Vesical calculus formation on non-absorbable sutures used for open inguinal hernia repair

INTRODUCTION

Iatrogenic injuries to the urogenital tract are rare, with the bladder being the organ most affected. We describe a case of a vesical calculus that formed on non-absorbable sutures that were used to repair an inguinal hernia.

PRESENTATION OF CASE

A 45-year-old male presented with frank haematuria and dysuria 2 years following an open left inguinal hernia repair. A CT urography showed a vesical calculus adherent to the left anterio-lateral wall of the bladder. Cystoscopy revealed that the calculus formed on non-absorbable sutures. Cystolapaxy was performed followed by cystoscopic excision of the sutures. The patient''s post-operative course was uneventful.

DISCUSSION

Foreign bodies in the urinary bladder always act as a nidus for formation of a calculus. Iatrogenic bladder injuries are common during hernia repair. It is however rare for sutures used to repair an inguinal hernia to involve the urinary bladder wall. The patient most likely had a full bladder at the time of hernia repair or the bladder was part of the contents of the hernia sac.

CONCLUSION

This case illustrates the need to ensure that the bladder is empty prior to pelvic surgery and for surgeons to have a good understanding of inguinal anatomy to avoid injuring the contents of the hernia sac.     

一种交叉异位融合肾新亚型及其诊治

目的:观察一种交叉异位融合肾新亚型的发病情况,探讨其临床分型、诊断与治疗以及发病机制。方法:回顾性分析1例交叉异位融合肾合并髂血管后巨输尿管异位开口和胸椎侧弯患者的临床资料,包括患者的病史资料、影像资料和手术探查交叉异位融合肾的术中所见,然后进行文献复习。结果:文献复习证实这可能是交叉异位融合肾的一种新亚型,交叉异位融合肾合并髂血管后异位输尿管在以前的文献中也从未见报道,患者的异位输尿结石并感染通过手术治愈。结论:男性的异位输尿管开口更为隐蔽,需要联合多种方法进行诊断。     

川西地区500例泌尿系结石成分构成及相关因素分析

目的：探讨川西地区泌尿系结石的成分构成及其相关因素。方法：前瞻性收集2011年11月～2013年11月经确诊为泌尿系结石的患者500例,采用红外光自动分析仪（LIIR一20型）分析结石成分构成。用SPSS13．0软件描述性分析相关研究指标。结果：泌尿系结石患者的性别比（男：女）为1．86：1,且以中青年（29～48岁）居多（46．8％）。少年患者以肾结石为主（55％）,青年、中年和老年患者以输尿管结石为主（分别占69．9％、65．2％和53．6％）。泌尿系结石成分主要为纯一水草酸钙（28．4％）,但青年患者以混合结石（一水草酸钙／二水草酸钙和碳酸）居多（38．2％）。汉族患者结石成分主要为纯一水草酸钙（29．8％、）;藏族多为混合结石（38．0％）。结论：川西地区泌尿系结石成分主要为草酸钙,且具有民族和地区差异,建议针对结石成分的特点采取相应的预防和治疗措施。     

经皮肾镜碎石术分期处理结石性脓肾的疗效分析

目的:评价经皮肾镜钬激光碎石术分期治疗结石性脓肾的安全性和治疗效果。方法:回顾性分析2009年6月~2013年9月收住的65例结石性脓肾患者临床资料:分别在B超引导下完成经皮肾镜钬激光碎石术,其中29例为Ⅰ期经皮肾镜钬激光碎石术(Ⅰ期组),36例为Ⅰ期穿刺引流后行Ⅱ期经皮肾镜钬激光碎石术(Ⅱ期组)。结果:两组均顺利完成手术。Ⅰ期组术后发热9例,高热4例,菌血症1例,肾周感染2例;Ⅰ期结石清除率为75.8%,结石残余7例(5例1cm);造瘘管留置时间为(5.69±1.51)d,术后住院时间分别为(7.58±1.97)d,总住院时间为(14.46±4.47)d,总住院平均费用为(20 134±3 930)元。Ⅱ期组术后发热6例,高热2例,感染性休克1例;结石清除率为88.9%,结石残余4例(均1cm);总住院时间平均为(19.53±5.65)d,造瘘管留置时间为(11.17±1.63)d,术后住院时间分别为(6.39±2.54)d,总住院平均费用为(28 261±3 191)元。比较造瘘管留置时间、总住院时间、住院费用等,两组差异有统计学意义(P0.05)。均未出现肾切除、大出血、腹腔脏器损伤等严重并发症。结论:Ⅰ期经皮肾镜钬激光碎石术可有效减少患者术后留置造瘘管时间和住院时间,降低住院费用,通过有效的术前准备,注意术中操作细节,对选择性结石性脓肾患者是一种安全有效的治疗方法。     

A new method for computer-assisted detection,definition and differentiation of the urinary calculi

Purpose: Urinary stones are common and can be diagnosed with computed tomography (CT) easily. In this study, we aimed to specify the opacity characteristics of various types of calcified foci that develop through the urinary system by using an image analysis program. With this method, we try to differentiate the calculi from the non-calculous opacities and also we aimed to present how to identify the characteristic features of renal and ureteral calcules. Materials and methods: We obtained the CT studies of the subjects (n?=?48, mean age?=?41 years) by using a dual source CT imaging system. We grouped the calculi detected in the dual-energy CT sections as renal (n?=?40) or ureteric (n?=?45) based on their locations. Other radio-opaque structures that were identified outside but within close proximity of the urinary tract were recorded as calculi “mimickers”. We used ImageJ program for morphological analysis. All the acquired data were analyzed statistically. Results: According to thorough morphological parameters, there were statistically significant differences in the angle and Feret angle values between calculi and mimickers (p?p?=?0.003) and kidney (p?=?0.001) stones. Conclusions: Computer-based morphologic parameters can be used simply to differentiate between calcular and noncalcular densities on CT and also between renal and ureteric stones.     

痛风患者肾脏结石与关节部位尿酸盐晶体沉积的相关性

目的:探讨痛风患者关节部位尿酸盐结晶沉积与肾脏结石形成的相关性。方法:回顾分析复旦大学附属中山医院门诊痛风患者(n=190)的肾脏超声检查结果及急性痛风性关节发作部位双源CT结果。采用卡方检验及Spearman相关分析明确双源CT上显示的尿酸盐结晶沉积部位、尿酸盐结晶大小与肾脏结石形成的关系。结果:肾脏超声显示无肾脏结石患者139例(73.2%),肾脏结石患者51例(26.8%)。双源CT检查部位分为双足、踝关节152例,双膝关节24例,双手、腕关节14例。其中,155例双源CT发现有尿酸盐结晶沉积,35例双源CT未见尿酸盐晶体沉积。以超声检查是否存在肾脏结石将患者分为肾脏结石组和无肾脏结石组。两组患者在尿酸盐沉积部位及体积上差异无统计学意义。结论:痛风患者肾脏结石的形成与关节尿酸盐沉积无明显相关性。     

双J管在输尿管腔内碎石术中的应用及并发症

目的 探讨应用双J管内引流的并发症及其防治方法.方法 对207例输尿管腔内碎石术中应用双J管内引流的临床资料进行回顾性分析.结果 双J管内引流与支撑效果良好.置管后主要并发症为血尿、尿路感染、双J管移位、管周及管腔结石生成、双J管堵塞及拔管后输尿管狭窄.结论 双J管具有内支架和内引流的双重作用,操作简单,使用安全、可靠,缩短了住院时间.置管后出现的并发症一般较轻,正确置管,适时拔管,及时处理,能减少并发症的发生.     

体外培育牛黄治疗慢性乙型肝炎湿热蕴结证临床观察

目的：观察体外培育牛黄治疗慢性乙型肝炎（ CHB）湿热蕴结证患者的临床疗效及安全性。方法：本研究为开放研究,采用前瞻性随机平行对照临床实验方法,来自于湖北省中医院肝病科的66例CHB湿热蕴结证患者随机分为治疗组33例（脱落1例）,对照组33例。对照组患者予以西医常规治疗（包括抗HBV治疗）,治疗组患者在对照组治疗基础上,加用体外培育牛黄0.15～0.3g口服,1次/d。两组均以4周为1个疗程。观察两组患者治疗前后中医证候疗效、肝功能的改善情况、安全性指标及不良反应,并进行比较。结果：治疗组患者中医证候疗效明显优于对照组（100％vs 81.8％, P＜0.05）,尤其对主要症候如倦怠乏力、胁肋刺痛、身目尿黄等的改善明显优于对照组（P＜0.05）;对于ALT、 GGT及TBil的改善明显优于对照组（P＜0.05）;无不良反应。结论：体外培育牛黄治疗CHB湿热蕴结证,具有显著的护肝、降酶和退黄作用,尤其対中医证候的改善有显著效果,安全性良好。     

膀胱巨大结石治疗并国内文献复习——附1例报告

目的 探讨膀胱巨大结石的成因、诊断、鉴别诊断及治疗.方法 1例报告和复习国内个案文献,即结石＞5cm,进行分析予以讨论.结果 根据临床表现,体格检查,腹平片,B超等可明确诊断,耻骨上膀胱切开取石是有效的治疗手段.结论 膀胱结石诊断容易,多有明确病因;病因不明者应进一步检查明确病因,以防结石复发.膀胱巨大结石膀胱切开取石效果为佳;术后应充分引流,针对性应用抗菌素治疗,防止并发症发生.