Objective To study the reasons leading to readmission in patients with severe postoperative complications after transurethral prostatectomy. Methods Clinical data of 27 cases of readmission after transurethral resection of prostate (TURP, 14 cases), transurethral vaporization of prostate (TUVP, 3 cases), transurethral laser prostatectomy (TULP, 9 cases) or holmium laser enucleation of prostate (1 case) in this hospital from June 1998 to June 2003 were analyzed. Results Reason leading to readmission included: postoperative severe bleeding in bladder (4 cases), urinary retention (15 cases), urethral stricture (3 cases), bladder neck contracture (2 cases), severe urinary frequency (2 cases) and urinary incontinence (1 case). Conclusions More weight should be placed on the fact that various modes of transurethral prostatectomy may precipitate severe long-term complications.

443) ?mol/L) due to upper urinary calculous obstruction,urgently treated by pneumatic lithotripsy(EMS,Switzerland) under ureteroscopy,from August 2002 to April 2006 in this hospital.After stone fragmentation and removal,an indwelling double-J stent was placed into the ureter at the same time.Results The continuity of the ureter was restored after one session of lithotripsy in all the 9 cases(14 sides).The ureteral calculi were thoroughly removed on one session in 7 cases(12 sides).Few residual stones were found in the renal pelvis in 2 cases(2 sides),in one of which the stones were spontaneously expelled after oral medication,and in another,after extracorporeal shock wave lithotripsy(ESWL).No severe complications happened,such as ureteral avulsion,rupture,or perforation.Concentrations of serum creatine were decreased to normal levels within 3~7 days after operation in all the 9 cases.The gross blood urine disappeared in 1~4 days postoperatively.The patients were discharged from the hospital after 3~7 days (mean,5 days) after operation.The double-J catheter was removed at 1~2 months postoperatively.Follow-up examinations in 7 cases for 2~30 months(mean,14 months) found normal levels of serum creatine and no recurrent urinary stones under B-ultrasonography or X-ray radiography.Conclusions Ureteroscopic pneumatic lithotripsy in the treatment of acute renal failure due to upper urinary calculous obstruction is an effective treatment with short operation time,safety,and minimal trauma.By using this procedure,both sides of ureteral stones can be removed on one session.

Objective To evaluate clinical effects of single-dose intra-arterial infusion chemotherapy for the treatment of refractory bladder cancer after transurethral resection of bladder tumor (TURBt). Methods A retrospective analysis was made on clinical data of 12 cases of refractory bladder cancer treated by single-dose intra-arterial infusion chemotherapy after TURBt from November 1999 to June 2005. The bladder tumor was resected as thoroughly as possible. Postoperatively, a bilateral internal iliac arteriography was made by using the Seldinger technique. The tumor vessels and normal blood supply were identified through the intubation of the right femoral artery. Half dose of chemotherapeutics (epirubicin 25 mg) was infused into both internal iliac artery, then tumor vessels of bladder was selected and infused with peripheral embolization agent (a mix of fragmented gelatin sponge and cisplatin 200 mg). The embolization agent was used repeatedly until all tumor vessels were embolized. Intravesical instillation with epirubicin was carried out postoperatively, and cystoscopy was performed every 3 months after operation. Results After intra-arterial infusion chemotherapy, there were 12 cases of nausea and anepithymia, 3 cases of vomiting, and 2 cases of fever, all of which were symptomatically relieved with expectant treatment. Mild hip pain occurred in 6 cases and subsided in 3~5 days. Decreased erythrocyte and leucocyte were restored to normal levels in 2 weeks. Liver and renal functions did not present marked changes. Follow-up was conducted for 4~55 months (mean, 34 months). There were 1 case of recurrence at 32 postoperative month and 11 cases of progression free survival. Conclusions This technique lowers the recurrent rate of refractory bladder cancer and the incidence of side effects, being a new alternative for patients who are not willing to receive total cystectomy.

Objective To evaluate the efficacy of trans-obturator tension free vaginal tape(TVT-O)for the treatment of stress urinary incontinence(SUI)in women.Methods From January 2006 to September 2007,15 female patients with SUI received TVT-O in our hospital.A 1-cm longitudinal incision was made along the anterior wall of the vagina for the dissection of the urethra from the vaginal submucosal space to the obturator membrane.Then,a butteryfly-shape guide pole was inserted to guide the puncture of a spiral needle from the obturator membrane to the skin covering the root of the thigh.Afterwards,a trans-obturator tape was placed underneath the urethra without tension.Results The operation time was 15-40 min(mean,30 min),and blood loss was 10-40 ml(mean,20 ml).No intraoperative complication occurred in the series.One patient developed urinary retention,and was relieved by indwelling urethral catheter.Ten patients complained pain at the root of the thigh,and was cured simultaneously 3 to 10 days postoperation.Fifteen of the patients were followed up for 2 to 19 months with a mean of 8 months,during which no recurrence was found.Conclusion TVT-O is a simple,effective and reliable method for SUI.

Objective To evaluate the efficacy of ureteroscopic pneumatic lithotripsy for ureteric calculi.Methods From January 2003 to June 2007,221 patients with ureteric calculi underwent ureteroscopic pneumatic lithotripsy in our hospital.Under continuous epidural anesthesia combined with spinal anesthesia,the surgery was performed in lateral lithotomy position.Double-J catheter was used for drainage after the operation.Results The mean operation time was 55 minutes(ranged from 15 to 118 minutes).Among the patients,the calculi were found in the upper ureter in 16 cases,middle segment in 52 cases,and lower ureter in 153 cases.A total of 228 stones in the 211 patients were all fragmented with a success rate of 100%.The discharging rate was 95.5%(211/221).ESWL was used in 7 cases with unsatisfied outcomes and 3 patients who had ipsilateral renal calculi.A 3-to 6-month follow-up was achieved in 189 of the patients,who had no recurrence during the period.Conclusions Ureteroscopic pneumatic lithotripsy is a minimal invasive and effective treatment for ureteric calculi.Postoperative ESWL is an alternative which can increase the rate of stone clearance.

Objective To evaluate the curative effectiveness of ureteroscopic pneumatic lithotripsy in the treatment of ureteral lithiasis.Methods Ureteroscopic pneumatic lithotripsy was performed in 158 cases of ureteral calculi(163 sides)by using the Wolf F8/9.8 rigid ureteroscope and the EMS pneumatic ballistic lithotriptor from August 2002 to April 2006.The operation was carried out under intravertebral anesthesia.Under the irrigation with normal saline,the ureteroscope was advanced into the ureter.Then the ureteral stones were fragmented by pneumatic lithotripsy and removed.Afterwards,a further exploration of the ureter above the lesion was conducted and a double-J drainage tube was placed.Results The operation time was 15-90 min(mean,40 min).The total successful fragmentation rate was 96.9%(158/163),involving a success rate of 86.6%(13/15)for upper stones,96.9%(46/49)for middle stones,and 100%(99/99)for lower stones.The stone migration into the renal pelvis was encountered in 2 cases of upper ureteral calculi(treated by extracorporeal shock wave lithotripsy following a double-J tube placement)and in 3 cases after stone fragmentation(treated by stone expulsion with drugs or extracorporeal shock wave lithotripsy following a double-J tube placement).Ureteral perforation happened during the procedure in 3 cases(1.8%),requiring a double-J tube placement.No serious complications occurred,such as ureteral mucous avulsion or rupture and injuries of neighboring organs or vessels.No conversion to open surgery was required.Follow-up checkups for 1-38 months in 125 cases with B-ultrasonography or KUB film found no recurrence.Conclusions Ureteroscopic pneumatic lithotripsy is a safe,effective,and feasible technique for ureteral lithiasis.

Objective To summarize that the distant interval metastasis of nasopharyngeal carcinoma(NPC) patients who have been examined by 18F-FDG PET/CT and analysis the diagnostic efficacy of doctors using PET/CT device.Methods 75 patients were divided into three groups including primary patients without any treatment and patients in treating and patients after radiotherapied.The distant interval metastasis sits,incidence and their difference were analyzed.We adopt five grades to diagnose distant interval metastasis of NPC.And we choose the difference grade as cut off point to draw ROC curve and then decide the best diagnostic cut off point.Result There are 22patients in the first group and 2patients in the second group and 51patients in the third group in all 75paients.The incidence of distant interval metastasis in the first group is 59.1% and third 68.6% and there are statistical significance between groups(P=0.0001).The most frequent sites of distant interval metastasis is the distant interval lymph nodes(38.67%) and the second is skeleton(36%) and the third is liver(25.33%).ROC curve indicate that third one is the best cut off point because of doctors using PET/CT device can acquire the optimal sensitivity(86.36%)and specificity(88.24%) and accuracy(76.8%).Conclusion The incidence of distant interval metastasis is higher and the most frequent part is distant interval lymph nodes.And the doctors using PET/CT device diagnose the distant interval metastasis of NPC efficacy is higher.

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.

Objective To study the changes of resting-state brain activity in knee osteoarthritis(KOA)patients with chronic pain.Methods The data of 21 KOA patients (KOA group) and 21 healthy controls (HC group) who underwent standard resting-state fMRI scan were analyzed with regional homogeneity (ReHo) method to observe the changes in the patients in contrast to the controls.Results Compared to HC group,patients of the KOA group showed ReHo changes in bilateral frontal lobe,bilateral parietal lobe,bilateral temporal lobe,bilateral cerebellum,limbic system and default-mode network.Conclusion Patients with chronic pain demonstrate abnormal neuron activities in the brain regions, and control loops not only related with pain but also related with emotive function disorder and cognitive impairment.

ObjectiveTo discuss the incidence,treatment and effect of cryptogenic hemoptysis (CH).MethodsPatients with CH were selected from 231 patients with hemoptysis according to clinical evaluation,chest radiography,fiberoptic bronchoscopy and CT scan,and the clinical data and treatment methods were retrospectively analyzed.ResultsFifty-three of 231 patients referred for CH,the incidence of CH was 22.94 ％ (53/231),of which 45 (45/53,84.91％ ) received internal conservative treatment and 8 (8/53,15.09％) received bronchial artery embolization (BAE).High resolution CT (HRCT) showed ground-glass opacities in 20 CH patients after hemoptysis.Bronchial arteriography showed abnormalities,including arterial enlargement and localized hypervascularity in 8 patients and systemic to pulmonary shunting in 3 patients.No recurrence of hemoptysis was observed during 1 to 8-year follow-up.ConclusionBleeding can be controlled in most of CH patients by internal conservative treatment,only a few patients with massive hemoptysis need BAE,and both treatments have good short and long term results.