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Clinical analysis of urolithiasis in pregnancy

Guoqing LIU ; Shilin ZHANG ; Jianfeng WANG ; Yongfu DUO ; Jierong LI ; Chunjing LI

Chinese Journal of Urology.2014;35(10):745-748. doi:10.3760/cma.j.issn.1000-6702.2014.10.007

Objective To analyze the risk factors of urolithiasis in pregnancy and the relationship between urolithiasis in pregnancy and pregnancy outcomes.Methods From January 2004 to December 2009,the clinical data of 162 pregnant women (Group A),diagnosed as upper urinary tract calculi,were reviewed,retrospectively.Their age ranged from 18 to 41 years (mean 24±5 years).Seven of them had history of urolithiasis before pregnant.At the same time,150 pregnant women without urinary stone (Group B) were also included in this study,whose mean age was 23±5 years.In addition,150 women without pregnant and urinary stone (Group C) were included in this study,whose mean age was 24±4 years.The blood and urine routine results,blood uric acid and electrolytes were recorded and compared among those groups.In group A,119 cases had symptomatic urolithiasis.Surgical intervention was performed in 24 cases and the conservative therapy was performed in 95 cases.The rates of abortion,premature delivery and cesarean delivery were compared between two groups.Results Compared group A with group B and group C,there were significant differences in the urine WBC (145.16±202.18 vs.46.00± 119.50 and 55.33 ± 145.36 per high power lens) and urine ketone body (2.41 ± 6.14 mmol/L vs.0.30± 1.75 mmol/L and 0.17± 1.26 mmol/L) (P＜0.05).Meanwhile,there were significant differences in the blood leukocytes [(11.39±3.89)× 109/L,(10.78±2.98) ×109/L vs.(6.21±1.48) × 109/L],the blood uric acid (331.12±215.22 μmol/L,329.32± 88.50 μmol/L vs.280.01±69.88 μmol/L),the urine protein (0.29±2.00 mmol/L,0.10±0.19 mmol/L vs.0.02±0.09 mmol/L),urine glucose (2.50±8.44 mmoL/L,2.35±8.63 mmol/L vs.0.25± 1.97 mmol/L) and urine erythrocyte (76.60±98.11,77.43±71.00 vs.13.77±37.93 per high power lens) (P＜0.05).In those patients with symptomatic urolithiasis,there was 1 case of abortion in the conservative treatment and surgery intervention groups,respectively.The premature delivery rate and cesarean delivery rate were 5.3％ vs.0％ and 17.9％ vs.4.2％,respectively.Conclusions The blood leukocytes,blood uric acid,urine protein,urine glucose and urine erythrocytes are significantly high in pregnant women than those in non-pregnant women.However,the relationship between those abnormality and urolithiasis in pregnancy is still indefinite.Since the urine leukocytes and ketone increase obviously,it might suggest that the occurrence of the urine calculi is related with the metabolism of nourishment and electrolytes,urinary tract infection in pregnancy.The surgery intervention may be a risk of fetus miscarriage.

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Primary retroperitoneal schwannoma: report of 11 cases

Guizhong LIU ; Qingjie WANG ; Guang SUN ; Yong XU ; Chunxiao XUE

Chinese Journal of Urology.2014;35(10):749-752. doi:10.3760/cma.j.issn.1000-6702.2014.10.008

Objective To study the diagnosis and treatment of retroperitoneal schwannoma.Methods Clinical data of 11 cases of primary retroperitoneal schwannomas were analyzed retrospectively from February 1990 to September 2014.There were 6 males and 5 females,with a median age of 46 years,and the median tumor size was 9.6 cm (4.5-12.3 cm).Seven cases were revealled due to physical examination,3 cases were revealled due to ipsilateral lower back pain or discomfort,and 1 case was revealled due to right lower extremity numbness.There were no clinical manifestations of hypertension or appearance shape change,and there were no abnormal findings in routine laboratory and endocrine examinations.Radiological examination showed a retroperitoneal mass.There were 3 cases in the left adrenal gland,1 case in the right adrenal gland,3 cases in the lower pole of left kidney and 4 cases in the lower pole of right kidney.Four patients were initially diagnosed as adrenal tumors,and 7 patients were diagnosed as kidney tumors.Results All the 11 cases underwent surgical resection,with 7 cases of complete resection,1 case of capsule resection,2 cases of partial resection and 1 case of biopsy.The pathology of immunohistochemical staining showed S-100 positive in 10 cases of benign retroperitoneal schwannomas.During the follow-up period for 1.5-24 years (median 14 years),no recurrence and malignance was observed.One case of malignant retroperitoneal schwannoma died of multiple metastases in 17 months after opreation.Conclusions Primary retroperitoneal schwannoma is rare and preoperative diagnosis is difficult.Clinical manifestations and radiological findings are usually nondiagnostic,and histopathology is the only way for final diagnosis.Complete surgical resection is proved to be the best choice.

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Ambulatory urodynamics monitoring system in diagnosis of female stress urinary incontinence

Jun LI ; Feng RU ; Dongwen WANG

Chinese Journal of Urology.2014;35(10):771-773. doi:10.3760/cma.j.issn.1000-6702.2014.10.014

Objective To compare the diagnostic accuracy of conventional urodynamic (CUD) and ambulatory urodynamic monitoring (AUM) in diagnosis of female stress urinary incontinence (SUI).Methods Forty women with SUI were prospectively enrolled and performed urodynamic studies after the ICI-Q-SF questionnaire.According to clinical symptoms,patients were divided into three groups:mild,moderate and severe group.Half patients in each groups performed CUD exam,and the other half of patients performed AUM exam.And two micturition cycles were recorded during AUM.Results There were no significant differrences in age,pregnant production times and ICI-Q-SF score between two groups.Three patients with SUI symptoms had negative findings in AUM group and 15 patients in CUD group (P＜0.05).Among women with SUI,1 1 patients had positive findings in AUM group and 2 patients in CUD group (P＜ 0.05).Conclusion AUM can provide objective evidence for the majority of patients with SUI than CUD.

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The value of urine derived prostate cancer gene 3 score for predicting the result of prostate biopsy : a meta-analysis

Yan LIU ; Yong XU ; Zhihong ZHANG ; Bangdong YANG

Chinese Journal of Urology.2014;35(11):841-844. doi:10.3760/cma.j.issn.1000-6702.2014.11.013

Objective To systematic review the clinical value of urine derived prostate cancer gene 3 (PCA3) scores for predicting the result of prostate biopsy during diagnosing the prostate cancer.Methods Articles related to the value of urine derived PCA3 score for forecasting the result of prostate biopsy during diagnosing the prostate cancer,published from inception to November 2013,were retrieved in the databanks including PubMed (1966-2013),CNKI (1979-2013),EMBASE(1988-2013),and Cochrane liberary.Meta-Disc 1.4 software was used to analyze data.According to the inclusion and exclusion criteria,the literatures were screened.And the quality of included literatures were evaluated.The pooled sensitivity,specificity,the likelihood ratio(LR) were calculated and summary receiver operating characteristic curve(SROC curve) was made.Results A total of 22 articles with 3 060 prostate cancer cases and 5 307 normal or BPH cases were included.Since there was heterogeneity between the studies,the data was calculated by the random effect model.The pooled sensitivity of PCA3 score was 63％ (95％CI:0.61-0.65) and the pooled specificity was 70％ (95％CI:0.69-0.72),respectively.The positive (P-LR) and negative likelihood ratio (N-LR) were 2.38 (95％CI:2.05-2.77) and 0.51 (95％CI:0.46-0.58),respectively.The diagnosis odds ratio (DOR) was 4.88 (95％ CI:3.83-6.21).Summary receiver operating characteristic curve area under curve (SROC AUC) was 0.7445,Q* index was 0.689,respectively.Conclusions The performance of urine derived PCA3 score has higher accuracy of detection than other method in the diagnosis of prostate cancer.It can be a novel and optional non-invasive test and an important adjunct test for predicting the result of prostate biopsy.

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Significance of the PADUA nephrometry scoring system in determining the operative method for T1 stage renal tumour

Yong LIU ; Detian JIANG ; Xin MAO ; Xiulong ZHONG ; Hong WANG ; Jianlei JI ; Shuxin SONG

Chinese Journal of Urology.2014;35(10):734-738. doi:10.3760/cma.j.issn.1000-6702.2014.10.004

Objective To evaluate the efficacy of preoperative aspects and dimensions used for an anatomical (PADUA) scores in determining the surgical approach for T1 stage renal masses.Methods From Jan 2010 to Dec 2012,clinical data of 122 cases (76 males and 46 females),who underwent surgery for T1 stage renal masses,were collected retrospectively.The mean age was 51 years(range 21-81) and mean body mass index was (22.8±3.9) kg/m2.Sixty-three tumors were found in left kidney and 59 in right kidney.Among them,78 patients were diagnosed as T1a stage and 44 patients were T1b stage.In patients with T1a stage,56 received nephron sparing surgery (NSS) and 22 received radical nephrectomy (RN).In patients with T1b stage,21 received NSS and 23 received RN.The PADUA nephrometry score was analyzed to evaluate their relationships to surgical type and the approach of NSS.Results According to the PADUA nephrometry score,the number of low risk,middle risk and high risk patients were 24,62,26,respectively.Inlow risk group,middle risk group and high risk group,the proportion of RN and NSS was 8.3％/ 91.7％,30.6％/69.4％,66.7％/33.3％.In 77 patients received NSS,the unmber of laparoscopic NSS and open NSS was 18 ∶ 4,25 ∶ 18,2 ∶ 10,respectively.The PADUA nephrometry score was significantly associated with the type of surgery (x2 =23.16,P＜0.01),and the NSS approach (x2 =13.57,P＜0.01).Tumor size (HR =2.79 ; 95％ CI,1.29-6.02 ; P＜ 0.01),percentage of tumor deepening into the kidney (HR =3.82; 95％CI,1.77-8.09; P＜0.01),longitudinal (HR=4.00;95％CI,1.83-8.72; P＜0.01),tumor relationships with renal sinus(HR=103.13; 95％CI,21.85-486.81 ; P＜0.01),tumor relationships with urinary collecting system (HR =15.11 ; 95％ CI,5.95-38.35 ; P＜ 0.01),rim tumor location (HR =3.50 ; 95％ CI,1.61-7.59; P＜0.01) were closely related with surgery approach.The correlation coefficients of relationship with renal sinus was highest (r=0.70).Conclusions The PADUA nephrometry score provides a simple,useful and stable system to character the salient renal anatomy and guide the surgery.Low risk group should consider the NSS as the first line therapy.NSS could also be chosen in the middle risk group.However,the renal anatomy in those patients should be referred.RN should be chosen in high risk group.

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Analysis of incidence and mortality of prostate cancer in cancer registration area in Zhejiang province from 2000 to 2009

Lingbin DU ; Huizhang LI ; Weimin MAO ; Chuanding YU ; Xianghui WANG

Chinese Journal of Urology.2014;35(10):757-761. doi:10.3760/cma.j.issn.1000-6702.2014.10.010

Objective To investigate the epidemic characteristics and trends of incidence and mortality of prostate cancer in cancer registration areas in Zhejiang province from 2000 to 2009.Methods Clinical data incidence and mortality of prostate cancer were collected from 6 cancer registration areas in Zhejiang province,including Hangzhou,Jiaxing,Jiashan,Haining,Shangyu and Xianju.Crude rates,standardized rate and change trend,age-specific rates and annual percent change (APC,95％ CI) of prostate cancer were checked,sorted and analyzed in Zhejiang Cancer Center.Results The prostate cancer incidence rate from 2000 to 2009 was 9.79/100 000,age-standardized incidence rates by world standard population (ASIRW) was 6.39/100 000,and the incidence cumulative risk of males aged 0-74 was 0.72％ ; while the mortality rate was 2.73/100 000,age-standardized mortality rates by world standard population was 1.74/100 000,and the mortality cumulative risk of males aged 0-74 was 0.14％.Age-specific incidence of prostate cancer remained low before 50,years old and peaked at over 85-year-old group (130.30/100 000).Age-specific mortality of prostate cancer increased after 55,and also peaked at over 85-year-old group (81.19/100 000).The annual prostate cancer incidence rate generally grew from 1.39/100 000 (2000) to 13.89/100 000 (2009),and the APC was 14.18％ (95％ CI,9.68％-18.98％).Meanwhile,the prostate cancer mortality rate also increased from 1.52/100 000 (2000) to 3.58/100 000 (2009),and the APC was 11.83％ (95％ CI,5.69％-18.33％).Conclusion Prostate cancer incidence and mortality in Zhejiang cancer registration areas increased sharply,and the prevention and treatment of prostate cancer should be strengthened.

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Repairing mechanism of adipose-derived mesenchymal stem cell for acute kidney injury in rats

Rongfu LIU ; Jiasheng GAO ; Guo FU

Chinese Journal of Urology.2014;35(10):778-781. doi:10.3760/cma.j.issn.1000-6702.2014.10.016

Objective To study the mechanism of adipose-derived mesenchymal stem cell (ADMSC) in treating rats ischemia/reperfusion (I/R) induced acute kidney injury (AKI).Methods From June 2011 to March 2012,AKI was induced in 40 male SD rats (weight 180-220 g) by clamping bilateral renal pedicles for 40 minutes.Another 8 SD rats (weight 60-80 g) were used to obtain the primary ADMSC from inguinal fat tissue.After being transferred by lentivirus,those cells were cultured for transplantation until passage two.Animals with AKI were then randomly treated by intraparenchymally injecting ADMSC/PBS solutions (ADMSC/PBS group,n =20) or PBS solutions only (PBS group,n =20) (2× 106 cells,100 μl).During injection,the solutions were injected into the upper,middle and lower part of left kidney.The HE staining from 5 rats in each group was used to detect the histological injury at 3 days and 4 weeks after injection,respectively.The apoptosis and proliferation of host renal cells were evaluated using TUNEL staining and PCNA staining.The serum levels of SCr and BUN in animals were measured at day 1,3,14 and 28 after injection.Results HE staining showed ADMSC/PBS group got a lower injury score compared with that in PBS group at 3 days and 4 weeks,respectively (2.0 vs.3.4,1.3 vs.2.6,P＜0.05).In the result of TUNEL staining,the mean number of apoptosis cells was 30 in ADMSC/PBS group and 55 in PBS group.In terms of PCNA staining,the mean number of proliferative cells was 35 in ADMSC/PBS group and 10 in PBS group.All those results suggested that ADMSC could significantly reduce apoptosis and increase proliferation of renal cell (P＜0.05,repectively).The levels of serum SCr in ADMSC/PBS group were lower than those in PBS groups at day 1,3,14 and 28,after injection,respectively (40 vs.70 μmol/L,32 vs.58 μmol/L,26 vs.38 μ mol/L,26 vs.37 μmol/L; P＜0.05).The similar results were shown in the levels of serum BUN between the 2 groups (15 vs.24 mmol/L,13 vs.20 mmol/L,10 vs.13 mmol/L,7 vs.10 mmol/L; P＜0.05).Conclusion ADMSC could repair AKI after acute I/R injury.

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Efficacy of laparoscopic nephron-sparing surgery without renal wound suturing

Xiaojun TIAN ; Lulin MA ; Shenrong ZHUANG ; Yi HUANG ; Shudong ZHANG ; Hai BI

Chinese Journal of Urology.2014;35(11):807-810. doi:10.3760/cma.j.issn.1000-6702.2014.11.003

Objective To evaluate the feasibility and clinical efficacy of laparoscopic nephron-sparing surgery without renal wound suturing.Methods From December 2012 to February 2014,9 patients (4 male,5 female) with renal tumor underwent laparoscopic nephron-sparing surgery without suturing in our hospital.The mean age in those patients was 56 years (range 42-72 years).The mass size ranged from 1.1to 3.8 cm (mean 2.4 cm).The location of tumor included 2 in left kidney,7 in right kidney.Meanwhile,6 tumors were found in the middle part of kidney,2 tumors were demonstrated in the lower part of kidney,and 1 tumor located in the upper part of kidney.The imaging examination confirmed that all tumors protruded the renal surface and infiltrated into the renal parenchyma about 0.1-1.2 cm,which could be defined as the peripheral renal tumor without the invasion of collective system.The retroperitoneal approach was used in all patients with 3 trocars.During the operation,the renal artery was exposed and fats surrounding or on the surface of the tumor were resected.The renal artery was occluded.Tumor excision was then performed using scissors.An incision was made at the point 0.5 cm away from the margin of the tumor,extending deeply to completely cut the tumor.Meanwhile,bleeding was controlled with bipolar diathermy.Then,the clamping of the renal artery was removed and the retroperitoneal pressure was reduced in order to check the site of bleeding.If the bleeding occurred severely,the kidney wound was sutured with 2-0 absorbable sutures.Otherwise,the coagulative glue was sprayed on the wound surface.Results In all the patients,the procedures were done without conversion to open surgeries.The renal wound suturing appeared in one case because the tumor infiltrated into the deep of the kidney and the bleeding could not be completely controlled by bipolar diathermy.Eight of 9 cases were successfully performed without suturing.The mean time of renal artery occlusion was 8 min (range 3-18 min).In our patients,the mean operation time was 120 min (90-180 min),and the mean blood loss was 60 ml (10-200 ml).None of the patients received blood transfusion during the surgery.The mean postoperative hospital stay was 7 days (5-9 days).No complications,such as urine leakage,bleeding occurred after the operation.All the patients were followed up with no recurrence of tumor.Conclusions Laparoscopic nephron-sparing surgery without renal wound suturing is feasible and safe for patients with the small and the depth of infiltration less than 0.5 cm tumor in the kidney.

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Survival analysis of renal cell carcinoma patients with bone metastases treated with targeted therapy

Kewen ZHENG ; Hanzhong LI ; Yongqiang LI ; Yushi ZHANG ; Jianhua DENG

Chinese Journal of Urology.2014;35(11):811-814. doi:10.3760/cma.j.issn.1000-6702.2014.11.004

Objective To investigate the prognostic related factors in patients with renal cell carcinoma(RCC) and bone metastases,treated by targeted therapy.Methods Forty-five patients with RCC and osseous metastases were treated by targeted therapy between June 2006 and April 2013.The mean age was 59 years (range 32-81 years) with 33 male cases and 12 female cases.Twenty-seven cases were diagnosed as RCC accompanied with bone metastases initially,and the median time between the diagnosis of RCC and that of osseous metastasis for the other 18 cases was 12.5 months.All the cases underwent target therapy with sorafenib in 38 cases and sunitinib in 7 cases.Data was retrospectively analyzed and the relationship between several clinical features and overall survival (OS) was examined univariately.The Cox proportional hazards model was then performed multivariately to identify the independent risk factors.According to the independent risk factors,RCC patients with osseous metastases were categorized into high risk group (≤ 1 favorable factors) and low risk group (＞ 1 favorable factors).The median OS in those groups was compared.Results The median OS from the diagnosis of bone metastasis was 19 months,and overall survival was 74.7％ at 1 year,and 32.7％ at 2 year.Clinical features correlated with longer survival in the multivariate analysis were the absence of osseous metastases when initially diagnosed as RCC (HR:2.401,95％CI:1.210-5.699),the resection of primary renal tumor (HR:2.635,95％CI:1.021-6.307) and the absence of extraosseous metastases (HR:2.323,95％CI:1.003-6.221).The median OS of high risk group in 23 patients was 16months.On the other hand,22 patients in the low risk group had a longer median OS with 22 months.There was a significant difference in median OS between the two groups (P＜0.05).Conclusions The three prognostic factors including the absence of osseous metastases when initially diagnosed as RCC,the resection of primary renal tumor and the absence of extraosseous metastases could be favorable factors for RCC patients with bone metastasis treated with target therapy.

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Clinical significance of multispectral imaging in cystoscopic examination

Xiaofeng YANG ; Xiaojing ZHANG ; Sen YANG ; Ziqiang ZHANG ; Nan YIN ; Wei ZHANG ; Dongwen WANG

Chinese Journal of Urology.2014;35(11):819-823. doi:10.3760/cma.j.issn.1000-6702.2014.11.006

Objective To explore the imaging characteristics and clinical value of multispectral cystoscopy.Methods From May 2011 to May 2013,31 male and 4 female patients were included in this study,including benign prostatic hyperplasia in 14 patients,bladder tumor in 16 patients,upper urinary tract disease alone in 5 patients.The mean age in this group was 56 years (range 43 to 84 years).All patients accepted the bladder CT scan for diagnosis.TURBT procedure and pathological examination were performed in those patients with bladder tumor.Under the epidural anesthesia,the 27 F resectoscope was inserted to bladder through the urethra.Then,the conventional light source was replaced by multispectral endoscope light source.The white light,UV-light (401.0 nm),blue light (467.6 nm),green light (534.2nm),red light (660.6 nm),and near-infrared light (763.8 nm) were used,subseqently.Meanwhile,the following data were recorded,such as the visibility of bladder cavity,the color of bladder tumors and bladder mucosa,the density of blood vessels,three-dimensional structure of blood vessels,the mobility between mucosa and submucosa.Results When UV-light and near-infrared light irradiated bladders,there were not any imaging on monitor.However,the bladder mucosa and submucosa blood vessels were showed clearly and constituted the three-dimensional blood vessel network when using green light.The density of blood vessels in mucosal and submucosal layer was increased but less clarity when using blue light.The mucosal surface was covered in red when using red light,which vascular and mucosal can not able to be distinguished.Among 16 patients who were accepted the TURBT procedure,seven cases with T1 stage tumors were resected to the submucosa by TURBT.The superficial muscle layer with integrity structure could be observed under white light.While,blood vessels were not appeared when using green light.In six cases with Ta stage tumors,the clear connection of blood spots between mucous blood vessels and the blood vessel from the tumor could be observed under the green-light conditions.In three patients with Tis stage tumors,the mucosal blood vessels were normal under the white-light after tumor resection.However,structural disorder could be found under the green-light,which should be highly suspected as Tis stage tumors.Conclusions Without any photosensitizer or fluorescent dye,tumor blood vessels and bladder mucosal vascular can be showed under the green light.This technique is useful for identify the minimal tumor and evaluate the carcinoma infiltrated depth.

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