ObjectiveTo evaluate the efficiency of reversed vesical muco-muscular flap in the treatment of vesicoureteral reflux.MethodsFrom 1999 to 2000,a new anti-reflux operation was performed for 4 cases of vesicoureteral reflux (one with grade Ⅲ and three with grade Ⅳ) using reversed vesical muco-muscular flap.The vesicoureteral reflux was primary in 2 patients and secondary to ureteromeatotomy for the management of intramural ureteral calculi in the other 2.ResultsAll the 4 patients were successfully treated with this new technique.2 patients exhibited bladder irritation and spasm after operation,which were palliated in one month and vanished in three months.The lumbodynia and distending pain vanished during the follow-up (mean 22 months). Intravenous urography revealed normal renal function of the involved kidney.Hydronephrosis and ureteric dilatation were cured in 3 patients and significantly improved in 1.Voiding cystography demonstrated no reflux.The reconstructed ureteral orifice was labiate under cystoscopic view.ConclusionsThe anti-reflux operation is simple,convenient and effective in the treatment of vesicoureteral reflux.The postoperative bladder irritation is transient and shortcoming.

Objective To probe into the clinical and urodynamic features of primary bladder neck obstruction(PBNO) in females. Methods A retrospective analysis was made with comprehensive urodynamic evaluation in 61 cases with PBNO and 32 cases with genuine stress incontinence. Results According to the modified phentolamine UPP tests,there were 41 cases of internal sphincter spasticity(ISS)and 20 cases of bladder neck obstruction(BNO).The success rate of P Q plot analysis in the ISS group was lower than those of BNO and the control(49%vs 80% and 81%).94% of both ISS and BNO patients had a Lin PURR grading of ≥grade Ⅱ,whereas 99% of the control group were of grade 0 of I.There were a significant difference in such parameters as PVB,A G number(Pdet Qmax -2Qmax),post voiding residual,and maximum urethral closure pressure between the obstructed groups and nonobstructed group. Conclusions The meaningful diagnostic parameters for PBNO are Lin PURR grading(≥grade Ⅱ),PVB and A G number.The modified phentolamine UPP test is a reliable index for the assessment of internal sphincter sphincter functional obstruction.

Objective To evaluate Ho:YAG laser in the treatment of superficial bladder tumors. Methods 30 patients with superficial bladder tumors underwent endoscopic holmium laser resection with postoperative intravesical instillation therapy.There were 25 male patients and 5 famale with an average age of 54.The growth has been single in 15 and multiple in 15.The diameter of the tumor was 0.2～3.5 cm with the pathology grade G 1～G 2 and clinical stage T 1～T 2. Results The procedure has been successful in all and cold cup biopsies of the tumor base and incisal margin were negative.The mean resection time was 18 minutes,the mean volume of bleeding was less than 15 ml and no intraoperative bladder perforation or secondary hemorrhage occurred.All patients have been followed up for 3 to 14 months with a mean of 7.5 months.One patient (3%) had out-of-field recurrence. Conclusions Ho:YAG laser resection of bladder tumor (HoLRBt) provides an useful clinical therapeutic method that has the advantages of precise resection,simple technique,as well as no serious intraoperative or delayed complications.

Objective To highlight diagnosis and treatment of primary fibroepithelial polyp of ureter. Methods 7 cases of primary fibroepithelial polyp of ureter treated from May of 1990 to July of 2002 were analyzed retrospectively.Among them ,18～56 age of year,and right side in 5 cases,left in 2 cases.The foci are in upper,middle and lower part 2,3,2 cases respectively.The diagnosis was all ascertained on pathological studies. Results Hematuria and flank pain are the usual presentation.Preoperative image will reveal the lesion but the diagnosis of fibroepithelial polyp cannot be made by radiographic means alone.Surgical intervention was undertaken in all 7 cases.The initial case has undergone unnecessary nephroureterectomy as misdiagnosis of carcinoma of ureter.Surgical exploration and polypectomy was performed in 4 cases and polypectomy with holimlaser under ureteroscopy in 2 cases.The therapeutic results were satisfactory without relapse in 3 months～11 years follow up. Conclusions The diagnosis may be established with intravenous urogram and retrograde pyelography and surgical exploration may be performed when necessary.With the advent of ureteroscopy, a new minimally invasive approach to fibroepithelial polyp of ureter was introduced.

0.05).The urethral catheter was indwelled for a mean of 2.5 days(2-4 days).Follow-up examinations were conducted for 5-24 months(mean,17 months).At the first postoperative month,the IPSS and maximum urinary flow were 6.7?2.4 and 16.3?6.1 ml/s,respectively,both of which were significantly improved as compared with preoperative values(t=8.975 and 7.325,P

Objective To evaluate the effectiveness of a newly designed flexible,deflectable tip ureteroscope for the management of renal calyceal calculi. Methods We designed an actively deflectable tip, flexible ureteroscope for the treatment of renal calyceal calculi.From 2003 to 2004,25 patients with renal calyces calculi underwent deflectable,flexible ureteroscopic lithotripsy with holmium laser.Of them, 7 had concomitantly upper ureteral calculi.The mean diameter of the renal caliceal calculi was 1.3 cm (range,0.8-2.4 cm);and the mean diameter of the upper ureteral calculi was 0.6 cm (range,0.4-0.9 cm).The disease course ranged from 1 to 38 months with a mean of 17 months.Thirty days after the procedure, KUS showed no remnant fragmented calculi≥0.1 cm,suggesting clearance of the calculi.The completion rate of the procedure, lithotripsy rate and operative complications were analyzed. Results The procedure was successful in all the 25 patients with mean operative time of 28 min (range,19-45 min).The mean lithotripsy time was 11 min (range,5-22 min).No severe complication such as perforation of the ureter occurred during operation.The mean hospital stay was 3 d.The overall stone-free rate at 1 month after treatment was 92%(23/25). Conclusions The flexible,deflectable tip ureteroscope has the advantages of both rigid and flexible ureteroscopes,thus it is safe and effective in lithotripsy, especially for renal calyceal calculi of relatively small size.

From 1983 to 2000, 2 patients with squamous cell carcinoma of the renal pelvis associated with renal calculi were treated in our department. The literature was reviewed to discuss the diagnosis and the treatment. Both of the 2 patients presented with typical renal colic, gross hematuria and renal abscess. In one patient, renal pelvic tumor was diagnosed by CT before operation and radical nephrectomy was carried out after squamous cell carcinoma was detected with frozen section during operation. No recurrence was developed during a follow-up of 18 months. Another patient received systemic chemotherapy and died from cancer collapse after 4 months. Squamous cell carcinoma of the renal pelvis is uncommon and associated with renal calculi. Typically, these are poorly differentiated tumors with poor prognosis. Early diagnosis is difficult and radical nephrectomy is the first-choice treatment.

Objective:To compare the clinical characteristics of patients with Gleason score 3+4 and Gleason score 4+3 after radical prostatectomy for prostate cancer.Methods: The clinical records of patients who underwent radical retropubic prostatectomy in our hospital from 2001 to 2006 were retrospectively analyzed.Thirty-seven patients with a Gleason score of 7 after operation were divided into 2 groups,Gleason score 3+4 group and Gleason score 4+3 group,according to major grading.The patients were followed up for biochemical recurrence and distant metastases.Radioimmunoassay was used to detect the serum prostate-specific antigen(PSA) level.Kaplan-Meier method was used to compare the progression-free survival curves and Cox regression model was used to analyze the independent factors influencing the disease progression.Results: The rates of extraprostatic extension at radical prostatectomy were not significantly different between 3+4 and 4+3 groups(21.1% vs 33.3%,P=0.462).The non-progression survival time of 3+4 group was markedly longer than that of 4+3 group(P=0.030).Cox regression model showed that Gleason primary grade was an independent factor of prognosis(P=0.033).4+ 3 group had a higher risk for biochemical recurrence.Conclusion: Prostate cancers of Gleason score 7 with different grades have different biologic behaviors.The prognoses of patients in 3+4 group and 4+3 group are different after operation.It is quite feasible to further classify the patients with Gleason 7 according to major grades.

Objective To summarize the construction,upgrading process and clinical application of prostate cancer database (PC-Follow).Methods From September 2008 to December 2014,we designed two versions of off-line PC-Follow clinical databases based on Microsoft Access to support clinical follow-up and research in prostate cancer patients.Then,in order to achieve unified management of clinical data import and multi-center clinical research,we further upgraded PC-Follow to a browser/server (B/S) schema based web database.After upgrade,a simulated multi-center operation pattern was adopted to transfer all existed data-We then attempted to linkage our database with the hospital information system (HIS) and had eventually undertaken reality and stress testing on 3,124 cases'data migration in the hospital.The nationwide software testing and personnel training was conducted in 12 major medical centers.Results Twice of upgrade and alteration of schema of PC-Follow preserved the original user interface.Multiple functions,including data import,follow-up,research support,were obviously enhanced.Notably,the perfection in multi-user and hierarchical access control meet the future needs for multi-center clinical research.Via the import tool for PC-follow V3.0,we successfully migrated all data from the original one.After linking our database with the HIS software by one-way transmission protocol,the safety data extracting could be achieved.Specified administrators were appointed to process and analyze PC-Follow data in bulk,and data were voluntarily shared between attending centers,and showed stable performance on the 3,124 patients in our database.Feedback from nationwide multicenter training and testing indicated that our database was easy,readily accessible,with functionally stable modules,accurate website displays,and ideal response time.Conclusions The online PC-Follow database with hierarchical access provides support for multi-center clinical research in prostate cancer.The off-line PC-Follow database also grants certain degrees of data management for underdeveloped clinical centers,and it has its advantage to serve as prototypes for data migration to future online PC-Follow database once conditions are ripe.

Objective To present the clinical outcomes of 11 patients who underwent radical prostatectomy for incidental prostate cancer in transurethral resection. Methods From July 1995 to January 2001, we performed radical retropubic prostatectomy on 11 patients with incidental prostate carcinoma by TURP (clinical stage T 1a or T 1b ). Results There was no death or serious morbidity during the operation. Median operative blood loss was 650 ml. During the follow up (range 2～7.5 years,mean 4.5 years),all patients remained disease free,except for one who lost follow up.After nerve sparing potency was preserved in 4 of 7 sex active men,most returning patients got recovered by 1 year.Anastomotic stricture and complete incontinence occurred in 2 and 1 patient,respectively. Conclusions Radical prostatectomy may be performed safely with an acceptable morbidity rate following transurethral resection for benign prostatic hyperplasia.Prior transurethral resection will make the operation difficult during the radical prostatectomy.Furthermore,it is possibly associated with more long term complications,such as anastomotic stricture and impotence.The radical surgery should not be deferred more than 1 month after TURP.