Objective To evaluate the efficacy of modular flexible ureteroscopy combined with holmium laser lithotripsy for the treatment of renal and upper ureteral stones . Methods A total of 97 patients with renal and upper ureteral stones were treated with modular flexible ureteroscopy combined with holmium laser lithotripsy in our hospital from October 2012 to February 2016.Under general anesthesia (90 cases) or epidural anesthesia (7 cases), a flexible ureteroscope was used to find renal or ureteral calculus and holmium laser lithotripsy was applied at a maximum energy of 1.2-1.6 J/10 -12 Hz (12-20 W).F6 or F7 double-J stents and catheters were routinely placed postoperatively .B-ultrasonography , KUB or CT were performed to evaluate the stone free rate 4 weeks after operation . Results Two patients suffered ureteral perforation due to stenosis and tortuosity of the ureter , and were given double-J stent placement under rigid ureteroscopy for 2 weeks and then flexible ureteroscopic treatment .Six patients underwent staged operations because of ureteral strictures .The operations were successful in the remaining 89 patients.Except for unsuccessful exploration in 3 cases of lower calyx calculi , the operation time of other 94 patients was 30-190 min (mean, 100 min).The stone detection rate was 96.9%(94/97), and the stone free rate was 88.6% (86/97).The stone free rates were 100.0% (25/25) for upper and middle calyx calculi, 75.0%(9/12) for lower calyx calculi, and 85.1% (23/27) for pelvis and multiple calyx calculi. Ureteral perforation was encountered in 2 cases.No massive hemorrhage occurred .Postoperative high fever was seen in 5 cases, with a body temperature of 38.5-39.3℃, which were cured after anti-infection treatment for 2 -7 d.The patients were discharged from hospital in 2-7 days (mean, 3.3 days) after operation.Review with B-ultrasonography, KUB or CT at 4 weeks after operation found 5 cases of residual stones >4 mm, including 3 cases located in lower calyx and 2 cases in multiple calyx . Conclusion Modular flexible ureteroscopy combined with holmium laser lithotripsy is effective and safe for the treatment of renal calculi .

To explore the diagnosis and treatment of emphysematous pyelonephritis so as to improve its diagnosis and reduce its mortality.The clinical data were retrospectively analyzed for 2 diabetic patients with emphysematous pyelonephritis.Their symptoms included high fever,chills and lumbago.Computed tomography (CT) scans were performed to reach a definite diagnosis of emphysematous pyelonephritis with gas within renal parenchyma and/or perirenal tissue.Both received intravenous antibiotics.One patient underwent open abscess drainage while another percutaneous puncture under ultrasonic guidance.Their conditions improved and healed.CT scan is an efficient imaging modality for early diagnosis.The combination of antibiotics and early drainage may offer a better outcome.

Objective To compare the safety and effectiveness of disposable circumcision suture device (DCSD) with conventional circumcision in surgical treatment of phimosis and redundant prepuce . Methods One hundred and sixty one patients with phimosis or redundant prepuce were randomly assigned to be treated by circumcision using disposable circumcision suture device ( DCSD group , n =89 ) or conventional circumcision (CC group,n =72),respectively.Results The operation time was (3.8 ± 0.5)min in DCSD group and (31.6 ±2.7)min in CC group (F=71.21,P=0.000),blood loss was 1.0(0.9, 1.2)ml in DCSD group and 6.2(5.7, 7.0)ml in CC group (Z =-10.90,P=0.000).There were no significant differences in intraoperative pain score (1.4 ±0.6 vs.2.9 ±0.8, F=2.08, P=0.151) and wound healing time [(14.0 ±1.3) vs.(16.8 ±2.1) d, F=0.10, P=0.754] between two groups.There was no need to change the dressing for patients in DSCD group 3 days after the operation , while patients in CC group changed dressing 3 times after the operation .No significant differences in postoperative complication rate [10%(9/89) vs.4%(3/72),χ2 =2.04,P=0.153] and satisfaction rate with the penile appearance [98%(87/89) vs.94%(68/72), χ2 =0.47,P=0.494] were found between two groups .Conclusion DCSD exhibits superiority over CC for shorter operation time and less blood loss in circumcision .

The clinical and pathological data of 6 patients with urahcal adenocar,cinoma of the bladder admitted in Beijing Luhe Hospital from 1996 to 2016 were analyzed and relevant literature was reviewed.Urachal carcinoma accounted for 0.66% of the bladder cancers admitted at the same period (6/906) and 6/16 of the bladder adenocarcinomas.Painless hematuria was the most common symptom.One patient had extensive metastasis as shown in biopsy and died 6 month after the diagnosis.Two patients underwent partial excision of bladder with no tumor recurrence.One patient underwent partial cystectomy followed by chemotherapy and radiotherapy, recurrence occurred one year later and he then received radical cystectomy.Another 2 patients underwent laparoscopic cystectomy and en bloc resection of umbilical ligament and umbilicus, and no recurrence was found in the follow-up for 6 years and 15 months, respectively.Pathological and immunohistochemistry are essential for the diagnosis of urachal adenocarcinoma.As it is not sensitive to radiotherapy or chemotherapy,surgery is the preferred treatment for patients with early stage diseases.Individual anticancer therapy may be the trend of treatment.

The clinical data of 9 patients with huge adrenal tumors (≥6 cm) undergoing retroperitoneal laparoscopic adrenalectomy between February 2015 and September 2016 were retrospectively analyzed.There were 2 males and 7 females aged 29-65 years.The tumors were detected due to investigation of paroxysmal hypertension in 4 cases, and during the health check-up in 5 cases.The lesions were located on the right side in 4 cases, on the left side in 4 cases and bilaterally in 1 case.The operations were all successful, there was no case transferring to open surgery.The average operation time was 70 min (50-100 min),mean bleeding volum was 100 ml(50-200 ml).The postoperative diagnosis: 4 cases of pheochromocytoma, 2 cases of cortical adenoma, 2 cases of neurilemmoma and 1 case of neuroinoma.The average follow-up time was 13.5 months (6-24 months) and no recurrence was found.

We retrospectively reviewed the clinical data of 7 patients with intraoperative or postoperative hemorrhage, who underwent percutanous nephrolithotomy (PCNL) in Beijing Luhe Hospital between 2010 and 2016.There are 5 males and 2 females with a mean age 50.7 year (30-75 years). There were 4 cases of multiple stones in kidney, 2 cases of mold stones and 1 case of stone in upper ureter.Digital subtraction angiography (DSA) showed 5 cases of false aneurysms after operation: on lower pole arterial branches in 3 cases and on middle pole arterial branches in 2 cases.Two patients with hemorrhage during operation underwent immediate digital subtraction angiography with negative result and the bleeding disappeared 1 week later with conservative therapy.False aneurysms and arteriovenous fistula caused by the procedure may lead to hemorrhage during and after PCNL.Hyperselective renal arteriolar embolization is an effective and safe method to treat delayed hemorrhage after PCNL.

ABSTARCT Purpose To investigate the clinicopathologic characteristics and genetic mutations of metastatic follicular thy-roid carcinoma(FTC).Methods A total of 22 cases of meta-static FTC were collected,including previous medical history,imaging,treatments and outcomes,and next-generation sequen-cing study and Sanger sequencing were performed in 12 cases.Results There were 16 women and 6 men.Sixteen cases were older than 50 years.Seven cases presented with metastases as the first symptom.Fourteen cases developed metastases 3 to 12 years after thyroid surgery.Sixteen cases developed bone metas-tasis,10 cases had lung metastasis,and 3 cases had brain me-tastasis.Those patients with multiple bone metastases progressed during the follow-up period.The common gene mutations in me-tastases were NRAS p.Q61R(6 cases),HRAS p.Q61R(2 ca-ses)and KRAS p.Q61R(1 case),followed by TERT promoter mutation(8 cases).Other mutated genes included KEL,BRCA1/2,ALK,ROS1,ErbB4,etc.Conclusion FTC has a high misdiagnosis rate.Those diagnosed with FTC should under-go regular systemic examinations to detect potential metastasis,especially in bone,lung,and brain.Further research on the sig-nificance of NRAS and other molecular indicators in FTC metas-tasis will help to better predict its biological behaviors.

Objective To investigate the efficacy and safety of transurethral plasmakinetic enucleation of the prostate (PKEP)combined with suprapubic cystostomy rotary resection in the treatment of large volume(>100 ml)benign prostatic hyperplasia(BPH). Methods From June 2015 to December 2015,28 patients with BPH[volume,(112.6 ±9.8)ml]were given transurethral PKEP.The resected gland was pushed into the bladder and the vesical stoma was extended.Whereafter a 10 mm trocar was introduced via suprapubic cystostomy, and then rotary resection of glands was performed and removed under transurethral observation. Results All the operations were successfully completed.The operating time was(85.8 ±26.5)min,the enucleation time was(38.0 ±11.3)min, and the rotary resection time was(47.5 ±20.2)min.Two patients had much flushing fluid extravasated into retropubic space and were given no special treatment.Two patients suffered the complication of transient stress urine incontinence after removal of catheter,and they were recovered within 4 weeks.Follow-up for 3-6 months found no urethral stricture. The IPSS scores at 3 months after operation were(13.5 ±3.6)points. Conclusion Transurethral PKEP combined with suprapubic cystostomy rotary resection in the treatment of large BPH is safe.

From June 2017 to December 2018, 60 patients with large-volume prostatic hyperplasia underwent transurethral plasmakinetic enucleation of the prostate (PKEP) with shovel electrode in Luhe Hospital. During the procedure the resected glands were pushed into the bladder and the tissues were broken and sucked with STROZ Tissue Morcellator. All operations were performed successfully. The mean total operating time was (63.0±20.5) min, including (46.0±11.3)min for enucleation and (17.0±10.2) min for morcellation time. None of the 60 patients received blood transfusion perioperatively, and there was no transurethral resection prostate (TURP) syndrome. Four patients suffered the complication of transient stress urine incontinence after removed catheter, they were recovered within 4 weeks; no true urinary incontinence or urethral stricture occurred in 6 months of postoperative follow-up. Compared with the traditional technique of sheath+electric ring to enucleate the gland, the shovel electrode enucleation has shorter operation time, lower incidence of transient stress urine incontinence after operation, and reduced medical cost.