Objective To investigate the efficacy and safety of plasmakinetic enucleation and resection of the prostate by divided into three parts and blocking blood flow in advance (PKERPDPB). Methods 158 patients with BPH were randomly divided two groups: 81 patients treated by plasmakinetic enucleation and resection of the prostate by divided into three parts and blocking blood flow in advance (PKERPDPB), 77 patients treated by plasmakinetic resection of the prostate (PKRP). All patients were evaluated preoperatively and at 1, 6, 12 months after surgery by IPSS, QOL, Qmax and PVR. Operation time, resected adenoma weight, catheterization time, hospital stay and complications were documented. Results There were no significant differences in preoperative parameters. The resected adenoma weight in the PKERPADPB group was heavier than that in the PKRP group, the difference was significant. Compared with PKRP, PKERPDPB required a longer operation time, but resulted in less hemoglobin decrease, less catheterization time and hospital time. During the 1, 6, 12 months of follow-up, there was no significant difference in Qmax, IPSS, PVR and QOL between the groups. Conclusion PKERPDPB was statistically superior to PKRP in blood loss, catheterization time, hospital stay but inferior in operation time. It was a safe and effective treatment for BPH.

Objective To investigate the clinical efficacy of inserting a ureteral access sheath under direct view in flexible ureteroscopy with the help of rigid ureteroscope.Methods From March 2013 to July 2015,there were 68 patients accepted a ureteral access sheath in flexible ureteroscopy with the help of rigid ureteroscope for the treatment of kidney stones.There were 46 cases male,22 cases female,aged from 22 to 76 years old,average 43.9 years.There were 68 cases with backaches or hematuria.There were 48 cases with single stone,20 patients with multiple stones.There were 5 cases with stones on both sides.The stone diameter were from 1.2 to 2.5 cm,the average (1.83 ± 0.16) cm.There was no hydronephrosis in 18 cases,mild hydronephrosis 42 cases.The operations were carry out under general anesthesia.By using rigid ureteroscope placed zebra guidewire,then intercept F8 single lumen tip to 1.0 cm section on rigid ureteroscope,was placed into a modified 42 cm ureteral access sheath.Then the modified 42 cm ureteral access sheath was inserted under direct view with the help of rigid ureteroscope.Preoperative patient characteristics,radiographic stone size,operation time,success rate of lithotripsy,serious complications especially ureteral injury was recorded.4 weeks and 12 weeks after operation,ultrasound and/or CT were reexamined to assess the success rate of lithotripsy and the incidence ureteral stricture.Results All the procedures were successful.The operation time was (62.2 ± 6.5)min,the hospital stay was (3.1 ± 0.2) d.The success rate of ureteral access sheath completely placement was 97.1％,partially placement was 2.9％.Postoperative complications included Clavien classification grade Ⅰ 6 cases and grade II 2 cases.The postoperative follow-up averaged (12 ± 1.2) months for all case.The success rate of lithotripsy was 76.5％ in 4 weeks postoperative,and it was 95.6％ in 12 weeks.During the follow-up,compared with the preoperative cases,62 cases were not found to increase the degree of hydronephrosis.There were 58 cases (58/62) without hydronephrosis.4 cases were mild hydronephrosis (4/62).CT showed normal ureter 52 cases (52/52).Conclusions It was safe and reliable procedure with good results.It would be a safe procedure to inserting a ureteral access sheath under direct view in flexible ureteroscopy with the help of rigid ureteroscope.

The placement of the flexible ureteroscopic sheath during lithotripsy may injure the ureter. We have developed a double-tube flexible ureteral access sheath. Thirteen patients with renal calculi were treated with double-tube and flexible sheath in one stage. CT examination of 13 cases showed that the ureter was normal. The double-tube flexible ureteral access sheath makes the operation of sheathing easy, safe and effective.