Abstract With improvements in endoscopy and laser technology, flexible ureteroscopy (FURS) has been a viable treatment option for large renal stones. Here, we share our experience of the FURS treatment for renal stones 2 cm or greater. We evaluated 251 consecutive patients who underwent FURS and holmium laser lithotripsy for renal stones 2 cm or greater between January 2015 and April 2019. Stone size was defined as the longest axis on non-contrast computed tomography. Data were retrospectively collected from electronic medical records. Patient demographics, stone clearance rates and perioperative complications were evaluated. There were 165 male patients and 86 female patients with an average age of 46.9 years (range 22–80 years). Mean stone size was 2.7 cm and the average number of procedures was 1.4 (range 1–5). The stone-free rate at the end of the first, second and third procedure was 61.9%, 82.9%, and 89.5%, respectively. The final stone-free rate decreased as stone size grows, and it was only 58.3% for kidney stones larger than 4 cm after an average of 2.3 procedures. The lowest clearance rates were observed in lower calyx calculi (87.2%) and multiple calyx calculi (83.5%). The overall complication rate was 15.1%, and the most common complication was postoperative fever (9.6%). One patient required blood transfusion, owing to postoperative coagulation disorders induced by urosepsis. Single or staged FURS is a practical treatment option for the renal stones sized 2 to 4 cm with acceptable efficacy and safety. Stone clearance rate of FURS treatment is mainly affected by stone size and location.
Objective To establish a new retroperitoneal laparoscopic technique which can keep the kidney in cold ischemia and has the characteristics of safety,effective and simplicity.Methods Twenty-two patients who needs to do the retroperitoneal laparoscopic partial nephrectomy were divided into two groups:the research group and the control group.There were 12 males and 10 females with average age of 37-69 years old.There were 4 cases of angiomyolipoma,and 18 cases of renal cell carcinoma.In research group,the renal temperature was reduced by circumfusion system of ice saline after clamping the renal artery,and then the retroperitoneal laparoscopic partial nephrectomy was done.In the control group,we did the same as well except the renal hypothermia.The renal temperature and the rectal temperature during the surgery,and the glomerular filtration rate (GFR) of both bilateral kidneys and the affected kidney before and after the surgery were compared.Results All the surgical operations were done successfully in both groups.No post-operative bleeding,inflammation and leakage of urine occurred.In the research group,the average cold ischemia time was (47.2 ±3.8) min,the average minimum renal temperature was (17.73 ± 0.91),and the average time reducing the renal temperature to 25 ℃ was (4.6 ±0.4) min.In the control group,the average cold ischemia time was (27.8 ± 1.5) min,and the average minimum renal temperature was (38.08 ± 0.33)℃.In the research group,the average GFR of the bilateral kidneys and the affected kidneys was (66.24 ±3.98) and (30.57 ±4.07) ml/min one week before the surgery,that was 53.89 ±7.53 and (20.92 ±4.49) ml/min one month after the surgery,that was (54.49 ±7.92) and (21.63 ±5.21) ml/min 3 months after the surgery,and that was (54.77 ± 7.84) and (21.73 ± 9.99) ml/min 6 months after the surgery,respectively.In the control group,the average GFR of th bilateral kidneys and the affected kidney was 66.49 ±9.87 and (30.65 ±5.45) ml/min one week before the surgery,that was (54.89 ±9.61) and (17.90 ±3.50) ml/min one month after surgery,that was (55.68 ± 10.02) and (18.09 ±3.39) ml/min 3 months after the surgery,and that was 55.82 ±5.12 and (18.17 ±3.39) ml/min 6 months after the surgery,respectively.The follow-up duration was 1-16 months without local recurrence and metastasis.Conclusion The new equipment with circumfusion system of ice saline can keep the kidney in cold ischemia,and is easy-to-use and efficient,especially it doesn' t need special equipment so it can be widely used in retroperitoneal laparoscopic surgery.
Key words:
Laparoscopy ; Partial nephretomy; Cold ischemia
Abstract Background The dogma that urine is sterile in healthy individuals has been overturned by recent studies applying molecular-based methods. Mounting evidences indicate that dysbiosis of the urinary microbiota is associated with several urological diseases. In this study, we aimed to investigate the characteristics of the urinary microbiome of patients with calcium-based kidney stones and compare it with those of healthy individuals.Method We collected bladder urine samples from 22 adult male patients with calcium-based kidney stones and 21 age-matched healthy controls by transurethral catheterization. For kidney stone patients, paired renal pelvis urine was also collected via ureteral catheter using aseptic technique. The V3-V4 region of the bacterial 16S rRNA gene was sequenced, and the urinary microbiota was analyzed by kidney stone status and specimen-type.Results The diversity of the urinary microbiota in kidney stone patients was significantly lower than that of healthy controls based on the Shannon and Simpson index (P<0.001 for both indices). The urinary microbiota structure also significantly differed between kidney stone patients and healthy controls (ANOSIM, R = 0.11, P <0.001). Differential representation of inflammation associated bacteria (e.g., Acinetobacter ) and several enriched functional pathways were identified in the urine of kidney stones patients. Meanwhile, we found the species diversity, overall composition of microbiota and predicted functional pathways were similar between bladder urine and renal pelvis urine in kidney stone patients.Conclusion A marked dysbiosis of urinary microbiota in male patients with calcium-based kidney stones was observed, which may be helpful to interpret the association between bacteria and calcium-based kidney stones.
Abstract Background The dogma that urine is sterile in healthy individuals has been overturned by recent studies applying molecular-based methods. Mounting evidences indicate that dysbiosis of the urinary microbiota is associated with several urological diseases. In this study, we aimed to investigate the urinary microbiome of male patients with calcium-based kidney stones and compare it with those of healthy individuals. Results The diversity of the urinary microbiota in kidney stone patients was significantly lower than that of healthy controls based on the Shannon and Simpson index ( P < 0.001 for both indices). The urinary microbiota structure also significantly differed between kidney stone patients and healthy controls (ANOSIM, R = 0.11, P < 0.001). Differential representation of inflammation associated bacteria (e.g., Acinetobacter ) and several enriched functional pathways were identified in the urine of kidney stones patients. Meanwhile, we found the species diversity, overall composition of microbiota and predicted functional pathways were similar between bladder urine and renal pelvis urine in kidney stone patients. Conclusions A marked dysbiosis of urinary microbiota in male patients with calcium-based kidney stones was observed, which may be helpful to interpret the association between bacteria and calcium-based kidney stones.
Objective
Through inserting the ureteral stent covered with physical antimicrobial film, to investigate the roles of physical antibacterial material in preventing and treating infection caused by indwelling ureteral stent.
Methods
120 cases were randomly divided into two groups: observation group and control group. The ureteral stent covered with physical antimicrobial film was placed into the ureter after ureteroscopy lithotripsy in observation group. And in control group, the ureteral stent not covered with physical antimicrobial film was inserted into the ureter after ureteroscopy lithotripsy. The ureteral stents were from the same company and had the same assignment. The infection related to the ureteral stent indwelling was compared between two groups after operation.
Results
Patients in the observation group,3,7,14,28 days after the operations the incidence of urinary tract infection were 3.3%, 6.7%, 6.7% and 6.7% respectively. In control group, the incidence of urinary tract infection were 6.7%, 20.0%, 30.0% and 43.3% respectively after the operations 3, 7, 14 and 28 days. The urinary tract infection rate at 3rd day post- operations in the observation group and control group had no significant difference. At 7th, 14th, and 28th day post- operation, the urinary tract infection rate in the observation group was lower than in the control group obviously(P 0.05).At 7th, 14th,and 28th day post- operation, the CRP, PCT and urine white blood cell count were reduced in the observation group as compared with those in the control group (P< 0.05).
Conclusion
The clinical studies confirmed that the ureteral stent covered with physical antimicrobial film can effectively avoid and reduce the infection related to ureteral stent indwelling.
Key words:
Urinary infection; Antibacterial material; Ureteral calculus
Objective:To observe and compare the de-epithelialization effects of intestine treated by dehydrated alcohol and by Silver Nitrate in rabbit model. Methods:Twenty-five rabbits were randomly divided into five groups, five in each group. All rabbits were anesthetized before operation. A 20 cm ileum segment was isolated with intact vessel. The ileum segments were treated in each group respectively with:(A)dehydrated alcohol for 8 min,(B)dehydrated alcohol for 15 min,(C)6%Silver Nitrate solution for 8 min(D)3%Silver Nitrate solution for 15 min(E)0.9% Sodium Chloride for 8 min.At the end of four weeks, we observed the absorptive function of the segments through Glucose-absorption test and also observed the histological changes.Results:Both dehydrated alcohol and Silver Nitrate can effectively de_epithelialize intestinal segments. Comparing with the control group, the mucosa from four treatment groups were atrophied (significance0.01).The Glucose-absorption test demonstrated the absorptive function of the ileum segments in treated groups was decreased(significance0.05).The group A and group C has a better result, mucosa from the two groups has poorer absorptive and secretive function, but when comparing the histological changes between them, it shows no significant differences.Conclusions: Treatment of the ileum segment by dehydrated alchol for 8 min or by 6% Silver Nitrate solution for 8 min effectively depressed the absorptive and secretive function.
Abstract Background The dogma that urine is sterile in healthy individuals has been overturned by recent studies applying molecular-based methods. Mounting evidences indicate that dysbiosis of the urinary microbiota is associated with several urological diseases. In this study, we aimed to investigate the urinary microbiome of male patients with calcium-based kidney stones and compare it with those of healthy individuals. Results The diversity of the urinary microbiota in kidney stone patients was significantly lower than that of healthy controls based on the Shannon and Simpson index (P<0.001 for both indices). The urinary microbiota structure also significantly differed between kidney stone patients and healthy controls (ANOSIM, R = 0.11, P <0.001). Differential representation of inflammation associated bacteria (e.g., Acinetobacter) and several enriched functional pathways were identified in the urine of kidney stones patients. Meanwhile, we found the species diversity, overall composition of microbiota and predicted functional pathways were similar between bladder urine and renal pelvis urine in kidney stone patients. Conclusions A marked dysbiosis of urinary microbiota in male patients with calcium-based kidney stones was observed, which may be helpful to interpret the association between bacteria and calcium-based kidney stones. Key Words: kidney stone, calcium-based, microbiome, urine, renal pelvis
Objective
To evaluate of efficacy and safety of nerve sparing laparoscopic retroperitoneal lymph node dissection for early stage testicular cancer.
Methods
From January 2001 to September 2014, 83 patients with primary testicular nonseminomatous germ cell tumors (NSGCT) received nerve sparing LRPLND at 1-4 week after orchiectomy.Their age ranged from 18 to 44 years old, mean 25 years old.Serum AFP was abnormally elevated in 51 patients, ranged from 15to 1432μg/L (mean 874 μg/L). beta-HCG were abnormally elevated in 46 patients, ranged from 5-70 IU/L(mean 56 IU/L). All of their clinical stage was stage Ⅰ and did not suffer from ejaculatory dysfunction.The operating time, intraoperative blood loss, postoperative intestinal function recovery time, drainage removal time, hospital stay, intra - and post - operative complications were recorded.
Results
The nerve sparing laparoscopic retroperitoneal lymph was successfully performed in all patients.The mean operating time was 218 min, (range 158-285 min). The mean intraoperative blood loss was 368ml (range 255-587ml). The postoperative intestinal function recovery time ranged from 24 to 48 hours (mean 31 hours). And the hospital stay ranged from 5 to 9 days (mean 7days). The inferior vena cava was injured during operation and was sutured laparoscopically in 1 patient.Mild chylous retroperitoneal drainage was seen in 3 patients, which was cured within 1 week after operation by restriction of high - fat diet.22 cases were noticed ejaculation dysfunction postoperatively, which recovered spontaneously within 8 to 12 weeks.Within the 3 to 76 months follow - up, 73 patients revealed no evidence of recurrence or distant metastasis.
Conclusions
Nerve sparing LRPLND is technically feasible, mini invasive, the morbidity and complication were significantly lower.It can be performed with satisfactory results in young patients with early stage NSGCT.
Key words:
Testicle; Nonseminomatous germ cell tumors; Nerve sparing retroperitoneal lymph node dissection; Laparoscopy; Ejaculation
Zinc finger protein 24 (ZNF24) has been demonstrated to regulate proliferation, differentiation and migration as well as invasion in several types of cells. However, the molecular role and clinical effects of ZNF24 in prostate cancer (PCa) remain unclear. The present study revealed that ZNF24 expression is upregulated in PCa, and associated with tumor volume, Gleason score, pathological grade and metastasis. Wound healing and Transwell invasion assays revealed that ectopic ZNF24 expression facilitated cell migration and invasion through the Twist1-induced epithelial-to-mesenchymal transition (EMT) process. In addition, colony formation and Cell Counting Kit-8 assays were used to determine the regulatory effects of ZNF24 on proliferation. The results suggested that ZNF24 also promoted cell proliferation in PCa. ZNF24 acted as an oncogene and promoted migration, invasion and EMT of PCa cells via the regulation of Twist1.
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