Objective To explore the effect of thrombolysis on incisions in the patients with pulmonary embolism (PE) following fracture surgery. Methods The congestion distance of PE in 15 patients after surgery was measured to observe correlation between congestion distance and haemolytic time. Results All 15 patients had congestion, with congestion distance of (4.18?0.81) cm. Negative correlation was found between haemolytic time and congestion distance (r=-0.657, P=0.008).Conclusion Thrombolysis exerts distinct effect on the incisions, but it is relatively safe with over 10 days of thrombolysis after surgery.

Objective To report a multiple metastatic renal cell carcinoma (RCC) case successfully treated with cytoreductive nephrectomy after neoadjuvant Sunitinib,and discuss the efficacy and treatment regime of neoadjuvant targeting therapy.Methods A 51 years man presented with painless gross hematuria for one week and admitted into our hospital in August 2010.Abdominal CT demonstrated a 6.6 cm ×6.3 cm left lower pole renal tumor associated with renal vein tumor thrombus,bulky hilar lymph nodes and extensive local invasion.The patient was also found to have lung and right tibial metastasis.The clinical stage was T3bN1 M1.Percutaneous biopsy confirmed clear cell renal carcinoma.Neoadjuvant Sunitinib 50 mg daily was administered with 4 weeks on,2 weeks off schedule for two cycles.Cytoreductive nephrectomy was preformed 2 weeks after discontinuation of neoadjuvant Sunitinib.Imaging evaluation was performed to assess the primary tumor and metastatic sites.The patient was followed up till present.Results After two cycles of neoadjuvant treatment,CT scan revealed 23％ size reduction of left renal tumor to 5.1 cm ×4.4 cm,renal vein tumor thrombus regression,local perirenal invasion improvement,lung metastasis resolution and static right tibial metastasis.According to RECIST criteria,the objective response was stabilization of disease (SD).Cytoreductive nephrectomy was successfully performed to remove the primary tumor in December 2010.Pathology revealed Fuhrman Ⅱ renal cell carcinoma with major necrosis in primary tumor and thrombus localized in renal vein.During 6 months of post-operative follow-up,there was no local recurrence,lung metastasis had vanished completely and tibial metastasis had not progressed.Local recurrence and other distant metastasis were not demonstrated in 20mon follow-up till now.Disease control of this patient was partial response (PR) by RECIST.Conclusions Neoadjuvant Sunitinib treatment could result in downstaging of primary tumor and facilitate cytoreductive nephrectomy,thus eventually increase patient overall survival.

ObjectiveTo report our experience and assess the safety and efficacy of ultrasound-guided percutaneous nephrolithotomy (PCNL) with ultrasonic and pneumatic lithotripters for complete renal staghorn stones.MethodsFrom Jan 2006 to Jan 2015, 128 patients (142 kidneys) with complete staghorn stones underwent PCNL, included 14 patients with bilateral renal complete stones,13 patients with solitary or founctional solitary kidney, 22 patients with renal insufficiency, 25 patients with renal empyema, 4 patients with spine malformation, ultrasound-guided PCNL were performed. Stones were fragmented and cleared using a combination of ultrasonic and pneumatic lithotripters.ResultsAll PCNL procedures were successful. Successful access to the collecting system was 100%. Mean operation time was 64.5±39. 1min (range 30–150). The primary stone-free rate of PCNL was 76.8%(109/142). Most of the renal stones(63.4%, 90/142)were managed satisfactorily by a single tract,a second tract was used in 25 renal stones(17.6%, 25/142). There were 36 auxiliary procedures (24 second PCNL and 3 third PCNL and 9 extracorporeal shock wave lithotripsy). One month after treatment, the overall stone-free rate was 85.2%(121/142). Six patients (4.2%) received blood transfusion,three patients(2.1%) received angiography and embolization . Three patients (2.1%) with infective shock were cured by intravenous antibiotics and antishock treatments. Three patients with temporary renal function receded were observed in solitary kidney for two tracts PCNL. No other severe complications occurred. The mean postoperative stay was 5.2 days (range 2–12). Conclusion: Ultrasound-guided Percutaneous Nephrolithotomy with ultrasonic and pneumatic lithotripters for management of renal complete staghorn stones is safe, effective, and worthy of wider use in clinical practice.

Objective:To compare the efficacy and safety of tubeless percutaneous nephrolithotomy ( tubeless-PCNL) and ureteroscopic lithotripsy ( URL) in treatment of impacted upper-ureteral calculi ≥1.5 cm in size.Methods:Patients with ureteral stones sized ≥1.5 cm and lodged above the fourth lum-bar vertebra who were treated between September 2009 and July 2013 in Peking University People ’ s Hos-pital were retrospectively analyzed .In the study , 182 patients underwent tubeless-PCNL or URL treat-ment respectively , and the operation success rates were compared .The duration of operation , intraopera-tive blood loss ( average hemoglobin decrease ) , complications , mean hospital stay and residual stone rates were also compared.Results: Fifty-four patients underwent tubeless-PCNL treatment,the average stone size was (1.9 ±0.4) cm,nephrostomy tubes were placed in two patients ,and the operation success rate was 96.3%(52/54).In the rest of the 52 patients,and the mean operation time was (30.1 ±14.8) minutes with an average postoperative hemoglobin decrease of (10.2 ±6.1) g/L, and the mean hospital stay was (3.0 ±1.4) days.Only one of the patients had residual fragments (2%).The main complica-tions included minor perirenal hematoma in 1 patient, fever in 2 patients, elevated blood WBC in 11 patients,and analgesics requirement in 3 patients.In the study, 128 patients were treated with URL,the average stone size was (1.7 ±0.3) cm.19 procedures failed,and 10 patients were converted to PCNL, extracorporeal shock wave lithotripsy was executed subsequently after double -J stent placement in 5 patients,and migration of calculi or stone fragments happened in 4 patients.The mean operative time was (51.3 ±25.5) minutes for the remaining 109 patients with a hemoglobin reduction of (5.2 ±7.2) g/L. The mean hospital stay was (2.9 ±1.3) days, and residual stones were found in 13 of the 109 patients (11.9%).The main complications included fever in 3 patients, elevated blood WBC in 42 patients, an-algesics requirement in 13 patients because of pain in the urethra or flank .The size of the stones between the two group didn ’ t show significant difference ,but the success rate of the tubeless-PCNL procedure was significantly higher .Except that hemoglobin decrease was slightly higher in the tubeless-PCNL group ,the mean operative time , the rate of residual stones and rate of complications of the tubeless-PCNL group were lower significantly.Conclusion:Treating stones above 4th lumbar vertebra larger than 1.5 cm were challenging .It is difficult to treat these stones with URL because of a high probability to fail , but on the contrary, tubeless-PCNL was more likely to be performed successfully .For surgeons experienced with the PCNL technology, treating stones≥1.5 cm with tubeless-PCNL procedure may turn out to be more effi-cient and with a higher operation success rate , and the risk of complications was lower without lengthe-ning the postoperative hospital stay .

Objective To summary our experiences in percutaneous nephrolithotomy for treating the caliceal diverticular calculi and postoperative outcome with technical modification.Methods A retrospective review was performed on 34 patients with caliceal diverticular calculi who underwent percutaneous nephrolithotomy between January 2009 and June 2013.The patients were divided into 2 groups.In group A (1 1patients),stones were removed and diverticular neck was incised.In group B (23 patients),fulguration of diverticular wall was performed after the stone removal and diverticular neck incision.Group A had 11 cases including 4 male and 7 female with average age (36.7± 16.0) years.Mean size of stone was (1.8±0.4) cm.Mean maximum diameter of diverticulum was (2.3±0.5) cm.Group B had 23 cases including 10 male and 13 female with average age (40.1±12.0) years.Mean size of stone was (1.9±0.6) cm.Mean maximum diameter of diverticulum was (2.3±0.8) cm.There were no significant difference in stone size and maximum diameter of diverticulum within two groups (P＞0.05).The following parameters such as operative time,drop in hemoglobin,stone clearance,complication rate and ablation rate of diverticulum were compared between two groups.Results In group A,average operative time was (62.7±11.7) min.Mean hemoglobin dropping was (12.0t9.7) g/L.Stone clearance rate was 90.9％ (10/11) and overall complications rate was 18.2％ (2/11).The ablation rate of diverticulum was 63.6％ (7/11).In group B,average operative time was (76.3±21.6) min.Mean Hemoglobin reducing was (12.9±16.7) g/L.Stone clearance rate was 91.3％(21/23) and overall complication rate was 21.7％.The ablation rate of diverticulum was 91.3％ (21/23).There was no significant difference in stone clearance and complication rate between two groups.It seemed that the operativc timc in group B was longer than that in group A.However,no significant difference was found (P＞0.05).The ablation rate of diverticulum in group B was significantly higher than that in group A (P＜0.05).Conclusion In percutaneous nephrolithotomy treatment for caliceal diverticular calculi,fulguration to diverticular wall is an effective method to achieve diverticular obliteration and reduce possibility of stone recurrence.

Objective:To evaluate the clinical effect of retroperitoneoscopic renal pedicle lymphatic disconnection via extra-adipose capsule in the management of chyluria and to discuss the management of its complications.Methods:From August 2013 to June 2008,five patients with chyluria were admitted. All the patients were female,aged from 26 to 73 years,and disease course from 1 to 10 years.All the five patients had complained of intermittently voiding milky urine with varying degrees of weight loss,and fa-tigue,of whom two presented with flank pain and one with anemia.Their urine chyle tests were con-firmed to be positive.Preoperative cystoscopy found that chyluria was from the left side in 3 cases,and from the right side in 2 cases.Their proteinuria ranged from +to ++++.All the cases had been treated with the modified procedure by which lymphatic ligation was performed to hilar vessels and proximalureter via extra-adiposecapsule without disconnection of perirenal fat tissues.The operation time,intraoperative blood loss,postoperative intestinal function recovery,catheter time,drainage tube removal time and com-plications during operation were collected.Results:All the five cases were performed successfully.The operation time ranged from 75 to 170 minutes,mean (126.0 ±39.6)minutes,with the intraoperative blood loss 20 to 60 mL,mean (38.0 ±16.4)mL,and the postoperative intestinal function recovery time 1 to 3 days,mean (1.9 ±0.4)days.The catheter time was 1 to 4 days,mean (2.1 ±0.3)days and the drainage tube removal time ranged from 3 to 15 days,mean (9.3 ±1.8)days.Postoperatively lym-phorrhagia was found in two cases.No renal vessels injury occurred during operation.Chyluria of all the patients disappeared on the operation day with negative chyluria test after surgery.Furthermore,urine test revealed that proteinuria was totally negative.No recurrence was detected in our patients in the 9 to 31 months’follow-up.Conclusion:This modified procedure does not have to disconnect perirenal fat tissues and nephropexy during operation.It was characterized with shorter operation time,definitive effect and fewer complications.

Objectives:To validate the Chinese version of the Ureteral Stent Symptoms Questionnaire(Chinese-USSQ) in patients with an indwelling ureteral stent.Methods:The original USSQ was translated into Chinese and linguistically validated following the cross-cultural adaptation of health-related quality of life measures.A total of 83 patients (cases) with indwelling ureteral stent and 90 healthy subjects (controls) were asked to complete the Chinese-USSQ as well as European Quality of Life Visual Analogue scale(EQ-VAS)(for both genders), the International Prostate Symptom Scale (IPSS) (for male), and Urogenital Distress Inventory-6 (for female). Patients were evaluated at weeks 1 and 4 after stent placement and at week 4 after removal. The psychometric properties of the questionnaire were analyzed.Results:The Chinese version of USSQ include 43 items, which addressed various domains of health(6 sections) covering urinary symptoms, pain, general health, work performance and sexual matters with additional problems. A total of 78 patients(45 males and 33 females) and 90 controls (41 males and 49 females)were included for analysis. Internal consistencies (Cronbach′s α coefficients: 0.60-0.78) and test-retest reliability (Spearman correlation coefficient: 0.69-0.91) were satisfactory for urinary symptom, body pain, general health, and work performance domains. Most USSQ domains showed moderate correlations with each other. The convergent validity determined by correlation between other instruments and corresponding USSQ domain was satisfactory. At week 4 it was moderate for the urinary symptoms index compared to the IPSS in men(Spearman correlation coefficient>0.60), for the urinalry symptoms index compared to the UDI-6 score in women(Spearman correlation coefficient 0.52).Sensitivity to change and discriminant validity were also good in most domains ( P<0.01). Only a small proportion of the study population had an active sexual life with the stent in situ, which limited its analysis. Only 1(1.3%) and 6(7.7%) patients had an active sex life at week 1 and 4 after stent placement; meanwhile, 34(43.6%) patents were sexually active at week 4 after stent removal. Conclusion:The Chinese version of the USSQ is a reliable and valid instrument that can be used for Chinese patients with a indwelling ureteral stent in the clinical and research settings.

Objective:To investigate the characteristics of severe renal hemorrhage after percutaneous nephrolithotomy(PNL) and timing of selective transarterial embolization(TAE).Methods:Between May 2005 and March 2010,superselective renal angiography was used to control severe bleeding in 15 of 1 418 cases(1 520 PNL procedures,1.06%).In the 15 cases,superselective renal angioembolization was used to control severe bleeding in 13(0.92%).The medical records of all the patients who underwent renal angiography and angioembolization were reviewed.Results:Severe bleeding cases after PNL were dividide into 3 types according to the clinical characteristics:type Ⅰ(urgency type),type Ⅱ(intermittence type) and type Ⅲ(persistant slow type).There were 3 patients in type Ⅰ,6 in type Ⅱ and 6 in type Ⅲ.All the patients had a normal coagulation profile before surgery.A total of 11 patients(84.6%) underwent the first-time successful embolization and 2(15.4%) the second-time successful embolization.The longer time between angioembolization and bleeding was,the more blood loss and transfusion volume were,except for 1 patient in type Ⅱ.Temporality serum creatinine abnormity was found in 2 patients,one with a solitary kidney patient and the other with angioembolization for both renal bleeding.Conclusion:TAE is a minimally invasive,safe,simple,and highly effective modality for the management of post PNL renal bleeding.This option should be considered early in the management of these cases,especially for Urgency type bleeding.

Objective:To discuss the clinical manifestation, diagnosis and treatment of upper urinary tract calculi complicating with emphysematous pyelonephritis(EPN).Methods:The clinical data of 5 cases of upper urinary tract calculi complicating with EPN diagnosed in our department from July 2012 to December 2019 were retrospectively analyzed, and literatures were reviewed. 5 patients were identified by computed tomography scanning to upper urinary tract calculi complicating with EPN, 3 female and 2 male, aged 40-67 years, 2 staghorn calculi and 3 multiple stones. One patient suffered from diabetes mellitus. All cases presented with fever at the enrollment point, and the body temperature were 38.7℃, 38.8℃, 37.5℃, 38.6℃, 40.0℃, respectively. And the number of white blood cells and neutrophile granulocyte of these cases were higher than normal reference value, were 17.2×10 9/L, 0.90; 14.9×10 9/L, 0.89; 11.2×10 9/L, 0.85; 15.1×10 9/L, 0.87; 13.3×10 9/L, 0.88, respectively. The C-reactive protein were increased in all of the cases, especially in case 1(68 mg/l), case 2(253 mg/l), and case 5(67 mg/l). And 3 cases with renal insufficiency. Case 3 and case 4 were controlled the infection with medical management alone, and case 5 with percutaneous drainage plus medical management. The pyelonephritis of other 2 cases were uncontrolled, the body temperature of case 1 returned to normal after treated with percutaneous drainage of perirenal abscess plus nephrostomy plus medical management, but the imaging findings of kidney was not relief by CT scan after 4 weeks. Case 2 was persistent fever until treated with fluconazole according to the medicine sensitive experiment’s result of urine culture after undergoing nephrostomy plus indwelled a double J tube in ureter, but the CT findings of kidney grew worse 1 week later. Results:Of the 5 patients, 1 received first-stage nephrostomy and second-stage percutaneous nephrolithotomy, 2 received same session surgery, 2 received nephrectomy. There was no complications occurred except postoperative fever in 1 case. Postoperative pathology of the nephrectomy revealed glomerular sclerosis, glomerulus dilation, and inflammatory granulation tissue was formed. And 1-84 months follow-up showed no recurrence in all the cases.Conclusions:Upper urinary tract calculi complicating with EPN is an rare acute severe infection, CT is the best choice of early diagnosis, double J stenting or percutaneous drainage of abscess with broad-spectrum antibiotics could be the preferred treatment.