良性前列腺增生(benign prostatic hyperplasia,BPH)是一种以前列腺肥大为特征的医学疾病,尤其常见于50岁以上的中老年男性,是导致其发生排尿困难最常见的疾病,严重程度的排尿困难者,手术解除梗阻是治疗中老年前列腺增生最有效的方法^([...良性前列腺增生(benign prostatic hyperplasia,BPH)是一种以前列腺肥大为特征的医学疾病,尤其常见于50岁以上的中老年男性,是导致其发生排尿困难最常见的疾病,严重程度的排尿困难者,手术解除梗阻是治疗中老年前列腺增生最有效的方法^([1])。如今,经尿道前列腺电切术(transurethral resection of the prostate,TURP)是标准的治疗方法^([2]),但该术式术后性功能障碍发生率为78%,并发症发生率为2.3%~22%^([3])。展开更多
目的:分析倒Y形保留功能尿道钬激光前列腺剜除术对术后尿失禁的影响。方法:收集了2022年6月至2023年5月在武汉大学人民医院泌尿外科住院的109例良性前列腺增生患者的相关临床资料,进行回顾性分析。采用计算机生成的随机数字表来进行随...目的:分析倒Y形保留功能尿道钬激光前列腺剜除术对术后尿失禁的影响。方法:收集了2022年6月至2023年5月在武汉大学人民医院泌尿外科住院的109例良性前列腺增生患者的相关临床资料,进行回顾性分析。采用计算机生成的随机数字表来进行随机分组,将患者随机分为两组,A组52例进行传统保留前列腺尖部尿道瓣膜的钬激光前列腺剜除技术,B组57例进行倒Y形保留功能尿道钬激光前列腺剜除术。记录术中及术后相关指标。根据国际尿失禁状态推荐的标准,对患者尿失禁状态和排尿后症状进行评价。结果:B组拔管后压力性尿失禁率为10.52%,显著低于A组的26.92%(P=0.027);B组术后2周有1.75%的尿失禁率,而A组术后2周的尿失禁率为11.54%,A组尿失禁率明显高于B组(P=0.037);B组术后1个月尿失禁率同样明显低于A组(0 vs 7.69%,P=0.033)。结论:使用倒Y形保留功能尿道钬激光前列腺剜除术治疗良性前列腺增生相较于传统保留前列腺尖部尿道瓣膜的钬激光前列腺剜除术,能够使患者术后压力性尿失禁情况有较为明显的改善。展开更多
目的:探讨代谢综合征(MS)对泌尿系结石术后留置双J管患者附管结石发生风险的影响。方法:选取2022年10月至2023年10月本院行泌尿系结石术后留置双J管的79例患者作为研究对象,根据代谢指标检查结果将患者分为MS组(58例)与非MS组(21例),收...目的:探讨代谢综合征(MS)对泌尿系结石术后留置双J管患者附管结石发生风险的影响。方法:选取2022年10月至2023年10月本院行泌尿系结石术后留置双J管的79例患者作为研究对象,根据代谢指标检查结果将患者分为MS组(58例)与非MS组(21例),收集患者一般资料、实验室指标,返院拔除双J管时确认患者术后附管结石发生情况,采用单因素、多因素Logistic回归分析附管结石发生危险因素。结果:MS组高血压、糖尿病、高脂血症、吸烟史的患者占比体重指数及拔管时的SBP、FBG、UA、TC、TG、LDL-C、hs-CRP水平均高于非MS组,HDL-C低于非MS组(P P P P P Objective: To investigate the effect of metabolic syndrome (MS) on the risk of tubular stones in patients with postoperative urinary calculi after indentation of double J tubes. Methods: From October 2022 to October 2023, 79 patients who underwent urinary calculi surgery with double J tubes were selected as the study objects. According to the results of metabolic indexes, the patients were divided into MS group (58 cases) and non-MS group (21 cases). General data and laboratory indexes of the patients were collected. After the double-J tube was removed, the occurrence of tubular stones was confirmed, and the risk factors of tubular stones were analyzed by univariate and multivariate Logistic regression. Results: The proportion of patients with hypertension, diabetes, hyperlipidemia and smoking history in MS group and the levels of SBP, FBG, UA, TC, TG, LDL-C and hs-CRP at extubation were higher than those in non-MS group, and HDL-C was lower than those in non-MS group (P P P P P < 0.05). Conclusion: MS is closely related to the formation of tubular stones after double-J tube surgery, and can be used as an independent predictor of the occurrence of postoperative stones. In addition, long catheter indwelling time, presence of urinary protein and high level of FBG, UA and hs-CRP during extubation are risk factors for tubular stones. Early life style intervention in high-risk people with MS can help reduce the risk of morbidity.展开更多
BACKGROUND Post-transplant tertiary hyperparathyroidism(PT-tHPT)is a well-recognized complication following kidney transplantation,characterized by persistent excessive secretion of parathyroid hormone(PTH)despite imp...BACKGROUND Post-transplant tertiary hyperparathyroidism(PT-tHPT)is a well-recognized complication following kidney transplantation,characterized by persistent excessive secretion of parathyroid hormone(PTH)despite improved renal function.It is potentially associated with an increased risk of cardiovascular events,renal osteodystrophy,pathologic fractures,graft loss,and mortality.AIM To evaluate the incidence,risk factors,and outcomes of PT-tHPT amongst kidney transplant recipients.METHODS A total of 887 transplant recipients who underwent transplantation between 2000 and 2020 were evaluated.Univariable and multivariable logistic regression was performed to determine the predictors of tertiary hyperparathyroidism.Graft and recipient outcomes were assessed using multivariable Cox regression.A separate multivariable Cox regression was performed to determine the effect of treatment strategies on outcomes.RESULTS PT-tHPT,defined as elevated PTH(>65 ng/L)and persistent hypercalcemia(>2.60 mmol/L),was diagnosed in 14%of recipients.Risk factors for PT-tHPT included older age[odds ratio(OR)=1.36,P<0.001],Asian ethnicity(OR=0.33,P=0.006),total ischemia time(OR=1.03,P=0.048 per hour),pre-transplant serum calcium(OR=1.38,P<0.001)per decile increase,pre-transplant PTH level(OR=1.31,P<0.001)per decile increase,longer dialysis duration(OR=1.12,P=0.002)per year,history of acute rejection(OR=2.37,P=0.012),and slope of estimated glomerular filtration rate change(OR=0.91,P=0.001).There were a 3.4-fold higher risk of death-censored graft loss and a 1.9-fold greater risk of recipient death with PT-tHPT.The three treatment strategies of conservative management,calcimimetic and parathyroidectomy did not significantly change the graft or patient outcome.CONCLUSION Pretransplant elevated calcium and PTH levels,older age and dialysis duration are associated with PT-tHPT.While PT-tHPT significantly affects graft and recipient survival,the treatment strategies did not affect survival.展开更多
文摘良性前列腺增生(benign prostatic hyperplasia,BPH)是一种以前列腺肥大为特征的医学疾病,尤其常见于50岁以上的中老年男性,是导致其发生排尿困难最常见的疾病,严重程度的排尿困难者,手术解除梗阻是治疗中老年前列腺增生最有效的方法^([1])。如今,经尿道前列腺电切术(transurethral resection of the prostate,TURP)是标准的治疗方法^([2]),但该术式术后性功能障碍发生率为78%,并发症发生率为2.3%~22%^([3])。
文摘目的:分析倒Y形保留功能尿道钬激光前列腺剜除术对术后尿失禁的影响。方法:收集了2022年6月至2023年5月在武汉大学人民医院泌尿外科住院的109例良性前列腺增生患者的相关临床资料,进行回顾性分析。采用计算机生成的随机数字表来进行随机分组,将患者随机分为两组,A组52例进行传统保留前列腺尖部尿道瓣膜的钬激光前列腺剜除技术,B组57例进行倒Y形保留功能尿道钬激光前列腺剜除术。记录术中及术后相关指标。根据国际尿失禁状态推荐的标准,对患者尿失禁状态和排尿后症状进行评价。结果:B组拔管后压力性尿失禁率为10.52%,显著低于A组的26.92%(P=0.027);B组术后2周有1.75%的尿失禁率,而A组术后2周的尿失禁率为11.54%,A组尿失禁率明显高于B组(P=0.037);B组术后1个月尿失禁率同样明显低于A组(0 vs 7.69%,P=0.033)。结论:使用倒Y形保留功能尿道钬激光前列腺剜除术治疗良性前列腺增生相较于传统保留前列腺尖部尿道瓣膜的钬激光前列腺剜除术,能够使患者术后压力性尿失禁情况有较为明显的改善。
文摘目的:探讨代谢综合征(MS)对泌尿系结石术后留置双J管患者附管结石发生风险的影响。方法:选取2022年10月至2023年10月本院行泌尿系结石术后留置双J管的79例患者作为研究对象,根据代谢指标检查结果将患者分为MS组(58例)与非MS组(21例),收集患者一般资料、实验室指标,返院拔除双J管时确认患者术后附管结石发生情况,采用单因素、多因素Logistic回归分析附管结石发生危险因素。结果:MS组高血压、糖尿病、高脂血症、吸烟史的患者占比体重指数及拔管时的SBP、FBG、UA、TC、TG、LDL-C、hs-CRP水平均高于非MS组,HDL-C低于非MS组(P P P P P Objective: To investigate the effect of metabolic syndrome (MS) on the risk of tubular stones in patients with postoperative urinary calculi after indentation of double J tubes. Methods: From October 2022 to October 2023, 79 patients who underwent urinary calculi surgery with double J tubes were selected as the study objects. According to the results of metabolic indexes, the patients were divided into MS group (58 cases) and non-MS group (21 cases). General data and laboratory indexes of the patients were collected. After the double-J tube was removed, the occurrence of tubular stones was confirmed, and the risk factors of tubular stones were analyzed by univariate and multivariate Logistic regression. Results: The proportion of patients with hypertension, diabetes, hyperlipidemia and smoking history in MS group and the levels of SBP, FBG, UA, TC, TG, LDL-C and hs-CRP at extubation were higher than those in non-MS group, and HDL-C was lower than those in non-MS group (P P P P P < 0.05). Conclusion: MS is closely related to the formation of tubular stones after double-J tube surgery, and can be used as an independent predictor of the occurrence of postoperative stones. In addition, long catheter indwelling time, presence of urinary protein and high level of FBG, UA and hs-CRP during extubation are risk factors for tubular stones. Early life style intervention in high-risk people with MS can help reduce the risk of morbidity.
文摘BACKGROUND Post-transplant tertiary hyperparathyroidism(PT-tHPT)is a well-recognized complication following kidney transplantation,characterized by persistent excessive secretion of parathyroid hormone(PTH)despite improved renal function.It is potentially associated with an increased risk of cardiovascular events,renal osteodystrophy,pathologic fractures,graft loss,and mortality.AIM To evaluate the incidence,risk factors,and outcomes of PT-tHPT amongst kidney transplant recipients.METHODS A total of 887 transplant recipients who underwent transplantation between 2000 and 2020 were evaluated.Univariable and multivariable logistic regression was performed to determine the predictors of tertiary hyperparathyroidism.Graft and recipient outcomes were assessed using multivariable Cox regression.A separate multivariable Cox regression was performed to determine the effect of treatment strategies on outcomes.RESULTS PT-tHPT,defined as elevated PTH(>65 ng/L)and persistent hypercalcemia(>2.60 mmol/L),was diagnosed in 14%of recipients.Risk factors for PT-tHPT included older age[odds ratio(OR)=1.36,P<0.001],Asian ethnicity(OR=0.33,P=0.006),total ischemia time(OR=1.03,P=0.048 per hour),pre-transplant serum calcium(OR=1.38,P<0.001)per decile increase,pre-transplant PTH level(OR=1.31,P<0.001)per decile increase,longer dialysis duration(OR=1.12,P=0.002)per year,history of acute rejection(OR=2.37,P=0.012),and slope of estimated glomerular filtration rate change(OR=0.91,P=0.001).There were a 3.4-fold higher risk of death-censored graft loss and a 1.9-fold greater risk of recipient death with PT-tHPT.The three treatment strategies of conservative management,calcimimetic and parathyroidectomy did not significantly change the graft or patient outcome.CONCLUSION Pretransplant elevated calcium and PTH levels,older age and dialysis duration are associated with PT-tHPT.While PT-tHPT significantly affects graft and recipient survival,the treatment strategies did not affect survival.
