Clinical Application of Percutaneous Nephrostomy in Some Urologic Diseases

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.

A Panorama of the Urological Diseases at the Former Military Teaching Hospital of Cotonou

Background: Urological care has been advancing quickly over the last ten years in Benin. In order to conveniently support that trend towards better urological care standards, decision-makers need sound data on urological diseases in the country. Objective: To determine the prevalence of urological diseases in the former Military Teaching Hospital of Cotonou. Patients and Method: We retrospectively collected the urological diseases that the institution had managed from January 2012 to December 2020. We used Excel© 2010 and SPSS© to analyze the collected data. Results: 4244 patients, i.e. 3717 males (87.58%) and 527 females (12.42%) were managed during the study period. The main diseases diagnosed were benign prostatic hyperplasia (32.61%, n = 1384), erectile dysfunction (10.44%, n = 443), chronic prostatitis (5.94%, n = 252), prostate cancer (4.03%, n = 171), and ejaculatory disorders (3.44%, n = 146). In patients ≤ 15 years, predominant diseases were peritoneal vaginal canal (15.9%, n = 43), circumcision (15.6%, n = 42), testicular dystopia (10.7%, n = 29), hydrocele (7.8%, n = 21), and hypospadias (5.6%, n = 15). Wilms tumor (1.9%, n = 5) was the first cancer, testicular (0.4%, n = 1) and para-testicular (0.4%, n = 1) tumors were the next. In patients > 15 and ≤40 years, the main diseases were infertility (14.1%, n = 189), chronic prostatitis (12.9%, n = 173), erectile dysfunction (10.1%, n = 135), ejaculatory disorders (6.2%, n = 83), genital infections (6.2%, n = 83) and urinary stone (4.9%, n = 66). The first cancer was kidney cancer (0.97%, n = 13) followed by bladder cancer (0.3%, n = 4) and testicular tumor (0.3%, n = 4). In patients >40 years, the most prevalent diseases were BPH (52.0%, n = 1370), erectile dysfunction (11.7%, n = 308), prostate cancer (6.5%, n = 171), inguinal hernia (5.1%, n = 134), and urinary stone (3.9%, n = 102). Prostate cancer is the first cancer;the next were bladder (0.95%, n = 25) and kidney (0.68%, n = 18) cancers. Conclusion: Benign prostatic hyperplasia and urological cancers (prostate, bladder and kidney cancers) were the main urological diseases at the former Military Teaching Hospital of Cotonou. Urological malformations and Wilms tumor were the main diseases in the children.

Epidemiological Aspects of Female Urological Diseases, at the National University Teaching Hospital H. K. Maga of Cotonou from 2008 to 2017

Most urological conditions are represented by male disorders. Analyzing certain epidemiological aspects of female urological disorders at the National University Teaching Hospital of Cotnou, will allow us objectively to have reliable data to optimize the urological management of women. Patients and Methods: This was a retrospective, analytical and descriptive study that was conducted at the CNHU-HKM over a 10-year period from January 2008 to December 2017 on the epidemiological aspects of female urological diseases from the study of patient records. The variable studied was: the age, the profession, the year of admission, the organ affected, and the type of pathology. The confidentiality of the data has been ensured. Results: Female urological disorders over 10 years accounted for 9.62% of all patients received in Urology Department. The age group greater than 50 years was the most common at 31.34%. Traders and housewives were the most numerous (39.93% and 14.55%). Bladder diseases were the most frequent (51.50), dominated by vesico-vaginal fistulas (29.85%). In addition to fistulas, tumoral affections were most prevalent at 27.99% followed by infectious diseases at 8.21%. The lithiasic affections were infrequent at 6.72%. Conclusion: Female urological conditions are infrequent but not negligible, dominated by vesico-vaginal fistulas and tumors in the context of developing countries. The specific evaluation of each pathology group can help optimize management.

The impact of the cor on avirus disease 2019 Checkfol pandemic on elective urological procedures in Australia

Objective:To investigate the changes in elective private urological procedures in Australia during the coronavirus disease 2019 pandemic.Methods:Data were extracted from publicly available datasets from Medicare Ben efits Schedule using item nu mbers assig ned to each comm only performed urological interve ntion.These procedures were divided into three groups:Oncological therapeutic,diagnostic,and non-oncological therapeutic procedures.A smoothing model,based on the historic procedure numbers from 2017 to 2019,was used to forecast monthly number of procedures performed in each category between January 2020 and June 2020.These forecasted models were compared with reported figures.Results:A total of 108169 procedures were performed between January 2020 and June 2020 based on the Medicare Ben efits Schedule item nu mbers listed.There was a sign ifica nt reducti on(perce nt-age cha nge)in total procedures performed in April 2020(22.6%,95%con fide nee in terval[CI]:-28.7%to-15.4%)and May 2020(-33.2%,95%CI:-37.5%to 28.3%).There was a significant reduction in oncological therapeutic,non-oncological therapeutic,and diagnostic procedures performed in April 2020 and May 2020(p<0.05).These nu mbers did not in elude procedures performed in public sector.Conclusion:There was a significant reduction in total urological procedures(including diagnostic,oncological,and non-on cological)performed in mon ths of April 2020 and May 2020 during time of federal restrictions.Both public and private healthcare sectors need to be supported in the up-comi ng mon ths to preve nt further delays in treatme nt and poorer clinical outcomes.

Daily activities and training experiences of urology residents during the coronavirus disease 2019 pandemic in Indonesia: A nationwide survey

Objective:To explore the impact of the coronavirus disease 2019(COVID-19)pandemic on the training experiences of urology residents in Indonesia.Methods:A cross-sectional study using a web-based questionnaire(SurveyMonkey)involved all registered urology residents in Indonesia.The questionnaire was structured in Bahasa Indonesia,composed of 28 questions,and divided into three sections:demographic characteristics,current daily activities,and opinions regarding training experiences during the COVID-19 outbreak.The survey was distributed to all respondents via chief of residents in each urology center from May 26,2020 to Jun 2,2020.Results:Of the total 247 registered urology residents,243 were eligible for the study.The response and completeness rate for this study were 243/243(100%).The median age of respondents was 30(range:24e38)years old,and 92.2%of them were male.Among them,6(2.5%)respondents were confirmed as COVID-19 positive.A decrease in residents’involvement in clinical and surgical activities was distinguishable in endourological and open procedures.Most educational activities were switched to web-based video conferences,while others opted for the in-person method.Smart learning methods,such as joining a national or international speaker webinar or watching a recorded video,were used by 93.8%and 80.7%of the respondents,respectively.The respondents thought that educational activities using web-based video conferences and smart learning methods were effective methods of learning.Overall,the respondents felt unsure whether training experiences during the COVID-19 pandemic were comparable to the respective period before.Conclusion:The COVID-19 pandemic negatively affected urology residents’training experiences.However,it also opened up new possibilities for incorporating new learning methodologies in the future.

Urological manifestations and treatment of the primary systemic vasculitides

The primary systemic vasculitides(PSV) are a group of rare inflammatory disorders affecting blood vessels of varying size and multiple organs. Urological manifestations of PSV are uncommon. Testicular vasculitis is the most commonly reported finding and is associated with Polyarteritis Nodosa(PAN), Henoch-Sch?nleinPurpura(HSP), anti-neutrophil cytoplasm antibody associated Vasculitides(AAV), Giant Cell Arteritis(GCA) and Kawasaki disease. Prostatic vasculitis has been reported in association with GCA and AAV. Ureteric involvement has been noted in PAN, HSP and AAV. Other urogenital manifestations of PSV include genital ulceration and bladder dysfunction in Beh?ets Disease and haematuria which is commonly seen in many of the PSV. Finally, therapies used to treat the PSV, especially cyclophosphamide, are associated with urological sideeffects including haemorrhagic cystitis and urothelial malignancy. The aim of this review is to examine how the urological system is involved in the PSV. Each PSV is examined in turn, with a brief clinical description of the disease followed by a description of the urological manifestations and management. Identification of urological manifestations of PSV is important as in many cases symptoms may improve with immunosuppressive therapy, avoiding the need for invasive surgery. Additionally, patients who present with isolated urogenital PSV are at higher risk of developing subsequent systemic vasculitis and will need to be followed up closely.

Use of intralesional collagenase in the treatment of peyronie's disease: A review

AIM:To review the relevant literature in an effort to examine the body of evidence available to date.METHODS:Ovid MEDLINE search database was queried using MeS H terms"penile induration","peyronie’s disease","Collagenases"and"Collagenase"using various permutations.No temporal parameters were employed.RESULTS:In all,5 relevant clinical trials were isolated from 34 results.These trials were analyzed using the Oxford Centre for Evidence-Based Medicine criteria.They were further examined based on study design and methods;the primary and secondary outcomes were reviewed for treatment efficacy and collagenase-related side effects.CONCLUSION:Intralesional collagenase appears to be safe and effective in the non-surgical treatment of Peyronie’s disease.However,the data remains limited and further inquiries into the safety of collagenase,treatment standardization and standardized outcomesreporting remain necessary.Furthermore,studies comparing intralesional collagenase to alternative medical and surgical therapy will be important in guiding the future treatment decision process.

Reconstructive surgery in Peyronie's disease: What's new?

Surgical treatment of Peyronie's disease(PD) is still a challenge and a gold standard approach does not exist; however the main goal is to straight penile shaft, and to restore penetrative and coital capacity. The less invasive approach aims to correct curvature without intervening directly on the fibrous plaque while the more complex "corporoplasty" applies specific geometric criteria and uses different autologous and heterologous grafts. Each approach has its pros and cons and decisionmaking should be tailored to the individual patient's expectations. Other surgical options include different use of patches to cover the tunica albuginea defect, with the choice depending on the surgeon's personal experience. Despite the wide range of autologous(buccal mucosa, vein, dermis, etc.) and heterologous grafts(bovine pericardium, swine intestinal submucosa, porcine dermis, etc.) none currently represents the real "gold standard" because the data are extremely variable and frequently not representative. Several factors seem to favor buccal mucosa grafts over inert biocompatible materials: as vital tissue, buccal mucosa tends to heal rapidly, immediately integrating with the surrounding albuginea tissue. This translates into a more rapid resumption of spontaneous erections(after 3/4 d) and sexual activity and into a reduced risk of curvature relapse and erectile dysfunction after surgery. Another advantage of the buccal mucosa graft is its low cost. In conclusion, despite the recent development of some exciting new surgical techniques we are still unable to deliver a definitive take-home message about reconstructive surgery in PD because the majority of the studies reported insufficient data. However, since it is clear that major outcomes, besides the cosmetic result, are the patient's and partner's satisfaction and the economic impact of each technique, we recommend they be included among the outcome assessment parameters in further

网络CBL-PBL教学在泌尿外科教学中的应用

探索基于网络平台的CBL-PBL教学模式在“泌尿外科疾病”教学中的应用效果,选取同一学期内的苏州大学苏州医学院临床医学专业学生62名,随机分为两组,分别接受基于网络平台的CBL-PBL教学模式(38名学生)和传统教学模式(24名学生),比较分析两种教学模式在“泌尿外科疾病”教学中的教学效果差异。在对教师满意度评分、病情分析、治疗节点鉴别、个体化方案选择能力等方面接受CBL-PBL模式教学的学生均显著优于接受传统教学模式的学生(p<0.05)。此外,教师对接受CBLPBL模式教学的学生的满意度也优于接受传统教学模式的学生(p<0.05)。基于网络平台的CBL-PBL教学模式在“泌尿外科疾病”教学中的教学效果优于传统教学模式,适宜推广和应用。

尿游离DNA的液体活检有望成为泌尿系疾病诊治的重要方向

尿液由泌尿系统直接产生,其中的游离DNA(cfDNA)携带了来源于泌尿系的基因组DNA,并且尿液样本具有非侵入性、数量不受限及获取方便等优点,因此尿cfDNA是诊治泌尿系疾病的一种很有潜力的生物标志物,对尿cfDNA进行液体活检在泌尿系疾病的诊治中具有重要的临床应用价值。本文就尿cfDNA在泌尿系疾病临床诊治中的应用研究作一综述。

中青年泌尿外科癌症病人生育忧虑现状及影响因素分析

目的:了解中青年泌尿外科癌症病人生育忧虑现状及影响因素,为提升病人生活质量提供理论依据。方法:采用便利抽样的方法,选取2022年6月-2023年6月住院治疗的118例中青年泌尿外科癌症病人作为研究对象,应用病人一般资料调查表、中文版生育忧虑问卷、疾病感知问卷简化版、癌症病人生活质量量表对其进行横断面调查。结果:中青年泌尿外科癌症病人生育忧虑问卷条目均分为(1.82±0.53)分,与疾病感知问卷简化版总分呈显著正相关关系,与癌症病人生活质量量表总分呈显著负相关关系,多元线性回归分析结果显示,性别、疾病分期、疾病感知以及生活质量水平为影响中青年泌尿外科癌症病人生育忧虑的主要因素(P<0.05)。结论:中青年泌尿外科癌症病人生育忧虑处于中等水平,医护人员要重点关注女性、疾病分期较高、疾病感知水平较高以及生活质量水平较低的病人,采取针对性的干预措施减轻病人的心理痛苦,降低其生育忧虑水平。

后腹腔镜手术在泌尿外科中的应用(附39例报告)

目的 :探讨后腹腔镜在泌尿外科手术中的应用。方法 :对 39例泌尿外科患者施行后腹腔镜手术。其中肾囊肿去顶术 2 9例、肾上腺肿瘤切除术 7例、肾切除术 2例、肾盂造瘘术 1例。均经后腹腔途径。结果 :39例成功。手术时间 1.0～ 4.0h ,平均 2 .0h。术中及术后均未输血 ,无明显并发症。住院时间 5～ 10d ,平均 7.8d。结论 :后腹腔镜手术具有微创、术后恢复快、住院时间短等优势 。

腹腔镜技术在泌尿外科中的应用总结(附509例报告)

泌尿外科腹腔镜技术近10余年来取得了飞速发展,但临床上关于手术的许多具体问题仍有分歧,值得探讨。1998年10月至2006年8月,我科采用腹腔镜技术治疗泌尿系疾病共509例,取得较好效果,得到一些经验,供同行参考。(1)手术入路:与腹腔入路相比,后腹腔入路能迅速进入术野,且可更多地借鉴开放手术经验,因此除少数高难度及需要同时处理双侧病变的患者外,建议一般采用后腹腔入路。(2)肾脏切除手术:肾癌手术应于脂肪囊外游离,完整将肾切除,包括肾门周围淋巴组织;>10 cm的肿瘤或伴有癌栓者考虑开放手术;除上极肿瘤外,不考虑切除肾上腺;行肾盂肿瘤根治术时应防止肿瘤细胞沿输尿管种植。肾切除术中须仔细分离肾脏血管,建议首先以hemo-lock夹闭肾脏动脉。(3)肾上腺手术:腹腔镜肾上腺切除术是肾上腺手术的“金标准”,必须根据肾上腺疾病的性质、部位、累及范围和血供特点选择手术方式、手术范围以及相应的术前准备。(4)其他:对前列腺癌根治术等较高难度手术建议根据医生腹腔镜操作的熟练程度和患者身体状况决定是否采用腹腔镜手术;对于精索静脉曲张手术,由于开放手术能较好解决问题,不主张腹腔镜手术。

后腹腔镜技术在泌尿外科的应用(附237例报告)

目的:探讨后腹腔镜手术治疗泌尿系疾病的疗效及方法。方法:采用后腹腔镜手术治疗泌尿系疾病237例,其中肾囊肿去顶术132例,多囊肾去顶术6例,肾上腺手术46例(原醛25例,皮质醇腺瘤6例,皮质增生5例,无功能皮质腺瘤3例,肾上腺囊肿3例,嗜铬细胞瘤3例,肾上腺髓质增生1例),输尿管切开取石术31例,单纯肾切除5例,肾癌根治性肾切除3例,肾盂癌肾输尿管全切3例,肾盂成型术10例,腔静脉后输尿管矫形术1例。结果:手术全部成功,无改开放手术者,手术时间15～240min(平均115min),术中出血20～100mL(平均55mL),患者均于术后12h～3d下床活动,术后住院时间3～18d(平均6.5d),术中术后未发生严重并发症。结论:后腹腔镜手术具有创伤小、疼痛轻、恢复快、并发症少等优点,临床疗效可靠,实用性较强,具有良好的应用前景。

腔内泌尿外科的新进展

Endourology has developed very quickly during the past decades. For transurethral therapy of diseases of lower urinary tract, it has been gradually accepted by both urologists and patients for plasmatic electrocautery resection, holmium laser and electrochemical enucleation of benign prostatic hyperplasia. Flexible ureteroscope has been widely used for examination of upper urinary tract for unknown urinary bleeding and micronephrostomy has achieved great success for percutaneous nephrolithotripsy. Laparoscope has become very popular and can be used to perform most of the operations in the field of urology.

后腹腔镜手术在泌尿外科的应用

目的：用微创性内窥镜手术代替传统的开放性泌尿外科手术。方法：１９９７年４月～１１月，应用后腹腔镜手术治疗泌尿外科系统疾病１３例，其中单纯性肾囊肿去顶术３例，肾盂旁囊肿去盖术１例，肾上腺肿瘤８例，腹膜后淋巴囊肿１例。结果：手术全部成功，无严重并发症发生。结论：该方法与传统开放性手术相比，具有损伤小，住院时间短，病人康复快等优点。

腹腔镜在泌尿外科的临床应用(附43例报道)

目的 :总结腹腔镜在泌尿外科的治疗进展。方法 :自 1993年 6月～ 2 0 0 0年 4月共治疗泌尿外科疾病 43例。其中腹腔镜肾切除术 1例 ,肾上腺腺瘤切除术 5例 ,肾上腺囊肿去顶术 3例 ,肾囊肿去顶术 2 7例 ,盆腔淋巴结活检术 5例 ,输尿管切开取石术 2例。结果 :43例腹腔镜手术均一次成功 ,无中转、无并发症发生 ,术后也未用止痛剂。平均手术时间 (94.3± 72 .1)min ,平均术中出血 (12 6 .7± 94.6 )ml,平均住院天数 (5 .1± 3.2 )d。结论 :虽然腹腔镜泌尿外科的手术指征有待进一步总结 ,但可以肯定它是一种值得推广的方法。

3种后腹腔镜建腔方式在泌尿外科手术中的应用

目的比较泌尿外科后腹腔镜建立后腹腔的3种方式的耗时、安全性、术中术后并发症以及对手术操作的影响。方法 2010年12月~2012年12月,对施行后腹腔镜术的810例患者,按建腔方式的不同,随机分为A、B、C3组。A组采用自制气囊法建立后腹腔;B组采用手指分离法建立后腹腔;C组采用北京大学泌尿外科研究所的IUPU法（Istitute of Urology,Peking University）,建立后腹腔。分别记录建腔时间、统计术中术后并发症、评价对手术操作的影响及跟踪随访Trocar切口愈合情况等。结果除A组因1例气囊破裂改为开放手术外,其余均可顺利建立后腹膜腔。建立起的后腹腔均足够大,对手术操作无明显影响。A、B、C3组建立后腹腔的时间分别为：A组（7.3±3.2）min,B组（4.8±2.8）min,C组（3.7±1.8）min,三组间比较时间差异有显著性（P〈0.05）。3组患者的曲卡切口均愈合良好。但气囊组14例患者术后患侧腰肋部外凸,无明显不适。3组术后均无明显并发症。结论 IUPU法最为简便、省时且切口也最小;气囊法最耗时,气囊有破裂的风险,且术后可能出现患侧腰肋部外凸;而手指法在上述优劣性上介于两者之间。在泌尿外科后腹膜腔建腔中,可采用简便省时的IUPU法,而传统的气囊法并无优势。

后腹腔镜手术在泌尿外科的应用

目的 探讨后腹腔镜手术治疗泌尿系疾病的方法及疗效。方法 采用后腹腔镜手术治疗泌尿系疾病3 5例 ,其中肾上腺肿瘤及肾上腺囊肿切除 13例 ,肾囊肿去顶术 15例 ,精索静脉曲张高位结扎术 4例 ,UPJ成形术 1例 ,乳糜尿行肾蒂淋巴管结扎术 1例 ,肾切除 1例。结果 3 5例手术全部成功。手术时间 3 0～ 13 0分钟 ,术中平均出血 2 0ml。术后住院时间 1.5～ 14天 ,平均 4.5天。结论 腹腔镜手术治疗泌尿系疾病 ,具有损伤小 ,住院时间短 ,恢复快 ,并发症少等优点 。

64层螺旋CT尿路成像技术在泌尿系统疾病中的临床应用

目的探讨64层螺旋CT尿路成像技术对泌尿系统疾病的诊断价值。方法收集50例手术或临床确诊的泌尿系统疾病患者,均进行64层螺旋CT尿路成像检查,对影像资料进行回顾性分析。结果 50例中,泌尿系统结石29例,泌尿系先天性畸形8例,输尿管炎性狭窄5例,肾盂癌3例、输尿管癌3例,膀胱癌2例。CT尿路成像技术能够清晰显示输尿管走行、腔内情况、梗阻部位和原因。结论 64层螺旋CT尿路成像技术能够准确的诊断泌尿系统疾病,图像清晰直观,可以作为早期确诊泌尿系统疾病的有效影像检查方法。