Horseshoe kidney with retrocaval ureter: one case report.

Horseshoe kidney and retrocaval ureter are uncommon congenital anomalies of the genitourinary system that are easily diagnosed by typical imaging features. Both anomalies presenting in one patient is a rare disease characterized by isthmus of horseshoe kidney between the abdominal aorta and inferior vena cava. The clinical diagnosis and treatment of horseshoe kidney with retrocaval ureter remain a challenge. Here, we reported a case of a 44-year-old man with the two anomalies who was preoperatively diagnosed by unenhanced computed tomography scanning immediately after retrograde pyelography. The literatures on such combined anomalies are reviewed and the diagnostic evaluation and surgical management of this rare entity are discussed.

Pilot study of intravesical instillation of two new generation anthracycline antibiotics in prevention of superficial bladder cancer recurrence.

BACKGROUND: Superficial bladder cancer accounts for 60% - 70% of all bladder cancer cases in China, when treatment consists of only transurethral resection of the bladder tumor (TUR-BT), recurrence and progresses in the bladder are observed in some patients. There are numerous reports of trials of intravesical instillation of anticancer agents with the objective of lowering this recurrence rate. The aim of this study was to compare the prophylactic efficacy and safety of epirubicin (EPI), pirarubicin (THP) and hydroxycamptothecin (HCPT) in superficial bladder cancer. METHODS: This study enrolled a total of 189 patients who had been diagnosed with superficial bladder cancer during the period from 2004 through 2007 at Beijing Friendship Hospital. All patients were randomly allocated to one of three treatment groups. Patients in group A received 29 doses of EPI 30 mg/30 ml, patients in group B received 29 doses of THP 30 mg/30 ml, and patients in group C received 29 doses of HCPT 30 mg/30 ml, over a period of 24 months. RESULTS: The recurrence-free rate in the 2 anthracycline treatment groups (A and B) were significantly better than that of the HCPT treatment group. In the safety evaluation, the incidences of pollakiuria, pain on urination, dysuria, hematuria, and contracted bladder were not significantly different between groups A and B, but some were significantly higher in groups A and B than that in group C. CONCLUSION: The efficacy of EPI and THP was significantly better than HCPT in the prevention of bladder cancer recurrence.

[Clinical study of application of sirolimus with dose-reduced or discontinued cyclosporine A for prevention of acute rejection after kidney transplantation].

OBJECTIVE: To study the clinical efficacy, safety and feasibility of sirolimus (SRL) for preventing acute rejection of kidney transplantation. METHODS: Thirty patients with end-stage kidney dysfunction received kidney transplants from June 2004 to December 2004. There were 21 male and 9 female aged from 22 to 67 years old, with a mean of (46.3 +/- 10.0) years old. SRL was used in primary immunosuppression therapy to prevent acute rejection after surgery, and all of them were treated in combination with dose-reduced cyclosporine A (CsA) and steroid. CsA reduction began 3 months after the surgery, the weekly dose of CsA about 10 to 25 percent reduction until completely discontinued. During a 4-year follow-up period, the adverse events, acute rejection and infection were observed and recorded in detail. The graft function and other laboratory indicators were checked and analyzed. RESULTS: Of the 30 patients, 4 recipients died, patients survival rate was 86.7%. In other 26 cases, 25 recipients had good graft function, the average blood creatinine was (103.8 +/- 4.6) micromol/L at the end of 4(th) year and the incidence of acute rejection was 6.7% (2/30). The side effects included hyperlipidemia, proteinuria, delayed healing incision, lactate dehydrogenase increased and joint pain. CONCLUSION: The combination of sirolimus with dose-reduced CsA till completely discontinued and steroid to prevent acute rejection of kidney transplantation is safe and efficient.

[Carcinoma recurrence rates after laparoscopic nephroureterectomy in patients undergoing transurethral incision of the ureteral orifice and open excision of bladder cuff].

OBJECTIVE: To compare the oncologic efficacy of transurethral incision of the ureteral orifice and open excision of bladder cuff in retroperitoneal laparoscopic nephroureterectomy (LNU) for patients with upper tract urothelium carcinoma. METHODS: The hospital records of 86 patients with upper tract urothelium carcinoma who underwent laparoscopic nephroureterectomy were reviewed retrospectively. 53 of the 86 patients, 22 males and 31 females, aged (68.6+/-14.1), underwent transurethral incision of the ureteral orifice (TUIUO), and 33, 14 males and 19 females, aged (72.4+/-15.2), underwent open excision of bladder cuff. Electric cauterization of the ureteral orifice was performed prior to resection. Follow-up was conducted for 28 (3-47) months. RESULTS: In all the specimens in the TUIUO group scar at the ureter orifice caused by electric excision could be seen. Test to check the pressure of distal ureter in 25 specimens proved that the ureters were all sealed. The distal ureter end began to leak at the water pressure of 135 cm in 1 case, at the water pressure of 167 cm in 1 case, and at 175 cm in 2 cases, but no leaking was seen even at 197 cm H2O in the other cases. Recurrence of bladder tumor was seen in 13 of the 53 patients of the TUIUO group and in 8 of the 33 patients of the open excision of bladder cuff group. Local recurrence developed in one case with the tumor at stage pT4N0M0 8 months after operation. CONCLUSION: Electric cauterization of the ureteral orifice prior to resection effectively ensures the leakproofness of the distal ureter end during LNU. As compared with open excision of bladder cuff, TUIUO does not increase the rate of neoplasm recurrence.

Prevalence and influential factors of erectile dysfunction in male renal transplant recipients: a multiple center survey.

BACKGROUND: Renal transplants can improve the quality of life for recipients, but the quality of their sexual life might not be improved. This study was conducted to research the prevalence of erectile dysfunction (ED) and the influential factors in male renal transplant recipients (RTRs). METHODS: A cross-sectional survey was conducted in three renal transplantation centers. Structured questionnaires were administrated by trained interviewers to 824 male renal transplant patients, who had active sexual lives in the last 6 months. RESULTS: Complaints of ED were reported by 75.5% of the 809 RTRs (age range 19 - 75 years, mean age (45 +/- 10) years), whose questionnaires were completed. Mild, moderate and severe ED were reported at 53.6%, 8.3% and 13.6%, respectively. The mean age and the graft duration were significantly higher in male RTRs with ED compared to potent graft recipients (P = 0.00 and 0.04, respectively). The prevalence of ED increased with the increase in age. It was 60.7%, 65.8%, 75.2%, 87.5% and 92.2% in patients with age below 30 years, 31 - 40 years, 41 - 50 years, 51 - 60 years and over 60 years, respectively (P = 0.000). Moreover, the severity of ED increased with aging. The percentage of moderate and severe cases of ED increased from 6.7% in patients below 40 years to 28.9% in those over 40 years (P = 0.000). The prevalence of ED in the RTR who had no occupation was higher than in those who were holding a position (P = 0.001). The prevalence of ED decreased with the increase in the education level. The prevalence of ED was 94.3%, 86.4%, 74.0% and 67.8% in men with elementary school or lower, middle school, high school, and college or higher degrees, respectively (P = 0.000). Patients, whose distal end of arteria iliaca interna was interrupted and underwent iterative transplantation, worried transplanted kidney function was impacted by sexual life, and received cyclosporine (CsA)-based immunosuppressive regimens, were more likely to have ED (P = 0.000, 0.001, 0.000, 0.000, respectively). After Logistic regression analysis, only five factors, age, education level, interruption of arteria iliaca interna distal end, worrying transplanted kidney function impacted by sexual life and CsA-based immunosuppressive regimens sustained their significance. CONCLUSIONS: Renal transplant has varying effects on erectile function. ED is highly prevalent among RTRs and its influential factors are multiple. Age, education level, interruption of arteria iliaca interna distal end, worrying transplanted kidney function impacted by sexual life, CsA-based immunosuppressive regimens are the main influential factors of ED in male RTRs.

[Differentiation of prostate cancer from benign prostatic disease by total prostate specific antigen dynamic profiles after transrectal prostate biopsy].

OBJECTIVE: To investigate the possibility of differentiating prostate cancer (PCa) from benign prostatic disease by total prostate specific antigen (T-PSA) dynamic profiles following transrectal prostate biopsy, and to determine the cutoff value of the T-PSA ratio between pre- and post-biopsy. METHODS: A total of 36 men at the mean age of 69.89 years with increased serum PSA underwent prostate biopsy guided by transrectal ultrasound, followed by measurement of T-PSA at 10, 30, 60 and 90 min, plotting of T-PSA dynamic profiles and calculation of the pre- and post-biopsy T-PSA ratio at different time points. The patients were divided into a PCa and a non-PCa group according to the pathological results and compared for the difference in T-PSA ratios. The cutoff value of the pre- and post-biopsy T-PSA ratio was determined for the differentiation of PCa from benign prostatic diseases. RESULTS: The post-biopsy T-PSA ratio was obviously higher in the non-PCa than in the PCa group (P < 0.05). With the ROC curve applied, the cutoff value of the T-PSA ratio was 1.5 and the best time for blood sampling was 30 minutes after the biopsy, with a 75% sensitivity and a 93% specificity. CONCLUSION: Evaluation of the T-PSA ratio 30 minutes after biopsy might help screen the high-risk PCa population. Biopsy should be repeated for those with a lower T-PSA ratio in spite of initial benign results. The results are to be further supported by more prospective studies.

[Xuanju compound capsule combined with erogenous focus exercise is effective for premature ejaculation].

OBJECTIVE: To investigate the effect of the Chinese medicine Xuanju compound capsule combined with erogenous focus exercise on premature ejaculation. METHODS: Fifty-two patients with premature ejaculation were divided into a treatment group (n = 28) and a control group ( n = 24) , both treated by erogenous focus exercise and the former given Xuanju compound capsule in addition. After four weeks of treatment, comparisons were made of the sexual satisfaction between the two groups. RESULTS: The cure rate and the rate of improvement of sexual satisfaction were 21.43% and 67. 86% respectively in the treatment group, significantly higher than in the control group. CONCLUSION: Xuanju compound capsule combined with erogenous focus exercise is highly effective in the treatment of premature ejaculation, with few adverse effects.

[Evaluation of sexual function in men with symptomatic benign prostatic hyperplasia].

OBJECTIVE: To evaluate the degree of sexual dysfunction in an unselected population of men with benign prostatic hyperplasia (BPH) accompanied by lower urinary tract symptoms (LUTS), and to assess the correlation between sexual dysfunction and urinary symptoms and age. METHODS: A total of 88 men with symptomatic BPH were investigated using the International Prostate Symptom Score (IPSS), International Index of Erectile Function-5 (IIEF-5), Brief Sexual Function Inventory (BSFI), and the measurement of urinary flow rate, the total prostatic volume and serum testosterone. Regression analysis was used to determine the correlation among the variables. RESULTS: The mean age of the patients was (67.90 +/- 7.59) years, the mean IPSS score was (18.4 +/- 7. 79), and the mean IIEF-5 was (8.50 +/- 8.98). There were 76 cases of erectile dysfunction (86.36%). Among the BSFI scores, the mean sexual drive score was (1.92 +/- 2.21), the mean erectile function score was (4.18 +/- 4.96), the mean ejaculation score was (2.55 +/- 3.57), the mean problem assessment score was (10.44 +/- 3.57), and the mean overall satisfaction score was (1.90 +/- 1.37). Among the 88 cases, 65 (72.86%) had poor sexual drive, 70 (79.55%) erectile dysfunction, and 60 (68.18%) poor ejaculation. There was statistically significant correlation between age and sexual symptom scores for erection (gamma = -0.552, P = 0.000), IIEF-5 scores (gamma = - 0.567, P = 0.000), and IPSS (gamma = 0.213, P = 0.047) as well as between IPSS and sexual symptom scores for erection and overall satisfaction (gamma = -0.332, P = 0.002 and gamma = -0.302, P = 0.005). IIEF-5 scores were significantly correlated with sexual symptom scores for each of the three categories (sexual drive, erection and ejaculation) (P < 0.05). Serum testosterone did not correlate to age, IIEF-5 scores and sexual function (P > 0.05), nor did peak urinary flow rate and total prostatic volume to IPSS, IIEF-5 scores and sexual function (P > 0.05). CONCLUSION: Results of this study suggest that age and LUTS are risk factors of sexual function, and sexual dysfunction is closely related to the severity of LUTS.

Efficacy of low-dose tamsulosin in chinese patients with symptomatic benign prostatic hyperplasia.

OBJECTIVE: To determine the efficacy and tolerability of low-dose tamsulosin 0.2 mg/day in Chinese patients with symptomatic benign prostatic hyperplasia (BPH). METHODS: A total of 505 patients were enrolled in a 6-week nonblind, multicentre study, and 499 patients were followed for the entire 6-week treatment period. After a 2-week washout period, patients with confirmed symptomatic BPH were treated with tamsulosin 0.2mg daily. International Prostate Symptom Score (I-PSS), quality-of-life (QOL) index, maximum urinary flow rate (Q(max)) and average urinary flow rate (Q(ave)) were the efficacy parameters. Adverse events and variations in blood pressure and heart rate were also monitored. RESULTS: Total I-PSS and QOL index scores were improved from baseline with an average score reduction of 7.50 and 1.40, respectively (p < 0.01). Mean Q(max) and Q(ave) were increased by an average of 4.33 mL/sec (p < 0.01) and 2.04 mL/sec, respectively (p < 0.01). A subgroup analysis showed that total I-PSS, QOL index and Q(max) were significantly improved irrespective of baseline I-PSS, age, duration of BPH, comorbid conditions, or the use of concomitant antihypertensive agents. A positive correlation was noted between improvement in total I-PSS and QOL index (r = 0.70). Relative to baseline, systolic and diastolic blood pressure decreased by a mean of 3.35mm Hg and 2.74mm Hg, respectively (p < 0.01). A total of 28 treatment-related adverse reactions were reported in 24 patients (4.75%), the majority of which were mild dizziness and headache. CONCLUSIONS: Low-dose tamsulosin 0.2 mg/day has a favourable efficacy and tolerability profile in Chinese patients with symptomatic BPH irrespective of the baseline characteristics of these patients. No serious, unexpected adverse effects were identified.