原发性前列腺尿路上皮癌（附1例报告）

目的 探讨原发性前列腺尿路上皮癌的诊断与治疗原则.方法 分析1例原发性前列腺尿路上皮癌患者的临床资料,并结合文献复习讨论.结果 患者行经尿道前列腺电切术,术后予吡柔比星膀胱灌注化疗.结论 原发性前列腺尿路上皮癌是恶性度较高的疾病,确诊主要依赖前列腺穿刺活检及术后病理检查,治疗以手术加膀胱灌注化疗为主,经尿道前列腺电切术不能改善其预后,其预后较其他前列腺癌差.     

膀胱癌术后再发上尿路肿瘤临床分析（附11例报告）

膀胱癌是泌尿系肿瘤中最常见的恶性肿瘤之一，上尿路肿瘤术后膀胱癌再发率为15％-40％，但膀胱癌术后再发上尿路癌的发生率文献报道不一。我院自1996—2006年共收治膀胱癌316例，术后再发上尿路癌11例，行根治性患侧上尿路全切术10例，输尿管部分切除＋膀胱部分切除＋输尿管膀胱吻合术1例，现报告如下。     

小儿重复肾合并其他尿路畸形（附60例报告）

６０例重复肾中，４８例合并输尿管口异位，７例合并输尿管囊肿，４例伴巨大输尿管积水，５例合并肾发育不良，１例为肾积水。年龄４个月～１３岁。临床表现：滴沥性尿失禁４８例，尿路感染１０例，腹部包块６例，排尿困难５例，尿道口有肿物脱出４例。诊断主要依靠ＩＶＵ。５８例经手术治疗，其中５１例作患侧上肾部及输尿管切除，７例行患侧肾切除。术后除１例尿内仍有异常外，均恢复满意。     

慢性马兜铃酸肾病伴发尿路上皮恶性肿瘤16例报告

目的提高对慢性马兜铃酸肾病伴发尿路上皮恶性肿瘤的认识。方法回顾性分析16例慢性马兜铃酸肾病伴发尿路上皮恶性肿瘤患者的临床资料。16例均有长期间断小剂量服用含马兜铃酸成分药物病史,根据病史及相关检查均可诊断为慢性马兜铃酸肾病、慢性肾功能不全。患者临床表现均为间歇性无痛肉眼血尿,术前经B超、逆行造影、CT或MRU、输尿管镜等检查明确诊断。膀胱肿瘤6例;上尿路肿瘤10例,其中双侧同时发生肿瘤者6例、伴膀胱肿瘤1例。结果6例膀胱肿瘤行经尿道膀胱肿瘤电切术(TURBt);10例上尿路肿瘤者中6例8侧行保肾手术;4例5侧行根治性切除术,其中1例双侧肾盂肿瘤者另一侧术中探查发现肾周肿瘤明显外浸,粘连明显,手术困难,仅行活检术;1例双侧肾盂及双侧输尿管肿瘤者仅行活检术。术后病理均为移行细胞癌,WHO标准病理分级:Ⅰ级1例、Ⅰ～Ⅱ级4例、Ⅱ级6例、Ⅲ级5例。14例获随访3～37个月,平均14个月。死亡4例,其中1例为未手术的双侧肾盂及双侧输尿管肿瘤患者,术后5个月因瘤死亡;输尿管肿瘤、膀胱肿瘤及双肾盂肿瘤者各1例分别于术后17、19、26个月死于多发转移。4例膀胱肿瘤术后4～9个月复发6次,其中2例为2次复发者;上尿路肿瘤2例术后9～10个月膀胱肿瘤3次复发;3例输尿管肿瘤术后3～32个月复发,其中1例原位复发,2例异位复发;5例未见肿瘤复发。结论慢性马兜铃酸肾病伴发的尿路上皮恶性肿瘤以上尿路肿瘤为主,双侧发病率较高,肿瘤具有多发、易复发及恶性程度高等特点。     

脾脏恶性肿瘤（附七例报告）

脾脏恶性肿瘤（附七例报告）程骏王玉明脾脏肿瘤临床少见，脾脏恶性肿瘤不论原发还是继发更为少见。我院自１９８８年来共收治脾脏恶性肿瘤７例，其中原发６例，继发１例，均经病理证实，现报道如下：临床资料１一般资料本组男性３例，女性４例，年龄３５岁～７０岁，平均...     

肾移植术后并发尿路上皮肿瘤(附25例报告)

目的 探讨肾移植术后并发尿路上皮肿瘤的临床特点及其诊治方法.方法 回顾性分析1998年～2006年间肾移植术后发生尿路上皮肿瘤的临床资料25例.就患者性别、移植时年龄、导致肾功能不全的原发病、移植后肿瘤发生的时间、临床症状、肿瘤发生部位及转归等项目进行临床分析.所有病例移植前均排除肿瘤.肿瘤均经影像学和膀胱镜等检查方法诊断.22例患者行手术治疗,术后所有患者免疫抑制剂用量减少1/3并辅以局部灌注化疗.结果 本组25例患者中男4例,女21例;移植时患者平均年龄55.1岁;原发病为慢性间质性肾炎的患者19例;术后发生肿瘤的时间距肾移植时间平均26个月;临床表现为肉眼血尿或镜下血尿25例,反复泌尿系感染10例,肾盂输尿管积水者12例;肿瘤为多发者22例;移植肾同侧有上尿路肿瘤者16例;3例行姑息性治疗的晚期肿瘤患者分别于发现肿瘤5个月、6个月及8个月后死亡,22例手术治疗患者已随访2～7年,18例肿瘤复发,再行手术治疗;所有患者在免疫抑制剂减量期间均未出现急性排斥,肾功能正常.结论 本组显示慢性间质性肾炎导致肾功能衰竭的肾移植患者和女性肾移植患者易发生移植后尿路上皮肿瘤;血尿、泌尿系感染和肾盂积水是常见的症状,多发性和易复发性是另一临床特点;移植肾同侧上尿路较对侧好发肿瘤.     

盆腔恶性肿瘤浸润尿路的诊治

目的：探讨提高盆腔恶性肿瘤浸润尿路诊治效果的途径。方法：对63例浸润尿路的盆腔恶性肿瘤患者．CT扫描48例，MRI检查15例，B超检查36例，膀胱镜检查32例。术前发现癌灶侵犯尿路25例(39．7％)，术中发现癌灶侵犯尿路33例(52．4％)。手术治疗58例，姑息治疗5例，其中7例无尿患者采用膀胱镜置管或经皮肾穿刺造瘘术处理。结果：63例中，44例随访1．0～5．0年，原发癌灶和尿路同时处理的29例均未出现梗阻性肾功能衰竭和血尿；原发癌灶和尿路未同时处理的15例中，12例需再次手术，其中10例并发泌尿系症状。7例无尿患者肾功能不全均得到改善。结论：提高对盆腔恶性肿瘤浸润尿路的认识，影像学和膀胱镜检查可以提高本病的确诊率；原发癌灶和尿路同时手术可以提高其疗效。     

经尿道切除技术在下尿路疾病中的应用（附128例报告）

目的 探讨经尿道切除技术（TUR）治疗下尿路疾病的适应证、操作方法、术中术后处理及并发症预防的要点。方法 应用经尿道汽化电切术（TURVP）和双极等离子汽化电切术（TUPKVP），分别以5％葡萄糖液和生理盐水作冲洗介质，选择性耻骨上膀胱造瘘，持续低压灌洗，术后气囊导尿管留置5～7天拔管，自行排尿。结果 经尿道前列腺双极等离子汽化电切术7例，经尿道前列腺汽化电切术58例，合计前列腺手术65例；腺性膀胱炎汽化电切术43例；膀胱肿瘤汽化电切术15例；后尿道狭窄等离子汽化电切术3例；精阜腺瘤汽化电切术2例。全部病例均一次手术完成，有效率（126／128）98．4％。无膀胱穿孔、电切综合征、大出血、真性尿失禁发生。前列腺术后尿道狭窄、排尿困难再次手术者2例，占3．08％，排尿疼痛、不适感6例，占9．23％，逆行射精4例，占6．15％。结论 TUR技术是一种微创、安全、迅速、有效、恢复快、并发症较少的腔内泌尿外科治疗方法，特别适用于下尿路疾病的手术；术中持续低压灌注对确保切割视野清晰、预防并发症至关重要。     

原发性输尿管恶性肿瘤（附34例报告）

为探讨原发性输尿管肿瘤的诊断方法和治疗效果，报道原发性输尿管恶性肿瘤３４例，其中移行细胞癌３１例，鳞癌２例，平滑肌肉瘤１例。男性２３例，女性１１例；年龄２５～８４岁，平均５４．５岁。１７例行患侧肾及输尿管全切及膀胱袖状切除术，３例行患侧肾及输尿管部分切除术，４例行输尿管节段切除术，１例行患侧肾输尿管及膀胱全切术。２６例获随访，死亡８例。认为尿路造影、膀胱镜检查是最重要的诊断手段，患侧肾输尿管全切及膀胱袖状切除术是首选术式，本组５例存活５年以上者均为采取此术式患者。     

尿路结构异常儿童合并泌尿系感染的病原菌分析

目的探讨尿路结构异常儿童合并泌尿系感染（UTI）致病菌的分布及药物敏感及耐药情况。 方法收集2012年1月至2016年12月中山大学附属第三医院及汕头市中心医院符合UTI住院患儿476例,分为尿路正常组及尿路异常组,比较两组间病原菌构成比及对抗菌药物的敏感和耐药情况。 结果尿路异常者162例（肾积水最为常见,占43.83%）,尿路正常儿童314例。尿路异常儿童合并感染常见于男性（P<0.05）,共检出致病菌166株,革兰氏阴性菌（G^-）为主（71.08%）,大肠埃希菌占首位（40.36%）,肠球菌属居第2位（22.89%）,粪肠球菌在尿路异常组常见（χ²=4.59,P=0.032）。两组间常见病原菌耐药性差异无统计学意义。 结论尿路结构异常男性儿童易发生泌尿系感染,且肠球菌感染的发生率高于尿路结构正常儿童。     

尿路真菌感染（附20例报告）

报告２０例尿路真菌感染，上尿路感染３例，下尿路感染１７例。病原菌为白色念珠菌，酵母样菌，平滑球拟酵母菌和曲霉菌。上尿路真菌感染的治疗以应用抗真菌药嘛康唑或氟康唑获佳良效果。这些新型抗真菌药抗菌谱广，疗效佳，安全而副作用少，下尿路真菌感染应用两性霉素Ｂ或咪康唑滴注膀胱治疗获良好疗效。     

Investigation of the dilated urinary tract

Dilatation of the urinary tract does not necessarily imply obstruction, and other factors may be operative: maldevelopment, infection, reflux, and polyuria. Obstruction of the urinary tract in intra-uterine life is associated with renal dysplasia: the original obstructive lesion may be transient but the consequent dysplasia and dilatation may be permanent. Routine antenatal ultrasound identifies a new population of infants with urinary tract dilatation, many of whom remain asymptomatic and would not otherwise have come to medical attention: the natural history and appropriate schedules of investigation and management of this group are still being evaluated. Anatomical imaging by ultrasound establishes the presence and extent of dilatation. Micturating cystourethrography, intravenous urography and antegrade pyelography establish the site but not the functional significance of an obstructive lesion. Isotope renal scaning with^99mTc-DTPA may identify an acutely obstructed kidney with a decreased renal uptake, prolonged parenchymal transit time, and delayed clearance of the isotope from the renal pelvis after furosemide. However, such analyses often give equivocal results in infants with poor renal function and markedly dilated urinary tracts. Obstructive uropathy should be seen as a disturbance of the normal pressure-flow relationships in the urinary tract, and be defined and investigated as such. Antegrade perfusion with renal pelvic pressure measurements has technical pitfalls, but is the definitive method of establishing upper tract obstruction. Videocystourethrography is the established method of investigating the lower urinary tract in older children but needs further development to be applicable to infants.     

Symptomatic urinary problems in female genital tract anomalies

Most of urological abnormalities in urogenital anomalies are asymptomatic and need no special treatment; however, a few patients have critical urinary complaints and surgical corrections are required for them. Unfortunately, these coexisting urinary problems are often neglected and failed to be treated. So, it is necessary to delineate the diagnosis and treatment of similar anomalies. Eight typical patients who had urogenital anomalies with urinary discomfort in our institution were excerpted and reported. In this series, the urinary symptoms ranged from cyclical hematuria and urinary incontinence to infection symptom. The involved urological anatomies were generally categorized into three types: abnormal communication of urogenital tracts, malformation of bladder or ectopic ureter, and anomalies of urethral orifice. Surgical corrections were helpful for most cases. For patients with genitalia anomalies, the coexisting urological defects should be highlighted by our gynecologists, especially when they are symptomatic and require surgical correction. Shu Wang and Jing He Lang contributed equally to this article.     

Comparative immunohistochemistry of malignant fibrous histiocytoma and sarcomatoid carcinoma of the urinary tract

Summary An immunohistochemical analysis using antibodies to cytokeratin, epithelial membrane antigen, alpha-1-antitrypsin, alpha-1-antichymotrypsin and factor XIIIa was performed in four cases of malignant fibrous histiocytoma and five cases of sarcomatoid carcinoma in the urinary tract. All cases of malignant fibrous histiocytoma showed positive staining for factor XIIIa, alpha-1-antitrypsin and alpha-1-antichymotrypsin. No case was positive for factor XIIIa, but one case with sarcomatoid carcinoma stained positive for alpha-1-antitrypsin and alpha-1-antichymotrypsin. All cases showed positive staining for cytokeratin and 4 cases with sarcomatoid carcinoma were positive for epithelial membrane antigen, but no cases with malignant fibrous histiocytoma were positive. Immunohistochemical analysis would thus help to distinguish malignant fibrous histiocytoma from sarcomatoid carcinoma of the urinary tract.     

Significance of urinary endotoxin concentration in patients with urinary tract infection

Summary Endotoxin is a component of the outer membrane of gram-negative rods (GNR). Since GNR are responsible for the majority of urinary tract infection (UTI), we measured the concentration of endotoxin in urine using chromogenic endotoxin-specific assay and examined its diagnostic utility in patients with suspected UTI. In all 18 urine samples with an endotoxin concentration exceeding 350 pg/ml and 2 samples with 10–350 pg/ml of endotoxin concentration, GNR were detected at a count of 10⁴ cfu/ml. Negative for endotoxin were 3 samples of culture positive for grampositive cocci (GPC), 2 samples containing various bacterial contaminants and all 37 samples with no growth on culture. Two urine samples collected 5 h after antibiotic dosage showed negative culture for GNR but a significant concentration of endotoxin. In an in vitro experiment, a residual concentration of antibiotic in urine inhibited bacterial growth, leading to a falsenegative culture. These results suggest that chromogenic endotoxin assay is a reliable method for diagnosing UTI caused by GNR and detecting false-negative culture of GNR.     

上尿路移行细胞癌术后发生膀胱癌的危险因素分析

目的探讨上尿路移行细胞癌临床与病理特点及对术后膀胱癌发生及预后的影响.方法对133例肾盂和(或)输尿管癌病例的临床特点与术后发生膀胱癌以及预后情况分别应用Cox比例风险模型分析,作Kaplan-Meier曲线并行LogRank检验.结果133例患者接受根治手术后发生膀胱癌者40例,占30.1%.原发上尿路肿瘤数目、分期和有无同发膀胱癌对术后发生膀胱癌有显著影响,风险度>1,回归系数>0,二者间相关系数小.应用LogRank检验显示原发肿瘤为单发者术后无膀胱癌发生的机率低于多发者(P=0),随着病理分期的升高,膀胱癌发生率随之增加(P＝0.0039).首次发生膀胱癌者有92.5%在2年之内.原发肿瘤数目、分期、有无同发膀胱癌以及术后膀胱癌发生间隔时间对存活率有显著影响,四种因素的相关系数小.结论原发上尿路肿瘤的数目、分期和有无同发膀胱癌为术后发生膀胱癌的危险因素;原发肿瘤数目、分期、有无同发膀胱癌以及术后膀胱癌发生间隔时间对存活率有显著影响.     

Encrustation of biomaterials in the urinary tract

This review considers the problem of the encrustation of biomaterials used for urinary prostheses. After a general discussion of the problem it deals with exciting new developments which may prove to be clinically applicable in preventing this costly and resource consuming complication. The widespread use of use of in vitro models which accurately simulate the conditions found in the human urinary tract will allow appropriate preliminary studies. Perhaps then clinical evaluation will be warranted.     

体外冲击波碎石治疗尿路结石术后复发性结石

目的探讨尿路结石术后复发结石的原因及治疗。方法1988年～1999年应用ESWL治疗尿路结石取石术后复发性结石88例。结果结石粉碎率为100％,三个月结石排净率为93．1％。结石残留、梗阻因素、尿路感染和代谢紊乱是尿路结石术后复发的主要因素。结论ESWL是治疗尿路结石术后复发性结石的有效方法,提出首次治疗结石应以消除结石,解除梗阻,防治感染,纠正代谢紊乱为原则。     

Probiotics to prevent urinary tract infections: the rationale and evidence

For over 30 years, urologists have recognized in females, that urinary pathogens almost always infect the host through ascension from the rectum, vagina to the urethra and bladder. Likewise, the Lactobacillus organisms that predominate in the vagina of healthy women, spread from the rectum and perineum and form a barrier in the vagina to bladder entry by uropathogens. The concept of artificially boosting the lactobacilli numbers through probiotic instillation has long been conceived, but only in recent years shown to be possible. Not all lactobacilli are effective, and to date clinical efficacy only exists for Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri B-54 and RC-14. These strains are only commercially available in Austria, and therefore for most urologists, while some probiotic organisms may reduce the recurrences of bladder cancer or oxaluria, no probiotics can be recommended widely to prevent UTI at present.