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Objectives:To validate the Chinese version of the Ureteral Stent Symptoms Questionnaire(Chinese-USSQ) in patients with an indwelling ureteral stent.Methods:The original USSQ was translated into Chinese and linguistically validated following the cross-cultural adaptation of health-related quality of life measures.A total of 83 patients (cases) with indwelling ureteral stent and 90 healthy subjects (controls) were asked to complete the Chinese-USSQ as well as European Quality of Life Visual Analogue scale(EQ-VAS)(for both genders), the International Prostate Symptom Scale (IPSS) (for male), and Urogenital Distress Inventory-6 (for female). Patients were evaluated at weeks 1 and 4 after stent placement and at week 4 after removal. The psychometric properties of the questionnaire were analyzed.Results:The Chinese version of USSQ include 43 items, which addressed various domains of health(6 sections) covering urinary symptoms, pain, general health, work performance and sexual matters with additional problems. A total of 78 patients(45 males and 33 females) and 90 controls (41 males and 49 females)were included for analysis. Internal consistencies (Cronbach′s α coefficients: 0.60-0.78) and test-retest reliability (Spearman correlation coefficient: 0.69-0.91) were satisfactory for urinary symptom, body pain, general health, and work performance domains. Most USSQ domains showed moderate correlations with each other. The convergent validity determined by correlation between other instruments and corresponding USSQ domain was satisfactory. At week 4 it was moderate for the urinary symptoms index compared to the IPSS in men(Spearman correlation coefficient>0.60), for the urinalry symptoms index compared to the UDI-6 score in women(Spearman correlation coefficient 0.52).Sensitivity to change and discriminant validity were also good in most domains ( P<0.01). Only a small proportion of the study population had an active sexual life with the stent in situ, which limited its analysis. Only 1(1.3%) and 6(7.7%) patients had an active sex life at week 1 and 4 after stent placement; meanwhile, 34(43.6%) patents were sexually active at week 4 after stent removal. Conclusion:The Chinese version of the USSQ is a reliable and valid instrument that can be used for Chinese patients with a indwelling ureteral stent in the clinical and research settings.
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Objective:To discuss the clinical manifestation, diagnosis and treatment of upper urinary tract calculi complicating with emphysematous pyelonephritis(EPN).Methods:The clinical data of 5 cases of upper urinary tract calculi complicating with EPN diagnosed in our department from July 2012 to December 2019 were retrospectively analyzed, and literatures were reviewed. 5 patients were identified by computed tomography scanning to upper urinary tract calculi complicating with EPN, 3 female and 2 male, aged 40-67 years, 2 staghorn calculi and 3 multiple stones. One patient suffered from diabetes mellitus. All cases presented with fever at the enrollment point, and the body temperature were 38.7℃, 38.8℃, 37.5℃, 38.6℃, 40.0℃, respectively. And the number of white blood cells and neutrophile granulocyte of these cases were higher than normal reference value, were 17.2×10 9/L, 0.90; 14.9×10 9/L, 0.89; 11.2×10 9/L, 0.85; 15.1×10 9/L, 0.87; 13.3×10 9/L, 0.88, respectively. The C-reactive protein were increased in all of the cases, especially in case 1(68 mg/l), case 2(253 mg/l), and case 5(67 mg/l). And 3 cases with renal insufficiency. Case 3 and case 4 were controlled the infection with medical management alone, and case 5 with percutaneous drainage plus medical management. The pyelonephritis of other 2 cases were uncontrolled, the body temperature of case 1 returned to normal after treated with percutaneous drainage of perirenal abscess plus nephrostomy plus medical management, but the imaging findings of kidney was not relief by CT scan after 4 weeks. Case 2 was persistent fever until treated with fluconazole according to the medicine sensitive experiment’s result of urine culture after undergoing nephrostomy plus indwelled a double J tube in ureter, but the CT findings of kidney grew worse 1 week later. Results:Of the 5 patients, 1 received first-stage nephrostomy and second-stage percutaneous nephrolithotomy, 2 received same session surgery, 2 received nephrectomy. There was no complications occurred except postoperative fever in 1 case. Postoperative pathology of the nephrectomy revealed glomerular sclerosis, glomerulus dilation, and inflammatory granulation tissue was formed. And 1-84 months follow-up showed no recurrence in all the cases.Conclusions:Upper urinary tract calculi complicating with EPN is an rare acute severe infection, CT is the best choice of early diagnosis, double J stenting or percutaneous drainage of abscess with broad-spectrum antibiotics could be the preferred treatment.
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Objective To analyze and summarize the risk factors and treatment options of post-renal transplantation. Methods We reviewed 445 renal transplant cases from May 1991 to October 2016 from our hospital. And we had 24 patient received renal transplantation elsewhere who developed malignant tumor afterwards. Among them, 14 patients were male, and 10 patients were female. The age ranged from 42 to 61 years old, with an average age of 54.5 years. 22 patients underwent hemodialysis, with an average of 14.6 months; 2 patients underwent peritoneal dialysis, and the duration is 15 months. 19 patients underwent the transplant for the first time, and 5 patients underwent second transplant. 13 of them developed tumors, and the incidence is 2.9%. In the 24 tumor patients: 19 were urothelial cancer, accounting for 79% (9 renal pelvis and ureter cancer, 8 primary ureter urothelial cancer and 2 primary bladder urothelial cancer), transplant kidney cancer 1 case, thyroid cancer 1 case, colon cancer 1 case and lymphoma 1 case. We analyzed the incidence rate of tumor, type of tumor, time to malignant tumor after surgery, time to diagnosis of tumor after surgery, usage of immune-suppressive medications and prognosis to stratify risk factors of malignant tumor development.Results Only 1 patient with lymphoma underwent chemotherapy, other 23 patients underwent radical operations. All the patients underwent eradicative surgery of malignant tumor, except one patient with lymphoma underwent chemotherapy. Among the 21 patients with urinary system cancers: 2 patients underwent open surgeries (1 patient underwent semi-urinary system resection, 1 patient underwent transplant kidney partial resection), 2 patient underwent TURBT, 17 patients underwent laparoscopic renal pelvis and ureter kidney resection. 3 patients underwent secondary TURBT in one year, 2 patients underwent 3 operations due to recurrent. 18 of them remain healthy; 5 patients had tumor recurrence after the surgery and are deceased 3 years later.Conclusions Post-transplantation patients are susceptible to malignant tumor development, which is closely related to the use of immune suppressant after transplantation. The key to optimal treatment is to detect tumor at an early stage.
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Objective To investigate self-management behaviors of kidney transplantation recipients after discharge.Methods A total of 97 kidney transplantation recipients were recruited from a teaching hospital of Peking University From September 2009 to June 2012,and all eligible subjects were then assigned to 3 groups:post-transplantation less than 6 months group (group A),post-transplantation 6-12 months group (group B),and post-transplantation more than 12 months group (group C).The subjects were required to complete self-management scale for renal transplant recipients.ANOVA was used for data analysis.Results There were 32 patients in group A,31 in group B,and 34 in group C.Self-management behavior score of the participants of the three groups was 100.1 ± 7.0,99.0 ± 7.3 and 91.3 ± 5.8,respectively (F =3.53,P =0.03).In terms of diet,group B got the highest score (F =16.41,P =0.00).However,group A showed excellence in physical activities (F =11.50,P =0.00).For three groups,score of drug effect and side effect was 2.00 ±0.00,2.03 ±0.18,and 2.41 ±0.50; score of routine laboratory values was 2.00 ±0.00,2.05 ± 0.16 and 2.82 ±0.39; and score of skin protection was 3.09 ±0.30,3.03 ± 0.91,and 2.85 ±0.36,respectively.Conclusions Post-transplantive self-management behavior of patients who completed the surgery for more than 12 months may not be better than others.Healthcare professionals need to improve patients' self-management through health education.
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Objective To investigate the current dyslipidemia profiles and correlation with etiological factors in early stage post-transplantation, and the impact of lipid metabolic disorder on renal function. Methods The clinical data of 1032 renal allografts from eight hospitals in Beijing between 2004 and 2008 were collected and evaluated retrospectively. Before and at the 1st, 3rd, 6th and 12th month post-transplantation, the changes in blood total cholesterol (TC), triglycerides (TG),low density lipoprotein (LDL)-cholesterol and high density lipoprotein (HDL)-cholesterol were analyzed. The difference in the blood lipid disorder at different stages stratified by time and different age group, the effects of immunosuppressive agents on blood lipid, and the impact of blood lipid disorder on the blood creatinine were studied. Results Except HDL-cholesterol, TC, LDL-cholesterol and TG levels were increased gradually at the first year, especially LDL-cholesterol and TG. The TC and LDL-choleaterol abnormalities were obviously related with age (P<0. 01 ). The effect of Tacrolimus (Tac)-based immunosuppressive regimen on the lipid metabolic disorder was less than cyclosporine (CsA). At the first year, there was no significant difference in blood creatinine between lipid-lowering treatment and non-lipid-lowering treatment (P>0. 05). For the recipients not subject to lipid-lowering treatment and their TG level higher than the normal at the first month after operation, the creatinine level at the first year was significantly higher than in those with normal TG level (P< 0. 05). Conclusion The lipid metabolic disorder following renal transplantation is a common complication after the first transplant year, and was related with age and immunosuppressive agent regimen. Tac-based immunosuppressive regimen has little effects on the blood lipid metabolism.
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Objective To monitor the production of nitric oxide(NO)and to study its role during ischemia-reperfusion of kidney transplantation in rats using electron paramagnetic resonance(EPR). Methods LEW male rats (age of 8 to 10 months,body weight of 200 to 230 g) were included.Of them 30 were assigned to donor group whose kidney grafts were stored at 0℃ for 24 hours.The remaining 45 rats were equally divided into 3 groups (15 in each group).Group 1 served as controls.In Group 2,allotransplantations of kidneys were performed,and both original kidneys were removed during reperfusions.In Group 3,2 hours prior to the operation,the donors and the recipients were both treated with L-NAME at the dose of 30 mg/kg.Reperfusions were done to the transplanted kidneys and both original kidneys were removed.The production of NO was measured with ERP at each time point before and after blood flow recovery.The creatinine level,GFR and the tissue carbonyl content were recorded on the first and fifth days after operation. Results In Group 2,the production of NO remarkably increased after 15 minutes' reperfusion and kept increasing for 120 minutes. Then the level fell to normal after 210 minutes.In Group 3,the recorded creatinine levels were higher than those in Group 2 at the 24th hour ( P
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0.05). Conclusions Bacterial biofilm formation on the surface of the catheter is an important pathogenetic factor,which contributes to the recurrence and antibiotic resistance of urinary tract infection. Shortening the period of catheter dwelling and using closed drainage remain the predominant prevention and treatment of urinary tract infection.