Yanqun Na

A Prospective Comparative Study Between Minimally Invasive Percutaneous Nephrolithotomy in Supine Position and Flexible Ureteroscopy in the Management of Single Large Stone in the Proximal Ureter

OBJECTIVE To investigate the difference and relative advantages between minimally invasive percutaneous nephrolithotomy (MPCNL) in supine position and flexible ureteroscopy (FURS) in the management of surgically indicated single large stone in the proximal ureter. METHODS Patients with single large stone in the proximal ureter with slight to moderate hydronephrosis were prospectively selected and assigned into groups of MPCNL and FURS on the basis of the patients choice. Demographic data, operative duration, postoperative hospital stay, complication rate, and stone-free rate were recorded and compared. RESULTS From October 2010 to May 2012, 76 such patients were consecutively included into the study. No significant difference was found in preoperative demographics, including age, sex, and severity of hydronephrosis. Stone size was 15.6 ± 2.5 and 14.9 ± 2.3 mm (P = .349), operative duration 49.3 ± 11.7 and 67.2 ± 17.3 minutes (P <.001), postoperative hospital stay 4.2 ± 1.1 and 1.8 ± 0.8 days (P <.001), stone-free rate (residual ≤ 3 mm) 93.7% and 84.1% (P = .198), and complication rate over grade II (modified Clavien system) 12.5% and 6.8% (P = .398) in MPCNL and FURS groups respectively. CONCLUSION Both MPCNL in supine position and FURS are effective and safe surgical options for patients with single large stone in the proximal ureter, when indicated. FURS is associated with faster recovery and less invasiveness than MPCNL in supine position.

Efficacy of Combined Amlodipine/Terazosin Therapy in Male Hypertensive Patients With Lower Urinary Tract Symptoms: A Randomized, Double-blind Clinical Trial

OBJECTIVES To investigate the therapeutic efficacy and safety of Amlodipine alone or in combination with terazosin for the presence of lower urinary tract symptoms (LUTS) and hypertension. LUTS and hypertension often coexist in elderly men. METHODS A total of 355 patients with Stage 1 or 2 hypertension and LUTS (as defined by an International Prostate Symptom Score of > or =10) were randomly assigned to receive 2 mg of terazosin (n = 117), 5 mg of Amlodipine (n = 119), or 5 mg of Amlodipine plus 2 mg of terazosin (n = 119) once daily for a total of 28 days. The primary outcomes were a reduction in the total and subscores of the International Prostate Symptom Score and blood pressure. Analyses were performed by intention to treat. This trial is registered with ClinicalTrials.gov (No. NCT00693199). RESULTS At day 28 of the trial, the Amlodipine plus terazosin group demonstrated comparable efficacy in lowering the total International Prostate Symptom Score and significant improvement in the presence of overactive bladder compared with the terazosin group (P < .05) and significant improvement in quality of life compared with the Amlodipine group (P < .05). The Amlodipine plus terazosin group also achieved the greatest blood pressure control compared with either the terazosin group (P < .01) or Amlodipine group (P < .05). All 3 treatment regimens were well tolerated by the study patients. CONCLUSIONS The results of this 4-week, double-blind, randomized trial have demonstrated that in Chinese male hypertensive patients with LUTS, low-dose Amlodipine plus terazosin therapy appears to be a safe and effective combination therapy to control both conditions, especially for those with predominant overactive bladder symptoms.

The Association Between Metabolic Syndrome and the National Institutes of Health Chronic Prostatitis Symptom Index: Results From 1673 Men in China

OBJECTIVE To investigate the association between metabolic syndrome (MetS) and the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) in a population-based sample of Chinese men. METHODS From October 2010 to July 2011, 1896 men, aged between 20 and 50 years, residing in Shijingshan district of Beijing, China, were selected to participate in the Male Reproductive Health Program (a random cross-sectional survey). The Chinese version of the NIH-CPSI questionnaire was used to identify men with prostatitis-like symptoms. The presence of MetS was determined according to the 2005 National Cholesterol Education Program-Adult Treatment Panel III criteria for Asian Americans. RESULTS Complete data were available for 1673 men. The major domains of NIH-CPSI scores were significantly different among different body mass index (BMI) groups (P <.05). No significant differences were identified in the incidence of prostatitis-like symptoms or each NIH-CPSI scores between patients with MetS and those without MetS. When the age and BMI were adjusted, there was no significant correlation between the components of MetS and each NIH-CPSI scores. CONCLUSION There was no significant correlation between MetS or components of MetS and chronic prostatitis/chronic pelvic pain syndrome. Age and BMI were identified as a risk factor for chronic prostatitis/chronic pelvic pain syndrome. Further studies are necessary to confirm our results.

Validation of a novel non-biological bench model for the training of percutaneous renal access

PURPOSE The percutaneous renal access (PRA) is the most critical step of percutaneous renal surgery (PRS). For the training of PRA in the lab, a novel non-biological bench model was developed and set for validation test. MATERIALS AND METHODS Experts in PRS (> 60 cases) and novices were included to perform fluoroscopy guided PRA on the model. Overall time, X-ray exposure time and puncture attempts were recorded to establish construct validity. After accomplishment, the experts rated the model using a standardized questionnaire for face and content validity based on a 5-point Likert scale, with 1 denoting very bad and 5 as excellent. Baseline and post-training data of novices were analyzed for skill acquisition. RESULTS 9 experts and 30 novices were finally included. The overall appraisal was 4 by the experts, and consensus of all experts was reached for the model as an excellent training tool. Significant difference between experts and novices was detected with the experts using less total time 183.11 ± 29.40 vs. 278.00 ± 50.30 seconds (P < 0.001), shorter X-ray exposure time 109.22 ± 19.93 vs. 183.13 ± 38.83 seconds (P < 0.001), and fewer attempts 1.28 ± 0.44 vs. 2.35 ± 0.65 (P < 0.001). After training, the novices demonstrated significant skill improvement in total and fluoroscopy time, and number of attempts (P < 0.001). CONCLUSIONS Our non-biological model provides a new method for PRA training. The face, content and construct validity were demonstrated. This model allows contact with PRA skills and could be applied to the first step in the learning curve.

Fungus ball and emphysematous cystitis secondary to Candida tropicalis: A case report.

Fungus ball and fungal emphysematous cystitis are two rare complications of fungal urinary tract infection. A 53-year-old male patient presented with these complications caused by Candida tropicalis simultaneously. The predisposing factors were diabetes mellitus and usage of broad-spectrum antibiotics. The fungus ball, measuring 3.5 × 2.0 cm on the left wall of the urinary bladder, shrank significantly to 1.6 × 0.8 cm after 5 days of intermittent irrigation with saline before surgery. With transurethral removal of the fungus ball and antifungal treatment with fluconazole, the patient fully recovered. We conclude that a bladder fungus ball and fungal emphysematous cystitis should always be suspected in patients with diabetes mellitus with uncontrolled funguria and abnormal imaging. Treatment should include a systemic antifungal therapy and thorough surgical removal of the fungus ball. A systemic antifungal therapy combined with a local irrigation with saline or antifungal drugs might help decrease the dissemination of fungemia during an invasive manipulation.

A Large Bladder Tumor Covered With a Thick “Shell” of Necrotic Material: Misdiagnosis of a Patient With Spina Bifida

AbstractBladder tumor arising in a spina bifida patient is rare and may be clinically latent.We report the case of a 61-year-old female patient with spina bifida, neurogenic bladder, and a history of recurrent urinary tract infections. A B-ultrasound and non-contrast computed tomography scan did not reveal any bladder mass, but an unexplained “well-filled” bladder was observed, which was confusing as the catheter was present and open. However, a subsequent cystoscopic evaluation revealed a large bladder mass measuring 9.5 × 9.0 × 6.5 cm3, which almost filled the entire bladder. The mass had coarse and flocculent surface and seemed to be free from each observed wall of the urinary bladder. It was diagnosed as an infectious necrotic mass based on its appearance.During transurethral resection of the mass, a bladder tumor was suspected as small blood vessels and bleeding appeared within the inner layer of the mass. Pathological examination revealed necrotic material, inflammatory cells, and urothelial carcinoma cells. Then, a radical cystectomy was performed, and the pathological results indicated stage pT3bN0M0 transitional cell carcinoma. In the gross specimen, the base of the tumor measured 3 × 3 cm2 on the top of the back wall of the bladder.Bladder tumors may have atypical presentations in patients with spina bifida. Regular screening is helpful for earlier detection and improving outcomes of bladder tumors in such patients.