超声和X线引导建立经皮肾取石术通路的临床对比分析

目的 比较超声和C臂X线引导下建立经皮肾取石通路的疗效。方法分析2008年1月至2008年10月完成的经皮肾镜手术,排除上尿路解剖异常,超声引导定位穿刺30例（超声组）,男16例,女14例,平均年龄（45±12）岁;C型臂X线定位穿刺30例（X线组）,男18例,女12例,平均年龄（44±13）岁。结果两组建立通道所需时间分别为（13±3）min和（22±4）min（P〈0．01）,穿刺成功率分别为96．7％和93．3％（P=0．554）,一次穿刺成功率分别为86．7％和60．0％（P=0．02）。结论超声引导定位建立经皮肾取石通路较X线优越,且无放射伤害。     

尿酸结石8例溶石治疗体会

尿酸结石占尿路结石的 14 %～ 2 5 % [1] ,发生率仅次于草酸钙结石。用药物溶解结石是治疗结石最理想的方法之一。自 1992年至今 ,作者采用 1/6mol/L乳酸钠经静脉滴注治疗8例尿酸结石患者 ,取得了满意效果 ,报道如下。1　临床资料1.1　一般资料　本组 8例 ,男 3例 ,女 5例 ,年龄 2 7～ 5 8岁 ,平均 4 2岁。均为一侧单发结石 ,肾结石 6例 ,输尿管上段结石 2例 ;并发轻度肾积水 2例 ;结石直径 0 .4～ 1.3cm ,平均 0 .7cm。治疗前患者心电图、胸部拍片及肝、肾功能均无异常。尿常规检查正常 ,仅 1例患者血压达临界值。1.2　诊断标准[2 ] 　有…     

下尿路梗阻性肾积水患者逼尿肌功能变化

目的：探讨下尿路梗阻性肾积水患者逼尿肌功能变化。方法：对20例（3．5－73岁）下尿路梗阻导致的肾积水组和10例（13－67岁）无肾积水的对照组进行膀胱压力容积测定与压力－流率测定，并记录不同膀胱灌注量的逼尿肌基础压力。结果：下尿路梗阻性肾积水组逼尿肌－括约肌协同失调（DSD）11例（55％），逼尿肌功能过度活跃5例；而对照组仅发现1例（10％）DSD，未发现有逼尿肌功能过度活跃。下尿路梗阻性肾积水组平均膀胱顺应性显著低于对照组（P＜0．05），而下尿路梗阻性肾积水组平均逼尿肌基础压力，平均逼尿肌最大收缩压和残余尿量均显著高于对照组（P＜0．05），且下尿路梗阻性肾积水组在灌注量逐渐增加时高逼尿肌基础压力发生率逐渐增加。结论：下尿路梗阻性肾积水多伴有逼尿肌功能异常，提示膀胱逼尿肌功能改变与下尿路梗阻性肾积水的形成及发展有一定的相关性。     

电刺激联合盆底肌训练治疗女性压力性尿失禁合并特发性逼尿肌过度活动的疗效观察

Objective To investigate the short-term efficacy of pelvic floor electrical stimulation (PFES) and pelvic floor training (PFT) for female with idiopathic detrusor overactivity (IDO) and stress urinary incontinence (SUI). Methods PFES and PFT were performed on 70 women (average age 40±7 years old) with IDO and SUI for twelve weeks. Urinary diary, International Continence In-quiring Committee's Questionnaire (ICI-Q-SF) scores were recorded and urodynamic study was per-formed before and after the treatment. Results Fifty women (71%) finally completed treatment for twelve weeks. Urinary incontinence disappeared in 8 (16%), detrusor overactivity disappeared in 10 (20 %). The leakage was not found in 6 (12 %) in leakage point pressure measurement. Moreover, the frequency of voiding (28±5 times/72 h), frequency of leakage (10±5 times/72 h), total scores of ICI-Q-SF(10±3), max detrusor uninhibited contraction pressure (18±8 cmH20) and detrusor unin-hibited contraction duration (8±3 s) were significantly lower than those before treatment (43±8 times/72 h, 20±6 times/72 h, 17±3, 27±9 cm H2O and 13±6s,P<0.01). Maximal voided vol-ume(225±48 ml), normal desired cystometric capacity (210±48 ml), maximal cystometric capacity (247±48 ml), Valsalva leak point pressure (94±11 cm H2O) and maximal urethral closure pressure (59±8 cm H2O) were significantly higher than those before treatment (159±37 ml, 141±39ml, 178±36ml, 81±15 cm H2O and 55±8 cm H2O, P<0.01). The effective rate during three months follow up was 60%, similar to time after treatment (P>0.05). Conclusions Pelvic floor electrical stimulation and pelvic floor training could be a useful therapy to treat women with IDO and SUI. It is both convenient and economical.     

电刺激联合盆底肌训练治疗女性压力性尿失禁合并特发性逼尿肌过度活动的疗效观察

Objective To investigate the short-term efficacy of pelvic floor electrical stimulation (PFES) and pelvic floor training (PFT) for female with idiopathic detrusor overactivity (IDO) and stress urinary incontinence (SUI). Methods PFES and PFT were performed on 70 women (average age 40±7 years old) with IDO and SUI for twelve weeks. Urinary diary, International Continence In-quiring Committee's Questionnaire (ICI-Q-SF) scores were recorded and urodynamic study was per-formed before and after the treatment. Results Fifty women (71%) finally completed treatment for twelve weeks. Urinary incontinence disappeared in 8 (16%), detrusor overactivity disappeared in 10 (20 %). The leakage was not found in 6 (12 %) in leakage point pressure measurement. Moreover, the frequency of voiding (28±5 times/72 h), frequency of leakage (10±5 times/72 h), total scores of ICI-Q-SF(10±3), max detrusor uninhibited contraction pressure (18±8 cmH20) and detrusor unin-hibited contraction duration (8±3 s) were significantly lower than those before treatment (43±8 times/72 h, 20±6 times/72 h, 17±3, 27±9 cm H2O and 13±6s,P<0.01). Maximal voided vol-ume(225±48 ml), normal desired cystometric capacity (210±48 ml), maximal cystometric capacity (247±48 ml), Valsalva leak point pressure (94±11 cm H2O) and maximal urethral closure pressure (59±8 cm H2O) were significantly higher than those before treatment (159±37 ml, 141±39ml, 178±36ml, 81±15 cm H2O and 55±8 cm H2O, P<0.01). The effective rate during three months follow up was 60%, similar to time after treatment (P>0.05). Conclusions Pelvic floor electrical stimulation and pelvic floor training could be a useful therapy to treat women with IDO and SUI. It is both convenient and economical.     

Nd：YAG激光治疗膀胱颈纤维性挛缩15例

Ｎｄ：ＹＡＧ激光治疗膀胱颈纤维性挛缩１５例宋东奎，杨锦建，张卫星河南医科大学第一附属医院泌尿外科郑州４５００５２关键词激光；膀胱颈；纤维性挛缩自１９９３年１２月至１９９５年６月，采用国产Ｎｄ：ＹＡＧ激光治疗膀胱颈纤维性挛缩１５例，疗效满意，报告如下：...     

回肠膀胱扩大术联合髂腰肌盆底肌加强术治疗神经源性膀胱的疗效分析

目的 探讨去黏膜带蒂回肠膀胱扩大术联合髂腰肌盆底肌加强术治疗神经源性膀胱的疗效.方法 前瞻性研究去黏膜带蒂回肠膀胱扩大联合髂腰肌盆底肌加强术治疗神经源性膀胱的疗效.神经源性膀胱患者12例.男9例,女3例.年龄18 ～ 27岁,平均25岁.临床表现为不同程度的尿失禁.病程6 ～ 64个月,平均23个月.应用超声、膀胱造影、尿动力学等检查前瞻性比较术前和术后1年的尿动力学参数,上尿路形态和肾功能情况.结果 12例手术顺利.术后出现切口延迟愈合2例,肠梗阻1例,膀胱腹壁尿瘘1例,未出现黏液尿.术后1年1例因发热性泌尿系感染行自我清洁间歇导尿,11例为腹压排尿.术前膀胱输尿管反流8例,术后反流消失5例,反流程度改善3例.术前肾功能不全5例,术后血肌酐水平下降至正常范围3例.术前和术后1年最大膀胱压测定容量[( 247±27)和(412±32) ml]、膀胱顺应性[(4.4±1.2)和(26.2±4.0)ml/cm H2O,1 cm H2O =0.098 kPa]、相对安全容量[(206±24)和(368±26) ml]、最大尿流率[(11±2)和(20±3)ml/s]、残余尿量[(136±25)和(26±8)ml]、逼尿肌漏点压[(63.1±4.9)和(17.8±3.6)cm H2O]比较差异均有统计学意义(P＜0.05).结论 去黏膜带蒂同肠浆肌层膀胱扩大联合髂腰肌盆底肌加强术可有效治疗神经源性膀胱.     

膀胱肿瘤表皮生长因子和受体表达的意义

表皮生长因子（ＥＧＦ）以尿液中浓度最高［１］。表皮生长因子受体（ＥＧＦＲ）是细胞恶变的标志。为了解ＥＧＦ、ＥＧＦＲ在膀胱肿瘤中的表达及意义,我们采用免疫组化技术对９６例膀胱肿瘤和１０例正常膀胱粘膜进行了研究。１．资料和方法：组织标本系本院和解放军第１５３医院１９７５～１９９４年间手术及电切的膀胱肿瘤组织。其中乳头状瘤１５例,移行细胞癌８１例。１０例正常粘膜来自非泌尿系疾患者群。标本常规ＨＥ染色,进行病理组织学分类,判别分化程度,浸润深度。ＡＢＣ免疫组化染色,分别作二种抗体染色的阳性对照和磷酸盐缓…     

外泌体在膀胱癌中的现状与展望

外泌体是一种由人体细胞分泌的具有双层膜结构的囊性小泡,是胞外囊泡中的一种类型。研究显示,外泌体通过多种途径参与细胞间的信息传导,在膀胱癌的发生、发展和凋亡过程中发挥着重要作用。同时,外泌体的膜结构可以保护其内容物不被人体酶类物质所分解,因此可以作为载体携带相关治疗因子进入膀胱癌细胞。外泌体在膀胱癌的诊治过程中展现出了良好的应用价值,但同时也面临着一些技术挑战,现对上述问题进行文献综述,希望能为膀胱癌的诊疗提供参考。