ObjectiveTo review the current literature on ketamine-associated upper urinary tract (UUT) dysfunction and provide an overview of its pathogenesis and treatment principles.MethodsA literature search was conducted usin...ObjectiveTo review the current literature on ketamine-associated upper urinary tract (UUT) dysfunction and provide an overview of its pathogenesis and treatment principles.MethodsA literature search was conducted using PubMed and Cochrane databases for relevant articles published in English between 2008 and 2023. Keywords used included “ketamine” and “upper urinary tract”.ResultsA total of 22 papers were included. Relatively few studies have focused on ketamine-associated UUT dysfunction. Exclusion criteria included lack of hydronephrosis, or pathological findings. After careful screening and exclusion, we finally adopted 11 of these papers and analyzed them. Ketamine-associated UUT dysfunction may be a concern in this field.ConclusionKetamine abuse can lead to UUT impairment and dysfunction, with symptoms such as bladder dysfunction and contracted bladder with vesicoureteral reflux, direct damage and barrier dysfunction, inflammation, apoptosis, fibrosis and stricture, and papillary necrosis. Oxidative stress, autophagy, and microvascular injury are also potential pathogenic mechanisms. The detection of these symptoms largely depends on laboratory and imaging examinations. The treatment principles of ketamine-associated UUT dysfunction are protecting the UUT, improving bladder dysfunction, and resuming normal social life. More investigations are needed to clarify the mechanisms and shed light on the treatment of ketamine-associated UUT damage.展开更多
BACKGROUND Urinary sepsis is frequently seen in patients with diabetes mellitus(DM)complicated with upper urinary tract calculi(UUTCs).Currently,the known risk factors of urinary sepsis are not uniform.AIM To analyze ...BACKGROUND Urinary sepsis is frequently seen in patients with diabetes mellitus(DM)complicated with upper urinary tract calculi(UUTCs).Currently,the known risk factors of urinary sepsis are not uniform.AIM To analyze the risk factors of concurrent urinary sepsis in patients with DM complicated with UUTCs by logistic regression.METHODS We retrospectively analyzed 384 patients with DM complicated with UUTCs treated in People’s Hospital of Jincheng between February 2018 and May 2022.The patients were screened according to the inclusion and exclusion criteria,and 204 patients were enrolled.The patients were assigned to an occurrence group(n=78)and a nonoccurrence group(n=126).Logistic regression was adopted to analyze the risk factors for urinary sepsis,and a risk prediction model was established.RESULTS Gender,age,history of lumbago and abdominal pain,operation time,urine leukocytes(U-LEU)and urine glucose(U-GLU)were independent risk factors for patients with concurrent urinary sepsis(P<0.05).Risk score=0.794×gender+0.941×age+0.901×history of lumbago and abdominal pain-1.071×operation time+1.972×U-LEU+1.541×U-GLU.The occurrence group had notably higher risk scores than the nonoccurrence group(P<0.0001).The area under the curve of risk score for forecasting concurrent urinary sepsis in patients was 0.801,with specificity of 73.07%,sensitivity of 79.36%and Youden index of 52.44%.CONCLUSION Sex,age,history of lumbar and abdominal pain,operation time,ULEU and UGLU are independent risk factors for urogenic sepsis in diabetic patients with UUTC.展开更多
BACKGROUND The current standard surgical treatment for non-metastatic upper urinary tract urothelial carcinoma(UTUC)is radical nephroureterectomy(RNU)with bladder cuff excision(BCE).Typically,BCE techniques are classi...BACKGROUND The current standard surgical treatment for non-metastatic upper urinary tract urothelial carcinoma(UTUC)is radical nephroureterectomy(RNU)with bladder cuff excision(BCE).Typically,BCE techniques are classified in one of the following three categories:An open technique described as intrasvesical incision of the bladder cuff,a transurethral incision of the bladder cuff(TUBC),and an extravesical incision of the bladder cuff(EVBC)method.Even though each of these management techniques are widely used,there is no consensus about which surgical intervention is superior,with the best oncologic outcomes.AIM To investigate the oncological outcomes of three BCE methods during RNU for primary UTUC patients.METHODS We retrospectively analyzed the data of 248 primary UTUC patients,who underwent RNU with BCE between January 2004 to December 2018.Patients were analyzed according to each BCE method.Data extracted included patient demographics,perioperative parameters,and oncological outcomes.Statistical analyses were performed using chi-square and log-rank tests.The Cox proportional hazards regression model was utilized to identify independent predictors.P<0.05 was considered statistically significant.RESULTS Of the 248 participants,39.9%(n=99)underwent intrasvesical incision of the bladder cuff,38.7%(n=96)EVBC,and 21.4%(n=53)TUBC.At a median followup of 44.2 mo,bladder recurrence developed in 17.2%,12.5%,and 13.2%of the cases,respectively.Cancer-specific deaths occurred in 11.1%,5.2%,and 7.5%of patients,respectively.Kaplan-Meier survival curves with a log-rank test highlighted no significant differences in intravesical recurrence-free survival,cancer-specific survival,and overall survival among these approaches with P values of 0.987,0.825,and 0.497,respectively.Multivariate analysis showed that the lower ureter location appears to have inferior intravesical recurrence-free survival(P=0.042).However,cancer-specific survival and overall survival were independently influenced by tumor stage(hazard ratio[HR]=8.439;95%condence interval:2.424-29.377;P=0.001)and lymph node status(HR=14.343;95%CI:5.176-39.745;P<0.001).CONCLUSION All three techniques had comparable outcomes;although,EVBC and TUBC are minimally invasive.While based upon rather limited data,these findings will support urologists in blending experience with evidence to inform patient choices.However,larger,rigorously designed,multicenter studies with long term outcomes are still required.展开更多
Objective:We evaluated who would need further evaluations such as retrograde pyelography(RP)and/or ureteroscopy to diagnose upper urinary tract urothelial cancers(UUTUCs)when abnormal findings for the upper urinary tr...Objective:We evaluated who would need further evaluations such as retrograde pyelography(RP)and/or ureteroscopy to diagnose upper urinary tract urothelial cancers(UUTUCs)when abnormal findings for the upper urinary tract(UUT)were detected by enhanced computed tomography(CT).Methods:We retrospectively analyzed 125 patients who underwent enhanced CT for various reasons and had abnormal findings for the UUT.Patients whose tumors were suspected to be of extraureteral origin were excluded.All patients received RP and/or ureteroscopy to evaluate the UUTUCs.Results:The median age of the 125 patients was 70 years and gross hematuria(26.4%)was the most frequently observed symptoms.RP,ureteroscopy and both were performed for 121,59 and 55 patients,respectively.CT revealed tumor-like lesions in 58 patients and the other patients had non-tumor-like lesions.UUTUCs were found in 43(34.4%)of the 125 patients.All of them had tumor-like lesions on CT.In 58 patients who had tumor-like lesions on CT,univariate and multivariate analyses revealed that tumor diameter and tumor enhancement were significant predictive factors for UUTUCs.ROC curve analysis of enhanced CT to diagnose UUTUCs revealed that a tumor diameter of 18 mm was the best cutoff point.The sensitivity,specificity and accuracy were 90.0%,98.8% and 92.7% for RP and 95.5%,100% and 97.1%for ureteroscopy,respectively.Both of them had high sensitivity,specificity and accuracy.Conclusion:We should decide to evaluate the UUT according to the tumor diameter on enhanced CT.When we evaluate the UUT in patients with tumor diameters of less than 20 mm,ureteroscopy is recommended.展开更多
BACKGROUND Lymphoepithelioma-like carcinomas(LELCs)are rare,malignant epithelial tumors,generally considered a subtype of squamous cell carcinoma.LELCs are undifferentiated and can occur in multiple tissues,although L...BACKGROUND Lymphoepithelioma-like carcinomas(LELCs)are rare,malignant epithelial tumors,generally considered a subtype of squamous cell carcinoma.LELCs are undifferentiated and can occur in multiple tissues,although LELCs in the urinary tract are extremely rare.As such,evidence does not provide clinicians with guidelines for the best practices.Even though this is a rare disease,it is associated with high morbidity and mortality.Therefore,we must learn to differentiate LELC types and identify risk factors for early identification.AIM To develop an evidence base to guide clinicians treating primary LELCs of the upper urinary tract(UUT-LELC).METHODS We performed a systematic review of all reports on UUT-LELC from the first published case in 1998 until October 2019,according to the PRISMA.A database was then developed by extracting data from previously published reports in order to analyze interactions between clinical characteristics,pathological features,interventions and outcomes.Survival was analyzed using Kaplan–Meier estimates,which were compared using log rank tests.RESULTS A total of 28 previously published cases were identified for inclusion.The median age was 72 years with a male to female ratio of 4:3.Pure type LELCs were most common with 48.3%(n=14),followed by 37.9%(n=11)predominant LELCs and 3.4%(n=1)focal LELCs.Epstein-Barr virus testing was negative in all cases.Fourteen patients received radical nephroureterectomy(RNU)-based intervention.Twenty-three patients survived with no evidence of further metastasis,although six died before the median 18 mo follow-up point.Survival analysis suggests pure histological subtypes,and patients who receive complete tumor resection have more favorable prognoses.As always in cancer care,early identification generally increases the probability of interventional success.CONCLUSION The most effective treatment for UUT-LELC is RNU-based therapy.Since cases are few in number,case reporting must be enhanced and publishing encouraged to both save and prolong lives.展开更多
Nuclide renal dynamic imaging was performed on 88 transplanted kidney. Two kinds of renal scintigraphic characteristics were identified in recipients with supravesical obstruction of the graft. First, the regular typ...Nuclide renal dynamic imaging was performed on 88 transplanted kidney. Two kinds of renal scintigraphic characteristics were identified in recipients with supravesical obstruction of the graft. First, the regular type was characterized by radioactivity defect area in kidney parenchyma during early uptake period followed by ureteropelvic retention. Second, the tubular type was typified by cortical retention and attenuation in collecting system during the whole test period with a special sign of “hollow kidney”. Non obstructive dilated calyces showed similar signs as the regular type. Acute rejection reaction and tubule necrosis demonstrated obstructive time activity curves. However, the radioactivity retention appeared in cortex. It was suggested that dilated calyces and obstructive renogram might not be reliable evidence for upper urinary tract obstruction. The signs of radioactivity attenuation in kidney parenchyma during early uptake period followed by ureteropelvic retention may be more valuable for the evaluation. As for tubular obstruction, specified “hollow kidney” was the characteristic sign which is helpful for the diagnosis.展开更多
Introduction: The management of urinary lithiasis in our settings has long been conventional surgery. The recent introduction of endoscopy of the upper urinary tract represents a major advance in our department. The a...Introduction: The management of urinary lithiasis in our settings has long been conventional surgery. The recent introduction of endoscopy of the upper urinary tract represents a major advance in our department. The aim was to contribute to the study of the treatment of lithiasis of the upper urinary tract in Conakry and to report on our initial experience of ureteroscopy in Conakry. Methodology: This is a prospective descriptive study lasting one year, from January 1 to December 31, 2022, carried out at the Urology Department of the Ignace Deen National Hospital and at the PERCHIN Urological Clinic. The study included all patients treated surgically for lithiasis of the upper urinary tract who met the selection criteria. Results: The study included 57 patients. The mean age was 30 years, with extremes of 20 and 73 years;the most represented age group was 31 to 40 years, followed by 20 to 30 years with 29.9% and 26.3% respectively. Males predominated in 36 cases (63.15%), with a M/F sex ratio of 1.71. Left-sided renal colic was the most common, at 75.43% (n=43), and right-sided renal colic at 40.35%, associated with digestive signs at 43.85%. 77.19% had normal creatinine levels before surgery, versus 22.81% with elevated creatinine levels, i.e. 15.78% improvement in renal function after surgery. Urinary tract infection was found in 47.36%, and Escherichia coli in 31.57%, followed by staphylococcus aureus in 8.77%. Overall, 82.45% of patients had organic damage to the kidneys or ureters. Right ureterohydronephrosis was noted in 56.14%, followed by left hydronephrosis in 26.32%. Open surgery was predominant in 52.63% of cases, with endoscopic surgery (URS) accounting for a significant 47.36% during the study period. The endoscopic treatment used was laser ureteroscopy. In our study, 73.68% underwent drainage of the upper excretory tract, including 64.91% with a JJ catheter. The average length of stay was 07 days, with extremes of 02 and 28 days, and 81.4% of patients who underwent URS had a length of stay of less than 4 days. Conventional surgery had the highest complication rate (14.28%). The stone free rate for the two surgical treatment methods (open and endoscopic surgery) was 73% and 92.59%.展开更多
Objective: to discuss the treatment method and efficacy evaluation of severe upper urinary tract infection secondary to ureteral stones. Methods: 97 patients with severe upper urinary tract infection secondary to Uret...Objective: to discuss the treatment method and efficacy evaluation of severe upper urinary tract infection secondary to ureteral stones. Methods: 97 patients with severe upper urinary tract infection secondary to Ureterolithiasis were mainly treated from September 2009 to January 2022, and they were treated as the subjects of this study group. The treatment method mainly adopts surgery and anti-infection treatment mode, and the efficacy is taken as the research observation index. Results: in 97 patients with secondary infection, 72 patients accounting for 74.23%, and 25 patients accounting for 25.77%. Then percutaneous renal puncture and positional shock wave lithotripsy were successful. Of 72 patients had successful retrograde drainage, 32, or 44.44%, or 40, 22 ultrasound-guided percutaneous renal puncture, or 30.56%, and 18 CT, ureteroscopy and 25%. None of the patients had serious complications after treatment, and the renal function indexes of 2 microglobin, creatinine and blood urea nitrogen were closer to the normal state than before surgery, which was statistically significant (P <0.05). Conclusion: according to the fact of the patients, selecting the appropriate surgical methods and sensitive antibiotic drug treatment can improve the treatment effect of severe upper urinary tract infection secondary to ureteral stones, namely, on the basis of anti-infectious drug treatment, the first phase of catheterization and drainage, and the second phase of selecting the appropriate minimally invasive lithotripsy treatment for the patients.展开更多
Objective To evaluate the decision process to perform staged or synchronous bilateral percutaneous nephrolithotripsy ( PCNL) in the treatment of bilateral upper urinary tract calculi. Methods Patients with an indicati...Objective To evaluate the decision process to perform staged or synchronous bilateral percutaneous nephrolithotripsy ( PCNL) in the treatment of bilateral upper urinary tract calculi. Methods Patients with an indication for bilateral PCNL were enrolled in the study展开更多
To the Editor:Ureteral stricture can lead to dilation of the proximal upper urinary tract and collecting system.Stretching and loading of the ureter by long-term hydronephrosis trigger a stress relaxation effect,which...To the Editor:Ureteral stricture can lead to dilation of the proximal upper urinary tract and collecting system.Stretching and loading of the ureter by long-term hydronephrosis trigger a stress relaxation effect,which decreases the contractility of the ureter.[1]Morphological changes after surgery may not be obvious even if the obstruction is successfully relieved.Diuretic renography judges split renal function and the nature of obstruction by the uptake and excretion of radionuclides.However,it is influenced by the response of the ipsilateral kidney to diuretics.[2]Currently,there is a lack of homogenized diagnostic and treatment standards,especially evaluation criteria,which makes it difficult to assess the surgical effect and postoperative conditions.展开更多
Background Transitional cell carcinoma of the upper urinary tract （UUT-TCC） accounts for 5% to 10% of all renal tumours and 5% to 6% of all urothelial tumours all over the world. In China, the proportion of UUT-TCC ...Background Transitional cell carcinoma of the upper urinary tract （UUT-TCC） accounts for 5% to 10% of all renal tumours and 5% to 6% of all urothelial tumours all over the world. In China, the proportion of UUT-TCC to all urothelial tumours may be 26%, which is higher than that in the western world. The early diagnosis of UUT-TCC is difficult and the present study elucidates the diagnostic value of poor or nonvisualization （PNV） in intravenous urography in patients with UUT-TCC and its correlations with pathological findings and clinical characteristics. Methods The data of 172 consecutive patients between January 1997 and January 2005 with UUT-TCC who underwent nephroureterectomy in our departments were selected and analyzed retrospectively. Results Of our sample, 144 cases presented with gross haematuria （83.7%） and 12 with microscopic haematuria （7.0%）. Forty-six cases （26.7%） were detectable by cytology. Filling defect identified 36 positive cases of 172 patients （20.9%）, PNV was present in the images of 105 of 172 patients （61.0%）. The detection rate by PNV （61.0%） was significantly different from that by cytology （26.7%） or by filling defect （20.9%） （P=-0.031, P=-0.001, respectively）. Univariate logistic regression analysis for PNV showed that tumour stage, grade and size were significant predictors （P=0.028; P=-0.031; P=-0.006, respectively）. Tumour stage and size were identified as independent risk factors in the multivariate logistic regression model （P=-0.042; P=-0.014）.Conclusions Except for suspected urolithiasis, urinary tuberculosis or congenital abnormalities, UUT-TCC should be considered if PNV exists in intravenous urography especially of old patients. The value of PNV is much more significant than filling defect in intravenous urography in the diagnosis of UUT-TCC. It is supposed that PNV carries more risk of higher stage and larger tumour size in UTT-TCC.展开更多
Background Bladder recurrent disease is still a challenge in the treatment of upper tract urothelial carcinoma （UTUC）. This controlled study aims to investigate the efficacy of early clipping of the distal ureter pr...Background Bladder recurrent disease is still a challenge in the treatment of upper tract urothelial carcinoma （UTUC）. This controlled study aims to investigate the efficacy of early clipping of the distal ureter prior to nephroureterectomy （NU） to prevent bladder recurrence after UTUC.展开更多
Upper urinary tract urothelial carcinomas(UTUCs)are uncommon and account for only 5%e10%of urothelial carcinomas.Pyelocaliceal tumors are about twice as common as ureteral tumors.Sixty percent of UTUCs are invasive at...Upper urinary tract urothelial carcinomas(UTUCs)are uncommon and account for only 5%e10%of urothelial carcinomas.Pyelocaliceal tumors are about twice as common as ureteral tumors.Sixty percent of UTUCs are invasive at diagnosis.Radical nephroureterectomy,including the excision of the distal ureter and bladder cuff is standard of care for treatment of localized UTUCs,because of the high potential for recurrence,multifocality,and progression.Since first laparoscopic nephroureterectomy(LNU)was introduced by Clayman et al.in 1991 and improvement of laparoscopic technique and equipment,LNU has been reported to be equivalent to conventional open method.We reviewed the current literature of patients with UTUCs treated by LNU focusing on technical aspects,peri-operative and oncological outcomes.Laparoscopic radical nephroureterectomy offers the advantages of minimally invasive surgery without deteriorating the oncological outcome for treatment of UTUCs.Indications tend to increase as operator skills increase.Indications for laparoscopic or open nephroureterectomy are in principle the same.The basic requirement for laparoscopic surgery in UTUCs is to achieve benefits of minimal invasive surgery and maintain oncologic principles.展开更多
BACKGROUND Renal papillary necrosis(RPN)is a rare disease.It is difficult to distinguish RPN with urinary tract obstruction from upper urinary tract occupying lesions.We reported a case of RPN and made a definite diag...BACKGROUND Renal papillary necrosis(RPN)is a rare disease.It is difficult to distinguish RPN with urinary tract obstruction from upper urinary tract occupying lesions.We reported a case of RPN and made a definite diagnosis largely based upon its endoscopic characteristics.CASE SUMMARY A 75-year-old woman presented with right flank pain,visible hematuria and a body temperature greater than 39℃.Laboratory investigations revealed leukocytosis with 12.7×10/L white blood cells and 93.6%neutrophils.Blood creatinine was 333 umol/L.Ultrasonography showed hydronephrosis of the right kidney and a right distal ureteric lesion.After urgent placement of right ureteral double J stent and treatment with antibiotics,the patient’s symptoms and the blood abnormalities improved rapidly.Computed tomography urography showed the presence of multiple occupying lesions in the right pelvis.The endoscopic ureteroscopy revealed that renal papillary necrosis and the subsequent migration of sloughed papillae into the upper ureter and calyces.The sloughed papillae appeared like“cottons”,which were whitish,soft,and irregularly-shaped without blood supply.In addition,the necrotic and sloughed renal papillae were removed by flexible ureteroscopy to prevent further obstruction.Pathological examination found that infarcted renal papillae were associated with inflammatory exudation.Three months after discharge,follow-up computed tomography urography showed no obvious lesions in the renal pelvis.CONCLUSION This case revealed the endoscopic features of RPN.In addition,flexible ureteroscopy proves to be vital in diagnosis and treatment of RPN.展开更多
Objective: to investigate the lithotripsy, blood loss and safety of patients with upper urinary calculi by MPCNL and RIRS. Methods: 80 clinical trial participants were counted. From June 2020, they were treated accord...Objective: to investigate the lithotripsy, blood loss and safety of patients with upper urinary calculi by MPCNL and RIRS. Methods: 80 clinical trial participants were counted. From June 2020, they were treated according to the protocol provided by the hospital. By December 2021, they were treated according to their own treatment procedures. The number of each patient was limited to 40. After the completion of the control group and the study group, statistics and sorting were carried out. MPCNL, RIRS and MPCNL were used for comparison in the control group, and the gravel situation, blood loss, safety mental state and quality of life. Results: after comparison, the stone treatment results of the two cases were compared. The success rate of one-time treatment was 92.50%, and the treatment effect of the treatment group was 70.00%;Comparing the bleeding rates of the two groups, the bleeding rate of the control group was significantly lower than that of the control group;The incidence of comorbidities in the two groups was 5.00% and 22.50%, and the incidence of comorbidities in the experimental group was lower. In this study, individual cases were used for psychological and emotional comparison. Among them, the anxiety level was (38.59 ± 3.54) and (42.86 ± 3.73), the emotional fluctuation in the control group was more obvious, the depression status was (35.86 ± 3.26) and (38.64 ± 3.18), and the improvement in the research group was more excellent;In this trial, the survival quality of cases was used as control, and the results showed that the quality of life of control patients was relatively poor. Conclusion: MPCNL and RIRS can significantly improve the clinical effect of patients with urinary system symptoms. It can reduce intraoperative bleeding and complications, make full use of a variety of bad emotions in patients, improve their daily quality of life, and comprehensively protect patients lives and physical health. It has very obvious clinical application value and is worth widely recommended.展开更多
Purpose:To describe the imaging characteristics of the upper urinary tract(UUT)in addition to the bladder on computed tomography(CT)in adult patients with late-onset hemorrhagic cystitis(LOHC)after allogeneic hematopo...Purpose:To describe the imaging characteristics of the upper urinary tract(UUT)in addition to the bladder on computed tomography(CT)in adult patients with late-onset hemorrhagic cystitis(LOHC)after allogeneic hematopoietic stem cell transplantation(HSCT).Subjects and methods:This retrospective study included 24 patients with LOHC who underwent urinary system CT between April 2006 and August 2013.UUT and bladder wall thickness and attenuation were measured before and after contrast material administration.Kidney density,collecting system dilatation,mucosal enhancement,submucosal edema,perivesical stranding around the UUT and bladder,and intravesical clots were evaluated.Diffuse and/or focal renal pelvis and ureter and bladder wall thickening were identified.Correlations between LOHC degree and UUT thickness,UUT attenuation,and uronephrosis were analyzed using Spearman's rank correlation coefficient.Results:Diffuse and/or focal severe UUT and bladder wall thickening was observed in 22 patients(91.7%)with LOHC after HSCT.The median UUT and bladder wall thicknesses(interquartile range)were 2.5 mm(1.0-4.6 mm)and 4.8 mm(3.1-7.3 mm),respectively.Collecting system dilation(17;70.8%),stranding surrounding the UUT and bladder(19;79.2%),and intraluminal clots(two;8.3%)were noted.Three patients underwent ureteral balloon dilation and D-J catheter implantation to resolve irreversible ureteral stenosis and uronephrosis.No significant positive correlation was seen between LOHC classification,UUT wall thickness or attenuation,or uronephrosis(P>0.05).Conclusion:UUT and bladder wall thickening and uronephrosis were observed on CT in patients with LOHC after allogeneic HSCT.Surgical treatment may be needed for irreversible ureteral stenosis.展开更多
Introduction:Upper urinary tract urothelial carcinoma(UTUC)is a rare malignancy,particularly in the ureter,and is associated with high rates of recurrence and metastasis.Although body mass index(BMI)has been associate...Introduction:Upper urinary tract urothelial carcinoma(UTUC)is a rare malignancy,particularly in the ureter,and is associated with high rates of recurrence and metastasis.Although body mass index(BMI)has been associated with prognosis in multiple cancer types,its role as a predictive factor in UTUC is still debated.This study aimed to investigate how BMI influences survival outcomes in patients with UTUC treated with radical nephroureterectomy(RNU).Methods:This multi-center retrospective analysis by the Taiwan UTUC Collaboration Group involved 2503 patients who underwent treatment across 19 hospitals from 1988 to 2022.Patients were categorized into normal(18.5≤BMI<24),overweight(24≤BMI<27),and obese(BMI≥27)groups.Demographic,clinical,and pathological data were analyzed.Overall survival(OS),cancer-specific survival(CSS),disease-free survival(DFS),and intravesical recurrence-free survival(IVRFS)were assessed using Kaplan–Meier analysis and Cox proportional hazards models.Results:The median follow-up period was 44.2 months.In multivariable analysis,overweight patients demonstrated significantly better OS compared with normal-weight patients(p=0.033),and the obesity group showed a favorable,though not statistically significant,trend toward better OS.However,BMI was not an independent predictor of CSS,DFS,or IVRFS.Independent predictors of worse outcomes included older age,end-stage renal disease,ureteral tumor location,tumor size≥3 cm,and high-grade urothelial carcinoma.Tumor stage and grade were comparable across BMI groups.Conclusions:Overweight status was associated with better OS in patients with UTUC treated with RNU,while BMI had no significant impact on CSS,DFS,or IVRFS.These findings suggest a potential protective effect of higher BMI on OS,warranting further investigation in prospective studies.However,BMI alone should not guide clinical decisions and may instead reflect broader patient health characteristics.展开更多
BACKGROUND Urosepsis is a life-threatening condition frequently associated with renal and ureteral calculi(RUC)and diabetes mellitus(DM),a combination that exacerbates susceptibility to infection due to urinary obstru...BACKGROUND Urosepsis is a life-threatening condition frequently associated with renal and ureteral calculi(RUC)and diabetes mellitus(DM),a combination that exacerbates susceptibility to infection due to urinary obstruction and impaired immune response.AIM To identify the risk factors for urosepsis in patients with RUC complicated by DM to enhance early detection and intervention strategies.METHODS This retrospective observational study included 298 patients with RUC and DM admitted between January 2020 and June 2024.Patients were divided into an observation group(n=32)with urosepsis and a control group(n=266)without urosepsis.Comprehensive clinical,laboratory,and imaging data were collected and analyzed using univariate and multivariate logistic regression models to identify factors associated with urosepsis.The study adhered to the STROBE guidelines and received ethical approval.RESULTS Multivariate analysis identified several independent risk factors for urosepsis.Female sex(OR=2.237,95%CI:1.086-4.605,P=0.03),advanced age(OR=1.05,95%CI:1.018-1.084,P=0.002),and fever(OR=2.999,95%CI:1.283-7.015,P=0.015)significantly increased the risk.Laboratory findings such as elevated urine leukocyte(U-LEU)(+++,OR=66.0,95%CI:7.031–580.125,P<0.001)and glucose(U-GLU)(+++,OR=7.248,95%CI:1.862-28.211,P=0.005)levels were strongly associated with urosepsis.Severe hydronephrosis also emerged as a significant predictor(OR=6.129,95%CI:3.027-9.623,P=0.011).Other factors,such as gross hematuria,stone laterality,and mild to moderate hydronephrosis,were not significantly associated with urosepsis.CONCLUSION This study identifies key demographic,clinical,laboratory,and imaging factors associated with urosepsis risk in patients with RUC and DM.Early identification of female patients,elderly individuals,those presenting with fever,severe hydronephrosis,and elevated U-LEU and U-GLU levels may facilitate timely intervention.These findings highlight the importance of comprehensive assessment and targeted management in the care of high-risk patients.展开更多
BACKGROUND Urothelial carcinoma(UC)is a common malignancy of the urinary system that can occur anywhere from the renal pelvis to the proximal urethra.Most UCs are in the bladder and have multifocal growth.Upper urinar...BACKGROUND Urothelial carcinoma(UC)is a common malignancy of the urinary system that can occur anywhere from the renal pelvis to the proximal urethra.Most UCs are in the bladder and have multifocal growth.Upper urinary tract UC(UTUC),which occurs in the renal pelvis or ureter,accounts for only 5%to 10%of UCs.CASE SUMMARY In March 2015,a 70-year-old male who initially presented to a local hospital with a complaint of painless hematuria was diagnosed with UTUC of the right renal pelvis.The doctors administered radical nephroureterectomy and bladder cuff excision.Although the doctors recommended intravesical chemotherapy and regular follow-up,he rejected this advice.In December 2016,the patient presented at our hospital with dysuria.We identified UC in the residual bladder and administered radical cystectomy and left cutaneous ureterostomy.In November 2021,he presented again with urethral bleeding.We detected urethral UC as the cause of urethral orifice bleeding and administered radical urethrectomy.Since then,he has visited regularly for 6-mo follow-ups,and was in stable condition as of December 2022.CONCLUSION UTUC is prone to seeding and recurrence.Adjuvant instillation therapy and intense surveillance are crucial for these patients.展开更多
文摘ObjectiveTo review the current literature on ketamine-associated upper urinary tract (UUT) dysfunction and provide an overview of its pathogenesis and treatment principles.MethodsA literature search was conducted using PubMed and Cochrane databases for relevant articles published in English between 2008 and 2023. Keywords used included “ketamine” and “upper urinary tract”.ResultsA total of 22 papers were included. Relatively few studies have focused on ketamine-associated UUT dysfunction. Exclusion criteria included lack of hydronephrosis, or pathological findings. After careful screening and exclusion, we finally adopted 11 of these papers and analyzed them. Ketamine-associated UUT dysfunction may be a concern in this field.ConclusionKetamine abuse can lead to UUT impairment and dysfunction, with symptoms such as bladder dysfunction and contracted bladder with vesicoureteral reflux, direct damage and barrier dysfunction, inflammation, apoptosis, fibrosis and stricture, and papillary necrosis. Oxidative stress, autophagy, and microvascular injury are also potential pathogenic mechanisms. The detection of these symptoms largely depends on laboratory and imaging examinations. The treatment principles of ketamine-associated UUT dysfunction are protecting the UUT, improving bladder dysfunction, and resuming normal social life. More investigations are needed to clarify the mechanisms and shed light on the treatment of ketamine-associated UUT damage.
文摘BACKGROUND Urinary sepsis is frequently seen in patients with diabetes mellitus(DM)complicated with upper urinary tract calculi(UUTCs).Currently,the known risk factors of urinary sepsis are not uniform.AIM To analyze the risk factors of concurrent urinary sepsis in patients with DM complicated with UUTCs by logistic regression.METHODS We retrospectively analyzed 384 patients with DM complicated with UUTCs treated in People’s Hospital of Jincheng between February 2018 and May 2022.The patients were screened according to the inclusion and exclusion criteria,and 204 patients were enrolled.The patients were assigned to an occurrence group(n=78)and a nonoccurrence group(n=126).Logistic regression was adopted to analyze the risk factors for urinary sepsis,and a risk prediction model was established.RESULTS Gender,age,history of lumbago and abdominal pain,operation time,urine leukocytes(U-LEU)and urine glucose(U-GLU)were independent risk factors for patients with concurrent urinary sepsis(P<0.05).Risk score=0.794×gender+0.941×age+0.901×history of lumbago and abdominal pain-1.071×operation time+1.972×U-LEU+1.541×U-GLU.The occurrence group had notably higher risk scores than the nonoccurrence group(P<0.0001).The area under the curve of risk score for forecasting concurrent urinary sepsis in patients was 0.801,with specificity of 73.07%,sensitivity of 79.36%and Youden index of 52.44%.CONCLUSION Sex,age,history of lumbar and abdominal pain,operation time,ULEU and UGLU are independent risk factors for urogenic sepsis in diabetic patients with UUTC.
基金Supported by the Capital Clinical Characteristics Applications Research Program,No.Z171100001017201the Beijing Hospital Clinical Research 121 Project,No.BJ-2018-090the Beijing Hospital Clinical Research,No.BJ-2015-098.
文摘BACKGROUND The current standard surgical treatment for non-metastatic upper urinary tract urothelial carcinoma(UTUC)is radical nephroureterectomy(RNU)with bladder cuff excision(BCE).Typically,BCE techniques are classified in one of the following three categories:An open technique described as intrasvesical incision of the bladder cuff,a transurethral incision of the bladder cuff(TUBC),and an extravesical incision of the bladder cuff(EVBC)method.Even though each of these management techniques are widely used,there is no consensus about which surgical intervention is superior,with the best oncologic outcomes.AIM To investigate the oncological outcomes of three BCE methods during RNU for primary UTUC patients.METHODS We retrospectively analyzed the data of 248 primary UTUC patients,who underwent RNU with BCE between January 2004 to December 2018.Patients were analyzed according to each BCE method.Data extracted included patient demographics,perioperative parameters,and oncological outcomes.Statistical analyses were performed using chi-square and log-rank tests.The Cox proportional hazards regression model was utilized to identify independent predictors.P<0.05 was considered statistically significant.RESULTS Of the 248 participants,39.9%(n=99)underwent intrasvesical incision of the bladder cuff,38.7%(n=96)EVBC,and 21.4%(n=53)TUBC.At a median followup of 44.2 mo,bladder recurrence developed in 17.2%,12.5%,and 13.2%of the cases,respectively.Cancer-specific deaths occurred in 11.1%,5.2%,and 7.5%of patients,respectively.Kaplan-Meier survival curves with a log-rank test highlighted no significant differences in intravesical recurrence-free survival,cancer-specific survival,and overall survival among these approaches with P values of 0.987,0.825,and 0.497,respectively.Multivariate analysis showed that the lower ureter location appears to have inferior intravesical recurrence-free survival(P=0.042).However,cancer-specific survival and overall survival were independently influenced by tumor stage(hazard ratio[HR]=8.439;95%condence interval:2.424-29.377;P=0.001)and lymph node status(HR=14.343;95%CI:5.176-39.745;P<0.001).CONCLUSION All three techniques had comparable outcomes;although,EVBC and TUBC are minimally invasive.While based upon rather limited data,these findings will support urologists in blending experience with evidence to inform patient choices.However,larger,rigorously designed,multicenter studies with long term outcomes are still required.
文摘Objective:We evaluated who would need further evaluations such as retrograde pyelography(RP)and/or ureteroscopy to diagnose upper urinary tract urothelial cancers(UUTUCs)when abnormal findings for the upper urinary tract(UUT)were detected by enhanced computed tomography(CT).Methods:We retrospectively analyzed 125 patients who underwent enhanced CT for various reasons and had abnormal findings for the UUT.Patients whose tumors were suspected to be of extraureteral origin were excluded.All patients received RP and/or ureteroscopy to evaluate the UUTUCs.Results:The median age of the 125 patients was 70 years and gross hematuria(26.4%)was the most frequently observed symptoms.RP,ureteroscopy and both were performed for 121,59 and 55 patients,respectively.CT revealed tumor-like lesions in 58 patients and the other patients had non-tumor-like lesions.UUTUCs were found in 43(34.4%)of the 125 patients.All of them had tumor-like lesions on CT.In 58 patients who had tumor-like lesions on CT,univariate and multivariate analyses revealed that tumor diameter and tumor enhancement were significant predictive factors for UUTUCs.ROC curve analysis of enhanced CT to diagnose UUTUCs revealed that a tumor diameter of 18 mm was the best cutoff point.The sensitivity,specificity and accuracy were 90.0%,98.8% and 92.7% for RP and 95.5%,100% and 97.1%for ureteroscopy,respectively.Both of them had high sensitivity,specificity and accuracy.Conclusion:We should decide to evaluate the UUT according to the tumor diameter on enhanced CT.When we evaluate the UUT in patients with tumor diameters of less than 20 mm,ureteroscopy is recommended.
文摘BACKGROUND Lymphoepithelioma-like carcinomas(LELCs)are rare,malignant epithelial tumors,generally considered a subtype of squamous cell carcinoma.LELCs are undifferentiated and can occur in multiple tissues,although LELCs in the urinary tract are extremely rare.As such,evidence does not provide clinicians with guidelines for the best practices.Even though this is a rare disease,it is associated with high morbidity and mortality.Therefore,we must learn to differentiate LELC types and identify risk factors for early identification.AIM To develop an evidence base to guide clinicians treating primary LELCs of the upper urinary tract(UUT-LELC).METHODS We performed a systematic review of all reports on UUT-LELC from the first published case in 1998 until October 2019,according to the PRISMA.A database was then developed by extracting data from previously published reports in order to analyze interactions between clinical characteristics,pathological features,interventions and outcomes.Survival was analyzed using Kaplan–Meier estimates,which were compared using log rank tests.RESULTS A total of 28 previously published cases were identified for inclusion.The median age was 72 years with a male to female ratio of 4:3.Pure type LELCs were most common with 48.3%(n=14),followed by 37.9%(n=11)predominant LELCs and 3.4%(n=1)focal LELCs.Epstein-Barr virus testing was negative in all cases.Fourteen patients received radical nephroureterectomy(RNU)-based intervention.Twenty-three patients survived with no evidence of further metastasis,although six died before the median 18 mo follow-up point.Survival analysis suggests pure histological subtypes,and patients who receive complete tumor resection have more favorable prognoses.As always in cancer care,early identification generally increases the probability of interventional success.CONCLUSION The most effective treatment for UUT-LELC is RNU-based therapy.Since cases are few in number,case reporting must be enhanced and publishing encouraged to both save and prolong lives.
文摘Nuclide renal dynamic imaging was performed on 88 transplanted kidney. Two kinds of renal scintigraphic characteristics were identified in recipients with supravesical obstruction of the graft. First, the regular type was characterized by radioactivity defect area in kidney parenchyma during early uptake period followed by ureteropelvic retention. Second, the tubular type was typified by cortical retention and attenuation in collecting system during the whole test period with a special sign of “hollow kidney”. Non obstructive dilated calyces showed similar signs as the regular type. Acute rejection reaction and tubule necrosis demonstrated obstructive time activity curves. However, the radioactivity retention appeared in cortex. It was suggested that dilated calyces and obstructive renogram might not be reliable evidence for upper urinary tract obstruction. The signs of radioactivity attenuation in kidney parenchyma during early uptake period followed by ureteropelvic retention may be more valuable for the evaluation. As for tubular obstruction, specified “hollow kidney” was the characteristic sign which is helpful for the diagnosis.
文摘Introduction: The management of urinary lithiasis in our settings has long been conventional surgery. The recent introduction of endoscopy of the upper urinary tract represents a major advance in our department. The aim was to contribute to the study of the treatment of lithiasis of the upper urinary tract in Conakry and to report on our initial experience of ureteroscopy in Conakry. Methodology: This is a prospective descriptive study lasting one year, from January 1 to December 31, 2022, carried out at the Urology Department of the Ignace Deen National Hospital and at the PERCHIN Urological Clinic. The study included all patients treated surgically for lithiasis of the upper urinary tract who met the selection criteria. Results: The study included 57 patients. The mean age was 30 years, with extremes of 20 and 73 years;the most represented age group was 31 to 40 years, followed by 20 to 30 years with 29.9% and 26.3% respectively. Males predominated in 36 cases (63.15%), with a M/F sex ratio of 1.71. Left-sided renal colic was the most common, at 75.43% (n=43), and right-sided renal colic at 40.35%, associated with digestive signs at 43.85%. 77.19% had normal creatinine levels before surgery, versus 22.81% with elevated creatinine levels, i.e. 15.78% improvement in renal function after surgery. Urinary tract infection was found in 47.36%, and Escherichia coli in 31.57%, followed by staphylococcus aureus in 8.77%. Overall, 82.45% of patients had organic damage to the kidneys or ureters. Right ureterohydronephrosis was noted in 56.14%, followed by left hydronephrosis in 26.32%. Open surgery was predominant in 52.63% of cases, with endoscopic surgery (URS) accounting for a significant 47.36% during the study period. The endoscopic treatment used was laser ureteroscopy. In our study, 73.68% underwent drainage of the upper excretory tract, including 64.91% with a JJ catheter. The average length of stay was 07 days, with extremes of 02 and 28 days, and 81.4% of patients who underwent URS had a length of stay of less than 4 days. Conventional surgery had the highest complication rate (14.28%). The stone free rate for the two surgical treatment methods (open and endoscopic surgery) was 73% and 92.59%.
文摘Objective: to discuss the treatment method and efficacy evaluation of severe upper urinary tract infection secondary to ureteral stones. Methods: 97 patients with severe upper urinary tract infection secondary to Ureterolithiasis were mainly treated from September 2009 to January 2022, and they were treated as the subjects of this study group. The treatment method mainly adopts surgery and anti-infection treatment mode, and the efficacy is taken as the research observation index. Results: in 97 patients with secondary infection, 72 patients accounting for 74.23%, and 25 patients accounting for 25.77%. Then percutaneous renal puncture and positional shock wave lithotripsy were successful. Of 72 patients had successful retrograde drainage, 32, or 44.44%, or 40, 22 ultrasound-guided percutaneous renal puncture, or 30.56%, and 18 CT, ureteroscopy and 25%. None of the patients had serious complications after treatment, and the renal function indexes of 2 microglobin, creatinine and blood urea nitrogen were closer to the normal state than before surgery, which was statistically significant (P <0.05). Conclusion: according to the fact of the patients, selecting the appropriate surgical methods and sensitive antibiotic drug treatment can improve the treatment effect of severe upper urinary tract infection secondary to ureteral stones, namely, on the basis of anti-infectious drug treatment, the first phase of catheterization and drainage, and the second phase of selecting the appropriate minimally invasive lithotripsy treatment for the patients.
文摘Objective To evaluate the decision process to perform staged or synchronous bilateral percutaneous nephrolithotripsy ( PCNL) in the treatment of bilateral upper urinary tract calculi. Methods Patients with an indication for bilateral PCNL were enrolled in the study
基金supported by grants from the Peking University Medicine Sailing Program for Young Scholar’s Scientific&Technological Innovation(No.BMU2023YFJHPY013)National High Level Hospital Clinical Research Funding(Scientific Research Seed Fund of Peking University First Hospital)(No.2023SF09).
文摘To the Editor:Ureteral stricture can lead to dilation of the proximal upper urinary tract and collecting system.Stretching and loading of the ureter by long-term hydronephrosis trigger a stress relaxation effect,which decreases the contractility of the ureter.[1]Morphological changes after surgery may not be obvious even if the obstruction is successfully relieved.Diuretic renography judges split renal function and the nature of obstruction by the uptake and excretion of radionuclides.However,it is influenced by the response of the ipsilateral kidney to diuretics.[2]Currently,there is a lack of homogenized diagnostic and treatment standards,especially evaluation criteria,which makes it difficult to assess the surgical effect and postoperative conditions.
文摘Background Transitional cell carcinoma of the upper urinary tract （UUT-TCC） accounts for 5% to 10% of all renal tumours and 5% to 6% of all urothelial tumours all over the world. In China, the proportion of UUT-TCC to all urothelial tumours may be 26%, which is higher than that in the western world. The early diagnosis of UUT-TCC is difficult and the present study elucidates the diagnostic value of poor or nonvisualization （PNV） in intravenous urography in patients with UUT-TCC and its correlations with pathological findings and clinical characteristics. Methods The data of 172 consecutive patients between January 1997 and January 2005 with UUT-TCC who underwent nephroureterectomy in our departments were selected and analyzed retrospectively. Results Of our sample, 144 cases presented with gross haematuria （83.7%） and 12 with microscopic haematuria （7.0%）. Forty-six cases （26.7%） were detectable by cytology. Filling defect identified 36 positive cases of 172 patients （20.9%）, PNV was present in the images of 105 of 172 patients （61.0%）. The detection rate by PNV （61.0%） was significantly different from that by cytology （26.7%） or by filling defect （20.9%） （P=-0.031, P=-0.001, respectively）. Univariate logistic regression analysis for PNV showed that tumour stage, grade and size were significant predictors （P=0.028; P=-0.031; P=-0.006, respectively）. Tumour stage and size were identified as independent risk factors in the multivariate logistic regression model （P=-0.042; P=-0.014）.Conclusions Except for suspected urolithiasis, urinary tuberculosis or congenital abnormalities, UUT-TCC should be considered if PNV exists in intravenous urography especially of old patients. The value of PNV is much more significant than filling defect in intravenous urography in the diagnosis of UUT-TCC. It is supposed that PNV carries more risk of higher stage and larger tumour size in UTT-TCC.
基金This study was supported by a grant from-the National Natural Science Foundation of China （No. 81072101/H1619）.
文摘Background Bladder recurrent disease is still a challenge in the treatment of upper tract urothelial carcinoma （UTUC）. This controlled study aims to investigate the efficacy of early clipping of the distal ureter prior to nephroureterectomy （NU） to prevent bladder recurrence after UTUC.
文摘Upper urinary tract urothelial carcinomas(UTUCs)are uncommon and account for only 5%e10%of urothelial carcinomas.Pyelocaliceal tumors are about twice as common as ureteral tumors.Sixty percent of UTUCs are invasive at diagnosis.Radical nephroureterectomy,including the excision of the distal ureter and bladder cuff is standard of care for treatment of localized UTUCs,because of the high potential for recurrence,multifocality,and progression.Since first laparoscopic nephroureterectomy(LNU)was introduced by Clayman et al.in 1991 and improvement of laparoscopic technique and equipment,LNU has been reported to be equivalent to conventional open method.We reviewed the current literature of patients with UTUCs treated by LNU focusing on technical aspects,peri-operative and oncological outcomes.Laparoscopic radical nephroureterectomy offers the advantages of minimally invasive surgery without deteriorating the oncological outcome for treatment of UTUCs.Indications tend to increase as operator skills increase.Indications for laparoscopic or open nephroureterectomy are in principle the same.The basic requirement for laparoscopic surgery in UTUCs is to achieve benefits of minimal invasive surgery and maintain oncologic principles.
文摘BACKGROUND Renal papillary necrosis(RPN)is a rare disease.It is difficult to distinguish RPN with urinary tract obstruction from upper urinary tract occupying lesions.We reported a case of RPN and made a definite diagnosis largely based upon its endoscopic characteristics.CASE SUMMARY A 75-year-old woman presented with right flank pain,visible hematuria and a body temperature greater than 39℃.Laboratory investigations revealed leukocytosis with 12.7×10/L white blood cells and 93.6%neutrophils.Blood creatinine was 333 umol/L.Ultrasonography showed hydronephrosis of the right kidney and a right distal ureteric lesion.After urgent placement of right ureteral double J stent and treatment with antibiotics,the patient’s symptoms and the blood abnormalities improved rapidly.Computed tomography urography showed the presence of multiple occupying lesions in the right pelvis.The endoscopic ureteroscopy revealed that renal papillary necrosis and the subsequent migration of sloughed papillae into the upper ureter and calyces.The sloughed papillae appeared like“cottons”,which were whitish,soft,and irregularly-shaped without blood supply.In addition,the necrotic and sloughed renal papillae were removed by flexible ureteroscopy to prevent further obstruction.Pathological examination found that infarcted renal papillae were associated with inflammatory exudation.Three months after discharge,follow-up computed tomography urography showed no obvious lesions in the renal pelvis.CONCLUSION This case revealed the endoscopic features of RPN.In addition,flexible ureteroscopy proves to be vital in diagnosis and treatment of RPN.
文摘Objective: to investigate the lithotripsy, blood loss and safety of patients with upper urinary calculi by MPCNL and RIRS. Methods: 80 clinical trial participants were counted. From June 2020, they were treated according to the protocol provided by the hospital. By December 2021, they were treated according to their own treatment procedures. The number of each patient was limited to 40. After the completion of the control group and the study group, statistics and sorting were carried out. MPCNL, RIRS and MPCNL were used for comparison in the control group, and the gravel situation, blood loss, safety mental state and quality of life. Results: after comparison, the stone treatment results of the two cases were compared. The success rate of one-time treatment was 92.50%, and the treatment effect of the treatment group was 70.00%;Comparing the bleeding rates of the two groups, the bleeding rate of the control group was significantly lower than that of the control group;The incidence of comorbidities in the two groups was 5.00% and 22.50%, and the incidence of comorbidities in the experimental group was lower. In this study, individual cases were used for psychological and emotional comparison. Among them, the anxiety level was (38.59 ± 3.54) and (42.86 ± 3.73), the emotional fluctuation in the control group was more obvious, the depression status was (35.86 ± 3.26) and (38.64 ± 3.18), and the improvement in the research group was more excellent;In this trial, the survival quality of cases was used as control, and the results showed that the quality of life of control patients was relatively poor. Conclusion: MPCNL and RIRS can significantly improve the clinical effect of patients with urinary system symptoms. It can reduce intraoperative bleeding and complications, make full use of a variety of bad emotions in patients, improve their daily quality of life, and comprehensively protect patients lives and physical health. It has very obvious clinical application value and is worth widely recommended.
文摘Purpose:To describe the imaging characteristics of the upper urinary tract(UUT)in addition to the bladder on computed tomography(CT)in adult patients with late-onset hemorrhagic cystitis(LOHC)after allogeneic hematopoietic stem cell transplantation(HSCT).Subjects and methods:This retrospective study included 24 patients with LOHC who underwent urinary system CT between April 2006 and August 2013.UUT and bladder wall thickness and attenuation were measured before and after contrast material administration.Kidney density,collecting system dilatation,mucosal enhancement,submucosal edema,perivesical stranding around the UUT and bladder,and intravesical clots were evaluated.Diffuse and/or focal renal pelvis and ureter and bladder wall thickening were identified.Correlations between LOHC degree and UUT thickness,UUT attenuation,and uronephrosis were analyzed using Spearman's rank correlation coefficient.Results:Diffuse and/or focal severe UUT and bladder wall thickening was observed in 22 patients(91.7%)with LOHC after HSCT.The median UUT and bladder wall thicknesses(interquartile range)were 2.5 mm(1.0-4.6 mm)and 4.8 mm(3.1-7.3 mm),respectively.Collecting system dilation(17;70.8%),stranding surrounding the UUT and bladder(19;79.2%),and intraluminal clots(two;8.3%)were noted.Three patients underwent ureteral balloon dilation and D-J catheter implantation to resolve irreversible ureteral stenosis and uronephrosis.No significant positive correlation was seen between LOHC classification,UUT wall thickness or attenuation,or uronephrosis(P>0.05).Conclusion:UUT and bladder wall thickening and uronephrosis were observed on CT in patients with LOHC after allogeneic HSCT.Surgical treatment may be needed for irreversible ureteral stenosis.
基金funded by the Buddhist Tzu Chi Medical Foundation(TCMF-JCT-113-09)Taipei Tzu Chi Hospital,Buddhist Tzu Chi Medical Foundation(TCRD-TPE-112-12,TCRD-TPE-113-32).
文摘Introduction:Upper urinary tract urothelial carcinoma(UTUC)is a rare malignancy,particularly in the ureter,and is associated with high rates of recurrence and metastasis.Although body mass index(BMI)has been associated with prognosis in multiple cancer types,its role as a predictive factor in UTUC is still debated.This study aimed to investigate how BMI influences survival outcomes in patients with UTUC treated with radical nephroureterectomy(RNU).Methods:This multi-center retrospective analysis by the Taiwan UTUC Collaboration Group involved 2503 patients who underwent treatment across 19 hospitals from 1988 to 2022.Patients were categorized into normal(18.5≤BMI<24),overweight(24≤BMI<27),and obese(BMI≥27)groups.Demographic,clinical,and pathological data were analyzed.Overall survival(OS),cancer-specific survival(CSS),disease-free survival(DFS),and intravesical recurrence-free survival(IVRFS)were assessed using Kaplan–Meier analysis and Cox proportional hazards models.Results:The median follow-up period was 44.2 months.In multivariable analysis,overweight patients demonstrated significantly better OS compared with normal-weight patients(p=0.033),and the obesity group showed a favorable,though not statistically significant,trend toward better OS.However,BMI was not an independent predictor of CSS,DFS,or IVRFS.Independent predictors of worse outcomes included older age,end-stage renal disease,ureteral tumor location,tumor size≥3 cm,and high-grade urothelial carcinoma.Tumor stage and grade were comparable across BMI groups.Conclusions:Overweight status was associated with better OS in patients with UTUC treated with RNU,while BMI had no significant impact on CSS,DFS,or IVRFS.These findings suggest a potential protective effect of higher BMI on OS,warranting further investigation in prospective studies.However,BMI alone should not guide clinical decisions and may instead reflect broader patient health characteristics.
文摘BACKGROUND Urosepsis is a life-threatening condition frequently associated with renal and ureteral calculi(RUC)and diabetes mellitus(DM),a combination that exacerbates susceptibility to infection due to urinary obstruction and impaired immune response.AIM To identify the risk factors for urosepsis in patients with RUC complicated by DM to enhance early detection and intervention strategies.METHODS This retrospective observational study included 298 patients with RUC and DM admitted between January 2020 and June 2024.Patients were divided into an observation group(n=32)with urosepsis and a control group(n=266)without urosepsis.Comprehensive clinical,laboratory,and imaging data were collected and analyzed using univariate and multivariate logistic regression models to identify factors associated with urosepsis.The study adhered to the STROBE guidelines and received ethical approval.RESULTS Multivariate analysis identified several independent risk factors for urosepsis.Female sex(OR=2.237,95%CI:1.086-4.605,P=0.03),advanced age(OR=1.05,95%CI:1.018-1.084,P=0.002),and fever(OR=2.999,95%CI:1.283-7.015,P=0.015)significantly increased the risk.Laboratory findings such as elevated urine leukocyte(U-LEU)(+++,OR=66.0,95%CI:7.031–580.125,P<0.001)and glucose(U-GLU)(+++,OR=7.248,95%CI:1.862-28.211,P=0.005)levels were strongly associated with urosepsis.Severe hydronephrosis also emerged as a significant predictor(OR=6.129,95%CI:3.027-9.623,P=0.011).Other factors,such as gross hematuria,stone laterality,and mild to moderate hydronephrosis,were not significantly associated with urosepsis.CONCLUSION This study identifies key demographic,clinical,laboratory,and imaging factors associated with urosepsis risk in patients with RUC and DM.Early identification of female patients,elderly individuals,those presenting with fever,severe hydronephrosis,and elevated U-LEU and U-GLU levels may facilitate timely intervention.These findings highlight the importance of comprehensive assessment and targeted management in the care of high-risk patients.
基金Supported by National Natural Science Foundation of China,No.82060462The Science and Technology Plan Project of Guizhou Province,No.[2019]5405Foundation of Health and Family Planning Commission of Guizhou Province,No.gzwjkj2019-1-127。
文摘BACKGROUND Urothelial carcinoma(UC)is a common malignancy of the urinary system that can occur anywhere from the renal pelvis to the proximal urethra.Most UCs are in the bladder and have multifocal growth.Upper urinary tract UC(UTUC),which occurs in the renal pelvis or ureter,accounts for only 5%to 10%of UCs.CASE SUMMARY In March 2015,a 70-year-old male who initially presented to a local hospital with a complaint of painless hematuria was diagnosed with UTUC of the right renal pelvis.The doctors administered radical nephroureterectomy and bladder cuff excision.Although the doctors recommended intravesical chemotherapy and regular follow-up,he rejected this advice.In December 2016,the patient presented at our hospital with dysuria.We identified UC in the residual bladder and administered radical cystectomy and left cutaneous ureterostomy.In November 2021,he presented again with urethral bleeding.We detected urethral UC as the cause of urethral orifice bleeding and administered radical urethrectomy.Since then,he has visited regularly for 6-mo follow-ups,and was in stable condition as of December 2022.CONCLUSION UTUC is prone to seeding and recurrence.Adjuvant instillation therapy and intense surveillance are crucial for these patients.
