[Objective] To Compare the effectiveness of conventional local anesthesia (CLA) and two-plane local anesthesia (TPLA) in percutaneous nephrolithotomy (PCNL) so as to provide reference for clinical selection of appropriate anesthetic methods. [Methods] Clinical data of 345 patients with renal or ureteral calculi who underwent PCNL under local infiltration anesthesia in our hospital during Jan.2013 and Dec.2023 were retrospectively analyzed.The patients were divided into CLA group (n=114) and TPLA group (n=231) according to anesthetic methods.The intraoperative visual analogue scale (VAS) score, stone-free rate and incidence of complications were compared between the two groups. [Results] There were no significant differences in the baseline data between the two groups (P>0.05). When the cutaneous and renal channels were established, the VAS score was lower in the TPLA group than in the CLA group [(3.2±0.5) vs. (3.8±0.4), P=0.023]. However, there was no significant difference in the VAS score during lithotripsy [(3.3±0.5) vs. (3.4±0.5), P=0.061]. There were no significant differences between the two groups in terms of operation time, stone-free rate, hemoglobin drop, postoperative hospital stay, and time to remove nephrostomy tube and DJ tube retention time (P>0.05). [Conclusion] Both CLA and TPLA can provide good analgesia in PCNL, but TPLA can significantly reduce the pain sensation when the cutaneous and renal channels are established.

Objective To investigate the changing trends in etiology and treatment of male urethral stricture in recent 10 years.Methods A total of 940 male patients with urethral stricture admitted to the Department of Urology of Beijing Jishuitan Hospital during Jan.2013 and Dec.2022 were continually collected.The clinical data were divided into two groups according to the time of admission,namely the group from 2013 to 2017 and the group from 2018 to 2022,for a comparative analysis of the previous and subsequent 5 years.The etiology,location,length and the type of treatment of urethral stricture were retrospectively analyzed.Results The causes of the 940 cases of male urethral stricture were trauma in 447(47.55％),iatrogenic injury in 220(23.40％),idiopathic causes in 128(13.62％),lichen sclerosus(LS)in 78(8.30％),infection in 46(4.89％),and other causes in 21(2.23％).The treatment methods were urethroplasty in 691(73.51％),direct vision internal urethrotomy(DVIU)in 122(12.98％),urethral dilatation in 86(9.15％),and suprapubic cystostomy in 41(4.36％).Compared with the previous 5 years,in the past 5 years,the proportion of urethral stricture caused by trauma decreased significantly(60.34％vs.41.71％,P＜0.001),while the proportion of iatrogenic injury increased significantly(17.63％vs.26.05％,P=0.005).In the past 5 years,the proportion of urethroplasty increased from 68.81％to 75.66％(P=0.027),while the proportion of DVIU decreased from 19.66％to 9.92％(P＜0.001).Inthe past 5 years,the proportion of membranous urethral stenosis decreased significantly(26.98％vs.50.85％,x2=51.06,P＜0.001),the proportion of penile urethral stricture(21.40％vs.7.80％,=26.37,P＜0.001)and meatal stenosis(9.30％vs.4.75％,x2=5.80,P＜0.001)increased significantly.Conclusion In the past decade,trauma was the main cause of male urethral strictures,but its proportion showed a decreasing trend.Iatrogenic injury led to a gradual increase in urethral strictures,which was the second leading cause of male urethral stricture.The application of urethroplasty increased significantly,making it the main treatment method for male urethral stricture.

Objective:To evaluate the efficacy of low-intensity extracorporeal shock wave therapy (LI-ESWT) in patients with traumatic erectile dysfunction.Methods:The present study included 62 patients with traumatic erectile dysfunction, including 30 patients treated with low intensity shock waves and 32 controlled patients. The treatment groups were performed six times (twice per week), each by 3 000 impulses. The follow-up was performed 4, 8 and 12 weeks after LI-ESWT. The International Index of Erectile Function-5 (IIEF-5), nocturnal penile tumescence (NPT) and the Erection Hardness Score (EHS) were used to evaluate the therapeutic efficacy of LI-ESWT.Results:LI-ESWT could significantly improve IIEF-5 (15.67±3.89 vs. 9.41±4.66, P<0.01). 67% of patients in the LI-ESWT group and none of the control group answering 'yes’ to the SEP-Q2 elevated. In the low intensity shock wave treatment group and the control group 67% and 0 of patients, respectively, achieved erection hard enough for vaginal penetration, that is an EHS (Erection Hardness Score) of 3 ( P<0.01). According to changes in the IIEF-5 score treatment was effective in 70% of men who received low intensity shock wave treatment but in none in the control group ( P<0.01). Therapeutic efficacy could last 12 weeks ( P<0.05). No adverse events were reported during and following treatment. Conclusions:These studies suggest that LI-ESWT could improve the IIEF and EHS of traumatic ED patients.

Objective To summarize the long-term efficacy of oral mucosal urethroplasty.Methods The clinical data of 324 patients with anterior urethral stricture who underwent oral mucosal urethroplasty from January 2013 to May 2018 were retrospectively analyzed.The patients were 27-65 years old with an average age of 47 years.Among them,51 patients had urethral meatal stenosis,174 patients had penile urethral stricture and 99 patients had bulbar urethral stricture.The length of urethral stricture was 2.8-14.0 cm,with an average of 6.4 cm.The preoperative maximal urinary flow rate Qmax was 3.2-8.4 ml/s,with an average of 4.8 ml/s.In the urethral meatal stenosis group (51 patients),15 underwent urethrotomy and 36 underwent meatal urethroplasty.In the penile urethral stricture group (174 patients),ventral sagittal incision was done in 21 patients,subcoronal circumferential incision in 49 patients and midline perineal incision in 104 patients.The perineal incision or verted Y incision were done in all the bulbar urethral strictures.Results The patients were followed-up for 3-75 months,with an average of 35.0 months.The results were satisfied in 290 (89.5％) patients.The post-operative maximal urinary flow rate Qmax was 15.8-32.2ml/s,with an average of 21.5 ml/s.Thirty-four patients (10.5％) developed recurrent urethral stricture,including 7 patients in the urethral meatus,17 patients in the penile urethra and 12 patients in the bulbar urethra.Among the recurrent urethral stricture patients,18 treated with the dilatation and 16 treated with the urethroplasty.Five patients (1.5％) developed fistula,including 2 patients in the ventral sagittal incision,1 patient in the circumferential incision and 2 patient in the perineal incision.Conclusions The long-term effect of oral mucosal urethroplasty is realistic.The rate of urethral stricture recurrence and fistula is low.The recurrence can be treated again by urethroplasty.The surgical approach for oral mucosa urethroplasty depends on the location and length of the anterior urethral stricture.

Objective To analyze the clinical outcome of definitive perineal urethrostomy for the treatment of complex adult anterior urethral strictures.Methods From June 2012 to February 2018,28 patients who underwent the definitive perineal urethrostomy for a complex anterior urethral stricture were retrospectively reviewed.The mean age of the patients was 62.3 (range 34 to 77) years and stricture etiology was lichen sclerosus in 46.4％ (13/28) of the cases,iatrogenic stricture after transurethral resection of the prostate in 35.7％ (10/28),failed hypospadias repair in 10.7％ (3/28),infection 3.6％ (1/28)and idiopathic etiology 3.6％ (1/28).The mean stricture length was 9.6 (range 4.5 to 16.0) cm and the stricture length ＜5 cm in 7.1％ (2/28) of the cases,5-10 cm in 35.7％ (10/28) and ＞ 10 cm in 57.1％ (16/28).0f28 patients 21 (75％) underwent prior urethral dilation,4 (14.3％) underwent direct vision internal urethrotomy (DVIU) and 17 (60.7％) underwent urethroplasty.Among the medical history of interest,hypertension was observed in 17 patients (60.7％),chronic ischemic heart disease in 11 patients (39.3％),diabetes mellitus in 9 patients (32.1％) and chronic obstructive pulmonary disease (COPD) in 9 patients (32.1％).All patients completed the perineal urethrostomy with inverted U-shaped perineal skin flap.The patient was placed in a normal lithotomy position and an inverted U-shaped perineal incision was made.We can get an inverted U-shaped perineal skin flap after dissecting along the bulbospongiosus muscle.The bulbar urethra was opened along the ventral surface and the margins of the spongiosum tissue were closed with perineal skin flap.We analyzed the clinical characteristics of the patients,the outcome of the technique and investigated the satisfaction rates of the patients by outpatient follow-up or telephone interview.Surgical success was defined as functional voiding without the need for further procedures.Results The perioperative complications included 3 cases of urinary tract infection,1 case of bleeding and 1 case of wound dehiscence.Mean follow-up length was 27.2 (range 6.0 to 64.0)months.Of 28 cases 26 (92.9％) were successful and the mean maximum urinary flow rate was 26.5 (range 17.0 to 40.0) ml/s.Postoperatively,2 cases of urethrostomy strictures were found in 2 months and 4 months,respectively.They required periodic outpatient dilation and the younger one was in the waiting list for revision of the perineostomy and the older one refused the revision.Of 28 patients 24 (85.7％) were satisfied with the results obtained with surgery,15 were very satisfied,9 cases satisfied and 4 cases dissatisfied.Conclusions The successful rate of the definitive perineal urethrostomy for the complex adult anterior urethral strictures was high and patients were satisfied with the outcome of the surgery.The definitive perineal urthrostomy is a well-tolerated treatment option for patients with complex anterior urethral strictures,especially for those aged and with extensive comorbidities.

Objective? To construct the certification evaluation index system for specialized nurse in operating room in accord with nursing practice in China, so as to provide a reference for administrative department to formulate the standards. Methods? From November 2017 to February 2018, we established the certification evaluation index and standard for specialized nurse in operating room by literature review, expert interview and Delphi method, and we tested the reliability of expert enquiry by the concentration degree of expert opinion, coordination coefficient, active coefficient and authority coefficient. The analytic hierarchy process was used to determine the indexes and weight of evaluation standards. Results? A total of 22 experts participated in the study. Among two rounds of enquiries, the active coefficients were 86.67% and 84.62% respectively, and authority coefficients were 0.89 and 0.93 respectively. In the second enquiry, the coordination coefficient was 0.215. The certification evaluation index system for specialized nurse in operating room consisted of 8 primary indexes, 28 secondary indexes and 76 evaluation criteria. The weight of primary indexes, secondary indexes and valuation criteria ranged from 0.031 4 to 0.275 8,from 0.002 0 to 0.206 9 and from 0.000 7 to 0.137 9 respectively. CI values of comparison matrix were from 0 to 0.0480 and CR values were from 0 to 0.053 3. Conclusions? The certification evaluation index system for specialized nurse in operating room is reliable, which can be a reference standard for certification evaluation for specialized nurse in operating room.

Objective To assess the value of procalcitonin (PCT) levels compared to C-reactive protein (CRP) levels and blood white cell count in early detection of sepsis following percutaneous nephrolithotomy.Methods This prospective observational study included 91 patients,including 59 male patients and 32 female patients,undergoing percutaneous nephrolithotomy between April 2014 and October 2015.Their mean age was (54 ± 15)years old,ranging 15 to 88 years old.The average size of stone was (20.9 7.0) am.Those patients were classified into two groups,based on whether the postoperative sepsis existed.In this group,51 cases were concluded in the sepsis group and 40 in the non-sepsis group.A statistically significant difference between patients with and without sepsis was found in the hydronephrosis (44 vs.25,P =0.009),urine white cell count [(402 ± 970) / μ1 vs.(70 ± 171) / μ1,P ＜ 0.01],positive urine culture(36 vs.20,P ＜ 0.05),positive pelvic urine culture (22 vs.5,P =0.001).There was not any significant difference in sex,age,size of calculi and blood culture between patients with and without sepsis (P ＞ 0.05).Blood white blood cell count,CRP,and PCT were measured in patients with an acute onset of sepsis.Diagnostic accuracy of PCT values was analyzed by the receiver operating characteristics (ROC) curve.Results A statistically significant difference between patients with and without sepsis was found in the PCT [(7.43 ± 10.15)μg/L vs.(0.14 ± 0.10)μg/L,P ＜ 0.01] and blood white cell count [(14.18 ± 6.47) × 109/L vs.(11.22±4.22) × 109/L,P ＜0.05].There was not any significant difference in CRP [(64.93 ± 68.60) mg/ml vs.(70.76 ± 53.36) mg/ml,P ＞ 0.05] between patients with and without sepsis.ROC curve analysis showed that blood white cell count and PCT concentrations had similar predictive values for the development of sepsis (area under the curve,0.78 and 0.90,respectively) with the best cut-off values of blood white cell count for 12 × 109/L (sensitivity 50％,specify 88％) and 0.5 μg/L (sensitivity 64％,specify 100％)for PCT.54 cases were performed blood culture,which showed positive in 12 cases and negative in 42 cases.The significant difference of PCT level could be noticed in two groups [(16.99 ± 11.64) μg/ L vs.(3.77 ± 7.23) μg/ L,P ＜ 0.05)].No significant difference was found in CRP,Blood white cells count among those groups (P ＜ 0.05).ROC curve analysis showed that PCT concentrations had predictive values for the positive blood culture (area under the curve,0.80) with the best cut-off values of 8 μg/L (sensitivity 71％,specify 88％) for PCT.Conclusions PCT was a useful marker for the diagnosis of the sepsis after percutaneous nephrolithotomy as compared with WBC and CRP.

Objective To investigate the clinical study of sarcoside combined with tamsulosin in the treatment of type Ⅲ prostatitis. Methods 84 patients with type Ⅲ prostatitis who were treated and diagnosed in Jishuitan Hospital from November 2015 to December 2016 were randomly divided into experimental group and control group according to the time of hospitalization, 42 cases in each group. The control group was treated with tamsulosin hydrochloride sustained-release capsules, and the experimental group was treated with the addition of the new drug. The maximum urinary flow rate and mean urinary flow before and after treatment were recorded, compared and analyzed before and after treatment. Results The maximum urinary flow rate and mean urinary flow rate were increased in both groups after treatment, and there was significant difference between the two groups (P<0.05). The data of the maximum urinary flow rate and the mean urinary flow rate in the experimental group were significantly better than those in the control group. The data of the two groups were statistically significant (P<0.05). In addition, the experimental group after treatment of prostate symptom score was significantly better than the control group score, the two groups of data were significantly different, the data were statistically significant (P<0.05). In addition, the total effective rate of the experimental group was significantly higher than the control group(80.95%vs. 73.81%). The data were statistically significant (P<0.05). Conclusion The clinical efficacy of sorbenaside combined with tamsulosin in the treatment of type Ⅲ prostatitis is better than that of the original treatment. The treatment can improve the patient's urination and prostate symptoms and improve the patient's comfort.

Objective To investigate the clinical effect of antidepressants combined with α-blockers in the treatment of chronic prostatitis.Methods A retrospective analysis of 90 cases of chronic prostatitis treated in our hospital from January 2016 to December 2016 was divided into two groups according to the random number table.The control group was treated with α-blocker Combined with vitamin C treatment, the study group using antidepressants combined with α-blockers treatment.The NIH-CPSI score and SDS score were recorded before and after treatment, and the therapeutic effects were compared between the two groups.Results There were no significant differences in NIH-CPSI scores and SDS scores between the two groups.After treatment, the scores of NIH-CPSI and SDS were significantly better than those before treatment, and the study group was superior to the control(91.1%) was higher than that of the control group(71.1%), the total effective rate of depression(93.3%) was higher than that of the control group(73.3%), and the total effective rate was 91.1%, The difference was statistically significant(P<0.05),comparable.Conclusion Antidepressants combined with α-blockers are effective in the treatment of chronic prostatitis, which is beneficial to the alleviation of clinical symptoms and the improvement of their symptoms.Therefore, it has a good clinical value and worthy of further popularization.

Objective To investigate the efficacy of thorough rectal disinfection with povidone-iodine in prevention of postoperative infection of transrectal ultrasound-guided prostate biopsy. Methods A retrospective analysis was carried out on 520 patients who received transrectal ultrasound-guided prostate biopsy in our department from April 2014 to January 2017.To ensure the faeces were watery,all patients took polyethylene glycol electrolyte powder orally for bowel preparation the day before surgery.And all patients were asked to fast from 10 pm the day before biopsy. From April 2014 to June 2015,a total of 206 patients(Group A)were admitted to our department for transrectal ultrasound -guided prostate biopsy,who received routine rectal disinfection before biopsy,and the rectum was disinfected with povidone-iodine for 3 times. While from July 2015 to January 2017,a total of 314 patients(Group B)were admitted to our department for transrectal ultrasound-guided prostate biopsy,who received thorough rectal disinfection before biopsy,and the rectum was disinfected with the mixture of povidone-iodine solution and 5 milliliters of 2 % lidocaine solution for 20 times. There was no significant difference in patients′mean age,PSA or prostate volume between the two groups. All patients received 13 cores transrectal ultrasound-guided prostate biopsy using 18 gauge biopsy needles,and they all received infusion of 300 mg etimicin sulfate once daily for 2 days post operation to prevent infections.We analyzed the differences of infection rate between the two groups.Results Infectious complications were observed in 7(3.4%)patients in group A,while none(0%)in group B(P=0.004),indicating a significantly lower infection rate in group B than that in group A. Conclusions Thorough rectal disinfection with povidone-iodine is a safe,effective and low-cost way in preventing infectious com-plications after transrectal ultrasound-guided prostate biopsy,which is worthy of promotion in clinic.