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.

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.

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.

ObjectiveTo evaluate the effect of double dosage tolterodine (4 mg/d) on patients with detrusor overactivity after spinal cord injury (SCI).Methods30 patients with detrusor overactivity after SCI who poorly responsed to tolterodine (2 mg/d) were treated with double dosage tolterodine. Urine leakage and quality of life by ICI-Q-SF was used to assess the treatment effect.Results28 of 30 patients completed this study after 4 weeks. 2 patients quited for dry mouth. After treatment with double dosage tolterodine, bladder capacity increased significantly from (196.3±44.7) ml to (393.5±54.3) ml, urine leakage decreased from (4.96±2.15) to (3.92±2.14) times per day. 25 of the 28 patients showed improvement in quality of life by ICI-Q-SF. ConclusionTreatment with double dosage tolterodine showed improvements in bladder capacity and urine leakage in patients with detrusor overactivity after SCI if the patients could tolerate the dry mouth and other side effects.

The need to find an alternative to the use of bowel for urinary reconstruction has renewed research interests involving bladder regeneration. Small intestinal submucosa (SIS) is an acellular, nonimmunogenic, biodegradable, xenogeneic, collagen-based material that is derived from the submucosa layer of porcine small intestine. SIS has demonstrated regenerative capacities in multiple organ systems, including the aorta, vena cava, ligaments, tendons, abdominal wall, and skin. This article reviewed the history of the development of the bladder regeneration and the studies involving the use of SIS for bladder augmentation.

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.