BJU International
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Prevalence of kidney stones in China: an ultrasonography based cross‐sectional study Objectives To investigate the prevalence and associated factors of kidney stones among adults in China. Subjects and Methods A nationwide cross‐sectional survey was conducted among individuals aged ≥18 years across China, from May 2013 to July 2014. Participants underwent urinary tract ultrasonographic examinations, completed pre‐designed and standardised questionnaires, and provided blood and urine samples for analysis. Kidney stones were defined as particles of ≥4 mm. Prevalence was defined as the proportion of participants with kidney stones and binary logistic regression was used to estimate the associated factors. Results A total of 12 570 individuals (45.2% men) with a mean (sd, range) age of 48.8 (15.3, 18–96) years were selected and invited to participate in the study. In all, 9310 (40.7% men) participants completed the investigation, with a response rate of 74.1%. The prevalence of kidney stones was 6.4% [95% confidence interval (CI ) 5.9, 6.9], and the age‐ and sex‐adjusted prevalence was 5.8% (95% CI 5.3, 6.3; 6.5% in men and 5.1% in women). Binary logistic regression analysis showed that male gender, rural residency, age, family history of urinary stones, concurrent diabetes mellitus and hyperuricaemia, increased consumption of meat, and excessive sweating were all statistically significantly associated with a greater risk of kidney stones. By contrast, consumption of more tea, legumes, and fermented vinegar was statistically significantly associated with a lesser risk of kidney stone formation. Conclusion Kidney stones are common among Chinese adults, with about one in 17 adults affected currently. Some Chinese dietary habits may lower the risk of kidney stone formation.
BJU International - Tập 120 Số 1 - Trang 109-116 - 2017
Antibiotic prophylaxis in ureteroscopic lithotripsy: a systematic review and meta‐analysis of comparative studies Objective To explore the efficacy of antibiotic prophylaxis and the different strategies used to prevent infection in ureteroscopic lithotripsy (URL ) by conducting a systematic review and meta‐analysis. Materials and Methods A systematic literature search using Pubmed, Embase, Medline, the Cochrane Library, and the Chinese CBM , CNKI and VIP databases was performed to find comparative studies on the efficacy of different antibiotic prophylaxis strategies in URL for preventing postoperative infections. The last search was conducted on 25 June 2017. Summarized unadjusted odds ratios (OR s) with 95% confidence intervals (CI s) were calculated to assess the efficacy of different antibiotic prophylaxis strategies. Results A total of 11 studies in 4 591 patients were included in this systematic review and meta‐analysis. No significant difference was found in the risk of postoperative febrile urinary tract infections (fUTI s) between groups with and without antibiotic prophylaxis (OR : 0.82, 95% CI 0.40–1.67; P = 0.59). Patients receiving a single dose of preoperative antibiotics had a significantly lower risk of pyuria (OR : 0.42, 95% CI 0.25–0.69; P = 0.0007) and bacteriuria (OR : 0.25, 95% CI 0.11–0.58; P = 0.001) than those who did not. Intravenous antibiotic prophylaxis was not superior to single‐dose oral antibiotic prophylaxis in reducing fUTI (OR : 1.00, 95% CI 0.26–3.88; P = 1.00). Conclusions We concluded that preoperative antibiotic prophylaxis did not lower the risk of postoperative fUTI , but a single dose could reduce the incidence of pyuria or bacteriuria. A single oral dose of preventive antibiotics is preferred because of its cost‐effectiveness. The efficacy of different types of antibiotics and other strategies could not be assessed in our meta‐analysis. Randomized controlled trials with a larger sample size and more rigorous study design are needed to validate these conclusions.
BJU International - Tập 122 Số 1 - Trang 29-39 - 2018
Endoluminal isoproterenol reduces renal pelvic pressure during semirigid ureterorenoscopy: a porcine model OBJECTIVE To investigate the effects on the pressure‐flow relation of renal pelvic pressure during semirigid ureterorenoscopy and endoluminal perfusion of isoproterenol (ISO) 0.1 µg/mL, with emphasis on local effects and cardiovascular side‐effects, as topically administered ISO effectively and dose‐dependently causes relaxation of the upper urinary tract in pigs with no concomitant cardiovascular side‐effects. MATERIALS AND METHODS In anaesthetized female pigs (60 kg), 16 macroscopically normal upper urinary tract systems were subjected to ureterorenoscopy. Via a subcostal incision a 6‐F catheter was placed in the renal pelvis for pressure measurements, and a semirigid ureteroscope (7.8 F) was inserted retrogradely in the renal pelvis, through which the pelvis was perfused. The blood pressure and heart rate were recorded. The increase in renal pelvic pressure was examined with increasing flow rates (0, 4, 8, 12, 16, 25 and 33 mL/min) with saline alone or saline + ISO 0.1 µg/mL. Perfusion was initiated on the left side, with randomization for adding ISO or not. Thereafter perfusion was done on the right side as a control in each pig. The surgeons were unaware of whether ISO was added or not. RESULTS The mean (sd ) baseline pelvic pressures in the saline and ISO group were 28 (7.1) and 25 (9.8) mmHg, respectively, with no significant difference (P = 0.079). Endoluminal perfusion with ISO significantly inhibited the pelvic pressure increase to perfusion at all perfusion rates. The pressure‐flow relation was linear; the maximum relaxation (27%) was obtained at 4 mL/min, from 52 to 38 mmHg during saline alone and ISO 0.1 µg/mL perfusion, respectively. The mean blood pressure did not change significantly (P = 0.330). The mean (sd ) heart rate in the saline and ISO group were 109 (4.5) and 97 (2.1) beats/min, respectively (P < 0.001), i.e. a markedly greater rate in the saline than in the ISO group. CONCLUSION The pressure‐flow relation during semirigid ureterorenoscopy was linear. ISO 0.1 µg/mL in saline significantly reduced the pressure‐flow relation during semirigid ureterorenoscopy in this porcine model. ISO might be a potential additive to the irrigation fluid during upper urinary tract endoscopic procedures, minimizing pressure increases due to irrigation and manipulation.
BJU International - Tập 105 Số 1 - Trang 121-124 - 2010
Recurrent granular cell tumour of the bladder in a patient with von Recklinghausen’s disease
BJU International - Tập 84 Số 7 - Trang 871-872 - 1999
Genetic Associations of Transitional Cell Carcinoma
BJU International - Tập 51 Số 2 - Trang 73-77 - 1979
Trends in renal function after radical nephrectomy: a multicentre analysis Objective
To evaluate serial changes in renal function by investigating various clinical factors after radical nephrectomy (RN ). Patients and Methods
The study population consisted of 2068 consecutive patients who were treated at multiple institutions by RN for renal cortical tumour without metastasis between 1999 and 2011. We measured the serial change in estimated glomerular filtration rate (eGFR ) and clinical factors during a 60‐month follow‐up period. The changes in eGFR over time were analysed according to baseline eGFR (eGFR ≥60 and 15–59 mL/min/1.73m2 ) using a linear mixed model. The independent prognostic value of various clinical factors on the increase in eGFR was ascertained by multivariate mixed regression model. Results
Overall, there was a subsequent restoration of renal function over the 60 months. The slope for the relationship between the eGFR and the time since RN was 0.082 (95% confidence interval [CI ] 0.039–0.104; P < 0.001) and 0.053 (95% CI 0.006–0.100; P = 0.038) in each baseline group, indicating that each month after RN was associated with an increase in eGFR of 0.082 and 0.053 mL/min/1.73m2 , respectively. When we analysed renal function based on various factors, postoperative eGFR of patients with diabetes mellitus, old age (≥70 years) or a preoperative eGFR of <30 mL/min/1.73 m2 , was decreased or maintained at a certain level without any improvement in renal function. Preoperative predictors of an increase in eGFR after RN were young age, no DM , no hypertension, a preoperative eGFR of ≥30 mL/min/1.73m2 and time after surgery (≥36 months). Conclusions
Renal function recovered continuously during the 60‐month follow‐up period after RN . However, the trends in functional recovery change were different according to various clinical factors and such information should be discussed with patients when being counselled about their treatment for renal cell carcinoma (RCC ).
BJU International - Tập 113 Số 3 - Trang 408-415 - 2014
Impact of ischaemia time on renal function after partial nephrectomy: a systematic review Objective To assess the impact of ischaemia on renal function after partial nephrectomy (PN ). Materials and methods A literature review was performed according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA ) criteria. In January 2015, the Medline and Embase databases were systematically searched using the protocol (‘warm ischemia’[mesh] OR ‘warm ischemia’[ti]) AND (‘nephrectomy’[mesh] OR ‘partial nephrectomy’[ti]). An updated search was performed in December 2015. Only studies based on a solitary kidney model or on a two‐kidney model but with assessment of split renal function were included in this review. Results Of the 1119 studies identified, 969 abstracts were screened after duplicates were removed: 29 articles were finally included in this review, including nine studies that focused on patients with a solitary kidney. None of the nine studies adjusting for the amount of preserved parenchyma found a negative impact of warm ischaemia time on postoperative renal function, unless this was extended beyond a 25‐min threshold. The quality and the quantity of preserved parenchyma appeared to be the main contributors to postoperative renal function. Conclusion Currently, no evidence supports that limited ischaemia time (i.e. ≤25 min) has a higher risk of reducing renal function after PN compared to a ‘zero ischaemia’ technique. Several recent studies have suggested that prolonged warm ischaemia (>25–30 min) could cause an irreversible ischaemic insult to the surgically treated kidney.
BJU International - Tập 118 Số 5 - Trang 692-705 - 2016
Long‐term response to renal ischaemia in the human kidney after partial nephrectomy: results from a prospective clinical trial Objective To assess the 1‐year renal functional changes in patients undergoing partial nephrectomy with intra‐operative renal biopsies. Patients and Methods A total of 40 patients with a single renal mass deemed fit for a partial nephrectomy were recruited prospectively between January 2009 and October 2010. We performed renal biopsies of normal renal parenchyma and collected serum markers before, during and after surgically induced renal clamp ischaemia during the partial nephrectomy. We then followed patients clinically with interval serum creatinine and physical examination. Results Peri‐operative data from 40 patients showed a transient increase in creatinine levels which did not correlate with ischaemia time. Renal ultrastructural changes were generally mild and included mitochondrial swelling, which resolved at the post‐perfusion biopsy. A total of 37 patients had 1‐year follow‐up data. Creatinine at 1 year increased by 0.121 mg/dL , which represents a 12.99% decrease in renal function from baseline (preoperative creatinine 0.823 mg/dL , estimated glomerular filtration rate = 93.9 mL/min/1.73 m2 ). The only factors predicting creatinine change on multivariate analysis were patient age, race and ischaemia type, with cold ischaemia being associated with higher creatinine level. Importantly, the duration of ischaemia did not show any significant correlation with renal function change, either as a continuous variable (P = 0.452) or as a categorical variable (P = 0.792). Conclusions Our data suggest that limited ischaemia is generally well tolerated in the setting of partial nephrectomy and does not directly correspond to long‐term renal functional decline. For surgeons performing partial nephrectomy, the kidney can be safely clamped to ensure optimum oncological outcomes.
BJU International - Tập 117 Số 5 - Trang 766-774 - 2016
STAPHYLOCOCCIC INFECTIONS IN THE FEMALE URETHRA AND GENITALIA
BJU International - Tập 10 Số 4 - Trang 392-399 - 1938
A STUDY OF 310 CASES OF ENURESIS TREATED BY URETHRAL DILATATION*
BJU International - Tập 13 Số 3 - Trang 149-162 - 1941
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