[Predictive value of preoperative pelvic floor electrophysiological parameters on early urinary incontinence following radical prostatectomy].

OBJECTIVE: To explore the predictive value of preoperative pelvic floor electromyography (EMG) parameters for the risk of urinary incontinence after prostate cancer surgery. METHODS: This study retrospectively analyzed the medical records of 271 patients who underwent radical prostatectomy in the urology department of Peking University First Hospital from January 2020 to October 2022. The data included patient age, body mass index (BMI), international prostate symptom score (IPSS), prostate-specific antigen (PSA) levels, Gleason score, type of surgery, urethral reconstruction, lymph node dissection, nerve preservation, catheterization duration, D ' Amico risk classification, American Society of Anesthesiologists (ASA) score, Charlson comorbidity index, postoperative duration, prostate volume, and pelvic floor EMG parameters (pre-resting mean, fast muscle mean, and slow muscle mean scores). Independent risk factors affecting early postoperative urinary incontinence were identified through multivariate Logistic regression analysis. The predictive efficacy of pelvic floor EMG results was evaluated by calculating the area under the receiver operating characteristic (ROC) curve, and the optimal threshold for early postoperative urinary incontinence was determined based on the Youden index and clinical significance. RESULTS: The study included 271 prostate cancer patients, with an 81.9% rate of voluntary urinary control post-surgery. The median score for fast pelvic floor muscles was 23.5(18.2, 31.6), and for slow muscles, it was 12.5(9.6, 17.3). Among the patients, 179 (66.1%) did not preserve nerves, and 110 (40.6%) underwent urethral reconstruction. Advanced age and low fast muscle scores were identified as independent risk factors for urinary incontinence. Patients aged ≤60 had 5.482 times the voluntary urinary control rate compared with those aged ≥70 (95%CI: 1.532-19.617, P < 0.05). There was a significant correlation between fast muscle scores and urinary incontinence recovery (OR=1.209, 95%CI: 1.132-1.291, P < 0.05). When the optimal threshold for preoperative fast muscle score was set at 18.5, the ROC sensitivity and specificity were 80.6% and 61.2%, respectively. CONCLUSION: Preoperative pelvic floor EMG parameters show good predictive accuracy and clinical applicability for the risk of urinary incontinence after prostate cancer surgery. These parameters can be used for early identification of urinary incontinence risk, with age and fast muscle scores being important predictors.

Clinical Features and Outcomes of Spinal Tuberculosis in Central China.

Purpose: The appropriate management of spinal tuberculosis (TB) is challenging for clinicians and the key to treat spinal TB. Surgery and long course anti-TB chemotherapy may not be necessary to all situations. This study aimed to characterize the clinical features and factors affecting treatment outcomes. Patients and Methods: A retrospective study of patients with spinal TB over a 5-year period at a teaching hospital in central China was conducted. Features of patients with spinal TB who received different treatment modalities and factors associated with patient outcomes at the end of chemotherapy were analyzed. Results: Forty-five patients (21 men and 24 women) with spinal TB were available for analysis. The mean age was 55.39 ± 14.94 years. The most common vertebral area involved was the lumbar (42.2%). The mean number of vertebrae involved was 2.20 ± 0.59. 27 patients (60.0%) received surgical treatment, of which 21 (77.8%) received radical surgical treatment. Thirty-five patients (77.8%) had achieved a favorable status. Statistically, there was no significant correlation between favorable status and surgery, but among 27 surgical patients with spinal tuberculosis, patients receiving radical surgery tended to achieve good prognosis (P = 0.010; odds ratio = 0.053; 95% confidence interval 0.006-0.493). Moreover, there was no significant difference between long course and short course of anti-TB chemotherapy in prognosis in different treatment modalities. Conclusion: Although the patients with spinal TB who needed surgical treatment often got a better prognosis when they had radical surgery, surgery was not actually a factor for the favorable outcomes of patients with spinal TB. In different treatment modalities, there was no additional benefit in longer anti-TB chemotherapy periods.

The diagnostic and therapeutic efficacy of cystoscopy with hydrodistension and random biopsies in clinically suspected interstitial cystitis/bladder pain syndrome.

OBJECTIVE: We aimed to explore the diagnostic and therapeutic efficacy of cystoscopy with hydrodistension and random biopsies for clinically suspected interstitial cystitis/bladder pain syndrome (IC/BPS). STUDY DESIGN: We reviewed the data of fifty-five clinically suspected IC/BPS patients underwent cystoscopy with hydrodistension and random biopsies. Global Response Assessment was used to evaluate the efficacy. Disease severity was assessed by thorough history, physical examination, 3-day frequency volume chart, visual analog scale of pain, Interstitial Cystitis Symptom Index (ICSI) and clinical phenotype system (UPOINT). RESULTS: According to the pathologic outcomes from random biopsies, three out of the 55 clinically suspected IC/BPS were diagnosed as bladder carcinoma. Among the 52 IC/BPS patients, thirty-six patients (69.2%) had initial chief complaints of urinary frequency and urgency. Under cystoscopy, twenty-nine patients and 23 patients were classified as Hunner ulcer type and diffuse global mucosal bleeding (grade III glomerulation). The median functional bladder capacity of the 52 IC/BPS patients was 100 ml. Hydrodistension was effective in 28 patients (53.8%) at postoperative 3 months, which decreased to 25% at post-hydrodistension 6 months and to 13.5% at 12 months. For the 28 hydrodistension-effective patients, the remission degrees of daytime frequency, nocturia, VAS bladder pain and ICSI score were 50.3%, 49.4%, 68.1% and 48%, which were significantly higher than the 16.9% (daytime frequency, P < 0.001), 20.5% (nocturia, P = 0.021), 7.4% (VAS pain score, P < 0.001) and 6.1% (ICSI, P < 0.001) in the hydrodistension-negative group. According to the UPOINT system, the hydrodistension-effective cases had significantly higher rates of symptom remission in U (P = 0.002), P (P = 0.026), O (P < 0.001), and T (P < 0.001) domains than the corresponding negative cases. In effective group, the O domain had the most remission rate (26 out of 28, 92.9%, P < 0.001), followed by the U domain (12 out of 28, 42.9%, P < 0.001) and T domain (12 out of 28, 42.9%, P < 0.001). CONCLUSION: Histopathological analysis from random biopsies could distinguish bladder carcinoma from clinically suspected IC/BPS. Hydrodistension is more likely to be effective when chronic pelvic pain is obviously alleviated. The efficacy of hydrodistension could act in a certain period of time.

A modified Whitaker test (upper urinary tract videourodynamics) using for evaluating complex upper urinary tract reconstruction surgical effect.

BACKGROUND: To evaluate the feasibility and effect of upper urinary tract videourodynamics in complex reconstructed upper urinary tract. METHODS: From January 2016 to December 2018, patients who underwent complex upper urinary tract reconstruction and received upper urinary tract videourodynamics were included in the study. The modified Whitaker test was performed at 3 months after operation. The relative pelvic pressure was defined as the pelvic pressure minus the bladder pressure. Based on the flow rate, the test was divided into physiological phase and high flow phase. The results of pressure and image were classified into 3 types. Successful nephrostomy removal was defined as no symptoms and improved or stable hydronephrosis. RESULTS: A total of 12 patients who underwent complex upper urinary tract reconstruction received modified Whitaker test. All tests were successfully completed without adverse reactions. The relative pelvic pressure of 3 patients kept steady near the baseline throughout the examination and was classified into type 1. The pelvic pressure of 7 patients increased as the perfusion continued, and the relative pressure dropped to relative low level due to the peristalsis of ureter (type 2). The pressure of 2 patients increased along with increasing perfusion speed, and the relative pelvis pressure could easily reach 15 cmH2O. The peristalsis of ureter disappeared or appeared very weakly on the video record (type 3). Patients in type 1 (3 cases) and type 2 (7 cases) groups were allowed to remove the nephrostomy tube immediately. Patients in type 3 group needed to keep the nephrostomy for close follow up, and the tubes were removed 2 weeks and 4 weeks after the examination, respectively. None of the 12 patients received further treatment for recurrent symptoms and exacerbation of hydronephrosis. CONCLUSIONS: The modified Whitaker test is initially safe and feasible in postoperative evaluation of complex upper urinary tract reconstruction surgery. Detailed results can provide more evidence to judge whether nephrostomy tube could be removed safely.

Clinical and Pathological Features of Prostatic Stromal Tumor of Uncertain Malignant Potential: A Retrospective Study of 23 Chinese Cases.

INTRODUCTION: Prostatic stromal tumor of uncertain malignant potential (STUMP) is a rare disease that may coexist with prostate stromal sarcoma (PSS). We aimed to analyze the histological and clinical features of STUMP. METHODS: Twenty-three patients diagnosed with STUMP from 2008 to 2019 were included. Clinicopathological and follow-up information was collected. In the subgroup analysis, we divided the patients into a pure STUMP group (N = 18) and a mixed STUMP (STUMP coexisting with PSS) group (N = 5). Student's t test was used to compare the 2 groups. RESULTS: Patients had a mean age of 55.5 ± 19.4 years and an average follow-up time of 42.3 months. The mean prostate volume was 109.2 ± 73.5 cm3, and the mean prostate-specific antigen was 8.03 ± 10.5 ng/mL. In the subgroup analysis, 16.7% (2/12) of pure STUMP patients had disease progression, while 100% (3/3) of mixed STUMP patients suffered from recurrence. Compared with the pure STUMP group, the mixed STUMP group was younger (37.2 vs. 60.6 years, p = 0.013) and had lower expression of estrogen receptor and progesterone receptor (p = 0.004 and p < 0.001, respectively). CONCLUSION: STUMP is a rare disease with a relatively good prognosis. However, there is still a possibility of disease progression or coexistence with stromal sarcoma. Timely diagnosis and regular monitoring may be helpful in improving treatment outcomes.

Morphologic changes after bladder neck intussusception in laparoscopic radical prostatectomy contribute to early postoperative continence.

PURPOSE: To explore the mechanism and efficacy of the modified bladder neck intussusception in laparoscopic radical prostatectomy (LSRP) on postoperative early continence. METHODS: We prospectively collected clinical information of prostate cancer patients who underwent LSRP with modified bladder neck intussusception (n = 10) and non-intussusception (n = 10). At postoperative 1 month, the prostate-specific antigen (PSA), pad test, real-time magnetic resonance imaging (rt-MRI), and flow rate were performed. At postoperative 3 months, the PSA, pad test, international prostate symptom score (IPSS), overactive bladder symptom score (OABSS), incontinence questionnaire short form (ICI-Q-SF), and quality of life (Qol) were recorded. RESULTS: The intussusception and non-intussusception patients had similar baseline characteristics. At postoperative 3 months, intussusception patients had lower OABSS than non-intussusception patients (P = 0.038). The non-intussusception patients suffered from more severe incontinence (P = 0.026). The continence rate of intussusception patients was significantly higher (90% vs. 20%, P = 0.005). And intussusception patients had significantly lower Qol scores (P = 0.038). According to the morphologic analysis by rt-MRI, there were 7/10 non-intussusception patients and 2/10 intussusception patients having funnel-shaped bladder necks at Valsalva movement. The intussusception patients had larger angle between anterior and posterior wall at bladder neck (P = 0.029) and longer length of functional posterior urethra (P = 0.029). During micturition, the intussusception bladder neck was found to move less dynamically on X-axis and Y-axis, but the difference did not reach significance. CONCLUSIONS: The modified technique of bladder neck intussusception in laparoscopic radical prostatectomy prolongs the length of functional posterior urethra and is effective to improve postoperative early continence.

A nomogram predicting re-operation due to secondary hemorrhage after monopolar transurethral resection of prostate.

We aim to develop a nomogram to predict re-operation due to secondary hemorrhage after Monopolar transurethral resection of the prostate (M-TURP). We identified patients undergoing M-TURP at Peking University First Hospital from 2000 to 2013. Univariate and multivariate logistic regression models were developed to predict the occurrence re-operation due to secondary hemorrhage. The discriminatory ability of the nomogram was tested using the area under the receiver operating characteristic curve (ROC), and internal validation was performed via bootstrap resampling. Of the 1901 patients who underwent M-TURP during the study period, 9.1% (173 patients) experienced hemorrhage after M-TURP, and they had a 22.0% re-operation rate (38 patients). Benign prostatic hyperplasia (BPH)-related complications (odds ratio, 0.386; 95% CI, 0.177-0.841), percent of resected prostate (OR, 0.156; 95% CI, 0.023-1.060) and suprapubic cystostomy (OR, 0.298; 95% CI, 0.101-0.881) were independently associated with re-operation. The nomogram accurately predicted re-operation (area under the ROC curve 0.718). The negative predictive value was 88.0%, while the positive predictive value was 47.9%. Re-operation due to secondary hemorrhage after M-TURP was associated with no BPH-related complications, lower percent of resected prostate and no suprapubic cystostomy and was accurately predicted with using the nomogram.

Expression of programmed death ligand-1 on bladder tissues is detected in a clinically and histologically well-defined interstitial cystitis cohort.

OBJECTIVE: To investigate the expression of programmed death ligand-1 (PD-L1) in interstitial cystitis (IC). METHODS: We reviewed the data of IC patients underwent hydrodistension plus bladder biopsy. Follow-ups were performed. We assessed the degree of inflammation of the bladder wall on slides stained with hematoxylin and eosin (H&E). We performed immunohistochemistry for PD-L1 expression detection and for counting T lymphocytes and B lymphocytes. RESULTS: The present study included eight men and 32 women. With H&E staining, we detected 13, 15, and 12 patients with mild, moderate, and severe inflammation. The degree of inflammation was negatively correlated with disease course (P = 0.018) and positively correlated with bladder pain (P < 0.001). Hydrodistension was found effective at postoperative 3-month for 19 patients. Overall, 17, 15, 7, and 1 subject had no, mild, moderate, and high PD-L1 expression, that correlated positively with the degree of inflammation. Compared with patients with no and mild PD-L1 expression, patients with moderate and high PD-L1 expression tended to have more effective hydrodistension outcomes (12 of 32 vs 7 of 8; P = 0.017). In the subset of 12 patients with severe inflammation, there were five of six patients (83.3%) with moderate or high PD-L1 expression and one of six patients (16.7%) with no and mild PD-L1 expression with an effective hydrodistension outcome. CONCLUSIONS: Expression of PD-L1 on bladder is detected in a cohort of IC patients presented with diffuse global glomerulation or Hunner ulcer. PD-L1 expression is more common in IC patients with severe bladder inflammation.

Urodynamic characteristics of pelvic lipomatosis with glandular cystitis patients correlate with morphologic alterations of the urinary system and disease severity.

AIMS: To explore urodynamic characteristics and their clinical value in pelvic lipomatosis (PL) patients. METHODS: We reviewed the clinical information of 84 PL patients. A voiding pressure-flow study was used to classify patients into nonoutlet obstruction (NOO), latter-half-section obstruction (LHSO), or whole-section bladder outlet obstruction (BOO) groups. Urinary morphologic features were measured by imaging examination and cystoscopy. RESULTS: A unique LHSO that presented as sudden increasing detrusor pressure (Pdet) and decreasing flow rate in the latter half of voiding was observed for 52.4% (44 of 84) patients. Overall, 27.4% (23 of 84 patients) were diagnosed with BOO with whole-section increasing Pdet and decreasing flow rate. According to the morphologic feature analyses, the NOO patients had the largest angle of anteroposterior vesical walls (P < 0.001) and the least severe thickened bladder trigone (P = 0.015). The external compression at the bladder neck and thickened bladder trigone caused a prolonged and strictured bladder outlet tract (see the Supplementary video). There were 0, 5, and 4 urinary diversions performed in the NOO, LHSO, and BOO groups at diagnosis (P = 0.055). No patients in the NOO group, seven in the LHSO group, and two patients in the BOO group had disease progression at follow-up. Two LHSO patients and one BOO patients without hydronephrosis at diagnosis developed to hydronephrosis during follow-up. CONCLUSIONS: Morphologic alterations of the urinary system of PL patients lead to unique LHSO or BOO on UDS. The presences of LHSO and BOO are associated with disease severity and progression.

Suprapubic cystostomy versus nonsuprapubic cystostomy during monopolar transurethral resection of prostate: a propensity score-matched analysis.

We aim to reassess the safety of the monopolar transurethral resection of the prostate (M-TURP) without suprapubic cystostomy at our institution over the past decade. This retrospective study was conducted in patients who underwent M-TURP at Peking University First Hospital between 2003 and 2013. A total of 1680 patients who had undergone M-TURP were identified, including 539 patients in the noncystostomy group and 1141 patients in the cystostomy group. After propensity score matching, the number of patients in each group was 456. Smaller reductions in hemoglobin and hematocrit (10.9 g vs 17.6 g and 3.6% vs 4.7%, respectively) were found in the noncystostomy group. In addition, patients undergoing surgery without cystostomy had their catheters removed earlier (4.6 days vs 5.2 days), required shorter postoperative stays in the hospital (5.1 days vs 6.0 days), and were at lower risk of operative complications (5.7% vs 9.2%), especially bleeding requiring blood transfusion (2.9% vs 6.1%). Similar findings were observed in cohorts of prostates of 30-80 ml and prostates >80 ml. Furthermore, among patients with a resection weight >42.5 g or surgical time >90 min, or even propensity-matched patients based on surgical time, those with cystostomy seemed to be at a higher risk of operative complications. These results suggest that M-TURP without suprapubic cystostomy is a safe and effective method, even among patients with larger prostates, heavier estimated resection weights, and longer surgical times.

Correlation of benign prostatic obstruction-related complications with clinical outcomes in patients after transurethral resection of the prostate.

We aim to investigate the correlation of benign prostatic obstruction (BPO)-related complications with clinical outcomes in patients after transurethral resection of the prostate in China. We reviewed the medical history of all patients who underwent surgery from 1992 to 2013. We assessed the preoperative clinical profile, clinical management, and operative complications. Overall, 2271 patients were enrolled in the study. Of these patients, 1193 (52.5%) had no BPO-related complications and 1078 (46.3%) had BPO-related complications. Compared with patients without BPO-related complications, those with BPO-related complications were older (p = 0.001) and usually had other urologic comorbidities (p = 0.003). Additionally, they tended to have more tissue resected (p < 0.001), a higher American Society of Anesthesiologists grade (p = 0.002), and larger prostates (p < 0.001). Nonetheless, there was no obvious difference in surgical complications between both groups (p > 0.05). Among patients with BPO-related complications, compared with the bladder stone group, only the bladder stone+ group tended to have a greater urinary infection risk after transurethral resection of the prostate. Compared with patients with one or two BPO-related complications, those with three BPO-related complications tended to have a higher risk of pulmonary embolism and acute coronary syndrome (p < 0.05). Despite the widespread use of medication, patients with BPO-related complications were older and had larger prostates; however, transurethral resection of the prostate is still considered a safe and recommended surgical treatment. Nevertheless, those with three or more complications were at a higher risk of severe complication after surgery, and active surgical intervention is needed once BPO-related complications develop.

Repair of complex vesicovaginal fistulas by combining a rotational bladder flap and full thick vascular peritoneal interposition.

PURPOSE: To present the experience of repairing iatrogenic vesicovaginal fistulas (VVFs) using a rotational bladder flap and peritoneal interposition technique. METHODS: Between January 2009 and June 2014, a total of 18 patients (mean age, 44.0 years; age range, 29-51 years) with VVFs were treated using a transperitoneal approach. All VVFs were complications of gynecologic procedures. Twelve patients experienced recurrent VVFs and one patient had a concomitant rectovaginal fistula after radiotherapy. The fistula was approached transabdominally. The peritoneum covering the bladder was isolated to expose the bladder and prepare for the interposition. The bladder was opened along the sagittal plane to the fistula and a bladder flap was rotated downward to fill the fistula defect. The vaginal defect was closed, then a flap using the isolated peritoneum was interposed and fixed between the vagina and bladder. A ureteral re-implantation was performed in one patient. All VVF procedures were performed by one urologist (SW). Repair of the rectovaginal fistula was performed by a general surgeon at the same time. RESULTS: Seventeen patients (success rate = 94% [100% for primary cases and 92% for recurrent cases]) had no evidence of recurrent VVF at a mean follow-up of 20 months (range, 6-36 months). The only patient who had previously undergone a repair procedure failed. CONCLUSIONS: A transperitoneal approach with the use of a rotational bladder flap and peritoneal interposition might be a feasible and reliable procedure for surgical management of iatrogenic VVFs, especially in complicated cases. Neurourol. Urodynam. 35:934-938, 2016. © 2015 Wiley Periodicals, Inc.

[Long-term outcome of isolated local recurrence following radical nephrectomy].

OBJECTIVE: To characterize the long-term outcome of surgical extirpation for local recurrence after radical nephrectomy of renal cell carcinoma (RCC) and identify prognostic factors for locally recurrent RCC. METHODS: Peking University First Hospital urologic database was queried for all patients with isolated local recurrence following radical nephrectomy for localized RCC. According to previous literature, local recurrence included relapse in the renal fossa, ipsilateral adrenal gland and ipsilateral retroperitoneal lymph nodes. The median follow up was 62 months. The cancer specific survival and relapse patterns were estimated using the Kaplan-Meier method. RESULTS: In our institutional database,1 045 patients were treated with nephrectomy for localized RCC from January 1994 to December 2011.With a postoperative follow-up of (62.7 ± 36.2) months, 15 patients (1.44%) experienced local recurrence, 9 of which were managed by surgical resection, and the rest 6 did not receive operation. The patients who received surgical resection had a 1-year cancer specific survival rate of 87%, compared with 60% of the patients without receiving surgical treatment. The 4-year cancer specific survival rate was 72% vs. 30%.The survival time was(51.8 ± 7.4) months vs. (28.4 ± 9.2) months. The recurrence interval was (39.4 ± 29.5) months vs. (29.3 ± 23.9) months. CONCLUSION: Surgical resection for local recurrence of RCC in selected patients is a feasible management and may prolong the survival time.

[Comparation of the transperitoneal and extraperitoneal laparoscopic radical prostatectomy].

OBJECTIVE: To compare the transperitoneal laparoscopic radical prostatectomy procedures with extraperitoneal laparoscopic radical prostatectomy procedures to assess for differences in outcomes and complications. METHODS: A retrospective review 190 patients who had received laparoscopic radical prostatectomy for prostate cancer from June 2002 to January 2013. The results were compared between 116 transperitoneal laparoscopic radical prostatectomy procedures and 74 extraperitoneal laparoscopic radical prostatectomy procedures. RESULTS: The cohorts were similar in terms of mean patient age, height, weight, body mass index, Gleason score from biopsy, and clinical stage. Patients receiced extraperitoneal laparoscopic radical prostatectomy had shorter operation time (146 minutes vs. 224 minutes, Z = -7.220, P = 0.000), less postoperative drainage time (3 days vs. 7 days, Z = -7.115, P = 0.000) and shorter postoperative length of hospital stay (5 days vs. 10 days, Z = -7.250, P = 0.000) than patients receiced transperitoneal procedures. However, the Gleason score, pathological stage, positive margin rate, intraoperative and early postoperative complications has no differences between the 2 groups (P > 0.05). CONCLUSIONS: The patients who received extraperitoneal laparoscopic radical prostatectomy had shorter operative time and revovered faster recovery and the effect of surgery was similar.

[Risk factors for interstitial cystitis/painful bladder syndrome in patients with lower urinary tract symptoms presenting for urologic care].

OBJECTIVE: To identify the risk factors in interstitial cystitis/painful bladder syndrome (IC/PBS) patients with lower urinary tract symptoms (LUTS) without urinary tract infection or benign prostate hyperplasia in China. METHODS: A total of 954 outpatients with LUTS presenting for care to urology clinics at 8 hospitals throughout China from November 20, 2008 to August 24, 2012 were surveyed with a standardized questionnaire and validated outcome measures. The definitions for IC/PBS based on the O'Leary-Sant interstitial cystitis symptom and problem indices were used. The possible risk factors was analyzed with the Fisher's exact and Pearson chi-square tests. And multivariate predictive models were developed with binary Logistic regression methods. RESULTS: There were 491 females and 463 males. And 44.7% (427/954) met the criteria for IC/PBS. There was significant gender difference (51.7% (254/491) vs 37.4% (173/463), P < 0.05) . After adjusting for confounding factors, bladder pain was significantly associated with stimulatory foods (OR: 81.16, 95%CI: 11.50-590.00, P = 0.001) and anorectal disease (OR: 54.90, 95%CI: 9.52-401.00, P = 0.001) in females. Caffeine beverage intake (OR: 4.29, 95%CI: 1.86-9.86, P = 0.001) was the only modifiable association according to multivariate analysis of males. CONCLUSIONS: Stimulatory foods, anorectal disease and caffeine beverages are potential risk factors for IC/PBS.Further studies are necessary to determine their roles in the pathogenesis of this disorder.

Further evidence of endogenous hydrogen sulphide as a mediator of relaxation in human and rat bladder.

We investigated the expression of hydrogen sulphide (H2S) in human and rat lower urinary tract (including bladder, prostate and urethra) tissues, and we sought to determine whether H2S induces relaxation of human and Sprague-Dawley (SD) rat bladder strips. Human normal lower urinary tract tissue was obtained for the evaluation of endogenous H2S productivity using a sulphide-sensitive electrode and for the analysis of the expression levels of all three synthases of endogenous H2S, cystathionine ß-synthase (CBS), cystathionine γ lyase (CSE) and 3-mercaptopyruvate sulphur transferase (MPST, as known as 3-MST) by Western blot assay. CBS, CSE and MPST were located in human sample slides by immunohistochemistry. Human and male adult SD rat bladder strips were tested for H2S function with a transducer and recorded. All experiments were repeated six times. The endogenous H2S productivity and the H2S synthases had various distributions in the human and rat lower urinary tract tissues and were located in both epithelial and stromal sections. L-cysteine (L-Cys, a substrate of CBS, CSE and MPST) elicited relaxation in a dose-dependent manner on human bladder strips pre-contracted by acetylcholine chloride. This effect could be diminished by the ATP-sensitive potassium ion (KATP) channel blocker glibenclamide (GLB), the CSE inhibitor DL-propargylglycine (PPG) and the CBS inhibitor hydroxylamine (HA). H2S and its three synthases were present in the human and rat lower urinary tract tissues and relaxed human and rat bladder strips, which implied that endogenous H2S might play a role in physiological function and pathological disorders of the lower urinary tract symptoms (LUTS) or overactive bladder (OAB).

[Management of idiopathic renal subcapsuler fluid collection: 10 cases report].

OBJECTIVE: To discuss the clinical characteristics of idiopathic renal subcapsuler fluid collection and its treatment. METHODS: From 2009 to 2012, 10 patients with idiopathic renal subcapsuler fluid collection were treated at Urology Department of Peking University First Hospital and retrospective analysis was performed. RESULTS: These patients' ages were 19-73 years, with an average age of 39.9 years. All the patients were female. Their tumors were excluded by image studies before any treatment. Eight cases were treated by percutaneous drainage, 1 by surgery, and 1 under active surveillance. The patients were followed up for 3-15 months, with a median follow-up of 7 months. Recurrence occurred in 1 patient who took percutaneous drainage, and later she took capsulectomy. All the other patients had satisfied results. CONCLUSION: Idiopathic renal subcapsular fluid collection is a rare condition, whose cause is still unknown. The aim of therapy is to relieve symptoms and release the compression to the kidney. Percutaneous drainage or capsulectomy are both therapy options with satisfied results.

Squamous cell carcinoma of the enlarged prostatic utricle in an adult.

A 39-year-old man with gross terminal hematuria and urethral discharge for 5 months was found to have a partial cystic and partial solid mass above the normal site of prostate, which was confirmed by magnetic resonance imaging (MRI) and transrectal ultrasonagraphy. A radical resection of the tumor was performed, and classical squamous cell carcinoma was confirmed by pathologic assay.

[Treatment of renal colic with double-J stent during pregnancy: a report of 25 cases].

OBJECTIVE: There is no consensus on the treatment of renal colic, a hazardous condition for both pregnant women and their fetus during pregnancy. The present study was to evaluate the therapeutic safety and efficacy of double-J stent. METHODS: Twenty-five pregnant women were admitted into our hospital for renal colic between January 2008 and June 2009. The mean age was (28.3 ± 4.9) years old. And the mean gestational week was (20.1 ± 6.9) weeks. The diagnostic and therapeutic procedures were as follows: (1) Upon admission, routine urine and blood tests, chemistry panel and ultrasonography were performed. (2) Analgesics or antispasticity drugs were dispended to the patients, such as progesterone. (3) Magnesium sulfate was used for anti-inflammation. (4) If renal colic was not relieved, a double-J stent was inserted into the ureter via cystoscopy. At pre-, intra- and post-operation, an obstetrician monitored the fetal heart and uterine contraction. (5) Ultrasonography was conducted to check the location of double-J stent. (6) After delivery, the women underwent ESWL (extracorporeal shock wave lithotripsy) and then the double-J stent was extracted. RESULTS: Five (20%, 5/25) patients had a positive previous history: three for renal calculus (n = 3), solitary kidney (n = 1) and reimplantation of ureter (n = 1). Only one patient run a high fever of 40°C. Most patients (84%) had a positive percussion over renal regions. Only 6 patients (24%, 6/25) were found to have a great quantity of red blood cells in urine. Half of the patients showed 10 - 20 white blood cells (WBC) per high power field in urine. Fifteen patients (60%, 15/25) had an elevated count of WBC in routine blood test. Only one patient was with elevated serum creatinine because of her solitary kidney. The calcium level decreased in 8 patients (32%, 8/25). All patients suffered hydronephrosis while 18 patients (72%, 18/25) were not found with calculus in ureters or kidneys. Pain of six patients (24%, 6/25) was relieved after the dosing of analgesics. Eighteen patients (72%, 18/25) underwent double-J stent insertion and 1 patient (4%, 1/25) received percutaneous renal puncture. Then pain was relieved and hydronephrosis vanished. After delivery, calculi were treated properly and then the double-J stent were extracted. Iconography showed no residual calculi. CONCLUSION: For pregnant women with renal colic, retrograde intra-ureteral cannula of double-J stent is both safe and effective. It should be recommended for all renal colic women during pregnancy with or without calculus after the ineffective dosing of analgesics.

Risk factors for interstitial cystitis/painful bladder syndrome in patients with lower urinary tract symptoms: a Chinese multi-center study.

BACKGROUND: Despite 100 years of research, the continued absence of well-established risk factors impedes the diagnosis and treatment of interstitial cystitis/painful bladder syndrome (IC/PBS). We aimed to identify risk factors in patients with lower urinary tract symptoms (LUTS) without urinary tract infection or benign prostate hyperplasia in China. METHODS: A total of 397 outpatients with LUTS presenting for care to urology clinics in several hospitals throughout China were surveyed using a standardized questionnaire and validated outcome measures. The definitions for painful bladder syndrome based on the O'Leary-Sant interstitial cystitis symptom and problem indices were used. The prevalence of possible risk factors was analyzed using the Fisher's exact test and Pearson chi-square test, and multivariate predictive models were developed using binary Logistic regression methods. RESULTS: Of those multi-centre patients surveyed, including 174 women and 223 men, 41% (162/397) met criteria for painful bladder syndrome. There was a significant difference between women and men (55% (95/174) vs. 30% (67/223), P < 0.001). Women with IC/PBS were more likely than those without IC/PBS to report a history of gynecological infections (odds ratio (OR): 2.85; 95% confidence interval (CI): 1.32 - 6.16, P = 0.007), intake of stimulatory foods (OR: 3.52; 95%CI: 1.50 - 8.30; P = 0.004), irritable bowel (OR: 3.46; 95%CI: 1.22 - 9.80; P = 0.014) and/or anorectal disease (OR: 2.68; 95%CI: 1.12 - 6.40, P = 0.023). After adjusting for confounding factors, bladder pain was significantly associated with stimulatory foods (OR: 3.85; 95%CI: 1.58 - 9.36, P = 0.003) and anorectal disease (OR: 2.76; 95%CI: 1.09 - 7.04, P = 0.03) in women. Caffeine beverage intake (OR: 3.54; 95%CI: 1.54 - 8.12, P = 0.003) was identified the only modifiable association noted in multivariate analysis of men. CONCLUSIONS: We found that stimulatory foods, anorectal disease and caffeine beverages are potential risk factors for IC/PBS. Further studies are necessary to determine their role in the pathogenesis of this disorder.