[Open stone surgery: is it justified in the era of minimally invasive therapies?].

OBJECTIVE: To summarize the efficacy of open stone surgery for renal and ureteral calculi, and to investigate the current indications for upper urinary tract stones treated by open stone surgery. METHODS: To analyze retrospectively the cases with upper urinary tract calculi treated by open stone surgery from January 1995 to December 2004. RESULTS: In all, there were 667 patients treated for renal and ureteral calculi by open stone surgery, at the same time 9000 cases with upper urinary tract calculi also treated in our centre with open surgery rate 7.4%. Indications for open surgery were complex stone burden of 297 cases, nephrectomy for non-functioning kidneys of 137 cases, with anatomical abnormalities of 134 cases, ESWL or endoscopy failure of 57 cases, with co-morbid medical diseases of 30 cases, with renal carcinoma of 5 cases, with xanthogranulomatous pyelonephritis of 3 cases, with kidney injury of 2 cases, and with other ipsilateral operation of 2 cases. Of 145 cases for nephrectomy, 16 patients and 6 patients suffered from various intraoperative and postoperative complications respectively;of 522 patients treated by open stone surgery, 7 patients and 34 patients were suffered from various intraoperative and postoperative complications respectively; 57 patients with multiple renal calculi had residual calculi with overall stone-free rate 89.1%. And no case died in perioperative period. CONCLUSIONS: Open surgery maintains its important role for treatment of renal and ureteral calculi because of its safety and efficacy. Nephrectomy for nonfunctioning kidney with renal and/or ureteral calculi, huge and complex renal calculi, anatomical abnormalities, minimal invasive therapies failure and some selective patients with co-morbid medical diseases are suitable for open stone surgery with high success and low morbidity rate.

Circumcision with "no-flip Shang Ring" and "Dorsal Slit" methods for adult males: a single-centered, prospective, clinical study.

This paper was aimed to compare the clinical effectiveness and safety of adult male circumcision using the Shang Ring™ (SR) with the no-flip technique compared with Dorsal Slit (DS) surgical method. A single-centered, prospective study was conducted at the West China Hospital, where patients were circumcised using the no-flip SR (n = 408) or the DS (n = 94) procedure. The adverse events (AEs) and satisfaction were recorded for both groups, and ring-removal time and percentage of delayed removals were recorded for the SR group. Finally, complete follow-up data were collected for 76.1% of patients (SR: n = 306; DS: n = 76). The average ring-removal time for the SR group was 17.62 ± 6.30 days. The operation time (P < 0.001), pain scores during the procedure (P < 0.001) and at 24 h postoperatively (P < 0.001), bleeding (P = 0.001), infection (P = 0.034), and satisfaction with penile appearance (P < 0.001) in the SR group were superior to those in the DS group. After two postoperative weeks, the percentage of patients with edema in the SR group (P = 0.029) was higher but no differences were found at 4 weeks (P = 0.185) between the two groups. In conclusions, the no-flip SR method was found to be superior to the DS method for its short operation time (<5 min), involving less pain, bleeding, infection, and resulting in a satisfactory appearance. However, the time for recovery from edema took longer, and patients may wear device for 2-3 weeks after the procedure.

Circumcision Status and Risk of HIV Acquisition during Heterosexual Intercourse for Both Males and Females: A Meta-Analysis.

In this study, we evaluated if male circumcision was associated with lower HIV acquisition for HIV (-) males and HIV (-) females during normal sexual behavior. We performed a systematic literature search of PubMed, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) databases to identify studies that compared HIV acquisition for the circumcised and uncircumcised groups. The reference lists of the included and excluded studies were also screened. Fifteen studies (4 RCTs and 11 prospective cohort studies) were included, and the related data were extracted and analyzed in a meta-analysis. Our study revealed strong evidence that male circumcision was associated with reduced HIV acquisition for HIV(-) males during sexual intercourse with females [pooled adjusted risk ratio (RR): 0.30, 95% CI 0.24 0.38, P < 0.00001] and provided a 70% protective effect. In contrast, no difference was detected in HIV acquisition for HIV (-) females between the circumcised and uncircumcised groups (pooled adjusted RR after sensitivity analysis: 0.68, 95%CI 0.40-1.15, P = 0.15). In conclusion, male circumcision could significantly protect males but not females from HIV acquisition at the population level. Male circumcision may serve as an additional approach toward HIV control, in conjunction with other strategies such as HIV counseling and testing, condom promotion, and so on.