Objective To assess the necessity and safety of ureteral stenting after ureteroscopic lithotripsy in treatment of middle and distal ureteral calculi. Methods We electronically searched MEDLINE, EMbase, Cochrane Library, CBM, VIP and CNKI to collect randomized controlled trials (RCTs) involving men with or without ureteral stenting after ureteroscopic lithotripsy from 2000 to March 2010. The quality of included trials was assessed. Data were extracted and analyzed with RevMan5.0 software. Results Six RCTs involving 543 patients were identified. The results of meta-analysis showed that: a) There was no statistical difference between two groups in stone clearance rate (RR=0.45, 95% CI 0.98 to 1.01, P=0.15), dysuria rate (RR=1.35, 95% CI 0.99 to 1.84, P=0.06), and hematuria rate (RR=2.12, 95% CI 1.00 to 4.49, P=0.05); b) There was statistical difference between two groups in frequent micturition rate (RR=2.17, 95% CI 1.13 to 4.17, P=0.02), the mean visual analog score 3 days postoperatively (WMD=0.94, 95% CI 0.47 to 1.42, P=0.000?1), and the operation time (WMD=3.57, 95% CI 1.40 to 5.72, P=0.001). Without postoperative ureteral stenting can shorten the operation time, decrease the irritation signs of bladder, and can improve quality of postoperative life without influence on stone clearance. Couclusions The routine ureteral stenting after ureteroscopic lithotripsy may be not necessary in order to keep patients from unsafety. More reasonable randomized double blind controlled trails with large sample are required to provide proofs with high quality because the methodology quality of included studies is lower.
目的 总结1例腹膜后神经鞘瘤合并胃神经鞘瘤的临床诊疗方法。 方法 2010年12月收治1例女性患者，因呕血行CT检查发现胃体前壁及右肾上腺区占位入院，行胃楔形切除术及右肾上腺肿瘤切除术治疗。 结果 术后病理证实为腹膜后神经鞘瘤合并胃神经鞘瘤，随访半年无复发。 结论 腹膜后神经鞘瘤合并胃神经鞘瘤病例罕见且诊断困难，影像学检查缺乏特异性，可依靠术后病理检查确诊；外科手术完整切除肿瘤是有效的治疗方法，预后较好。
Objective To evaluate the effectiveness and safety of chemotherapeutics bladder irrigation (CBI) after transurethral resection (TR) in the treatment of cystitis glandularis (CG). Methods Databases including MEDLINE, The Cochrane Library, EMbase, VIP, CNKI and CBM were searched from January 2001 to November 2011 to collect randomized controlled trials (RCTs) and case-control studies (CCSs) on pirarubicin or mitomycin bladder irrigation after TR in the treatment of CG. Two reviewers independently screened articles according to the inclusion and exclusion criteria, extracted data and evaluated the quality of the included studies. Then meta-analysis was performed using RevMan 5.0. Results A total of 11 articles involving 5 RCTs and 6 CCSs were included. Among the total 1032 patients involved, 497 patients were in the control group treated by TR alone, while the other 535 patients were in the treatment group given CBI after RT. There were two subgroups, one involving 347 patients irrigated by pirarubicin in 7 studies, and the other involving 188 patients irrigated by mitomycin in 4 studies. The results of meta-analysis showed: (a) pirarubicin bladder irrigation after TR could increase both short-term and long-term cure rates and decrease both short-term and long-term relapse rates, but no significant differences were found in both short-term and long-term improvement rates, compared with the control group. As for the safety, pirarubicin was similar to the control group in the incidence of urinary irritation, but it was superior in the incidence of bloody urine; and (b) mitomycin bladder irrigation after TR could increase long-term cure rate and decrease long-term relapse rate, but no significant differences were found in short-term cure rate and short-term improvement rate, compared with the control group. Mitomycin was similar to the control group in incidence of urinary irritation and bloody urine. Sensitivity analyses indicated the outcomes regarding to some indexes in different studies were inconsistent. Conclusion Based on the current evidence, pirarubicin or mitomycin bladder irrigation after TR can increase long-term cure rate and decrease long-term relapse rate in treating CG, but pirarubicin tends to easily cause bloody urine. For the inconsistent outcomes of different studies, the results of this meta-analysis are instable and highly possible to be inconsistent to the future outcomes, hereby it is uncertain of the better effectiveness of CBI after, TR compared with TR alone, and more high-quality and large-scale RCTs are needed to be performed.