ABSTRACT
Objective:To investigate the predictors of the efficacy of extracorporeal shock wave lithotripsy (ESWL) in the treatment of ureteral calculi, and to evaluate the predictive value of the maximum ureteral wall thickness (UWT) in the treatment of ureteral calculi with ESWL.Methods:The clinical data of 138 patients with ureteral calculi treated with ESWL in the Second People's Hospital of Hefei from January 2020 to December 2020 were retrospectively analyzed. There were 91 males and 47 females. The age was (50.9±14.8) years old. The body mass index was (25.3±3.6) kg/m 2. The stones of 73 cases were located on the left side and 65 cases were on the right side. 70 cases had upper ureteral stones, 18 cases had middle ureteral stones, and 50 cases had lower ureteral stones. The median length of the stone was 8.5 (7.5, 10.5) mm. The CT value of the stone was 509 (343, 783) HU. The anteroposterior diameter of the renal pelvis was 12.0 (10.1, 16.0) mm, and UWT was (2.8 ± 0.8) mm. All patients underwent urinary non-contrast CT before lithotripsy, and the UWT of the stone bed was measured on the CT images. According to the stone removal situation 2 weeks after the operation, the patients were divided into a successful lithotripsy group and a failed lithotripsy group. Univariate analysis was used to compare the differences of various indicators between the two groups, and multivariate logistic regression was used to analyze the independent predictors of ESWL in the treatment of ureteral calculi for the indicators. The receiver operating characteristic (ROC) curve was used to calculate the area under the curve (AUC) of each independent predictor, and the cut-off value, sensitivity and specificity were analyzed. Results:All operations were successfully completed, and the success rate of the first-stage lithotripsy was 71.7% (99/138). The results of univariate analysis showed that the stone length diameter, stone CT value, anteroposterior diameter of renal pelvis, stone skin distance, and UWT were significantly different between the successful lithotripsy group and the failure group ( P<0.05). There was no significant difference in age, gender, body mass index, stone side and stone location ( P>0.05). The results of multivariate logistic analysis showed that stone length ( OR=1.393, P=0.015), stone CT value ( OR=1.002, P=0.043) and UWT ( OR=17.997, P<0.001) were all for the efficacy of ESWL in the treatment of ureteral stones. The ROC curve was used to compare the three independent predictors. The area under the UWT curve was the largest (AUC=0.898, P<0.001), followed by the length of the stone (AUC=0.744, P<0.001), and the CT value of the stone (AUC=0.672, P= 0.002). The cut-off value for UWT was 3.19 mm, which had a sensitivity of 91.9% and a specificity of 71.8% for predicting the success of ESWL lithotripsy. When dividing the patients into thin wall group (UWT ≤3.19 mm) and thick wall group (UWT>3.19 mm) according to the cut-off value, the success rates of one-stage lithotripsy in the two groups were 89.2% (91 / 102) and 22.2% (8/36), respectively ( P<0.05). Conclusions:UWT, calculus length and calculus CT value are independent predictors of the efficacy of ESWL in the treatment of ureteral calculi, and UWT has the best predictive value. When UWT≤3.19 mm, the success rate of ESWL in the treatment of ureteral calculi is higher.
ABSTRACT
Aggressive fibromatosis(AF)is a rare soft tissue tumor clinically that presents with local aggressive growth, are prone to relapse, but rarely metastasize to distant sites. It occurs in the limbs, trunk, mesentery, etc., but is rare in the pelvis or around the urinary system. This article reported a case of ureteral stenosis secondary to pelvic AF. The surgical treatment was effective.
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Objective To improve early diagnosis of testicular torsion,reduce misdiagnosis and reduce the rate of orchiectomy.Methods The diagnosis and treatment of testicular torsion in 31 cases were retrospectively ana-lyzed.Results 54.8% misdiagnosis rate was in this group,all the 31 cases were diagnosed by color Doppler ultra-sound,including 19 cases of retained testicle and orchiectomy in 12 cases (38.7%).In 19 cases of this group retained testis,testicular torsion time within 5 hours was 2 cases,and postoperative had testicles survival.In the 6 cases of testicular torsion time within 5 hours to 10 hours,5 cases had the testis survival.In the 5 cases of torsion of testis time was 10 hours to 24 hours,3 caseshad the testis survival.In the 6 cases of testicular torsion time more than 24 hours,2 cases of testis survival.After postoperative following-up,19 cases of retained testis had no recurrence,all the 31 cases were found no contralateral testicular torsion and all cases sex hormone levels were in the normal levels. Conclusion Testicular torsion is easily misdiagnosed,color doppler ultrasound should be preferred.Early diagnosis and aggressive surgical exploration,unity and strictly control the orchiectomy surgery indications,means a lot to reduce the rate of orchiectomy.