Clinical Significance of Preoperative Assessment of Intravesical Prostatic Protrusion in Radical Prostatectomy.

Background: Intravesical prostatic protrusion (IPP) is common in prostate-related diseases, whose clinical significance in radical prostatectomy was unknown. Methods: 791 patients underwent robot-assisted or open radical prostatectomy at our institution were enrolled. The transabdominal ultrasound examination of prostate and IPP was carried out preoperatively, by which IPP was classified as no (0-0.5cm, grade 0), slight (0.6-1.0cm, grade 1) and noticeable (>1.0cm, grade 2). Results: 185 (23.4%), 170 (21.5%) and 436 (55.1%) patients had no, slight and noticeable IPP, respectively. Generally, prostate specific antigen (PSA), Gleason score and pT stage increased with IPP grade. In particular, cases with grade 0 IPP had a decreased proportion of seminal vesicles' involvement than those with grade 1 and grade 2 IPP (p=0.035). Reconstruction of the bladder neck (in robot-assisted group), increased surgical bleeding (>200ml), and prolonged postoperative hospital stays (>14 days) happened more in patients with grade 2 IPP. Blood transfusion only happened in patients with noticeable IPP. PSM of bladder neck was only associated with higher IPP grade in open surgery group (p=0.032), not in robot-assisted surgery group. Conclusion: IPP is associated with cancer aggressiveness, surgery difficulty and PSM of bladder neck in prostate cancer. Assessment of it provides more information for operations.

Short interval of biopsy to robotic-assisted laparoscopic radical prostatectomy does not render any adverse effects on the perioperative outcomes.

The aim of our study was to investigate the effects of prostate biopsy on perioperative outcomes of robotic-assisted laparoscopic prostatectomy (RALP).A total of 181 patients who underwent the RALP in our institution have been retrospectively reviewed, patients were divided into different groups according to the interval of biopsy to RALP and core numbers of biopsy. Perioperative outcomes including estimated blood loss (EBL), operative time (OT), surgical margin status, postoperative drainage, hospital stay, and perioperative complications were served as endpoints.Interval of biopsy to RALP was not significantly correlated with any perioperative outcomes, while the biopsy core numbers had significant correlation with the EBL. In logistic regression analysis, the biopsy core numbers were associated with higher risk of positive surgical margins. Body mass index (BMI) was also a significant factor related to OT.Delay of the RALP after biopsy was not applicable in the era of RALP and surgeons could be more freely in selecting the time of RALP. Besides, further studies should focus on how to improve the diagnostic efficiency of prostate cancer without increasing the incidence of surgical complications.

A preliminary study on classification and therapeutic strategies for spontaneous perirenal hemorrhage.

BACKGROUND: The aim of our study was to report our experience in the classification and therapeutic management strategies for spontaneous perirenal hemorrhage (SPH). METHODS: From September 2005 to April 2015, 20 patients with SPH were newly diagnosed in our hospital. Their clinical features, image findings, identification of underlying causes, and therapeutic management were retrospectively analyzed, and relevant literature was reviewed. In this study, patients were classified according to the degree of severity of the disease or emergency imaging diagnosis of underlying causes. On the basis of the former, patients were classified as critical and noncritical, and on the basis of the latter, patients were classified as renal cell carcinoma (RCC), undefined solid neoplasm, angioleiomyolipoma (AML), and unknown cause. RESULTS: In the acute stage, contrast-enhanced computed tomography (CT) was superior to ultrasonography for both diagnostic accuracy of SPH (p = 0.02) and etiology discovery power (p = 0.004). The results of contrast-enhanced magnetic resonance imaging (MRI) were identical to those of contrast-enhanced CT. We summarized a flowchart in the whole classification and therapeutic strategies of SPH. According to the imaging diagnosis of underlying causes, all the patients with undefined solid neoplasm or RCC underwent emergency operation. Patients with AML or unknown cause underwent selective arterial embolization (SAE) or conservative management according to the critical degree. Acute hemorrhage was controlled in 19 cases, of which 14 were cured by the operation and only one critical patient with severe shock died shortly despite rescue efforts. CONCLUSIONS: Contrast-enhanced CT or MRI is the first choice of imaging examination, which could not only accurately diagnose SPH but also detect the underlying causes. Choice of therapeutic strategies for SPH should vary according to the identification of critical patients and imaging diagnosis of underlying cause.

Mini-flank supra-12th rib incision for open partial nephrectomy for renal tumor with RENAL nephrometry score ≥10: an innovation of traditional open surgery.

The skill of supra-12th rib mini-flank approach for open partial nephrectomy (MI-OPN) provides an advanced operative method for renal tumor. Compared with laparoscopic and robotic surgery, it may be a feasible selection for the complex renal tumors. We describe our techniques and results of MI-OPN in complex renal tumors with high RENAL nephrometry score (RENAL nephrometry score ≥10). Fifty-five patients diagnosed with renal tumors between January 2009 and July 2013 were included in this study. Eligibility criteria comprised of patients with complex renal tumor (RENAL score ≥10) being candidates for partial nephrectomy (PN). All patients received MI-OPN and all surgeries were performed by a single urologist. The preoperative workup comprised of medical history, physical examination, and routine laboratory tests. Serum creatinine was recorded preoperatively and 2 to 3 months after operation. Operative time, ischemia time, blood loss, operative and postoperative complications, renal function, and pathology parameters were recorded. MI-OPN was successfully performed in all cases. Mean tumor size was 4.7 cm (range: 2.5-8.1). Mean warm ischemia time was 28.1 minutes (range: 21-39), mean operative time was 105 minutes (range: 70-150) and mean estimated blood loss was 68 mL (range: 10-400). Mean postoperative hospital stay was 6.5 days (range: 5-12). Postoperative complications were found in 3 patients (5.5%). The mean pre- and postoperative serum creatinine levels were 76.2 µmol/L (range: 47-132) and 87.1 µmol/L (range: 61-189) with significant difference (P = 0.004). The mean pre- and postoperative estimated glomerular filtration rate (eGFR) were 91.5 (range: 34-133) and 82.5 (range: 22-126.5), respectively with significant difference (P = 0.024). In an average follow-up of 19.9 months (range: 8-50), no local recurrence or systemic progression occurred. In conclusion, MI-OPN can combine the benefits of both minimal invasive and traditional open partial nephrectomy (OPN) techniques with a smaller incision. It is an innovation of traditional OPN and suitable for the complex renal tumors with high RENAL nephrometry score safely and effectively.

Modified technique in treating recurrent priapism: a technique report.

Recurrent ischemic priapism is a problem in clinical treatment. Most of the cases require more invasive surgery to shunt the blood stasis. We introduce a modified technique in treating recurrent ischemic priapism. The technique described is applied to acute ischaemic priapic episodes in patients with a history of stuttering priapism. It was carried out by a Winter's shunt combined with a continuous cavernosal irrigation system. Priapism was effectively resolved on the patients without recurrence. The four patients who received this treatment recovered most sexual function after 6 months follow-up.

Mini-flank supra-12th rib incision for open partial nephrectomy compared with laparoscopic partial nephrectomy and traditional open partial nephrectomy.

PURPOSE: The purpose of this study was to report our approach of partial nephrectomy (PN) using a supra-12th rib mini-flank incision. We compared mini-incision open partial nephrectomy (MI-OPN) with open partial nephrectomy (OPN) and laparoscopic partial nephrectomy (LPN) to verify whether MI-OPN can be an alternative to OPN and LPN. METHODS: This was a retrospective single-center study including 194 patients who underwent partial nephrectomy (PN) between February 2005 and December 2010. Demographic, perioperative, and complication data were compared among the MI-OPN group, OPN group and LPN group. RESULTS: No statistical differences were reported in either group for age, sex, BMI, tumour side (right or left kidney), RENAL nephrometry scores, PADUA score and preoperative eGFR. The operative time was longer in LPN group when compared with MI-OPN and OPN group (all P<0.001). The warm ischemia time of LPN group was longer than MI-OPN group (P = 0.032) and OPN group (P = 0.005). The length of stay of LPN group was shorter than OPN group (P = 0.018), but was similar to MI-OPN group (P = 0.094). The incidence of renal artery clamping was lower in OPN group when compared with MI-OPN and LPN group (all P<0.001). More estimated blood loss was found in OPN group when compared with MI-OPN group (p = 0.003) and LPN group (P = 0.014). The overall incidence of postoperative complications was similar. CONCLUSIONS: The approach of MI-OPN can couple the benefits of both minimally invasive and open partial nephrectomy techniques with less estimated blood loss, shorter operative time, shorter length of stay, less postoperative complications, and a smaller incision. MI-OPN may be an effective alternative to laparoscopic or traditional open approaches, which maybe more suitable for the tumors with high RENAL nephrometry score or PADUA score.

Temporary filters and liver mobilization technique improve the safety and prognosis of radical nephrectomy and inferior vena cava thrombectomy in renal cell carcinoma with subdiaphragmatic thrombosis.

AIMS: This study aimed to investigate the safety and efficacy of preoperative temporary inferior vena cava (IVC) filter placement and intraoperative application of a liver mobilization technique. MATERIALS AND METHODS: The experiment cohort of 42 cases and the control cohort of 36 cases of renal cell carcinoma involving the IVC were analyzed retrospectively. In the experiment cohort, patients were implanted with a temporary IVC filter as routine preoperative treatment. The control cohort of 36 cases received traditional radical nephrectomy + IVC thrombectomy. RESULTS: In the experiment cohort, 42 cases did not show any symptom of tumor thrombus embolism perioperatively. The average operation time was 220 min and the average blood loss was 750 ml. Overall survival rate of improved surgery was significantly higher than traditional surgery (p = 0.0055). Moreover, tumor thrombus size and position was associated with overall survival (p = 0.0185). CONCLUSIONS: Preoperative temporary IVC filter placement and intraoperative application of a liver mobilization technique to expose the IVC can effectively prevent tumor thrombosis embolism shedding and improve surgical safety.

NGF/γ-IFN inhibits androgen-independent prostate cancer and reverses androgen receptor function through downregulation of FGFR2 and decrease in cancer stem cells.

Androgen-independent prostate cancer (AIPC) is difficult to treat. Present study is to explore the inhibitory effect of a cytokine environment on AIPC and its mechanism. We utilized nerve growth factor (NGF)/γ-interferon (γ-IFN) to change the cytokine environment. Animal models and 2 androgen receptor (AR)-negative prostate cancer cell lines were used to evaluate the effect of NGF/γ-IFN. Flow cytometry, immunocytochemistry, western blotting, Tunel assay, colony formation efficiency, gene microarray, and in vivo bioluminescence were used to discern the mechanisms within NGF/γ-IFN that effect the environment. In vitro, NGF/γ-IFN effectively inhibited the proliferation of AIPC cell lines and promoted the apoptosis of the cancer cells. In vivo, NGF/γ-IFN suppressed the growth and metastasis of a tumor mass that arose from the AIPC cell line. After NGF/γ-IFN treatment, the AR-negative cell lines re-expressed AR and were then able to respond to the androgen. Contrary to expectations, the proliferation of cells was inhibited after dihydrotestosterone was added, and the results indicated that NGF/γ-IFN decreased the proportion of cancer stem cells. NGF/γ-IFN worked mainly through the downregulation of fibroblast growth factor receptor 2.

Radiotherapy may improve overall survival of patients with T3/T4 transitional cell carcinoma of the renal pelvis or ureter and delay bladder tumour relapse.

BACKGROUND: Since transitional cell carcinoma (TCC) of the upper urinary tract is a relatively uncommon malignancy, the role of adjuvant radiotherapy is unknown. METHODS: We treated 133 patients with TCC of the renal pelvis or ureter at our institution between 1998 and 2008. The 67 patients who received external beam radiotherapy (EBRT) following surgery were assigned to the radiation group (RT). The clinical target volume included the renal fossa, the course of the ureter to the entire bladder, and the paracaval and para-aortic lymph nodes, which were at risk of harbouring metastatic disease in 53 patients. The tumour bed or residual tumour was targeted in 14 patients. The median radiation dose administered was 50 Gy. The 66 patients who received intravesical chemotherapy were assigned to the non-radiation group (non-RT). RESULTS: The overall survival rates for the RT and non-RT groups were not significantly different (p = 0.198). However, there was a significant difference between the survival rates for these groups based on patients with T3/T4 stage cancer. A significant difference was observed in the bladder tumour relapse rate between the irradiated and non-irradiated bladder groups (p = 0.004). Multivariate analysis indicated that improved overall survival was associated with age < 60 years, T1 or T2 stage, absence of synchronous LN metastases, and EBRT. Acute gastrointestinal and bladder reactions were the most common symptoms, but mild non-severe (> grade 3) hematologic symptoms also occurred. CONCLUSION: EBRT may improve overall survival for patients with T3/T4 cancer of the renal pelvis or ureter and delay bladder tumour recurrence in all patients.

[Analysis of microchimerism in living renal transplantation between mothers and children relationship].

OBJECTIVE: To compare the microchimerismic and rejection rates in living donor kidney transplant recipients in mother and child relations and other relations. METHODS: This retrospective single-center study enrolled 130 recipients to receive allografts from living related donors from 2004 to 2008 at our hospital. They were followed up for 1 - 5 years. The demographic data of the study population were analyzed by basic statistical methods. A total of 43 recipient blood samples were collected for the detection of microchimerism by the assays of short tandem repeat (STR) and sex-determining region-y gene (SRY) polymerase chain reaction (PCR). RESULTS: The 1-year patient/graft survival rates were 93.8% and 92.3% respectively. And there was no significant differences between mother and child group and other relative group. Forty-six biopsy samples were collected from 46 recipients. Twenty-six (20.0%) cases had the occurrences of acute rejection episodes in different Banff degrees as proven by biopsy. 53.8% (14/26) cases were mother and child renal transplantation, higher than other relative (46.2%, 12/26). The mother donor kidney transplant recipients had about a twice higher rejection rate (30.4% vs 14.3%, P = 0.028) and a twice higher microchimerismic rate (25.0% vs 14.8%) than other relative. CONCLUSION: Compared with other relations, the mother donor kidney recipients tend to have higher rates of microchimerism and acute rejection. And the special immune effect in mothers and children renal transplantation may influence its outcomes.

[The clinical characteristic of adrenal metastatic tumor].

OBJECTIVE: To analyze the clinical features of adrenal metastasis. METHODS: From January 1993 to December 2004, 103 cases of adrenal metastasis were reviewed. RESULTS: Lung and hepatocellular carcinoma were the most common primary tumor of adrenal metastatic tumor, which about 36.9% (38/103) and 42.7% (44/103) of all cases, followed by renal carcinoma 6.8% (7/103), colorectal carcinoma 4.9% (5/103), stomach carcinoma 3.9% (4/103), breast cancer 1.9% (2/103), unknown primary tumor 2.9% (3/103). Most of these were low differentiation. The mean diameter of adrenal metastasis was 3.9 cm. The mean interval from detection of primary tumor to adrenal metastasis was 9.5 months. And 79.6% (82/103) were detected as a part of multiorgan metastasis. Only 5 cases (4.9%) were presented with pain in the back. There was little characterization of ultrasonography, CT and MRI, color-Doppler and selective arterial imaging showed little blood supply. All of patients were treated with synthetic methods, 16 cases (15.5%) who had undergone adrenalectomy for metastasis disease had a improved survival compared with those non-adrenalectomy. CONCLUSIONS: There is no particular presentation of clinic and imaging, diagnosis depending on history, follow-up and the pathological presentation of primary tumor. There are no standard treatment guidelines for this group of patients. When the primary tumor could be resected or be well controlled, and there is no other evidence of metastasis, adrenalectomy is recommended. Transarterial chemoembolization (TACE) could not actually be performed.

[An experimental study on high intensity focused ultrasound combined with mitomycin treatment of bladder tumor].

OBJECTIVE: To study the therapeutic effect and synergistic inhibition effect of high intensity focused ultrasound in combination with mitomycin on T739 mice bladder tumor. METHODS: BTT739 tumor-bearing mice receiving HIFU and/or mitomycin in two weeks, were divided into control group, low dose chemotherapy group, high dose chemotherapy group, HIFU group and HIFU combined chemotherapy group. The growth of mice tumor volume was observed in two weeks, by which we counted tumor volume doubling time and performed the growth curve. All specimens were analysed histologically. RESULTS: HIFU combined mitomycin has significant synergistic inhibition effect. Tumor tissue damage such as huge coagulation necrosis was observed using light microscopy. However, there were still some remaining alive cells. The apoptosis of tumor cell in HIFU group and HIFU combined chemotherapy group obviously increased in comparison with other groups. CONCLUSIONS: HIFU group, HIFU combined chemotherapy group can distinctively inhibit tumor growth; HIFU combined with mitomycin has notable synergistic inhibitory effect. HIFU may induce the apoptosis of tumor cell.