Publications by authors named "Junhong Fan"

16 Publications

  • Page 1 of 1

Erectile Dysfunction in Type-2 Diabetes Mellitus Patients: Predictors of Early Detection and Treatment.

Urol Int 2021 May 5:1-7. Epub 2021 May 5.

Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, China.

Purpose: To identify risk factors and potential predictors of erectile dysfunction (ED) in type-2 diabetes mellitus (T2DM) patients for early detection and treatment.

Methods: A retrospective cohort was used to assess the clinical data of 105 diabetic patients with ED from May 2019 to April 2020 age-matched to 105 diabetic patients without ED. Potential risk factors that could contribute to ED were compared between the groups. Erectile function was evaluated using the International Index of Erectile Function-5 questionnaire.

Results: There were higher rates of diabetic peripheral neuropathy (p = 0.036) and retinopathy (p < 0.001), longer duration of diabetes (p < 0.001), lower estimated glomerular filtration rate (p = 0.010) values, and higher uric acid (p < 0.001) and C-reactive protein (p = 0.001) levels in the ED group compared to the non-ED group. Multivariate logistic analysis identified uric acid, diabetic retinopathy, and T2DM course as independent predictors of diabetic ED. Diabetics with retinopathy and T2DM for ≥49 months were 3.028 and 3.860 times more likely to have ED, respectively. Uric acid values ≥392.5 μmol/L were associated with 18.638 times greater risk of having ED, though the values were within normal range.

Conclusion: In T2DM patients, higher uric acid (≥392.5 μmol/L), longer diabetes duration (≥49 months), and the presence of diabetic retinopathy were important and reliable predictors for diabetic ED. For patients who have high risk factors for developing ED, diligent screening and early treatment are necessary.
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http://dx.doi.org/10.1159/000514700DOI Listing
May 2021

Administration of HS improves erectile dysfunction by inhibiting phenotypic modulation of corpus cavernosum smooth muscle in bilateral cavernous nerve injury rats.

Nitric Oxide 2021 02 24;107:1-10. Epub 2020 Nov 24.

Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China. Electronic address:

Phenotypic modulation of Corpus Cavernosum Smooth Muscle Cells (CCSMCs) is an important step in the development and progression of bilateral cavernous nerve injury induced erectile dysfunction (BCNI-ED). To investigate the effect of exogenous hydrogen sulfide (HS) on the phenotypic modulation of CCSMCs in BCNI-ED rats, a total of 18 male Sprague-Dawley rats were equally divided into 3 groups, including sham-operated (Sham) group, BCNI group and BCNI treated with NaHS (BCNI + NaHS) group. The treated group received intraperitoneal injection of NaHS (100 μmol kgday) for 4 weeks starting day 1 postoperatively. Erectile function was measured by the ratio of intracavernous pressure (ICP)/mean arterial pressure (MAP), and relevant tissues were harvested for Immunohistochemistry, Hematoxylin and eosin (H&E), Masson's trichrome staining, HS fluorescent probe WSP-1 and Western blot. The primary CCSMCs were isolated and pretreatment with NaHS before exposed to PDGF-BB (platelet-derived growth factor). Relative expression mRNA and protein of phenotypic biomarkers, RhoA, ROCK-1 and cell cycle proteins were detected. Cystathionine-β-synthase (CBS) and cystathionine-γ-lyase (CSE), 3-mercaptopyruvate sulfurtransferase (3-MST) and HS levels in penile tissue was significantly decreased in the BCNI group compared with the Sham group. Compared with the BCNI group, administration of NaHS significantly increased the ratio of ICP/MAP, ratio of smooth muscle to collagen, expressions of a-SMA, calponin and decreased the expression of OPN, collagen-I, RhoA, ROCK1 in the penile tissue. PDGF-BB-treated CCSMCs exhibited higher expression of OPN, RhoA, ROCK1, and lower α-SMA, calponin, which were attenuated by NaHS pretreatment. NaHS suppressed RhoA/ROCK activity and decreased the expression of CDK2, Cyclin E, while increased the expression of P27 induced by PDGF-BB in CCSMCs. Taken together, this study indicated that exogenous HS inhibited the phenotypic modulation of CCSMCs by suppressing RhoA/ROCK1 signaling and affecting its downstream factor, CDK2, Cyclin E P27, thereby improved BCNI rat erectile function.
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http://dx.doi.org/10.1016/j.niox.2020.11.003DOI Listing
February 2021

Corrigendum to "Sodium Tanshinone IIA Sulfonate Attenuates Erectile Dysfunction in Rats with Hyperlipidemia".

Oxid Med Cell Longev 2020 15;2020:1062074. Epub 2020 Oct 15.

Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.

[This corrects the article DOI: 10.1155/2020/7286958.].
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http://dx.doi.org/10.1155/2020/1062074DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7585669PMC
October 2020

Sodium Tanshinone IIA Sulfonate Attenuates Erectile Dysfunction in Rats with Hyperlipidemia.

Oxid Med Cell Longev 2020 4;2020:7286958. Epub 2020 Mar 4.

Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.

Hyperlipidemia is considered one of the most important risk factors for erectile dysfunction (ED). To determine the effect of sodium tanshinone IIA sulfonate (STS) as an antioxidant agent on ED in high-fat diet- (HFD-) induced hyperlipidemia in rats and to investigate if STS administration could improve erectile function via hydrogen sulfide (HS) production by inhibition of oxidative stress. Hyperlipidemia was induced in Sprague-Dawley rats by feeding HFD for 16 weeks. The rats were randomly divided into 3 groups: control, HFD, and HFD treated with STS (10 mg/kg/day for 12 weeks, intraperitoneal injection). Erectile function including intracavernosal pressure (ICP), HS production, and antioxidant capacity was assessed. In addition, cavernosal smooth muscle cells (CSMC) isolated from SD rats were pretreated with STS in vitro and exposed to HO. Expressions of nuclear factor erythroid 2-related factor 2 (Nrf2)/heme oxygenase-1 (HO-1), activity of antioxidant enzymes, and HS-generating enzymes within CSMC were examined. ICP was significantly decreased in HFD rats compared with control. In addition, decreased HS production and expression of cystathionine -lyase (CSE) and cystathionine -synthase (CBS) associated with increased oxidative stress were observed in the penile tissue of HFD rats. However, all these changes were reversed by 16 weeks after STS administration. STS also increased antioxidant defense as evidenced by increased expression of Nrf2/HO-1 in the penile tissue of HFD rats. In CSMC, pretreatment with STS attenuated the decreased expression of CSE and CBS and HS production by HO. STS exerted similar protective antioxidative effect as shown in the in vivo hyperlipidemia model. The present study demonstrated the redox effect of STS treatment on ED via increased HS production in HFD-induced hyperlipidemia rat model by increased antioxidant capacity via activation of the Nrf2/HO-1 pathway, which provides STS potential clinical application in the treatment of hyperlipidemia-related ED.
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http://dx.doi.org/10.1155/2020/7286958DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7081035PMC
October 2020

Recommended antibiotic prophylaxis regimen in retrograde intrarenal surgery: evidence from a randomised controlled trial.

BJU Int 2019 09 20;124(3):496-503. Epub 2019 Jun 20.

Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.

Objective: To study the incidence of postoperative systemic inflammatory response syndrome (SIRS) following different antibiotic prophylaxis (ABP) regimens in retrograde intrarenal surgery (RIRS).

Patients And Methods: Single-centre, randomised, controlled trial (August 2014-September 2017) including 426 patients with renal stones with preoperative sterile urine managed by RIRS (ClinicalTrials.gov NCT02304822). Different ciprofloxacin-based ABP regimens were used and included a zero dose, single dose (30 min before surgery) or two doses (first dose at 30 min before RIRS and additional dose within 6 h after RIRS). The incidence of SIRS was compared using intention-to-treat (ITT) and per-protocol (PP) analyses.

Results: Each group enrolled 142 patients. In the ITT analysis, a zero dose of ABP was statistically similar to the two ABP regimes for the incidence of SIRS (9.9% vs single dose 4.9%, P = 0.112; vs two doses 4.2%, P = 0.062). There were also no relevant differences across groups in the PP analysis; no urosepsis was recorded. In subgroup analysis with stratification by stone area, the three regimens all had a low and similar incidence of SIRS for stones of ≤200 mm in the ITT analysis with a sufficient power value (5.4% vs 6.2% vs 3.6%, P = 0.945 vs single dose and P = 0.553 vs two doses). However, there was a greater chance of SIRS in patients who received no ABP with stones of >200 mm (18% vs single dose 4.3%, P = 0.036; vs two doses 5.5%, P = 0.044). Similar trends were seen in the PP analysis.

Conclusions: For patients with preoperative sterile urine, ABP is not strongly recommended in patients with stones of ≤200 mm , but for stones >200 mm single-dose ABP is still required.
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http://dx.doi.org/10.1111/bju.14832DOI Listing
September 2019

The role of super-mini percutaneous nephrolithotomy (SMP) in the treatment of symptomatic lower pole renal stones (LPSs) after the failure of shockwave lithotripsy (SWL) or retrograde intrarenal surgery (RIRS).

Urolithiasis 2019 Jun 15;47(3):297-301. Epub 2018 Jun 15.

Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.

To assess the safety and efficacy of super-mini percutaneous nephrolithotomy (SMP) in the treatment of symptomatic lower pole renal stones (LPSs) after the failure of shockwave lithotripsy (SWL) or retrograde intrarenal surgery (RIRS), we retrospectively evaluated 44 patients with symptomatic LPSs with previously failed SWL or RIRS and consequently underwent SMP from October 2014 to March 2016. The percutaneous renal access was performed 12-14F with C-arm fluoroscopy or ultrasonographic guidance. Stone disintegration was performed using either Holmium laser or pneumatic lithotripter. Perioperative parameters along with operations were assessed in detail. A total of 44 patients (mean age 49.1 ± 13.7 years) were included in the study. Stone size was 18.4 ± 6.0 mm (range 9-29), operative time was 63.9 ± 32.7 min (range 14-145) and hospital stay was 2.8 ± 1.2 days (range 1-5). The hemoglobin drop was 12.4 ± 8.8 g/L (range 0-31), and no patients required blood transfusion. Complete stone-free status was achieved in 40 (90.9%) patients. Clinically insignificant residual fragments were observed in three (6.8%) patients and only one (2.3%) patient had a 6 mm residual calculus. A total of three minor complications (urinary tract infection, hemorrhage resolved by hemostatics and renal colic requiring analgesics) were observed postoperatively. For symptomatic LPSs after the failure of SWL or RIRS, SMP is a safe and efficient auxiliary option and even might be an alternative to SWL or RIRS, while further considering the stone-free rates and stone-related events.
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http://dx.doi.org/10.1007/s00240-018-1068-4DOI Listing
June 2019

Super-mini percutaneous nephrolithotomy (SMP) vs retrograde intrarenal surgery for the treatment of 1-2 cm lower-pole renal calculi: an international multicentre randomised controlled trial.

BJU Int 2018 12 26;122(6):1034-1040. Epub 2018 Jul 26.

Department of Urology, Dr. Lutfi Kirdar Kartal Research and Training Hospital, Istanbul, Turkey.

Objectives: To compare the safety and effectiveness of super-mini-percutaneous nephrolithotomy (SMP) and retrograde intrarenal surgery (RIRS) for the treatment of 1-2 cm lower-pole renal calculi (LPC).

Patients And Methods: An international multicentre, prospective, randomised, unblinded controlled study was conducted at 10 academic medical centres in China, India, and Turkey, between August 2015 and June 2017. In all, 160 consecutive patients with 1-2 cm LPC were randomised to receive SMP or RIRS. The primary endpoint was stone-free rate (SFR). Stone-free status was defined as no residual fragments of ≥0.3 cm on plain abdominal radiograph of the kidneys, ureters and bladder, and ultrasonography at 1-day and on computed tomography at 3-months after operation. Secondary endpoints included blood loss, operating time, postoperative pain scores, auxiliary procedures, complications, and hospital stay. Postoperative follow-up was scheduled at 3 months. Analysis was by intention-to-treat. The trial was registered at http://clinicaltrials.gov/ (NCT02519634).

Results: The two groups had similar baseline characteristics. The mean (sd) stone diameters were comparable between the groups, at 1.50 (0.29) cm for the SMP group vs 1.43 (0.34) cm for the RIRS group (P = 0.214). SMP achieved a significantly better 1-day and 3-month SFR than RIRS (1-day SFR 91.2% vs 71.2%, P = 0.001; 3-months SFR 93.8% vs 82.5%, P = 0.028). The auxiliary procedure rate was lower in the SMP group. RIRS was found to be superior with lower haemoglobin drop and less postoperative pain. Blood transfusion was not required in either group. There was no significant difference in operating time, hospital stay, and complication rates, between the groups.

Conclusions: SMP was more effective than RIRS for treating 1-2 cm LPC in terms of a better SFR and lesser auxiliary procedure rate. The complications and hospital stay were comparable. RIRS has the advantage of less postoperative pain.
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http://dx.doi.org/10.1111/bju.14427DOI Listing
December 2018

The Influence of Super-Mini Percutaneous Nephrolithotomy on Renal Pelvic Pressure In Vivo.

J Endourol 2018 09 13;32(9):819-823. Epub 2018 Jul 13.

1 Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University , Guangzhou, China .

Objective: Renal pelvic pressure (RPP) is expected to rise during percutaneous procedures. A very small tract size was expected to bring high RPP, and super-mini percutaneous nephrolithotomy (SMP) uses a 14F sheath, which is even smaller than that used in mini-percutaneous nephrolithotomy, so the RPP in SMP was more worrisome. Interestingly, the sheath had suction, which aimed to decrease the RPP, so we measured the RPP in an in vivo model to explore the relationship of implying negative pressure through the sheath with the RPP.

Methods: Seventy-four consecutive patients were enrolled for RPP measurement during SMP between April 2016 and July 2017. Prospective RPP measurements were recorded using the MINDRAY-PM9000 monitor by connecting its baroceptor of the invasive blood pressure channel to a retrogradely inserted renal pelvic open-ended ureteric catheter. RPP data were collected each second by a computer program. All data were evaluated statistically with SPSS 13.0 software.

Results: During SMP with a 14F irrigation-suction sheath, the average RPP was 19.51 ± 5.83 mm Hg. The median accumulative time of RPP ≥30 mm Hg was 55 (3-345) seconds. Postoperative fever was recorded in four patients (5.4%). A receiver operating characteristic -curve analysis showed that when suction pressure was set to 0.03 Mpa (≈230 mm Hg), irrigation pressure between 200 and 250 mm Hg, and the irrigation flow to 320 mL/minute, the accumulative high RPP was more likely <50 seconds, and the sensitivity and specificity were 75.0% and 66.7%, respectively.

Conclusions: The RPP in SMP remains <30 mm Hg. Controlling the pressures as well as the flow of irrigating saline is important for the safety and efficiency of percutaneous procedures.
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http://dx.doi.org/10.1089/end.2018.0239DOI Listing
September 2018

miR-195 inhibits cell proliferation and angiogenesis in human prostate cancer by downregulating PRR11 expression.

Oncol Rep 2018 Apr 31;39(4):1658-1670. Epub 2018 Jan 31.

Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University and Guangdong Key Laboratory of Urology, Guangzhou, Guangdong 510230, P.R. China.

hsa-miR-195-5p (miR-195) has been proven to be a critical regulator in the progression of prostate cancer (PCa). To identify additional targets and molecular functions of miR-195, we overexpressed miR-195 by transient oligonucleotide transfection in DU145 and LNCaP cells and examined the effects. RNA-based microarray and dual-luciferase assays were carried out to identify novel targets of miR-195, while in vitro functional assays, a subcutaneous xenograft model, tissue microarray (TMA) analysis and a cohort of publicly available data (Taylor cohort) were used to investigate the biological function and clinical value of miR-195 targeting. The results shown that miR-195 overexpression could markedly suppress cellular proliferation and tube formation compared with miR-negative control. The RNA-based microarray identified a total of 153 differentially regulated genes with fold changes of ≤|1.5|, including 138 (90.2%) downregulated and 15 (9.8%) upregulated genes. Among the downregulated genes, we found that proline-rich protein 11 (PRR11) combined with miR-195 expression (miR-195/PRR11) could be used as an independent predictor of the risk of biochemical recurrence in the Taylor cohort. Additionally, the dual-luciferase assay identified PRR11 as a novel target of miR-195, and the in vitro assays indicated that PRR11 abrogated the suppressive effects of miR-195 on cell proliferation, tube formation and cell cycling. Furthermore, the subcutaneous tumor xenograft model indicated that knockdown of PRR11 inhibited xenograft growth and angiogenesis, while the results of the TMA and Taylor cohort analyses collectively demonstrated that PRR11 expression was upregulated in aggressive tumors and is associated with poor clinical outcome. Taken together, these findings further illustrate the suppressive role of miR-195 in PCa, and indicate a novel role of PRR11 in PCa. Importantly, the newly identified miR-195/PRR11 axis may aid with identifying potential therapeutic targets in PCa.
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http://dx.doi.org/10.3892/or.2018.6240DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5868402PMC
April 2018

Comparison of super-mini PCNL (SMP) versus Miniperc for stones larger than 2 cm: a propensity score-matching study.

World J Urol 2018 Jun 31;36(6):955-961. Epub 2018 Jan 31.

Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangzhou, China.

Purpose: To compare the efficacy and safety of Super-mini percutaneous nephrolithotomy (SMP, F12-F14) and Miniperc (F18) in the treatment of renal stones of 2-4 cm in size.

Methods: A prospective comparative analysis of outcomes of patients who underwent SMP and Miniperc for treatment of 2-4 cm renal stones was conducted between July 2014 and January 2017. Demographic data, stone criteria, operative technique, complications, blood transfusion, hemoglobin decrease, stone-free rate (SFR) and length of hospital stay were compared between the two groups. Propensity score-matching (PSM) analysis was performed to further compare the outcomes between the two groups.

Results: 79 and 257 patients underwent SMP and Miniperc, respectively. After matching, 73 patients in each group were included. The stone burden was comparable for both groups (3.0 ± 1.1 vs 3.2 ± 0.7 cm, p = 0.577). Mean operation time was not significant different between two groups (p = 0.115), while the hospital stay of SMP was much shorter than Miniperc (2.6 ± 1.4 vs 5.2 ± 1.8, p < 0.0001). Both groups had similar SFRs in postoperative 1 day and at 1 month follow-up (p = 0.326, p = 0.153), while SMP achieved a markedly higher tubeless rate than Miniperc (84.9 vs 47.9%, p < 0.0001). The total complication rate was significantly lower in SMP (16.4 vs 41.1%, p = 0.0001), and the SIRS rate was markedly lower in SMP group (1.4 vs 12.3%, p = 0.009).

Conclusions: SMP is equally effective as Miniperc in the treatment of moderate renal calculi, and has the significant advantage in hospital duration and tubeless rate.
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http://dx.doi.org/10.1007/s00345-018-2197-7DOI Listing
June 2018

Antibiotic prophylaxis in ureteroscopic lithotripsy: a systematic review and meta-analysis of comparative studies.

BJU Int 2018 07 11;122(1):29-39. Epub 2018 Jan 11.

Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.

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 (ORs) with 95% confidence intervals (CIs) 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 (fUTIs) 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.
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http://dx.doi.org/10.1111/bju.14101DOI Listing
July 2018

Percutaneous nephrolithotomy: position, position, position!

Urolithiasis 2018 Feb 21;46(1):79-86. Epub 2017 Nov 21.

Guangdong Key Laboratory of Urology, Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.

Percutaneous nephrolithotomy (PCNL) is the regular surgery for treating large or complex renal stones. Since its first inception, many variations have come in the approach including the modifications of patient position. The prone position is traditionally used, and subsequently, variations in prone and supine technique have been proposed and assessed over time. In an attempt to provide comprehensive information about the strategy applications of patient's position, the present review describes the position-related general basis, and provides a literature review of the pros and cons of various positions from a surgical and anaesthetic point of view. Latest evidence has shown the major advantages of supine PCNL compared with standard prone PCNL to be as follows: optimal cardiovascular and airway control; shorter operation time due to lack of the need for repositioning; opportunity for a combined retrograde approach. However, the prone position provides a broader surface area for percutaneous access; a wider space for manipulating the nephroscope and lithotripters; and opportunity for bilateral simultaneous PCNL. To overcome their respective limitations, various positioning modifications have been proposed. However, most reports are based on case series and/or have not obtained their results in a randomized controlled fashion and/or have not been analysed according to stone complexity and particular body status (e.g. obesity, etc.), thereby limiting the ability to make strong recommendations. One important caveat is that endourology training of supine PCNL would increase supine popularization, and the prone ureteroscopic technique would overcome the difficulty of endoscopic combined intrarenal surgery in the prone position. Thereby, adequate training in the different techniques for PCNL is important for optimizing the indications and treatment outcomes.
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http://dx.doi.org/10.1007/s00240-017-1019-5DOI Listing
February 2018

Prospective Comparative Study of the Efficacy and Safety of New-Generation Versus First-Generation System for Super-Mini-Percutaneous Nephrolithotomy: A Revolutionary Approach to Improve Endoscopic Vision and Stone Removal.

J Endourol 2017 11 10;31(11):1157-1163. Epub 2017 Oct 10.

1 Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University , Guangzhou, China .

Purpose: The study sought to compare the procedural and clinical results of super-mini-percutaneous nephrolithotomy (SMP) with the use of first- and new-generation devices.

Methods: A prospective, comparative cohort study was carried out between February 2013 and January 2017. Patients who underwent either first- or new-generation SMP were eligible for the study. Inclusion criteria were adult patients with renal stone <4 cm, or in pediatric patients with renal stone <2.5 cm with a history of failed extracorporeal shockwave lithotripsy. The primary outcome of the present study was the operating time, which was calculated from the starting of percutaneous puncture to the wound closure. Secondary outcomes were the stone-free rate (SFR), blood loss (hemoglobin decrease), hospital stay, and postoperative complications.

Results: One hundred fifty-six consecutive patients who underwent SMP for treatment of renal stones were eligible for the study, with the first 85 patients undergoing SMP with the first-generation device, and the remaining 71 consecutive patients being treated with the new-generation SMP system. The two groups of patients had comparable demographic data, including age, BMI, stone size, Guy's score, stone location, comorbidities, grade of hydronephrosis, and history of urinary tract infection. The new-generation SMP had a shorter operation time (39.3 vs 50.5 min, p = 0.016) and shorter postoperative hospitalization time (2.1 vs 3.0 days, p < 0.001) than the first-generation SMP. No significant difference existed between the two groups for SFR, hemoglobin decrease, and tubeless rate. The overall operative complication rates using the Clavien-Dindo grading system were similar between the two cohorts of patients.

Conclusion: The clinical outcomes of the new-generation SMP in patients with moderate-sized renal stone were comparable when compared with the first-generation SMP. New-generation SMP system using an irrigation/suction sheath improved intraoperative irrigation, a more efficient hydrodynamic mechanism for retrieval of fragments. This may account for the shorter operative time than the first-generation SMP system demonstrated in this study.
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http://dx.doi.org/10.1089/end.2017.0558DOI Listing
November 2017

The new generation super-mini percutaneous nephrolithotomy (SMP) system: a step-by-step guide.

BJU Int 2017 11 3;120(5):735-738. Epub 2017 Aug 3.

Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.

Objective: To present our novel miniaturised endoscopic system and describe a step-by-step guide for successful implementation of the super-mini percutaneous nephrolithotomy (SMP).

Patients And Methods: The new-generation SMP endoscopic system consists of (i) a 40 000-pixel super-mini nephroscope with an 8.0-F outer diameter and 7.5-F inner diameter dismountable sheath, and (ii) a newly designed irrigation-suction sheath available in either 12 F or 14 F. The irrigation-suction sheath is a two-layered metal structure. The key feature of the irrigation-suction sheath is to allow irrigation and suction respectively (the inflow through the space between the two layers of the sheath, the outflow through the central lumen of the sheath). This property improves irrigation and stone clearance despite reduced instrument dimension. In all, 59 patients with renal stones underwent new-generation SMP between April 2016 and December 2016. The percutaneous tract dilatation was carried out to 14 F. Lithotripsy was performed using either holmium laser or a pneumatic lithotripter. Stone fragments were sucked out by vacuum suctioning through the sheath. A nephrostomy tube or JJ stent was placed only if clinically indicated. Low-dose computed tomography was performed to assess the stone-free status on the morning after the procedure.

Results: The mean stone burden was 2.4 cm. Of the 59 patients, nine had diabetes and five had hypertension. SMP was completed successfully in all patients with a mean operation duration of 32.9 min and a mean haemoglobin decrease of 13 g/L. The stone-free rate was 91.5%. Complications occurred in 5.1% of the patients, all of them were Clavien-Dindo Grade I (minor fever managed by antipyretic therapy), and no transfusions were needed.

Conclusion: The new-generation SMP system is safe, feasible, and effective for managing renal calculi of <3 cm, with the advantages of a small percutaneous tract, less blood loss, high efficacy in stone clearance, improved visual field, short operation duration, and ease of operating.
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http://dx.doi.org/10.1111/bju.13955DOI Listing
November 2017

Predictors for uroseptic shock in patients who undergo minimally invasive percutaneous nephrolithotomy.

Urolithiasis 2017 Dec 22;45(6):573-578. Epub 2017 Feb 22.

Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.

To identify risk factors that can predict which patient is likely to progress from systemic inflammatory response syndrome (SIRS) to uroseptic shock after minimally invasive percutaneous nephrolithotomy (MPCNL) for the upper urinary tract stones. We retrospectively reviewed 156 patients who suffered infectious complications after MPCNL from March 2014 to February 2016. Perioperative risk factors that could potentially contribute to uroseptic shock were compared to those of patients with only SIRS. 135 of the 156 patients developed to SIRS only, the remaining 21 patients progressed to uroseptic shock. The rate of positive preoperative urine nitrite was significantly higher (p < 0.001), stone diameter was larger (p = 0.015) and operative time was longer (p < 0.001) in uroseptic shock group. Multivariable logistic analysis showed that preoperative urine nitrite (OR 10.570, p = 0.025), stone size (OR 11.512, p = 0.009) and postoperative blood leukopenia (OR 0.009, p < 0.001) were independently related to uroseptic shock. Moreover, ROC curve analysis showed that white blood count threshold within the first 3 h of uroseptic shock was 2.98 × 10/L. The sensitivity and specificity of leukocyte count in predicting uroseptic shock were 90.5 and 92.6%, respectively. Preoperative urine nitrite, stone size and postoperative leukocyte count are statistically linked to uroseptic shock after MPCNL. Leukopenia of less than 2.98 × 10/L within 3 h after MPCNL can be a predictor for uroseptic shock. For patients who have high risk factors for developing uroseptic shock, the white blood count should be measured within 3 h after MPCNL.
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http://dx.doi.org/10.1007/s00240-017-0963-4DOI Listing
December 2017

Determination of five sesquiterpenoids in Xingnaojing injection by quantitative analysis of multiple components with a single marker.

J Sep Sci 2015 Oct 27;38(19):3313-23. Epub 2015 Aug 27.

Chengde Medical University, Chengde, China.

A quantitative analysis of multiple components with a single-marker method was established for the simultaneous determination of five sesqutiterpenoids in Xingnaojing injection. This method was established with Xingnaojing injection determined by high-performance liquid chromatography coupled with diode array detection. The durability and system suitability of the established method were evaluated, and the reliable relative correction factors were obtained with curdione selected as an internal reference. The contents of the five components in all Xingnaojing injections were determined by external standard method and the contents of curcumenone, curcumenol, curzerenone, and germacrone were also calculated with the obtained relative correction factors. Then, relative error was investigated to estimate the difference of the two methods. As a result, the established new method possesses good adaptability, and there is no significant difference between the two methods, except for the content of curzerenone in eight samples. To put the established method into practice, the limits of quantitation of the established method of the five components were proposed and defined. Thus, the developed methodology can also be utilized to the quality evaluation of Xingnaojing injection, in spite of the difference found in the content of curzerenone between the external standard method and the newly established method.
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http://dx.doi.org/10.1002/jssc.201500494DOI Listing
October 2015