Feasibility and safety of laparoscopic radical cystectomy for male octogenarians with muscle-invasive bladder cancer.

This study was designed to evaluate the safety and feasibility of laparoscopic radical cystectomy (LRC) for male octogenarian patients with muscle-invasive bladder cancer (MIBC). Briefly, a total of 57 male octogenarian patients (A group) with bladder carcinoma were enrolled and underwent LRC and intracorporeal pelvic lymph node dissection with bilateral cutaneous ureterostomy from May 2016 to December 2022. Besides, 63 male patients (age < 80 years old) with bladder carcinoma undergoing LRC and 17 octogenarian male patients with bladder carcinoma undergoing open radical cystectomy (ORC) were enrolled in B and C groups as control. All perioperative clinical materials and outcomes of long-term follow-up, and complication were collected. The specific results were shown as follows. Compared with C group, the operation time and resected lymph node in A group was increased, and the estimated blood loss, the number of transfusion needed, duration of pelvic drainage and hospital stay after surgery was decreased. The death rate and ileus complication rate were higher in A group (12 cases) than in C group (15 cases). The cases of ureteral stricture in A group (13 cases) was decreased compared with that in C group. Overall, LRC and bilateral cutaneous ureterostomy are safe, feasible and better choices for the treatment of male octogenarian patients with MIBC. The octogenarian receiving cutaneous ureterostomy heals slowly and exists certain incomplete intestinal obstruction after surgery.

Bilateral adrenal hemorrhage after hip arthroplasty: an initially misdiagnosed case.

BACKGROUND: Bilateral adrenal hemorrhage (BAH) is a rare but potentially catastrophic condition. Its clinical manifestation is often non-specific and sometimes difficult to be diagnosed in time. A 57-year-old woman, who presented with severe fatigue, nausea and vomiting after left hip arthroplasty due to her femoral neck fracture in a local hospital, was transferred to our medical center. Laboratory results revealed significant hyponatremia, low serum cortisol and elevated serum ACTH. Computed tomography (CT) showed a bilateral adrenal mass, measured 3.6 × 2.7 cm on the left and 3.4 × 2.3 cm on the right. Further magnetic resonance imaging (MRI) confirmed the diagnosis of BAH. The patient was prescribed with oral prednisolone acetate, 5 mg, tid, and her condition improved gradually. Nine months after, the patient was in good condition with 5 mg prednisolone acetate per day. CT revealed a clearly shrunken adrenal mass compared with 9 months ago. CONCLUSIONS: This case illustrates the difficulty in making the diagnosis of BAH with atypical presentation. Such cases necessitate greater alertness on the part of the clinician and require rapid diagnosis and prompt glucocorticoid replacement for better clinical outcomes.

[A dosage regimen of M-receptor blocker after TURP for severe BPH with predominant urine storage symptoms].

OBJECTIVE: To study the dosage regimen of oral M-receptor blocker following transurethral resection of the prostate (TURP) for severe benign prostate hyperplasia (BPH) with predominant urine storage period symptoms (USPSs) and its clinical effect. METHODS: Severe BPH patients with predominant USPSs received oral tolterodine (2 mg q12d or 4 mg qd) 6 hours after TURP for 4 weeks. The medication continued for another 2 weeks in case of recurrence of USPSs or until the 12th week in case of repeated recurrence. Before and at 1, 4, 8 and 12 weeks after TURP, we analyzed the International Prostate Symptoms Score (IPSS), quality of life (QoL) score, maximum urinary flow rate (Qmax), and postvoid residual volume (PVR) of the patients. RESULTS: Complete clinical data were collected from 106 cases, of which 33 achieved successful drug withdrawal with no aggravation of USPSs at 4 weeks after TURP, 51 at 6－8 weeks, 13 at 10－12 weeks, and 9 needed medication after 12 weeks. Before and at 1, 4, 8 and 12 weeks after TURP, the total IPSSs were 25.33 ± 3.45, 19.33 ± 3.62, 11.56 ± 2.45, 8.38 ± 2.0 and 7.74 ± 1.87, those in the urine storage period were 11.97 ± 1.53, 10.76 ± 1.82, 6.16 ± 1.22, 4.08 ± 1.19 and 3.91 ± 1.15, those at urine voiding were 9.80 ± 1.60, 5.59 ± 1.45, 3.40 ± 0.92, 2.85 ± 0.71, and 2.61 ± 0.67, and the QoL scores were 4.70 ± 0.78, 3.92 ± 0.75, 2.55 ± 0.74, 1.83 ± 0.72 and 1.66 ± 0.75, respectively, with statistically significant differences between the baseline and the scores at 1 and 4 weeks (P <0.01) but not at 8 or 12 weeks (P >0.05). Qmax and PVR were improved progressively and significantly at 1 and 4 weeks (P <0.01) but not at 8 or 12 weeks (P >0.05). CONCLUSIONS: Four to eight weeks of oral administration of M-receptor blocker may be an effective dosage regimen for severe BPH with predominant USPSs after TURP.

A Large Bladder Tumor Covered With a Thick "Shell" of Necrotic Material: Misdiagnosis of a Patient With Spina Bifida.

Bladder tumor arising in a spina bifida patient is rare and may be clinically latent. We report the case of a 61-year-old female patient with spina bifida, neurogenic bladder, and a history of recurrent urinary tract infections. A B-ultrasound and non-contrast computed tomography scan did not reveal any bladder mass, but an unexplained "well-filled" bladder was observed, which was confusing as the catheter was present and open. However, a subsequent cystoscopic evaluation revealed a large bladder mass measuring 9.5 × 9.0 × 6.5 cm³, which almost filled the entire bladder. The mass had coarse and flocculent surface and seemed to be free from each observed wall of the urinary bladder. It was diagnosed as an infectious necrotic mass based on its appearance. During transurethral resection of the mass, a bladder tumor was suspected as small blood vessels and bleeding appeared within the inner layer of the mass. Pathological examination revealed necrotic material, inflammatory cells, and urothelial carcinoma cells. Then, a radical cystectomy was performed, and the pathological results indicated stage pT3bN0M0 transitional cell carcinoma. In the gross specimen, the base of the tumor measured 3 × 3 cm² on the top of the back wall of the bladder. Bladder tumors may have atypical presentations in patients with spina bifida. Regular screening is helpful for earlier detection and improving outcomes of bladder tumors in such patients.

Evaluation of three-dimensional printing for laparoscopic partial nephrectomy of renal tumors: a preliminary report.

OBJECTIVES: To investigate the impact of three-dimensional (3D) printing on the surgical planning, potential of training and patients' comprehension of minimally invasive surgery for renal tumors. METHODS: Patients of a T1N0M0 single renal tumor and indicated for laparoscopic partial nephrectomy were selected. CT data were sent for post-processing and output to the 3D printer to create kidney models with tumor. By presenting to experienced laparoscopic urologists and patients, respectively, the models' realism, effectiveness for surgical planning and training, and patients' comprehension of disease and procedure were evaluated with plotted questionnaires (10-point rating scales, 1-not at all useful/not at all realistic/poor, 10-very useful/very realistic/excellent). The size of resected tumors was compared with that on the models. RESULTS: Ten kidney models of such patients were fabricated successfully. The overall effectiveness in surgical planning and training (7.8 ± 0.7-8.0 ± 1.1), and realism (6.0 ± 0.6-7.8 ± 1.0) were reached by four invited urologists. Intraoperative correlation was advocated by the two performing urologists. Patients were fascinated with the demonstration of a tactile "diseased organ" (average ≥ 9.0). The size deviation was 3.4 ± 1.3 mm. CONCLUSIONS: Generating kidney models of T1N0M0 tumors with 3D printing are feasible with refinements to be performed. Face and content validity was obtained when those models were presented to experienced urologists for making practical planning and training. Understandings of the disease and procedure from patients were well appreciated with this novel technology.

Fungus ball and emphysematous cystitis secondary to Candida tropicalis: A case report.

Fungus ball and fungal emphysematous cystitis are two rare complications of fungal urinary tract infection. A 53-year-old male patient presented with these complications caused by Candida tropicalis simultaneously. The predisposing factors were diabetes mellitus and usage of broad-spectrum antibiotics. The fungus ball, measuring 3.5 × 2.0 cm on the left wall of the urinary bladder, shrank significantly to 1.6 × 0.8 cm after 5 days of intermittent irrigation with saline before surgery. With transurethral removal of the fungus ball and antifungal treatment with fluconazole, the patient fully recovered. We conclude that a bladder fungus ball and fungal emphysematous cystitis should always be suspected in patients with diabetes mellitus with uncontrolled funguria and abnormal imaging. Treatment should include a systemic antifungal therapy and thorough surgical removal of the fungus ball. A systemic antifungal therapy combined with a local irrigation with saline or antifungal drugs might help decrease the dissemination of fungemia during an invasive manipulation.

Validation of a novel non-biological bench model for the training of percutaneous renal access.

PURPOSE: The percutaneous renal access (PRA) is the most critical step of percutaneous renal surgery (PRS). For the training of PRA in the lab, a novel non-biological bench model was developed and set for validation test. MATERIALS AND METHODS: Experts in PRS (> 60 cases) and novices were included to perform fluoroscopy guided PRA on the model. Overall time, X-ray exposure time and puncture attempts were recorded to establish construct validity. After accomplishment, the experts rated the model using a standardized questionnaire for face and content validity based on a 5-point Likert scale, with 1 denoting very bad and 5 as excellent. Baseline and post-training data of novices were analyzed for skill acquisition. RESULTS: 9 experts and 30 novices were finally included. The overall appraisal was 4 by the experts, and consensus of all experts was reached for the model as an excellent training tool. Significant difference between experts and novices was detected with the experts using less total time 183.11 ± 29.40 vs. 278.00 ± 50.30 seconds (P < 0.001), shorter X-ray exposure time 109.22 ± 19.93 vs. 183.13 ± 38.83 seconds (P < 0.001), and fewer attempts 1.28 ± 0.44 vs. 2.35 ± 0.65 (P < 0.001). After training, the novices demonstrated significant skill improvement in total and fluoroscopy time, and number of attempts (P < 0.001). CONCLUSIONS: Our non-biological model provides a new method for PRA training. The face, content and construct validity were demonstrated. This model allows contact with PRA skills and could be applied to the first step in the learning curve.

Validation of a novel non-biological bench model for the training of percutaneous renal access

Purpose: The percutaneous renal access (PRA) is the most critical step of percutaneous renal surgery (PRS). For the training of PRA in the lab, a novel non-biological bench model was developed and set for validation test. Materials and Methods: Experts in PRS (> 60 cases) and novices were included to perform fluoroscopy guided PRA on the model. Overall time, X-ray exposure time and puncture attempts were recorded to establish construct validity. After accomplishment, the experts rated the model using a standardized questionnaire for face and content validity based on a 5-point Likert scale, with 1 denoting very bad and 5 as excellent. Baseline and post-training data of novices were analyzed for skill acquisition. Results: 9 experts and 30 novices were finally included. The overall appraisal was 4 by the experts, and consensus of all experts was reached for the model as an excellent training tool. Significant difference between experts and novices was detected with the experts using less total time 183.11 ± 29.40 vs. 278.00 ± 50.30 seconds (P < 0.001), shorter X-ray exposure time 109.22 ± 19.93 vs. 183.13 ± 38.83 seconds (P < 0.001), and fewer attempts 1.28 ± 0.44 vs. 2.35 ± 0.65 (P < 0.001). After training, the novices demonstrated significant skill improvement in total and fluoroscopy time, and number of attempts (P < 0.001). Conclusions: Our non-biological model provides a new method for PRA training. The face, content and construct validity were demonstrated. This model allows contact with PRA skills and could be applied to the first step in the learning curve. .

Proficiency of virtual reality simulator training in flexible retrograde ureteroscopy renal stone management.

BACKGROUND: Minimally invasive flexible ureteroscopy techniques have widely adopted in the management of patients with renal stones. We performed this study to investigate the value of virtual reality simulator training in retrograde flexible ureteroscopy renal stone treatment for catechumen. METHODS: Thirty catechumen, included 17 attending physicians and 13 associate chief physicians, were selected for study. The trainees first underwent 1-hour basic training to get familiar with the instrument and basic procedures, then followed by 4-hour practice on virtual reality simulators. Before and after the 4-hour training, all trainees undertake an assessment with task 7 program (right low pole calyces stone management). We documented for each trainee the total time of procedure, time of progressing from the orifice to stone, stone translocation and fragmentation time, laser operate proficiency scale, total laser energy, maximal size of residual stone fragments, number of trauma from the scopes and tools, damage to the scope and global rating scale (GRS). The proficiency of this training program was analyzed by the comparison of the first and second assessment outcomes. RESULTS: Significant improvement was observed in retrograde flexible ureteroscopy management of renal stone on virtual reality simulators after finishing the 4 hour special-purpose training. This was demonstrated by improvement in total procedure time ((18.37±2.59) minutes vs. (38.67±1.94) minutes), progressing time from the orifice to stone ((4.00±1.08) minutes vs. (13.80±2.01) minutes), time of stone translocation ((1.80±0.71) minutes vs. (6.57±1.01) minutes), fragmentation time ((4.43±1.25) minutes vs. (13.53±1.46) minutes), laser operate proficiency scale (8.47±0.73 vs. 3.77±0.77), total laser energy ((3231.6±401.4) W vs. (5329.8±448.9) W), maximal size of residual stone fragments ((2.66±0.39) mm vs. (5.77±0.63) mm), number of trauma from the scopes and tools (3.27±1.01 vs. 10.37±3.02), damage to the scope (0 vs. 0.97±0.76) and GRS (29.27±2.95 vs. 9.87±2.21). The differences between the first and the second assessment were all statistically significant (all P < 0.01). CONCLUSION: The virtual reality simulator training program can help the trainees to rapidly improve their retrograde flexible ureteroscopy skill in renal stone treatment.

Efficacy of immediate instillation combined with regular instillations of pirarubicin for Ta and T1 transitional cell bladder cancer after transurethral resection: a prospective, randomized, multicenter study.

BACKGROUND: Immediate intravesical instillation of chemotherapeutic agents after transurethral resection (TUR) of nonmuscle invasive transitional cell bladder cancer has recently been suggested and has been proven to decrease the tumor recurrence rate significantly. This study is to evaluate the efficacy and safety of immediate intravesical instillation combined with regular instillations of Pirarubicin (THP(®)) as prophylaxis compared to regular instillations only after TUR operation. METHODS: This was a prospective, randomized, multi-center, clinical study. Patients diagnosed with non-muscle invasive bladder cancer (Ta and T1) pathologically and suitable for TUR were enrolled randomly into two groups. In the study group, the patients received intravesical instillation within 24-hour post TURBT, followed by regular intravesical therapy using 30 mg/50 ml of THP(®) once a week for 8 weeks, and then once a month to 1 year postoperatively Among the patients. In the control group, patients received regular instillation only. RESULTS: A total of 403 patients were enrolled into this study from 26 institutions in China. Among the potients, 210 were enrolled into the study group and 193 were enrolled into the control group. At the median follow-up of 18 months, the recurrence rate was 7.8% in the study group, significantly lower than that in the control group (14.3%; P = 0.042). Subgroup analysis showed that the recurrence rate in low and intermediate-risk patients was significantly lower in the study group (6.8%) than in the control group (14.0%; P = 0.047), although no significant differences were found in high-risk patients. CONCLUSION: One immediate dose of THP(®) 30 mg after TURBT followed by regular intravesical therapy appears well tolerated and more effective than regular intravesical therapy for preventing tumor recurrence, especially in low and intermediate-risk patients.

[Maximal androgen blockade little influences bone mineral density in prostate cancer patients].

OBJECTIVE: To determine the influence of maximal androgen blockade (MAB) on bone mineral density (BMD) in men with prostate cancer. METHODS: We enrolled 40 men with prostate cancer treated by MAB for 7 to 12 months. We obtained the laboratory results of PSA, testosterone, serum calcium and phosphorus, 24-h urine calcium and phosphorus, alkaline phosphatase, and parathyroid hormone, measured the BMD of the lumbar spine and femoral neck by dual energy X-ray absorptiometry, recorded pain scores, and compared the results before and after the treatment. RESULTS: Before MAB treatment, 5 (12.5%) of the patients met the BMD criteria of lumbar spine (L2-4) osteopenia, 8 (20%) lumbar spine (L2-4) osteoporosis, 13 (32.5%) left femoral neck osteopenia, and 15 (37.5%) left femoral neck osteoporosis. The PSA and testosterone levels were decreased from (52.9 +/- 69.9) microg/L and (18.9 +/- 6.5) nmol/L before MAB to (1.5 +/- 1.6) microg/L and (1.9 +/- 1.3) nmol/L after it (P<0.05). There were no statistically significant differences before and after MAB in the levels of serum calcium and phosphorus, 24-h urine calcium and phosphorus, alkaline phosphatase, and parathyroid hormone (P>0.05), nor in the BMD levels of the lumbar spine ([1.1 +/- 0.1] vs [1.1 +/- 0.2] g/cm2) and femoral neck ([0.8 +/- 0.2] vs [0.8 +/- 0.1] g/cm2), nor in the pain score ([0.6 +/- 0.2] vs [0.7 +/- 0.1], P>0.05). CONCLUSION: MAB treatment (range from 7 to 12 months) has no significant influence on BMD in men with prostate cancer, but BMD should be measured before MAB.

[Effects of modification of transferrin on cytotoxicity and intracellular delivery of paclitaxel loaded PLGA nanoparticles].

OBJECTIVE: To evaluate the effects of modification of transferrin on cytotoxicity and intracellular delivery of paclitaxel loaded Poly (lactide-co-glycolide) (PLGA) nanoparticle (NPs). METHODS: PLGA NPs were formulated with microemulsion method, Polyvinyl alcohol (PVA) was used as surfactant (PVA NPs). Transferrin (Tf) was used to modify the NPs (Tf NPs). The cytotoxicity of paclitaxel solution and paclitaxel loaded PVA NPs and Tf NPs were measured in bladder cancer cell line J-82. The intracellular delivery of two kinds of NPs was measured. RESULTS: The half maximal inhibitory concentration (IC50) of paclitaxel loaded PVA NPs and Tf NPs was (44 ± 7) and (49 ± 11) ng/ml respectively and significantly lower than that of paclitaxel solution, which was (81 ± 18) ng/ml (both P < 0.05). The uptake of PVA NPs and Tf NPs by J-82 cells after 2 hours was (89 ± 19) µg/mg cellular protein and (76 ± 16) µg/mg cellular protein. The uptake of two kinds of NPs had no significantly difference. The intracellular level of NPs decreased significantly upon the withdrawal of NPs in medium. However, it became stable 2 hours later and 11.3% PVA NPs and 18.0% Tf NPs remained. The intracellular level of PVA NPs and Tf NPs had no significantly difference at any time point. NPs were distributed in cytoplasm after endocytosis. CONCLUSIONS: PLGA NPs can significantly improve the anti-neoplastic effect of paclitaxel on bladder cancer. However, modification of Tf does not change the intracellular dynamics.

[Value of laparoscopic virtual reality simulator in laparoscopic suture ability training of catechumen].

OBJECTIVE: To investigate the value of laparoscopic virtual reality simulator in laparoscopic suture ability training of catechumen. METHODS: After finishing the virtual reality training of basic laparoscopic skills, 26 catechumen were divided randomly into 2 groups, one group undertook advanced laparoscopic skill (suture technique) training with laparoscopic virtual reality simulator (virtual group), another used laparoscopic box trainer (box group). Using our homemade simulations, before grouping and after training, every trainee performed nephropyeloureterostomy under laparoscopy, the running time, anastomosis quality and proficiency were recorded and assessed. RESULTS: For virtual group, the running time, anastomosis quality and proficiency scores before grouping were (98 ± 11) minutes, 3.20 ± 0.41, 3.47 ± 0.64, respectively, after training were (53 ± 8) minutes, 6.87 ± 0.74, 6.33 ± 0.82, respectively, all the differences were statistically significant (all P < 0.01). In box group, before grouping were (98 ± 10) minutes, 3.17 ± 0.39, 3.42 ± 0.67, respectively, after training were (52 ± 9) minutes, 6.08 ± 0.90, 6.33 ± 0.78, respectively, all the differences also were statistically significant (all P < 0.01). After training, the running time and proficiency scores of virtual group were similar to box group (all P > 0.05), however, anstomosis quality scores in virtual group were higher than in box group (P = 0.02). CONCLUSION: The laparoscopic virtual reality simulator is better than traditional box trainer in advanced laparoscopic suture ability training of catechumen.

[Viviperception on renal vessel variation by retroperitoneal laparoscopy a report of 525 cases].

OBJECTIVE: To study the variation of renal vessels with retroperitoneal laparoscopy so as to increase the safety of retroperitoneal laparoscopic surgeries. METHODS: A total of 525 patients underwent retroperitoneal laparoscopic nephrectomy or partial nephrectomy at our hospital between January 2004 and June 2008. There were 316 males and 209 females with a mean age of (58 ± 13) years old. The procedures were as follows: (1) patients lay on one side with their waist up and the retroperitoneal cavity was established with our institutional method; (2) gerota's fascia was separated widely along the ventral surface of major psoas muscle; (3) the tissues around renal arteries and veins were isolated by ultrasonic scalpel. Careful observation was performed to explore if there were duplicated or accessory renal vessels; (4) renal vessels were cut by Endo-GIA/Hem-o-lok or blocked by bulldog clamps; (5) whole or partial kidney was finally resected (remaining procedures omitted). RESULTS: Among all patients, 58 patients (11.0%, 58/525) had a variation of renal vessels. There were double renal arteries on one side (n = 18), double renal veins (n = 10), 3 renal veins (n = 1) and double arteries and veins on one side (n = 3). Twenty-five patients (4.8%, 25/525) had one accessory renal artery on one side while 19 (76.0%, 19/25) accessory renal arteries went toward the upper kidney pole. The diameter of one patient's left spermatic vein was similar with that of renal vein and they were joined by lumber vein. CONCLUSION: The variation of renal artery is more common than that of renal vein. The accessory renal arteries are common and usually go toward the upper kidney pole. The variation of renal vessels should be considered before and during a laparoscopic procedure.

[Nanometer silver dressing alleviates pain after circumcision].

OBJECTIVE: Postoperative pain is a common problem in male circumcision. We investigated the effect of nanometer silver dressing (Shenzhen AGT Pharm. Co. Ltd.) in relieving pain following male circumcision. METHODS: Sixty patients undergoing circumcision in the outpatient department were randomized into an experimental and a control group, the incision covered with nanometer silver dressing in the former and with vaseline dressing in the latter. None of the patients received any analgesics or other pain-killing therapies after surgery. The postoperative pain intensity was accessed using the modified numeric pain intensity assessment scale at 1, 2, 3, 5 and 7 days after the operation, and statistical analyses were performed using SPSS 12.0 software. RESULTS: The patients averaged (31.13 +/- 13.94) years in age, and had no significant differences in age and body mass index (BMI) between the two groups. At 1, 2, 3 and 5 days, postoperative pain intensity was significantly lower in the experimental than in the control group (P > 0.05). Multiple regression analysis revealed that postoperative pain score was not correlated with patients' age, BMI and types of disease, but with the types of dressing. CONCLUSION: Nanometer silver dressing can significantly alleviate postoperative pain of circumcision, and is particularly applicable to such moist parts as the perineum, genitals, and urethra.

[Analysis of safety and efficacy of laparoscopic and open partial nephrectomy for small renal cell carcinoma].

OBJECTIVE: To compare the safety and efficacy of laparoscopic and open partial nephrectomy for small renal cell carcinoma. METHODS: To collect and analyze the data such as operation time, warm ischemia time, complications, recovery and surgical margins of 110 patients of small renal carcinoma (T1aN0M0) from January 2004 to March 2009, 52 of which underwent laparoscopic partial nephrectomy (LPN) and the other 58 patients underwent open partial nephrectomy (OPN). RESULTS: The mean operation time of LPN group and OPN group were 177.8 min and 126.7 min (t = 3.973, P < 0.01), respectively. The warm ischemia time of the two groups were 28.3 min and 21.9 min (t = 4.627, P > 0.05), respectively. Two cases in LPN group and 1 case in OPN group (3.8% vs 1.7%, chi(2) = 0.010, P > 0.05) needed blood transfusion. The increment of creatine after operation were 4 micromol/L in LPN group and 6 micromol/L in OPN group (t = -2.018, P > 0.05). Six cases (11.5%) in LPN group and 8 cases (13.8%) in OPN group needed collection system repairing (chi(2) = 0.130, P > 0.05)and the same data of hematuria after operation was observed. There was no urinary fistula or other severe complications in all patients. The hospital stay after operation was 10.6 d and 12.9 d (t = -3.244, P < 0.01) in the two groups, respectively. All surgical margins were negative. CONCLUSION: LPN and OPN have the same safety and efficacy, LPN primary treatment can be used for selected patients of T1aN0M0 renal cell carcinoma because of its fast recovery.

[Efficacy and safety of long-acting gonadotropin-releasing hormone analogue in the treatment for metastatic prostate cancer].

OBJECTIVE: To evaluate the efficacy and safety of gonadotropin-releasing hormone analogue (GnRHa) triptorelin 11.25 mg 3-month sustained release formulations in the treatment of metastatic prostate cancer. METHODS: From January 2004 to March 2006, a randomized, parallel-controlled, multicenter clinical trial was conducted. One hundred and twenty-seven patients with documented metastatic prostate cancer were randomized to receive one injection of the 11.25 mg formulation triptorelin (n = 65) or three injections at 28-day intervals of the 3.75 mg formulation (n = 62). Changes from baseline of TPSA, prostate volume, testosterone, LH, FSH, PRL and estradiol were assessed over 3 months. Changes of the metastatic lesions were also observed and evaluated. The occurrences of adverse events were evaluated as well. RESULTS: After 3 months treatment, total PSA level decreased significantly from baseline both in 11.25 mg group and 3.75 mg group. At 30, 60 and 90 days, TPSA (median level) declined from 164.55 microg/L into 11.34, 4.12, 3.89 microg/L in 11.25 mg group, and from 101.38 microg/L into 6.88, 2.41, 2.57 microg/L in control group respectively. The patients ratio with over 90% decreasing from TPSA baseline were 78.6% and 75.5% respectively in two groups (P = 0.700). Prostate volume were also decreased significantly in both groups, median volume declined from 48.0 mm(3) into 21.5 mm(3) in 11.25 mg group and from 45.0 mm(3) into 21.0 mm(3) in 3.75 mg group. No significant differences were found between the two groups in changes of TPSA (P = 0.601) and prostate volume (P > 0.05). Both formulations were able to induce castration levels, 0.31 microg/L in 11.25 mg group and 0.26 microg/L in 3.75 mg group (P > 0.05). 13.8% and 17.7% of adverse events were recorded respectively in two groups, and no differences were found (P = 0.547). CONCLUSION: As a new long-acting sustained release formulation, triptorelin 11.25 mg is comparable to triptorelin 3.75 mg formulation in the aspect of efficacy and safety for the treatments of metastatic prostate cancer.

[Diagnosis and treatment of retroperitoneal fibrosis: report of 26 cases].

OBJECTIVE: To evaluate and improve the diagnosis and surgical treatment of the retroperitoneal fibrosis (RPF). METHODS: The medical records of 26 patients with the RPF (21 men and 5 women with mean age 54 years) were analyzed retrospectively. They were been treated from January 1996 to May 2007. Fourteen cases received double-J inter-ureter drainage or pricking pyelostomy and 9 of 15 cases who received open surgery were performed bilateral ureterolysis with their ureters translocated intraperitoneally. RESULTS: For masses in retroperitoneal space, the diagnostic rate of B mode ultrasonography, CT and MRI was 12% (3/26), 86% (18/21) and 57% (8/14) respectively. The patients were followed up from 1 to 106 months. After drained by double-J inter-ureter stent or pricking pyelostomy, the mean serum creatinine level decreased from 373.9 micromol/L to 157.1 micromol/L of 14 patients. Those patients who underwent ureterolysis with ureteral intraperitoneal translocation had good results and their mean serum creatinine level decreased from 171.0 micromol/L before operation to 139.6 micromol/L after operation. Four patients had normal B-ultrasound and intravenous urogram findings with at least 24 months of follow-up. CONCLUSIONS: CT scan has better accuracy for diagnosis of the RPF than B mode ultrasonography and MRI. Prompt and appropriate relief of urinary obstruction with surgical intervention can effectively protect the renal function in patients with the RPF, and the ureterolysis with ureteral intraperitoneal translocation is an effective surgical procedure to treat this disease.

[Study of prognostic factors of ureter cancer].

OBJECTIVE: To evaluate the prognostic factors of ureter transitional cell carcinoma (TCC). METHODS: Between January 2001 and December 2005 133 TCC patients were treated. And the data was retrospectively analyzed. RESULTS: A mean age of the 133 patients was 68 years (range 43 - 87 years) at diagnosis. Altogether the non-invasive ureter TCC was found in 42 patients (31.6%) and the invasive ureter TCC in 91 patients (68.4%). Invasive ureter TCC growth was more common in distally located tumors (82.5%) compared to mid (62.5%) and proximal ureter (47.1%). Tumor stage, grade and location of the tumor were all correlated with disease specific survival in a univariate analysis. In a multivariate Cox analysis, tumor stage and grade were significantly associated with disease specific survival. CONCLUSIONS: More invasive tumors are found in ureter than in bladder. Ureter cancer is more frequently found in the distal part. Distally located ureteral tumors are more likely invading into the muscular cell layers compared to proximally located tumors. Tumor stage and grade are still the more important prognostic factors for ureter TCC.

[Comparison of different drugs on the treatment of benign prostate hyperplasia].

OBJECTIVE: To compare the differences of the efficacy and different therapeutic drugs on the treatment of benign prostatic hyperplasia (BPH) in order to ensure the optimal indication for different BPH patients. METHODS: A randomized, parallel-controlled, multicenter clinical trial was conducted. From September 2002 to December 2003 906 BPH patients were enrolled into 7 therapeutic groups, including selective-adrenoceptor antagonist (terazosin, doxazosin tamsulosin and naftopidil), 5 alpha-reductase inhibitor (finasteride and epristeride) and natural product (cernilton). International Prostate Symptom Score (IPSS) and Quality of Life (QOL), uroflowmetry, total prostatic volume (TPV) and transitional zone volume and residual urine were used as efficacy criteria. RESULTS: According to the baseline, the IPSS and Qmax were significantly correlated to the prostatic volume and transitional zone volume (P < 0.01). At average follow-up of 6 months, significant improvements in IPSS, QOL, Qmax and residual urine volume were observed in each therapeutic group, and no difference in IPSS improvement was found among the groups. Prostatic volume and transitional zone volume were significant decreased in 5alpha-reductase inhibitor groups (P < 0.05). In patients with baseline TPV greater than 35.5 cm3, the improvement of Qmax was more significant than that in patients with TPV less than 35.5 cm3 in finasteride group (P < 0.01) (5.7 ml/s and 2.2 ml/s respectively), and more significant symptomatic improvements were also found in cernilton, doxazosin and naftopidil group. In each group, the improvement of symptom were more significant in patients with IPSS higher than 20 points (P < 0.01). CONCLUSIONS: Each drug observed in this study can improve the subjective and objective symptoms significantly for BPH patients, especially for patients with higher IPSS baseline. When using 5alpha-reductase inhibitor, prostatic volume can be decreased significantly and more obviously subjective and objective improvement can be found in the patients with TPV greater than 35.5 cm3.