ELECTROHYDRAULIC LITHOTRIPSY: AN EFFECTIVE AND ECONOMICAL MODALITY OF ENDOSCOPIC URETERIC LITHOTRIPSY

Background : Electrohydraulic lithotripsy (EHL) has been available for endoscopic treatment of urinary calculi since 1960, but the large probe size and concerns regarding safety had previously restricted its use to the treatment of bladder calculi. However, recent refinements have made it particularly suitable for the treatment of ureteric calculi. Methods : The authors report their initial experience using EHL in conjunction with mini-ureteroscopy in the treatment of 94 ureteric calculi in 89 patients. The size of the calculi ranged from 3 to 19 mm in diameter, with a mean of 8.2 mm. The mean operating time was 29 min, ranging from 10 to 120 min. Results : A complete fragmentation rate of 91.5% of the calculi was achieved. There were no major complications and a low incidence of minor complications: haematuria (2.2%), urinary tract infection (3.4%) and postoperative ureteric colic (2.2%). There were four cases of minor ureteric perforations (4.5%); all were successfully treated using conservative measures. Conclusions : It is concluded that EHL is a safe and effective method of treating ureteric calculi.     

哈乐在良性前列腺增生伴急性尿潴留中的应用

目的 :探讨α1A肾上腺素能受体阻滞剂哈乐 (tamsulosin)对良性前列腺增生 (BPH)伴急性尿潴留病人的治疗作用。方法 :对 72例BPH伴急性尿潴留病人采用随机、对照研究 ,分为治疗组和对照组。病人均行保留导尿 ,口服抗生素治疗。治疗组加用哈乐 0 .4mg ,1次 /d ,连续服用 3次。 72h后拔除导尿管。　结果 :拔除导尿管后 4 4 % (32 / 72 )的病人能自行排尿。有效率治疗组为 6 1% (2 2 / 36 ) ,对照组为 2 8% (10 / 36 ) ,两组比较差异有显著性 (P <0 .0 1)。　结论 :对BPH伴急性尿潴留应用哈乐治疗 ,可提高早期拔除导尿管后病人自行排尿的成功率 ,且疗效与前列腺体积大小无关。     

输尿管硬镜处理复杂肾结石残余结石

目的：提高复杂肾结石的治疗水平。方法：采用输尿管硬镜在术中从肾实质切口，术后从肾造接口取肾内残余结石。结果：5例手术中取石，4例取净；11例手术后取石，其中3例一次取石，5例二次取石，3例三次取石，7例取净。结论：复杂肾结石术中、术后配合输尿管硬镜取石可有效处理残余结石。     

无张力阴道吊带术治疗女性压力性尿失禁

目的：探讨无张力阴道吊带术(TVT)治疗女性压力性尿失禁的初步疗效和手术安全性。方法：对20例经过临床和尿动力学检查诊断为压力性或混合性尿失禁的女性患者进行TVT手术治疗，并对手术效果和并发症进行初步的随访研究。结果：平均手术时间40min(25—100min)，平均术后住院3．2d(1—28d)。18例单纯性压力性尿失禁患者16例治愈，治愈率为88．89％(16／18)，另2例显效(11．1％)。2例混合性尿失禁患者中1例显效，另1例无效。术后发生尿潴留3例，2例作松解术，1例延长导尿管留置时间后缓解。发生局部血肿1例经保守治疗后康复。结论：TVT手术是一种治疗压力性尿失禁的安全有效的方法，具有手术简单、创伤小、并发症少、患者康复快等优点。     

无张力阴道吊带术治疗女性压力性尿失禁(附20例报告)

目的 评价无张力阴道吊带术(tension-free vaginal tape，TVT)治疗女性压力性尿失禁的疗效。方法 总结采用TVT术治疗女性压力性尿失禁20例的临床资料。结果 平均手术时间26.5min。拔除尿管后，19例病人控尿满意，1例仍有轻微尿失禁。术后平均随访12(3-24)个月，20例病人均无尿失禁。合并症有1例膀胱穿孔，1例术后轻度排尿不畅，2例尿频尿急。结论 TVT术操作简便快捷，创伤小，合并症少，术后康复快，是一种治疗女性压力性尿失禁的理想方法。     

胃管作尿道支撑引流管在尿道下裂中的应用

目的 评价单纯用胃管兼作尿道支撑管和引流管在尿道下裂尿道成形术中的作用。方法 回顾性分析新华医院1997年12月～2004年12月间收治的先天性尿道下裂患者，在做尿道成形手术中单纯应用胃管作尿道支撑引流管1176例，年龄6个月-20岁。未进行膀胱造瘘等尿液改道引流方法。结果 术后因发生尿瘘而需再次尿道成形术的113例（9．6％），尿道狭窄需再次手术成形的8例（0．7％），尿道裂开需尿道再成形的5例（0．4％）。结论 在尿道下裂尿道成形术中单纯用胃管兼作尿道支撑管和引流管引流尿液是充分有效的，无须另行尿流改道。     

原位低温阻断肾血管肾实质切开取石术

目的探讨原位低温阻断肾血管肾实质切开取石术治疗复杂性肾结石的效果。方法2000年3月～2005年1月采用原位低温阻断肾血管肾实质切开取石术治疗肾内型肾盂复杂性肾结石患者22例,术中快速静脉滴注肌苷2.0g,静滴20%甘露醇250ml。根据术前影像检查结果及术中所见选择肾切口径路:13例充填于各盏的鹿角状结石,行肾背侧Brodt线肾实质肾盏切开取石;5例肾下盏肾盂鹿角状结石,行肾盂肾实质联合切开取石;4例结石过多者,于肾皮质最薄处另作放射状切口取石。结果肾血管阻断时间平均45(30～60)min;手术时间平均110(90～180)min;平均失血量150(80～400)ml。结石一次取净21例,1例残余结石,术后2个月带双J管行ESWL碎石排出。术后1～2月复查肾功能,术前有肾功能损害的8例,血清Cr平均110.2μmol/L,血清BUN平均8.0mmol/L,均明显改善,其余患者肾功能无损害,无严重术后并发症。18例随访6个月～3年无一例复发。结论原位低温阻断肾血管肾实质切开取石术治疗复杂性肾结石安全有效、出血少、结石残留率低。     

An effective treatment for functional urinary incoordination

Twenty women diagnosed with functional urinary incoordination were randomly assigned to one of two treatment groups: biofeedback or progressive muscle relaxation. Ten subjects who were placed on a waiting list prior to treatment allocation served as a comparison group. The biofeedback intervention focused specifically on retraining of pelvic floor musculature (PFM). Patients were assessed pretreatment, posttreatment, and at 2-month follow-up. Outcome measures included self-reported symptomatology, psychological functioning, psychophysiological assessment of the PFM, and urologist ratings of problem severity and treatment efficacy. Both treatment approaches proved effective in improving symptomatology and psychological state. Subjects on the waiting list demonstrated no change in urological difficulties. No differences were found between the two treatment groups on any of the outcome measures. Theoretical and practical implications of the results are discussed.     

肾盂切开气压弹道碎石治疗鹿角形肾结石(附46例报告)

目的 探讨肾盂切开气压弹道碎石治疗鹿角形肾结石的疗效。方法 对46例鹿角形肾结石采用肾盂切开气压弹道碎石，将结石分解成数块，再逐一取出。双侧肾结石采用一次分侧手术取石。结果 46例鹿角形肾结石均较顺利取出，无黏膜撕脱、出血等并发症。25例肾功不全者均显著改善。结论肾盂切开结合气压弹道碎石是治疗鹿角形肾结石较好方法；双侧肾结石多有梗阻致肾功能受损，应双侧一次取石，有利于双肾功能恢复。     

Prejunctional effects of muscarinic agonists on 3H-acetylcholine release in the rat urinary bladder strip

Summary The inhibitory effects of some muscarinic agonists on tritiated acetylcholine release evoked by field stimulation were investigated in the rat urinary bladder strip. The acetylcholine stores of the preparation were labelled with ³H-choline. Electrical field stimulation caused an outflow of tritium, reflecting the release of ³H-acetylcholine. The release of ³H-acetylcholine was decreased in a concentration-dependent manner by all the agonists tested: oxotremorine, muscarone, muscarine, carbachol and methylfurtrethonium. On the contrary, only muscarine and muscarone enhanced the basal efflux of tritium in a concentration-dependent fashion. Concentration-response curves were determined both at 2 Hz and at 1 Hz by using intermittent administration of the drugs. Maximal depression in release (by 78 – 82%) was observed in experiments at 1 Hz. A similar inhibition was obtained at 2 Hz frequency only when a low concentration of calcium (0.6 mM) in the medium was used. Oxotremorine was the most potent among the tested compounds with the same intrinsic activity as the other drugs. In contrast to the other agonists investigated, oxotremorine showed in about 10-fold greater potency at pre- than at postjunctional muscarine receptors in the rat urinary bladder. This difference might depend either on heterogeneity of muscarine receptors or on different mechanism(s) relating to the transducing properties of receptors at the pre- and postjunctional level. A comparison between the relative prejunctional potencies in the rat urinary bladder and in the guinea pig myenteric plexus (data from the literature) suggests that prejunctional muscarine receptors are similar in these tissues. Furthermore, the findings obtained with a low concentration of calcium in the medium may support the view that intraneuronal availability of calcium plays a significant role in modulating the prejunctional negative feed-back mechanism in the rat urinary bladder.Send offprint requests to Dr. G. D'Agostino at the above address