[Ejaculatory duct dilation combined with seminal vesicle clysis for refractory hematospermia: A report of 32 cases].

OBJECTIVE: To evaluate the effect of ejaculatory duct dilation combined with seminal vesicle clysis in the treatment of refractory hematospermia. METHODS: Using ureteroscopy, we treated 32 patients with refractory hematospermia by transurethral dilation of the ejaculatory duct combined with clysis of the seminal vesicle with diluent gentamicin. RESULTS: The operation was successfully accomplished in 31 cases, with the mean operation time of 32 (26－47) minutes. The patients were followed up for 6－39 (mean 23.6) months. No complications, such as urinary incontinence and retrograde ejaculation, were found after operation. Hematospermia completely disappeared in 27 cases, was relieved in 1, and recurred in 3 after 3 months postoperatively. Those with erectile dysfunction or mental anxiety symptoms showed significantly decreased scores of IIEF-Erectile Function (IIEF-EF) and Self-Rating Anxiety Scale (SAS). CONCLUSIONS: Ejaculatory duct dilation combined with seminal vesicle clysis under the ureteroscope, with its the advantages of high effectiveness and safety, minimal invasiveness, few complications, and easy operation, deserves general clinical application in the treatment of refractory hematospermia.

Diagnosis of male posterior urethral stricture: comparison of 64-MDCT urethrography vs. standard urethrography.

BACKGROUND: There are no reports regarding voiding/retrograde urethrography with 64-row multidetector CT (64-MDCT).To compare the clinical relevance of conventional voiding/retrograde urethrography and 64-MDCT urethrography for the evaluation of male posterior urethral stricture. METHODS: From January to October 2009, 21 men were referred to our institution for the management of posterior urethral stricture. The patients were evaluated with conventional voiding and retrograde urethrography and 64-MDCT urethrography. The patients were examined by open operative intervention which was required in all patients. The radiologic data were compared using the operative findings. RESULTS: 64 MDCT urethrography provided extra clinical data in ten patients. It was superior to conventional urethrography for judging the urethral stricture length in three patients, characterizing the site of urethra-rectal fistula in four patients, and accurately delineating the proximal urethra in six patients. CONCLUSIONS: 64-MDCT urethrography is a promising tool as an alternative to traditional radiographic methods for defining male urethral strictures. It has the advantage of examining patients only in one position, without distortion, and by generating three-dimensional images; it can accurately measure the stricture length, aid in the diagnosis of some associated pathological conditions, such as urethrorectal fistula, and does not expose the physician to radiation.

[Superiority of modified method in urine drainage for hypospadias repair: a 20 years' experience with 864 cases].

OBJECTIVE: To explore an ideal urine drainage method and new urethral secretions of hypospadias repair. METHODS: The authors retrospectively analyzed 864 cases of hypospadias undergoing hypospadias repair and different post-operative urine drainages. The patients were divided into 5 groups based on the methods of urine drainage. RESULTS: The rates of such complications as cystospasm, infection of incisional wound and urinary fistula were as follows: modified method group: 2.86%, 3.33%, 1.90%; 3-tube method group: 10.77%, 11.54%, 8.46%; He's method group: 20.89%, 15.04%, 9.75%; traditional method group: 36.25%, 41.25%, 37.50%; 1-tube method group: 56.47%, 58.82%, 48.23%. The modified method was significantly better than all the other four methods (P < 0.05). CONCLUSION: As an ideal drainage method of urine and new urethral secretions of hypospadias repair, the modified method boosts the success ratio of hypospadias repair.

[Clinical value of ATP determination in CD4+ cells of patients with cytomegaloviral pneumonia after kidney transplantation].

OBJECTIVE: To explore the clinical value of determination of ATP levels in CD4(+) cells of patients with cytomegaloviral pneumonia after kidney transplantation. METHODS: Twenty-eight patients with cytomegaloviral pneumonia following kidney transplantation and 30 healthy volunteers were enrolled in this study. ATP-bioluminescence assay (ATP-CVA) was used to assess the immune response of CD4(+) cells to phytohemagglutinin (PHA) stimulation in the normal volunteers and the recipients (before and at 1, 2, and 4 weeks after renal transplantation, before and at 2 and 4 week after the treatment). RESULTS: ATP concentration in CD4(+) cells of the recipients was 402-/+58 ng/ml before the operation, significantly lower than that in normal volunteers (458-/+196 ng/ml, P<0.05), and reached the lowest level in the first week after operation especially in the recipients with antibody-inducing therapy; ATP level increased slowly since week 2 post-operation, but still remained significantly lower than the preoperative by the fourth week (266-/+87 ng/ml, P<0.05), especially in the recipients receiving antibody-inducing therapy. In the event of cytomegaloviral pneumonia, ATP level underwent a mild reduction to 152-/+78 ng/ml in comparison with the postoperative level at the first week (P>0.05), and was significantly lower than preoperative level (P<0.01); the decrease was especially obvious during the exacerbation of the condition. ATP level then increased slowly after effective treatment, but was still lower than the preoperative level at 4 weeks after the operation (336-/+92 ng/ml, P<0.05). CONCLUSION: The determination of ATP level in CD4(+) cells allows more accurate assessment of the cellular immunity in the renal transplant recipients with cytomegaloviral pneumonia to help in the clinical treatment of the patients.

[Comparison of the surgical approaches for nephrectomy in living related donors].

OBJECTIVE: To compare the clinical effects and graft outcomes of 4 surgical approaches for nephrectomy in living related kidney donors. METHODS: Between June, 2004 and June, 2007, 119 living related kidney donors underwent nephrectomy via different surgical approaches, and their clinical data were retrospectively analyzed. Of these donors, 22 received retroperitoneal open nephrectomy, 21 had retroperitoneoscopic nephrectomy, 13 had hand-assisted laparoscopic nephrectomy, and 63 underwent transperitoneal open nephrectomy. The operating time, warm ischemia time of the graft, renal graft artery and vein lengths, reduction rate of recipient serum creatinine in the first 3 days after renal transplantation, mean hospital stay and complications of the donors were compared between the 4 surgical approaches. RESULTS: Open surgeries were associated with significantly shorter operating time (P=0.0033) and warm ischemia time of the graft (P=0.0001), longer hospital stay (P=0.0000), higher hospital expenses (P=0.0000), faster postoperative reduction of recipient serum creatinine (P=0.0001), and longer renal artery and vein lengths (P=0.0000 on the left and P=0.0001 on the right) than laparoscopic surgeries. In the laparoscopic surgery group, subcutaneous emphysema occurred in 1 case, DGF in 2 cases, and lumbar vein hemorrhage in 2 cases for which open surgery was performed. In the open surgery group, only one case required reoperation due to adrenal gland hemorrhage. All the kidney grafts were successfully harvested without other complications observed in the donors. CONCLUSIONS: Both open and laparoscopic surgeries are safe for nephrectomy in living related kidney donors, and the selection of the surgical approaches depends on the kidney and donor conditions and the surgical proficiency of the surgeons.

[Immunocytochemical study of phospholipase C-gamma1 expression in mouse embryonic tissue].

To investigate the expression of phospholipase C-gamma1 (PLC-gamma1) in mouse embryonic tissues, serial tissue sections were prepared routinely for immunocytochemistry for PLC-gamma1. The results showed that PLC-gamma1 was expressed in the cartilage, skeletal muscles, myocardium, the collecting tubule of the kidney, connective tissues and the brain, suggesting the important role PLC-gamma1 and the related signal pathway may play in the development of mouse embryonic tissues.

[Half-dose Zenapax for acute rejection prevention after renal transplantation].

OBJECTIVE: To investigate the efficacy and safety of half-dose Zenapax for prevention of acute rejection after renal transplantation. METHODS: According to the immunosuppressive regimen and renal function after transplantation, patients were divided into 4 groups, namely groups A, B, C, and D of 90, 73, 11 and 13 patients, respectively. Blood creatinine measured 1 week after operation was <176.6 micromol/L in groups A and B, and was >353 micromol/L in groups C and D. Patients in groups A and C were given 25 mg Zenapax (0.5 mg/kg) and MMF 0.75 g before operation, and those in groups B and D had only MMF of 0.75 g. All patients were given Pred, CsA and MMF after operation, and the rejection episodes, the time of acute rejection onset, the rate of rejection reversal and complications were analyzed in the time period of 6 months after operation. RESULTS: After the operation, 13 patients (14.4%) developed acute rejection in group A, 18 (24.6%) in group B, 6 (54.5%) in group C and 7 (53.8%) in group D (P<0.01). The incidence of acute rejection in group B was significantly lower than that in groups C and D groups (P<0.01), and the latter two groups had similar incidence. The time of acute rejection onset ranged from 3 to 9 days postoperatively (mean 6.2-/+3.2 days) in group A, significantly delayed as compared with that in group B (range 2-8 days, mean 4.7-/+3.1 days), group C (range 2-7 days, mean 4.3-/+4.2 days) and group D group (range 2-9 days, mean 3.9-/+3.5 days), but the time was similar between groups B, C, and D (P>0.05). All acute rejection cases in group A was reversed, and the rate of reversal was 88.9% (16/18) in group B, 83.3% in group C, and 71.4% in group D. No significant differences were noted in such complications as infection, vascular injuries or gastrointestinal reactions between the 4 groups (P>0.05). CONCLUSION: Zenapax at the dose of 25 mg can safely decrease the risk of acute rejection in patients with good postoperative renal function recovery, but dose not seem effective in patients with delayed graft function recovery.

[Management of urinary obstruction following renal transplantation: report of 16 cases].

OBJECTIVE: To explore the diagnosis and treatment of urinary obstruction involving the transplanted kidney. METHODS: A retrospective analysis was performed in 16 cases of urinary obstruction involving the transplanted kidney, including 5 cases of ureteral calculi, 6 vesicoureteral anastomotic stricture, 2 pyeloureteral junction stricture after transplantation, 1 ureter necrosis due to graft rejection, and 2 infection surrounding the renal graft and ureter end necrosis. RESULTS: Only one patient had the renal graft removed due to massive hemorrhage in an open surgery for correction of urinary obstruction, and the renal function of the graft was preserved in all the other cases after endoscopic or open surgeries. In the follow-up for 0.5 to 3 years after the second surgery, serum creatinine of the patients were maintained within the range of 90-150 micromol/L, without further renal enlargement or exacerbation of renal retention shown by B-mode ultrasonography. CONCLUSION: Urinary obstruction after renal transplantation is a difficult surgical complication, which can be managed by endoscopic or open surgeries depending on the causes of the obstruction.

[Comparative anatomical study of three surgical approaches for treating complex posterior urethral stricture].

OBJECTIVE: To evaluate the advantages and disadvantages of 3 surgical approaches via superior intermedial margin of the pubis, inferior medial margin of the pubis, and the perineum, respectively, in the treatment of posterior urethral stricture. METHODS: Thirty-five adult male corpses were dissected in which the distances from the bulbo-membranous urethra conjunction (D), the apex of prostate (E), and the bladder neck (F) to the superior medial margin of the pubis (A), the inferior medial margin of the pubis (B) and the midpoint of linear distance between the two ischial tuberosities on the perineum (C) were respectively measured and compared. Another 20 adult male corpses were subjected to the 3 surgical approaches as described above and the urethra was exposed to identify the tissues and organs with possible injuries resulted from the surgery, which were evaluated by scoring. RESULTS: The distances measured were as follows: AD=6.5+/-0.5 cm, BD=2.2+/-0.5 cm, CD =3.4+/-0.6 cm, and BD0.05, t=0.13). The angles FAE (beta(1)) =(22.7+/-2.6)(degrees), FBE (beta(2))=(32.9+/-6.4)(degrees), FCE (beta(3))=(15.0+/-3.2)(degrees), and beta(2) beta(1) beta(3) (P=0.05, SNK means). The score for tissue and organ injuries for the approach of the superior medial margin of the pubis was 13, 20 for the approach of inferior medial margin of the pubis, and 15 for perineum approach. CONCLUSIONS: In terms of operative field exposure, the best operation approach is via the inferior pubis, followed by superior pubis approach and perineum approach; while in view of the injuries, superior pubis approach is better than the perineum and inferior pubis approaches. The inferior pubis approach should be the primary choice in the treatment of posterior urethral stricture.

[Surgical techniques for the ureterointestinal anastomosis in continent urinary diversion].

OBJECTIVE: To compare the complications of direct and antirefluxing techniques of ureterointestinal anastomosis in continent urinary diversion. METHODS: Sixty-three patients underwent continent urinary diversion. Twenty-four patients were treated by the direct ureteroenteric anastomosis and the others treated by the antirefluxing technique. The follow up studies included following-up the information of ureteric stricture, ureteric reflux, renal function and acute urinary infection. It was assessed for 3 months to 6 years with a mean follow up of 26 months after operation. RESULTS: Of 78 ureters reimplanted using antirefluxing technique. A total of 12 ureters had anastomotic stricture formation postoperatively. Only one of 48 ureters reimplanted using direct anastomoses had anastomotic stricture. The difference between the direct and antirefluxing technique groups was remarkable (chi2 = 4.375, P < 0.05). Furthermore, there was no significant difference between the direct and antirefluxing technique groups in regard to ureteric reflux, renal function and acute urinary infection. CONCLUSIONS: Antirefluxing anastomoses resulted in obviously higher rate of ureterointestinal anastomotic stricture in comparison with the direct anastomosis. The direct ureteroenteric anastomosis may be the suitable choice for patients undergoing continent urinary diversion.

[Application of multihole U-shaped drainage stent in complex posterior urethra surgery].

OBJECTIVE: To study a method for using a new drainage stent following complex posterior urethral operation. METHODS: Fifty-five patients,15 of whom had complex posterior urethrorectal fistula, 35 had complex posterior stricture or atresia, and 5 had bladder exstrophy, received surgical treatment, after which multihole U-shaped drainage stent was applied. RESULTS: All the patients were normal in micturition and no complications occurred during the follow-up period lasting for 1 to 10 years. CONCLUSION: Multihole U-shaped drainage stent performs the functions of both stenting and drainage, and is applicable in complex posterior urethral surgery.

Interventional therapy for stenosis and aneurysm in renal graft artery: report of 9 cases.

OBJECTIVE: To study the interventional therapy for renal graft artery stenosis and aneurysm patients with renal transplantation to further improve the survival rate of the graft. METHOD: Seven patients with of renal graft artery stenosis received balloon dilatation of the stenotic artery, followed by stent implantation. For renal graft artery aneurysm in another 2 patients, thrombin infusion and stent implantation were respectively performed. RESULTS: The condition was successfully managed in 6 of the 7 patients with renal artery stenosis, whose serum Cr levels dropped to below 106 micromol/L 3 d after the operation. Thrombin infusion in one of the 2 patients with renal artery aneurysm caused thrombus in the renal graft and then aneurysm rupture, resulting in final graft loss. The other aneurysm case was successfully managed with stent implantation. CONCLUSIONS: Interventional therapy as balloon dilatation combined with stent implantation is ideal for treating renal graft artery stenosis, and stent implantation constitutes an important management for artery aneurysm in the renal graft.

[Modified Madigan prostatectomy].

OBJECTIVE: To improve Madigan prostatectomy (MPC) for a much satisfactory effect in open surgery. METHODS: A total of 52 patients with benign prostatic hyperplasia (BPH) were treated using MPC. The MPC procedure was modified by exposing anterior prostatic urethra near the bladder neck and conjunction with cystotomy. This modified procedure preserved prostatic urethra intact and could also deal with intracystic lesions at the same time. RESULTS: The intact of prostatic urethra was kept completely or almost for 48 cases. The hemorrhage amount during modified procedure was a less. The mean operative time was 120 minutes. The 35 patients had been followed up for 1 - 12 months. The average Qmax was 18.9 ml/s. The cystourethrography revealed that the urethra and bladder neck were intact in 8 patients postoperatively. Furthermore, the prostatic urethra was obviously wider after modified MPC. CONCLUSIONS: The modified MPC can reduce the urethra injury and enlarge the MPC indications. The modified technique is easy to perform with little complications and much more satisfactory clinical result. The modified MPC is highly recommended.

[Misdiagnosis of corticomedullary mixed pathological changes in adrenals: report of 4 cases].

Pathological changes usually occur independently in the adrenal cortex and medulla because of their distinct embryonic origins, and changes involving both the cortex and medulla are rare. We report 4 cases of corticomedullary mixed pathological changes adrenal glands. CT scanning of the adrenal glands showed unilateral abnormalities in all the 4 cases, 3 of which were diagnosed as aldosteronism and the other pheochromocytoma before surgery. Unilateral adrenalectomy was performed in the 4 patients 3 being cured and discharged. The other 1 had recurrence 18 months postoperatively with suspected pathological changes on the other side. Subsequent pathological examination confirmed the suspicion in both the cortex and medulla of the other adrenal gland. In cases with clinical presentations as simultaneous onset of aldosteronism and catecholamine responses, pathological changes in both the cortex and medulla of the adrenal glands should be considered. Perioperative management of such cases should be the same as that in cases of catecholamine responses, and the diagnosis relies on histopathological examination.

[Diagnosis and treatment of adrenal medullary hyperplasia (with report of 8 cases)].

OBJECTIVE: To study the diagnosis and treatment of adrenal medullary hyperplasia (AMH). METHODS: An retrospective analysis of the clinical data of 8 patients with AMH admitted in our hospital from May 1998 to May 2002 were conducted with a review of the follow-up study. RESULTS: CT scanning of the adrenal gland showed unilateral abnormal appearance in all 8 cases. Diagnoses of AMH in 4 patients and pheochromocytoma in the other 4 patients were established before surgery. All the patients underwent unilateral adrenalectomy, among whom 7 were cured and 1 suffered recurrence 1 month after operation because of medullar hyperplasia in the contralateral adrenal gland. CONCLUSIONS: AMH should be differentiated from pheochromocytoma, especially from adrenal nodules shown by catecholamin assay. Definite diagnosis depends on pathological examination and surgical removal through abdominal approach is the best choice of treatment, in which both sides of the adrenal glands should be explored.