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 clinical effects of single-dose intra-arterial infusion chemotherapy for the treatment of refractory bladder cancer after transurethral resection of bladder tumor (TURBt). Methods A retrospective analysis was made on clinical data of 12 cases of refractory bladder cancer treated by single-dose intra-arterial infusion chemotherapy after TURBt from November 1999 to June 2005. The bladder tumor was resected as thoroughly as possible. Postoperatively, a bilateral internal iliac arteriography was made by using the Seldinger technique. The tumor vessels and normal blood supply were identified through the intubation of the right femoral artery. Half dose of chemotherapeutics (epirubicin 25 mg) was infused into both internal iliac artery, then tumor vessels of bladder was selected and infused with peripheral embolization agent (a mix of fragmented gelatin sponge and cisplatin 200 mg). The embolization agent was used repeatedly until all tumor vessels were embolized. Intravesical instillation with epirubicin was carried out postoperatively, and cystoscopy was performed every 3 months after operation. Results After intra-arterial infusion chemotherapy, there were 12 cases of nausea and anepithymia, 3 cases of vomiting, and 2 cases of fever, all of which were symptomatically relieved with expectant treatment. Mild hip pain occurred in 6 cases and subsided in 3~5 days. Decreased erythrocyte and leucocyte were restored to normal levels in 2 weeks. Liver and renal functions did not present marked changes. Follow-up was conducted for 4~55 months (mean, 34 months). There were 1 case of recurrence at 32 postoperative month and 11 cases of progression free survival. Conclusions This technique lowers the recurrent rate of refractory bladder cancer and the incidence of side effects, being a new alternative for patients who are not willing to receive total cystectomy.

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.

Objective To investigate the main causes and strategies for the difficulties in ureteroscopic lithotripsy.Methods From March 2004 to December 2006,19 cases of ureteral calculi,who experienced difficulties during holmium laser lithotripsy or pneumatic lithotripsy under a rigid ureteroscope,were analyzed retrospectively.Among the cases,3 had difficulties in ureteroscope placement due to the narrow ureteral ingress,6 owing to calculus obstruction complicated with ureteral inflammatory polypi,4 resulted from twisted ureter,and 6 because of stenosis of the ureter.Results In 15 of the patients,the operation was successfully performed by changing surgical approach,controlling the hydraulic irrigation,and incising the stenotic segments,etc.Two patients,who had stenotic ureter,received ESWL with double-J catheter dwelling.Lithotripsy failed in 2 cases,and PCNL was used to remove the calculi.The postoperative complications occurred in 4 cases,including 2 with mucosal laceration and 2 ureteral perforations.One of the 4 cases was transferred to an open surgery,and the other 3 were cured by conservative treatments.Conclusions Holmium Laser lithotripsy and pneumatic lithotripsy under a rigid ureteroscope are safe and effective in treating ureteral calculi.

Objective To evaluate the efficacy of trans-obturator tension free vaginal tape(TVT-O)for the treatment of stress urinary incontinence(SUI)in women.Methods From January 2006 to September 2007,15 female patients with SUI received TVT-O in our hospital.A 1-cm longitudinal incision was made along the anterior wall of the vagina for the dissection of the urethra from the vaginal submucosal space to the obturator membrane.Then,a butteryfly-shape guide pole was inserted to guide the puncture of a spiral needle from the obturator membrane to the skin covering the root of the thigh.Afterwards,a trans-obturator tape was placed underneath the urethra without tension.Results The operation time was 15-40 min(mean,30 min),and blood loss was 10-40 ml(mean,20 ml).No intraoperative complication occurred in the series.One patient developed urinary retention,and was relieved by indwelling urethral catheter.Ten patients complained pain at the root of the thigh,and was cured simultaneously 3 to 10 days postoperation.Fifteen of the patients were followed up for 2 to 19 months with a mean of 8 months,during which no recurrence was found.Conclusion TVT-O is a simple,effective and reliable method for SUI.

Objective To evaluate the efficacy of ureteroscopic pneumatic lithotripsy for ureteric calculi.Methods From January 2003 to June 2007,221 patients with ureteric calculi underwent ureteroscopic pneumatic lithotripsy in our hospital.Under continuous epidural anesthesia combined with spinal anesthesia,the surgery was performed in lateral lithotomy position.Double-J catheter was used for drainage after the operation.Results The mean operation time was 55 minutes(ranged from 15 to 118 minutes).Among the patients,the calculi were found in the upper ureter in 16 cases,middle segment in 52 cases,and lower ureter in 153 cases.A total of 228 stones in the 211 patients were all fragmented with a success rate of 100%.The discharging rate was 95.5%(211/221).ESWL was used in 7 cases with unsatisfied outcomes and 3 patients who had ipsilateral renal calculi.A 3-to 6-month follow-up was achieved in 189 of the patients,who had no recurrence during the period.Conclusions Ureteroscopic pneumatic lithotripsy is a minimal invasive and effective treatment for ureteric calculi.Postoperative ESWL is an alternative which can increase the rate of stone clearance.

1cm.

Objective To study the reasons leading to readmission in patients with severe postoperative complications after transurethral prostatectomy. Methods Clinical data of 27 cases of readmission after transurethral resection of prostate (TURP, 14 cases), transurethral vaporization of prostate (TUVP, 3 cases), transurethral laser prostatectomy (TULP, 9 cases) or holmium laser enucleation of prostate (1 case) in this hospital from June 1998 to June 2003 were analyzed. Results Reason leading to readmission included: postoperative severe bleeding in bladder (4 cases), urinary retention (15 cases), urethral stricture (3 cases), bladder neck contracture (2 cases), severe urinary frequency (2 cases) and urinary incontinence (1 case). Conclusions More weight should be placed on the fact that various modes of transurethral prostatectomy may precipitate severe long-term complications.

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.