Miniaturized percutaneous nephrolithotomy(PCNL)procedures have gained increased popularity in recent years.They aim to reduce percutaneous tract size in order to lower complication rates,while maintaining high stone-f...Miniaturized percutaneous nephrolithotomy(PCNL)procedures have gained increased popularity in recent years.They aim to reduce percutaneous tract size in order to lower complication rates,while maintaining high stone-free rates.Recently,miniaturized PCNL techniques have further expanded,and can currently be classified into mini-PCNL,minimally invasive PCNL(MIP),Chinese mini-PCNL(MPCNL),ultra-mini-PCNL(UMP),micro-PCNL,mini-micro-PCNL,and super-mini-PCNL(SMP).However,despite its minimally-invasive nature,its potential superiority in terms of safety and efficacy when compared to conventional PCNL is still under debate.The aim of this review is to summarise different available modalities of miniaturized PCNL,details of instruments involved,and their corresponding safety and efficacy.In particular,this article highlights the role of the SMP and our experience with this novel technique in management of urolithiasis.Overall,miniaturized PCNL techniques appear to be safe and effective alternatives to conventional PCNL for both adult and pediatric patients.Well-designed,randomized studies are required to further investigate and identify specific roles of miniaturized PCNL techniques before considering them as standard rather than alternative procedures to conventional PCNL.展开更多
BACKGROUND Although metastatic adenocarcinoma of the ileum is not uncommon,solitary metastasis to the seminal vesicle has not been reported.We report a patient with recurrent hematospermia diagnosed with metastasis to...BACKGROUND Although metastatic adenocarcinoma of the ileum is not uncommon,solitary metastasis to the seminal vesicle has not been reported.We report a patient with recurrent hematospermia diagnosed with metastasis to the seminal vesicle following ileal adenocarcinoma resection,his subsequent management and outcome.CASE SUMMARY A 46-year-old man presented with recurrent episodes of painless hematospermia.This was not associated with any lower urinary tract symptoms.He had a past medical history of ileal tumor at the terminal ileum with solitary mesenteric lymph node metastasis on presentation,and underwent partial ileectomy and lymphadenectomy 4 years ago.Subsequent investigations included positronemission tomography and computed tomography imaging confirmed the very unusual diagnosis of a solitary tumor at the left seminal vesicle.Laparoscopic leftsided vesiculectomy was carried out.Histological analysis with immunohistochemistry showed that CDX-2 was positive and CK7 was negative,and the appearance was consistent with the diagnosis of recurrent metastatic adenocarcinoma of his previously treated intestine primary.The patient had an uneventful post-operative recovery.He received adjuvant chemoradiotherapy following surgery.He remained asymptomatic until he developed multiple bone and pulmonary metastases one year after surgery.CONCLUSION Clinicians should be aware of hematospermia as the first symptom of metastatic recurrence in patients with a history of ileal adenocarcinoma.展开更多
基金financed by a grant from the National Natural Science Foundation of China(Nos.81670643 and 81370804)the Science and Technology Program of Guangzhou,China(No.201604020001).
文摘Miniaturized percutaneous nephrolithotomy(PCNL)procedures have gained increased popularity in recent years.They aim to reduce percutaneous tract size in order to lower complication rates,while maintaining high stone-free rates.Recently,miniaturized PCNL techniques have further expanded,and can currently be classified into mini-PCNL,minimally invasive PCNL(MIP),Chinese mini-PCNL(MPCNL),ultra-mini-PCNL(UMP),micro-PCNL,mini-micro-PCNL,and super-mini-PCNL(SMP).However,despite its minimally-invasive nature,its potential superiority in terms of safety and efficacy when compared to conventional PCNL is still under debate.The aim of this review is to summarise different available modalities of miniaturized PCNL,details of instruments involved,and their corresponding safety and efficacy.In particular,this article highlights the role of the SMP and our experience with this novel technique in management of urolithiasis.Overall,miniaturized PCNL techniques appear to be safe and effective alternatives to conventional PCNL for both adult and pediatric patients.Well-designed,randomized studies are required to further investigate and identify specific roles of miniaturized PCNL techniques before considering them as standard rather than alternative procedures to conventional PCNL.
文摘BACKGROUND Although metastatic adenocarcinoma of the ileum is not uncommon,solitary metastasis to the seminal vesicle has not been reported.We report a patient with recurrent hematospermia diagnosed with metastasis to the seminal vesicle following ileal adenocarcinoma resection,his subsequent management and outcome.CASE SUMMARY A 46-year-old man presented with recurrent episodes of painless hematospermia.This was not associated with any lower urinary tract symptoms.He had a past medical history of ileal tumor at the terminal ileum with solitary mesenteric lymph node metastasis on presentation,and underwent partial ileectomy and lymphadenectomy 4 years ago.Subsequent investigations included positronemission tomography and computed tomography imaging confirmed the very unusual diagnosis of a solitary tumor at the left seminal vesicle.Laparoscopic leftsided vesiculectomy was carried out.Histological analysis with immunohistochemistry showed that CDX-2 was positive and CK7 was negative,and the appearance was consistent with the diagnosis of recurrent metastatic adenocarcinoma of his previously treated intestine primary.The patient had an uneventful post-operative recovery.He received adjuvant chemoradiotherapy following surgery.He remained asymptomatic until he developed multiple bone and pulmonary metastases one year after surgery.CONCLUSION Clinicians should be aware of hematospermia as the first symptom of metastatic recurrence in patients with a history of ileal adenocarcinoma.
