Objective To study the clinical features of renal angiomyolipomas with tuberous sclerosis and to improve the recognization of this disease. Methods The diagnosis and treatment of 4 cases of tuberous sclerosis with bilateral and multiple renal angiomyolipomas were reviewed.The age range was 17 to 44 years,two of them were men.One patient presented with the classic triad:facial angiofibroma,seizures,and mental retardation.Facial angiofibroma occurred in three and seizures were found in two,three patients showed multiple extrarenal organ involvement including liver,spleen and bone.Brain CT revealed classical calcified cortical tuber and(or) subependymal nodule in three cases. Results The diagnosis of renal angiomyolipomas in three cases was affirmed on CT scan.However,the giant renal angiomyolipomas in one case can not be diagnosed from renal CT scan which did not demonstrate characteristic fatty tissue whereas the diagonsis was confirmed by ultrasound-guided right renal tumor biopsy and subsequent right nephrectomy for the large leisions.Regular monitoring of one patient was adopted for his mild symptomatic small renal leisions,the other two with hemorrhage in renal angiomyolipomas were reluctant to aggressive treatment and underwent conservative therapy.Follow-up ranged 6 to 36 months, none had recurrent symptoms and no significant growth of renal lesions was observed. Conclusions CT may not be pathognomonic for renal angiomyolipomas associated with tuberous sclerosis,needle biopsy may be needed to exclude renal carcinoma.The choice of treatment is based on tumor size distribution pattern,progression,and associated symptoms.

Objective To discuss the risk factor of infection after intracavity lithotripsy in upper urinary tract calculi,and establish a pre-operation warming score system.Methods From Jan.2013 to May 2016,412 upper urinary calculi patients who underwent intracavity lithotripsy were analyzed to evaluate the associated risk factors before operation and infection after operationg by non-conditional logistic regression analysis.The pre-operation warming score system was established by giving those risk factor 1-4 point based on OR value.The best threshold was then determined by ROC curve.Results Diabetes mellitus,infection history,renal calculus and uretero-pelvic junction calculus,stone burden,the degree of hydronephrosis and the gender of female were high-risk factors contributed to infection after intracavity lithotripsy,which were given 3,3,3,2,2,2point respectively based on their OR value(8.660,7.046,3.723,2.675,2.256,1.891),and the patients who got high socre were more likely to suffered infection.The sensitivity and specificity of the wanning score system for infection after intracavity lithotripsy were 74.3％ and 84.0％ respectively when its truncation point was 7.5 point(total score was 15 piont).Conclusions Patients who got more than 7.5 point according to the wanning score system were high risk groups of infection after intracavity lithotripsy.

Objective To investigate the value of procalcitonin (PCT) for urosepsis secondary to ureteral calculus.Methods Samples of 68 ureteral calculi patients who were suspected of urosepsis were obtained for PCT level,C-reactive protein (CRP) level,blood routine examination,urinary sediment,blood culture and urine culture.Sixty-eighy patients were divided into urosepsis group and non-urosepsis group based on the urosepsis diagnostic standard.The age sex,stone location,stone size,blood WBC count,CRP level,PCT level and urine WBC count were compared between the 2 groups.PCT levels before and after treatment were also compared.Results The age,stone size in urosepsis group were significantly higher than those in non-urosepsis group.The PCT levels of patients in urosepsis group and non-urosepsis group were 19.09±25.15 μg/L and 2.09± 1.85 μg/L respectively before treatment,and there was a significant difference between the 2 groups (P＜0.05).The blood WBC counts (× 109/L) of patients in urosepsis group and non-urosepsis group were 11.00± 3.47 and 10.27±2.32 respectively before treatment (P＞0.05).The CRP levels of patients in urosepsis group and non-urosepsis group were 17.41±15.24 mg/L and 15.02±4.94 mg/L respectively before treatment (P＞0.05).The median urine WBC counts (per HPF) of patients in urosepsis group and non-urosepsis group were 54 and 47 respectively before treatment (P＞0.05).The PCT levels of patients in urosepsis group before and after treatment were 19.09 ± 25.15 μg/L and 1.06 ± 0.56 μg/L,and there was a significant difference (P＜0.05).Conclusion PCT has a definite value for early diagnosis of urosepsis,condition assessment and treatment guideline.

Objective To evaluate the prognostic significance of carbonic anhydrase IX (CA IX) expression in patients with clear cell renal cell carcinoma (ccRCC). Methods CA IX expression in a cohort of 120 patients with ccRCC was evaluated by P-V immunohistochemistry with a rabbit CA IX polyclonal antibody. Twenty-five normal kidney tissues were used as a control. The relationship between CA IX expression and prognosis was analyzed by univariate and multiple-factor analysis (Cox regression model). The primary end point was cancer specific survival. Results One hundred and twelve (93.3%) patients were followed up with the median follow-up time of 45 months (range, 6 to 94 months). Seventy-five patients survived without evidence of tumor recurrence, 3 patients survived with tumor recurrence, and 34 patients died, 28 of the 34 died of cancer. CA IX expression was negative in all normal renal tissue. High CA IX expression was observed in 89 (74.2%) patients, among which 82 patients were followed up, and the disease free survival was 75.6% (62/82). Two (2.4%) patients survived with tumor recurrence, and 18 (22.0%) patients died, of which 13 (15.9%) died of cancer. Tumor recurrence and (or) metastasis occurred in 9 (11.0%) patients, with a median survival of 92 months in this high expression group. Low CA IX expression was observed in 31 (25.8%) patients, among which 30 patients were followed up, and the disease free survival was 43.3% (13/30). One (3.3%) patient survived with tumor recurrence, and 16 (53.3%) patients died, of which 15 (50.0%) died of cancer. Tumor recurrence and (or) metastasis occurred in 8 (26.7%) patients with a median survival of 53 months in this low expression group. Cancer specific survival between CA IX high expression group and low expression group was significantly different (P=0.000, χ2=15.950), and tumor relapse and (or) metastasis rates were significantly different (P=0.040, χ2=4.200). The 1, 3, 5 and 7 year cancer specific survival rates were 95.2%, 83.9%, 81.2% and 78.2% respectively in the high CA IX expression group, and 89.5%, 63.9%, 46.8% and 40.1% respectively in the low expression group. Multivariate analysis with Cox regression model showed that CA IX expression was a prognostic factor (RR=0.186). Conclusions High CA IX expression is negatively correlated with postoperative mortality, relapse and (or) metastasis in ccRCC. CA IX expression could be used as a prognostic biomarker in ccRCC.

Objective To evaluate the efficacy and safety of ureteral stenting after transurethral resection ( TUR) of bladder tumors involving the ureteral orifice.Methods From March 2009 to November 2015,34 cases of non-muscle invasive bladder tumor including 28 male and 6 female aged from 26 to 79 years( mean 51 years) were treated by TUR.14 cases had single tumor and 20 had multiple tumors,and 29 were primary and 5 were recurrent.All the patients had tumors involving the ureteral orifice without preoperative hydronephrosis revealed by IVU or CTU examination.The tumors were resected into the deep muscle layer and the involved ureteral orifices were resected during the procedure,and after that a double-J ureteral stent was placed in 18 cases.All patients received one immediate intravesical instillation of 50mg epirubicin after TUR, and further scheme of adjuvant intravesical chemotherapy instillations were made according to the pathological diagnosis.Ureteral stents were removed 10-12 weeks after TUR,and cystoscopy and urinary tract ultrasound examinations were performed every 3 months for 1-2 years postoperatively. Results The operations were successful without complications.No serious adverse reaction occurred in immediate and further adjuvant intravesical chemotherapy.During the follow-up period of 3-71 months, no ureteral stricture, hydronephrosis or tumor recurrence in the upper urinary tract occurred in all the 18 patients with ureteral stent, and the resected ureteral orifices recovered well with normal appearance and ejecting urine.Hydronephrosis was observed in 3 of 16 patients without ureteral stent including 2 cases of nontumoral stenosis at the ureterovesical junction requiring ureteral reimplantation and 1 case of lower ureteral tumor on the involved side requiring nephroureterectomy and bladder cuff excision.No patient complained of symptoms secondary to vesicoureteral reflux or continuous unrelievable lower urinary tract symptoms.2 cases of bladder tumor recurred out of the resected area.Conclusions Ureteral stenting after TUR of bladder tumors involving the ureteral orifice can prevent stricture at the ureterovesical junction without increasing the risk of tumor cell seeding along the upper urinary tract.The existence of a double-J ureteral stent does not increase complications of adjuvant intravesical chemotherapy, and also won't cause intolerable lower urinary tract symptoms.

Objective:To investigate the methods and complications of ultrasound-guided percutaneous nephrostomy (PCN) for treat-ing cancer-related hydronephrosis. Methods:From June 2003 to December 2015, 289 patients (342 kidneys) with cancer-related hy-dronephrosis were treated by ultrasound-guided PCN in Fujian Provincial Hospital. Among the 97 cases of renal insufficiency, 4 pa-tients were treated with hemodialysis before PCN. Except for the anterior mid calyx of nine kidneys in nine patients, the posterior mid or lower pole calyx of all other kidneys was punctured with ultrasound guidance. With the one-step PCN technique, 8F pigtail nephros-tomy tubes were placed into six kidneys in six patients;with the Seldinger PCN technique, 14F balloon and Malecot catheters were placed into 25 kidneys in 25 patients and 311 kidneys in 258 patients, respectively. Results:No severe bleeding and injury in the intes-tine, liver, spleen, pleura, or lung occurred. Two pigtail tubes were blocked one week after PCN. Seven balloon catheters failed to drain well because of the tip and balloon of the catheters located in the proximal part of the dilated ureters. Four balloons slipped out of the collection system of the kidney because of the auto-deflation of three balloons and one case of meager renal parenchyma failing to hold the balloon after a severe hydronephrosis was emptied. All, except 1, Malecot catheter drained well, and 8/9 PCNs through anteri-or mid calyx were successful. Serum creatinine levels were significantly decreased in all the 97 patients with renal insufficiency, of which 81 cases returned to normal, and no one needed persistent hemodialysis. Conclusion:Ultrasound-guided PCN is safe and effec-tive for treating cancer-related hydronephrosis. For appropriately selected patients, puncturing the anterior mid calyx may be an op-tion without additional complications. One-step pigtail nephrostomy tubes are recommended for patients with poor systemic condi-tions. For patients with long life expectancy or suspected complicated urinary infection, large sized Malecot catheters should be consid-ered.

Objective: To improve the diagnosis and treatment of primary adrenal cortical carcinoma. Methods: The clinical and pathological data of 11 patients who diagnosed as primary adrenal cortical carcinoma by pathology were retrospectively analyzed.The median age was 43 years, including 6 males, 5 females.7 cases(63.6%) got the tumor on the left.9 cases(81.8%) presented the maximum diameter of tumor more than 6 cm, and the average maximum diameter was 12.9 cm.All cases had CT or MRI imaging examination.Among most of them, CT showed mixed density lesions, or MRI showed mixed signal.Only 3 cases(27.3%) were considered adrenal cortical cancer through preoperative examinations. Results: 11 patients were treated with surgical treatment.Of them, 9 cases(81.8%) had complete resection of tumor.3 cases were lost to follow-up, while other 8 cases were followed up for 5-58 months.3 cases presented tumor-specific death at 5-15 months after surgery, with each 1 case in AJCC stage Ⅱ, Ⅲ and Ⅳ, respectively.Survive were in 5cases, and 3cases of them were tumor-free survival, while the other 2 cases of them had local recurrence. Conclusion Adrenal cortical carcinoma is very difficult to diagnose preoperatively.Adrenal cortical cancer should be considered when tumor size more than 4cm and tumor presenting inhomogeneous enhancement.Then, the surgical treatment should be performed as soon as possible, and as appropriate, chemotherapy and other comprehensive treatment should be given subsequently.Clinical and basic research such as genes test may provide more treatment options for advanced tumors in future.

Objective To determine the predictive parameters of impacted ureteral stones and evaluate the predictive value of ureteral wall thickness for impacted ureteral stones.Methods A total of 93 patients with proximal ureteral stones from January 2017 to December 2017 were included in the study [71 males and 22 females,aged 30-80 years,and body mass index (23.7 ± 2.7) kg/m2].Both clinical and computed tomography urography (CTU) data were compared between patients with or without impacted ureteral stone,including sex,age,body mass index,renal pelvic diameter,longitudinal size of stone,transverse size of stone,stone surface area,stone volume,hounsfield units of stone,diameter of the ureter proximal to the stone,and ureteral wall thickness at the impacted ureteral stone site.The receiver operating characteristic curve (ROC) was used to analyze the performance of each of the above-mentioned parameters for predicting the impacted ureteral stones.Multivariate logistic regression analysis was used to select the independent risk factors of impacted ureteral stones.Results Among 93 patients,38 (40.8％) patients were with impacted stones and 55 (59.1％) without impacted stones.Univariate analysis showed significant difference in ureteral wall thickness (t =6.344,P ＜ 0.001),diameter of the ureter proximal to the stone (U =607.5,P =0.001),longitudinal size of stone(U =580.5,P ＜0.001),transverse size of stone(t =4.172,P ＜0.001),stone surface area(U =508.5,P ＜ 0.001),stone volume (U =508.5,P ＜ 0.001) and hounsfield units of stone (t =6.344,P =0.006) between patients with or without impacted stones.Ureteral wall thickness(UWT)showed the largest area under curve (AUC) among those parameters (AUC =0.825,P ＜ 0.001),followed by stone surface area and stone volume.The optimal cut-off value of ureteral wall thickness was 3.16 mm,with sensitivity of 71.1％ and specificity of 85.5％.Multivariate analysis showed that ureteral wall thickness (Wald =18.709,P ＜ 0.001) and stone volume (Wald =8.391,P =0.004) were independent predictors of impacted stones.Conclusion Ureteral wall thickness was related to the presence of impacted ureteral stones and could be used for predicting impacted ureteral stones.