Реферат
Objective To investigate whether E.coli infection increases surgical site infection and postoperative fever in comparison with other pathogens.Methods A retrospective cohort study was conducted on 506 patients who underwent urethral segment resection and end anastomosis for the bulb or posterior urethral stenosis in our department during 2011 and 2019.According to occurrence of postoperative surgical site infection(SSI)or postoperative fever(POF),they were divided into SSI group(n=19)and non-SSI group(n=487),as well as POF group(n=61)and non-POF group(n=445 patients)respectively.Multivariate logistic regression analysis and LASSO algorithm were used to screen the potential risk factors.According to the results of positive preoperative urine culture in 302 patients,they were subsequently divided into E.coli infection group(n=80)and other pathogen infection group(n=222),and after reducing potential bias with propensity score matching,finally 48 patients were assigned into E.coli infection group,and 192 into other pathogen infection groups.The differences in occurrences of SSI and POF were compared between the above 2 groups of patients.Results Multivariate logistic regression analysis and LASSO algorithm revealed that positive preoperative urine culture was an independent risk factor for predicting SSI(P=0.012)and POF(P＜0.01).Among the 302 patients with positive results in preoperative urine culture,E.coli infections was in the first rank,accounting for 26.5％.After propensity score matched treatment,the incidence of SSI in the E.coli group and other pathogen groups was 29.2％and 2.1％,respectively(P＜0.01).The incidence of POF was also higher in the E.coli infection group than the other pathogen infection group(27.1％vs 13.5％,P=0.02).Conclusion Preoperative E.coli infection may increase the risk of SSI and POF after urethroplasty when compared with other pathogen infections.
Реферат
Objective:To explore the risk factors for urethral stricture after transperineal anastomotic urethroplasty (TAU) by retrospectively analyzing patient data and to develop a nomogram to predict the risk of recurrence before the surgery.Methods:Clinical data of patients who underwent TAU because of post-traumatic urethral stricture from January 2016 to December 2017 in West China Hospital, Sichuan University were reviewd. A total of 78 patients were included in the retrospective analysis, with 13 of them having recurrence. The patients in the recurrence group had a median age of 49.8 and 76.9% (10/13) of them had membranous urethral stricture. The proximal urethra end was located above the superior margin of the pubic ramus (higher stricture site) in 53.8%(7/13)of patients in the recurrence group and the length of the stricture measured in the operation was (2.19±0.22) cm. In the non-recurrence group, the median age was (44.8±13.6) years old, 58.5% (38/65) of them had membranous urethral stricture, 21.5% (14/65) had higher stricture site, and the length of the stricture was (2.03±0.11) cm. Both univariate and multivariate logistics analyses were performed to evaluate the risk factors of recurrence of urethral stricture 5 years after surgery. The nomogram was built based on the multivariate logistics analysis. The Concordance Index (C-index), Receiver Operating Characteristic(ROC) curve and Calibration curve were used to evaluate the nomogram.Results:Univariate logistics analysis showed that higher stricture site, history of urethral dilation, smoking, diabetes and total serum protein may be associated with recurrence after surgery. Multivariate logistics analysis further confirmed that higher stricture site ( OR=34.64, 95% CI 3.71-754.53), history of urethral dilation( OR=13.15, 95% CI 1.27-210.00), smoking ( OR=13.75, 95% CI 2.15-166.05) and diabetes ( OR=64.98, 95% CI 3.80-1957.60) were independent risk factors for recurrent urethral stricture while higher total serum protein before surgery was related to lower recurrence risk ( OR=0.78, 95% CI 0.62-0.93). A nomogram was built based on the results. The C-index of the nomogram was 0.923(95% CI 0.908-0.938), the area under curve (AUC) was 0.923 (95% CI 0.855-0.991), and the Brier Score was 0.079. Conclusion:Higher stricture site, history of urethral dilation before surgery, smoking, diabetes and lower total serum protein before surgery are associated with higher recurrence TAU of post-traumatic urethral stricture patients. With the nomogram developed, prediction of the risk of recurrence could be achieved prior surgery.
Реферат
Objective:To investigate the efficacy and safety of bladder neck resection combined with multipoint injection of triamcinolone acetonide in the treatment of bladder neck contractures (BNC) after transurethral resection prostate (TURP).Methods:The data of 25 patients with BNC after TUPR who underwent transurethral surgery in West China Hospital of Sichuan University from July 2019 to November 2021 were retrospectively analyzed, and the patients were divided into 2 groups according to the treatment method. There were 15 cases in the steroid injection group, with an average age of (67.5±8.8) years, 1 case of diabetes, and 2 cases of hypertension. And the average postoperative time after TURP was (21.9±29.1) months, the preoperative International Prostate Symptom Score (IPSS) was (30.0±3.5) points, quality of life (QOL) score was (5.7±0.5) points. There were 10 cases in the non-steroid injection group, with an average age of (65.2±10.5) years, 1 case of diabetes, and 2 cases of hypertension. And the average postoperative time of TURP was (29.3±33.5) months, and the preoperative IPSS was (30.4±2.6) points, QOL score was (5.8±0.4) points. There was no significant difference between the two groups ( P>0.05). In the steroid injection group, bladder neck resection combined with multipoint injection of triamcinolone acetonide was performed. The patients were in the lithotomy position, and a scope was placed through the urethra into the distal end of the narrow urethra under direct vision for observation, and a supersmooth guide wire was placed. The narrow section is then incised at 6 o'clock. After replacing the resectoscope, the urethral stricture scar was excised until the normal tissue of the bladder neck was exposed. Hemostasis by electrocoagulation resulted in no active bleeding from the urethra after resection. After the bladder injection needle was inserted, 80 mg (12 ml) of triamcinolone acetonide injection was injected in 6 equally spaced needles at the direction of the bladder neck from 3 to 9 o'clock. A supersmooth guide wire was placed, and a three-channel silicone urinary catheter was indwelled along the guide wire. The non-steroid injection group underwent simple bladder neck resection. Re-examination of urethroscopy at 3 and 6 months after operation showed that the patient had obvious dysuria and the microscopic examination showed that the recurrence of bladder neck stenosis was defined as the recurrence of stenosis. The efficacy, complications, and recurrence-free survival rates of the two groups were compared. Predictors of postoperative BNC recurrence were analyzed. Results:The operations in both groups were successfully completed. The operation time of the steroid injection group and the non-steroid injection group were (36.0±17.8) min and (48.5±57.9) min respectively ( P=0.438), and the intraoperative blood loss was (1.9±3.0) ml and (12.0±31.1) ml ( P=0.221)respectively. The length of hospital stay was (5.8±1.2) d and (4.4±2.5) d, respectively ( P=0.070). There was 1 case of transient hematuria and 1 case of epididymitis in the steroid injection group, and 1 case of transient hematuria and 1 case of transient dysuria in the non-steroid injection group ( P>0.05), all of which were relieved after symptomatic treatment. The IPSS of steroid injection group and non-steroid injection group were (11.0±5.6) points and (12.4±3.9) points at 3 months after operation, and (10.1±4.9) points and (14.7±7.7) points at 6 months after operation, respectively. QOL at 3 months after operation was (1.7±1.2) points and (2.1±1.5) points, respectively, and at 6 months after operation, it was (1.5±1.3) points and (3.0±2.0) points, respectively. There was statistical significance ( P<0.05). There were 1 case and 2 cases of recurrence in the steroid injection group and non-steroid injection group at 3 months after operation ( P=0.543), and 1 case and 5 cases at 6 months after operation ( P=0.023). The difference in survival curve between the two groups was statistically significant ( P=0.013). Combined steroid therapy ( OR=14.000, 95% CI1.299-150.889, P=0.030), time after scar resection ( OR=1.138, 95% CI1.017-1.273, P=0.025), postoperative IPSS( OR=1.302, 95% CI1.018-1.666, P=0.036), postoperative QOL score ( OR=4.280, 95% CI1.523-12.030, P=0.006) were the predictors of stenosis recurrence 6 months after surgery. Conclusion:Bladder neck scar resection combined with steroid injection could be safe and effective in the treatment of BNC after TURP, and local steroid injection may help reduce the recurrence rate of postoperative stenosis.
Реферат
Three dimensional (3D) bioprinting is a new biological tissue engineering technology in recent years. The development of 3D bioprinting is conducive to solving the current problems of clinical tissue and organ repairing. This article provides a review about the clinical and research status of 3D bioprinting and urinary system reconstruction. Furthermore, the feasibility and clinical value of 3D bioprinting in urinary system reconstruction will be also discussed.
Тема - темы
Humans , Bioprinting , Printing, Three-Dimensional , Tissue Engineering , Urinary TractРеферат
Objective This systematic review and Meta-analysis was conducted to clarify the safety and efficacy of robotic-assisted (RP),laparoscopic (LP) and open (OP) dismembered pyeloplasty.Methods A systematic literature search on MEDLINE,Cochrane Central Register of Coutrolled Trials,and Web of Science was conducted to identify the relevant studies published before December 2018.Information was extracted from each eligible article.All statistical analyses of this Meta-analysis were performed with Stata 14 and RevMan 5.3 software.Results A total of 24 studies met the inclusion criteria and were included in this Meta-analysis.Compared with OP,LP showed similar results on success rate (OR =0.89,95 ％ CI 0.47-1.69,P =0.729) and complication rate (OR =0.89,95％ CI0.58-1.36,P =0.585).LP had a longer operative time(WMD =53.86,95％ CI 13.23-94.29,P =0.009) and shorter length of stay (WMD =-2.32,95％ CI-3.48--1.16,P ＜ 0.001).Our study found that RP was superior to LP with respect to success rate (OR =2.53,95 ％ CI 1.03-6.19,P =0.043),complication rate (OR =0.54,95 ％ CI 0.31-0.96,P =0.034),operative time (WMD =-25.94,95％ CI-47.56--4.23,P =0.019) and length of stay (WMD =-25.94,95％ CI-47.56--4.23,P =0.019).Conclusions RP has some advantages,it may be applied for UPJO routinely in the future if the costs can be decreased.
Реферат
During kidney transplant, the non-specific inflammatory response induced by ischemia-reperfusion injury (IRI) will lead to decreased survival ability of transplanted kidney. However, the effect of IRI on long-term survival rate of allograft is not sure. Here we illuminated the relationship between early IRI and decreased long-term survival ability of allograft by retrospectively analyzing the clinical evidences and laboratory investigations. Previous studies showed that early IRI resulted in the graft loss through reduction of renal functional mass, vascular injury, chronic hypoxia and subsequent fibrosis. IRI was also one of the main factors to induce dysfunction of transplanted kidney and acute rejection reaction, and to decrease the allograft survival. Therefore, it's better to substitute traditional methods with novel measures during kidney transplant which may relieve the renal IRI much better.
Реферат
Objective To systematically review the efficacy and safety of mini-percutaneous nephrolithotomy (MPCNL) and flexible ureteroscopic lithotripsy (FURL) in management of lower pole kidney stones.Methods PubMed, Embase, Scopus, Cochrane library, CNKI, VIP and Wanfang Data were searched from the beginning of database to September 2016 and clinical trials that compared the two above operation for treatment of lower pole stones were collected.Two researchers independently filtered literature,extracted data and evaluated the methodological quality of research papers.The meta-analysis was performed using the RevMan 5.3 software.Results One randomized and seven non-randomized studies were analyzed, which consists of 621 patients including MPCNL group 327 cases, FURL group 294 cases.The results of meta-analysis showed that MPCNL was better than FURL in stones clearance (OR =2.65,95％ CI 1.58-4.46,P ＜ 0.01) and operative time (WMD =-21.86,95％ CI-28.52--15.20, P ＜ 0.01).FURL was better in hospital stay time (WMD =2.28,95％ CI 0.29-4.28, P =0.02), decrease in haemoglobin levels (WMD =0.78,95 ％ CI 0.68-0.89, P ＜ 0.01), bleeding (OR =5.11,95 ％ CI 1.12-23.31,P =0.04), transfusion(OR =7.04,95％ CI 1.59-31.15, P =0.01).There was no significant difference in fever,urinary tract infection, hematuria (P ＞ 0.05).Conclusions Both MPCN and FURL are safe and effective for the treatment of lower pole stones, MPCNL can get higher stone clearance rates and shorter operation time.However, FURL can get shorter hospitalization time and lower complication rates.
Реферат
Objective To assess the outcome of vesicoureteral reflux after augmentation cystoplasty in patients with neurogenic bladder.Methods Between January 2008 and January 2014,a total of 25 patients,with a hypocompliant bladder associated with vesicoureteral reflux confirmed by video-urodynamics preoperatively,were recruited in this study.They all had undergone bladder augmentation with a generous detubularized segment of bowel at our institution.No effort had been made to correct existing reflux.Preoperatively assessment included urinalysis,kidney function tests,ultrasonography,video-urodynamic evaluation.All patients had various degrees of vesicoureteral reflux.The status of vesicoureteral reflux and bladder function were studied by video-urodynamic.Results Mean follow-up was 2.2 years (range 0.5 to 5.5 years).The video-urodynamics manifested a significant improvement of bladder capacity,diminution of intravesical pressure and resolution of reflux after bladder augmentation.Of the 25 patients,20 (80％) no longer had reflux,3 (12％) had improvement,2 (8％) had no change.Sixteen of 18 with grades Ⅰ to Ⅲ (89％),all refluxing units with grade Ⅳ to grade Ⅴ (100％) showed complete cessation of reflux.Symptomatic urinary infection was not found after surgery.Conclusions Augmentation enterocystoplasty without ureteral reimplantation is effective and adequate for patients with high pressure and hypocompliant neurogenic bladder.Therefore,ureteral reimplantation is not necessary underwent when augmentation enterocystoplasty is recommended to patients with neurogenic bladder and vesicoureteral reflux.
Реферат
ObjectiveTo investigate the etiology and management of male urethral stricture at 8 medical centers in China during the period from 2004 to 2009 years,and to investigate whether there were any changes in etiology and management of urethral stricture with time change.MethodsThe database on 3455 male patients with urethral stricture who underwent treatment at 8 medical centers in China between January 2004 and December 2009 were prospectively collected.The databases were analyzed for possible cause of stricture and treatment techniques for urethral stricture,and for the changes in etiology and management with time change.ResultsThere were 3455 operations for urethral stricture during the study period.The main causes of urethral strictures were traumas in 1833 patients (53.05％),among which pelvic fractures were in 1327 (38.41％) and perineal trauma in 506 (14.65％).The second cause was iatrogenic causes in 1181 patients (34.18％ ),among which transurethral operations or examinations were in 602 (17.42％),hypospadias surgery in 291 (8.42％) and urethral catheterization in 164 (4.75％ ).Less common causes were urethritis in 201 patients (5.82％),lichen sclerosus in 149 (4.31％),undefined in 91 (2.63％).The treatments of urethral strictures were endourological surgery including internal urethrotomy and dilation and open urethroplasty including end-to-end urethroplasty and the substitude urethroplasty etc.The ratios of using various techniques in total number of patients were obviously different by time.The most application technique for treatment of urethral stricture was endourological surgery ( 709 ) during 2004 -2006 and occupied 52.67％ in total number of patients.It was gradually decreased during 2007 -2009 (726) and only occupied 34.42％ (P ＜0.01 ).Open urethroplasty gradually increased during 2007 -2009 ( 1243,58.94％ ) compared with the first three years (563,41.83％ ) (P ＜ 0.01 ). Conclusions During the recent years there was an increase in the incidence of urethral stricture being trauma and iatrogenic causes.The main treatments of urethral strictures were endourological surgery and open urethroplasty.Endourological surgery was significantly decreased in total number of patients,while open urethroplasty were significantly increased during the late three years.
Реферат
Objective To investigate the effects of amplitude dependent morphological and proliferative changes in human bladder smooth muscle cells (hBSMCs) undergoing physiological stretch in vitro.Methods The hBSMCs were cuhured on silicone membrane and stretched similarly to a bladder cycle at range of stretches and time.The elongation would increase up to 2.5％ every 3 h and 5％ (or 10％,15％,20％ and 25％ depending on the experiment design) in the next 1 h,followed by a rapid decrease,cyclically maintained for a total of 16 h.In subsequent 8 h (24 h cycles) the membrane was maintained in relaxed position.Immunofluorescence and confocal laser scanning microscope were employed to assess the morphological changes.Cell counting kit-8 (CCK-8) and flow cytometry were used to assess the cell proliferation.Results The hBSMCs showed contractile phenotype after application of mechanical strain.Compared with control,the strains at 5％,10％,15％,20％ and 25％ induced most of the cells to change from a more spread-out and stellate state with large cell surface contact areas to a typical spindle-like morphology.The orientation angle of BSMCs remarkably differed depending on the applied strain's magnitude.Absorbance value,which reflects the proliferation activity,analyzed by CCK-8 was improved from 0.471 ± 0.027 (control) to 1.320 ± 0.094 (5％ elongation group,P ＜ 0.0001),1.001 ± 0.029 (10％ elongation group,P ＜0.0001),0.821 ±0.032 (15％ elongation group,P＜0.0001),0.621 ±0.032 (20％ elongation group,P =0.0004) and 0.591 ± 0.056 (25％ elongation group,P =0.0268),respectively.Cell proliferation index increased from (29.35 ±0.55)％ (control) to (55.55 ± 1.05)％ (5％ elongation group,P ＜0.0001),(47.70 ±0.20)％ (10％ elongation group,P＜0.0001),(35.40 ±2.10)％ (15％ elongation group,P ＜0.0001),respectively.However,no significant difference was found in either 20％ elongation group (34.85 ±0.55)％ (P=0.1372) or 25％ elongation group (30.35 ±0.45)％ (P=0.5234).Conclusions Proliferative and morphological changes could be observed in hBSMCs in vitro.Maximal proliferative potential could be seen at 5％ of stretch.
Реферат
Objective To evaluate the efficacy and safety of dorsal onlay buccal mucosa urethro-plasty for the treatment of long anterior urethral stricture. Methods From October 2005 to SeDtem-ber 2007,57 patients(17-52 years old)underwent buccal mucosal dorsal onlay urethroplastv for the treatment of anterior urethral stricture.The mean urethral stricture length was 3.0cm(2.5-7.0 cm).Previously,29(51%)patients had experienced one direct vision internal urethrotomy(DVIU),20(35%)patients had accepted twice DVIU and 8(14%)patient had 3 times DVIU for the treatment of urethral stricture.All patients recurred urethral stricture after DVIU.The length of urethral stric-ture was measured by combined retrograde urethrography and voiding cystourethrography before ure-throplasty.All patients accepted urethroplasty at more than 6 months after last failed surgery.Buccal mucosa was harvested from right cheek.The urethra was exposed and dors'al side was rotated to out-side. A longitudinal incision was made on urethra. Buccal mucosal free grafts were sutured to the open edges of urethra with 6-0 absorbable suture. 1 8 F silicon fenestrated urethral catheter was Dlaced and kept for 4 weeks. Urethrography was used at 4 weeks and 3 months after the urethroplastv,and thenevery 6 months to evaluate the urethral recovery.Dysuria and urethral caliber less than 1 6 F which was confirmed by urethrography and urethroscopy were regarded as stricture recurrence. Resuits The mean fellow-up time were 11.2 months(1-23 months).Fifty-four(95%) patients remained stricture free.Three(5%)patients recurred at the 2 to 3 months after the operation and were treated with DVIU.Three patients had wound infection and recovered without other complication.There was no fistula,diverticulum in all patients.The pain of cheek lasted for 2 5 days(average 2.3 days).No case had hypoesthesia of cheek,obstruction of stenseffs duct or cheek scar.Conclusions Dorsal on-1ay buccal mucosal urethroplasty for long anterior urethral stricture provides stable results with few and acceptable complications.
Реферат
Objective To evaluate the role of different kinds of nitric oxide synthase(NOS)in the growth and angiogenesis of bladder transitional cell carcinoma. Methods Bladder transitional cell carcinoma tissue specimens were procured from 25 patients undergoing cystectomy, and compared with 6 normal bladder tissue specimens from donors in renal transplantation. Immunohistochemical staining was performed to detect the expression of 3 kinds of NOS. Results The malignant epithelial cells showed strong positive on immunohistochemistry whereas normal bladder showed only a weak positive iNOS immunostaining. The endothelial cells of precapillary vessels in the stroma of carcinoma showed a highly positive endothelial NOS (eNOS) immunostaining as compared with the stroma of normal bladder tissue. The expression of neuronal NOS(nNOS) was found in fibers in the fibromuscular stroma of the two groups. Conclusions Bladder transitional carcinoma tissue had a higher content of iNOS and which might be related to the genesis and development of bladder carcinoma.