[Composition analyses of bilateral urinary tract calculis].

OBJECTIVE: To explore the composition of bilateral urinary tract calculi so as to guide treatments. METHODS: A total of 126 patients with bilateral urinary calculi were recruited to undergo percutaneous nephrolithotomy or ureteroscopes lithotripsy. And 256 extracted stones were analyzed by infrared spectrophotometry. RESULTS: The components of these stones were mainly mixture. The compositions included calcium oxalate (n = 214, 85%), carbonate apatite (n = 113, 45%), phosphate (n = 43, 17%) and uric acid (n = 28, 11%). And 63 patients had the same stone composition in bilateral urinary stones and 26 of them were of pure calcium oxalate, 2 phosphate while another 36 mixture. Different compositions were present in 60 patients with bilateral urinary stones. CONCLUSION: The compositions of bilateral urinary stones are not always identical in a patient. The overall patient status should be considered if one side urinary stone is treated according to the composition analysis results of another side counterpart.

Effects of renal pelvic high-pressure perfusion on nephrons in a porcine pyonephrosis model.

The aim of this study was to investigate the effects of various renal pelvic pressure gradients on nephrons with purulent infection. Five miniature test pigs were selected. One side of the kidney was used to prepare the pyonephrosis model and the other side was used as the healthy control. A piezometer and a water fill tube were inserted into the renal pelvis through the ureter. Prior to perfusion, punctures were made on the healthy and purulent sides of the kidneys to obtain tissues (as controls). Subsequently, a puncture biopsy was conducted on the kidneys at five pressure levels: 10, 20, 30, 40 and 50 mmHg. Once the renal pelvic pressure had increased, the healthy and injured kidneys presented pathological changes, including dilation of the renal tubule and capsule and compression of the renal glomerulus. When the renal pelvic pressure exceeded 20 mmHg, the injured kidney presented more damage. Electron microscopy revealed that the increase in pressure resulted in the following: the podocyte gap widened, the epithelial cells of the renal capsule separated from the basement membrane, the basement membrane thickness became uneven, the continuity of the basement membrane was interrupted at multiple positions and the renal tubule microvillus arrangement became disorganised. The manifestations in the pyonephrosis model were more distinct compared with those in the healthy kidney. As the renal pelvic pressure exceeds 20 mmHg under a renal purulent infection status, the nephrons become damaged. The extent of the damage is aggravated as the pressure is increased.

[Transurethral plasmakinetic enucleation of prostate and suprapubic small cut in the treatment of high risk and senior patient with benign prostatic hyperplasia and bladder stones].

OBJECTIVE: To explore the safety and efficiency of transurethral plasmakinetic enucleation of prostate (TUPKEP) and suprapubic small cut in the treatment of high-risk and senior patients with benign prostatic hyperplasia and bladder stones. METHODS: A retrospective review was conducted for 68 high-risk and senior patients with benign prostatic hyperplasia and bladder stones. All of them were treated by TUPKEP and suprapubic small cut. RESULTS: Operation was successfully performed in all 68 cases. And there was no instance of transurethral resection syndrome, shock, myocardial infarct, cerebral infarction, cerebral hemorrhage, permanent urinary incontinence or surgical site infection. Seven patients with temporal urinary incontinence recovered at a mean time of (9.48 ± 1.52) days post-operation. The mean operative duration was (48.63 ± 4.14) min and the mean volume of blood loss (50.97 ± 5.33) ml. The changes of maximum flow rate (Qmax), international prostatic symptom score (I-PSS) and quality-of-life (QOL) were statistically significant before and after operation. Qmax increased from (4.56 ± 0.35) to (18.82 ± 1.65) ml/s (P < 0.001), I-PSS decreased form (21.96 ± 1.89) to (11.23 ± 0.86) (P = 0.018) and QOL decreased from (4.94 ± 0.35) to (1.95 ± 0.32) (P = 0.011). CONCLUSION: The approach of TUPKEP and suprapubic small cut is both safe and effective in the treatment of high-risk and senior patient with benign prostatic hyperplasia and bladder stones and should be widely applied.

[Hemorrhage during and after percutaneous nephrolithotomy via standard nephrostomy tract].

OBJECTIVE: To investigate the intra- and postoperative hemorrhage of percutaneous nephrolithotomy via the standard nephrostomy tract. METHODS: A retrospective analysis was conducted among 1578 patients undergoing percutaneous nephrolithotomy. During the operations, all the nephrostomy tracts were dilated to F24 size after successful puncture. The stones were shattered and removed by EMS lithotrity system. RESULTS: All the patients showed intra- and postoperative hemorrhage, and in 121 cases, blood transfusion was needed. In 18 patients, the operation had to be terminated for severe hemorrhage. The 8 patients with repeated bleeding were managed and cured by blood transfusion and medication. In another 2 cases, severe hemorrhage was found to result from false aneurysms by renal arteriography and managed by superselective embolization. CONCLUSION: Percutaneous nephrolithotomy through standard nephrostomy tract is safe and does not increase the risk of bleeding with careful operation.

[Treatment of calculous pyonephrosis with percutaneous nephrolithotomy via the standard access].

OBJECTIVE: To investigate the feasibility of treatment for calculous pyonephrosis with first stage percutaneous nephrolithotomy under the standard access. METHODS: Thirty-six cases of calculous pyonephrosis and 36 cases of urolithiasis with no pyonephrosis were treated by percutaneous nephrolithotomy. In the nephrostomy, the caliber was dilated to F24. All the operations were preformed through the EMS lithotrity system. The intrapelvic pressure was detected in the operation. The hemoculture before and after operation, the germi culture of urine, and the temperature and blood leucocyte changes after operation were recorded. All the patients were treated by antibiotics before and after the operation. RESULTS: All the patients were treated successfully. The average intrapelvic pressure were 23.2 cmH(2)O in non-pyonephrosis group and 22.8 cmH(2)O in pyonephrosis group. Both of the groups had 1 case of transient bacteremia after the operation. No significant difference was found in the other indices between the two groups. CONCLUSION: EMS lithotrity system is safe and feasible for treating calculous pyonephrosis with stage I percutaneous nephrolithotomy via the standard access.

[Comprehensive therapy for chronic bacterial prostatitis: report of 52 cases].

OBJECTIVE: To evaluate the effects of comprehensive therapy for chronic bacterial prostatitis. METHODS: Comprehensive therapy was prescribed for 52 cases of chronic bacterial prostatitis during June, 2000 to June, 2001, and summaries and analysis of the cases were conducted. RESULTS: Of the 52 cases, 27 (51.9%) were cured and 21 (40.4%) had improvement, while 4 (7.7%) did not respond to the treatment. CONCLUSION: Comprehensive therapy may produce satisfactory effects in treatment of chronic bacterial prostatitis.