 (4-7) days with median hospital stay of 8(6-14)days. Median specimen weight on pathological examination was 107.7 (79.8-147.4)g with median of 64.2% (49.4%-86.2%) resection ratio. At 3-mo follow-up, median IPSS score, Qmax, Vmax, PV and QOL were 6(4-18), 17.3 (13.8-21.1)ml/s, 167(140-310)ml, 50(0-61)ml, 1(0-3) , respectively. At 12-mo follow-up, median IPSS score, Qmax, Vmax, PV and QOL were 4(1-9), 20.1 (17.9-24.1)ml/s, 205(176-305)ml, 24(0-35)ml and 1(0-2) , respectively. All patients showed great improvement of IPSS, Qmax, Vmax, PV and QOL after median 17 (12-44) months follow-up compared with preoperative parameters (P<0.05). Erectile function was not impaired in 17 patients who have normal erectile function pre-operatively and 14 cases (82.4%) preserved satisfactory anterograde ejaculation. No significant complication occurred during the procedure. No patient developed permanent urinary incontinence. \u0000 \u0000 \u0000Conclusions \u0000US-RASP is a safe and effective treatment option for selected patients with large-gland obstructive BPH(>100 ml). Our data showed significant improvement in voiding function and maintaining satisfactory anterograde ejaculation following urethral-sparing technique. It may be a new alternative method in the future for large-volume symptomatic BPH. \u0000 \u0000 \u0000Key words: \u0000Prostatic hyperplasia; Prostatectomy; Robotic-assisted surgery; Extraperitoneal approach; Urethra-sparing","PeriodicalId":10343,"journal":{"name":"Chinese Journal of Urology","volume":"40 1","pages":"757-762"},"PeriodicalIF":0.0,"publicationDate":"2019-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44314585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical study of radical cystectomy under totally laparoscopy and ρ shape orthotopic ileal neobladder","authors":"Xin Wang, Meng Zhu, Lixin Ren, Wei Li, Dong-bin Wang, Yuepeng Liu, Jinchun Qi","doi":"10.3760/CMA.J.ISSN.1000-6702.2019.10.006","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1000-6702.2019.10.006","url":null,"abstract":"Objective \u0000To explore the feasibility and advantages of totally laparoscopic radical cystectomy plus ρshape orthotopic ileal neobladder, and to summarize the experiences. \u0000 \u0000 \u0000Methods \u0000The clinical data of 11 patients with bladder cancer admitted to the second hospital of Hebei medical university from October 2018 to May 2019 were retrospectively analyzed. All patients were male, aged 33 to 77 years, with an average of 64.4 years. Body mass index ranged from 18.0 to 31.8 kg/m2, with an average of 23.2 kg/m2. One case underwent partial cystectomy and 10 cases underwent transurethral resection of bladder tumor, with 10 cases of invasive urothelial carcinoma and 1 case of adenocarcinoma. No case underwent neoadjuvant therapy, and all cases were clinically staged as cT2a-3bN0-2M0. Totally laparoscopic radical cystectomy and ρ shape orthotopic ileal neobladder intraperitonealy were performed. The specific procedures were described as follows. After bladder resection, the ileal segment of 55 cm in length was intercepted at 25 cm from ileocecal valve, with the proximal part retaining 15 cm lumen as the input loop, and the distal part of 40 cm ileum being folded in 1∶1 ratio. The folded intestinal segment was made into a allantoic sac by using a linear incision closure device, forming a \"ρ\" shape with the input loop, bilateral ureters and the input loop. Anastomosis of wall, distal end of allantoic and urethra was performed.Record the perioperative data such as operation time, estimated bleeding, postoperative recovery, complications, and follow-up results. \u0000 \u0000 \u0000Result \u0000All of the 11 cases underwent successfully operation, and no cases were transferred to open surgery. The operation time ranged from 320 to 440 minutes, with an average of 357.1 minutes. The estimated amount of bleeding ranged from 100 to 300 ml, with an average of 207.1 ml. The total time of intestinal tract procedure was 80-100 minutes, with an average of 89.3 minutes, and the time of allantoic preparation was 14-19 minutes, with an average of 16.1 minutes. The pain score was 2-5 points at 4 hours after operation, with an average of 3.8 points, and 1-4 points at 24 hours after operation, with an average of 2.3 points. Postoperative exhaust time ranged from 2.5 to 3.5 days, with an average of 3.0 days.Catheter removed 21 days after operation, with 9 cases of urinary incontinence, including mild in 6 cases, moderate in 2 cases and severe in 1 case, with daytime pad of 0-3 and nighttime pad of 1-3.which improved gradually following pelvic exercise for 4-18 weeks. Postoperative hospital stay ranged from 7 to 13 days, with an average of 10.4 days. The drainage removal time was 4-11 days, with an average of 6.7 days. Postoperative pathology revealed 7 cases of high-grade invasive urothelial carcinoma, 3 case of low-grade invasive urothelial carcinoma and 1 case of adenocarcinoma. The tumors invade the prostate in adenocarcinoma patient, with left (3/13) and right (1/9) positive lymph nodes. On","PeriodicalId":10343,"journal":{"name":"Chinese Journal of Urology","volume":"40 1","pages":"747-752"},"PeriodicalIF":0.0,"publicationDate":"2019-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41852454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk nomogram model for predicting the postoperative upgrade to pT3a of cT1 renal cancer","authors":"Qiliang Cai, Jintao Li, Chuanfeng Liu, Dingrong Zhang, Shenzhe Ma, Zunke Xie, Yegang Chen, Wei Zhang, Y. Niu","doi":"10.3760/CMA.J.ISSN.1000-6702.2019.10.005","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1000-6702.2019.10.005","url":null,"abstract":"Objective \u0000To evaluate the risk factors of postoperative upgrade to pT3a of cT1 renal cell carcinoma, and to establish a nomogram prediction model to improve the ability of predicting locally advanced renal cell carcinoma and provide a reference for clinical surgical decision-making. \u0000 \u0000 \u0000Methods \u0000Clinical data of 1 376 patients with cT1 (diameter ≤ 7 cm) renal tumor hospitalized for surgery from January 2010 to December 2016 were retrospectively analyzed. There were 979 males and 397 females, with the mean age of (57.65±10.92) years. The mean body mass index (BMI) was (25.47±3.27) kg/m2 and the average tumor size was (4.02±1.52) cm. There were 711 tumors on the left and 665 on the right. There were 363 cases with clinical symptoms, 567 patients with smoking history , 732 cases with history of chronic disease. There were 289 cases with tumor necrosis, 636 cases with tumor protrusion, 822 cases with irregular tumor , and 738 cases with renal sinus compression. Partial nephrectomy and radical nephrectomy were performed in 396 cases and 980 cases respectively. Mann-whitney U test and chi-square test were used for univariate analysis, logistic regression analysis was used for multivariate analysis to analyze the predictors of upgrading, R software was used to construct the nomogram predictive model, C-index was used to evaluate the model discrimination, and calibration curve method was used to evaluate the consistency of the model. \u0000 \u0000 \u0000Results \u0000Postoperative pathology of total 1 376 cases showed that there were 1 195 cases of clear cell carcinoma of kidney, 48 cases of papillary cell carcinoma, 57 cases of chromophobe cell carcinoma, and 76 cases of other types. Among the 1 376 patients with cT1 renal tumor, 75 patients were upgraded to pT3a, accounting for 5.5% of all patients. Univariate analysis showed that the patients who upgraded to pT3a were older [(63.08±10.17) years old and (57.34±10.88) years old], and the tumor length and diameter were larger [(5.24±1.35) cm and (3.95±1.51) cm]. Patients with clinical symptoms [46.7% (35/75) vs. 25.2%(328/1 301)], patients with CT indication of tumor necrosis [40.0%(30/25 975) vs. 19.9% (259/1 301)], patients with irregular tumor contour [73.3%(55/76 775) vs. 59.0%(767/1 301)], and patients with radical nephrectomy were higher [(92.1% (70/91 075) vs. 70%(910/1 301)]. All the differences were statistically significant (P<0.01). Multivariate analysis showed that the independent predictors of upgrading were age (OR=1.046, P<0.001), larger tumor (OR=1.504, P<0.001), clinically symptom (OR=2.153, P=0.004), irregular tumor profile (OR=2.466, P=0.002), and tumor necrosis on CT (OR=2.588, P<0.001). The C-index was 0.808, the calibration curve of forecasting curve with the standard curve fit was good, and the prediction of renal cancer are better in predict consistency. \u0000 \u0000 \u0000Conclusions \u0000Based on the five preoperative predictors, including age, tumor size, clinical presence or absence of symptoms, tumor profile, a","PeriodicalId":10343,"journal":{"name":"Chinese Journal of Urology","volume":"40 1","pages":"742-746"},"PeriodicalIF":0.0,"publicationDate":"2019-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47309280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of flexible ureteroscopy in diagnosis and treatment of hematuria from upper urinary tract","authors":"Sixing Yang, Yue Xia, Z. Ye","doi":"10.3760/CMA.J.ISSN.1000-6702.2019.09.001","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1000-6702.2019.09.001","url":null,"abstract":"The aetiology of hematuria from upper urinary tract is sophisticated including benign and malignant lesions. With comprehensive utilization and improvement of flexible ureteroscopy(fURS), especially innovation and elaboration of digital fURS with auxillary armaments, it may present qualitative as well as localized evidence for etiological diagnosis of hematuria from upper urinary tract. Based on the precise decision of individual strategy, flexible ureteroscopic laser ablation gradually turns to be a direction and trend of option in selected cases based. Flexible ureteroscopy plays a critical role in the diagnosis and treatment of hematuria from upper urinary tract. \u0000 \u0000 \u0000Key words: \u0000Ureteroscopy; Flexible ureteroscope; Hematuria; Upper urinary tract; Upper tract urothelial carcinoma","PeriodicalId":10343,"journal":{"name":"Chinese Journal of Urology","volume":"40 1","pages":"641-644"},"PeriodicalIF":0.0,"publicationDate":"2019-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43927211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors analysis of urinary tract infection after flexible ureteroscopy combined with holmium laser lithotripsy for kidney calculi with human immunodeficiency virus infection","authors":"Chuanyu Cheng, Jianwei Hao, Yudong Wu, Bing-qian Liu","doi":"10.3760/CMA.J.ISSN.1000-6702.2019.09.010","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1000-6702.2019.09.010","url":null,"abstract":"Objective \u0000To investigate the risk factors of urinary tract infection after flexible ureteroscopy combined with holmium laser lithotripsy for kidney calculi with human immunodeficiency virus infection. \u0000 \u0000 \u0000Methods \u0000A total 96 patients from June 2016 to June 2018 were analyzed retrospectively. It included 53 males and 43 females, aged 21 to 57(average 41) years old. All patients were diagnosed with kidney stones by KUB, IVU and CT examination. 19 cases of bilateral kidney stones and 37cases in left and 40 cases in right. 67 cases of single stones and 29 cases of multiple. There were 34 cases of renal pelvis calculi, 19 cases of meddle calyx, 17 cases of superior calyx and 26 cases of inferior calyx. Maximum diameter of calculus was 0.8-2.9 cm, average(1.6±0.8)cm, of which 49 cases size were over 2 cm. There is no obvious stenosis of the renal pelvis and ureter. There were 29 cases of CD4+ lymphocyte count ≤400/μl, and 26 cases of preoperative ureteral stents. Urine test and urine bacterial culture were confirmed no urinary tract infection before lithotripsy. 46 cases with abnormal white blood cells due to urinary test could not meet the diagnostic criteria for urinary tract infection, and prophylactic antibiotics, 51 cases without antibiotics. All 96 cases underwent lithotripsy and record postoperative conditions. Then single factor analysis and multi-factor logistic regression analysis were used to analyze the related factors of urinary tract infection after lithotripsy. \u0000 \u0000 \u0000Results \u0000All 96 cases were successfully completed, no open surgery, no complications. The operation time was 40-130 min (average 57 min), of which 34 cases were over 60 min. Postoperative retained catheter time was 2 to 11 days (average 3.5 days), of which 27 cases were over 7 days. Urinary tract infection occurred in 18 of all patients, with an incidence of 18.8%. The results of urinary bacterial culture in 18 cases were 13 cases of Escherichia coli infection, 3 cases of Proteobacteria infection, and 2 cases of fecal cocci infection. There were 14 cases of calculi size over 2 cm, 10 cases of CD4+ lymphocyte count≤400/μl, 11 cases of preoperative ureteral stents, 3 cases of prophylactic antibiotics, 11 cases of operation time over 60 min, and 10 cases of postoperative retained catheter over 7 days. Single factor analysis found that CD4+ lymphocyte count≤400/μl, preoperative ureteral stents, larger calculi size, longer operation time, postoperative retained catheter for a long time could increase the risk of urinary tract infection after operation (P<0.05), Preoperative prophylactic antibiotics could reduce the incidence of postoperative infection (P<0.05). Multivariate logistic regression analysis suggested that CD4+ lymphocyte count ≤400/μl, preoperative ureteral stents, calculi size over 2 cm, operation time more than 60 min, postoperative retained catheter more than 7 days, and no prophylactic antibiotics before surgery were risk factors for postoperative urinary tract i","PeriodicalId":10343,"journal":{"name":"Chinese Journal of Urology","volume":"40 1","pages":"690-694"},"PeriodicalIF":0.0,"publicationDate":"2019-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48761673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}