Ureteroscopic holmium laser lithotripsy in patients with renal impairment

Objectives In this study, we try to evaluate the efficacy and safety of holmium lasers for treatment of ureteric stones in patients with renal impairment or obstructive anuria. Patients and methods Twenty-six patients were included in this study, of which 20 patients presented with elevated blood urea and serum creatinine (2.1–7.6 mg%), and six patients presented with calcular anuria (mean serum creatinine 22 mg%). None of the patients had a ureteric stent or nephrostomy tube before the ureteroscopy. All patients were treated with holmium laser. A stone basket or grasper was used to remove significant stone fragments at the end of the procedure in seven patients. In these seven patients, ureteric stents were placed at the end of the procedure. Results All patients were free of any stone fragments at 1 week and at 3 months postoperatively. In all patients, including the six with obstructive anuria, the renal impairment resolved or improved as evidenced by normalization or fall in blood urea and creatinine. Thus, in this small group of uremic patients, the success rate for treatment of ureteral stone was 100%. Conclusions A holmium laser is a safe and effective modality of ureteroscopic lithotripsy in patients with significant renal impairment or even obstructive anuria. The use of holmium laser with ureteroscopy may be considered in this group of patients as long as the general condition of the patient permits the safe administration of anesthesia.     

Coital urinary incontinence: impact on quality of life as measured by the King’s Health Questionnaire

The aim of this present study was to measure the impact of coital urinary incontinence (UI) on sexually active women quality of life (QoL). Epidemiological, observational, cross-sectional, and multicenter study including 633 sexually active women seeking treatment for UI and/or overactive bladder in a gynecological clinic, aged between 24 and 83 years. All women filled out the King’s Health Questionnaire—KHQ. With this questionnaire, we had a complete register of the different urinary symptoms, included coital UI, and the extent of how they affect patient’s life and the measurement of impact on the patient’s QoL by the KHQ score. Prevalence of coital incontinence in sexually active women was 36.2%, classifying this impact as low (59.8%), moderate (32.3%), and high (7.9%). Women reporting coital incontinence had similar mean age and body mass index (BMI) to those women without coital incontinence. Women with coital incontinence had higher scores (worse QoL) in all the dimensions and in the KHQ global score (p < 0.05). Coital incontinence was the only variable showing an independent relation to KHQ global score (B = 10.1; 95% confidence interval = 1.7–18.6) in a multiple regression model adjusted to age, BMI, and the other urinary symptoms under study. One third of the sexually active women with urinary symptoms had coital incontinence. Among sexually active women with urinary symptoms, patients with coital urinary incontinence had a higher impact on their QoL than those without coital incontinence. Coital incontinence is independently related to a KHQ high score, which suggest worse QoL.     

胆囊结石合并胆管结石微创治疗方案的选择

目的探讨胆囊结石合并继发胆道结石微创治疗的合理方案。方法108例胆囊结石合并可疑胆道继发结石均行腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）,其中腹腔镜联合胆道镜经胆囊管胆道探查取石（laparoscopic transcyctic common bile duct exploration,LTCBDE）＋LC70例,腹腔镜联合胆道镜胆总管切开胆道取石（laparoscopic common bile duct exploration,LCBDE）＋LC35例,其中放T管14例,不放T管21例,内镜乳头肌切开术（endoscopic sphincterotomy,EST）术后行胆囊切除3例。结果LCBDE＋LC术后放T管组中有1例胆漏经保守治疗治愈,4例术后胆道造影发现胆道残余结石经胆道镜取出结石治愈．其他病例无胆漏,术后3月复查B超无残余胆道结石,所有病例术后无胰腺炎发作。结论在胆囊结石继发胆道结石的治疗中合理选择多种微创手术方法能降低创伤及减少并发症的发生。     

倒立排石床与常规排石疗法治疗肾下盏结石的疗效对比

目的：观察自行设计的倒立排石床与常规排石法治疗肾下盏结石的疗效差异。方法：选取符合治疗标准的患者160例,包括原位肾下盏结石50例和ESWL后残留肾下盏结石110例。随机分为两组（各80例）分别接受倒立排石床和常规排石疗法的治疗,最长治疗时间为30d,观察结石排出肾下盏的排净率和排净时间。结果：倒立排石床治疗组80例中,56例ESWL后肾下盏残留结石全部排净,排净时间3－6d;24例原位下盏结石有12例排净,排净时间16－21d,12例治疗30d未能排出。常规排石治疗组80例中,54例ESWL肾下盏残留结石有28例排净,排净时间18－30d,26例治疗30d未能排净;26例原位肾盏结石有3例排净,排净时间16－30d,23例治疗30d未能排出。两组ESWL后肾下盏残留结石的排净率和排净时间差异均有显著性意义（P＜0．01）;原位肾下盏结石排净率差异有极显著性意义（P＜0．01）,排净时间差异无显著性意义（P＞0．05）。结论：倒立排石床将倒立疗法器械化,能显著提高ESWL后残留肾下盏结石的排净率,缩短排净时间,从而减少ESWL后结石复发率,亦能提高原位肾下盏小结石的排净率。     

泌尿外科腹腔镜手术改行开放手术的原因浅析

目的 分析泌尿外科腹腔镜手术改行开放手术的原因。方法 对165例泌尿外科腹腔镜手术患者的临床资料进行分析,其中26例（16％）改形开放手术。结果 26例改行开放手术原因;未找到病灶8例,气腹或腹膜后充气不满意5例,粘连分离困难5例,出血4例,损伤周围脏器2例,设备故障2例。不同疾病改行开放手术的比例分别为肾上腺手术42％（8／19）,肾切除术25％（2／8）,肾囊肿去顶术18％（11／61）,前列腺癌盆腔淋巴结活检术17％（1／6）,精索静脉结扎术3％（2／60）,隐睾探查术19％（2／11）。结论 掌握适应证和手术入路、熟悉操作技术、改进设备是提高泌尿外科腹腔镜手术成功率的关键。     

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.     

网状尿道支架治疗前列腺增生症急性尿潴留远期疗效

目的：总结应用网状尿道支架治疗前列腺增生症（BPH0并发急性尿潴留（AUR）远期临床疗效。方法：对28例年龄71－88（平均78．5）岁高危BPH所致AUR患者应用镍钛记忆合金网状尿道支架治疗,分别于术后6、12、24、36个月进行随访,随访例数分别为24、22、17及17例。结果：术后6、12、24及36个月的总有效率分别为87．5％、77．3％、64．8％、76．5％。结论：网状尿道支架适合部分BPH并发AUR患者。远期疗效良好。     

去带可控盲结肠膀胱术的疗效观察（附30例报告）

目的 评价去带可控盲结肠膀胱术的疗效。方法 采用膀胱全切去带可控盲结肠膀胱术治疗膀胱癌30例。结果 30例随访8－40个月。1年后贮尿囊容量360－580ml,贮尿囊内最大压力19．5－78．5cmH2O。白天完全可控28例,可控率93％;夜间完全可控27例,可控率90％。贮尿囊造影及IVU显示单侧输尿管狭窄并肾脏轻度积水1例,无输尿管返流。血清电解质及肾功能正常。结论 去带可控盲结肠膀胱术操作简单,并发症少,疗效可靠,是一种较理想的尿流改道方法。     

Urinary incontinence after pelvic trauma: A case report

Stress and urge urinary incontinence may develop after a pelvic trauma especially after pelvic bone fractures. Incontinence may persist eventhough any type of bladder neck suspension is performed if malunion occurs between fracture ends. In stress and urge urinary incontinence developed after pelvic trauma, patients should also be evaluated for malunion of fractures which may lead to bone spurs and during any type of bladder neck suspension these should also be removed. This revised version was published online in September 2006 with corrections to the Cover Date.     

Factors affecting renal hydrogen ion excretion capacity in healthy children

In 560 healthy German children and adolescents aged 2.8–22.0 years from the DONALD (Dortmund Nutritional and Anthropometric Longitudinally Designed) study, the relationship between urine pH and renal net acid excretion (mmol/day/1.73 m²) was analysed. A quadratic model showed the best fit (r ²=0.608). Using logistic regression analysis three parameters (urinary phosphorus excretion, total protein intake and urinary ratio of potassium and sodium) had a significant effect on renal hydrogen ion excretion capacity characterised by the probability of high or low net acid excretion with respect to the urine pH value. Urinary osmolality, in contrast to what has been seen in a previous experimental study with low birth weight infants, along with sex and age had no significant independent effects on renal net acid excretion with respect to the urine pH value over the range of osmolalities observed. In healthy children and adolescents a low fluid intake with high urinary osmolality does not at least substantially decrease the renal capacity of hydrogen ion excretion. Received: 7 April 2000 / Revised: 15 December 2000 / Accepted: 15 December 2000