Objective To investige the risk factors of urosepsis after percutaneous nephrolithotomy (PCNL).Methods We retrospectively analyzed 204 renal calculi or proximally ureter calcui patients,who underwent ultrasound-guided PCNL,from January 2013 to January 2014.Among them,there were 140 men and 64 women,whose mean age was 49 years (range from 29 to 75 years).Eighty-four operations were performed via standard channel and 120 operations were performed via micro channels.Fifty one patients had staghorn stones.Before operation,the urine culture positive rate was 14.7％ (30/204).The creatinine level ranged from 46 to 340 μmol/L [mean (87.9±33.9) μmol/L].Average stone diameter was (2.3±0.8) cm (range 1.0-7.0 cm).Mean operative time was (68.4±26.9) min (range 23-219 min).The chi-square test and a logistic regression model were used to identify key risk factors.Results The operation duration ranged from 23 to 219 min,mean (68.4±26.9) min.Of 204 patients,9 (4.4％) suffered septic shock,including 7 female patients and 2 male patients.Their mean age was (52.6± 15.2) years (20-73 years).Five operations were performed via standard channels and four operations were performed via micro channels.Five patients had staghorn stones.Urine culture positive rate was 77.8％ (7/9).The average stone diameter was (2.5±0.6) cm (range 1.8-3.5 cm).Mean operative time was (86±53) min (range 47-219 min).In univariate analysis,significant associations was observed between female gender (P =0.005),positive urine culture (P＜0.01),staghorn calculi (P =0.035),operative duration＞90 min (P =0.042) and sepsis after PCNL.While in multivariate analysis,female gender (OR=6.001,95％CI=1.190-30.276,P=0.03) and positive urine culture pre-operation (OR=19.647,95％CI=3.918-98.562,P＜0.01) were identified as independent risk factors for post-MPCNL septic shock.Conclusions Female gender and positive urine culture before operation are the key risk factors of urosepsis after percutaneous nephrolithotomy.

Objective To Compare the postoperative recovery of continence after 3D and 2D laparoscopic radical prostatectomy.Methods A retrospective analysis of 72 patients underwent radical prostatectomy in our department from January 2013 to December 2015,including 38 cases underwent 3D laparoscopic radical prostatectomy,3D group's mean age was (64.2 ± 6.0)years,mean of preoperative PSA was (14.5±7.6)ng/ml,Gleason score (13 cases≤6,17 cases =7,8 cases ≥8),the mean prostate volume (41.4 ±9.1) ml,the classification of clinical stage in 3D group included 2 cases in cT1,26 cases in cT2,9 cases in cT3a,1 cases in cT3b,mean body mass index was (22.8 ± 2.2) kg/m2,mean of MUL (membranous urethral length) was (15.6 ±2.6) mm;34 cases in the 2D group,3D group's mean age was (61.9 ±6.6)years,mean of preoperative PSA was (16.7 ±6.8) ng/ml,Gleason score (10 cases≤6,18 cases =7,6 cases ≥8),the mean prostate volume (42.1 ± 10.6) ml,the classification of clinical stage in 3D group included 1 cases in cT1,28 cases in cT2,5 cases in cT3a,mean body mass index was (21.7 ± 1.9) kg/m2,mean of MUL(membranous urethral length) was (15.5 ± 2.5) mm.All patients got a good function of micturition and urinary continence before the surgery.We compared surgical time,bladder neckurethral anastomosis time and blood loss in two groups.Membranous urethral length(MUL) were measured on preoperative and postoperative magnetic resonance imaging (MRI).Postoperative continence rate was analyzed at 2 weeks,4 weeks,8 weeks,12 weeks,24 weeks and 36 weeks after the remove of the catheter.Results All the operations were completed successfully by the same surgeon and none was transferred to open surgery.The age,PSA value,Gleason score,prostate volume,TNM stage,BMI (body mass index)and other relevant aspects of the clinical data showed no significant difference (P ＞ 0.05).The time of bladder neck-urethral anastomosis is less than the 2D group [(12.9 ± 1.7) min and (15.7 ±2.6) min,P =0.021],MUL loss in the 3D laparoscopic surgery group is less than that of 2D laparoscopic [(0.5 ±0.1) ml vs.(0.6±0.2) ml,P =0.044],the two groups in operative time [(162.7 ± 17.1) min vs.(175.7 ± 15.7) min,P =0.802],intraoperative blood loss[(191.1 ± 31.6) ml vs.(211.8 ±43.2) ml,P =0.021],intraoperative blood transfusion rate [5.2％ (2/38) vs.8.8％ (3/34),P =0.662],postoperative incidence of urine leakage [7.9％ (3/38) vs.14.7％ (5/34),P =0.463],postoperative the MUL [(15.1 ± 2.6) mm vs.(15.0 ± 2.6) mm,P =0.767),there was no statistically significant differen.All patients were followed up for urinary function at least 36 months.The continence rate between two groups at 8 weeks (60.5％ vs.35.3％),12 weeks (73.7％ vs.47.1％) got significantly difference.Conclusions Compared with 2D laparoscopic,3D laparoscopic may help early postoperative recovery of urinary continence after laparoscopic radical prostatectomy.

Objective:To establish a method of in vitro cultivation of epithelial cells of keratocystic odontogenic tumors(KCOT).Methods: Tissue block and enzyme digestion techniques were used for primary cultivation of KCOT cells.The cells were grown in keratinocyte-serum free medium(K-SFM).The biological characteristics of the cultivated keratinocytes were identified by phase microscopic observation and by immunohistochemistry of cytokeratin,vimentin,cytokeratin10 and 14.Results: KCOT keratinocytes could survive for 30-50 days in K-SFM after passing 2-4 generations.Cells were polygon and showed typical slabstone-like appearance.Immunostaining showed positive staining for cytokeratin antibody,and negative for vimentin.Conclusion: KCOT epithelial cells could be serially cultured in vitro in K-SFM by techniques suggested in this study.

Objective To access the practicality and safety of a new type Balloon dilatation combined with flank supine position in percutaneous nephrolithotomy.Methods Clinical data of 60 kidney stones patients were collected and retrospectively analyzed.This group of patients had been admitted and selected according to the inclusion criteria in our institute from July.2012 to Sep.2013.There was no obvious difference in sex,age,body mass index (BMI),stone location and size.According to the surgery approaches,this group of patients was divided into ballon group (dilated by balloon dilatation) and Amplatz group (dilated by Amplatz fascial dilation) and in each group there were 30 cases.All these patients received the surgery by the same group of surgeons.We collected the data of one-time success puncture rate,success puncture time,puncture complications (kidney calices fracture,perinephric fluid collection and postoperative delayed hemorrhages etc.),removing stones time and stone free rate.Results Compared with Balloon group,Amplatz group had a significant difference (P＜0.05) in one-time success puncture rate [100％ (30/30) vs 90％ (27/30)],success puncture time [(6.1±2.3)min vs (13.3±3.6)min],puncture complications [3％(1/30) vs 13％(4/30)] and removing stones time [(11.7±2.0)min vs (21.5±3.1)min]; but no significant difference (P＞0.05) in stone free rate [87％ (26/30) vs 83％ (25/30)].Conclusions Balloon dilatation combined with flank supine position in percutaneous nephrolithotomy is easy for surgery.It can establish the surgery access more accurately and faster,decreases removing stones time and reduces operative complications.

Objective To access the safety and efficacy of balloon dilation in percutaneous nephrolithotomy for staghorn stones.Methods Clinical data of 64 patients with staghorn stone according to the inclusion criteria in our institution from April 2013 to April 2014 were collected and analyzed retrospectively.According to the dilation methods,the patients were divided into balloon dilation group (dilated to 24 F by balloon dilator,31 cases) and fascial dilation group (dilated to 16 F by Amplatz fascial dilator,33 cases).There was no significant difference in sex,age,body mass index between the 2 groups.The data of duration of percutaneous access,one-attempt success rate of dilation,puncture complications (kidney calices fracture,perinephric fluid collection and postoperative delayed hemorrhage etc.),removing stones time,stone free rate,hemoglobin drop after surgery and number of patients who experienced postoperative fever ＞37.5 ℃ were recorded.Results Compare to fascial dilation group,balloon dilatation group had significant differences in terms of duration of percutaneous access [(5.6± 2.1) min versus (9.4± 1.7) min],oneattempt success rate of dilation[100％ (31/31) versus 88％ (29/33)],removing stone time[(32.4±3.4) min versus (49.5±3.7) min],stone free rate [84％ (26/31) versus 61％ (20/33)],hemoglobin drop after surgery [(16.7±3.3) g/L versus (28.4±2.6) g/L],renal intrapelvic pressure[(19±3) mmHg versus (25±6) mmHg] and rate of patients who experienced postoperative fever ＞37.5 ℃ [16％ (5/31) versus 39％(13/33)] (P＜0.05).No injury of adjacent organs,including pleura,liver,spleen,or bowel was noted in all patients.Conclusions Balloon dilation is quick and safe with less hemorrhage when building percutaneous renal channel.And it has higher stone free rate and less complication rate in percutaneous nephrolithotomy with staghorn stones.

Objective To explore the curative effect of combined use of minimally invasive percutaneous nephrolithotomy (MPCNL) and extracorporeal shockwave lithotripsy (ESWL) for the treatment of solitary renal staghorn calculi in patients with renal insufficiency. Methods Eight cases of solitary renal staghorn calculi associated with renal insufficiency were treated by a combination of MPCNL and ESWL. Results Stones were completely cleared away in 5 cases, while residual stones were found in 3 cases. No blood transfusion was required and no severe surgery-related complications were encountered. After surgery variable degrees of improvement in renal functions was observed. The serum creatinine (Cr) decreased from 289?166 ?mol/L pre-operation to 155?33 ?mol/L post-operation (t=4.69, P=0.004), and the blood urea nitrogen (BUN) decreased from 15.1?7.9 mmol/L to 8.3?1.9 mmol/L (t=4.00, P=0.005). The emission computed tomography (ECT) examinations showed the glomerular filtration rate (GFR) was elevated from 48.8?12.4 ml/s before operation to 63.0?8.4 ml/s after operation (t=4.68, P=0.003). Post-renal obstruction disappeared after operation. Follow-up for 0.5~4.5 years (mean, 2.8 years) in the 8 cases revealed no obvious changes in renal functions. Conclusions Combination of MPCNL and ESWL for solitary renal staghorn calculi associated with renal insufficiency is safe and effective.

Objective To explore the efficacy of four-step method for transurethral enucleation of the prostate . Methods A retrospective analysis was conducted on 120 cases of benign prostate hyperplasia ( BPH) treated with four-step method ( traction, enucleation, resection, and repair ) for transurethral plasmakinetic resection of the prostate in our hospital from January 2012 to February 2014. Results The average operation time was (91.4 ±35.3) min.The intraoperative blood loss was 78.8 ±34.1 ml. The resection of the prostate tissue weight was (32.1 ±15.7) g.The postoperative bladder infusion time was (1.5 ±0.5) days.The postoperative indwelling catheter time was 3.5 ±0.8 days.The postoperative hospital stay was (5.5 ±0.5) days.No death, blood transfusion, or TURS happened.Follow-up reviews at 3 months after surgery found postoperative international prostatic symptom score (IPSS) was significantly less than the preoperative level [4.5 ±2.2 vs.24.5 ±5.1, t=39.445, P=0.000], postoperative Qmax was significantly higher than preoperative level [(21.5 ±10.5) ml/s vs.(6.0 ±1.9) ml/s, t =15.912, P =0.000], and postoperative residual urine was significantly less than the preoperative level [(12.0 ±2.0) ml vs.(145.0 ±33.0) ml;t=44.069, P =0.000].No retrograde ejaculation, sexual dysfunction, or dysuria happened. Conclusion The four-step method for transurethral enucleation of the prostate is radical , safe, and simple.

Objective To study the mechanism of senile escaping of benign prostatic hyperplasia(BPH) condition. Methods With polymerase chain reaction based telomeric repeat amplification protocol assay(TRAP),telomerase activity was examined in 13 normal prostate tissues,35 benign prostatic hyperplasia tissues,33 hyperplastic tubercle and diaphragm. Results Telomerase activity was detected in 2 of 13(15%)normal prostate tissues,17 of 35(49%)benign hyperplasia tissues,14 of 33(42%)hyperplastic tubercle tissues and 1 of 33(3%)diaphragm tissues.The positive rate of telomerase in BPH is higher than normal prostate (P

Objective To explore the size of access channel that may influence the intrarenal pelvic pressure during percutaneous nephrolithotomy.Methods From April 2014 to July 2015,83 patiens with unilateral renal calculus,ranged from 20 to 40mam were divided into 2 group randomly.40 cases underwent F24 channel PCNL and 43 cases underwent F16 channel PCNL.There was no statistically significant difference between the groups in preoperative variables,such as age,gender,preoperative status of infection,status of hydrpnephrosis,size and location of stone (P ＞ 0.05).We used a 6Fr ureteral catheter positioned into the renal pelvic,and the intrarenal pelvic pressure was measured by anesthesia monitor IBP channel during PCNL in different stages (entrance into the collecting system,calculi fragmentation,and termination)for all patients.Removing calculus time,postoperative hemoglobin changing,fever rate,procalcitonin abnormal rate,white blood cell counts and calculi clearance rate were recorded and compared.Results The intrarenal pelvic pressure in different stages on F24 channel and F16 channel were (7.5 ± 1.3)、(22.5± 4.3)、(14.0 ± 2.7) mmHg and (10.3 ± 1.1)、(34.6 ± 4.1)、(23.0 ± 3.6) mmHg,respectively.There was statistically significant difference between 2 groups (P ＜ 0.05).Compared with F16 channel,F24 channel had significant differences in removing calculus time [(12.8 ± 3.7) min vs.(23.3 ± 3.6) min],fever rate [17.5％ (7/40) vs.39.5％ (17/43)],procalcitonin abnormal rate [15.0％ (6/40) vs.34.9％(15/43)] and white blood cell counts abnormal rate [10.0％ (4/40) vs.27.9％ (12/43)] (P ＜ 0.05).However,no significant difference in postoperative hemoglobin changing [(11.8 ± 4.4)g/L vs.(13.7 ±4.7)g/L] and calculi clearance rate [87.5％ (35/40) vs.81.4％ (35/43)] (P ＞0.05).Conclusions Compared with F16 channel,the F24 channel PCNL maintains lower renal pelvic pressure,which is less than reflux limit,during calculi fragmentation,It might be contributed to reduce the postoperative fever rate.It can short time for removing calculi and achieve the better effect.

Objective To study the pathologic changes of nephrotoxicity with CsA and to give advice on clinic drug administration. Methods Thirty two cases of renal allografts were biopsied.Histological changes of the biopsy specimens were examined by light microscopy. Results Twenty five cases of the 32 cases were identified having CsA nephrotoxicity.Of them 23 demonstrated acute nephrotoxicity.The main pathologic changes were vacuole's degenerations of glomerular tubular epithelial cells.The other 2 had chronic nephrotoxicity,and were histologically characterized by striped tubular interstitial fibrosis and hyalinization of the afferent arteriole. Conclusions Major histopathologic changes of CsA nephrotoxicity are tubular vaculation and vessel hyalinization,which are the main indicators for detection of CsA nephrotoxicity.