Urinary excretion of calcium and phosphate in preterm infants

The aims of this study were to determine reference ranges for the urinary calcium (UCa/Cr) and phosphate (UPO(4)/Cr) creatinine ratios and to study factors influencing these ratios in a representative population of preterm infants managed according to current nutritional guidelines. Spot urine samples were obtained from 186 preterm infants (gestation 24-34 weeks) for measurement of UCa/Cr and UPO(4)/Cr ratios as part of a routine metabolic bone screening program, once every 2-4 weeks from the 3rd to the 18th week of life. Data were also collected on gender, appropriate or small for gestational age (SGA), nutrition [total parenteral nutrition (TPN), preterm or term formula, and breast milk], plasma Ca, P0(4), urea, and electrolytes and on the use of drugs (frusemide, dexamethasone, and theophylline). Data from infants treated with any of these three drugs were analyzed separately and not included in establishing the reference ranges for UCa/Cr and UPO(4)/Cr. The mean gestational age of the study population was 28 weeks (range 24-34 weeks). The 95th percentile for UCa/Cr at 3 weeks of age was 3.8 mmol/mmol and decreased significantly with increasing postnatal age (P<0.001). The 95th per-centile for UPO(4)/Cr was 26.69 mmol/mmol at 3 weeks of age, but this did not change significantly with increasing postnatal age (P=0.296). On univariate analysis there was no significant association of UCa/Cr and UPO(4)/Cr with gender and type of enteral nutrition. The UCa/Cr was lower in infants who were SGA (P=0.013) and with low plasma Ca (P=0.008). Infants on TPN had significantly higher UCa/Cr (P =0.019) and lower UPO(4)/Cr ratios(P<0.001). Multivariate analysis confirmed the decrease in UCa/Cr ratio with increasing postnatal age, but the SGA effect was eliminated. The use of furosemide(P<0.001) and theophylline (P=0.003) was associated with a significant increase in the UCa/Cr ratio. The use of dexamethasone was also associated with an increase in UCa/Cr ratio, but this did not achieve statistical significance (P=0.339). The use of furosemide, theophylline,and dexamethasone had no effect on UPO(4)/Cr. We report a reference range for UCa/Cr and UPO(4)/Cr ratios and factors influencing these ratios in a representative population of preterm infants between 24 and 34 weeks gestation, managed according to current nutritional guide-lines.     

常规尿管回推与改良加压注水尿管回推方法在治疗男性尿道结石中的临床研究

目的 比较尿管常规回推与改良加压注水回推在男性尿道结石患者中应用的有效性、舒适性及并发症情况。方法 选取2013年7月至2016年12月在本院治疗的尿道结石患者52例，随机分组为常规组和加压组，各26例。比较两组的手术成功率、疼痛评分及3个月后尿常规、尿流率情况。结果 加压组成功率明显高于常规组，差异有统计学意义（P<0．001）；加压组VAS评分明显低于常规组，差异有统计学意义（P<0．001）；首次回推成功患者3个月后尿常规及尿流率均未见明显异常。结论 加压注水回推技术在治疗男性尿道结石是安全且更有效、更舒适的方法，值得临床上广泛使用。     

原位新膀胱术后新膀胱尿道吻合口狭窄的诊断和治疗

目的探讨根治性膀胱切除原位新膀胱术后新膀胱尿道吻合口狭窄的诊断和治疗效果。方法回顾性分析416例男性膀胱尿路上皮癌行根治性膀胱切除原位新膀胱术患者的临床资料,分析新膀胱尿道吻合口狭窄的发生率及其诊断和治疗。结果本组共15例（3.6%）发生新膀胱尿道吻合口狭窄,Ⅰ级狭窄（17F~22F）5例,Ⅱ级狭窄（〈17F）8例,Ⅲ级狭窄（针尖）2例。9例表现为排尿困难,3例表现为尿潴留,2例表现为泌尿系感染,1例表现为初发的充盈性尿失禁。7例初始行尿道探子或尿道镜扩张,其中2例无效改行经尿道狭窄钬激光或冷刀切开术,均恢复排尿通畅；3例初始即行经尿道狭窄钬激光或冷刀切开术,均恢复正常排尿；5例初始行单次或多次经尿道瘢痕切除术,4例能排空新膀胱,1例无效行新膀胱腹壁造瘘术。所有患者治疗后均定期随访,平均随访56个月,14例完全排空新膀胱,无患者出现新发的尿失禁。结论原位新膀胱术后新膀胱尿道吻合口狭窄发生率较低,主要表现为排尿困难,尿道扩张和腔内治疗是有效的微创治疗手段,大部分患者能获得满意的疗效。     

Normal urinary calcium/creatinine ratios in African-American and Caucasian children

A random urine calcium/creatinine ratio (UCa/Cr) is of practical use in screening for hypercalciuria. However, due to worldwide variations, reference values for the pediatric population are not yet well established. Furthermore, no study has been conducted to establish normal UCa/Cr values in young African-American (AA) children. It has also been previously reported that an elevated UCa/Cr is related to a high urine Na/K ratio (UNa/K). The objectives of the present study were: (1) to set normal values of random UCa/Cr by age and race in the pediatric population of Metropolitan Kansas City, (2) to identify potential racial differences in UCa/Cr between Caucasian (CS) and AA children, and (3) to determine the relationship between UCa/Cr and UNa/K in healthy children.A total of 368 healthy children of both genders were enrolled in the study. They were divided into four age groups as follows: (1) <7 months, (2) 8–18 months, (3) 19 months to 6 years, and (4) 7–16 years. Each group was subdivided into AA and CS. A non-fasting random urine specimen from each subject was analyzed for Ca, Na, K and creatinine.The median UCa/Cr values for AA were: (1) 0.13, (2) 0.09, (3) 0.06, and (4) 0.04 and for CS they were (1) 0.26, (2) 0.11, (3) 0.10, and (4) 0.09. The data showed a strong inverse relationship between UCa/Cr and age, the youngest children demonstrating the highest UCa/Cr. In each age group, UCa/Cr in CS exceeded the corresponding value in AA. The age-dependent 95th percentiles of UCa/Cr values for CS were (1) 0.70, (2) 0.50, (3) 0.28, and (4) 0.20 and for AA they were (1) 0.38 and (3) 0.24. Due to outliers, the 95th percentile could not be established for the other two AA subgroups. The relationship between UCa/Cr and UNa/K was found to be extremely weak in both AA (r ² =0.00005) and CS (r ² =0.02). On the other hand, a strong linear correlation was observed between UNa/K and age (CS r ² =0.23, P<0.001, AA r ² =0.19, P<0.001), explaining in part the lack of correlation between UNa/K and UCa/Cr.We conclude that the child’s age, ethnicity and geographic location should be taken into consideration when assessing UCa/Cr ratio. Contrary to what has previously been reported in hypercalciuric children, no significant relationship was found between UCa/Cr and UNa/K in healthy children. Received: 7 June 2000 / Revised: 21 September 2000 / Accepted: 23 September 2000     

双侧上尿路结石梗阻并发急性肾功能衰竭(附40例报告)

目的：探讨双侧上尿路结石梗阻并发急性肾功能衰竭的诊断及治疗方法。方法：通过Ｂ超、ＫＵＢ、逆行插管造影检查明确诊断并通过肾、输尿管切开取石，肾穿刺造瘘，输尿管插管引流，ＥＳＷＬ达到治疗目的。结果：术后全部患者尿毒症症状减轻或消失，血尿素氮（ＢＵＮ）、血肌酐（Ｃｒ）均不同程度降低或恢复正常。结论：对双侧上尿路结石宜争取同期施行双侧手术，因并发严重感染或患者一般情况差而无法取石者则应及早作输尿管逆行插管     

尿流改道术后尿路结石的治疗

目的 探讨尿流改道术后尿路结石的治疗方法.方法 选取20例既往因膀胱癌接受尿流改道的尿路结石患者(肾结石6例,输尿管结石5例,储尿囊结石9例),接受个性化的治疗:其中经皮肾取石术8例,经皮肾顺行输尿管软镜碎石术3例,储尿囊流出道入路手术5例,经皮膀胱穿刺人路手术3例,开放取石1例.结果 手术时间60～130min,平均104min;术后结石清除率90％(18/20);术后发热4例(20％o),其中l例经皮肾镜技术(PCNL)术后液胸,行胸腔闭式引流.结论 针对尿流改道术后的尿路结石患者,采取个性化治疗方案,能够有效的清除尿路结石.     

导尿管伴随性尿路感染及其防治

为探讨导尿管伴随性尿路感染（UTIc）的发生、发展规律及防治措施，对57例留置导尿管患者随机分组进行观察，具体方法是隔日收集尿液送细菌培养，当尿培养细菌数＞105／ml时定为尿路感染。结果3组患者随插管时间的延长，尿培养细菌阳性率逐日增加．3组间相应无效的细菌感染率有显著性差异（P＜0．05）．认为全身应用有效抗生素配合0．1％新洁尔灭定时冲洗导尿管并清除尿道口分泌物，可延缓UTIc的发生，对短期留置导尿管的患者，此法是一种较好的预防感染的方法，但对长期留置导尿管而发生感染的患者仍难以奏效．     

Pediatric enterocystoplasty: long-term complications and controversies

As enterocystoplasty has become a routine procedure in pediatric urology, long-term complications are emerging in adult patients. Pediatric urologists in general do not follow their patients beyond late adolescence. The sequelae of enterocystoplasty have fallen into the hands of their adult colleagues. Some of the complications of enterocystoplasty, such as reservoir stones, malignancy and perforation, are also seen in older adults following continent diversion. On the other hand, problems with bone growth, pregnancy and reflux nephropathy are unique to children and young adults. A better awareness and understanding of these complications will lead to improved prevention, surveillance and treatment.     

How variations in the composition of urine influence urease-induced crystallization

Summary To Study how the composition of urine influences urease-induced crystallization, human urine samples were incubated with urease and the subsequent precipitation measured. Beside the pH increase, the urinary content of magnesium and calcium had profound effects on the precipitation of magnesium ammonium phosphate and calcium phosphate, respectively. Urine phosphate, ammonium and osmolarity had no direct effects on the precipitation. Among the urine components with potential inhibitory properties, only albumin was found to be correlated with such an effect. This inhibitory activity was especially influential in urines with high calcium and magnesium levels. These findings suggest that the composition of urine could also influence the formation of stones consisting of magnesium ammonium phosphate and calcium phosphate.     

Severe edema of the uterine cervix — an unusual cause of acute urinary retention in pregnancy

A very unusual case of a healthy pregnant patient who developed recurrent acute urinary retention is described. A 34-year-old multiparous woman was admitted to the hospital in the 17th week of gestation with acute urinary retention and complete obstruction of the urethra. The reason for this was an enormous enlargement of the uterine cervix — possibly an acute allergic reaction to a new kind of a body lotion. She was treated with catheterization during the acute episode, and prolonged use of a vaginal ring pessary. She was admitted again several times at later stages in the pregnancy, with the same complaint. The possible reasons for such repeated episodes of retention and the need for prompt diagnosis and treatment are discussed.     

尿钙、尿钠与男性青少年骨矿含量

目的　研究北方男性青少年尿钙排出的影响因素,及尿钙排出量对骨矿含量、骨密度的影响。方法　我们对５１ 名发育正常,身体健康的男性青少年（年龄１７．２±０．７,１５．５～１８．７ 岁）进行人体测量,三天称重法膳食调查,采空腹静脉血、收集２４ 小时尿液,用ＢＨ－６０１２ 型二维扫描单光子骨密度仪测量非优势侧桡骨中远１／３ 处及桡骨超远端骨矿含量（ＢＭＣ,ｇ／ｃｍ ）、骨密度（ＢＭＤ,ｇ／ｃｍ ２）、骨宽（ｃｍ ）。对有关变量进行直线相关分析和多元逐步回归分析。结果　膳食钙摄入量为５４４ｍ ｇ／人日,蛋白质摄入量为８６ｇ／人日,尿钠排出量１４３．８５ｍ ｍ ｏｌ／ｄ,尿钙排出量为４．０４ｍ ｍ ｏｌ／ｄ。尿钠排出量是影响尿钙排出量的主要因素之一,［尿钙（ｍ ｍ ｏｌ／ｄ）＝ ２．３８１３＋ ０．０１１５×尿钠（ｍ ｍ ｏｌ／ｄ）,ｒ＝ ０．２８１１,Ｐ＜ ０．０５］。尿钠排出量与膳食钠摄入量呈较强正相关,尿钠排出量（ｍ ｍ ｏｌ／ｄ）＝ ６７．４７７８＋ ０．０２１５×膳食钠摄入量（ｍ ｍ ｏｌ／ｄ）,（ｒ＝ ０．６０７７,Ｐ＜ ０．０００１）。用前进法多元回归得出,尿钙排出量与桡骨中远１／３ 处骨矿含量、骨密度及桡骨超远端骨密度呈负相关（Ｐ＜     

去带盲结肠可控膀胱术20例报告

目的简化手术操作,探索去带盲结肠可控膀胱的应用价值。方法１９９５年１０月～１９９７年１２月,采用去带盲结肠可控膀胱术治疗全膀胱切除患者２０例。结果２０例平均随访１７７个月,完全可控１９例,可控率９５％。出院时贮尿囊容量为２５０～３５０ｍｌ,１年后为４００～７００ｍｌ。无输尿管返流,肾功稳定。结论去带盲结肠可控膀胱术操作简单、并发症少、疗效确实,是一种较好的尿流改道方式     

腹腔镜根治性全膀胱切除+原位回肠新膀胱术对膀胱癌患者的临床疗效及并发症分析

摘 要：目的 比较腹腔镜根治性膀胱全切除+原位回肠新膀胱术与开放手术的临床效果及安全性。方法 选择2010年1月至2015年3月在本院行膀胱全切除+原位回肠新膀胱术的70例患者作为研究对象,其中30例行腹腔镜下手术作为观察组,40例行开放手术作为对照组;对比两组患者围手术期情况、新膀胱功能及并发症发生情况。结果 观察组胃肠道功能恢复时间、术后住院时间明显缩短,术中出血量明显减少,与对照组相比差异具有统计学意义（P＜0.05）,手术时间则明显长于对照组（P＜0.05）;两组患者在控尿率、膀胱内压、膀胱容量、剩余尿量等方面差异无统计学意义（P＞0.05）,观察组最大尿流率显著高于对照组（P＜0.05）。两组患者术后主要并发症有肠梗阻、尿瘘、尿路感染、肺部感染、排尿困难、切口感染等;观察组总并发症发生率为16.7%,显著低于对照组（37.5%）,两组相比差异具有统计学意义（χ2=4.642,P＜0.05）。结论 腹腔镜根治性膀胱全切除+原位回肠新膀胱术具有创伤小、出血少、恢复快、新膀胱功能良好、术后并发生发生率低等优点,值得临床推广。     

Studer新膀胱术控尿重要结构的保护

目的 探讨保护控尿重要结构对原位新膀胱功能的作用. 方法男性膀胱癌患者68例,平均年龄63(42～73)岁.均为多发浸润性膀胱癌.行根治性膀胱切除Studer新膀胱术,术中积极保护尿道横纹括约肌、阴部神经及尿道肌筋膜支持组织等控尿重要结构.对新膀胱术后的控尿功能进行随访. 结果手术时间210～360 min,输血0～800 ml,分期为T3aN0M0 20例,T2N0M048例.随访6～36个月,平均12个月.患者均恢复生理控尿.术后3个月时IVU显示新膀胱形态良好,上尿路无扩张,无反流及明显残余尿.BUN、SCr和电解质均无异常.术后6个月白天控尿率为100%,夜间遗尿1例,给予夜间定时唤醒排尿后克服.膀胱完全排空者59例,残余尿20～30 ml者9例.膀胱容量200～350 ml;充盈期膀胱压17～22 cm H2O(1 cm H2O=0.098 kPa),排尿期膀胱压45～80 cm H2O;Qmax 16～32 ml/s. 结论保护控尿重要结构可改善Studer新膀胱的功能.     

乙状结肠直肠膀胱术

膀胱全切术后采用乙状结肠直肠膀胱术（ＭａｉｎｚＰｏｕｃｈＩＩ）作为可控性尿流改道。该术式以乙状结肠直肠交界为中点将肠管纵行剖开２０～２４ｃｍ，做乙状结肠直肠侧侧吻合形成大容量低压贮尿囊，输尿管采用粘膜下隧道方式做抗逆流吻合，利用肛门括约肌控制排尿。本组１１例，平均随访１０．５个月。肠代膀胱容量平均５５３ｍｌ，基础压力平均１．４７ｋＰａ（１ｋＰａ＝１０．２０ｃｍＨ２Ｏ），最大充盈压力平均２．１６ｋＰａ。在肠袋充盈过程中顺应性良好。拔除肛管１周～２个月后可获得满意的尿便分流，２个月后排尿次数稳定，白天４～５次，夜间０～３次。无夜间尿失禁，无逆行感染及高氯性酸中毒。１例出现双侧输尿管梗阻。该术式满足了可控膀胱的基本条件，易于被患者接受，术后生活质量较高     

引流液肌酐监测在腹盆腔手术后尿路损伤及尿漏诊断中的应用

目的研究术区引流液肌酐监测在诊断腹盆腔手术后尿路损伤及尿漏的作用。 方法回顾分析2015年1月至2021年6月在珠海市人民医院行腹盆腔术后尿路损伤及尿漏的33例患者资料，同时倾向性匹配该院同时期腹盆腔手术后无尿路损伤或尿漏的33例患者。比较两组患者引流液肌酐、引流液/血液肌酐比值的差异。 结果两组血肌酐差异无统计学意义，尿路损伤组的引流液肌酐2 754（2 133）μmol/L、引流液/血液肌酐比值133（57）均远远高于无尿路损伤组101（61）μmol/L，0.99（0.32），（P均<0.001）。 结论腹盆腔手术后监测引流液肌酐、引流液/血液肌酐比值对术后尿路损伤的诊断十分准确，是一个便捷、有效的诊断方法。     

Studer回肠膀胱的远期排尿功能和并发症的临床研究

目的 观察Studer回肠膀胱术后患者的远期排尿功能和并发症.方法 收集2004年5月至2008年1月接受Studer回肠膀胱术25例患者的临床资料,通过对其中20例患者进行6～44个月的随访,评估其术后6、12、24、36个月的功能性膀胱容量、剩余尿量、最大尿流率和尿失禁的变化情况,统计在此阶段内与手术相关的远期并发症、死亡情况及死亡原因.结果 功能性膀胱容量、最大尿流率在随访期间无明显变化(P>0.05),剩余尿量有所增加(36 ml vs 80 ml,P<0.01).主要并发症有肾积水、肾萎缩、尿路感染和持续、间断性血尿.结论 Studer回肠膀胱术是安全的,远期亦能够很好的保持回肠膀胱的排尿功能.手术技术的改进、经验的积累将会使治疗效果提高.     

Chronic urinary retention after radical cystectomy and orthotopic neobladder in women: Risk factors and relation to time

Purpose

To investigate the long-term cumulative incidence of chronic urinary retention (CUR) after radical cystectomy (RC) and orthotopic neobladder (ONB) in women and the possible risk factors.

The short-term prevalence of de novo urinary symptoms after different modes of hysterectomy

The aim of this study was to determine the short-term prevalence of de novo urinary symptoms after hysterectomy indicated by meno/metrorrhagia or dysmenorrhea/dyspareunia. The study group consisted of 451 women who had had a hysterectomy for reasons of meno/metrorrhagia or dysmenorrhea/dyspareunia. Fifty-three (12%) had a supracervical, 151 (33%) a total abdominal and 247 (55%) a vaginal hysterectomy. As a non-gynecologic background population we enrolled 110 women who had had their gallbladder removed laparoscopically. All women received a postal questionnaire 9-45 months after their operation. Specific questions were asked about their voiding habits, comprising significant stress incontinence, bothersome stress incontinence, significant urge incontinence, bothersome urge incontinence, pollakisuria, nocturia, use of pads, and the feeling of having a hygiene problem. To evaluate de novo symptoms or de novo cure, the women assessed the symptoms before as well as after the operation. Results showed that abdominal hysterectomy lasted longer, had heavier blood loss and required longer hospitalization than did vaginal or supracervical hysterectomy. Women scheduled for a supracervical hysterectomy had preoperatively more significant and bothersome urge incontinence, and postoperatively more significant urge, urgency, and feeling of having a hygienic problem than did women having a vaginal hysterectomy, a total abdominal hysterectomy or a laparoscopic cholecystectomy. When assessing de novo symptoms, supracervical hysterectomy was associated with more urgency and the feeling of having a hygienic problem. Some women experienced de novo cure, but these were almost exclusively in the study group and rarely in the control group. It was concluded that supracervical hysterectomy is related to more urinary symptoms than vaginal or total abdominal hysterectomy. De novo symptoms as well as de novo cure are common, which is why urinary symptoms after hysterectomy must be evaluated over time.