Objective To study a new procedure of surgical repairment of rectourethral fistula.Method By the perineum approach one stage urethroplasty using island skin tubes from perineum and scrotum has been adopted after the resection of fistular urethra and repairment of the defect of the anterior wall of rectum to substitute the defect of urethra in 9 cases during 1992-1998.Result The 9 cases were all cured and have been followed-up for 2 6 years without recurrence of rectourethral fistula.Conclusion This procedure was regarded as an ideal technique for the closure of rectourethral fistula especially for those complicated with urethra stricture.

Objective To investigate the protective mechanism of cyclosporine A to renal autografts in situ.Methods Thirty rabbits were divided into three groups at random (n=10 in each group), subjected to left renal in situ perfusion with normal saline (control group), HC-A solution (HC-A group) and HC-A solution containing CsA (30 ml/L, experimental group) respectively. By ~using self-made in situ cryopreservation device, the left kidney was cryopreserved in situ at 0-4 ℃ for 2 h. Then the right kidney was dissected and the left renal blood flow was opened. At 6th h and 24th h after reperfusion, blood BUN and Cr levels were determined. At 24th h, the left kidneys were ~dissected for the detection of the expression of HSP70 and NF-?B in left renal tissues. The apoptotic rate in left renal tissues was assayed by in situ end-labeling method. Results In the experimental group, the expression level of HSP70 was significantly higher, while the expression of NF-?B and ~apoptotic rate significantly lower than in the other two groups (all P

ObjectiveTo investigate the protective effect of ozone oxidative preconditioning (OzoneOP) on apoptosis induced by acute renal ischemia/reperfusion (I/R) injury in rats.Methods The right kidneys of rats in control group were excised.A rat I/R model was established in I/R group.In OzoneOP group,the renal OzoneOP was induced by rectal insufflation of 5.0～5.5 ml oxygen plus ozone (ozone 50 mg/L,1 mg· kg- 1 · d- 1,once every day).The parameters (blood urea nitrogen and creatine )of renal function were determined by auto-biochemical analyzer. The concentrations of malondialdehyde (MDA) and superoxide dismutase (SOD) were measured by using chromometry.Cytochrome c (CytC) was examined by using immunohistochemistry and Western blotting.The mRNA expression levels of TNF-α,IL-1β and IL-6 in the renal tissue were detected by using RT-PCR.ResultsCompared with the control group,the blood urea nitrogen,creatine,MDA and the release of CytC were increased significantly in I/R group.After OzoneOP,the levels of blood urea nitrogen,creatine,MDA,CytC and the mRNA expression levels of TNF-α,IL-1-β and IL-6were significantly decreased and SOD levels were significantly increased.ConclusionOzoneOP could relieve renal I/R injury of rats by improving antioxidation capability,cutting down cytokines contents and inhibiting the release of CytC from mitochondria.

Objective To evaluate the predictive value of urinary neutrophil gelatinase-associat-ed lipocalin (NGAL) and interleukin-18 (IL-18) for delayed graft function (DGF) in kidney transplan-tation. Methods Serial urine samples collected at 0, 12 and 24 h after operation from 86 kidney transplantation patients were analyzed by enzyme-linked immunosorbent assay for NGAL, IL-18 and RBP. Results Fifteen patients developed DGF. At 12 h after transplantation, the level of urine NGAL elevated significantly (1712.75±474.6 vs. 863.1±199.8 without DGF, P<0. 001). The in-creases of urine IL-18 (29. 2±4.1 vs. 28.7±4.2 without DGF, P>0. 05) was not significant. At 24 h, both urine NGAL(2905.0±1108.1 vs. 911.8±221.0 without DGF,P<0. 001) and IL-18(211.3± 34.0 vs. 86.9±22.8 without DGF, P<0. 001) increased significantly, whereas the changes of urine RBP and serum creatinine (SCr) were not significant. ROC analysis showed that the area under the curve of NGAL and IL-18 were 0. 90 and 0.76 respectively, the cut-off values were 996.5 ng/mg and 148.5 ng/mg, the diagnostic sensitivities in DGF were 90.2% and 76.3%, specificities were 82.6% and 66.4% respectively. Conclusions Both urine NGAL and IL-18 could potentially be early predic-tive marker of DGF. The level of NGAL elevated earlier than IL-18, which may be more effective in predicting DGF.

Objective To observe the effects of Triptolide on the expression of toll-like receptor 4 (TLR4) in renal ischemia/reperfusion (I/R) injury in rats. Methods A renal I/R model was established. Rats were randomly separated into the following experimental groups. Group 1, shamoperated control (n = 15) : rats were subjected to surgical manipulation, without the induction of renal ischemia. Group 2, I/R (n = 18): rats were subjected to left renal ischemia for 45 min followed by reperfusion. Group 3, TRI + I/R (n = 18): Before the I/R procedure (as in group 2), rats were intraperitoneally injected with TRI (0.4 mg/kg), once every day, three times. Rats were killed at the 1st, 3rd, and 5th day after I/R injury. The parameters of renal function were determined by autobiochemical analyzer. The expression of TLR4 was detected by RT-PCR and Western blotting. Results As comparedwith the sham-operated control group, serum BUN and Cr levels were significantly increased in the rats undergoing I/R procedure at the 1st, 3rd, and 5th day (P＜0. 01). After the treatment with TRI, the levels of BUN and Cr and the expression of TLR4 in the renal tissues were significantly decreased (P＜0. 05). Conclusion TRI could relieve renal I/R injury in rats by inhibiting the TLR4 expression.

Objective To summarize the experience in retroperitoneal living donor nephrectomy under 3D laparoscopy and to investigate its clinical effect and safety. Methods The clinical data of 19 cases who underwent retroperitoneal living donor nephrectomy under 3D laparoscopy were collected.Operation duration,intraoperative blood loss, renal warm ischemia time,length of renal artery,renal vein and ureter,incision size and operative complications were recorded.Postoperative renal function of donors and recipients was observed. Results Nineteen cases of living donor nephrectomy were successfully completed under the 3D laparoscopy,and there were no conversion into conventional laparoscopy and open surgery.The operation duration of living donor nephrectomy under 3D laparoscopy was 80.5﹣125.2 (with an average of 102.3)min;intraoperative blood loss was 40.6﹣90.4 (60.8)ml;renal warm ischemia time was 100﹣230 (161)s.Length of renal artery,renal vein and ureter was 2.6﹣3.2 (2.9)cm,2.2﹣3.0 (2.6)cm and 8﹣13 (10)cm, respectively.The incision size was about 5﹣6 cm,and the wound healed.Urine volume of the donors at 24 h after operation was 2 000﹣2 500 ml.Serum creatinine increased slightly in 1 case at 3 d after operation,and returned to normal through reexamination after 7 d and 1 month.The donors stayed in the hospital 5﹣7 (6)d after operation.All transplant operations were performed successfully,and delayed graft function did not occurred. Conclusions Accuracy of operation can be improved effectively by 3D laparoscopic surgery system.It is safe and feasible to perform retroperitoneal living donor nephrectomy under 3D laparoscopy.

OBJECTIVETo evaluate the basic principles of surgical correction of concealed penis.

METHODSFrom Jan. 1999 to Dec. 2002, 63 cases of concealed penis, aged from 1 year and 6 months to 19 years with a mean age of 7 years and 2 months, were corrected with two different approaches: 37 cases of group A with obesity were corrected by anchoring micrus tissue onto the pubis at the base of the penis, and 26 cases of group B by fixing the subcutateous tissues at both sides of the penile shaft to the deep tunica albuginea at the penile root. Then prepuce plasty was carried out.

RESULTSSix-month postoperative follow-up found adequate exposure of the penis in all of group A, prepuce oedema in 7 cases, abdomen fat liquidization in 3 cases, unsatisfactory recovery of incision hollow in 3 cases and patchy numbness of the glans in 1 case. The 25 cases of group B had satisfactory exposure of the penis, with no obvious prepuce oedema, 1 case with retraction of the penis 7 days after operation.

CONCLUSIONSVarious surgical procedures could be adopted for concealed penis, and the key to the satisfactory appearance is the restoration of penile tunicae and the fixation at the base of the penis. Further study is needed to determine the natural history of these disorders as well as which conditions and what age will benefit most from surgical intervention.

Adolescent ; Adult ; Child ; Child, Preschool ; Humans ; Infant ; Male ; Penis ; abnormalities ; surgery ; Retrospective Studies

Objective To analyze the reasons and outcomes of the unplanned re-operation in renal transplant recipients during perioperative period,and to summarize the corresponding strategies.Methods From January 2014 to September 2017,the clinical data of 20 cases of kidney transplantation which had a total of 22 unplanned re-operations were retrospectively analyzed.All patients were given quadruple immunosuppression with antibody induction and tacrolimus (TAC) and mycophenolate mofetil (MMF) plus prednisone (Pred).We analyzed the reasons,occurrence time,effect of re-operation and the renal function,as well as survival rate of all graft and recipient.The delayed graft function (DGF),acute rejection (AR) and incidence of pulmonary infection were monitored as well.Results Up to September 2017,during the follow-up of 1-36 months,the overall rate of unplanned re-operation was 4.6％,and 2 patients underwent 3 operations.For the reasons of re-operation,there were 18 cases of bleeding (13 cases of blood oozing from the wound surface,3 cases of renal parenchyma rupture because of rejection,and 2 cases of rupture of renal artery infection),2 cases of renal artery thrombosis and 2 cases of the repair of leakage of urine.Two operations were performed within 1 days for 9 cases,2-5 days for 5 cases,6-10 days for 3 cases,above 10 days for 45 cases.There was no deaths during the perioperative period.One patient died of rupture of exiliac aneurysm 3 months after the operation.One patient died of cerebral hemorrhage 6 months postoperation.The death censored graft survival rate was 72.2％ (13/18) and the incidence of DGF was 55 ％.Conclusion The major reason of unplanned re-operation for renal transplantation is associated with bleeding of various causes.And the incidence of DGF is high.If the secondary operation was performed with the correct decision,the kidney allograft recovers well.

Objective To summarzie the experiences of kidney transplantation from rhabdomyolysis.Methods The surgical procedures and treatment protocols of the kidney transplantation in 3 cases from DD donors who suffered from anuria due to rhabdomyolysis were retrospectively analyzed.Results Three recipients were donated by two donors.When the blood of kidneys is washed out,the color of the kidneys was brown,and when the kidneys restored the blood perfusion,the transplanted kidneys were dark brown.All of these 3 cases had delayed renal function,and 2 recipients who received the kidneys from the same donor secreted the urine 3 weeks after surgery.The creatinine gradually decreased,and they discharged when the renal function was normal.The urine volume in the another recipient was 3000 ml or more per day in the first two days,gradually decreased from the third day,until anuria.We conducted an exploration of the transplanted kidney due to the area of transplantation uplift.We found that the kidney was bright red during the operation,the hematoma was removed and hemostasis was done,the urine volume gradually increased from one week after surgery,and the creatinine levels gradually decreased.After two months the creatinine levels were 103μmol/L.Conclusion For the patients with rhabdomyolysis,their kidneys can be transplanted after active preservation,evaluation of the donor kidney function and blood flow,and the short-term outcome is satisfactory.

Objective To compare clinical efficacy and safety between standard double-and single-dose of basiliximab in renal transplantation.Methods A total of 121 patients undergoing allogeneic cadaveric renal transplantation in Department of Urology of Renmin Hopsital of Wuhan University from January 2008 to May 2011 were recruited as study subjects.Among them,53 patients were assigned into the double-dose of basiliximab group and they were intravenously administered with 20 mg of basiliximab before and 4 d after surgery according to product description.Sixty-eight cases were allocated in the single-dose of basiliximab group and they were given with 20 mg of basiliximab before renal transplantation.The changes of immune function in two groups during perioperative period were monitored.The incidence of adverse reactions including delayed graft function (DGF),acute rejection,pulmonary infection and the survival of patients and renal grafts were statistically compared between two groups.Results There was no significant difference in preoperative humoral immune and cellular immune function between two groups.Compared with preoperative period,cellular and humoral immune function in both groups were inhibited by varying degree at 5 d after surgery (both in P <0.05).Compared with patients in the single-dose group,cellular and humoral immune functions were evidently suppressed in the double-dose group (both in P <0.05).Compared with the parameters assessed at 5 d after surgery,cellular and humoral immune functions were restored to varying degree at 15 d after surgery,whereas still significantly lower than preoperative levels (CD3,CD4,IgM and IgA).Partial parameters (CD8 and IgG)were persistently inhibited and continued to decline compared with the levels at 5 d after surgery.The incidence of DGF was 8% in the double-dose group,and 7% in the single-dose group.During 1-year follow-up,the rejection rates in the double-and single-dose groups were 13% and 12%,and the incidence of pulmonary infection was 9% and 10%.No statistical significance was noted between two groups in terms of these parameters (all in P >0.05).The 1-year survival of patients in the double-and single-dose groups was 94% and 98%,93% and 96% for the survival of renal grafts.No statistical significance was found between two groups (both in P >0.05).Conclusions Both double-and single-dose of basiliximab are efficacious in renal transplantation and do not increase the incidence of adverse reaction.The 1-year survival rates of patients and renal grafts between two groups are almost equivalent.Detection of immune function during perioperative period effectively guides individualized immune induction therapy.