Under the new mode of training clinical post-graduate students, it is enhanced to train the clinical competence in rehabilita-tion medicine. As high level professionals, the scientific research ability is very important for the post-graduate students, too.

On the basis of previous classification of lower urinary dysfunction, the author developed a new classification of the comprehensive urinary tract dysfunction for neurogenic bladder, which included a new grading standard for the hydronephrosis and ureter dilatation. This classification can provide with comprehensive, scientific and objective basis for the evaluation, description and recording the pathphysical changes of lower and upper urinary tract dysfunction.

Objective To investigate the video-urodynamics indication of upper urinary tract dilation secondary to neurogenic bladder that may be resolved only by intermittent catheterization. Methods From January, 2008 to August, 2016, twelve cases of upper urinary dila-tion secondary to neurogenic bladder were treated by intermittent catheterization only. Their clinical data was reviewed. Results The mor-phology and function index of upper urinary tract were improved gradually during the regular follow-ups. The common video-urodynamics characteristics include no detrusor overactivity, no vesicoureteral reflux, cysctometry volume larger than 300 ml and detrusor presser at the capacity lower than 40 cmH2O, poor voiding efficiency with residual volume larger than 150 ml. Conclusion For upper urinary tract dilation secondary to neurogenic bladder characterized as passable storage and poor voiding, intermittent catheterization may be enough to resolve the dilation.

OBJECTIVE:To provide reference for clinical rational use of antidiabetic essential medicines. METHODS:Retro-spective analysis was used to sort and analyze the consumption sum,DDDs and DDC of antidiabetic drugs in the outpatient of our hospital from May 1st,2012 to Apr. 30th,2014. RESULTS:The consumption sum and DDDs of insulin and oral antidiabetic drugs had upward trend. The top 3 consumption sum and DDDs of oral antidiabetic drugs were acarbose,metformin and glimepiri-de,and the highest DDDs of insulin was short-acting and premixed recombinant human insulin,all of them were in the National Essential Medicine List (2012 edition);DDDs of Glibenclamide tablets,Glipizide tablets and Chinese patent medicine were rela-tively small;DDC in long-acting insulin analogues was obviously higher than other kinds of insulin. The sales ratio of essential medicines was increased from 10.48% to 67.78% after National Essential Medicine List (2012 edition)carried out. CONCLU-SIONS:The use of antidiabetic drugs in the outpatient of our hospital is basically rational. Acarbose and metformin have the high-est DDDs,and DDDs of insulin analogues grow rapidly.

Underactive bladder is the main part of lower urinary tract symptoms. As a conservative treatment, intravesical electrical stimulation can improve the function of bladder sensation, and promote micturition. Intravesical electrical stimulation is effective and safe on underactive bladder, both idiopathic and neurogenic. Rectilinear biphasic waveform, low frequency and short pulse width stimulation was recommended.

Objective To evaluate if replication-defective herpes simplex virus mediated kynurenine aminotransferase Ⅱ (HSV-KAT Ⅱ) could inhibit detrusor overactivity (DO) in rats with spinal cord injury by bladder wall injection.Methods From June 2012 to July 2013,48 male Wistar rats with T10 spinal cord transection (SCT) were randomly divided into normal saline group,HSV group and HSV-KAT Ⅱ group (n=16 each group).Normal saline (40 μl),HSV or HSV-KAT Ⅱ (40 μl,1×107 plaque forming unit viruses) was injected into the rat bladder wall of according group by 1 week after SCT.Three weeks after injection,cystometry was performed and the virus transfected efficiency,expression of KAT Ⅱ in L6-S1 dorsal root ganglia were examined.Results The DO number,DO amplitude,maximum voiding pressure and volume inducing voiding were decreased significantly by 59.6％-61.1％,21.6％-24.2％,30.3％-34.4％ and 44.1％-46.5％ (P＜0.01),while voiding efficiency,the time to first DO were increased significantly by 40.7％-47.7％ and 30.1％-49.0％ (P＜0.01) in the HSV-KAT Ⅱ group compared with normal saline group and HSV group.However,the leaking volumes were no significantly different among the 3 groups (P＞0.05).The relative intensity of KAT Ⅱ protein (0.50±0.13 versus 0.28±0.07,P＜0.05) and mRNA (0.78±0.06 versus 0.51±0.08,P＜0.01) were increased significantly in HSV-KAT Ⅱ group than those in HSV group.Conclusion HSV-KATⅡ bladder wall injection inhibits DO and may improve detrusor-sphincter dyssynergia in rats with spinal cord injury.

Objective To establish and recognize typical signal patterns (TSP) by analyzing cys-tometry data,and to verify their roles in real-time qualitative quality control. Methods Totally,582 datasets of free flow,filling and voiding cystometry from181 males(age range,43 -86 years)in a strictly quality-controlled study were analyzed.TSPs for the traces of Pves,Pabdand Pdetduring filling and voiding phases wererecognized and described. The TSP of pressures was classified into 4 types, ie, type Ⅰ: fine structure(noise);Ⅱ:minimal dynamic changes caused by breathing,talking and moving (microscopic changes);Ⅲ:major changes due to regular cough tests;Ⅳ:typical macroscopic changes related to straining,detrusor insta-bility,rectal contractions and detrusor contractions.TSPs were compared among Pves,Pabdand Pdettracings atbeginning of filling,during filling,before,during and after voiding respectively. Results At beginning offilling,91.8%(534/582) of traces showed the identical fine structure and microscopic changes with“live”signals;74.8%(435/582) of traces had the equal pressure changes corresponding to the test-coughs;3.1%(18/582) had the macroscopic changes of straining and rectal contractions.During filling,98.3%(572/582) of traces showed the identicalⅠ andⅡ types of TSP;98.5%(573/582) had the equal or similarchanges corresponding to the test-coughs;8.3%(48/582) of traces showed straining;33.7% (196/582)showed detrusor instability;and 17.4%(101/582),rectal contractions.Before voiding,94.0%(547/582) oftraces had the equal rises in Pvesand Pabdcorresponding to cough tests.During voiding,91.2%(531/582) oftraces showed the“live”signals;95.2%(554/582) of traces had the typical pattern of detrusor contraction;53.3%(310/582) showed straining,2.1%(12/582) showed rectal contractions;and 15.3%(89/582)showed relaxation of pelvic floor.After voiding,91.2%(531/582) of traces showed the“live”signals;87.5%(509/582) had the equal response to cough tests. Conclusions TSP is a powerful tool for the re-al-time qualitative quality control for urodynamic investigation.Combined with typical value ranges,they allowdefinitive quality control for urodynamic data.The familiarity and identification for the described TSP arehelpful for performing the qualitative quality control in clinical urodynamic practice.

Objective To establish typical value ranges (TVR) by analyzing cystometry data,andto verify their roles in real-time quantitative quality control. Methods Totally,582 data sets of free flow,filling,and voiding from cystometry 181 males(age range,43 -86 years)in a strictly quality-controlled studywere analyzed for Pves,Pabdand Pdetbefore,at beginning and end of filling,and after voiding,cystometric ca-pacity (MCC),Qmaxand Vvoid,and compliance.The mean values,standard deviation,median and variousTVRs of these parameters were calculated.Technical errors related to TVR were classified and examples giv-en. Results 50% TVRs for initial resting Pves,Pabdand Pdetwere 31 -42,28 -39 and 0 -4 cm H2O(1 cm H2O=0.098 kPa),respectively.Various technical errors were classified into typeⅠ:normal initialPdet,but both Pvesand Pabdwere wrong;typeⅡ:negative initial Pdet;and typeⅢ:too high initial Pdet.The in-cidences of typesⅠ,Ⅱ andⅢ errors were 9.8%(57/582),4.5%(26/582) and 1.4%(8/582),respec-tively.50% TVRs for MCC and compliance were 157 -345 ml and 26.6 -70.8 ml/cm H2O;50% TVRs forQmax.p,Pdet.Qmaxand Vvoidwere 5.5 -9.0 ml/s,57 -92 cm H2O and 167 -315 ml,respectively.Qmaxand Vvoidin free flow were 8.0 -9.2 ml/s and 167 -301 ml.During and after voiding,3 typical errors were found:typeⅣ:negative Pabd;typeⅤ: Pvesand Pdetafter voiding still high;typeⅥ:Pvesand Pdetnegative;the inci-dences of typesⅣ,Ⅴ andⅥ errors were 0.7%(4/582), 1.9%(11/582)and 1.4%(8/582), respective-ly. Conclusions TVRs in urodynamics are indispensable and effective tools for quantitative plausiblecheck and quality control on data.They are sensitive and reliable indicators for correct measurement and arelevant contribution to a collection of normal values.

ObjectiveTo introduce an improved implantation for urethral stents in patients with infra-sacral neurogenic voiding dysfunction and to evaluate its outcome.MethodsTwelve patients with infrasacral neurogenic voiding dysfunction were treated by implantation of urethral stent according to an improved method.The following objective parameters were used to evaluate the outcome:voiding diary,urine residue volume(URV),renal hydronephrosis and urodynamic tests.ResultsThese parameters were improved significantly after implantation:detrusor leak point pressure,voiding pressure and URV decreased,voiding volume and urine flow increased.The main complications were incontinence,difficult voiding and hematuria,but these were transient and disappeared during a week.ConclusionsThis procedure is effective with fewer complications,protects the function of upper urinary tract and improves the life quality of the patients with infra-sacral neurogenic voiding dysfunction.

The artificial urinary sphincter (AUS) has been used for the treatment of various incontinence due to intrinsic sphincter deficiency, and is considered as the gold standard treatment for incontinence after a prostatectomy. The long-term satisfaction rates exceed 80%, but almost a third of patients with AUS require revision surgery within 5 years. This paper reviewed the common complications of AUS implantation and the treatment.