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Objective To analyze the complication rates in 210 patients undergoing transrectal ultrasound-guided 24-core transperineal prostate biopsy.Methods Clinical data of 210 patients who underwent transrectal ultrasound-guided 24-core transperineal prostate biopsy from 2010 to 2012 were collected.A retrospective analysis of complications after prostate biopsy was conducted.Results The main postoperative complications were hematuria,bloody stool,dysuria,urinary retention,fever (＞38℃),urinary infection,vasovagal syncope,and their complication rates were 43.3 ％ (91/210),10.9％ (23/210),23.3％ (49/210),25.2％ (53/210),14.8％ (31/210),21.9％ (46/210),0.48％ (1/210) respectively.In addition,5 patients (2.5％) were hospitalized due to biopsy related complications.Conclusions Transrectal ultrasound guided 24-core transperineal prostate biopsy is an relatively safe and effective puncture method with common minor complications and less severe complications.Adequate attentions should be paid to its complications.
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Seven cases of renal tumor treated at our hospital from May 2009 to November 2011 were assigned to undergo laparoscopic ultrasonography assisted laparoscopic partial nephreetomy.The mean operative duration was 109 minutes (range:102-121).And the mean volume of blood loss was 82 ml (range:60-120).All patients had confirmed negative margins.Renal clear cell carcinoma was definitely diagnosed in all cases.Laparoscopic ultrasonography could provide more precise information of renal tumor within renal capsule.Thus it may be used to guide the operation so that tumors are excised more completely,residual tumor tissues avoided and normal renal tissues protected.
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A retrospective analysis was conducted for male Han patients aged 46 years or above undergoing serum test of total prostate specific antigen (tPSA) at our hospital from 2007 to 2009.Among them,there were 109 patients with complete clinical data (including a history of hypertension and dyslipidemia),including 36 type 2 diabetics and 73 non-diabetics.For type 2 diabetes and non-diabetes groups,the median values (lower quartile,upper quartile) of serum tPSA test results were 1.01 (0.44,3.43) μg/L and 2.26 (1.04,5.48) μg/L (t =-2.65,P ＜0.01) respectively.The serum level of tPSA in type 2 diabetics was significantly lower than that in non-diabetics.
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Objective To explore the diagnosis and treatment features of tuberous sclerosis complex associated renal cell carcinoma.Methods A 22-year-old boy with a childhood history of epilepsy and mental retardation presented with a complaint of intermittent painless gross hematuria for the past 2 years.After superselective left renal artery embolization was done twice in the past year, painless gross hematuria was still repeated with 6- 10 months intervals.Physical examination showed retarded face, obesity, visible facial angiofibroma and a ditch fibroma.CT scan showed irregular lesions.The largest cross-section 14.2 cm × 9.0 cm in the left kidney was inhomogeneous enhanced from 45 - 54 HU in the plain phase to 60 - 78 HU in the contrast phase.Filling defect in the left renal vein and multiple fat-density lesions (CT value of -25 - -38 HU) with the largest cross-section 7.2 cm× 5.7 cm in the right kidney were also found in contrast CT scan.The PUBMED and CBM database were reviewed.Results Open retroperitoneal radical left nephrectomy was performed.Pathology showed renal clear cell carcinoma and renal vein thrombosis.There was no tumor recurrence or distant metastasis at 4-month follow-up.Conclusions Tuberous sclerosis complex associated renal cell carcinoma is rarely reported.Timely nephron-sparing surgery is necessary when the diagnosis is established, or radical nephrectomy is also necessary if nephron-sparing surgery is impossible.
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Objective To investigate the curative effect of RevoLix 2 micron continuous wave laser va-poresection for treatment of elderly and high risk benign prostatic hyperplasia patients. Methods Clinical data of 36 benign prostatic hyperplasia patients with medical complications aging 70 -82 years were retro-spectively analyzed. Operations were done after their complications were controlled. The RevoLix 2 μm laser system with output power of 70 W was used, and normal saline was used as rinse solution. Operations were started after positions of seminal colliculns and distances to neck of bladder were confirmed. Results Oper-ation time varied from 65 to 135 rain with a mean time of (83.6±10. 6) rain. Occasional venous hemor-rhage occurred during operation but no arterial hemorrhage was observed. No blood transfusion necessitated and no TURP syndrome was observed. Catheter was removed 2-4 days after operation. All the patients could urinate freely. No urinary incontinence was found during follow-up except 2 patients with temporary urinary incontinence. A 3-6 months follow-up showed that IPSS decreased from 24. 26 ±2. 70 to 8.47±4. 32, QOL dropped from 4. 51±0. 56 to 1.34 ± 0. 53, and Qmax increased from (6. 37 ± 1.31) mL/s to (17.24± 2. 32) mL/s. Conclusions RevoLix 2 micron continuous wave laser vaporesection is a safe and effective method with less trauma and fast recovery for treating elderly and high risk benign prostatic hyperplasia pa-tients.
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The perivascular epithelioid cell (PEC) is a cell type constantly present in a group of tumors called PEComas(perivascular epithelioid cell tumors). PEC expresses myogenic and melanocytic markers,such as HMB45. PEComa is a widely accepted entity now. PEComas are related to the genetic alterations of tuberous sclerosis complex (TSC), an autosomal dominant genetic disease due to losses of TSC1 or TSC2 genes. PEComas are rare in the urinary system and there are some open questions about PEComas regarding its histogenesis, the definition of epithelioid angiomyolipoma and the identification of the histological criteria of malignancy. This review provides an update on PEComas of the urinary system.
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Objective To discuss the laparoscopic retroperitoneal dismembered pyeloplasty in the treatment of ureteropelvic junction (UPJ) obstruction. Methods From 2004 to 2007, a total of 41 consecutive patients (20 men and 21 women) with a mean age 30 years (range 12-45 years) un-derwent laparoscopic retroperitoneal dismembered pyeloplasty for UPJ obstruction. One patient had a congenital solitary kidney, 3 patients had renal calculi and 3 patients had horseshoe kidneys. Diuresis renogram and intravenous urography were performed at 3 and 6 months postoperatively, and annually thereafter. Success was defined by the absence of symptoms and improvement of intravenous urogra-phy and the diuretic renogram. Results The mean operative time was 160 min (range 95 to 300 min) with the average estimated blood loss was 35 ml (range 20 to 80 ml). There was no conversion to open surgery. Crossing vessels were found in 10 patients. Among these cases, the ureter was trans-posed anteriorly. Three patients with coexisting renal calculi were successfully had the stones re-moved. The mean hospital stay was 7.5 d (range 5 to 14 d). There were no intra-operative complica-tions. Postoperative complication was recorded in 1 patient with urine leakage. One patient developed an anastomotic stricture who took open surgery afterwards. The success rate was 97.6 % (40/41) at a mean follow-up of 28 months (range 13 to 52 months). Conclusion Laparoscopic retroperitoneal dismemebered pyeloplasty is effective and feasible.
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Objective To evaluate the feasibility of using pure laparoscopic radical nephrectomy and thrombectomy to treat renal tumor with renal vein and vena caval thrombus. Methods Two ca-ses o{ right renal tumor with renal vein and vena caval thrombus were reported. Contrast-enchanced CT showed renal tumor extended into renal vein and vena cava in 1 case, and filling defect was found in right renal vein and extended to vena cava in the other. Both patients received pure laparoscopic ra-dical nephrectomy and thrombectomy through retroperitoneal approach. Four trocars were placed du-ring the operation, and the renal artery was dissected before the vena cava was mobilized circumferen-tially above and below the renal vein, a faparoscopic vessel blockage clamp was used to partly occlude the vena cava containing the thrombus. The vena cava was repaired after the intact tumor thrombus was extracted. Results The tumor thrombus extended 0.3 cm and 1.0 cm above the renal vein, re-spectively. Both patients were discharged 5 d after operation. Pathological examinations showed that tumors were epithelioid renal angiomyolipoma and grade Ⅰ-Ⅱ clear cell carcinoma separately. Both patients were free of local recurrence and metastasis 5 months after operation. Conclusion Pure la- paroscopic radical nephrectomy and thrombectomy for renal tumor with vena caval and renal vein thrombus is feasible in carefully selected patients.
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Interleukin-22 (IL-22) is a new kind of eytokine discovered in 2000. The major sources of IL-22 are activated T1 -cells and NK-cells. Tissue cells at outer body barriers, i.e. of the skin, kidney, the di-gestive and respiratory systems all highly express IL-22R or respond to IL-22. IL-22 functions by promoting the anti-microbial defense, inducing phase reactants, protecting against damage and enhancing natural immu-nity. Furthermore, IL-22 mediates the proliferation, differentiation and apoptesis in cancer cells, that gives us a new idea about tumor therapy.
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Objective To evaluate the safety and feasibility of minimally invasive percutaneous nephro-lithotomy (mPCNL) with U100plus laser for the treatment of renal calculi. Methods From October 2006 to December 2008 ,mPCNL was performed on 133 patients suffering from renal calculi by using Wolf 8/9. 8 rig-id ureteroscope and U10Oplus laser. Results mPCNL was completed in all the 133 cases. Residual calculi were found in 7 cases after operation and use medical drags to treat. The most residual calculi were removed after 1 month and a few stones being survived. 5 cases with residual calculi were treated by ESWL. The total stone clearance was 91.0%. The operation time was 38 -65 min(mean 46 min). Nephrostomy tube was kept for a mean of 1 -2 d. The mean postoperational hospital stay was 2 -4 d. Among the patients, 133 were followed up for 1-16 months (mean 8. 3 months) , during which no recurrent renal stones were found by B ultrasonngraphy or X ray. Conclusion By using mPCNL with U100plus laser, patients with renal calculi can be treated safely and effectively.
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Objective To discuss the feasibility of laparoscopic renal surgery following kidney rupture.Methods Two patients with left kidney rupture were treated laparoscopiclly at our institution in the last 4 years. 1 operated 7 days after hemorrhage and another operated immediately. Both of them performed retroperitoneal laparoscopic nephrectomy. Results The operations succeeded, the operating time being 100～120 min, the blood loss 200～300 mL. There were no postoperative complications in all cases. Conclusion Laparuscopic exploration and extirpation offer a viable measure to treat kidney rupture.
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Objective To study the clinical features,diagnosis and treatment of bladder leiomyoma.Methods The clinical data of eight patients(3 men and 5 women)with bladder leiomyoma were analyzed retrospectively.Results The median age was 42 years ( range,27 -71 years).Three patients were treated with transurethral resection of bladder tumor( TURBT),two patients underwent partial cystectomy,two patients underwent enucleation of leiomyoma,and one patient underwent laparoscopic enucleation of leiomyoma of the bladder.The patients were well with no evidence of recurrent tumor after follow-up from 10 to 75 months.Conclusion Bladder leiomyoma is rare,surgery is the treatment of choice and technique depends on tumor size and localization.The laparoscopic approach seems to be an effective alternative in this group of tumors.
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Objective To study the factors associated with post-operattve renal function injury after laparoscopic nephron-sparing surgery(LNSS)for tumors. Methods Fifty consecutive patients were enroned in a prospective protocol and underwent LNSS.Preoperative and postoperative renal scintigraphic scan was performed in all patients. 99 Tcm-diethylenetetraminepentacetic acid scan was performed in all patients.Linear correlation and multivariate regression model were used to analysis the factors associated with postoperative renal damage.Twenty consecutive patients associated with risk factors were followed-up.These data in GFR were monitored at the preoperative,1 week and 3 months after operation.The duration Warm ischemia was recorded. Results In selected patients,assessed by renal scintigraphy,the function of the operated kidney was reduced by a mean of 24%.Linar correlation analysis showed that there was positive correlation between the age,tumor size,duration of warm ischemia and postoperative renal function injury.Furthermore,multivariate Legression analysis revealed that the duration of warm ischemia was the independent risk factor of postoperative renal damage.Twenty consecutive patients were included in this protocol.There was a significant difference between vessel clamp time≤30 min and vessel clamp time＞30 min.Renal scan data did not reveal any significant decrease in GFR in the affected kidney at 3 months after surgery for the patients whose yesscl clamp time less than 30 min.Renal function damage could not recover in the patients over 70 years with longer than 30 min warm ischemia or with longer than 60 min warm ischemia. Conclusions This paper evaluated renal function on the affected side before and after surgery by measuring renal function with renal scintigraphy using99 Tcm-DTPA.Risk factors for renal dysfunction in the affected kidney after LPN are age over 70 years with more than 30min warm ischemia time,and a warm ischemia time longer than 60 min.
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Objective To evaluate the clinical outcomes of a reformed endoscope assisted ureteral stripping technique in post renal transplant patients with renal pelvic tumor of the graft homonymy primitive kidney.Methods Seven post renal transplant patients with renal pelvic tumor of the graft homonymy primitive kidneys(2 males and 5 females)with average age of 54 years old were recruited.Standard retroperitoneal laparoscopic nephrectomies were performed for all patients after placement of a 5 F ureteral stent as the ureteral stripper. After the closure of the ureter at the lower kidney pole level with metal clips, the distal ureter was separated and the ureteral muscle layer and serous membrane layer were split. The ureter muscle layer was then tied tightly to the ureteral stent tip. The ureter and the stent were pulled out through urethra. Transurethral resection around the everted ureteral orifice was performed and the ureter was removed afterwards. The graft function, operation time,complication and estimated blood loss were recorded.Results All the 7 patients successfully underwent the operations and no major complication such as ureteral disruption, stripping embarrassment and converting to open operation happened. The mean operation time was 126 min (ranging from 105 to 160 min) and the mean blood loss was 124 ml (ranging from 80 to 160 ml). Introvesical chemotherapy with farmorubine hydrochloride was performed 3 weeks after surgery. The mean preoperation and 6 months post-operation creatinine and urea nitrogen levels were 136.5μmol/L, 138. 6μmol/L and 7.42 mmol/L, 7.80 mmol/L respectively and there was no statistical difference. There was no tumor recurrence during 6 month follow-up except one case having simultaneous bladder cancer had bladder cancer relapse 3 months after operation and required another TURBt.Conclusion The reformed endoscope assisted ureteral stripping technique is minimally invasive and convenient in the treatment of post renal transplant patients with renal pelvic tumor of the graft homonymy primitive kidney.
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Background and purpose:Surface enhanced laser desorption ionization time of flight mass spectrometry (SELDI-TOF-MS) is useful in helping to identify the molecular changes closely related to renal cell carcinoma. We explored the different expression of sera protein between human renal cell carcinoma patients and normal to screen renal cancer-specific biomarkers. Methods:The protein mass spectrometry of 28 cases with renal cell carcinoma and 28 normal persons were detected by WCX2 protein chip combining with SELDI-TOF-MS technique for screening the different proteins. Serum samples from 28 patients with clear renal cell carcinoma and 28 normal persons were used to detect biomarkers for clear renal cell carcinoma by SELDI-TOF-MS technique with WCX2 Proteinchip. Results:170 effective protein wave crests between 1.5?103-30?103(1.5-30 kD) were detected. Seven proteins were specifically detected in sera of patients with clear renal cell carcinoma, but not in normal donor. The proteins with MW 4.098,5.917,6.643 ?103 were down-regulated ,and four proteins with MW 5.572,6.344,6.529,8.518 ?103 were up-regulated. Conclusion:Detection of specific protein in human renal cell carcinoma sera is significant both for determination of clinical specific biomarkers and study of cancer development mechanism.
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Objective To understand the ultrastructure of detrusor musculature in areflexia neurogenic bladders. Methods The detrusor secured from the anterior wall of bladders was studied and compared by means of transmission electron microscope in 11 patients with areflexia neurogenic bladder during cystomyoplasty with musculus rectus abdominis and in 7 accidentally deceased young men in autopsy. Results Ultrastructural changes of de differentiation of detrusor cells were observed in areflexia neurogenic bladders,such as inconsistent contours,malalignment and disarray.Wide separation between muscle cells with reduction of intermediate cell junction and with abundant collagen fibrils and irregular dense structures between individual cells were noted.There were also such changes as reduction of pinocytotic vesicle and mitochondria,disarray of myofilaments and malalignment of dense body,etc.,in detrusor cells.By contrast normal detrusor cells were well arranged and well distributed with consistent contours and size.The distance between muscle cells was much smaller than the abnormal specimens with proper intermediate junction.Caveolae and dense area were evenly distributed among the sarcoplasm.Organelles,myofilament and dense body were well organized in the smooth muscle cells. Conclusions The ultrastructural changes of detrusor in areflexia neurogenic bladders may be associated with relative increment of bladder outlet obstruction,which is probably due to detrusor debility from diseased nerve and sequential disequilibrium between normal detrusor and sphincter muscle of the urethra.Prophylactic management of lower intra bladder pressure may be beneficial to the prevention of ultrastructural deterioration in detrusor cells.
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Objective To evaluate the effects of pregnancy and delivery on allograft function and newborns in renal transplant recipients.Methods The effects of pregnancy and delivery on allograft function and newborns in 3 renal transplant recipients were observed and analyzed.The age of the 3 recipients was 32,31 and 31 years,respectively,at pregnancy.They all received triple immunosuppressive therapy(CSA+AZA+prednisone) for the prevention of acute rejection after renal transplantation.Results No acute rejection occurred during pregnancy,and the liver and renal functions were normal in the 3 patients.Preeclampsia occurred in 2 of them.Caesarean section was performed successfully on them at 34,38 and 37 gestational weeks,respectively.The weight of the neonates was 2350 g,3800 g and 3800 g,respectively;and the Apgar scores of the newborns were all 10.(Apgar scores include appearance,pulse,grimace,activity,and respiration.Apgar score ≥8 means newborns in healthy status).After follow-up for 14-46 months,there was no abnormity of the function of transplanted renal and the upgrowth of the newborns.Conclusions Successful pregnancy and delivery are possible in renal transplant recipients with normal renal function.
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Objective To study the clinical and pathologic features of chromophobe cell renal carcinoma and to improve the diagnosis and treatment of the disease. Methods The clinical and pathologic data of 19 patients (10 men and 9 women;mean age,53 years) with chromophobe cell renal carcinoma (9 on the left and 10 on the right) were analyzed.Of the 19 cases,12 were incidentally diagnosed of renal tumor during physical examination.Gross hematuria,low back pain and discomfort and abdominal mass occurred in 7 cases. Results B-ultrasound was mainly characterized by low echo of mass with intact capsule.CT scan revealed that most of the tumors were homogeneous hypodense solid masses,which were well circumscribed.The tumors averaged 8.2 cm in diameter.By TNM staging,8 cases had T_1N_0M_0 stage tumors and 11 cases had T_2N_0M_0 stage tumors.Radical nephrectomy was performed in 17 cases,and partial nephrectomy,in 2 cases.Follow-up was available for 16 patients (mean,4.8 years;range,3 months to 16 years)who were alive without recurrence and metastasis.Pathological features were as follows.①The cross-sections of the tumors were grossly homogeneous, dark brown and solid. One case had fibrous bands coalescence in the center of the tumor.②Microscopically the tumors were composed of 2 types of cells, typical and eosinophilic types,with very distinct borders.③Immunohistochemical assay was positive for CK8 and negative for Vimentin, and Hale colloidal iron staining was positive for the carcinoma cells.④Electron microscopy showed large numbers of vesicles within the cytoplasm. Conclusions Chromophobe cell renal carcinoma is a morphologically distinctive neoplasm with no specific findings on B-ultrasound and CT examinations.The tumors are larger in most cases but usually at early TNM stages with a favorable prognosis.
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Objective To study the significance of rDNA transcription activity of peripheral blood T lymphocyte in patients with urinary tract tumors. Methods rDNA transcription activity of peripheral T lymphocyte was detected by a cell image analysis of Ag-NOR in 21 patients who were pathologically diagnosed with kidney cancer (including 6 cases of T_1N_0M_0,9 of T_2N_0M_0,4 of T_3N_0M_0 and 2 of T_4N_2M_1) and in 42 patients with bladder tumor (including 14 cases of TaN_0M_0,11 of T_1N_0M_0,1 of T_1N_0M_1,8 of T_2N_0M_0,4 of T_3N_0M_0 and 4 of T_4N_0M_0).Twenty-eight normal volunteers served as controls and 23 patients with uremia as positive controls.The peripheral blood was taken for detection of Ag-NORs in controls and in tumor patients before and after operation.The differences were compared among these groups. Results rDNA transcription activity of T cells was (8.55?1.11)%,(6.29?0.97)%,(5.44?0.68)% and (5.42? 0.68)% in controls and patients with uremia,renal and bladder tumors,respectively,showing a statistically significant difference among the normal uremia and tumor patients (P0.05).The parameters,such as TNM stages of renal and bladder tumor,the cell grades according to WHO criteria,tumor volume of the kidney,and invasion depth and recurrence frequencies of bladder tumors,had no significant correlation with rDNA transcription activity of T cells. Conclusions rDNA transcription activity of T cells may be used for monitoring the immune function in patients with kidney and bladder tumors,especially for primary screening of urinary tract tumors.
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Objective To evaluate the clinical value of transrectal ultrasound guided systematic 12-sample needle biopsy in patients with elevated serum prostate-specific antigen and/or abnormal digital rectal examination findings. Methods The data of 220 patients who underwent 12-sample transrectal ultrasound guided needle biopsy (comprising conventional 6 biopsies and 3 biopsies in each lateral peripheral zone) of the prostate were retrospectively analyzed. Results Of the 220 patients,73 (33.2%) had prostate cancers on biopsy;the clinical stages were as follows:4 cases of stage T 1,21 of T 2,15 of T 3 and 33 of T 4.If the conventional 6-core biopsy alone was performed, the detection rate would be 31.4%,4 cases (3 of stage T 1 and 1 of stage T 2,all with tumor volume less than 0.5 ml) would be missed. The improvement by 12-core biopsy was marked in patients with stage T 1-T 2 prostate disease (16%,4/25).No serious complications were observed in patients with transrectal ultrasound guided systematic 12-core biopsy of the prostate. Conclusions The 12-sample procedure can improve the cancer detection rate of the early stage prostate cancer and tumor with volume less than 0.5 ml.Therefore,more attention should be paid to the lateral peripheral zone biopsy.