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The efficacy of supine half-sitting lithotomy position in the treatment of upper ureteral calculi by surgery of ureteroscopic Holmium laser lithotripsy

Bao ZHANG ; Zhentao LEI ; Yuqiang SHI ; Lin YANG ; Weigang LIU ; Qiang GAO ; Jin SIMA

Chinese Journal of Urology.2017;38(12):937-940. doi:10.3760/cma.j.issn.1000-6702.2017.12.013

Objective To evaluate the efficacy and economic results in the treatment of upper ureteral calculi by surgery of ureteroscopic Holmium laser lithotripsy under the supine half-sitting lithotomy position.Methods To analyze the clinical data of upper ureter calculi patients who underwent ureteroscopy Holmium laser lithotripsy retrospectively.Patients in traditional lithotomy position with assistance of stone basket during the surgery were in group A.Those in traditional position surgery without stone basket were in group B.Those in supine,half-sitting,lithotomy position and without the assistance of stone basket were in group C.There were 62,31 and 75 patients in group A,B and C respectively.In group A,there were 32 males and 30 females;37 cases in left side,25 in right side,with degree of hydronephrosis of (2.9 ±0.6) cm and stone size of (1.7 ±0.4) cm.In group B,there were 18 males and 13 females;14 cases in left side,17 in right side,with degree of hydronephrosis of (2.8 ± 0.6) cm and stone size of (1.6 ±0.5) cm.In group C,there were 44 males and 31 females;36 cases in left side,39 in right side,with degree of hydronephrosis of (2.8 ± 0.7) cm and stone size of (1.7 ± 0.5) cm.There was no significant difference in aspects of age,degree of hydronephrosis and stone maximum diameter.Statistical analysis was performed regarding operation time,fee for hospitalization and stone free rate among the three groups.Results Ittook (71.8±9.6) min,(62.2±ll.4) min and (65.4±6.8) min in group A,BandC respectively,and there was significant difference among three groups.When comparing two groups respectively,the operation time in group A was more than group B and C significantly,while group B and C shared no difference.As for fees in hospitalization,they were (27.2 ± 4.0),(22.4 ± 5.0) and (22.4 ±3.8) thousand Yuan in three groups,and significant difference was found.By comparing two groups,we found that the fees in group A were more than group B and C significantly,while group B and C had no difference.Finally,stone free rate was compared among three groups,they were 90.3％,64.5％,96％ respectively,and there was significant difference as well.By further study,we found that stone free rate in group C was the highest,followed by A and B group.Conclusions There were higher stone free rates,less operation time and expense to perform ureteroscopic Holmium laser lithotripsy in supine half-sitting lithotomy position.

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Option of minimally invasive technique for living donor nephrectomy

Jianlin YUAN ; Geng ZHANG ; Weijun QIN ; Xiaojian YANG ; Lei YU ; Ping MENG ; Yanzhu WANG ; Guojun WU ; Rongliang QIN

Chinese Journal of Urology.2017;38(z1):49-53. doi:10.3760/j.issn.1000-6702.2017.z1.014

Objective To discuss the optimal operation mode and operation path in minimally invasive technique for living donor nephrectomy.Methods From September 2013 to August 2015, 68 living donor nephrectomy was retrospectively reviewed. Thirty-one patients were performed with robotic-assisted laparoscopic living donor nephrectomy(robotic group), twenty-nine patients underwent totally retroperitoneal laparoscopic living donor nephrectomy(non hand assisted group),and eight patients were performed with hand assisted retroperitoneal laparoscopic living donor nephrectomy(hand assisted group). Operation time, warm ischemia time, intraoperative hemorrhage volume, hospitalization time, complications and preoperative and postoperative serum creatinine value of the recipients between the two groups were compared.Results The operations of three groups were all performed successfully. Intraoperative hemorrhage volume in the three groups were(39±15)ml,(62±37)ml and(53±19)ml, and there were significant differences between these groups(P<0.05). But hospitalization time ,operation time, warm ischemia time and complications occurred rate in the three groups had no significant difference(P>0.05). In robotic group,2 donors occurred with splenic injury during operation and 1 donor was detected with hemorrhage after operation. In non-hand assisted group, 1 donor occurred with urinary tract infection, 1 donor occurred with external iliac vein thrombosis. In hand assisted group 1 donor was detected with wound fat liquefaction after operation. All the donors were followed up for more than 9 months, no hypertension, proteinuria and renal dysfunction complications were detected. The blood creatinine in three groups of recipients after operation of 5th day and 28th day were(118±26)μmol/L, (130±33)μmol/L,(128±41)μmol/L and(114±17)μmol/L,(116±34)μmol/L,(115±29)μmol/L, respectively, and there was no statistical difference(P>0.05).Conclusions Minimally invasive technique for living donor nephrectomy is beneficial to patients' recovery. Surgery doctors should combine personal experience and the hospital's hardware conditions and other factors. The principle is to ensure the donor's safety and to balance the interests of the donor and the recipient, to choose their own most skilled way of surgery.

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Malignant tumors after renal transplantation clinical analysis of malignant tumors after renal transplantation

Xingke QU ; Tao XU ; Kai MA ; Xiaowei ZHANG ; Xiaodan LI ; Xiaobo HUANG ; Xiaofeng WANG

Chinese Journal of Urology.2017;38(z1):45-48. doi:10.3760/j.issn.1000-6702.2017.z1.013

Objective To analyze and summarize the risk factors and treatment options of post-renal transplantation. Methods We reviewed 445 renal transplant cases from May 1991 to October 2016 from our hospital. And we had 24 patient received renal transplantation elsewhere who developed malignant tumor afterwards. Among them, 14 patients were male, and 10 patients were female. The age ranged from 42 to 61 years old, with an average age of 54.5 years. 22 patients underwent hemodialysis, with an average of 14.6 months; 2 patients underwent peritoneal dialysis, and the duration is 15 months. 19 patients underwent the transplant for the first time, and 5 patients underwent second transplant. 13 of them developed tumors, and the incidence is 2.9%. In the 24 tumor patients: 19 were urothelial cancer, accounting for 79% (9 renal pelvis and ureter cancer, 8 primary ureter urothelial cancer and 2 primary bladder urothelial cancer), transplant kidney cancer 1 case, thyroid cancer 1 case, colon cancer 1 case and lymphoma 1 case. We analyzed the incidence rate of tumor, type of tumor, time to malignant tumor after surgery, time to diagnosis of tumor after surgery, usage of immune-suppressive medications and prognosis to stratify risk factors of malignant tumor development.Results Only 1 patient with lymphoma underwent chemotherapy, other 23 patients underwent radical operations. All the patients underwent eradicative surgery of malignant tumor, except one patient with lymphoma underwent chemotherapy. Among the 21 patients with urinary system cancers: 2 patients underwent open surgeries (1 patient underwent semi-urinary system resection, 1 patient underwent transplant kidney partial resection), 2 patient underwent TURBT, 17 patients underwent laparoscopic renal pelvis and ureter kidney resection. 3 patients underwent secondary TURBT in one year, 2 patients underwent 3 operations due to recurrent. 18 of them remain healthy; 5 patients had tumor recurrence after the surgery and are deceased 3 years later.Conclusions Post-transplantation patients are susceptible to malignant tumor development, which is closely related to the use of immune suppressant after transplantation. The key to optimal treatment is to detect tumor at an early stage.

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A single center study of risk factors on short term prognosis after kidney transplantation from donors after cardiac death

Zhijian HAN ; Hongliang QUE ; Jun TAO ; Zhengkai HUANG ; Wanli ZHOU ; Shuang FEI ; Zhiwang TANG ; Xiaobing JU ; Ruoyun TAN ; Min GU

Chinese Journal of Urology.2017;38(z1):40-44. doi:10.3760/j.issn.1000-6702.2017.z1.012

Objective To discuss the risk factors on short-term prognosis after kidney transplantation from donors after cardiac death (DCD). Methods We retrospectively analyzed the information of donors and recipients who performed DCD donor kidney transplantation in our center between January 2011 and August 2015, including 64 donors and 95 recipients. Also, we analyzed the potential relationship among donors' clinical characteristics and the early recovery of graft function, including the incidence of delayed graft function(DGF)and the serum creatinine (SCr) on the 90th day, and infection rate after kidney transplantation.Results We found that when donors had the factors of WIT>10 min, urine volume<100 ml/h, SBP≤100 mmHg or a history of CPR, the incidence of recipients' DGF were 55.6%,73.3%,62.5%,77.8% respectively with a significant difference. Recipients would have more chance to be infected if donors have the following characteristics: male, older than 50 years, died of cerebral hemorrhage which was caused by cardiovascular diseases, WIT>30 min, treated in ICU for more than 10 days or infection. Conclusions Nowadays, DCD has become the main graft source in Chinese kidney transplantation. This research indicates that the donors' factors may affect the recovery of graft function and the incidence of infection after kidney transplantation to some extent.By evaluating rigorously and preserving quality of renal grafts carefully, DCD would become more safe and valid.

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The effect study of bladder perfusion with sodium hyaluronate combined with ultrashort wave in treatment of glandular cystitis

Yongliang NI ; Haixin WANG ; Qiang ZHOU ; Benkang SHI

Chinese Journal of Urology.2017;38(z1):34-39. doi:10.3760/j.issn.1000-6702.2017.z1.011

Objective To evaluate the efficacy of bladder perfusion with sodium hyaluronate combined with ultrashort wave irradiation in bladder region in treatment of glandular cystitis.Methods 22 patients diagnosed as typical glandular cystitis were selected from our hospital between March 2013 and March 2013. Those patients were given bladder perfusion with sodium hyaluronate combined with ultrashort wave irradiation in bladder region according to the designed course. The lesion areas were taked photos and bited samples for microscopic observation and HE staining.The evaluation indicators include pelvic pain and urgency/frequency symptom scores,cystitis histologic scores ,infiltrating lymphocyte counts, Brunn nest or cystica counts and residual urine volume were measured in the self-control expertiment before treatment and after. Results Over the course of treatment, above mentioned indicators had significant improvement compared with original data among those patients (P<0.01).Only 1 patient appeared itchy skin two times after bladder perfusion with sodium hyaluronate, others without serious complications. Conclusions The method that bladder perfusion with sodium hyaluronate combined with ultrashort wave irradiation has clear effect without serious complications.This method provides a new train of thought for glandular cystitis and opens up a new space.

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Comparison of application and effects of different urostomy education paths on patients with creation of urostomy

Weihong WANG ; Danfeng SHI ; Hongping YAO ; Qin ZHOU ; Yichao HU

Chinese Journal of Urology.2017;38(z1):72-75. doi:10.3760/j.issn.1000-6702.2017.z1.020

Objective To explore effects of different urostomy education paths in patients undergoing cystectomy with creation of a urostomy.Methods 42 cases of patients after radical cystectomy with creation of a urostomy were randomly divided into the control group and the observation group. The control group received the original version of urostomy education path, while observation group received modified version of urostomy education path. Knowledge of urostomy, stoma bag replacing skills, and length of hospital stay were compared between the two groups. Results Patients in the observation group who received modified version of urostomy education path showed better knowledge of urostomy and skills of replaceing stomy bag, as well as shorter hospital stay (P<0.05).Conclusions Our modified version of urostomy education path results in improved self-care ability among patients and their family members. It suggests the urostomy education needs constant innovation and enhancement on the basis of practice.

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Application of the systematic nursing management of "one specialty with four kinds of standardizations" in transrectal ultrasound guided prostate biopsy

Chan WU ; Aiguo WANG ; Ling ZHANG ; Ye ZHANG ; Huiqing WANG ; Yan WANG ; Xia SHENG

Chinese Journal of Urology.2017;38(z1):69-71. doi:10.3760/j.issn.1000-6702.2017.z1.019

Objective To discuss the application of the systematic nursing management of "one specialty with four standardizations" in transrectal ultrasound guided prostate Biopsy. Methods We have set up the "one specialty with four standardizations" method and accomplished the systematic nursing management in the management of transrectal ultrasound guided prostate biopsy in Changhai Hospital from September 2014 to February 2015. One specialty means to set up the prostate biopsy full-time nurses and the four standardizations means the standardization of selecting criteria, appointment procedures, working process and the post-biopsy work.Results The whole procedure of prostate biopsy has been simplified and clarified. This management helped to shorten the time for making the appointment, reduce the incidences of postoperative complications significantly and increase the patients satisfaction. It helped to build a well-defined responsibility for all the medical staff in prostate biopsy and make sure the reasonable medical resource distribution and the efficiency of medical work. It also maximized the health rights of the patients and medical safety. During the period when the "one specialty with four standardizations" nursing management was in effect, no biopsy related adverse event, disputes or protests occurred. Both the patients and the relatives satisfaction degree have been raised significantly.Conclusions The "one specialty with four standardizations" nursing management in prostate biopsy helps to simplify the appointment procedure and this management turned out to be safe and effect. It has achieved preferable results in clinical application and worth further spreading.

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The application of quality control circle in reducing operation associated actue pressure ulcers

Xiaofeng WU ; Chan YIN ; Yangyang JIN ; Xiaoying LU ; Xia SHENG

Chinese Journal of Urology.2017;38(z1):64-68. doi:10.3760/j.issn.1000-6702.2017.z1.018

Objective To study the role of quality control circle(QCC) in reducing operation-related acute pressure ulcer.Methods The QCC activity group composed by 13 nursing staff analyzed the current situation and causality of operation-related acute pressure ulcer,and made the pointed counter measures to reducing the incidence rate.Results Following the development of QCC activity,the incidence rate of operation-related acute pressure ulcer decreased from 1.83% to 0.73%. The sense of responsibility,communication,teamwork,motivation,quality control ability and harmony of all the group members were improved significantly after the activity.Conclusions The QCC activity could not only effectively reduced the incidence rate of operation-related acute pressure ulcer,but also consolidated our team spirit and enhanced the quality management capability of all team members.

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Construction of prostate cancer diagnosis model based on high throughput sequencing data

Funeng JIANG ; Xin ZHANG ; Chao CHEN ; Zhaodong HAN ; Yongding WU ; Weide ZHONG ; Yuxiang LIANG

Chinese Journal of Urology.2017;38(z1):61-63. doi:10.3760/j.issn.1000-6702.2017.z1.017

Objective We used the dataset base on high throughput sequencing data to construct a diagnosis model by ANN and GA.Methods We screened the Taylor_prostate datasets from GEO according to,then we used the GA to screen the datas further. Finally we used the ANN to analyze the datas and construct a diagnosis model. To validate the model,we used 10-folds crossvalidation as the inner validation and the datas from Grasso dataset( GPL6480 and GPL6848) were used as the outter validation.Results We got 5 genes ACADL,ACTG2, CACNA2D1,PCP4 and SPARCL1.And we used spss to get the AUC of the model which is 94.62.The result of validation is good.Conclusion The performance of the model is good because the AUC is larger than 0.5.

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Expression and significance of CD68 and TGF-β2 in benign prostatic hyperplasia

Haidong CAO ; Dongwen WANG ; Xiaoming CAO ; Wei ZHANG ; Xin WANG ; Changjian ZHAO

Chinese Journal of Urology.2017;38(z1):57-60. doi:10.3760/j.issn.1000-6702.2017.z1.016

Objective To study the expression and significance of CD68 and TGF-β2 in benign prostatic hyperplasia(BPH).Methods The immunohistochemistry PV two step method was used to detect the expression level of CD68 and TGF-β2 in 90 cases of benign prostatic hyperplasia and combined with clinical data were analyzed.Results Positive rate of CD68 as macrophages marker was 86%(77/90) in the epithelial cells,positive rate of TGF-β2 as transforming growth factor marker was 79%(71/90) in epithelial cells and stromal cells. Immune inlfammation mediated by macrophages,with coloring degree deepening,the degree of immune inlfammation increased,larger prostate volume(P<0.01),IPSS score higher (P<0.01),maximum urinary lfow rate lower(P<0.01),the dffierences between groups were statistically significant.Conclusions This point may indicate immune inlfammation play an important role in the development process of BPH and help to complete the pathogenisis theory.

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