[Intrauterine Device Totally Embedded in the Bladder Wall:Report of One Case].

Intrauterine device(IUD)migrating to the bladder is rare,especially the migration far away from the uterus into the bladder wall.Due to no obvious clinical symptom in the early stage and being far away from the uterus,the IUD totally embedded in the bladder wall is prone to misdiagnosis and delay in treatment.We reported one case of such migration,aiming to improve the clinical management of the IUD totally embedded in the bladder wall.

Efficacy and safety evaluation of complete intrafascial prostatectomy in suspected prostate cancer patients with dysuria: a retrospective cohort study.

Background: Suspected localized prostate cancer (PCa) patients with dysuria Complete intrafascial prostatectomy (CIP) can remove the whole prostate gland with the maximal retain of adjacent normal tissues around the prostate, and can be applied in some suspected localized prostate cancer (PCa) patients with dysuria. However, precious few studies have assessed the efficacy and safety of CIP in these patients without preoperative needle biopsies. Methods: In this retrospective single-arm cohort study, all 22 suspected PCa patients with dysuria who underwent CIP at our hospital were enrolled. The clinical data including age, prostate-specific antigen (PSA), free-serum PSA, prostate volume, perioperative and postoperative complications were collected. The PSA level at 6 weeks after CIP and recoveries of urinary continence and erectile function were acquired in the follow-up procedures, and were used as the main measurements of efficacy and safety for CIP respectively. Results: The patients had an average age of 71.91±8.29 years and an average preoperative PSA level of 10.75±4.25 ng/mL. The operations for all 22 patients were successfully completed. The average operation time was 135.20±41.44 min (range, 40.0-215.0 min), and the average blood loss volume was 128.64±145.09 mL. In total, 17 patients (77.27%) had PCa confirmed by postoperative pathology, and 5 patients (22.73%) had benign prostatic hyperplasia. The PSA level dropped to 0.010±0.004 ng/mL at 6 weeks after surgery. According to the loose criteria to assess urinary incontinence, the patients achieved continence rates of 63.6% immediately after the operation, 95.5% at 1 month, and 100% at 3 months. According to the strict criteria, the continence rates immediately, and at 1, 3, 6, and 9 months after surgery were 27.3%, 63.6%, 90.9%, 95.5%, and 100%, respectively. None of the patients complained of urinary obstruction symptoms after surgery. Before CIP, all the patients had erectile dysfunction and an International Index of Erectile Function 5 (IIEF-5) score of 9.64±5.91. After surgery, the patients had IIEF-5 scores at 3, 6, and 12 months of 5.45±4.43, 6.95±5.30, and 7.57±5.69, respectively. Conclusions: Although the study had some limitations, CIP may be a prudent option for patients with suspected localized PCa who also present with dysuria.

Construction of Decision Trees Based on Gene Expression Omnibus Data to Classify Bladder Cancer and Its Subtypes.

BACKGROUND Bladder cancer is a malignant tumor of the genitourinary system. Different subtypes of bladder cancer have different treatment methods and prognoses. Therefore, identifying hub genes affecting other genes is of great significance for the treatment of bladder cancer. MATERIAL AND METHODS We obtained expression profiles from the GSE13507 and GSE77952 datasets from the Gene Expression Omnibus database. First, principal component analysis was used to identify the difference in gene expression in different types of tissues. Differential expression analysis was used to find the differentially expressed genes between normal and tumor tissues, and between tumors with and without muscle infiltration. Further, based on differentially expressed genes, we constructed 2 decision trees for differentiating between tumor and normal tissues, and between muscle-infiltrating and non-muscle-infiltrating tumor tissues. A receiver operating characteristic curve was used to evaluate the prediction effect of the decision trees. RESULTS FAM107A and C8orf4 showed significantly lower expression in bladder cancer tissues than in normal tissues. Regarding muscle infiltration, CTHRC1 showed lower expression and HMGCS2 showed higher expression in non-muscle-infiltrating samples than in those with muscle infiltration. We constructed 2 decision trees for differentiating between tumor and normal tissue, and between tissues with and without muscle infiltration. Both decision trees showed good prediction results. CONCLUSIONS These newly discovered hub genes will be helpful in understanding the occurrence and development of different subtypes of bladder cancer, and will provide new therapeutic targets and biomarkers for bladder cancer.

Association of Vascular Endothelial Growth Factor Gene Polymorphism With Renal Cell Carcinoma Risk.

The conclusion of the relationship between vascular endothelial growth factor gene polymorphism and renal cell carcinoma risk was inconsistent. This study was performed to assess the relationship between vascular endothelial growth factor gene polymorphism and renal cell carcinoma risk using meta-analysis. The association studies were identified from PubMed, Embase, and Web of Science, and eligible studies were included and calculated. Ten studies were included for this meta-analysis. vascular endothelial growth factor (VEGF) +405G > CC allele and GG genotype were associated with renal cell carcinoma risk for overall populations in this meta-analysis (C allele: odds ratio = 1.18, 95% confidence interval: 1.05-1.33, P = .004; CC genotype: odds ratio = 1.20, 95% confidence interval: 0.96-1.50, P = .12; GG genotype: odds ratio = 0.79, 95% confidence interval: 0.67-0.93, P = .004). Furthermore, VEGF +936C>T gene polymorphism and VEGF -2578 C>A gene polymorphism were associated with renal cell carcinoma risk for overall populations (+936C>T: T allele: odds ratio = 1.16, 95% confidence interval: 1.05-1.29, P = .004; TT genotype: odds ratio = 1.25, 95% confidence interval: 1.02-1.52, P = .03; CC genotype: odds ratio = 0.86, 95% confidence interval: 0.75-0.98, P = .03; -2578 C>A: A allele: odds ratio = 1.26, 95% confidence interval: 1.15-1.38, P < .00001; AA genotype: odds ratio = 1.39, 95% confidence interval: 1.16-1.67, P = .0004; CC genotype: odds ratio = 0.75, 95% confidence interval: 0.61-0.92, P = .006). However, VEGF -634G>C, VEGF -460T>C, VEGF -1154 G>A, and VEGF +1612 G>A gene polymorphisms were not associated with renal cell carcinoma risk. In conclusion, VEGF +405G>CC allele and GG genotype, VEGF +936C>T gene polymorphism, and VEGF -2578 C>A gene polymorphism were associated with renal cell carcinoma risk for overall populations. However, more studies should be performed to assess this relationship in the future.

Correlations of Foxo3 and Foxo4 expressions with clinicopathological features and prognosis of bladder cancer.

OBJECTIVE: The study is performed to explore the correlations of forkhead box O3 (FoxO3) and forkhead box O4 (FoxO4) expressions with clinicopathological features and prognosis of bladder cancer. METHODS: Bladder cancer tissues and adjacent normal tissues from the recruited 222 patients were collected. Quantitative real-time polymerase chain reaction (qRT-PCR), Western blotting and immunohistochemistry were applied to determine the expressions of FoxO3 and FoxO4. Spearman correlation analysis was conducted to examine the correlation between the expressions of FoxO3 and FoxO4. All patients were followed up and overall survival (OS) and disease-free survival (DFS) were recorded. Kaplan-Meier survival curve was drawn to determine the associations of FoxO3 and FoxO4 expressions and postoperative survival. Cox proportional hazards model was conducted to analyze the risk factors for poor prognosis of bladder cancer. RESULTS: The mRNA and expressions of FoxO3 and FoxO4 proteins in the bladder cancer tissues were lower than that in the adjacent normal tissues (both P<0.05). The positive rates of FoxO3 and FoxO4 were lower in the patients with lymph node metastasis than that in the patients without lymph node metastasis (P<0.05), and significantly lower in the patients with non-muscle invasive bladder cancer (Tis-T1) than in those with non-muscle invasive bladder cancer (T2-T3) in TNM staging, and remarkably lower in the patients with high grade than in those with low grade in the histological type (P<0.05). Furthermore, the expressions of FoxO3 and FoxO4 were positively correlated in the bladder cancer tissues (P<0.05). Negative expressions of FoxO3 and FoxO4 and lymph node metastasis were the risk factors for the poor prognosis of bladder cancer. CONCLUSIONS: The FoxO3 and FoxO4 expressions may potentially associate with the clinicopathological features and prognosis of bladder cancer.

[Necessity analysis of bone scan in patients with newly diagnosed prostate cancer].

OBJECTIVE: To construct a classification and regression tree (CART) to predict the occurrences of bone metastases in patients with newly diagnosed prostate cancer so as to reduce unnecessary bone scans. METHODS: CART analyses were performed in 501 subjects from 2005 to 2011 of Fudan University Shanghai Cancer Center to establish Fudan CART model and externally validate Briganti's CART model. The both models were compared with regards to the area under the curve (AUC) and their clinical values. RESULTS: The rate of bone metastasis was 27.5% (138/501). The predictive accuracy of Fudan CART model, Briganti's CART model and skeleton-related events (SRE) model was 0.813, 0.691 and 0.645 respectively. There were statistically significant differences (P < 0.05). Fudan CART model had a lower missed diagnosis and an over-examination rate of bone scan within the probability threshold (Pt) range of 24.2% to 36.8%. CONCLUSION: With a higher predictive value, Fudan CART model may be employed to reduce the unnecessary bone scans for Chinese patients with newly diagnosed prostate cancer.

A nomogram to predict the duration of drainage in patients with penile cancer treated with inguinal lymph node dissection.

PURPOSE: We developed a nomogram to predict the duration of drainage in patients with penile cancer treated with inguinal lymph node dissection. MATERIALS AND METHODS: A total of 111 groin basins in 56 patients who underwent radical inguinal lymph node dissection for penile cancer were retrospectively assessed. We retrieved the clinicopathological factors from the medical records including age, body mass index, albumin, smoking history, hypertension, diabetes, preoperative radiotherapy/chemotherapy, palpable lymph nodes, previous lymph node biopsy, total number of resected lymph nodes and ratio of positive lymph nodes. The criterion of drain removal was total drain output of 50 ml or less per day for 2 days starting from postoperative day 3. A multivariate Cox proportional hazards model was used to explore the risk factors of drainage duration and variable selection was performed according to Akaike's information criteria. A nomogram was built based on regression coefficients and internally validated with 200 bootstrap resamples. RESULTS: Median postoperative drainage duration was 7 days. The prediction model using pretreatment factors showed a concordance index of 0.55. With the addition of lymph node related variables a second model was constructed which produced a better concordance index (0.65) and good calibration. On multivariate analysis young age, high body mass index, total number of resected lymph nodes and ratio of positive lymph nodes were independent predictors of prolonged lymphatic drainage. CONCLUSIONS: On the basis of readily obtained clinicopathological variables we developed a nomogram to predict the duration of lymphatic drainage which, if externally validated, could be helpful for patient consultation, treatment decision making and clinical trial design.

[Evaluation of perioperative complications in the elderly with radical prostatectomy].

OBJECTIVE: To evaluate the incidence and severity of perioperative complications in elderly patients with radical prostatectomy (RP). METHODS: A total of 242 patents underwent RP for prostate cancer were retrospectively assessed, whose clinicopathologic factors and perioperative complications were retrieved from the medical records. The mean age in the elderly group (n = 163) and control group (n = 79) were (73.2 ± 2.4) and (63.2 ± 4.8) years, respectively. The clinicopathologic factors including Charlson comorbidity index and preoperative prostate specific antigen were statistically significant different. The difference of clinicopathologic factors and perioperative complications between the elderly group (≥ 70 years old) and control group were statistically analyzed using the SPSS 17.0. RESULTS: The incidence of perioperative complications was 23.5% in the elderly group and 22.7% in the control group. Except for gross hematuria (there were 12 cases in elderly group and 1 case in control group, respectively, χ(2) = 3.89, P < 0.05) and perioperative transfusion (there were 36 cases in elderly group and 7 cases in control group, respectively, χ(2) = 6.37, P < 0.05), there was no significant difference in each kind or total of perioperative complications. CONCLUSION: The elderly patients underwent RP in experienced center are not associated with higher or more serious perioperative complications.

[The building and validation of a model to predict the bone metastases of patients with newly diagnosed prostate cancer].

OBJECTIVE: To develop and validate a nomogram used to predict the bone metastasis risks according to the clinicopathological factors of patients with newly diagnosed prostate cancer. METHODS: The 501 cases were randomly assigned into development sample (300 cases) and validation sample (201 cases). In the development sample, Logistic regression analysis was used to explore the predictors of bone metastases, and then a nomogram was built based on regression coefficients and validated in the validation sample. RESULTS: Prostate specific antigen, cT3, cT4 and Gleason score ≥ 8 were the independent prognostic factors (P < 0.05), and the OR values were 5.65, 2.89, 9.07 and 2.87 respectively. The concordance index was 0.830 in the model sample and 0.799 in the validation sample. CONCLUSION: A nomogram, built based on the clinicopathological factors, could be used to predict the risk of bone metastases and then could be helpful for the rational use of bone scan.