Objective To evaluate the success rate during ultrasound-guided percutaneous nephrolithotomy (PCNL) and analyze the reasons of puncture failure. Methods A retrospective analysis was performed based on the data of 58 patients who underwent ultrasound-guided PCNL by 4 experienced urologists(10 years' experience of PCNL and more than 80 cases per year)in our center from August 2018 to November 2018. Of all the 58 patients, there were 36 males and 22 females (aged from 22 to 73 years) with the mean age of 51 years. The calculi ranged from 9 mm to 93 mm, with the average of 26.5 mm. The separation of renal collecting system ranged from 5 mm to 30 mm, with the average of 15.1 mm. All of the 58 patients underwent one-stage PCNL and the numbers of punctures, the numbers of percutaneous tubes and the reasons for failure were recorded. Results All percutaneous tubes and surgeries were established and done successfully. Of all the 118 punctures, 74 punctures succeeded by detecting the urine and 68 surgery tracts were established (6 punctures failed because of the dilation). The total puncture success rate was 62.7%(74/118). Of the total 74 successful punctures, 56.8%(42/74)succeeded at the first puncture, 28.4%(21/74)succeeded at the second puncture and 14.9%(11/74)succeeded at least after three punctures. The success puncture rate of the 4 urologists were 59.2%(29/49), 64.1%(25/39), 66.7%(16/24), 66.7%(4/6)respectively, and there were no statistical differences between the puncture success rates of the urologists (P=0.679). Each channel needed 1.7 punctures on average. Fouty-four punctures failed without detecting the urine, including 20 failed punctures because of the puncture tract deviation, 17 punctures without seeing the urine after the core needle being removed, 7 punctures no display on the ultrasound imagine. There were 33 punctures to be tubeless while other 35 indwelling the nephrostomy tubes. Five nephrostomy tubes' position were different with the preoperationally predicted position which means the discrepancy rate was 14.3%(5/35). One patient had complications and classified as Grade II or above on the modified Clavien Grading System of aerothorax. Conclusions The puncture success rate during ultrasound-guided PCNL is not satisfied. The main reasons of puncture failure are the deviation of puncture tract, unclear imaging of puncture tract and other unclear reasons( puncture needle went too deep or superficially or tip of the needle embedded into the stone). Key words: Kidney calculi; Percutaneous nephrolithotomy; Puncture; Success rate
{"title":"Clinical study of the puncture success rate during ultrasound-guided percutaneous nephrolithotomy","authors":"Ting Huang, Yue Cheng, Guohai Xie, He-sheng Yuan, Jia-sheng Hu, Jiaqi Zhu","doi":"10.3760/CMA.J.ISSN.1000-6702.2019.12.010","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1000-6702.2019.12.010","url":null,"abstract":"Objective \u0000To evaluate the success rate during ultrasound-guided percutaneous nephrolithotomy (PCNL) and analyze the reasons of puncture failure. \u0000 \u0000 \u0000Methods \u0000A retrospective analysis was performed based on the data of 58 patients who underwent ultrasound-guided PCNL by 4 experienced urologists(10 years' experience of PCNL and more than 80 cases per year)in our center from August 2018 to November 2018. Of all the 58 patients, there were 36 males and 22 females (aged from 22 to 73 years) with the mean age of 51 years. The calculi ranged from 9 mm to 93 mm, with the average of 26.5 mm. The separation of renal collecting system ranged from 5 mm to 30 mm, with the average of 15.1 mm. All of the 58 patients underwent one-stage PCNL and the numbers of punctures, the numbers of percutaneous tubes and the reasons for failure were recorded. \u0000 \u0000 \u0000Results \u0000All percutaneous tubes and surgeries were established and done successfully. Of all the 118 punctures, 74 punctures succeeded by detecting the urine and 68 surgery tracts were established (6 punctures failed because of the dilation). The total puncture success rate was 62.7%(74/118). Of the total 74 successful punctures, 56.8%(42/74)succeeded at the first puncture, 28.4%(21/74)succeeded at the second puncture and 14.9%(11/74)succeeded at least after three punctures. The success puncture rate of the 4 urologists were 59.2%(29/49), 64.1%(25/39), 66.7%(16/24), 66.7%(4/6)respectively, and there were no statistical differences between the puncture success rates of the urologists (P=0.679). Each channel needed 1.7 punctures on average. Fouty-four punctures failed without detecting the urine, including 20 failed punctures because of the puncture tract deviation, 17 punctures without seeing the urine after the core needle being removed, 7 punctures no display on the ultrasound imagine. There were 33 punctures to be tubeless while other 35 indwelling the nephrostomy tubes. Five nephrostomy tubes' position were different with the preoperationally predicted position which means the discrepancy rate was 14.3%(5/35). One patient had complications and classified as Grade II or above on the modified Clavien Grading System of aerothorax. \u0000 \u0000 \u0000Conclusions \u0000The puncture success rate during ultrasound-guided PCNL is not satisfied. The main reasons of puncture failure are the deviation of puncture tract, unclear imaging of puncture tract and other unclear reasons( puncture needle went too deep or superficially or tip of the needle embedded into the stone). \u0000 \u0000 \u0000Key words: \u0000Kidney calculi; Percutaneous nephrolithotomy; Puncture; Success rate","PeriodicalId":10343,"journal":{"name":"Chinese Journal of Urology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49332401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-15DOI: 10.3760/CMA.J.ISSN.1000-6702.2019.12.003
D. Han, T. He, Hongpei Wu, N. Yu, Xirong Zhang, G. Ren, Yong Yu
Objective A predictive model of WHO/ISUP grading of renal clear cell carcinoma was constructed based on CT radiomics. Methods The clinical data of 104 patients with ccRCC confirmed by operation or biopsy from March 2014 to December 2018 in the Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine were retrospectively analyzed. There were 70 males and 34 females, and the age was 61.2±11.7 years. The patients were randomly divided into development cohort (73 cases) and validation cohort (31 cases) by stratified sampling according to 7∶3 ratio. According to the WHO/ISUP pathological grading criteria of renal cancer in 2016, Ⅰ and Ⅱ were defined as low-grade group, Ⅲ and Ⅳ were defined as high-grade group. The radiomics features of ccRCC were calculated in cortical phase images of CT enhanced scanning. LASSO regression was used to reduce the radiomics feature dimensionality in the training group, and to establish radiomics risk scores. The binary logistic regression was used to build the prediction model, which was used in the validation group. Bootstrap method was used to validate the model of training and validation group. AUC, sensitivity and specificity were calculated respectively. Hosmer-Lemeshow goodness-of-fit test was used to evaluate model calibration degree. Results After dimensionality reduction, the radiomics risk score of ccRCC was established. The low and high-level risk scores of the training group were -2.49±1.73 and 1.23±2.17, with significant difference (t=-7.785, P 0.05). The low and high-level risk scores of the Validation group were -2.27±2.02 and 0.82±2.08, with significant difference (t=-3.832, P<0.01). The AUC in validation group was 0.859(95%CI 0.723-0.995) with 77.8% sensitivity and 81.8% specificity, and with good Hosmer-Lemeshow goodness-of-fit test (χ2=14.554, P=0.068) as well. Conclusions The prediction model based on CT radiomics has high accuracy in predicting high or low grade of ccRCC. Key words: Carcinoma, renal cell; Radiomics; Pathological grading; Predictive model
{"title":"Establishment of WHO/ISUP grading prediction model for renal clear cell carcinoma based on CT radiomics","authors":"D. Han, T. He, Hongpei Wu, N. Yu, Xirong Zhang, G. Ren, Yong Yu","doi":"10.3760/CMA.J.ISSN.1000-6702.2019.12.003","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1000-6702.2019.12.003","url":null,"abstract":"Objective \u0000A predictive model of WHO/ISUP grading of renal clear cell carcinoma was constructed based on CT radiomics. \u0000 \u0000 \u0000Methods \u0000The clinical data of 104 patients with ccRCC confirmed by operation or biopsy from March 2014 to December 2018 in the Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine were retrospectively analyzed. There were 70 males and 34 females, and the age was 61.2±11.7 years. The patients were randomly divided into development cohort (73 cases) and validation cohort (31 cases) by stratified sampling according to 7∶3 ratio. According to the WHO/ISUP pathological grading criteria of renal cancer in 2016, Ⅰ and Ⅱ were defined as low-grade group, Ⅲ and Ⅳ were defined as high-grade group. The radiomics features of ccRCC were calculated in cortical phase images of CT enhanced scanning. LASSO regression was used to reduce the radiomics feature dimensionality in the training group, and to establish radiomics risk scores. The binary logistic regression was used to build the prediction model, which was used in the validation group. Bootstrap method was used to validate the model of training and validation group. AUC, sensitivity and specificity were calculated respectively. Hosmer-Lemeshow goodness-of-fit test was used to evaluate model calibration degree. \u0000 \u0000 \u0000Results \u0000After dimensionality reduction, the radiomics risk score of ccRCC was established. The low and high-level risk scores of the training group were -2.49±1.73 and 1.23±2.17, with significant difference (t=-7.785, P 0.05). The low and high-level risk scores of the Validation group were -2.27±2.02 and 0.82±2.08, with significant difference (t=-3.832, P<0.01). The AUC in validation group was 0.859(95%CI 0.723-0.995) with 77.8% sensitivity and 81.8% specificity, and with good Hosmer-Lemeshow goodness-of-fit test (χ2=14.554, P=0.068) as well. \u0000 \u0000 \u0000Conclusions \u0000The prediction model based on CT radiomics has high accuracy in predicting high or low grade of ccRCC. \u0000 \u0000 \u0000Key words: \u0000Carcinoma, renal cell; Radiomics; Pathological grading; Predictive model","PeriodicalId":10343,"journal":{"name":"Chinese Journal of Urology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49561127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective To investigate the independent predictors of inguinal lymph node metastasis (LLM) in patients with penile squamous cell carcinoma (SCCP), and to establish a nomogram for predicting individual LLM risk. Methods The data of patients with SCCP diagnosed at the department of urology, Xijing Hospital from July 2009 to June 2019 were analyzed retrospectively. A total of 101 patients were included in this study, with age of 55 (26-84) years. There were 25 (24.8%) and 76 (75.2%) patients with and without palpable inguinal lymph node enlargement, respectively. There were 47 cases (46.5%), 40 cases (39.6%) and 14 cases (13.9%) in T1, T2 and T3 stages, respectively; there were 67 cases (66.3%), 21 cases (20.8%) and 13 cases (12.9%) in Broder 1, 2 and 3, respectively. The average value (or median) of fibrinogen was 2.84 (1.72-5.00)g/L; alkaline phosphatase was 80(32±214)U, hemoglobin was 147(81-180)g, platelet count was (193.74±65.68×109/L, absolute value of neutrophils, monocytes and lymphocytes were 3.98(1.19-11.85)×109/L, 0.44(0.17-1.90)×109/L and 1.68(0.58-4.13)×109/L, respectively. The average (or median) value of PLR, NLR and LMR were 113.38(18.80-418.42), 2.42(0.59-10.22) and 3.84 (1.08-9.89), respectively. There were 26 cases (25.7%) with LLM and 75 cases (74.3%) without LLM. The independent predictors of LLM were identified by univariate and multivariate logistic regression analyses. The R software was used to establish the nomogram by integrating all independent predictors, and the bootstrap method was used to internally validated our nomogram, where the value of AUC (area under the ROC curve) was calculated and the calibration plot was drawn. Results Clinical inguinal lymph node status (P<0.006), T stage (P<0.021), Broder grade (P<0.017) and absolute neutrophil value (P<0.043) were independent predictors of LLM. The accuracy of our nomogram was 0.875 (AUC=0.875, 95%CI 0.859-0.891); Moreover, the risk of LLM predicted by nomogram was in good consistency with the actual LLM rate, and the errors of the nomogram-predicted LLM risks were all within 10%. Conclusions Clinical inguinal lymph node status, T stage, broder grade and absolute value of neutrophils were identified as independent predictors of LLM in patients with SCCP on the basis of single center data. A generic nomogram predicting LLM risk for Chinese patients was developed, which would be helpful to screen SCCP patients who need prophylactic inguinal lymph node dissection. Key words: Penile neoplasms; Squamous cell carcinoma; Inguinal lymph node metastasis; Nomogram
{"title":"Individualized prediction of the risk of inguinal lymph node metastasis in patients with squamous cell carcinoma of penile","authors":"G. Hou, Yu Zheng, Fuli Wang, Xi’an Li, Geng Zhang, Longlong Zhang, Wanxiang Zheng","doi":"10.3760/CMA.J.ISSN.1000-6702.2019.12.007","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1000-6702.2019.12.007","url":null,"abstract":"Objective \u0000To investigate the independent predictors of inguinal lymph node metastasis (LLM) in patients with penile squamous cell carcinoma (SCCP), and to establish a nomogram for predicting individual LLM risk. \u0000 \u0000 \u0000Methods \u0000The data of patients with SCCP diagnosed at the department of urology, Xijing Hospital from July 2009 to June 2019 were analyzed retrospectively. A total of 101 patients were included in this study, with age of 55 (26-84) years. There were 25 (24.8%) and 76 (75.2%) patients with and without palpable inguinal lymph node enlargement, respectively. There were 47 cases (46.5%), 40 cases (39.6%) and 14 cases (13.9%) in T1, T2 and T3 stages, respectively; there were 67 cases (66.3%), 21 cases (20.8%) and 13 cases (12.9%) in Broder 1, 2 and 3, respectively. The average value (or median) of fibrinogen was 2.84 (1.72-5.00)g/L; alkaline phosphatase was 80(32±214)U, hemoglobin was 147(81-180)g, platelet count was (193.74±65.68×109/L, absolute value of neutrophils, monocytes and lymphocytes were 3.98(1.19-11.85)×109/L, 0.44(0.17-1.90)×109/L and 1.68(0.58-4.13)×109/L, respectively. The average (or median) value of PLR, NLR and LMR were 113.38(18.80-418.42), 2.42(0.59-10.22) and 3.84 (1.08-9.89), respectively. There were 26 cases (25.7%) with LLM and 75 cases (74.3%) without LLM. The independent predictors of LLM were identified by univariate and multivariate logistic regression analyses. The R software was used to establish the nomogram by integrating all independent predictors, and the bootstrap method was used to internally validated our nomogram, where the value of AUC (area under the ROC curve) was calculated and the calibration plot was drawn. \u0000 \u0000 \u0000Results \u0000Clinical inguinal lymph node status (P<0.006), T stage (P<0.021), Broder grade (P<0.017) and absolute neutrophil value (P<0.043) were independent predictors of LLM. The accuracy of our nomogram was 0.875 (AUC=0.875, 95%CI 0.859-0.891); Moreover, the risk of LLM predicted by nomogram was in good consistency with the actual LLM rate, and the errors of the nomogram-predicted LLM risks were all within 10%. \u0000 \u0000 \u0000Conclusions \u0000Clinical inguinal lymph node status, T stage, broder grade and absolute value of neutrophils were identified as independent predictors of LLM in patients with SCCP on the basis of single center data. A generic nomogram predicting LLM risk for Chinese patients was developed, which would be helpful to screen SCCP patients who need prophylactic inguinal lymph node dissection. \u0000 \u0000 \u0000Key words: \u0000Penile neoplasms; Squamous cell carcinoma; Inguinal lymph node metastasis; Nomogram","PeriodicalId":10343,"journal":{"name":"Chinese Journal of Urology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47933676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective To discuss the application experience and predictive value of circulating tumor cells for urothelial carcinoma. Methods The clinical data of 96 patients with urothelial carcinoma treated by Beijing Cancer Hospital Urologic Department between September 2017 and September 2019 were analyzed retrospectively to evaluate relationship between the number of CTCs and pathological outcome. The mean age of the entire cohort was 62(40-87)years, with 74 males and 22 females. There were 13 cases of upper urinary tract tumors (pyelocarcinoma and ureteral carcinoma), 83 cases of bladder carcinoma, and 12 cases of lymph node metastasis. There were 77 cases of primary onset and 19 cases of recurrence. 68 cases in single focus group and 28 cases in multiple group. There were 29 cases in non infiltrative Ta stage, 42 cases in infiltrative lamina propria T1 stage, 16 cases in infiltrative muscle T2 stage, and 9 cases in extra-muscular≥T3 stage. At least 3ml of peripheral blood was collected after fasting for at least 8 hours, After cleavage and centrifugation, immunomagnetic beads were added, folate probe was added, and then amplification was carried out. Then the copy number of CTCs in each ml of blood was calculated. Logistic linear regression was used to analyze the risk factors of lymph node metastasis. Results The mean CNC of all patients was 12.3±7.3; the mean CNC of ≤62 years old group was 10.8±4.2; the mean CNC of >62 years old group was 13.7±9.2; the mean CNC of initial cases was 11.5±5.3; the mean CNC of recurrent cases was 15.5±12.2. Age (P=0.135) and frequency of onset (P=0.087) had no effect on the number of CTCs. The average CNC of single focus group was 10.5±5.2, multiple focus group was 16.5±9.7, Ta stage group was 8.2±2.3, T1 stage group was 12.0±4.4, T2 stage group was 16.4±6.8, and ≥T3 stage group was 19.5±16.6. The number of lesions (P<0.001) was significantly correlated with pathological T stage (P<0.001) and the number of CTCs. Univariate regression analysis showed that T stage (P<0.001) and the number of CTCs (P=0.02) might be correlated with lymph node metastasis; multivariate analysis showed that only T stage could be used as an independent predictor of lymph node metastasis (P=0.002). Conclusions CTCs can be used to predict lymph node metastasis of urothelial carcinoma. Key words: Carcinoma, transitional cell; Urothelial carcinoma; Bladder cancer; Circulating tumor cells (CTCs); Lymph node metastasis; Risk factor
{"title":"The value of detection of circulating tumor cells in predicting lymph node metastasis of urothelial carcinoma","authors":"Jia Liu, Yudong Cao, Xingxing Tang, Shuo Wang, Yong Yang, Ning Zhang","doi":"10.3760/CMA.J.ISSN.1000-6702.2019.12.002","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1000-6702.2019.12.002","url":null,"abstract":"Objective \u0000To discuss the application experience and predictive value of circulating tumor cells for urothelial carcinoma. \u0000 \u0000 \u0000Methods \u0000The clinical data of 96 patients with urothelial carcinoma treated by Beijing Cancer Hospital Urologic Department between September 2017 and September 2019 were analyzed retrospectively to evaluate relationship between the number of CTCs and pathological outcome. The mean age of the entire cohort was 62(40-87)years, with 74 males and 22 females. There were 13 cases of upper urinary tract tumors (pyelocarcinoma and ureteral carcinoma), 83 cases of bladder carcinoma, and 12 cases of lymph node metastasis. There were 77 cases of primary onset and 19 cases of recurrence. 68 cases in single focus group and 28 cases in multiple group. There were 29 cases in non infiltrative Ta stage, 42 cases in infiltrative lamina propria T1 stage, 16 cases in infiltrative muscle T2 stage, and 9 cases in extra-muscular≥T3 stage. At least 3ml of peripheral blood was collected after fasting for at least 8 hours, After cleavage and centrifugation, immunomagnetic beads were added, folate probe was added, and then amplification was carried out. Then the copy number of CTCs in each ml of blood was calculated. Logistic linear regression was used to analyze the risk factors of lymph node metastasis. \u0000 \u0000 \u0000Results \u0000The mean CNC of all patients was 12.3±7.3; the mean CNC of ≤62 years old group was 10.8±4.2; the mean CNC of >62 years old group was 13.7±9.2; the mean CNC of initial cases was 11.5±5.3; the mean CNC of recurrent cases was 15.5±12.2. Age (P=0.135) and frequency of onset (P=0.087) had no effect on the number of CTCs. The average CNC of single focus group was 10.5±5.2, multiple focus group was 16.5±9.7, Ta stage group was 8.2±2.3, T1 stage group was 12.0±4.4, T2 stage group was 16.4±6.8, and ≥T3 stage group was 19.5±16.6. The number of lesions (P<0.001) was significantly correlated with pathological T stage (P<0.001) and the number of CTCs. Univariate regression analysis showed that T stage (P<0.001) and the number of CTCs (P=0.02) might be correlated with lymph node metastasis; multivariate analysis showed that only T stage could be used as an independent predictor of lymph node metastasis (P=0.002). \u0000 \u0000 \u0000Conclusions \u0000CTCs can be used to predict lymph node metastasis of urothelial carcinoma. \u0000 \u0000 \u0000Key words: \u0000Carcinoma, transitional cell; Urothelial carcinoma; Bladder cancer; Circulating tumor cells (CTCs); Lymph node metastasis; Risk factor","PeriodicalId":10343,"journal":{"name":"Chinese Journal of Urology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45373913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-15DOI: 10.3760/CMA.J.ISSN.1000-6702.2019.11.002
Jinghao Yan, Ling Zhou, Shui-Xue Li
Objective This study was a retrospective analysis of the efficacy of conservative treatment of unilateral renal pelvic ureteral junction obstruction with good renal function at the time of initial diagnosis. Methods The clinical data of 101 children with unilateral pelvic ureteral junction obstruction from January 2008 to December 2017 was analyzed retrospectively. All the patients underwent non-surgical treatment. There were 67 males and 34 females. The age range is from 10 days to 10 years old, with an average age of 3.4 years. 52 cases got left side obstruction and 49 cases got the right side obstrction. 14 children had abdominal pain symptoms. Among the 37 neonates: 21 male, 16 female. 15 were left, 22 were right. 10 cases were found during prenatal pregnancy, and 27 were dignosed postpartum. The indication for conservative treatment is no hydronephrosis-related symptoms or normal renal function at the initial diagnosis. The hydronephrosis did not affect the child's breathing, growth and development. The B-ultrasound was done every 1 to 6 months which depended on the different grades of hydronephrosis during a conservative observation period. The diuretic radionuclide imaging was done every 6 to 12 months. The end point of follow-up was surgery or disappear of the hydronephrosis in the affected side. Surgical indications are symptoms of hydronephrosis during follow-up which affecting growth and development, renal function reduction >10%, hydronephrosis SFU, UTDP grade progressive increase. Among them, 3 cases were raised from SFU2 to SFU3, 17 cases were raised from SFU3 to SFU4; 4 cases of neonatal UTDP2 progressed to grade 3 hydronephrosis and UTDP3 increased in 5 cases. Regression of hydronephrosis test three consecutive urinary renal ultrasound was defined as no hydronephrosis in. Results Continuous follow-up ranged from 1 year to 5 years, a median follow-up is 37 months. Of the 101 patients, 41 (40.5%) required surgery, and 60 (59.5%) kept conservative follow up. 2 cases of SFU1 children with hydronephrosis spontaneously disappeared. Of the 26 SFU class 2 children, 15 (69.2%) spontaneously resolved, 7(30.7%) improved, and 4 underwent surgery. Of the 50 children with SFU grade 3 hydronephrosis, 11(22.0%) spontaneously resolved, 19 improved or remained unchanged, and 20 patients eventually underwent surgery. Of the 23 patients with SFU grade 4 hydronephrosis, 6(26.0%) improved (to SFU 2) and 17(73.9%) underwent surgery. 37 of the 101 children were enrolled in the neonatal group for SFU grading while performing UTDP grading. Twenty-seven (70.2%) of the 37 neonates underwent conservative treat ment, including 8(100.0%) UTDP grade 1 hydronephrosis, 8(66.7%) UTDP grade 2 hydronephrosis, and UTDP grade 3 10 cases (58.8%) of hydronephrosis were effective for conservative treatment. There was a statistically significant difference between the level of hydronephrosis at the time of initial diagnosis of hydronephrosis and the efficacy o
{"title":"Analysis of long-term follow-up results of conservative treatment of children with unilateral UPJO","authors":"Jinghao Yan, Ling Zhou, Shui-Xue Li","doi":"10.3760/CMA.J.ISSN.1000-6702.2019.11.002","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1000-6702.2019.11.002","url":null,"abstract":"Objective \u0000This study was a retrospective analysis of the efficacy of conservative treatment of unilateral renal pelvic ureteral junction obstruction with good renal function at the time of initial diagnosis. \u0000 \u0000 \u0000Methods \u0000The clinical data of 101 children with unilateral pelvic ureteral junction obstruction from January 2008 to December 2017 was analyzed retrospectively. All the patients underwent non-surgical treatment. There were 67 males and 34 females. The age range is from 10 days to 10 years old, with an average age of 3.4 years. 52 cases got left side obstruction and 49 cases got the right side obstrction. 14 children had abdominal pain symptoms. Among the 37 neonates: 21 male, 16 female. 15 were left, 22 were right. 10 cases were found during prenatal pregnancy, and 27 were dignosed postpartum. The indication for conservative treatment is no hydronephrosis-related symptoms or normal renal function at the initial diagnosis. The hydronephrosis did not affect the child's breathing, growth and development. The B-ultrasound was done every 1 to 6 months which depended on the different grades of hydronephrosis during a conservative observation period. The diuretic radionuclide imaging was done every 6 to 12 months. The end point of follow-up was surgery or disappear of the hydronephrosis in the affected side. Surgical indications are symptoms of hydronephrosis during follow-up which affecting growth and development, renal function reduction >10%, hydronephrosis SFU, UTDP grade progressive increase. Among them, 3 cases were raised from SFU2 to SFU3, 17 cases were raised from SFU3 to SFU4; 4 cases of neonatal UTDP2 progressed to grade 3 hydronephrosis and UTDP3 increased in 5 cases. Regression of hydronephrosis test three consecutive urinary renal ultrasound was defined as no hydronephrosis in. \u0000 \u0000 \u0000Results \u0000Continuous follow-up ranged from 1 year to 5 years, a median follow-up is 37 months. Of the 101 patients, 41 (40.5%) required surgery, and 60 (59.5%) kept conservative follow up. 2 cases of SFU1 children with hydronephrosis spontaneously disappeared. Of the 26 SFU class 2 children, 15 (69.2%) spontaneously resolved, 7(30.7%) improved, and 4 underwent surgery. Of the 50 children with SFU grade 3 hydronephrosis, 11(22.0%) spontaneously resolved, 19 improved or remained unchanged, and 20 patients eventually underwent surgery. Of the 23 patients with SFU grade 4 hydronephrosis, 6(26.0%) improved (to SFU 2) and 17(73.9%) underwent surgery. 37 of the 101 children were enrolled in the neonatal group for SFU grading while performing UTDP grading. Twenty-seven (70.2%) of the 37 neonates underwent conservative treat ment, including 8(100.0%) UTDP grade 1 hydronephrosis, 8(66.7%) UTDP grade 2 hydronephrosis, and UTDP grade 3 10 cases (58.8%) of hydronephrosis were effective for conservative treatment. There was a statistically significant difference between the level of hydronephrosis at the time of initial diagnosis of hydronephrosis and the efficacy o","PeriodicalId":10343,"journal":{"name":"Chinese Journal of Urology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41594087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-15DOI: 10.3760/CMA.J.ISSN.1000-6702.2019.11.008
Wei Xiyi, You Zebin, L. Guangyao, Chen Xinglin, Ren Xiaohan, Yu Lipeng, Mao Yimin, Li Juming, Qin Chao, W. Zengjun
Objective To investigate the assessment and treatment strategy of patients with renal cell carcinoma. Methods The clinical data of 43 patients with renal cell carcinoma and bone metastases admitted to the First Affiliated Hospital of Nanjing Medical University from January 2006 to December 2018 were retrospectively analyzed. The follow-up time was 6 years, with an average age of 55.4 years (21-87 years). There were 29 males, 14 females, 22 cases of limb bone metastasis, 12 cases of spinal metastasis, 9 cases of multiple bone metastasis, 21 cases of Fuhrman grade 1 and 2, 19 cases of T1, and 20 cases of N0. All patients were confirmed by postoperative pathological examination or imaging data suggesting that bone metastasis are from renal cell carcinoma. Forty-three patients underwent primary renal surgery, and molecular targeted therapy was used after the operation. The treatment process was smooth, no obvious discomfort, and postoperative pathology showed clear cell carcinoma.22 patients with limb bones metastasis and 12 patients with spinal metastasis included in the study all met the indications for secondary surgery after the disease assessment. After communicating with the patient, 13 patients with limbs metastasis and 6 patients with spinal metastasis received local treatment, including complete resection of the extremities and spinal fixation, the remaining 15 patients and 9 patients with multiple bone metastasis were treated conservatively. There were 19 patients in the local treatment group, 13 patients with limbs bone metastasis, 6 patients with spinal bone metastasis, the average age was 54.9 years, the average diameter of the primary tumor was 4.7 cm. There were 24 patients in the conservative treatment group, 9 patients with limbs metastasis, 6 patients with spinal metastases and 9 cases with multiple bone metastasis, with an average age of 56 years and a primary tumor diameter of 5.6 cm. Limb metastatic lesions were evaluated according to the patient's general condition, bone pain, fracture risk, and bone metastasis. Spinal lesions were evaluated according to Tokuhashi score, Harrington score, Tomita score, vertebral stability assessment, and molecular targeted therapy. Aminokinase inhibitors, conservative treatment with local radiotherapy and bisphosphonate treatment. Results During the follow-up period, the 1-year overall survival rate of the local treatment group was 100.0%, the 2-year overall survival rate was 89.4%, and the 5-year overall survival rate was 73.7%. The 1-year overall survival rate of the conservative treatment group was 87.5%, and the 2-year overall survival rate was 62.5%. The 5-year overall survival rate was 16.7%. The 2-year and 5-year survival rates of the local treatment group were statistically different (P=0.044, P=0.000) compared with the conservative treatment group. For patients with limb bone metastasis, the 5-year survival rate was significantly higher in patients receiving topical treatme
{"title":"Condition assessment and treatment strategy selection for patients with renal cell carcinoma bone metastasis","authors":"Wei Xiyi, You Zebin, L. Guangyao, Chen Xinglin, Ren Xiaohan, Yu Lipeng, Mao Yimin, Li Juming, Qin Chao, W. Zengjun","doi":"10.3760/CMA.J.ISSN.1000-6702.2019.11.008","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1000-6702.2019.11.008","url":null,"abstract":"Objective \u0000To investigate the assessment and treatment strategy of patients with renal cell carcinoma. \u0000 \u0000 \u0000Methods \u0000The clinical data of 43 patients with renal cell carcinoma and bone metastases admitted to the First Affiliated Hospital of Nanjing Medical University from January 2006 to December 2018 were retrospectively analyzed. The follow-up time was 6 years, with an average age of 55.4 years (21-87 years). There were 29 males, 14 females, 22 cases of limb bone metastasis, 12 cases of spinal metastasis, 9 cases of multiple bone metastasis, 21 cases of Fuhrman grade 1 and 2, 19 cases of T1, and 20 cases of N0. All patients were confirmed by postoperative pathological examination or imaging data suggesting that bone metastasis are from renal cell carcinoma. Forty-three patients underwent primary renal surgery, and molecular targeted therapy was used after the operation. The treatment process was smooth, no obvious discomfort, and postoperative pathology showed clear cell carcinoma.22 patients with limb bones metastasis and 12 patients with spinal metastasis included in the study all met the indications for secondary surgery after the disease assessment. After communicating with the patient, 13 patients with limbs metastasis and 6 patients with spinal metastasis received local treatment, including complete resection of the extremities and spinal fixation, the remaining 15 patients and 9 patients with multiple bone metastasis were treated conservatively. There were 19 patients in the local treatment group, 13 patients with limbs bone metastasis, 6 patients with spinal bone metastasis, the average age was 54.9 years, the average diameter of the primary tumor was 4.7 cm. There were 24 patients in the conservative treatment group, 9 patients with limbs metastasis, 6 patients with spinal metastases and 9 cases with multiple bone metastasis, with an average age of 56 years and a primary tumor diameter of 5.6 cm. Limb metastatic lesions were evaluated according to the patient's general condition, bone pain, fracture risk, and bone metastasis. Spinal lesions were evaluated according to Tokuhashi score, Harrington score, Tomita score, vertebral stability assessment, and molecular targeted therapy. Aminokinase inhibitors, conservative treatment with local radiotherapy and bisphosphonate treatment. \u0000 \u0000 \u0000Results \u0000During the follow-up period, the 1-year overall survival rate of the local treatment group was 100.0%, the 2-year overall survival rate was 89.4%, and the 5-year overall survival rate was 73.7%. The 1-year overall survival rate of the conservative treatment group was 87.5%, and the 2-year overall survival rate was 62.5%. The 5-year overall survival rate was 16.7%. The 2-year and 5-year survival rates of the local treatment group were statistically different (P=0.044, P=0.000) compared with the conservative treatment group. For patients with limb bone metastasis, the 5-year survival rate was significantly higher in patients receiving topical treatme","PeriodicalId":10343,"journal":{"name":"Chinese Journal of Urology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48691325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-15DOI: 10.3760/CMA.J.ISSN.1000-6702.2019.11.010
Li Wuxue, Changbao Xu, Xinghua Zhao, Bin Hao, You-zhi Wang, Junfang Fan, Dongsheng Pan
Objective To explore the feasibility of the modified RUSS (Resorlu-Unsal Stone Score) renal stone scoring system in predicting the stone free rate after Flexible Ureteroscopic Lithotripsy(FURL). Methods Retrospective analysis was performed on 104 cases of renal stones treated by FURL from March 2017 to January 2019 in the second affiliated hospital of zhengzhou university, including 75 males and 29 females. Age 20-75 (47.79±13.21) years. BMI 18.2-38.3 (24.4±3.7) kg/m2; Crushed stone site: left 56 cases, right 48 cases. There were 23 cases of renal inferior calyces calculi, 81 cases of non-inferior calyces calculi, and 19 cases of renal inferior calyces calculi with IPA<45°; American Society of Anesthesiology (ASA) scores: 65 cases of grade Ⅰ, 39 cases of grade Ⅱ; There were 71 patients with urinary tract infection before operation. There were 6 cases of renal puncture fistula before operation. Preoperative indwelling ureteral stent in 26 cases; There were 32 cases with history of extracorporeal shock wave lithotripsy. There were 27 patients with a history of urolithiasis therapy. The same physician used preoperative urinary CT+ 3D reconstruction imaging data to measure the factors influencing the postoperative stone free rate. RUSS renal stone scoring system was used to score the stones of patients before operation, and the relationship between the scores and the stones free rate was analyzed. The RUSS renal stone scoring system was supplemented and improved by including staghorn stone, duplicate renal, caliceal diverticulum, renal malrotation, stone area, and CT value related indexes. The modified RUSS renal stone scoring system was used to score the preoperative stone condition of patients, and the relationship between the score and the stone free rate was analyzed. The receiver operating characteristic curve (ROC) was drawn and the area under the curve (AUC) was calculated to compare the advantages and disadvantages of the modified RUSS, the characteristics of the stones, and RUSS system. Results The stone free rate was 69.2% (72/104) 4 weeks after the operation, and there were no postoperative complications. Single-factor analysis showed that stone area, CT value, number of renal calyx involved by stone, multiple stones, IPA, stone size grading, renal anatomic structure abnormality, staghorn stone were all related risk factors affecting postoperative patients. Multi-factor analysis showed that stone area, number of renal calyces involved by stone, multiple stones, IPA and stone size were independent risk factors affecting the stone free rate after FURL. RUSS scores ranged from 0 to 3 points, corresponding to stone clearing rates of 86.8% (33/38), 67.7% (23/34), 58.3% (14/24) and 25.0% (2/8), respectively. Stone clearing rates were significantly correlated with stone grading (P<0.05). The total scores of stone free group and residual stone group were (0.87±0.96) points and (1.53±0.98) points, respectively, with significant differe
目的探讨改良RUSS（Resorlu Unsal Stone Score）肾结石评分系统预测柔性输尿管镜碎石术后结石清除率的可行性。方法对郑州大学附属第二医院2017年3月至2019年1月收治的104例肾结石患者进行回顾性分析，其中男性75例，女性29例。年龄20-75岁（47.79±13.21）。BMI 18.2-38.3（24.4±3.7）kg/m2；碎石部位：左侧56例，右侧48例。IPA<45°的肾下盏结石23例，非下盏结石81例，肾下盏19例；美国麻醉学学会（ASA）评分：Ⅰ级65例，Ⅱ级39例；术前尿路感染71例。术前肾穿刺瘘6例。术前留置输尿管支架26例；32例有体外冲击波碎石术史。有27名患者有尿石症治疗史。同一位医生使用术前尿液CT+3D重建成像数据来测量影响术后结石清除率的因素。采用RUSS肾结石评分系统对患者术前结石进行评分，分析评分与结石清除率的关系。RUSS肾结石评分系统通过包括鹿角石、重复肾、杯状憩室、肾旋转不良、结石面积和CT值相关指标进行了补充和改进。采用改良的RUSS肾结石评分系统对患者术前结石情况进行评分，并分析评分与结石清除率的关系。绘制受试者工作特性曲线（ROC）并计算曲线下面积（AUC），以比较改良RUSS的优缺点、结石的特性和RUSS系统。结果术后4周结石清除率为69.2%（72/104），无并发症发生。单因素分析显示，结石面积、CT值、结石累及肾盏数、多发结石、IPA、结石大小分级、肾脏解剖结构异常、鹿角形结石均为影响术后患者的相关危险因素。多因素分析表明，结石面积、结石累及肾盏数、多发结石、IPA和结石大小是影响FURL术后结石清除率的独立危险因素。RUSS评分范围为0至3分，结石清除率分别为86.8%（33/38）、67.7%（23/34）、58.3%（14/24）和25.0%（2/8）。结石清除率与结石分级显著相关（P<0.05）。无结石组和残石组总分分别为（0.87±0.96）分和（1.53±0.98）分，两组间差异有统计学意义（P<0.05），改良RUSS评分范围为0-4分，对应结石清除率分别为100.0%（25/25）、92.3%（24/26），分别为54.2%（13/24）、47.4%（9/19）和10.0%（1/10）。无结石率与结石分级显著相关（P<0.05）。无结石组和残余结石组的总分分别为（1.15±1.13）分和（2.81±0.93）分，两组之间存在显著差异（P<0.05），结石特征的AUC小于改良的RUSS评分系统。RUSS评分系统的AUC（0.707，95%CI 0.598-0.815）小于改良的RUSS评分体系（0.865，95%CI 0.797-0.933）。关键词：输尿管镜；肾结石评分系统；弹性输尿管镜碎石术；石材免费率；影响因素
{"title":"Feasibility study of modified RUSS to predict the stone free rate after flexible ureteroscopic lithotripsy","authors":"Li Wuxue, Changbao Xu, Xinghua Zhao, Bin Hao, You-zhi Wang, Junfang Fan, Dongsheng Pan","doi":"10.3760/CMA.J.ISSN.1000-6702.2019.11.010","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1000-6702.2019.11.010","url":null,"abstract":"Objective \u0000To explore the feasibility of the modified RUSS (Resorlu-Unsal Stone Score) renal stone scoring system in predicting the stone free rate after Flexible Ureteroscopic Lithotripsy(FURL). \u0000 \u0000 \u0000Methods \u0000Retrospective analysis was performed on 104 cases of renal stones treated by FURL from March 2017 to January 2019 in the second affiliated hospital of zhengzhou university, including 75 males and 29 females. Age 20-75 (47.79±13.21) years. BMI 18.2-38.3 (24.4±3.7) kg/m2; Crushed stone site: left 56 cases, right 48 cases. There were 23 cases of renal inferior calyces calculi, 81 cases of non-inferior calyces calculi, and 19 cases of renal inferior calyces calculi with IPA<45°; American Society of Anesthesiology (ASA) scores: 65 cases of grade Ⅰ, 39 cases of grade Ⅱ; There were 71 patients with urinary tract infection before operation. There were 6 cases of renal puncture fistula before operation. Preoperative indwelling ureteral stent in 26 cases; There were 32 cases with history of extracorporeal shock wave lithotripsy. There were 27 patients with a history of urolithiasis therapy. The same physician used preoperative urinary CT+ 3D reconstruction imaging data to measure the factors influencing the postoperative stone free rate. RUSS renal stone scoring system was used to score the stones of patients before operation, and the relationship between the scores and the stones free rate was analyzed. The RUSS renal stone scoring system was supplemented and improved by including staghorn stone, duplicate renal, caliceal diverticulum, renal malrotation, stone area, and CT value related indexes. The modified RUSS renal stone scoring system was used to score the preoperative stone condition of patients, and the relationship between the score and the stone free rate was analyzed. The receiver operating characteristic curve (ROC) was drawn and the area under the curve (AUC) was calculated to compare the advantages and disadvantages of the modified RUSS, the characteristics of the stones, and RUSS system. \u0000 \u0000 \u0000Results \u0000The stone free rate was 69.2% (72/104) 4 weeks after the operation, and there were no postoperative complications. Single-factor analysis showed that stone area, CT value, number of renal calyx involved by stone, multiple stones, IPA, stone size grading, renal anatomic structure abnormality, staghorn stone were all related risk factors affecting postoperative patients. Multi-factor analysis showed that stone area, number of renal calyces involved by stone, multiple stones, IPA and stone size were independent risk factors affecting the stone free rate after FURL. RUSS scores ranged from 0 to 3 points, corresponding to stone clearing rates of 86.8% (33/38), 67.7% (23/34), 58.3% (14/24) and 25.0% (2/8), respectively. Stone clearing rates were significantly correlated with stone grading (P<0.05). The total scores of stone free group and residual stone group were (0.87±0.96) points and (1.53±0.98) points, respectively, with significant differe","PeriodicalId":10343,"journal":{"name":"Chinese Journal of Urology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47322540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-15DOI: 10.3760/CMA.J.ISSN.1000-6702.2019.11.004
Ling Yu, Jiewen Bao, Yan Chen, Huizhen Sun, Yiqing Lyu, Xiaoxi Li, Li Sun, Hua Xie, Fang Chen, Yi-Chen Huang
Objective To explore the effect of reducing complication in branched spongiosum repair for hypospadias Duckett surgery. Methods Retrospective analysis was performed for the clinical data of 140 surgical infants with hypospadias Duckett surgery from January 2016 to April 2018. According to different covering materials on newly formed urethra, the experimental group (68 cases) cut dysplasia, branched spongiosum and lateral Buck′s fascia from tunica albuginea to coronary groove and then sutured over newly formed urethra, and the control group (72 cases) used Dartos fascia or subcutaneous fascia. The operative age, penile curvature, length of urethral defect, operation time, added value of coronary groove before and after operation, maximum urinary flow rate and complication rate of postoperative follow-up were compared between the two groups, and the therapeutic effect was analyzed. Results There was no statistically significant difference between two groups in operating time[(135±49)min vs.(135±45)min, P=0.580] and the value added of coronary sulcus[(0.1±0.2)cm vs.(0.1±0.1)cm, P=0.167]. In experimental group, there were 8 cases of urethra percutaneous fistula (11.8%) (coronary groove fistula in 3 cases, 4.4%)and 6 cases of urethral stenosis (8.8%) without urethral dehiscence. In control group, there were 18 cases of urethra percutaneous fistula (25.0%)(coronary groove fistula in 11 cases, 15.3%), 10 cases of urethral stenosis (13.9%), and 2 cases of urethral dehiscence (2.8%). The incidence of postoperative urinary fistula and total complications in experimental group was lower than that in the control group, and the difference was statistically significant (P 0.05). The maximum urine flow rate of experimental group at 6 months after surgery was significantly higher than control group[(9.5±3.8)ml/s vs.(6.8±2.8)ml/s], and the difference was statistically significant (P<0.001). Conclusions Urethral cavernosum reconstruction can significantly reduce the incidence of postoperative coronary groove fistula of hypospadias Duckett surgery and improve the postoperative urine flow rate. Key words: Hypospadias; Duckett; Urine flow rate; Follow up
{"title":"Application of branchedspongiosum repair in duckett surgery for hypospadias","authors":"Ling Yu, Jiewen Bao, Yan Chen, Huizhen Sun, Yiqing Lyu, Xiaoxi Li, Li Sun, Hua Xie, Fang Chen, Yi-Chen Huang","doi":"10.3760/CMA.J.ISSN.1000-6702.2019.11.004","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1000-6702.2019.11.004","url":null,"abstract":"Objective \u0000To explore the effect of reducing complication in branched spongiosum repair for hypospadias Duckett surgery. \u0000 \u0000 \u0000Methods \u0000Retrospective analysis was performed for the clinical data of 140 surgical infants with hypospadias Duckett surgery from January 2016 to April 2018. According to different covering materials on newly formed urethra, the experimental group (68 cases) cut dysplasia, branched spongiosum and lateral Buck′s fascia from tunica albuginea to coronary groove and then sutured over newly formed urethra, and the control group (72 cases) used Dartos fascia or subcutaneous fascia. The operative age, penile curvature, length of urethral defect, operation time, added value of coronary groove before and after operation, maximum urinary flow rate and complication rate of postoperative follow-up were compared between the two groups, and the therapeutic effect was analyzed. \u0000 \u0000 \u0000Results \u0000There was no statistically significant difference between two groups in operating time[(135±49)min vs.(135±45)min, P=0.580] and the value added of coronary sulcus[(0.1±0.2)cm vs.(0.1±0.1)cm, P=0.167]. In experimental group, there were 8 cases of urethra percutaneous fistula (11.8%) (coronary groove fistula in 3 cases, 4.4%)and 6 cases of urethral stenosis (8.8%) without urethral dehiscence. In control group, there were 18 cases of urethra percutaneous fistula (25.0%)(coronary groove fistula in 11 cases, 15.3%), 10 cases of urethral stenosis (13.9%), and 2 cases of urethral dehiscence (2.8%). The incidence of postoperative urinary fistula and total complications in experimental group was lower than that in the control group, and the difference was statistically significant (P 0.05). The maximum urine flow rate of experimental group at 6 months after surgery was significantly higher than control group[(9.5±3.8)ml/s vs.(6.8±2.8)ml/s], and the difference was statistically significant (P<0.001). \u0000 \u0000 \u0000Conclusions \u0000Urethral cavernosum reconstruction can significantly reduce the incidence of postoperative coronary groove fistula of hypospadias Duckett surgery and improve the postoperative urine flow rate. \u0000 \u0000 \u0000Key words: \u0000Hypospadias; Duckett; Urine flow rate; Follow up","PeriodicalId":10343,"journal":{"name":"Chinese Journal of Urology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45508779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-15DOI: 10.3760/CMA.J.ISSN.1000-6702.2019.11.011
Hui Chen, K. Xie, Chonghe Jiang, Ma-ping Huang, Th Huang, P. Tang, Rubiao Ou, Jianwen Zeng, Xiangrong Deng, Qingqing Li, Qiuling Liu, Xiaoyi Yang
Objective To assess clinical effect and safety of botulinum toxin A injection in external urethral sphincter for male patient with neurogenic detrusor underactivity(DU). Methods A prospective and self-controlled trail was conducted from August 2012 to October 2017. Male patients with nerve injury, dysuria more than 6 months, DU(bladder contractility index less than 100) were enrolled in this study. Exclusion criteria included patients with acute urinary tract infection, bladder stone, benign prostate hyperplasia, urethral stricture and urethral diverticulum.100 IU BTX-A was dissolved in 4ml normal saline, and the solution of BTX- A was injected into 4 different points(3-o’clock, 6-o’clock, 9-o’clock, and 12-o’clock) in external urinary sphincter with each point of 1ml solution. Patients were evaluated at baseline and 12 weeks after injection. The outcomes included post void residual (PVR), maximum flow rate (Qmax), maximum detrusor pressure during voiding phases (Pdet.max), maximum urethral closure pressure (MUCP), the case number of intermittent catheterization (IC)and the score of quality of life (QOL score). Adverse events were also recorded. Results A total of 58 male patients (all from Guangdong provincial work injury rehabilitation hospital)with mean age 28.6 years suffered from cerebral palsy (n=2), cerebrovascular accident(n=19)and spinal cord injury(n=37) were included into the study. Compared to baseline data, significant difference were observed at week 12 in PVR (56.68 ml vs. 280.11 ml, P<0.001), Pdet.max(23.95 cmH2O vs. 30.01 cmH2O, P=0.019), Qmax(6.74 ml/s vs. 3.28 ml/s, P=0.042), MUCP(48.25 cmH2O vs. 79.34 cmH2O, P<0.001), the case number of IC(40 vs. 58, P<0.001) and QOL score(3.63 vs.5.22, P<0.001) respectively. 5 cases developed perineal pain and 16 cases developed mild transient haematuria. These adverse events were disappeared by medical symptomatic treatment during 3-5 days. Conclusions BTX-A externalurethral sphincter injections help reduce urethra resistance and also improve the quality of life for patients with neurogenic detrusor underactivity. Key words: Urethral sphincter; Botulinum toxin A; Neurogenic detrusor underactivity; Effect; Safety
{"title":"Effect and safety of botulinum toxin A injection in external urethral sphincter for male patients with neurogenic detrusor underactivity","authors":"Hui Chen, K. Xie, Chonghe Jiang, Ma-ping Huang, Th Huang, P. Tang, Rubiao Ou, Jianwen Zeng, Xiangrong Deng, Qingqing Li, Qiuling Liu, Xiaoyi Yang","doi":"10.3760/CMA.J.ISSN.1000-6702.2019.11.011","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1000-6702.2019.11.011","url":null,"abstract":"Objective \u0000To assess clinical effect and safety of botulinum toxin A injection in external urethral sphincter for male patient with neurogenic detrusor underactivity(DU). \u0000 \u0000 \u0000Methods \u0000A prospective and self-controlled trail was conducted from August 2012 to October 2017. Male patients with nerve injury, dysuria more than 6 months, DU(bladder contractility index less than 100) were enrolled in this study. Exclusion criteria included patients with acute urinary tract infection, bladder stone, benign prostate hyperplasia, urethral stricture and urethral diverticulum.100 IU BTX-A was dissolved in 4ml normal saline, and the solution of BTX- A was injected into 4 different points(3-o’clock, 6-o’clock, 9-o’clock, and 12-o’clock) in external urinary sphincter with each point of 1ml solution. Patients were evaluated at baseline and 12 weeks after injection. The outcomes included post void residual (PVR), maximum flow rate (Qmax), maximum detrusor pressure during voiding phases (Pdet.max), maximum urethral closure pressure (MUCP), the case number of intermittent catheterization (IC)and the score of quality of life (QOL score). Adverse events were also recorded. \u0000 \u0000 \u0000Results \u0000A total of 58 male patients (all from Guangdong provincial work injury rehabilitation hospital)with mean age 28.6 years suffered from cerebral palsy (n=2), cerebrovascular accident(n=19)and spinal cord injury(n=37) were included into the study. Compared to baseline data, significant difference were observed at week 12 in PVR (56.68 ml vs. 280.11 ml, P<0.001), Pdet.max(23.95 cmH2O vs. 30.01 cmH2O, P=0.019), Qmax(6.74 ml/s vs. 3.28 ml/s, P=0.042), MUCP(48.25 cmH2O vs. 79.34 cmH2O, P<0.001), the case number of IC(40 vs. 58, P<0.001) and QOL score(3.63 vs.5.22, P<0.001) respectively. 5 cases developed perineal pain and 16 cases developed mild transient haematuria. These adverse events were disappeared by medical symptomatic treatment during 3-5 days. \u0000 \u0000 \u0000Conclusions \u0000BTX-A externalurethral sphincter injections help reduce urethra resistance and also improve the quality of life for patients with neurogenic detrusor underactivity. \u0000 \u0000 \u0000Key words: \u0000Urethral sphincter; Botulinum toxin A; Neurogenic detrusor underactivity; Effect; Safety","PeriodicalId":10343,"journal":{"name":"Chinese Journal of Urology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48449366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-15DOI: 10.3760/CMA.J.ISSN.1000-6702.2019.11.007
L. Xiaodong, Xu Wanhua, Sun Junjie, Liu Shoulin
Objective Comparison of the efficacy of mini flank incision and laparoscopy in the treatment of infants with ureteropelvic junction obstruction. Methods We retrospectively analyzed 85 cases of infants with ureteropelvic junction obstruction in our hospital from Jan. 2016 to Jan. 2018, all the patients underwent dismembered pyeloplasty. According to the surgical approach, they were divided into two groups: There were 45 cases in the mini flank incision group, including 39 males and 6 females, aged from 1 month to 3 years, with a median age of 4 months, and 40 patients in the laparoscopy group, including 33 males and 7 females, aged from 2 months to 3 years, with a median age of 9 months. The clinical effects of the two groups were compared. Results The patients were followed up for 12-24 months. The operation time[(68.0±15.3)min vs.(79.6±18.8)min], fasting time[(5±1)h vs.(14±8)h] and indwelling time of peri-renal drainage tube[(3.1±1.4)d vs.(4.3±2.2)d] in the mini flank incision group were shorter than those in the laparoscopy group (P 0.05). The recurrence rate[0 vs.5%(2/40)] and the incidence of complications[11.1%(5/45)vs. 17.5%(7/40)] in the mini flank incision group were lower than those in the laparoscopy group, but there was no statistical difference (P>0.05). Conclusions Pyeloplasty via mini flank incision or laparoscopy are both safe, effective and cosmetic.Mini flank incision surgery has the advantage of short operation time, easy to master and less disturbance of physiological function. Pyeloplasty via mini flank incision it is one of the reasonable options for the treatment of infants with ureteropelvic junction obstruction. Key words: Ureteral obstruction; Ureteropelvic junction obstruction(UPJO); Laparoscopy; Pyeloplasty; Minimally invasive; Infant
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