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Objective To report the clinical features,management and prognosis of local recurrence with inferior vena cava tumor thrombus for renal cell carcinoma after laparoscopic partial nephrectomy.Methods A case of 37-year-old man was admitted to hospital for recurrent renal tumor in May 2013.The patient undervent laparoscopic partial nephrectomy for right kidney mass in June 2011,and renal cell carcinoma was diagnosed by pathological examination.The patient complained about pain of right flank in May 2013.Imaging examination (including CT,MRI and PET-CT) showed a 5 cm tumor on the upper-middle right kidney associated with inferior vena cava tumor thrombus,bulky retroperitoneal lymph nodes and extensive local invasion including psoas,ureter,perirenal fascia.Surgical excision of local recurrence,nephrectomy plus inferior vena eava thrombectomy was performed.Results Right nephrectomy and local recurrence incision plus inferior vena eava thrombectomy was performed successfully.The operation time was 360 min,blood loss was 4 000 ml.The patient was discharged on the 14th day after surgery.The pathological characteristics were as follows:the tumor was limited to the upper-middle right kidney,psoas,ureter,and inferior vena cava tumor thrombus,but carcinoma was not found in the lymph nodes,pelvis and others.The final pathological diagnosis was papillary renal cell carcinoma,type Ⅱ.Local recurrence and other distant metastasis were not demonstrated with CT in 12 months' follow-up.Conclusion Excision of locally recurrent renal cell carcinoma is possible,and complete surgical resection could lead to prolonged disease-free survival.
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Objective To evaluate the safety and effectiveness of endourological techniques in the treatment of benign prostate hyperplasia (BPH) in elderly high-risk patients.Methods A total of 202 BHP patients over 70 years old were treated with endourological techniques and followed up for 3-24 months.Patients were divided into transurethral resection of the prostate(TURP) group (n=90)and transurethral plasmakinetic resection of the prostate(PKRP) group (n =112).Results Compared with pre-treatment,the scores of IPSS and quality of life (QOL),residual urine volume and Qmax were improved in the TURP group after treatment [(6.3±1.2) vs.(27.8±2.5),(1.0±0.4)vs.(5.5±1.1),(18.0±2.8) ml vs.(95.0±18.0) ml,(17.5±1.4) ml/s vs.(5.4±2.0) ml/s,respectively,all P＜0.05].Compared with before treatment,the scores of IPSS and QOL,residual urine volume and Qmax were also improved in the PKRP group after treatment [(8.4 ± 2.5) vs.(27.9±2.3),(1.0±0.4) vs.(1.5±0.5),(25±4) mlvs.(150±26) ml,(19±2.3) ml/svs.(7.0±2.3) ml/s,respectively,all P＜0.05].There were no significant differences in IPSS,QOL,Qmax and RUV between the two groups after treatment (P＞0.05),but the complication incidence was less in PKRP group than in TURP group (6.25％ vs.22.2％,x2 =10.99,P＜0.05).Conclusions PKRP is a safe and effective therapy for elderly high risk patients with BPH.The individual treatment,intensive monitoring and adjustment before operation,and skilled manipulation are the key points to the successful operation.
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Objective To evaluate the clinical significance of simultaneous transurethral resection (TUR) of a bladder tumor and the prostate in the treatment of non-muscle invasive bladder cancer with benign prostatic hyperplasia (BPH).Methods Patients were divided into two groups.Group A contained 46 male patients who accepted TUR for the treatment of both bladder cancer and benign prostatic hyperplasia.Group B contained 69 male patients who accepted TURBt only.Clinical data were retrospectively collected and analyzed to compare clinical outcomes and safety in these two groups.Results The bladder cancer recurrence rates in group A and B were 50.0％ and 50.7％,the average recurrence free time was 20 and 18 months,and the progression rates were 6.5％ and 7.2％,respectively.There were no significant differences between the two groups for either average recurrence free time or progression rates (P ＞ 0.05).Recurrences in the prostatic urethra were found in two cases in group A and one case in group B and all three cases were in T1 G3.Conclusions Simultaneous TUR for bladder tumor and the prostate can be safely and effectively performed in terms of oncologica] control in patients who have non-muscle invasive and low grade bladder tumors ( T1G1 - G2 ) with lower urinary tract obstruction caused by BPH.But this procedure should be cautiously performed on patients with T1 G3 bladder tumors.
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Objective To evaluate the diagnosis of ureteral stone by helical CT. Methods 25 patients with acute flank pain. hematuria and suspected of ureteral stone on B ultrasonography yet with negative,KUB and IVU underwent helical CT scanning. Results 24 cases were found to have ureteral stone by helical CT,the accurate rate being 96%.Three cases were fond to have Hydronephrosis,Ureteral dilation,Edema periureteric and secondary signs of ureteral obstraction. Conclusions Helical CT is safe,quick and accurate in diagnosing ureteral stone.
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Objective To discuss the technique and therapeutic effect of pneumatic ballistic lithotripsy for the treatment of bladder calculi under ureteroscope via the outer sheath of resectoscope.MethodsTotally 42 patients with bladder calculi(39 men and 3 women)were treated in our hospital form March 2002 to February 2005.Among the patients,20 cases were complicated with BPH,and 3 had bladder fabrosis.The cystolith was crushed with pneumatic ballistic lithotripsy under an ureteroscope via the outer sheath of resectoscope.For the patients complicated with BPH(20 cases),prostatectomy was performed at the same time.ResultsAll the cases were cured in one session.No massive hemorrhage,bladder perforation,or overhydration occurred after the operation in this series.The patients were followed up for 6 to 18 months(mean 8 months),during which no recurrent cases were found,all the patients had normal urination.ConclusionsPneumatic ballistic lithotripsy via the outer sheath of resectoscope is an effective,simple,accurate method for the treatment of bladder stones.The procedure is superior in less complications and good outcomes.