Objective To report the long-term follow-up results on treating bladder transitional cell carcinoma with orthotropic ileal neobladder after radical cystectomy.Methods Thirty-three male patients with a mean age of 64 years were subjected to Carney Ⅱ orthotropic ileal neobladder oper-ation after cystectomy.The entire length of ileum was opened along the antimesenteric border,placed into a transverse U shape,and sutured with a running suture.The bottom of the U shape was anasto-mosed with urethra to reconstruct the urinary continuity.The perioperation mortality,complications,urinary continence,renal function,image findings,and urodynamic examination were all retrospec-tively investigated.The quality of life was evaluated using the Functional Assessment of Cancer Ther-apy-Bladder(FATC) and International Prostate Symptom Score (IPSS).Results Thirty patients were followed up for 12-60 months.Urodynamics was carried out after oporation.The average ca-pacity of the urinary reservoir,the peak flow rate and postvoid residual were (380±65) ml,(12.6±2.3) ml/s and (25±11) ml,respectively.But the intra-reservoir pressure was significant lower than the intra-urethra pressure(20.4±8.7 cm H2O vs.57.2±10.5 cm H2O).Twenty-eight patients had a satisfactory daytime urinary continence and 26 patients had a satisfactory nocturnal urinary continence.The total FACT was 110.5±16.0 and IPSS was 14.5±4.2.Conclusion CamyⅡ ileal neobladder is a satisfactory method for treatment of invasive bladder cancer after radical cystectomy; it has few com-plication and is clinically valuable.

Objective To probe the nephron spring surgery for renal neoplasms.Methods Form April 1995 to October 2001,nephron sparing surgery was done for 18 cases of renal tumor,of which there were 3 with carcinoma and 15 with benign neoplasms.Among them,1 case was sole kidney;and 17 cases were a unilateral renal neoplasm and a normal opposite kidney.The diameter of the tumor ranged from 1 cm to 8 cm,with a mean of 3.5 cm.17 patients underwent partial nephrectomy and 1 tumor nucleation.Result All patients have been followed up for 2 to 72 months with a mean of 32 months,no surgical complication or local tumor recurrence has been found.Conclusion Nephron sparing surgery is safe and effective for the treatment of renal neoplasms.

Objective To investigate the clinical effect of ureteroscopic holmium laser lithotripsy for the treatment of ureteral calculus.Methods A total of 72 cases of ureteral calculus was treated with stone fragmentation from April to November 2004,by using the Lumenis VersaPulse PowerSuite 100W Holmium Laser system and the Circon ACMI Micro Ureteroscope.Under ureteroscopic visualization,the laser lithotrite was introduced to the stones,and holmium laser intraluminal stone fragmentation was carried out. Results The operation time was 14~83 min(mean,28 min).Three cases of fragmentation failure were due to upper ureteral stones migrating to the renal pelvis.The success rate of fragmentation on one session was 95.8%(69/72),which was 92.1%(35/38) for upper segment calculi and 100%(34/34) for middle-to-lower segment calculi.Intraoperative complications included 3 cases of ureteral perforation(4.2%),9 cases of stone migration(12.5%),and 72 cases of hematuria(100%).Postoperative complications included 45 cases of lumbago(62.5%),72 cases of hematuria(100%),and 5 cases of urinary tract infection(6.9%), without ureteral stricture.The kidney,ureter,and bladder(KUB) X-ray radiograph on the first postoperative day showed a stone-free rate of 86.1%(62/72),and the remaining residual stones were thoroughly expelled within following 2 weeks.The length of postoperative hospital stay was 2~5 d(mean,3 d).Re-examinations with B-ultrasonography or intravenous urography(IVU) at 3 months after operation in 46 cases revealed no ureteral stricture.Hydronephrosis subsided by 1.4?0.5 cm in 28 cases and completely disappeared in 21 cases.Conclusions Ureteroscopic holmium laser lithotripsy for treating ureteral calculus offers satisfactory clinical effects and low complication rates.

Objective To study the relationship between serum trace elements and renal cell carcinoma.Methods The serum concentrations of multi-elements in 34 patients with renal cell carcinoma and 28 healthy volunteers were determined by inductively coupled plasma mass spectrometry(ICP-MS).The results were analyzed by partial least square discriminant analysis (PLS-DA) and Fisher discriminant.Results Compared with healthy voluteers,the levels of vanadium (5 034.56 ng/L:4 401.23 ng/L ),cobalt (211.34 ng/L:158.67 ng/L),nickel(l 850.55 ng/L:1 587.12 ng/L),manganese(1 873.35 ng/L:932.68 ng/L) and cadmium(95.63 ng/L:36.43 ng/L) were significantly higher in patients with renal cell carcinoma (P ＜ 0.05 ).While,the concentrations of calcium( 10.83 mg/L:11.78 mg/L) and zinc(67.11 μg/L:70.92 pg/L)were significantly lower ( P ＜ 0.05 ).Discriminant analysis showed that the serum elements levels in the patients with renal cell carcinoma were significantly different from the healthy volunteers.The scores plot showed distinct clustering between patients and controls,the points of patients were obviously offset from the controls.The classification accuracy of Fisher discriminant function was 97.61％.Conclusion Trace elements in serum are significantly different in patients with renal cell carcinoma and healthy volunteers.Discriminant analysis of serum samples based on trace element levels is possible.Thus,it is feasible for early diagnosis of renal cell carcinoma by determination of trace elements and discriminant analysis.

Objective To compare the outcomes of antegrade and retrograde approach ureteroscopy for impacted upper ureteric calculi and assess the safety and efficiency of the two types of minimally invasive technique. Methods A total of 106 patients with impacted upper ureteric calculi were treated with ureteroscopy. The procedure was performed via antegrade percutaneous nephrostomy tract in 50 patients (antegrade group) and via retrograde transurethral access in 56 patients (retrograde group). Results The success rate of retrograde group was 92.9% (52/56). Operating time was (45 ± 5 ) min, hospital stay was (6 ± 1) days. The stone free rate was 80.4%(45/56) at 1 month follow-up,7 patients with residual calculi required ESWL combination. Complication rate was 5.4% (3/56). The success rate of antegrade group was 100.0% (50/50). Operating time was (55 ± 8 ) min, hospital stay was (8 ± 2) days. The stone free rate was 100.0% (50/50) and no complication was noted. The stone free rate and the complication rate indicated significant difference between the two groups (P ＜ 0.05). Conclusions Antegrade and retrograde access ureteroscopy for impacted upper ureteric calculi are safe and effective. Success rate and stone free rate of antegrade approach are higher than those of retrograde approach.

Objective To evaluate the clinical effects and safety of percutaneous nephrolithotomy (PCNL) by middle renal calice used as the main target for the treatment of staghorn stones with the combination of pneumatic and ultrasonic lithotrite.Methods Clinical data of 73 patients underwent PCNL by middle renal calices as main access with 57 incomplete staghorn stones and 35 complete staghorn stones.To observe the situation calculus removal rate and complications.Results Seventy cases (88 sides) underwent one session PCNL by single access tract (middle caliees),3 cases (4 sides) underwent one session PCNL by double access tracts (2 cases by middle and low calices,1 case by up and middle caliees).After the first period of lithoclasty,17 patients (25 sides) residual stones and the stone removal rate 72.8％ (67/92),among these patients,1 case (1 side) had fragments of lateral renal calyeeal stones with no further treatment.Other 16 cases (24 sides)underwent second session PCNL,all were treated by single access tract (middle calices) and 2 cases (2 sides)had extracorporeal shock wave lithotripsy before the second PCNL.After the second period of lithoclasty,76 sides composed of 27 complete staghorn stones and 49 incomplete staghorn stones had no residual fragments with the stone removal rate 82.6％ (76/92).The operative time lasted 120-320 min.Hemoglobin dropped 1-4 g/L,11 cases in the operation procedure and 3 cases after operation needed blood transfusion respectively.One case of renal pelvic infection after operation and 1 case had split renal dysfunction with peri-parenchyma infection.The hospitalization time was 9-18 days.Conclusion It is effective and safe to perform PCNL for staghorn stone by middle calices as a main access.Combining pneumatic and ultrasonic lithotrite will be very useful with high stone clearance,short procedure time and less complications.

Objective To discuss the medium-term follow-up of clinically insignificant residual fragments (CIRF) after minimally invasive percutaneous nephrolithotomy lithotripsy (MPCNL).Methods The clinical data of 72 patients with CIRF medium-term follow-up were analyzed retrospectively.Results Seventy-two patients with CIRF.The anatomical distribution of CIRF was 10 at upper pole,15 at middle,35 at lower,10 at renal ureteropelvie junction and 2 at upper and lower pole.Stone analysis showed that 41 cases of calcium oxalate calculi,16 of calcium oxalate calculi mixed with carbonate calculi,3 calcium oxalate calculi mixed with uric acid,4 calcium oxalate calculi mixed with struvite stone,3 struvite stone,2 uric acid stone and 3 carbonate apatite mixed with struvite stone.Fifteen cases had clinical symptoms,including 2 renal colic pain,8 hematuria,5 lower urinary tract symptoms,4 cases CIRF located in upper pole,1 case in middle pole,4 cases in lower pole,6 cases in ureteropelvic junction,the incidence of clinical symptoms in ureteropelvic junction was significantly higher than that in other locations (6/10 vs.4/12,1/15,4/37,P ＜0.05).Eight cases required surgical procedure,5 cases underwent extracorporeal shock wave lithotripsy,3 cases with ureteral CIRF were performed with ureteroscopic lithotripsy.CIRF were clear after surgery,7 patients with ureteral CIRF had renal colic pains.The stones were excluded after spasmolytic analgesic treatments.Conclusions CIRF can be located variously in the kidney and ureter.Most CIRF are calcium oxalate calculi and locate in the lower pole.Patients with the history of previous open surgery or extracorporeal shock wave lithotripsy are more likely to get CIRF.Medium-term follow-up of CIRF reveals that CIRF located in the renal ureteropelvis junction are more likely to have clinical symptoms.

Objective To study the imaging characteristics of vesical leukoplakia under the cys-toscope imaging system. Methods The characteristics of vesical leukoplakia were observed under the cystoscope imaging system in 556 cases. After anti-infection treatment to these patients, the chan-ges of the characteristic under the cystoseope imaging system were re-observed and compared before and after treatment. SPSS 11.0 software package x2 teat for statistical analysis was used. Results Under the cystoscope imaging system, there were four different imaging manifestations in the 556 pa-tients. These were, from mild to severe, congestive type in 42 cases, spots type in 56 cases, thin macular type in 399 cases and thick macular type in 59 cases. One type could transform to another af-ter anti-infection treatment. When reexamination by the cystoscope, 131 cases got improved, 304 cases had no changes and 121 cases were aggravated. Statistical analysis showed the transformation among the 4 types had significant difference (x2 = 130.92, v=6, P<0.001). From congestive type to spots type, thin macular type and thick macular type, after anti-infection treatment, the ratio of improved cases decreased gradually, however the ratio of aggravated cases and cases without changes increased gradually. Conclusion Vesical leukoplakia could be classified into 4 types initially: congestive type,spots type, thin macular type, thick macular type. The different clinical treatments should be provid-ed.

Objective To investigate the therapeutics of solitary kidney complicated with complexcalculi,and improve the effect and safety of treatment.Methods Experiences in the treatment of 32 patients with solitary kidney complicated with complex calculi were summarized.Congenital solitary kidney was 6 cases (18.8%),postnatal reason was 26 cases(81.2%),left was 12 cases(37.5%),right was 20 cases (62.5%).All patients were with mould or multiple calculi,9 cases were complicated with ureter calculi,and 8 cases were hospitalized because of obstructive anuria.The patients with mould calculi received extracorporeal shock-wave lithotripsy (ESWL) prior to percutaneous nephrolithotomy(PCNL).While the patients with multiple calculi received PCNL prior to ESWL. Some cases were treated by lithedialysis.Results Twenty-nine cases (90.6%)were cured by ESWL combined with PCNL 12 cases received lithodialysis during PCNL. Eight cases with obstructive anuria recovered in 12 hours after emergent ESWL or lithodialysis,3 cases(9.4%)underwent open operation because of deformity or obstruction in renal pelvis and ureter,1 case had to keep nephrostomy because of repeated infection.Followed up 4-36 months,29 cases (90.6%)kept good kidney function,3 cases(9.4%)had renal insufficiency,2 cases(6.2%)reoccurred calculi.Conclusions The therapeutics of ESWL combined with PCNL may clear complex calculi of solitary kidney effectively and safely.It is necessary to take emergent ESWL in renal obstructive calculi cases.And the patients with lower ureter obstructive calculi may take lithodialysis first.It is proper to choose open operation on the patients with deformity of renal pelvis or obstruction of ureter.

Objective To investigate the proportion, risk factors and tendency of the change of stones composition in recurrent urolithiasis. Methods One hundred and fifty-six recurrent urolithiasis patients from January 2011 to January 2016 were enrolled. Compositions of initial and recurrent stones were measured by infrared spectrophotometry. Stones types, recurrence interval and recurrence frequency were studied as potential risk factors for composition change. Chi square test and Logistic regression analysis was employed in the statistical analysis. Results Stones composition changed during recurrence in 48 patients (30.8%). 22.8%(18/79) of calcium oxalate stones change to infection stones, and 25.8%(8/31) of infection stones changed to calcium oxalate. Univariate analysis showed the risk ratio of composition change in the patients with recurrence interval of 1- 5 years was 0.529(P = 0.039) , compared with those of less than 1 year or more than 5 years. Logistic regression analysis showed the odds ratio of recurrence interval of 1- 5 years was 0.242 (95%CI: 0.086- 0.718, P = 0.012). Conclusions Stones composition changes in about 30.8% of recurrent urolithiasis. The mutual conversion between calcium oxalate and infection stones is the most common. Recurrence interval is an independent risk factor to predict composition change.