Endoscopic combined ultrasound-guided access vs. ultrasound-guided access in endoscopic combined intrarenal surgery / 北京大学学报(医学版)

OBJECTIVE@#To compare the outcomes of endoscopic combined ultrasound-guided access (EUGA) with the conventional ultrasound-guided access (UGA) to achieve percutaneous renal access in endoscopic combined intrarenal surgery (ECIRS).@*METHODS@#A retrospective review of 53 patients undergoing ECIRS to treat upper urinary tract calculi between January 2017 and October 2019 was con-ducted. All of the cases were of complex upper urinary tract stones larger than 2 cm in diameter. The com-plex stone situations, such as multiple renal calyces calculi or staghorn calculi necessitated ECIRS. Under general anesthesia, the patients were placed in the galdakao-modified supine valdivia (GMSV) position, thus allowing both antegrade and retrograde accesss. The patients were divided to UGA and EUGA groups according to the protocol of achieving percutaneous renal access. In 28 cases, endoscopic combined ultrasound-guided accesss were obtained. Puncture and dilation were performed under direct flexible ureteroscopic visualization, while percutaneous renal access of 25 cases were performed with the conventional technique employing ultrasound guidance. Demographic and perioperative information, such as stone burden, presence of hydronephrosis and number of calyces involved was compared. Primary outcomes included total operative time, renal access time, repeat puncture, hemoglobin level, perioperative complications, and stone-free rate.@*RESULTS@#No major intra-operative complication was recorded in all the 53 ECRIS. No significant difference was observed between the groups in age and gender. There was no significant difference in body mass index[BMI (29.21±3.14) kg/m2 vs.(28.53±2.56) kg/m2], stone burden (37.68±6.89) mm vs. (35.53±6.52) mm, number of calyces involved 2.72±0.68 vs. 2.86±0.71, presence of hydronephrosis (56.0% vs. 46.4%), total operative time (93.0±12.2) min vs. (96.8±14.2) min, hemoglobin level reduction (6.56±2.16) g/L vs. 97.54±2.64) g/L, stone-free rate (92.0% vs. 92.8%), hospital stay (5.52±0.59) d vs. (5.64±0.62) d, perioperative complication rate (8.0% vs. 7.2%). Two patients in EUGA group experienced perioperative complications (one urinary tract infection and one hematuria) while two patients in UGA group experienced perioperative urinary tract infection. None in both groups received blood transfusion. The patients undergoing EUGA had shorter renal access time [(4.0±0.7) min vs. (6.8±2.6) min, P < 0.01] and less repeat puncture (0 vs. 4 cases, P < 0.05).@*CONCLUSION@#EUGA is an optimal technique to establish percutaneous renal access in ECIRS, which minimizes access time and repeated procedures.

Clinical outcomes of simultaneous bilateral endoscopic surgery for bilateral upper urinary tract calculi / 北京大学学报(医学版)

OBJECTIVE@#To discuss the efficacy and safety of simultaneous bilateral endoscopic surgery (SBES) for bilateral upper urinary tract calculi, and to summarize the initial experience.@*METHODS@#Patients diagnosed with bilateral upper urinary tract calculi who underwent SBES in the Department of Urology, Beijing Chao-Yang Hospital from January 2019 to January 2020 were enrolled retrospectively. The demographic and clinical data of the patients were recorded, and the operation status, stone free rate (SFR) and peri-operative complications were analyzed. The primary end point was SFR, and second end point was peri-operative complications.@*RESULTS@#A total of 23 patients underwent SBES, of which SBES was completed in 19 patients (12 males, and 7 females). The mean age was (41.3±12.0) years. Fourteen patients underwent modified supine position surgery and 4 patients in prone split-leg position. There was no statistical difference in the demographic and baseline clinical data of the patients in different positions. One patient underwent right percutaneous nephrolithotomy (PCNL) and left endoscopic combined intra-renal surgery (ECIRS) in the prone split-leg position, while 18 patients received simul-taneous surgery with PCNL and contralateral retrograde intra-renal surgery (RIRS). The mean anesthesia and operation time was (128.7±26.5) min and (70.7±20.3) min, respectively, which was significantly longer in the patients with prone split-leg position than in the patients with modified supine position, anesthesia time in the patients with prone split-leg position and modified supine position: (148.4±20.4) min vs. (121.6±25.3) min, respectively, t=－2.121, P=0.049, while the operation time in the patients with prone split-leg position and modified supine position: (86.4±21.1) min vs. (65.1±17.4) min, respectively, t=－2.222, P=0.040. There was no significant difference between the two groups in indwelling of nephrostomy [prone split-leg position and modified supine position: (2.6±0.9) d vs. (2.1±1.0) d, respectively; t=－0.880, P=0.391] and the length of hospital stay [prone split-leg position and modified supine position: (6.0±2.7) d vs. (5.2±1.8) d, respectively; t=－0.731, P=0.475]. One month after the operation, the SFR was 78.9%, and 3 patients had minor peri-operative complications (Clavien-Dindo grades Ⅰ/Ⅱ) without any serious complications (Clavien-Dindo grades Ⅲ/Ⅳ/Ⅴ).@*CONCLUSION@#The simultaneous bilateral endoscopic surgery would decrease the operation time and anesthesia exposure under the premise of ensuring the SFR, which is helpful to reduce the risk of peri-operative complications, especially to the patients who can not tolerate the second-stage or long-time operation.

Testicular tumor in Mongolian men (report of 35 cases) / 中华男科学杂志

<p><b>OBJECTIVE</b>To improve the diagnosis, therapy and prognosis of testicular tumor in Mongolian men.</p><p><b>METHODS</b>A retrospective review of 35 cases of testicular tumors in Mongolian men from seven medical centers dated from 1990 to 2004 was performed.</p><p><b>RESULTS</b>The usual presentation of a testicular tumor was a nodular or painless swelling of one gonad. The mean delay in diagnosis was 40.03 +/- 53.45 weeks. For 16 patients, delay in diagnosis was more than or equal to six months. The histologic composition of this series was 21 (60%) seminoma, 10 (28.6%) nonseminoma, 2 (5.7%) lymphoma, 1 (2.35%) fibroneuroma and 1 (2.35%) leiomyoma. Regarding stage, 22, 2, and 5 of 29 germ cell tumors were seen initially as stage I, II, and III, respectively. Combined therapy, including radical orchiectomy, radiotherapy and chemotherapy, were taken. 29 cases have been followed for 2 months to 10 years, 4 out of them died of distant metastasis, one died of other disease, one lives with tumor, the others live without relapse and metastasis. Three and 5-year survival rates for Mongolian patients with seminoma and nonseminoma were 95.0%, 95.0%, 57.1% and 42.8%, respectively.</p><p><b>CONCLUSION</b>In this article, the rate of seminoma to germ cell tumors is higher than that of general population. There is an increased mean delay in diagnosis for Mongolian patients. Three and 5-year survival rates for nonseminoma are lower than that for seminoma. Better public awareness regarding testicular tumor in this population, advances in diagnosis and therapy will help to improve therapeutic effectiveness and prognosis.</p>

Changes of gap junction in penile cavernous smooth muscle cells of hypertensive rats / 中华男科学杂志

<p><b>OBJECTIVE</b>To compare the changes of the intercellular conjunction in penile cavernous tissues between spontaneously hypertensive rats (SHR) and normotensive ones, and to study the relation of blood pressure with erectile function.</p><p><b>METHODS</b>After apomorphine (APO) injection, we observed penile erections in SHR (SHR group, n=5) and Wistar-Kyoto rats (WKY group, n=5), studied the ultrastructure of the cell-to-cell conjunction between the penile cavernous smooth muscle cells with a transmission electrical microscope, and examined the expression of mRNA and Connexin 43 protein by RT-PCR and immunohistochemistry.</p><p><b>RESULTS</b>The erectile frequency in the SHR group was significantly lower than in the WKY group. The smooth muscle cells were decreased and the collagen fibers between the smooth muscle cells were increased in the SHR group. The expression of mRNA and Connexin 43 protein in the cavernous tissues was significantly lower in the SHR group than in the WKY group (P < 0.05).</p><p><b>CONCLUSION</b>Hypertension affects penile erection, and the pathological changes of the cell-to-cell conjunction between the penile cavernous smooth muscle cells may be one of the important mechanisms of erectile dysfunction associated with hypertension.</p>