[Comparison of tubeless-percutaneous nephrolithotomy and ureteroscopic lithotripsy in treatment of upper-ureteral calculi sized ≥ 1.5 cm].

OBJECTIVE: To compare the efficacy and safety of tubeless percutaneous nephrolithotomy (tubeless-PCNL) and ureteroscopic lithotripsy (URL) in treatment of impacted upper-ureteral calculi ≥ 1.5 cm in size. METHODS: Patients with ureteral stones sized ≥ 1.5 cm and lodged above the fourth lumbar vertebra who were treated between September 2009 and July 2013 in Peking University People's Hospital were retrospectively analyzed. In the study, 182 patients underwent tubeless-PCNL or URL treatment respectively, and the operation success rates were compared. The duration of operation, intraoperative blood loss(average hemoglobin decrease), complications, mean hospital stay and residual stone rates were also compared. RESULTS: Fifty-four patients underwent tubeless-PCNL treatment,the average stone size was (1.9 ± 0.4) cm,nephrostomy tubes were placed in two patients,and the operation success rate was 96.3%(52/54). In the rest of the 52 patients,and the mean operation time was (30.1 ± 14.8) minutes with an average postoperative hemoglobin decrease of (10.2 ± 6.1) g/L, and the mean hospital stay was (3.0 ± 1.4) days. Only one of the patients had residual fragments (2%). The main complications included minor perirenal hematoma in 1 patient, fever in 2 patients,elevated blood WBC in 11 patients,and analgesics requirement in 3 patients. In the study, 128 patients were treated with URL,the average stone size was (1.7 ± 0.3) cm. 19 procedures failed,and 10 patients were converted to PCNL,extracorporeal shock wave lithotripsy was executed subsequently after double-J stent placement in 5 patients,and migration of calculi or stone fragments happened in 4 patients. The mean operative time was (51.3 ± 25.5) minutes for the remaining 109 patients with a hemoglobin reduction of (5.2 ± 7.2) g/L. The mean hospital stay was (2.9 ± 1.3) days, and residual stones were found in 13 of the 109 patients (11.9%). The main complications included fever in 3 patients, elevated blood WBC in 42 patients, analgesics requirement in 13 patients because of pain in the urethra or flank. The size of the stones between the two group didn't show significant difference,but the success rate of the tubeless-PCNL procedure was significantly higher. Except that hemoglobin decrease was slightly higher in the tubeless-PCNL group,the mean operative time, the rate of residual stones and rate of complications of the tubeless-PCNL group were lower significantly. CONCLUSION: Treating stones above 4th lumbar vertebra larger than 1.5 cm were challenging. It is difficult to treat these stones with URL because of a high probability to fail, but on the contrary, tubeless-PCNL was more likely to be performed successfully. For surgeons experienced with the PCNL technology, treating stones ≥ 1.5 cm with tubeless-PCNL procedure may turn out to be more efficient and with a higher operation success rate, and the risk of complications was lower without lengthening the postoperative hospital stay.

[Tubeless 24 F tract percutaneous nephrolithotomy in treatment of renal and proximal ureteral calculi].

OBJECTIVE: To evaluate the feasibility and efficacy of tubeless 24 F (1 F=0.33 mm)tract percutaneous nephrolithotomy (PCNL) in the treatment of renal and proximal ureteral stones in Chinese patients. METHODS: In the study, 108 patients treated with tubless 24 F tract PCNLs during September 2009 and April 2013 in our department were retrospectively analyzed, of whom, 42 were with renal calculi (the max diameter of calculi 2-4 cm, including 4 with simple staghorn stones), 41 with upper ureteral stones (the max diameter of calculi more than 1.5 cm or failure treated with extracorporeal shock wave lithotripsy), and 25 with upper ureteral stones combined with simple renal stones. Tubeless 24 F tract PCNL was performed when serious renal infection, obstraction in the distal of stone, the thickness of cortex less than 5 mm, operation time more than 90 min, residual stones needing second PCNL, severe bleeding during operation, pelvic perforation and obvious urinous infiltration were excluded. RESULTS: All the 108 patients were treated successfully with tubeless 24 F tract PCNL. Residual stone(about 5 mm in diameter)was found only 1 patient's lower calyces. The stone clearance rate was 99.1%, the average operation time was (40.5±9.1) min, the mean VAS on the first day postoperation was 3.0±1.6, the preoperative and postoperative hemoglobin decrease was (4.8±2.7) g/L, no blood transfusion and angiography and embolization needed, no pleural and other adjacent organ injury occurred. One patient got fever postoperatively (>38.5 °C). No perirenal hematoma and urine leakage were found. The average postoperative hospital stay was (2.4±0.6) days. All the patients were followed up for 1 month, and no other complication occurred. CONCLUSION: Tubeless 24 F tract PCNL can be a feasible way for renal stones and upper ureteral stones treatment, based on the severity candidate, perfect operative procedures and precise judgment at the end of the operation.

[Application of a novel intracorporeal combined pneumatic and ultrasonic lithotriptor (CQS-01) in percutaneous nephrolithotomy].

OBJECTIVE: To evaluate the safety and efficacy of a new intracorporeal pneumatic and ultrasonic lithotriptor (CQS-01) in percutaneous nephrolithotomy (PNL). METHODS: In the study, 408 patients with renal or upper ureteral stones suitable for PNL treatment were treated with CQS-01 ultrasonic and pneumatic lithotripter. Their stone position: Single side 368 patients and bilaterial 40 patients. Simple kidney stones: 312 patients, combined ureteral and kidney 42 patients, and simple ureteral stones 54 patients. Stone burden: staghorn stone: 95 patients. All the patients were followed up for 1 week post-operation. The data were collected and analyzed with regard to stone burden, postoperative stone clearance rate, operation time, occurrence rate of adverse events. RESULTS: The postoperative stone-free rate was 91.2% and the residual stone rate 8.8%; The mean operation time was (90.5±68.0) min; There were 6 patients (1.5%) who received selective renal artery embolism because of bleeding after operation. One patient had severe urinary infection and no other severe complications happened. CONCLUSION: CQS-01 ultrasonic and pneumatic lithotriptor is safe and effective in PNL, and suitable for clinical application.

[Clinical safety and efficacy of a novel intracorporeal combined pneumatic and ultrasonic lithotriptor (CQS-01) compared with Swiss LithoClast Master (EMS-III)].

OBJECTIVE: To evaluate the safety and efficacy of a new intracorporeal pneumatic and ultrasonic lithotriptor (CQS-01). METHODS: Eighty-six patients with renal or upper ureteral stones suitable for percutaneous nephrolithotomy (PNL) treatment were randomly divided into trial group (treated with CQS-01 device) and control group (treated with EMS-III device), with 43 patients in either group respectively. All the patients were followed up for 7 ± 3 days post-operation. The data were collected and analyzed with regard to stone burden, postoperative stone clearance rate, operation time, stone fragmentation and extraction time, volume of extracted stones, changes of red blood cells (RBC) and hemoglobin (Hb), occurrence rate of transfusion, changes of blood urea nitrogen (BUN) and creatinine (Cr), serum electrolytes, white blood cells (WBC), as well as body temperature and adverse events rate at 24 hours and 7 ± 3 days post PNL operation. RESULTS: No significant differences were found between the trial group and the control group (P>0.05), in terms of patients demography, renal characteristics and stone characteristics. In the trial group and the control group, respectively: the postoperative stone-free rate was 76.74% and 79.07% (P=0.796) and the partial stone clearance rate was 23.26% and 20.93% (P=0.796), the operation time was (92.49 ± 76.59) min and (87.28 ± 50.01) min (P=0.485), the stone fragmentation and extraction time was (50.16 ± 57.11) min and (40.59 ± 31.01) min (P=0.976), the volume of extracted stones was (10.85 ± 20.08) mL and (5.05 ± 6.00) mL (P=0.041). There were also no significant differences in postoperative RBC and Hb drops, occurrence rate of transfusion, post-operative BUN and Cr, body temperature changes, postoperative systemic inflammatory response and adverse events rate at 24 hours and 7 ± 3 days post-operation between the trial and control groups (P>0.05). CONCLUSION: There is no significant difference in clinical safety, efficacy, and the stone clearance capability between CQS-01 device and EMS-III device.

[Characteristics of renal hemorrhage after percutaneous nephrolithotomy and the timing of selective embolization: a report of 13 cases].

OBJECTIVE: To investigate the characteristics of severe renal hemorrhage after percutaneous nephrolithotomy (PNL) and timing of selective transarterial embolization(TAE) . METHODS: Between May 2005 and March 2010, superselective renal angiography was used to control severe bleeding in 15 of 1418 cases (1520 PNL procedures, 1.06%). In the 15 cases, superselective renal angioembolization was used to control severe bleeding in 13 (0.92%) . The medical records of all the patients who underwent renal angiography and angioembolization were reviewed. RESULTS: Severe bleeding cases after PNL were divided into 3 types according to the clinical characteristics: type I (urgency type), type II (intermittence type) and type III (persistent slow type). There were 3 patients in type I, 6 in type II and 6 in type III. All the patients had a normal coagulation profile before surgery. A total of 11 patients (84.6%) underwent the first-time successful embolization and 2 (15.4%) the second-time successful embolization. The longer time between angioembolization and bleeding was, the more blood loss and transfusion volume were, except for 1 patient in type II . Temporality serum creatinine abnormality was found in 2 patients, one with a solitary kidney patient and the other with angioembolization for both renal bleeding. CONCLUSION: TAE is a minimally invasive, safe, simple, and highly effective modality for the management of post PNL renal bleeding. This option should be considered early in the management of these cases,especially for Urgency type bleeding.

[Analysis and clinical implication of upper urinary tract stone's bacterial spectrum].

OBJECTIVES: To analyze the pathogenic bacterial's distribution and the drug resistance in the upper urinary tract stones, and to provide the information for choosing suitable antibiotics. METHODS: Stone samples were taken for culture and for drug sensitivity test in 146 patients undergoing percutaneous nephrolithotomy between April 2007 and October 2008, and the results were analyzed. RESULTS: Pathogens presented in 72 (49.3%) patients. There were 70 (86.4%) Gram-negative bacteria strains. Escherichia coli, Pseudomonas aeruginosa and Enterobacter cloacae were the predominant bacteria, accounted for 30.9%(25 strains), 23.5% (19 strains) and 12.3% (10 strains), respectively. There were 10 (12.3%) Gram-positive bacteria strains, the predominant bacteria was Staphylococcus epidermidis (6 strains), accounting for 7.4%. And there was 1 fungi strain (1.2%). Resistance to ampicillin/sulbactam (88.7%), ceftriaxone (81.3%) and ciprofloxacin (67.5%) was most commonly found in pathogen, and the rate of resistance to amikacin, imipenem and piperacillin/tazobactam were 8.6%, 10.0%, 10.0%, respectively. Erythromycylamine, teicoplanin, SMZ-TMP, nitrofurantoin were sensitive to Gram-positive bacteria. CONCLUSIONS: Bacterial's distribution of upper urinary tract stones are multiple, and the majority pathogen is Gram-negative bacteria. A big variant resistance is found among different bacterium. The suitable antibiotics should be chosen according to the different bacterium in the patients who underwent percutaneous nephrolithotomy.

[Clinical implication of stone culture in percutaneous nephrolithotomy].

OBJECTIVE: To evaluate the correlation between stone culture and SIRS, ascertain the clinical implication of stone culture in PCNL. METHODS: Clinical data of 66 patients who underwent PCNL in our department were analyzed retrospectively. Eight risk factors including stone culture + drug sensitivity, urine culture + drug sensitivity, age, gender, prophylactic antibiotics, stone volume, operative time and the number of tract. Multiple statistics methods were used for analysis to evaluate the impact of SIRS, and compare the difference between stone culture and urine culture. RESULTS: Univariate analysis and Multivariate logistic regression model showed that positive stone culture was the risk factor of SIRS (P < 0.05). Positive stone culture was found in 48.48% patients, which was higher than that of urine culture (30.30%). Fourteen patients (66.67%) of 21 postoperative SIRS patients were prescribed antibiotics according to the stone culture result. And all of them recovered unevenly without developing septic shock or MODS. CONCLUSIONS: Positive stone culture is the important risk factor of post-PCNL SIRS. Stone culture is better than urine culture in directing postoperative antibiotics prescripsion and should be routinely used.

[Infrared spectrophotometry for crystalline composition of staghorn calculi].

OBJECTIVE: To provide theoretic rationales for treatment and prevention of staghorn calculi by analyzing stone composition and studying the relationship between stone and urinary tract infections. METHODS: The clinical data of 51 staghorn calculi patients were analyzed retrospectively. The stone compositions were studied by infrared spectrophotometry. RESULTS: Six types of stone compositions were obtained. There were calcium oxalate monohydrate, calcium oxalate dehydrate, carbonate apatite, magnesium ammonium phosphate hexahydrate, uric acid and L-cystine. The majority of stones were of mixed compositions, pure stones were found in 15 cases (29.4%). Among all stones, calcium oxalate stones were found in 41 cases (80.4%) and uric stones in 10 cases (19.6%). Infectious stones were found in 26 cases (51.0%). Urinary tract infections were found in 40 (78.4%) patients and positive urine/stone culture was detected in 33 (64.7%) patients. CONCLUSION: With multiple crystalline compositions and etiological factors, the staghorn calculi are closely correlated with urinary tract infections.

[Analysis of pelvic lipomatosis and a case report of two brothers].

Two brothers presented with renal failure. CT and MRL showed bilateral hydronephrosis and hydroureters. A cystogram was performed and showed an elevated pear-shaped bladder secondary to thickening of the bladder wall. Bladder and sigmoid were surrounded by homogeneous fat tissue. The colon was symmetrically fusiform narrowed. Ileal bladder surgery was conducted. We reviewed a total of 96 studies reported between 1959 and 2005,a including 198 patients with pelvic lipomatosis. The ratio of males to females was 27:1. Pelvic lipomatosis was a rare disorder of benign mature adipose tissue proliferation around the bladder and rectum, with urological or digestive system symptoms as the chief presentation. Most cases were associated with hypertension, proliferative cystitis and upper tract obstruction. Also there were risks of thrombosis, calculi and bladder adenocarcinoma. The chief differential diagnosis was liposarcoma. Currently, urinary diversion is the main treatment to relieve urinary obstruction.

[Construction and screening of suppression subtractive hybridization library of renal cell carcinoma].

OBJECTIVE: To construct and screen the suppression subtractive hybridization (SSH) library of human renal cell carcinoma (RCC). METHODS: Poly A(+) RNA was isolated from RCC lines 786-O (tester) and renal cell (RC) lines HK-2 (driver), respectively. SSH procedure was performed according to the protocol of the PCR-Select cDNA Subtraction Kit (Clontech), and PCR products were cloned into pT-Adv vector and transformed E. coli TOP10F'. All positive clones picked out were digested and some of which were sequenced. RESULTS: The SSH library contained 362 clones with SSH cDNA fragments distributed mainly from 0.3 to 0.9 kb. Among 50 clones sequenced randomly, 2 represented unknown genes and the other 48 derived from 36 known genes. CONCLUSION: The quality of the SSH library of human RCC is reliable and its construction is the basis for further screening differentially expressed genes of RCC.

[Screening of novel genes differentially expressed in human renal cell carcinoma by suppression subtractive hybridization].

BACKGROUND AND OBJECTIVE: Identifying the differentially expressed genes in renal cell carcinoma (RCC) contributes to the elucidation of its genetic basis. However, the above knowledge has not yet been fully understood. The aims of this experiment were to screen novel genes differentially expressed in RCC tissues by suppression subtractive hybridization (SSH) and clone RCC-specific related genes. METHODS: To construct SSH library of RCC by using the mRNA from RCC tissues and matched normal kidney tissues as tester and driver, respectively. Partial positive clones in the library were selected randomly and sequenced, then analyze the sequences with the BLAST software. To confirm the location of the fragments of interest in human chromosome through comparing their sequences with the human genome draft. mRNA levels of the novel genes in RCC and matched normal kidney tissues were determined by Northern blot and semi-quantitative RT-PCR analysis. RESULTS: The SSH library contained 414 positive clones. Random analysis of 280 clones with enzyme restriction showed that 265 clones contained cDNA fragments distributed mainly between 300-900bp. Among 80 arbitrary clones with were derived from above 265 clones and sequenced, No. 28, 158, 170, and 249 clones are previously unknown genes and located in human chromosome 21q22, 4p15.3, 9q34, and 22q11.2 by electronic mapping, respectively. The consequence of semi-quantitative RT-PCR demonstrated that mRNA levels of the two novel genes were overexpressed in RCC compared to matched normal tissues by more than 2-6 folds. Northern blot analysis confirmed the above results. CONCLUSIONS: SSH is a reliable strategy for screening novel genes differentially expressed in RCC. The novel gene fragments can be used to clone their full length and further to study their functions.