Objective To perspectively compare the clinical outcomes of China-and Germany-made electromagnetic lithotripters in the treatment of upper urinary tract calculi.Methods Between January 2005 and August 2005,60 cases of upper urinary tract calculi were randomly divided into two groups:China-made and Germany-made groups(30 in each).Extracorporeal shock wave lithotripsy(ESWL)was performed by a same group of surgeons.Results The stone-free rate was 73%(22/30)in China-made group,and was 90%(27/30)in Germany-made group 3 weeks after ESWL(?2=2.283,P=0.095);and was 100% in both the groups 3 months postoperation.The retreatment rate was 27%(8/30)in China-made group,and 10%(3/30)in Germany-made group(?2=2.283,P=0.095).The rate of auxiliary procedure in both the groups was 0.The efficacy quotient(EQ)was 0.79 in China-made group,and was 0.91 in Germany-made group.Totally,39 ESWLs were performed on the patients in China-made group,while 33 ESWLs were carried out in Germany-made group.The rates of macroscopic hematuria,skin injury,and renal colic were 87%(34/39),64%(25/39),and 8%(3/39)respectively in China-made group,and were 91%(30/33),6%(2/33),and 6%(2/33)in Germany-made group(?2=0.016,P=0.900;?2=25.693,P=0.000;and ?2=0.000,P=1.000;respectively).One patient in China-made group developed fever after ESWL,while no one in Germany-made group had the symptom.In both the groups,no patients had hematuria,renal edema,or subcutaneous perinephric hemorrhage.Conclusion Both China-and Germany-made electromagnetic lithotripters are effective,safety,and non-invasive.

Objective To evaluate the efficacy and safety of prostat in the treatment of chronic nonbacterial prostatitis (CNP). Methods A multicentral open clinical trial was conducted.A total of 115 CNP patients were enrolled in the trial.For each patient 1 tablet of prostat (70 mg P5+4 mg EA10) was orally administered twice a day. Results After 4- and 8- week therapy,NIH-CPSI overall scores were averagely decreased 7.1 (29.5%) and 11.9 (49.4%),respectively.Symptom rating scores were averagely decreased 5.0 (32.1%) and 8.2 (52.5%),respectively.Quality of life scores were averagely decreased 2.1 (24.6%) and 3.7 (43.9%),respectively.WBC counts in prostate massage fluid were averagely decreased 8.8/HP (39.3%) and 13.9/HP (61.9%),respectively.The total effective rate was 82.1% after 8 week therapy.No adverse reaction associated with medication was observed. Conclusions Prostat is effective and safe in relieving the subjective symptoms and improving the objective evaluation in the treatment of CNP patients.

Objective To evaluate the improvement of diagnosis and treatment of hypercatecholaminism. Methods A total of 95 cases of hypercatecholaminism were reviewed.Of them 74 cases were of pheochromocytoma and 21 cases were of adrenal medullary hyperplasia (AMH).In pheochromocytoma group,67 cases (90.5%) had symptom of hypertension.Increase in 24 h urinary VMA occurred in 62 cases (83.8%) and elevated urinary catecholamine level in 67(90.5%).All thses had positive findings of ultrasound,CT scan and MRI.In AMH group,all the patients were hypertensive and their 24 h urinary VMA was increased.Most of them (15/16) had higher urinary catecholamine level than normal;14 out of the 21 cases had positive findings of B-ultrasound examination. Results Surgical operations were performed in the 74 patients with pheochromocytoma including 9 cases of extra-drenal pheochromocytoma.Of them 5 cases were confirmed as malignant pheochromocytoma.In the 21 cases of AMH,18 undewent surgical operation.Of them 12 received unilateral resection and 6 received bilateral resection of adrenal gland.The pathological examination confirmed the diagnosis of AMH. Conclusions The diagnosis of pheochromocytoma should be focused on endocrinological examination,ie,qualitative examination,whereas it is diffucult to localize the lesion in AMH compared with pheochromocytoma.The establishment of notion of AMH as an isolated clinicopathological entity broadens and perfects the theory of hypercatecholaminism.

Objective To look for a standard way to cure uric acid calculi in transplanted kidney with medicine.Methods Under the guide of the standard and widespread metabolic evaluation, citrate and allopurinol were used to treat 4 patients with uric acid calculi after kidney transplantation. These two kinds of medicines were used in the long term together with other conservative treatment to prevent the recurrence of calculi.Results In these 4 cases, all clinical syndromes disappeared and all the calculi dissolved. After follow-up for 1～2 years, no recurrence of calculi was found. Conclusion Citrate should be used to dissolve uric acid calculi in transplanted kidney and to prevent the recurrence of calculi under the guide of the standard metabolic evaluation.

Objective To explore the efficacy of outpatient treatment for residual ureteral calculi after minimally invasive percutaneous nephrolithotomy(MPCNL).Methods The treatments were conducted in an outpatient setting.The patients with residual ureteral calculi(

Objective To compare the efficacies of mini-incision dismembered pyeloplasty assisted by retroperitoneal laparoscopy and routine retroperitoneal laparoscopic dismembered pyeloplasty for ureteropelvic junction(UPJ) obstruction.MethodsThe clinical data of 47 patients with UPJ obstruction,who underwent dismembered pyeloplasty from January 2004 to November 2006 in our hospital,were retrospectively analyzed.Of the patients,22 were treated by mini-incision dismembered pyeloplasty assisted by retroperitoneal laparoscopy(group A),in whom a 4-cm incision was made under the costal margin at the posterior axillary line;and the other 25 cases underwent retroperitoneal laparoscopic dismembered pyeloplasty(group B).The clinical data of the two groups,including the operation time,blood loss,average airway resistance and partial pressure of carbon dioxide,recovery of intestinal function,length of drainage and hospital stay,incidence of urinary leakage,and remission rate of hydronephrosis and improvement of GFR,were statistical analyzed by SPSS 13.0.ResultsNo intra-operative complications occurred in either group.Compared with Group B,Group A had shorter operation time [(92.9?16.3) min vs(155.8?18.6) min,t=-12.251,P=0.000],more blood loss [(18.9?6.3) ml vs(13.6?6.7)ml,t=2.782,P=0.008],lower average airway resistance [(15.6?2.6) cm H2O vs(26.9?4.3) cm H2O,t=-10.715,P=0.000] and partial pressure of carbon dioxide [(36.0?6.9) cm H2O vs(51.6?6.7) cm H2O,t=-7.855,P=0.000].No statistical differences were detected in the recovery of intestinal function,postoperative length of drainage and hospital stay,incidence of urinary leakage,and remission rate of hydronephrosis and improvement of GFR.ConclusionMini-incision dismembered pyeloplasty assisted by retroperitoneal laparoscopy is a safe,effective,and minimally invasive therapy for UPJ obstruction.

Objective Castleman′s disease ( CD) is a rare lymphoproliferative disorder, which has a very high misdiagnosis rate according to its lack of clinical and imaging specificity.The study was to improve the recognition, diagnosis and management of this disease by analyzing the clinicopathological characteristics and concluding diagnosis and treatment as well as literature review. Methods Retrospective analysis was conducted on clinical data of 31 CD patients (13 males and 18 females) who were hospitalized in the Affiliated Drum Tower Hosipital to Medical college of Nanjing University from January 2006 to Feburary 2014.Their mean age was (47.4 ±13.3) years.There were 24 cases with unicentric Castleman′s disease (UCD) and 7 cases with multicentric Castleman′s disease ( MCD) .UCD tended to be present in the form of an enlarged and painless mass which generally remained asymptomatic by accidental touch or regular physical examination.MCD was usually associated with constitutional symptoms.All the 24 patients with UCD underwent complete surgical resection.7 patients with MCD received different treatment methods, such as surgical resection, ste-riod and rituximab in combination with chemotherapy ( CHOP) . Results Postoperative pathology confirmed 23 cases were hyaline vascular type while 8 were plasma cell type.25 cases had been followed up (46.3 ±32.3) months after operation, among which 1 UCD case died of pancreatic head carcinoma 13 months after operation, 1 case with MCD plus pemphigus died 2 months after surgical resection of retroperitoneal lymphadenectasis, another MCD case died in 1 month without any treatment.The remaining 22 cases were alive. Conclusion CD is lack of clinical specificity and its diagnosis should be made by pathology.Each subtype differ greatly in prognosis, therefore different treatments should be taken after definitive subtype diagnosis.

Objective To evaluate the clinical and pathological features of eosinophilic cystitis (EC),and to discuss its diagnosis and treatment.Methods The clinical and pathological data of one case of eosinophilic cystitis were reported.An 86-year-old male with gross hematuria and urinary urgency for 15 days was admitted on 16 March 2015.A computed tomography scan showed uneven thickening of the bladder wall and a nodular soft tissue on the anterior wall protruding into the bladder cavity.Results Cystoscopic examination showed diffuse thickening of the bladder with polypoid red lesions on the anterior wall.Transurethral biopsies revealed infiltrating eosinophils,which was consistent with the diagnosis of EC.The patient was then treated with anti-inflammatory drugs,corticosteroids and anti-histamine drugs.At 6 months of follow-up,the patient was asymptomatic and had no evidence of local recurrence by ultrasonography.Conclusions Eosinophilic cystitis is a rare disease without specific clinical and imaging features,which can mimic bladder tumor.The final diagnosis of this disease depends on the pathology.Transurethral resection of the lesion along with postoperative hormone and antihistamines administration are the main choices of treatment.

Objective To evaluate the clinical feasibility of laparoscopic cool-tip radiofrequency ablation (LCRFA)for renal cell carcinoma. Methods Twelve selected cases of primary renal, ceil carcinoma underwent LCRFA. Of them, 4 cases of left renal carcinomas, 7 cases had right renal carci-nomas and 1 case had bilateral renal carcinomas. The maximum diameter of the tumors was 2.1-8. 5 era. Eleven cases were T, No M0 and the other one was T2 N0 M0. Results The mean operation time was 92±24 min, and the mean blood loss was 50±29 ml. None of the cases need blood transfusion post-operation. No laparoscopic operative complications were observed. Six weeks after operation, complete ablation was achieved in 12 lesions and partial ablation in 1, with a complete ablation rate of 92.3%(12/13). There was no statistic change of Hb. ESR. SCr and GFR after operations (P>0.05). Ten cases underwent CT examination 3 months after the treatment ,9 cases showed complete necrosis of tumor,1 case showed partial necrosis. No recurrence was found. All of the 12 cases remained sur-vived during the follow-up for 1-16 months(median,7.8 months). Conelusions LCRFA for renal cell carcinoma is an accurate and effective intervention with a low incidence of complications, and is more accurate than ultrasound-guided pereutaneous radiofrequency ablation.

Objective To investigate the clinical and pathological characteristics of normotensive pheochromocytomas ( NP) . Methods This retrospective study included 97 patients with a pathological diagnosis of pheochromocytoma at the Drum Tower Hospital Affiliated to Nanjing University Medical School during January 2004 to December 2013. All available clinical, biochemical, and radiological records were reviewed in these patients who were then categorized into hypertensive pheochromocytomas (HP) (n=64) and NP (n=33) groups. 97 cases of Adrenal Gland Scale Score of pheochromocytoma were examined, including tissue microscopic pathology assessment, ki67 and phenylethanolamine-N-methyltransferase ( PNMT ) immunohistochemistry and catecholamine type. Biochemical examinations of 95 subjects with primary hypertension ( PH) were recorded for comparative study. Results The patients with NP showed lower proportion of clinical triad than HP, inapparent metabolic disorders, and lower urinary catecholamine levels than HP, but showed higher results than primary hypertension. The weight of tumor was positively correlated with 24 hour urinary norepinephrine level in patients with HP(Y=1. 376+0. 653X,R2=0. 118, P=0. 028), but not in patients with NP;and the size or diameter of the tumor was negatively correlated with PNMT immunohistochemistry in patients with NP(Y=0. 940-0. 356X, R2=0. 494, P=0. 005), but not in patients with HP, indicating that NP may be misdiagnosed clinically. Conclusion Patients with NP have distinct clinical, biochemical, and pathological phenotypes; the phenotypic changes are closely related with the expression levels of catecholamine pathway products during the occurrence and development of the tumors.