Objective To study the diagnostic techniques of acute anuria caused by upper urinary tract obstruction. Methods Fifty-eight patients with acute anuria caused by upper urinary tract obstruction were analyzed on clinical manifestations,etiology of obstruction and imageologic findings. Results The main clinical manifestations consisted of anuria in 58 cases,pain in renal region in 41,percussion tenderness over kidney region in 33,hypertension in 20,high levels of BUN and creatinine in 57 and hyperkaliemia in 8.The main adjuvant examinations included MRU,B-ultrasound,X-ray (KUB,IVU and retrograde pyelography),CT and MRI.The detection rates of upper urinary tract obstruction by above-mentioned examinations were as follows:100% (25/25) with MRU,88% (50/57) with B-ultrasound,60% (6/10) with CT/MRI,49% (19/39) with X-ray. The detection rates of MRU and B-ultrasound were significantly higher than those of X-ray and CT/MRI (P

Objective To present a modified technique of total cystectomy and ileal neobladder. Methods Radical cystectomy and ileal neobladder were performed for 25 male patients. The dome, the upper part or the lateral walls and the base of the bladder were dissected antegradly. After cutting the ureters, the mobilization was then made retrogradly.For the construction of the reservior, the isolated 40 cm ileal segment was opened along its antimesenteric border and then arranged into a W shape. The wall of ileal pouch was created by side-to-side blanket suture of the incised ileum. The ureters were implanted at the two corners of W shape with antireflux nipple. Results 24 of 25 cases of ileal neobladder have been followed up for 2 to 84 months with a mean of 24 months.The operation took 150 to 310 minutes with a mean of 240 minutes. The intraoperative blood transfusion was 0 to 1200 ml.1 patient died of cancer metastasis. 23 patients have achieved excellent daytime continence,whereas only 14 had nighttime continence. The mean bladder capacity for the entire group was 310 ml. Renal functions of 2 patients were mildly abnormal.Hypokalemia occurred in 2.There was no metabolic acidosis.There were 3 cases of hydroureter or hydronephrosis on one side. 1 calculus of neobladder was discovered on BUS. On voiding cystography, no reflux has been noted in all.And no patient suffered from urethral recurrence. Conclusions The modified total cystectomy and ileal neobladder takes less time and is more feasible.

Objective To evaluate autologous buccal mucosal patch grafting for correcting penile deformity in the surgical treatment of Peyronie's disease. Methods 14 patients with symptoms of Peyronie's disease for more than three months suffered from persistent pain ,severe curvature of the penile shaft and resistant to conservative treatment underwent plaque incision and autologous buccal mucosa patch grafting. Results Postoperative follow up has been 0.5 to 2years.The penile shaft became straight with no narrowing or indentation in 12 patients (86%) . In 14% of cases (2/14) some curvature of the penile shaft persisted and there was pain on erection.In all the patients there was no change in penile length. 86% of patients had overall satisfaction after surgery with improvement in psychological and social well-being. Conclusions The autologous buccal mucosal patch graft provides an anatomical and functional tunied substitute resulting in correction of the penile deformity in Peyronie's disease.

Objective To improve the levels of diagnosis and treatment of testicular torsion. Methods The clinical data of 39 cases of testicular torsions were summarized and analyed.All the 39 cases had the essential clinical symptom of colic in testis,and 20 cases had the positive Prehn's sign.Eight cases underwent out examination of radionuclide imaging of scrotum,which showed unilateral defect of radionuclide distribution.The 8 cases were all diagnosed as testicular torsions.B-ultrasound showed that the positions of testis and epididymis were changed in scrotum and the blood supply in testis was reduced clearly or disappeared. Results Five cases who received operation within 12 hours from attack time had testicles survival.Of 5 cases who had operation within 12 to 24 hours from attack time 3 had testicles survival.Of 27 cases who had operation more than 24 hours from attack time only 6 had testicles survival.Two cases had no operation. Conclusions It is helpful to get diagnosis for early testicular torsion by Radionuclide imaging of scrotum and B-ultrasound are helpful to make diagnosis of early testicular torsion.Early diagnosis and timely treatment are key of improving therapeutic effect.

Objective To study the diagnosis and treatment of spontaneous perirenal hemorrhage(SPH). Methods The clinical data of 31 cases of SPH were reviewed retrospectively.In the 31 cases,flank pain,flank mass,shock,gross hematuria,abdominal bleeding occured in 31,10,8,3 and 3 cases,respectively.The final diagnosis was established on CT scan,B-ultrasonography and IVU were 18,22 and 7 cases. Results In 31 cases,nephrectomy were performed in 18,radical nephrectomy in 1 case,nephron spare surgery in 4,renal artery embolization in 2,inspiration and drainage of hemorrage in 1 and careful watching in 5 cases.There were 11 cases of angiomyolipoma,6 renal cyst,4 of renal cell carcinoma,3 infectious diseases,2 aneurysm of renal artery and 2 hydronephrosis. Conclusions The clinical presentation may vary greatly depending on the degree and duration of bleeding,and the severe pain in the upper abdomen of abrupt onset is the common sign and symptom.The spontaneous rupture of renal cell carcinoma and angiomyolipoma are the most common cause of SPH.CT scan and B-ultrasonography are the most valuable in the diagnosis of SPH.It is demanded that management of SPH depends on the histopathology and the degree of bleeding.

Objective To investigate the correlation of clinical and pathological characteristics of bladder transitional cell carcinoma(BTCC) with platelet-derived endothelial cell growth factor (PD-ECGF). Methods Expression of PD-ECGF,VEGF and MVD were examined in the specimens of 52 cases of BTCC by Envision immunohistochemical staining.All the 52 cases were followed up via interview for a period of 5 years. Results Of the 52 cases 50 provided complete relevant data.The 5-year postoperative tumor-free survival rate was 42.9%(21/49) and overall survival rate was 78.0%(39/50).The positive expression rate of PD-ECGF in G 1 tumors was 17.6%(3/17);in G 2,59.3%(16/27) and in G 3,87.5%(7/8)(P

ObjectiveTo study the diagnosis and trea tm ent of bilateral renal angiomyolipomas.MethodsThe clin ic data of 13 cases of bilateral renal angiomyolipoms were reviewed.There were 2 male and 11 female patients with an average age of 42.Preoperative ultrasonogra phy and CT scanning have been undertaken in all.Renal angiomyolipoma was diagnos ed in 11 and cancer nodules could not be ruled out in the other 2.Unilateral and bilateral renal sparing surgerys were carried out in 5 and 8 cases respectively .ResultsAll cases were examined with rapid frozen sect ion analysis at operations.The renal function of all the patients except 1 was n ormal after operation except 1 with a temporary rise in Scr (350 ?mol/L).The pa tients have been followed up 1 to 4 years after discharging from hospital and th e renal function became normal in all.No recurrence was found.Conc lusionsUltrasonography and CT are important methods to diagnose ang iomyolipoma with specific manifestations.Rapid frozen section analysis at operat ions is helpful to diagnose and to choose the correct surgical technique.Attenti on should be paid to reserve the renal tissues as much as possible and renal fun ction should be protected properly.

Objective To evaluate the role of nephron sparing surgery in patients with renal cell carcinoma. Methods Retrospectively analyzed a total of 17 patients with renal cell carcinoma treated with nephron sparing surgery between September 1997 and September 2002.Among these patients,2 cases were bilateral asynchronous and multicentric tumor,15 cases were unifocal tumor.2 cases were in imperative indications,6 cases in relative indications,and 9 cases in elective indications.The tumor diameter ranged from 2 cm to 6 cm,all tumor were in T 1 (1997 TNM staging system).15 cases underwent tumor enucleation at 1 cm apart from surgical margin,1 case underwent upper polar nephrectomy,1 case underwent wedged resection.Selected 20 patients matched for age, tumor location and stage who underwent radical nephrectomy at same period for comparison with an average follow-up of 36.4 months. Results The patients were followed up for an average period of 35.2 months (range,3 to 63 months),no surgical complication or local recurrence has been observed,and its long-term cancer-free survival was comparable to that after radical nephrectomy. Conclusions Nephron sparing surgery is safe and effective for the treatment of renal cell carcinoma and indicated for patients with small,localized,often incidental tumors and a normal contra-lateral kidney.

Objective To investigate the characteristics and mechanism of W-shaped orthotopic ileal neobladder. Methods A total of 20 patients with W-shaped orthotopic ileal neobladder after total cystectomy were evaluated by urodynamic examinations (questionnaire of urination,uroflowmetry,post-voiding(PVR) residual urine volume measurement,enterocystometry and resting urethral pressure profilometry);meanwhile cystourethrography,B-ultrasound,renal function test and IVU were performed. Results Of the 20 cases,2 suffered from daytime incontinence and 6,nocturnal incontinence.The maximum capacity of neobladder was (492.9?177.8)ml,and maximum pressure within the reservoir was (32.1?8.6 )cm H 2O (1 cm H 2O=0.098 kPa).The urine flow curve showed continual type in 12 cases and intermittent type in 8,with maximum uroflow rates of (14.9?2.5 )ml/s,(7.7?2.8)ml/s;capacity of neobladders of (409.0?96.1)ml,(622.1?197.7)ml;PVR of (9.2?11.8)ml,(69.0?38.4)ml,respectively,in the 2 type groups.These values were significantly different between the 2 groups (P

Objective To research the clinical manifestations of renal tuberculosis and improve the diagnosis and treatment of renal tuberculosis. Methods From 1993 to 2007,223 cases of renal tuberculosis were hospitalized. Retrospective analysis was complied for all the cases about age, clinical manifestations, imaging and treatment. Results The incidence rates of the renal tuberculosis were obviously higher in the 20-40 years old(41.7%) and in the 41-54 years old (36.3%). The course of this disease was from 1 day to 30 years(mean 38. 5 months). Only 36 patients (16.1%) were made a definite diagnosis when they went to see a doctor primary. The miediagnosis of urinary tract infec-tions( 50.3%) was most frequent. The clinical manifestations of most patients included frequency(54.7%), urgency(50.2%), odynuria(42.2%)and hematuria(58.7%). About 58. 3% patients pres-ented with over 3 kinds of above manifestations. The positive yield of the tuberculin test in urine was only 41.9%. The positive diagnostic rate of renal tuberculosis was only 35.7% in KUB+IVU,72.2%in Type-B Ultrasonic, 76.0% in CT test. One hundred and seventy-three cases were performed with nephrectomy(78.6%) and partial nephrectomy(21.4%). Two cases were treated with dialysis due to uremia. Standard medication was taken for the other 48 patiernts, and effective for 41 cases. Conclu-sions The incidence of atypical renal tuberculosis is increasing. More attention must be paid especially to those patients with urinary infection.