Background Endoscopic treatment for urethral stricture, including cold knife and laser, poses a major challenge to clinical practice. Both the benefits and drawbacks of these two treatments remain controversial. This ...Background Endoscopic treatment for urethral stricture, including cold knife and laser, poses a major challenge to clinical practice. Both the benefits and drawbacks of these two treatments remain controversial. This article aimed to compare the efficacy and safety of laser and cold knife urethrotomy for urethral stricture. Methods We searched PubMed （1966-2009）, Embase （1980-2009）, Cochrane Central Register of Controlled Trials （CCRCT, 2009 No.l） and Chinese Biomedical Literature Database （CBM） for laser and cold knife urethrotomy as treatment for male urethral stenosis, looking in the English literatures. Two reviewers independently screened the literatures and extracted information. Chi-square test was used for statistical analysis with SPSS15.0. Results A total of 44 articles, including of 3230 cases was retrieved. Success rate of patients treated with laser was 74.9% compared with 68.5% for cold knife, with very similar clinical results despite a statistically significant difference （P=-0.004）. The trend in success rate at a different follow-up time was similar between the two groups. No significant difference in success rate was found between the groups of repeat operation for recurrence cases, first P=0.090 and second P=0.459. The shorter the stricture length was （〈1 cm）, the higher the success rate was （P 〈0.0001）. No significant difference in success rate between the laser and cold knife groups was found in neither bulbar nor membranous urethra, bulbar P=0.660 and membranous P=0.477. The rates of urinary incontinence, urinary extravasation, and urinary tract infection showed no significant difference （P=-0.259, P=0.938, P=-0.653, respectively）. Conclusions Success rates for laser and cold knife were very similar despite being statistically different, with the groups having a similar trend in success rates at different follow-up time. Stricture location and history of endoscopic intervention did impact treatment outcome but was not significantly different. The two group展开更多
The aim of this study was to present the epidemiological, clinical and therapeutic aspects of adult urological cancers in the department of urology at Zinder National Hospital. Patients and Methods: This was a cross-s...The aim of this study was to present the epidemiological, clinical and therapeutic aspects of adult urological cancers in the department of urology at Zinder National Hospital. Patients and Methods: This was a cross-sectional study of adult primary urologic cancers during the period of January 2019 to December 2023. Data were obtained from the record of patients admitted to urology, and the medical oncology department. The parameters studied were;frequency, age, sex, urogenital distribution, anatomopathological type, and therapeutic aspects. Data were recorded on Excel 2013 and analyzed with Epi-info version 7.2.5. Results: Epidemiology: About 289 cancers were diagnosed through 6017 consultations during the period, corresponding to 4.80% of urological pathologies: prostate cancer (n = 221;76.47%), bladder cancer (n = 46;15.92%), kidney cancer (n = 13;04.5%), testis cancer (n = 09;03.11%). Median age of patients was 50.42 years. Prostate cancer: was Adenocarcinoma in 100% (n = 221) with Gleason scores > 7 (77.83%) and prostatique specific antigen (PSA) > 20 ng/ml in 90.04%. Extension evaluation 134 cases (60.63%). Treatment was chirurgical castration in (62.44%) and resistance to castration appeared between 8 and 11 months. Hospital mortality for prostate cancer was 16.29%. Bladder cancer was found in 46 cases with Sex ratio 7/1. Cystoscopy was performed for all. Histology revealed squamous cell carcinoma (n = 41;89.13%), and (n = 5;10.87%) urothelial. Endoscopic resection performed (n = 14;30.43%). Kidney cancers were 13 cases (10 men, 03 women). Nephrectomy was performed in (n = 8;61.54%) cases and Histology revealed renal cell cancer in 76.92%. Testicular cancers were diag 09 cases. History of cryptorchidism was found in 4 cases, 4-year infertility in 3 cases. Orchidectomy was done in all cases. Chemotherapy in 3 cases. Conclusion: urological cancers are frequent, dominated by prostate cancer. The endemicity of bilharziasis has increased squamous cell carcinoma. The majority of patients have advanced form of th展开更多
目的观察BlockBuster喉罩用于泌尿外科日间手术的临床效果。方法选择泌尿外科日间手术患者42例,男38例,女4例,年龄65~83岁,ASAⅠ~Ⅲ级,随机分为BlockBuster喉罩组（B组）和Proseal喉罩组（P组）,每组21例。麻醉诱导后根据患者体重选择...目的观察BlockBuster喉罩用于泌尿外科日间手术的临床效果。方法选择泌尿外科日间手术患者42例,男38例,女4例,年龄65~83岁,ASAⅠ~Ⅲ级,随机分为BlockBuster喉罩组（B组）和Proseal喉罩组（P组）,每组21例。麻醉诱导后根据患者体重选择适当型号的喉罩,B组置入BlockBuster喉罩,P组置入Proseal喉罩;记录两组喉罩一次置入成功率、喉罩置入后15 min PETCO2和Ppeak、经喉罩插管次数或喉罩换管次数、胃反流误吸和拔出喉罩后声嘶、咽痛等并发症的发生情况。结果 B组喉罩一次置入成功率明显高于P组,插管或换管率明显低于P组（P〈0.05）;B组喉罩置入后15min Ppeak明显低于P组（P〈0.05）;B组声嘶发生率明显低于P组（P〈0.05）。结论与Proseal喉罩比较,BlockBuster喉罩在泌尿外科日间手术中可提供良好的声门上气道管理,同时增加声门下应急气管插管通道,反流误吸发生风险小且术后声嘶、咽痛等并发症少,有效提高泌尿外科日间手术术后患者恢复质量。展开更多
Objective:To explore the application effect of a doctor-nurse cooperation follow-up model based on an Internet platform in the continuation of care for patients after uro-oncology surgery.Methods:A convenient sampling...Objective:To explore the application effect of a doctor-nurse cooperation follow-up model based on an Internet platform in the continuation of care for patients after uro-oncology surgery.Methods:A convenient sampling method was used to select patients with urinary system tumors who underwent surgery in the Department of Urology in Grade III A general hospital in Shanghai from May to August 2022.Patients who underwent surgery from May to June 2022 were assigned to the control group,and those who underwent surgery from July to August 2022 were assigned to the experimental group.The control group received routine post-discharge nursing health education and telephone follow-up.On the basis of routine discharge guidance,the experimental group implemented the intervention method based on the Internet platform in continuation care.The levels of self-management efficacy,satisfaction,and incidence of unplanned readmission were compared one month after discharge between the two groups.Results:One month after discharge,the self-management efficacy of the experimental group(90.15±7.92)was significantly higher than that of the control group(79.10±7.84),and the patient satisfaction score(97.83±2.32)was significantly higher than that of the control group(90.23±2.58),with statistical significance(P<0.05).Additionally,the incidence of unplanned readmissions within one month after discharge in the experimental group(1.59%)was slightly lower than that in the control group(4.84%).Conclusion:The doctor-nurse cooperation follow-up model based on the Internet platform in continuation care can significantly improve the self-management efficiency of patients after discharge and enhance patient satisfaction,providing a new approach for discharge follow-up of urological tumor patients after surgery.展开更多
Objective:Selective angioembolization(SAE)effectively diagnoses and treats iatrogenic vascular complications following percutaneous nephrolithotomy(PCNL).Methods:We retrospectively reviewed 1329 consecutive PCNLs and ...Objective:Selective angioembolization(SAE)effectively diagnoses and treats iatrogenic vascular complications following percutaneous nephrolithotomy(PCNL).Methods:We retrospectively reviewed 1329 consecutive PCNLs and identified patients who underwent SAE following PCNL with at least 12-month follow-up.Estimated glomerular filtration rate(eGFR)was calculated for all patients preoperatively,postoperatively and at last followup.A 1:2 matched cohort analysis was performed.Results:Twenty-three patients underwent SAE and matched to 46 controls.There was no statistically significant difference in preoperative,postoperative,and follow-up eGFR when comparing patients who underwent SAE and those with an uneventful course.Conclusion:Long-term eGFR is comparable in patients who undergo uncomplicated PCNL and those requiring SAE.展开更多
Urinary incontinence after robot-assisted radical prostatectomy （RARP） is one of the most bothersome complications affecting patients＇ daily lives. The efficacy of the bladder neck plication stitch technique in pro...Urinary incontinence after robot-assisted radical prostatectomy （RARP） is one of the most bothersome complications affecting patients＇ daily lives. The efficacy of the bladder neck plication stitch technique in promoting an earlier return of continence was prospectively evaluated in 158 patients who underwent RARP for clinically localized prostate cancer by a single surgeon at our institute from March 2012 to January 2013. Patients were randomized 1：1 to undergo surgery with （n = 79） or without （n = 79） the bladder neck plication stitch, and their time to recovery from incontinence, defined as being pad free, was compared. Recovery from incontinence at 1, 3, and 6 months were observed in 22 （27.8%）, 42 （53.2%）, and 57 （72.2%） patients, respectively, treated with, and 23 （29.1%）, 47 （59.5%）, and 59 （74.7%） patients, respectively, treated without the bladder neck plication stitch, with no significant difference in time to recovery from incontinence between the two groups. Multivariate analysis showed that age, membranous urethral length and shape of the prostatic apex on magnetic resonance imaging were independent predictors of early recovery from urinary incontinence after RARP. The bladder neck plication stitch had no effect on time to recovery from postoperative urinary incontinence following RARR展开更多
Urgent urologic interventions create a challenging scenario when they occur in patients suffering from concurrent acute coronary syndrome. Herewith we report two patients with this scenario. Case 1, a male patient was...Urgent urologic interventions create a challenging scenario when they occur in patients suffering from concurrent acute coronary syndrome. Herewith we report two patients with this scenario. Case 1, a male patient was admitted with non-ST elevation myocardial infarction in which dual antiplatelet therapy was initiated. He developed symptomatic right obstructive uropathy. Case 2, a male patient developed non-ST elevation myocardial infarction and was commenced on dual antiplatelet therapy. Subsequently, he developed gross hematuria unresponsive to conservative measures. Urgent urological intervention was carried out while on aspirin in both cases with uneventful recovery. Upon coronary angiography, both cases were found to have multi-vessel disease requiring coronary artery by-pass graft later. Due to their concurrent urologic problems the patients described were not optimized fully to undergo coronary angiography. In close collaboration with cardiology, patients with acute coronary syndrome can be carefully selected to undergo urgent urologic interventions prior to coronary angiography/primary coronary intervention.展开更多
The Gleason grading system for prostate adenocarcinoma has evolved from its original scheme established in the 1960s-1970s, to a significantly modified system after two major consensus meetings conducted by the Intern...The Gleason grading system for prostate adenocarcinoma has evolved from its original scheme established in the 1960s-1970s, to a significantly modified system after two major consensus meetings conducted by the International Society of Urologic Pathology （ISUP） in 2005 and 2014, respectively. The Gleason grading system has been incorporated into the WHO classification of prostate cancer, the AJCC/ UICC staging system, and the NCCN guidelines as one of the key factors in treatment decision. Both pathologists and clinicians need to fully understand the principles and practice of this grading system. We here briefly review the historical aspects of the original scheme and the recent developments of Gleason grading system, focusing on major changes over the years that resulted in the modern Gleason grading system, which has led to a new ＂Grade Group＂ system proposed by the 2014 ISUP consensus, and adopted by the 2016 WHO classification of tumours of the prostate.展开更多
Objective:The objective of the study was to compare the outcome of tunica albuginea urethroplasty(TAU)and buccal mucosa graft(BMG)urethroplasty for anterior urethral stricture.Methods:Thirty patients who met the inclu...Objective:The objective of the study was to compare the outcome of tunica albuginea urethroplasty(TAU)and buccal mucosa graft(BMG)urethroplasty for anterior urethral stricture.Methods:Thirty patients who met the inclusion criteria were randomised into two groups:TAU(Group A)and BMG urethroplasty(Group B).Surgical outcome was evaluated with pre-and post-operative work-up involving retrograde urethrogram,voiding cystourethrogram,uroflowmetry,and urethroscopy.Patients were followed up till 1 year.Results:Mean duration of surgery was statistically significant between two groups(p=0.0005).Maximum urine flow rate was comparable when compared between two groups(p=0.22)but statistically significant when compared pre-and post-operatively(p<0.001).At follow-up of 1 year,the successful outcomes were 80% in Group A and 87%in Group B.A total of five patients who had unsuccessful results required redo urethroplasty.Complications were minimal in both the groups.Conclusion:TAU provides outcomes equivalent to those of BMG urethroplasty.TAU has less operative time,easy to perform,and beneficial in patients with poor oral hygiene.展开更多
BACKGROUND Penoscrotal constriction devices are either used as autoerotic stimuli or to increase sexual pleasure or performance by maintaining an erection for a longer period,and a variety of metallic and non-metallic...BACKGROUND Penoscrotal constriction devices are either used as autoerotic stimuli or to increase sexual pleasure or performance by maintaining an erection for a longer period,and a variety of metallic and non-metallic objects are used.On the other hand,penile strangulation is a rare urologic emergency that requires prompt evaluation and intervention to prevent long-term complications.The goal of treating penile incarceration is to remove the foreign object as soon as possible.On the other hand,removal can be very challenging,and often requires resourcefulness and a multidisciplinary approach.CASE SUMMARY A 47-year-old man who has sex with men was transferred to our hospital for persistent phallodynia and scrotal pain,accompanying swelling due to strangulation by stainless steel rings.His medical history included acquired immunodeficiency syndrome.One day prior,he had put three stainless steel rings on his penis and scrotum before sexual intercourse.After sexual intercourse,he was unable to remove them,due to swelling of his penis and scrotum.The swelling persisted,and he felt pain in the affected area the next day,then he was transferred to our hospital by ambulance.The emergency department found that his penis and scrotum were markedly engorged and swollen.We established a diagnosis of penile and scrotal strangulation by stainless steel rings.We unsuccessfully attempted to cut the rings using a cutter,then requested a rescue team via emergency medical service.They cut through each ring in two places,using an electric-powered angle grinder,and successfully removed all of the pieces.Finally,he was discharged and went home.CONCLUSION We report the first case of penile and scrotal strangulation by stainless steel rings in an human immunodeficiency virus positive person.展开更多
In recent years, immunotherapy has been gradually established as the fourth frequently adopted antitumor therapy, following surgery, chemotherapy and radiotherapy, for advanced urologic malignancies with an improved u...In recent years, immunotherapy has been gradually established as the fourth frequently adopted antitumor therapy, following surgery, chemotherapy and radiotherapy, for advanced urologic malignancies with an improved understanding of theoretical basis, such as molecular biology and immunology. Thereinto, adoptive cellular immunotherapy （ACI） has become one of the hotspots, which comprises a variety of treatment approaches, such as TIL, CIK cell, ~＇~ T cell, CAR-engineered T cell and Allogeneie stem cell transplantation （alloSCT）. Although preclinical efficacy has been demonstrated remarkably, clinical trials could not consistently show the benefit due to multi-factors in complex immnnosuppressive microenvironment in vivo compared to that of in vitro. Here we review some timely aspects of ACI for advanced urologic malignancies, and describe the current status and limitation of immunotherapy from the cellular level. It＇s our expectation to provide prompting consideration of novel combinatorial ACI strategies and a resurgence of interest in ACI for advanced urologic malignancies.展开更多
Percutaneous nephrostomy was applied in some other urologic diseases and the efficacy was evaluated. Percutaneous nephrostomy for percutaneous nephrolithotomy （PNL） was performed in patients with various renal, peri...Percutaneous nephrostomy was applied in some other urologic diseases and the efficacy was evaluated. Percutaneous nephrostomy for percutaneous nephrolithotomy （PNL） was performed in patients with various renal, perinephric and bladder diseases （n=79）. The tract establishment, operation duration and complications were observed and the efficacy was assessed. The results showed that the tracts were successfully established in 79 cases. The operation lasted 4–20 min. 12F–16F single tract was established in nephrohydrop patients and 16F–20F single or multiple tracts were established in patients with pyonephrosis, renal cortical abscess, renal cyst and perinephric abscess. During dilation, no leakage of liquor puris was noted. Establishment of 18F single tract was achieved in one urinoma patient. In two patients with foreign body in kidney, the foreign bodies were removed via established 14F single tract. 18F tracts were established in 2 patients with bladder contracture, which was followed by the placement of 16F balloon urethral catheter for drainage. No complications, such as massive bleeding, intestinal injury and spreading of infection took place in our series. All the patients were followed up for 2–12 months. No long-term complications such as dropping of drainage tube occurred. It is concluded that as a minimally invasive technique, percutaneous nephrostomy has the advantages of convenience, simplicity and causing less complications and can be used for various urologic diseases.展开更多
文摘Background Endoscopic treatment for urethral stricture, including cold knife and laser, poses a major challenge to clinical practice. Both the benefits and drawbacks of these two treatments remain controversial. This article aimed to compare the efficacy and safety of laser and cold knife urethrotomy for urethral stricture. Methods We searched PubMed （1966-2009）, Embase （1980-2009）, Cochrane Central Register of Controlled Trials （CCRCT, 2009 No.l） and Chinese Biomedical Literature Database （CBM） for laser and cold knife urethrotomy as treatment for male urethral stenosis, looking in the English literatures. Two reviewers independently screened the literatures and extracted information. Chi-square test was used for statistical analysis with SPSS15.0. Results A total of 44 articles, including of 3230 cases was retrieved. Success rate of patients treated with laser was 74.9% compared with 68.5% for cold knife, with very similar clinical results despite a statistically significant difference （P=-0.004）. The trend in success rate at a different follow-up time was similar between the two groups. No significant difference in success rate was found between the groups of repeat operation for recurrence cases, first P=0.090 and second P=0.459. The shorter the stricture length was （〈1 cm）, the higher the success rate was （P 〈0.0001）. No significant difference in success rate between the laser and cold knife groups was found in neither bulbar nor membranous urethra, bulbar P=0.660 and membranous P=0.477. The rates of urinary incontinence, urinary extravasation, and urinary tract infection showed no significant difference （P=-0.259, P=0.938, P=-0.653, respectively）. Conclusions Success rates for laser and cold knife were very similar despite being statistically different, with the groups having a similar trend in success rates at different follow-up time. Stricture location and history of endoscopic intervention did impact treatment outcome but was not significantly different. The two group
文摘The aim of this study was to present the epidemiological, clinical and therapeutic aspects of adult urological cancers in the department of urology at Zinder National Hospital. Patients and Methods: This was a cross-sectional study of adult primary urologic cancers during the period of January 2019 to December 2023. Data were obtained from the record of patients admitted to urology, and the medical oncology department. The parameters studied were;frequency, age, sex, urogenital distribution, anatomopathological type, and therapeutic aspects. Data were recorded on Excel 2013 and analyzed with Epi-info version 7.2.5. Results: Epidemiology: About 289 cancers were diagnosed through 6017 consultations during the period, corresponding to 4.80% of urological pathologies: prostate cancer (n = 221;76.47%), bladder cancer (n = 46;15.92%), kidney cancer (n = 13;04.5%), testis cancer (n = 09;03.11%). Median age of patients was 50.42 years. Prostate cancer: was Adenocarcinoma in 100% (n = 221) with Gleason scores > 7 (77.83%) and prostatique specific antigen (PSA) > 20 ng/ml in 90.04%. Extension evaluation 134 cases (60.63%). Treatment was chirurgical castration in (62.44%) and resistance to castration appeared between 8 and 11 months. Hospital mortality for prostate cancer was 16.29%. Bladder cancer was found in 46 cases with Sex ratio 7/1. Cystoscopy was performed for all. Histology revealed squamous cell carcinoma (n = 41;89.13%), and (n = 5;10.87%) urothelial. Endoscopic resection performed (n = 14;30.43%). Kidney cancers were 13 cases (10 men, 03 women). Nephrectomy was performed in (n = 8;61.54%) cases and Histology revealed renal cell cancer in 76.92%. Testicular cancers were diag 09 cases. History of cryptorchidism was found in 4 cases, 4-year infertility in 3 cases. Orchidectomy was done in all cases. Chemotherapy in 3 cases. Conclusion: urological cancers are frequent, dominated by prostate cancer. The endemicity of bilharziasis has increased squamous cell carcinoma. The majority of patients have advanced form of th
文摘目的观察BlockBuster喉罩用于泌尿外科日间手术的临床效果。方法选择泌尿外科日间手术患者42例,男38例,女4例,年龄65~83岁,ASAⅠ~Ⅲ级,随机分为BlockBuster喉罩组（B组）和Proseal喉罩组（P组）,每组21例。麻醉诱导后根据患者体重选择适当型号的喉罩,B组置入BlockBuster喉罩,P组置入Proseal喉罩;记录两组喉罩一次置入成功率、喉罩置入后15 min PETCO2和Ppeak、经喉罩插管次数或喉罩换管次数、胃反流误吸和拔出喉罩后声嘶、咽痛等并发症的发生情况。结果 B组喉罩一次置入成功率明显高于P组,插管或换管率明显低于P组（P〈0.05）;B组喉罩置入后15min Ppeak明显低于P组（P〈0.05）;B组声嘶发生率明显低于P组（P〈0.05）。结论与Proseal喉罩比较,BlockBuster喉罩在泌尿外科日间手术中可提供良好的声门上气道管理,同时增加声门下应急气管插管通道,反流误吸发生风险小且术后声嘶、咽痛等并发症少,有效提高泌尿外科日间手术术后患者恢复质量。
基金The Project of China Hospital Development Research Institute,Shanghai Jiao Tong University(No.CHDI-2022-B-11)Shanghai Jiao Tong University School of Medicine:Nursing Development Program。
文摘Objective:To explore the application effect of a doctor-nurse cooperation follow-up model based on an Internet platform in the continuation of care for patients after uro-oncology surgery.Methods:A convenient sampling method was used to select patients with urinary system tumors who underwent surgery in the Department of Urology in Grade III A general hospital in Shanghai from May to August 2022.Patients who underwent surgery from May to June 2022 were assigned to the control group,and those who underwent surgery from July to August 2022 were assigned to the experimental group.The control group received routine post-discharge nursing health education and telephone follow-up.On the basis of routine discharge guidance,the experimental group implemented the intervention method based on the Internet platform in continuation care.The levels of self-management efficacy,satisfaction,and incidence of unplanned readmission were compared one month after discharge between the two groups.Results:One month after discharge,the self-management efficacy of the experimental group(90.15±7.92)was significantly higher than that of the control group(79.10±7.84),and the patient satisfaction score(97.83±2.32)was significantly higher than that of the control group(90.23±2.58),with statistical significance(P<0.05).Additionally,the incidence of unplanned readmissions within one month after discharge in the experimental group(1.59%)was slightly lower than that in the control group(4.84%).Conclusion:The doctor-nurse cooperation follow-up model based on the Internet platform in continuation care can significantly improve the self-management efficiency of patients after discharge and enhance patient satisfaction,providing a new approach for discharge follow-up of urological tumor patients after surgery.
文摘Objective:Selective angioembolization(SAE)effectively diagnoses and treats iatrogenic vascular complications following percutaneous nephrolithotomy(PCNL).Methods:We retrospectively reviewed 1329 consecutive PCNLs and identified patients who underwent SAE following PCNL with at least 12-month follow-up.Estimated glomerular filtration rate(eGFR)was calculated for all patients preoperatively,postoperatively and at last followup.A 1:2 matched cohort analysis was performed.Results:Twenty-three patients underwent SAE and matched to 46 controls.There was no statistically significant difference in preoperative,postoperative,and follow-up eGFR when comparing patients who underwent SAE and those with an uneventful course.Conclusion:Long-term eGFR is comparable in patients who undergo uncomplicated PCNL and those requiring SAE.
文摘Urinary incontinence after robot-assisted radical prostatectomy （RARP） is one of the most bothersome complications affecting patients＇ daily lives. The efficacy of the bladder neck plication stitch technique in promoting an earlier return of continence was prospectively evaluated in 158 patients who underwent RARP for clinically localized prostate cancer by a single surgeon at our institute from March 2012 to January 2013. Patients were randomized 1：1 to undergo surgery with （n = 79） or without （n = 79） the bladder neck plication stitch, and their time to recovery from incontinence, defined as being pad free, was compared. Recovery from incontinence at 1, 3, and 6 months were observed in 22 （27.8%）, 42 （53.2%）, and 57 （72.2%） patients, respectively, treated with, and 23 （29.1%）, 47 （59.5%）, and 59 （74.7%） patients, respectively, treated without the bladder neck plication stitch, with no significant difference in time to recovery from incontinence between the two groups. Multivariate analysis showed that age, membranous urethral length and shape of the prostatic apex on magnetic resonance imaging were independent predictors of early recovery from urinary incontinence after RARP. The bladder neck plication stitch had no effect on time to recovery from postoperative urinary incontinence following RARR
文摘Urgent urologic interventions create a challenging scenario when they occur in patients suffering from concurrent acute coronary syndrome. Herewith we report two patients with this scenario. Case 1, a male patient was admitted with non-ST elevation myocardial infarction in which dual antiplatelet therapy was initiated. He developed symptomatic right obstructive uropathy. Case 2, a male patient developed non-ST elevation myocardial infarction and was commenced on dual antiplatelet therapy. Subsequently, he developed gross hematuria unresponsive to conservative measures. Urgent urological intervention was carried out while on aspirin in both cases with uneventful recovery. Upon coronary angiography, both cases were found to have multi-vessel disease requiring coronary artery by-pass graft later. Due to their concurrent urologic problems the patients described were not optimized fully to undergo coronary angiography. In close collaboration with cardiology, patients with acute coronary syndrome can be carefully selected to undergo urgent urologic interventions prior to coronary angiography/primary coronary intervention.
基金supported by grants from the Natural Science Foundation of China (NSFC 81272848, 81272820, 81302225, 81572540)
文摘The Gleason grading system for prostate adenocarcinoma has evolved from its original scheme established in the 1960s-1970s, to a significantly modified system after two major consensus meetings conducted by the International Society of Urologic Pathology （ISUP） in 2005 and 2014, respectively. The Gleason grading system has been incorporated into the WHO classification of prostate cancer, the AJCC/ UICC staging system, and the NCCN guidelines as one of the key factors in treatment decision. Both pathologists and clinicians need to fully understand the principles and practice of this grading system. We here briefly review the historical aspects of the original scheme and the recent developments of Gleason grading system, focusing on major changes over the years that resulted in the modern Gleason grading system, which has led to a new ＂Grade Group＂ system proposed by the 2014 ISUP consensus, and adopted by the 2016 WHO classification of tumours of the prostate.
文摘Objective:The objective of the study was to compare the outcome of tunica albuginea urethroplasty(TAU)and buccal mucosa graft(BMG)urethroplasty for anterior urethral stricture.Methods:Thirty patients who met the inclusion criteria were randomised into two groups:TAU(Group A)and BMG urethroplasty(Group B).Surgical outcome was evaluated with pre-and post-operative work-up involving retrograde urethrogram,voiding cystourethrogram,uroflowmetry,and urethroscopy.Patients were followed up till 1 year.Results:Mean duration of surgery was statistically significant between two groups(p=0.0005).Maximum urine flow rate was comparable when compared between two groups(p=0.22)but statistically significant when compared pre-and post-operatively(p<0.001).At follow-up of 1 year,the successful outcomes were 80% in Group A and 87%in Group B.A total of five patients who had unsuccessful results required redo urethroplasty.Complications were minimal in both the groups.Conclusion:TAU provides outcomes equivalent to those of BMG urethroplasty.TAU has less operative time,easy to perform,and beneficial in patients with poor oral hygiene.
文摘BACKGROUND Penoscrotal constriction devices are either used as autoerotic stimuli or to increase sexual pleasure or performance by maintaining an erection for a longer period,and a variety of metallic and non-metallic objects are used.On the other hand,penile strangulation is a rare urologic emergency that requires prompt evaluation and intervention to prevent long-term complications.The goal of treating penile incarceration is to remove the foreign object as soon as possible.On the other hand,removal can be very challenging,and often requires resourcefulness and a multidisciplinary approach.CASE SUMMARY A 47-year-old man who has sex with men was transferred to our hospital for persistent phallodynia and scrotal pain,accompanying swelling due to strangulation by stainless steel rings.His medical history included acquired immunodeficiency syndrome.One day prior,he had put three stainless steel rings on his penis and scrotum before sexual intercourse.After sexual intercourse,he was unable to remove them,due to swelling of his penis and scrotum.The swelling persisted,and he felt pain in the affected area the next day,then he was transferred to our hospital by ambulance.The emergency department found that his penis and scrotum were markedly engorged and swollen.We established a diagnosis of penile and scrotal strangulation by stainless steel rings.We unsuccessfully attempted to cut the rings using a cutter,then requested a rescue team via emergency medical service.They cut through each ring in two places,using an electric-powered angle grinder,and successfully removed all of the pieces.Finally,he was discharged and went home.CONCLUSION We report the first case of penile and scrotal strangulation by stainless steel rings in an human immunodeficiency virus positive person.
基金supported by a grant from National Natural Science Foundation of China(No.30901481,81372752,81472411)Wu-Jie Ping Medical Foundation(320.6750.13261)
文摘In recent years, immunotherapy has been gradually established as the fourth frequently adopted antitumor therapy, following surgery, chemotherapy and radiotherapy, for advanced urologic malignancies with an improved understanding of theoretical basis, such as molecular biology and immunology. Thereinto, adoptive cellular immunotherapy （ACI） has become one of the hotspots, which comprises a variety of treatment approaches, such as TIL, CIK cell, ~＇~ T cell, CAR-engineered T cell and Allogeneie stem cell transplantation （alloSCT）. Although preclinical efficacy has been demonstrated remarkably, clinical trials could not consistently show the benefit due to multi-factors in complex immnnosuppressive microenvironment in vivo compared to that of in vitro. Here we review some timely aspects of ACI for advanced urologic malignancies, and describe the current status and limitation of immunotherapy from the cellular level. It＇s our expectation to provide prompting consideration of novel combinatorial ACI strategies and a resurgence of interest in ACI for advanced urologic malignancies.
文摘Percutaneous nephrostomy was applied in some other urologic diseases and the efficacy was evaluated. Percutaneous nephrostomy for percutaneous nephrolithotomy （PNL） was performed in patients with various renal, perinephric and bladder diseases （n=79）. The tract establishment, operation duration and complications were observed and the efficacy was assessed. The results showed that the tracts were successfully established in 79 cases. The operation lasted 4–20 min. 12F–16F single tract was established in nephrohydrop patients and 16F–20F single or multiple tracts were established in patients with pyonephrosis, renal cortical abscess, renal cyst and perinephric abscess. During dilation, no leakage of liquor puris was noted. Establishment of 18F single tract was achieved in one urinoma patient. In two patients with foreign body in kidney, the foreign bodies were removed via established 14F single tract. 18F tracts were established in 2 patients with bladder contracture, which was followed by the placement of 16F balloon urethral catheter for drainage. No complications, such as massive bleeding, intestinal injury and spreading of infection took place in our series. All the patients were followed up for 2–12 months. No long-term complications such as dropping of drainage tube occurred. It is concluded that as a minimally invasive technique, percutaneous nephrostomy has the advantages of convenience, simplicity and causing less complications and can be used for various urologic diseases.
