Objective To present the primary effectiveness and morbidity of metallic ureteral stent in treating the patients with malignant ureteral obstruction .Methods The retrospective study enrolled 11 patients received metallic ureteral stent placement because of malignant ureteral obstruction at our hospital between Jul.2012 and Jan.2014.Total of 16 stents were inserted including 5 bilateral stent insertion. There were 4 males and 7 females, with a mean age of 56 years (range 28 to 88 years).Mild to moderate hydronephrosis were identified by ultrasound and CTU in all patients , including 2 recurrent fever and 1 renal colic in affected side , however serum creatinine level is normal .There were 10 patients received stents insertion through cystoscopic or nephroscopic retrograde approach and 1 through nephroscopic antegrade approach,under superficial , spinal or intravenous anesthesia .Patients were scheduled for follow-up at 6 months intervals by KUB and ultrasound and would be examined ahead of time if there were any obstructive symptoms including recurrent fever or renal colic of the affected side .Outcomes and complications were observed during follow-up.Results In total,11 patients underwent 13 operations,including 2 by staging operations.Hydronephrosis , recurrent fever and renal colic were relieved in all patients after operation , showing 100%success rate.The mean follow-up was 9 months,in which,9 patients had not reached the scheduled time (1 year) while 2 patients exceed the time limit of stent exchange because of poor physical status.During the follow-up, 1 patient died of the progression of urothelial carcinoma .Nine stents of 5 patients keep alleviating the obstruction without hydronephrosis evaluated by ultrasonography .Stents failure occurred in 6 ureters of 5 patients, including 3 encrustation and 2 migration, presenting of progressive hydronephrosis and recurrent fever . Functional restoration was achieved in one of the encrusted stent undergoing ESWL .One stent with encrustation fail to be removed and a polymer double-J stent replacement in the same side was required for drainage .The other 3 nonfunctional stents were removed and replaced by polymer double-J stents.Conclusions Ureteral obstruction secondary to extrinsic compression contributing to relatively stable malignant tumor could be treated safely and sufficiently with the resonance metallic stent . Surveillance on schedule and regularly change within 1 year is critical to achieve successful outcomes .Tumor progression with ureteral invasion as while as encrustation can cause stent failure ,and in these cases the stent should be changed every 6 months or less.

Objective To analyze the efficacy, safety, and learning curve of holmium laser enucleation of prostate (HoLEP). Methods From June 2014 to June 2015, there were 45 consecutive patients with benign prostatic hyperplasia who underwent HoLEP performed by one experienced urologic doctor ( having surgical experience of transurethral resection of prostate in more than 500 cases) in our hospital. The patients were divided into three groups:group A (patient 1-15), group B (patient 16-30), and group C (patient 31-45). The patient age, prostate specific antigen (PSA) and prostatic volume evaluated by ultrasound were similar among the 3 groups (P>0. 05). Clinical data including operative time, hemoglobin decrease, and catheterization duration were compared among the 3 groups. The efficiency for enucleation was calculated as prostatic volume divided by operation time. Results The average enucleation efficiency of 3 groups was 0. 34 ± 0. 14, 0. 36 ± 0. 16, and 0. 49 ± 0. 18 ml/min, respectively, with a significant difference among the 3 groups (F =4. 025, P =0. 025). The group C obtained significantly improved efficiency as comparing with the group A and group B (P=0. 013 and 0. 028, respectively). No significant difference was found in operative time, hemoglobin decrease, catheterization duration, and rate of blood transfusion and complication among the 3 groups (P>0. 05). There were several surgery-related complications, including 2 cases of conversion to TURP, 5 cases of postoperative temperature more than 38℃, 4 cases of severe stress incontinence, 1 case of bladder mucosal injury by morcellator, 1 case of urethral stricture, and 1 case of postoperative hemorrhage. It took 30 cases to overcome learning curve of HoLEP by self-taught modality. Conclusions For experienced endourologist, HoLEP can be learn by self-taught modality after 30 cases training. Cases with small prostatic volume less than 60 ml should be selected in the early stage of the learning curve.

Objective To evaluate the efficacy and safety of percutaneous nephroscopic lithotripsy for the treatment of bilateral upper urinary calculi. Methods From July 2004 to December 2008,we performed percutaneous nephroscopic lithotripsy under X-ray or ultrasonic guidance for 35 patients with bilateral upper urinary calculi. Of the 35 patients,bilateral renal calculi were found in 18 patients,unilateral renal and unilateral ureteral calculus in 10,bilateral ureteral calculi in 7. Results In 35 patients (70 sides),the calculi was removed through a single tract in 49 sides,through double tracts in 18 sides,and through triple tracts in 3 sides. The mean operation time for unilateral PCNL was 66 min (ranged from 20 to 185 min). The stone-free rate was 80% (56/70) on one session. A second-look stone removal was needed in 8 laterals,and 3 laterals underwent three times of lithotomy. In three sides,a few residual renal stones were found after the first operation,but no second operation was performed. The final stone-free rate was 91.4% (64/70) in all of the cases,among which the stone-free rate was 100% (24/24) for ureteral stones and was 87% (40/46) for renal stones. In this series,no chest or abdominal injuries,intestinal perforation,or injuries to surrounding organs were detected. The patients were discharged from hospital in 5 to 30 days,and then were followed up for 3 to 6 months. During the follow-up,B-ultrasonography and KUB+IVP found no recurrence of calculi. Conclusions Percutaneous nephrolithotomy is effective and safe for bilateral upper urinary calculi. By skilled urologists in conditioned hospital,simultaneous bilateral percutaneous nephrolithotomy performed on bilateral upper urinary calculi can shorten the cycle time of treatment and hospitalization.

443) ?mol/L) due to upper urinary calculous obstruction,urgently treated by pneumatic lithotripsy(EMS,Switzerland) under ureteroscopy,from August 2002 to April 2006 in this hospital.After stone fragmentation and removal,an indwelling double-J stent was placed into the ureter at the same time.Results The continuity of the ureter was restored after one session of lithotripsy in all the 9 cases(14 sides).The ureteral calculi were thoroughly removed on one session in 7 cases(12 sides).Few residual stones were found in the renal pelvis in 2 cases(2 sides),in one of which the stones were spontaneously expelled after oral medication,and in another,after extracorporeal shock wave lithotripsy(ESWL).No severe complications happened,such as ureteral avulsion,rupture,or perforation.Concentrations of serum creatine were decreased to normal levels within 3~7 days after operation in all the 9 cases.The gross blood urine disappeared in 1~4 days postoperatively.The patients were discharged from the hospital after 3~7 days (mean,5 days) after operation.The double-J catheter was removed at 1~2 months postoperatively.Follow-up examinations in 7 cases for 2~30 months(mean,14 months) found normal levels of serum creatine and no recurrent urinary stones under B-ultrasonography or X-ray radiography.Conclusions Ureteroscopic pneumatic lithotripsy in the treatment of acute renal failure due to upper urinary calculous obstruction is an effective treatment with short operation time,safety,and minimal trauma.By using this procedure,both sides of ureteral stones can be removed on one session.

Objective To evaluate the efficacy and safety of percutaneous nephrolithotomy under ultrasonic guidance for the treatment of renal calculi. Methods Percutaneous nephrolithotomy using pneumatic or holmium laser lithotripsy under ultrasonic guidance was performed in 26 patients from January 2005 to November 2006.Among them,46 patients had single stones and 27 had multiple renal calculi.Unilateral renal calculi were found in 67 patients and bilateral calculi in 6.Staghorn calculi were identified in 11 patients.Results Of the 73 patients,a successful stone removal on one session was achieved in 57 patients,a second-look stone removal was needed in 13 patients,and 3 patients underwent three times of operation.During the operation,a single tract was used in 53 patients,double tracts in 18 patients,and three tracts in 2.A mini-invasive tract(F14～F18) was used in 47 patients,and a standard tract(F24) was established in the remaining 26 patients.The operation time was 50～160 min(mean,86 min).The stone-free rate was 96.2%(68/73),and the residual stones in other 5 patients were all

Objective To evaluate the curative effectiveness of ureteroscopic pneumatic lithotripsy in the treatment of ureteral lithiasis.Methods Ureteroscopic pneumatic lithotripsy was performed in 158 cases of ureteral calculi(163 sides)by using the Wolf F8/9.8 rigid ureteroscope and the EMS pneumatic ballistic lithotriptor from August 2002 to April 2006.The operation was carried out under intravertebral anesthesia.Under the irrigation with normal saline,the ureteroscope was advanced into the ureter.Then the ureteral stones were fragmented by pneumatic lithotripsy and removed.Afterwards,a further exploration of the ureter above the lesion was conducted and a double-J drainage tube was placed.Results The operation time was 15-90 min(mean,40 min).The total successful fragmentation rate was 96.9%(158/163),involving a success rate of 86.6%(13/15)for upper stones,96.9%(46/49)for middle stones,and 100%(99/99)for lower stones.The stone migration into the renal pelvis was encountered in 2 cases of upper ureteral calculi(treated by extracorporeal shock wave lithotripsy following a double-J tube placement)and in 3 cases after stone fragmentation(treated by stone expulsion with drugs or extracorporeal shock wave lithotripsy following a double-J tube placement).Ureteral perforation happened during the procedure in 3 cases(1.8%),requiring a double-J tube placement.No serious complications occurred,such as ureteral mucous avulsion or rupture and injuries of neighboring organs or vessels.No conversion to open surgery was required.Follow-up checkups for 1-38 months in 125 cases with B-ultrasonography or KUB film found no recurrence.Conclusions Ureteroscopic pneumatic lithotripsy is a safe,effective,and feasible technique for ureteral lithiasis.

1cm.

Objective To investigate a new method of pneumatic ballistic lithotripsy for the treatment of bladder calculi. Methods A ureteroscope or nephroscope was inserted into the bladder via outer sheath of resectoscope. Then pneumatic ballistic lithotripsy was performed under endoscope to fragment and remove bladder stones. Results Stones were thoroughly removed from the bladder on one session in all 20 patients. No major haemorrhage, perforation of the bladder, or water intoxication happened intraoperatively or postoperatively. Follow-up for 2~18 months (mean, 4 6 months) in the 20 patients showed no recurrence of calculi under B-ultrasonography or symptoms of urethral stricture like dribble urination. Conclusions Pneumatic ballistic lithotripsy via outer sheath of resectoscope is effective in the treatment of bladder calculi.

Objective To evaluate the therapeutic efficacy of YunKe and prednisone on moderate and severe thyroid associated ophthalmopathy(TAO).Methods 1 08 hyperthyroidism patients with moderately severe TAO were randomly divided into YunKe group,hormone group and the control group.All of the patients were given anti -thyroid medication(ATD)treatment.By thyroid hormone level upper limit every times higher than normal for a sulfhydryl imidazole 5mg/day to calculate daily dosage,based on thyroid hormone level adjusted a sulfhydryl imidazole dose every two weeks,make thyroid hormone levels in the normal range.YunKe set:intravenous push note YunKe per day A +B agent four groups (including cloud 20mg),each treatment medicine for five days in A row,interval of 25 days to the next period of treatment,medication six procedures.Hormone group:oral prednisone for 6 months,monthly dose in the order 1 mg·kg -1 ·d -1 ,0.75mg·kg -1 ·d -1 ,0.5mg·kg -1 ·d -1 ,0.25mg·kg -1 ·d -1 ,0.1 25mg·kg -1 ·d -1 , 0.062 5mg·kg -1 ·d -1 ,1 time a day,took at 8 o'clock in the morning.The control group treated ATD.Before and 6 months after treatment,all of the patients were checked the TNF -αand TRab,CT scan to measure degree of exophthalmus.Six months after treatment,respectively,on the basis of TAO classification (NOSPECS)and TNF -α, TRab level changes to determine the efficacy of treatment.Data entry Excel 2003 statistical software,used SPSS 1 9.0 statistical software to analyze data.Non parametric tests of three groups of data with Kruskal Wallis test.Not matching the two independent samples nonparametric test with the Mann -Whitney test,with P <0.05 for the difference was statistically significant.Results The markedly effective rate,effective rate and ineffective rate of YunKe group were 36.1 %,47.2% and 1 6.7% respectively,which of the hormone group were 20.0%,37.1 % and 42.9%,which of the control group were 1 3.9%,22.2% and 63.9%.The efficacy among the three groups had statistically significant differences (Kruskal -Wallis χ2 =1 0.736,P =0.005 ).The lighter exophthalmos,tge curative effect was better (Mann -Whitney Z =-4.599,P <0.001 ).The changes of TNF alpha,TRab levels among the three groups had significant differences(YunKe group,the TNF alpha,TRab levels markedly reduced 75.0% and 80.6%,respectively, which of the hormone group were 37.1 % and 34.3%,which of the control group were 1 9.4% and 27.8%,TNF χ2 =23.527,P <0.001 ;TRab χ2 =23.831 ,P <0.001 ).Conclusion The therapeutic efficacy of YunKeon TAO is better than prednisone,but the long -term effect deserves more investigation.

Objective To evaluate the clinical efficacy of Jianpi pill in the treatment of leucocytopenia induced by anti -thyroid drug.Methods According to the digital table,195 Graves hyperthyroidism patients with leucocytopenia induced by anti -thyroid drug were randomly divided into the observation group(100 cases)and the control group(95 cases).The observation group was given Jianpi pill treatment,while the control group adopted the combination therapy of batilol tablets,leucogen tablets,vitamin B4 tablets.The facial color,whether or not limb weak-ness,whether or not palpitations after strenuous exercise in the two groups were observed.The number of white blood cells and the number of neutrophils in the two groups were observed.3 months later,the curative effect of the two groups was determined according to the degree of cure.Results The total effective rates of the control group and the observation group were 52.63% and 85.00% respectively,the difference was statistically significant between the two groups(χ2 =23.96,P <0.01 ).The disappear infection rates of the control group and the observation group were 25.00% and 69.05% respectively,the difference was statistically significant between the two groups (χ2 =15.93, P <0.01 ).The total effective rates of mild,moderate,severe leucocytopenia were 95.56%,87.50%,46.67%respectively,the difference was statistically significant between mild and severe leucocytopenia (χ2 =16.00,P <0.01),and the difference was statistically significant between moderate and severe leucocytopenia(χ2 =7.94,P <0.01).The excellence rates of mild,moderate,severe leucocytopenia were 48.89%,40.00% and 48.89% respec-tively,the difference was statistically significant between mild and severe leucocytopenia(χ2 =5.92,P <0.01),and the difference was not statistically significant between moderate and severe leucocytopenia(χ2 =2.41,P >0.05).The incidence rates of dry mouth,hyperactive bowel sounds and liver damage,constipation and diarrhea in the control group were 4.21%,2.10% and 1.05% respectively,and the incidence rates of dry mouth,hyperactive bowel sounds and liver damage in the observation group were 3.00% and 1.00% respectively,there was no significant difference in adverse reactions between the two groups(P >0.05).Conclusion The curative effect of Jianpi pill in the treatment of Graves hyperthyroidism patients with leucocytopenia induced by anti -thyroid drug is sure,and it is superior to the combination therapy of batilol tablets,leucogen tablets,vitamin B4 tablets.