[5-year follow-up to transurethral vaporesection of the prostate using the 2 micron continuous wave laser for the treatment of benign prostatic hyperplasia].

OBJECTIVE: To summarize the 5-year follow-up to 2 micron continuous wave laser vaporesection for the treatment of patients with low urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH), and evaluate the safety and clinical effects of the treatment. METHODS: From October 2006 to September 2007, 236 cases with low urinary tract symptom secondary to BPH were treated transurethrally under epidural or general anesthesia using the 70 Watt 2 micron laser system. Vaporesection of the prostate was performed with the traditional "U" or the "dividing" method. The 210 cases who met the inclusion criteria in this study were selected for further observation. Baseline and perioperative data were recorded and evaluated in resection time, transfusion rate, catheter-time, improvements in maximal urinary flow rate (Qmax), international prostate symptom scores (IPSS), quality of life (QoL), and post voiding residual volume (PVR). RESULTS: Out of the 210 cases, 179 cases were followed up to 5 years finally. All the surgical procedures were successfully conducted under epidural or general anesthesia. Mean operation time was (80 ± 22) minutes, and mean retrieved prostatic tissue was (24.9 ± 4.2) g. Resected prostatic tissues could be easily flashed out of the bladder. There were no significant differences in serum sodium concentrations and hemoglobin levels before and after the surgery. Mean catheter time and hospital stay was (114 ± 35) hours and (5.7 ± 1.9) days respectively. Only one postoperative secondary hemorrhage was found and treated with blood transfusion. During the 5-year follow-up, Qmax increased from (8.6 ± 3.5) ml/s preoperatively to (23.6 ± 4.2) ml/s by the end of the follow-up (P < 0.01), IPSS and QoL-Score improved from 25.3 ± 5.2 and 4.1 ± 1.3 to 6.1 ± 3.0 and 1.4 ± 0.8 respectively (P < 0.01), and PVR decreased from (248 ± 89) ml to (15 ± 13) ml. The 3 patients developed urinary incontinence and recovered 3 months later through functional exercises with the help of acupuncture. Five patients were found to have urethral stricture 3 months after the surgery and recovered with the treatment of urethral dilatation (3 cases) or internal urethrotomy (2 cases) respectively. CONCLUSIONS: Transurethral vaporesection of prostate using the 2 micron continuous wave laser system is a safe and effective treatment for benign prostatic hyperplasia with obvious improvements in subjective and objective voiding parameters, which were evident at 3 months after the surgery and were sustained throughout the 5-year long-term follow-up.

Transdifferentiation of human adipose-derived stem cells into urothelial cells: potential for urinary tract tissue engineering.

Autologous urothelial cells (UCs) provide a cell source for urinary tissue engineering because they can be used safely due to their lack of immunogenicity. However, these cells cannot be harvested under the following circumstances: malignancy, infection and organ loss, etc. Human adipose-derived stem cells (HADSCs) possess the traits of high differentiation potential and ease of isolation, representing a promising resource for tissue engineering and regenerative medicine. Nevertheless, HADSCs have been poorly investigated in urology and the optimal approaches to induce HADSCs into urothelium are still under investigation. In this study, we hypothesized that the change of microenvironment by a conditioned medium was essential for the transdifferentiation of HADSCs into UCs. We then used a conditioned medium derived from urothelium to alternate the microenvironment of HADSCs. After 14 days of culture in a conditioned medium, about 25-50% HADSCs changed their morphology into polygonal epithelium-like shapes. In addition, these cells expressed up-regulating of urothelial lineage-specific markers (uroplakin 2and cytokeratin-18) and down-regulating of mesenchymal marker (vimentin) in RNA and protein level, respectively, which confirmed that HADSCs were induced into urothelial lineage cells. We also measured the growth factors in the conditioned medium in order to analyze the molecular mechanisms regulating transdifferentiation. We observed that the expression levels of PDGF-BB and VEGF were significantly higher than those of the control group after 14 days induction, suggesting they were abundantly secreted into the medium during the culturing period. In conclusion, HADSCs showed in vitro the upregulation of markers for differentiation towards urothelial cells by culturing in an urothelial-conditioned medium, which provides an alternative cell source for potential use in urinary tract tissue engineering.

Introduction to biodegradable polylactic acid ureteral stent application for treatment of ureteral war injury.

OBJECTIVE: • To study the operability and effectiveness of a biodegradable ureteral stent for clinical treatment of ureteral war injury using a canine model. MATERIALS AND METHODS: • A device was designed and employed to generate firearm fragment wounds in unilateral ureters (on randomly chosen sides) of nine beagles (Group A). The wounded ureters were then debrided and sutured. • Intravenous pyelography (IVP) and radioactive renography were performed 40, 80 and 120 days postoperatively. In Group B, firearm fragment wounds were made to the bilateral ureters in nine beagles. A polylactic acid stent was placed unilaterally (on a randomly chosen side) whereas the ureter on the other side was debrided and sutured without stenting. • Both IVP and radioactive renography were performed 40, 80 and 120 days postoperatively. The operability and effectiveness of the biodegradable ureteral stent were studied thereafter. RESULTS: • In Group A, hydronephrosis and hydroureter occurred and worsened postoperatively on the wounded sides in all nine beagles. The ratio of the renal partial concentration indices (RPCI) between the kidneys (unwounded side : wounded side) increased. • The ratio of the kidney washout half-time between the kidneys (unwounded side : wounded side) decreased. In Group B, neither hydronephrosis nor hydroureter was found postoperatively in the stented ureters but both occurred in the unstented ureters in all nine beagles. • The ratio of RPCI between kidneys (stented side : unstented side) increased whereas the kidney washout half-time ratio between the stented and unstented sides decreased. Differences were significant. CONCLUSION: • In Group A, the new canine model for firearm fragment wounds was tested and proved to be operable and effective. In Group B, hydronephrosis and hydroureter were effectively prevented in ureters by biodegradable stent placement compared with the non-stented ureters where hydronephrosis and hydroureter occurred. The renal concentration capacity was effectively protected and the half-time of kidney washout was shortened.

[Association between lower urinary tract symptoms and erectile dysfunction in males aged 50 years and above: results from a multicenter community-based cross-sectional survey (BPC-BPH)].

OBJECTIVE: To survey the incidence of lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) in males aged ≥ 50 years and explore the correlation between LUTS and ED. METHODS: A cross-sectional study was performed at Beijing communities in 1644 males aged over 50 years. The International Index of Erectile Function-5 (IIEF-5) and International Prostate Symptom Score (IPSS) were recorded. Pearson's χ(2) test and Spearman correlation coefficients were used to analyze the results of IPSS, LUTS and their correlations with ED. RESULTS: The mean age was 64.5 years old (range: 50-93), the mean value of IPSS(9.9 ± 8.2), the prevalence of mild, moderate and severe LUTS 49.2% (809/1644), 36.4% (599/1644) and 14.4% (236/1644) respectively. The mean value of IIEF was (9.4 ± 8.6), the total incidence of ED 90.5% (1487/1644) and the incidence of ED of mild, moderate and severe LUTS 85.7% (694/809), 93.7% (561/599) and 97.9% (231/236) respectively. The total IIEF-5 score was found significantly correlated with the total IPSS score (r = -0.335, P < 0.01), the obstructive symptoms (r = -0.276, P < 0.01)and irritative symptoms (r = -0.326, P < 0.01). The severity of LUTS was correlated with the severity of ED (r = 0.304, P < 0.01). Correlations also existed between age and total IPSS score(r = 0.388, P < 0.01), LUTS severity (r = 0.457, P < 0.01), total IIEF score (r = -0.533, P < 0.01) or ED severity (r = 0.529, P < 0.01). CONCLUSION: The incidence of LUTS or ED in aging males increases with age. The severity of ED is positively correlated with the severity of LUTS. Irritative and obstructive symptoms influence the occurrence of ED in aging males.

[The influence of benign prostatic hyperplasia drugs on incidence and pathology grading of prostate cancer].

OBJECTIVE: To analyze the influence of benign prostatic hyperplasia (BPH) drugs on incidence and pathology grading of prostate cancer in China. METHODS: Retrospectively investigated the history of drug treatment in 1029 cases of BPH in patients from February 1998 to December 2004. According to the history of drug use, the patients were divided into 4 groups: finasteride group, alpha-receptor inhibitor group, finasteride and alpha-receptor inhibitor combination group and control group (untreated group). We gathered pathology sections of patients in all groups, and gave Gleason Score to each. The difference of incidence and pathology grading of prostate cancer were analyzed by Stata 7.0. RESULTS: The incidence of prostate cancer in the population of our study was 13.5%; The incidence in finasteride group, alpha-receptor inhibitor group, combination group and control group was 9.8%, 16.0%, 10.3% and 18.6%, respectively. There was significant difference between the two groups with the use of finasteride and the two groups without it (P < 0.05). In our study, the ratio of middle or high level pathology grading (Gleason ≥ 7) in prostate cancer patients was 58.3%, the ratio of middle or high level pathology grading prostate cancer patients in the four groups was 71.4%, 59.6%, 67.7% and 40.0%, respectively. In the comparison of composition ratio of middle or high level prostate cancer, there was significant difference between the two groups with the use of finasteride and the two groups without it (P < 0.05). CONCLUSIONS: Finasteride can lower the risk of prostate cancer, but increase the pathology grade of the prostate cancer which has occurred in the same time. The alpha-receptor inhibitor does not have the same effect.

[Transurethral partial cystectomy using a 2 microm continuous wave laser in treatment of bladder carcinoma: 1-year follow-up].

OBJECTIVE: To summarize and analyze the clinical features of bladder tumor patients who received transurethral partial cystectomy by 2 microm continuous wave laser, in 1 year post operation follow-up visits. METHODS: From December 2007 to May 2008, 47 bladder carcinoma patients were treated with 2 microm laser transurethrally under sacral block. Operation characteristics, operation time, intraoperative hemorrhages and postoperative complications, and pathology staging of the tumor were observed and postoperative follow-up visits were performed. RESULTS: All of the operation procedures were successful. The surgery time was 5 to 15 minutes. Blood loss in the operation was minimal. There was no obturator nerve reflection, and no hemorrhaging was detected after the operation. The pathological stages can be judged correctly with the obtained specimens. There was one case with peritoneum perforation. The patients received 12 to 17 months of postoperative follow-up visits, and there was no recurrence at the resection site. The survival rate was 100%. CONCLUSIONS: Transurethral partial cystectomy in the treatment of bladder tumor by 2 microm continuous wave laser is a safe, efficient and effective method. The tumor and all the basal part of bladder wall could be excised completely and the pathological stages can be judged correctly using these specimens to fulfill partial cystectomy for the treatment of bladder carcinoma.

[Suppression of tumor growth in renal cancer treatment with tumor vaccination after haploidentical bone marrow cell reconstitution].

OBJECTIVE: To investigate whether whole tumor cell vaccination strategies in combination with bone marrow transplantation (BMT) can stimulate graft-versus-tumor effect (GVT). METHODS: Twenty-six BALB/c mice were randomly divided into 3 groups: BMT group (group A, n = 10), BMT + vaccination group (group B, n = 10), control group (group C, n = 6). (BALB/c × C57BL/6) F1 mice [CB6F1, H-2K(b/d)] were used as donors. BALB/c mice of group C were only inoculated with Renca cell (2.6 × 10(6)). Mice of group A and B were conditioned with 8 Gy irradiation, followed by infusion by bone marrow cell of CB6F1 mice on day 1, then inoculated with Renca cell (2.6 × 10(6)) on day 8. All mice of group B were immunized subcutaneous on the back with 5 × 10(5) irradiated Renca tumor cells on day 9 and day 16. All mice of group C were inoculated with Renca cell (2.6 × 10(6)) on day 8. In group A and B, all mice were analyzed by fluorescence activated cell sorter (FACS) on day 14, and 28 day after BMT. Mice were killed on day 32 after inoculation with tumor cell and collected blood sample. All tumors were taken out to be weighed and then fixed in 10% buffered formalin, embedded in paraffin, and cut into 5 µm slices. The slices were stained with HE and examined by TdT mediated-dUTP nick end labeling (TUNEL). Liver, skin, intestine, and spleen were biopsied for histopathological examination. RESULTS: The results of chimera showed that engraftments of group A, B were full donor chimerism, and the chimerism of those remained above 90% and preserved even after 28 days. The tumor weight, tumor volume increment in the group B was lower than group A and C (P < 0.05). The tumor suppressing rates of the group A and B were 54%, 60% respectively. The area ratio of tumor necrosis and apoptosis index (AI) of the tumor in the group B were higher than group A and C (P < 0.05). Graft-versus-host disease was not observed in each group. CONCLUSION: The mechanism of GVT after haploidentical allogeneic bone marrow transplantation with tumor vaccination may be the promotion of tumor necrosis and apoptosis.

[An ex vivo study on the vaporization ratio of the prostatic tissue lased by the 2 micron laser].

OBJECTIVES: To observe the vaporesection efficiency of the 2 micron laser to the prostatic gland in benign prostatic hyperplasia, and investigate the method of estimating the amount of the vaporesected prostatic tissues during transurethral vaporesection of the prostate using the 2 micron laser system in the treatment of benign prostatic hyperplasia. METHODS: Total 9 fresh prostatic gland specimens were obtained from patients with BPH under open surgical procedures, and vaporesected under a simulated transurethral environment with the 2 micron laser system immediately after weighted. Energies and time consumptions were noted, collections of vaporesected tissue specimens and the remnants of the prostatic glands were weighted after the procedures. The ratios of the vaporized tissues and the collected tissues to the whole vaporesected tissues were calculated respectively. The vaporesection efficiency of the 2 micron laser to the prostatic tissues was also calculated. RESULTS: Among the total lost tissues, about (65.6 +/- 1.5) percent of which were that of vaporized, and nearly (34.5 +/- 1.5) percent were resected. Linear correlation between the weight of collected prostatic tissue(x) and the weight of prostatic gland specimens(y) could be defined as a formula of [y = 3.245x - 6.475 (t = 15.097, P = 0.000)]. CONCLUSION: The amounts of the whole prostatic tissues removed by the 2 micron laser could be calculated from the collected resected prostatic specimens under a simulated transurethral surgical procedure.

[Prevalence of overactive bladder in a community-based male aging population].

OBJECTIVE: To investigate the situation of overactive bladder (OAB) in a community-based male population. METHODS: Male participants over 50 years old were randomly selected from multiple communities in Beijing. The evaluation of lower urinary tract symptoms (LUTS) including the International Prostate Symptom Score (IPSS), quality of life (QOL) score, prostate volume and post voiding residue (PVR) by abdominal ultrasonography, and maximum flow rate (Qmax). Definition of OAB was determined as the score of item number 4 in IPSS ≥ 2. RESULTS: Of 1656 male participants enrolled, a total of 1639 men met our study criteria. The mean age was (64 ± 10) years. The prevalence of OAB was 26.3% (431/1639), and was significantly related to age, IPSS, QOL score, prostate volume, PVR and Qmax (P < 0.01). The prevalence of OAB was closely associated with aging (P < 0.01) and the degree of LUTS (P < 0.01). CONCLUSIONS: The prevalence of OAB increased with aging of the community-based male population. OAB would obviously affect the quality of life of the aging men.

Transurethral partial cystectomy with continuous wave laser for bladder carcinoma.

PURPOSE: To our knowledge we established a new technique to vaporize and incise the full-thickness bladder wall and peel off the entire muscular layers with a 2 microm continuous wave laser to treat bladder carcinoma. MATERIALS AND METHODS: Nine patients were treated transurethrally with a 2 microm laser under sacral block. This 2 microm laser was used to incise the full-thickness bladder wall around the tumors. The entire bladder wall was peeled between the detrusor muscle layer and outer connective tissues. Tumors with full-thickness detrusor muscle layers at the base were removed together and sent for pathological examination. Intraoperative hemorrhage and postoperative complications were observed, and pathological staging and postoperative followup were performed. RESULTS: All operations were successful. Mean +/- SD operative time was 8.7 +/- 2.6 minutes (range 7 to 15) per patient. Perioperative blood loss was minimal. There was no obturator nerve reflection and no hemorrhage was detected after surgery. Bladder perforation occurred in 1 case. Pathological stage of the tumors was T1 and T2a. Patients were followed for 6 to 9 months postoperatively with no recurrence at the resection site. This series included highly selected patients treated by a single high volume surgeon. CONCLUSIONS: To our knowledge this is the first report of a 2 microm laser used to treat bladder carcinoma. It can be applied to precisely vaporize and incise the full-thickness bladder wall and peel it between detrusor muscle layers and outer loose connective tissues, thus completing partial cystectomy for bladder carcinoma.

Vaporesection for managing benign prostatic hyperplasia using a 2-microm continuous-wave laser: a prospective trial with 1-year follow-up.

OBJECTIVE: To explore the safety and clinical efficacy of continuous-wave laser vaporesection for the treatment of obstructive benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: We treated 72 consecutive patients with obstructive BPH using a 70 W 2-microm continuous-wave laser. The mean (range) age of the patients was 68.6 (52-86) years. Before laser treatment, the patients were examined. The mean (SD, range) prostatic volume was 65.8 (21.7, 36-108) mL. The operative outcomes assessed were: resection time, transfusion rate, catheter time, and haemoglobin and serum sodium levels. The following variables were assessed before and after vaporesection: maximum urinary flow rate (Qmax), postvoiding residual urine volume (PVR), International Prostate Symptom Score (IPSS), Quality of Life Index (QoL) and sexual function. RESULTS: All cases were successful using general (two cases), epidural (28) or sacral block regional anaesthesia (42). The mean (SD) vaporesection time was 56 (12.8) min. None of the patients required a transfusion. The mean (SD) catheter time was 1.7 (0.6) days. The mean Qmax increased from 5.7 (1.2) mL/s before to 20.8 (2.1) mL/s after vaporesection and the PVR decreased from 150 to 36 mL. The IPSS and QoL scores improved after vaporesection from 24.6 (4.5) to 6.8 (1.2) and 4.8 (0.2) to 1.4 (0.3), respectively (P < 0.05). Apart from transient dysuria (8%) and irritative symptoms (29%), all patients were satisfied with voiding outcome after vaporesection and none had incontinence. CONCLUSION: Vaporesection using the 2-microm continuous-wave laser for the treatment of obstructive BPH is a safe and effective ablative procedure with minimal morbidity and rare bleeding.

Biodegradable urethral stents seeded with autologous urethral epithelial cells in the treatment of post-traumatic urethral stricture: a feasibility study in a rabbit model.

OBJECTIVE: To evaluate the adhesion and growth of rabbit urethral epithelial cells (UECs) on a biodegradable unbraided mesh urethral stent, and to assess the feasibility and effect of the cell-seeded urethral stent for treating post-traumatic urethral stricture (PTUS) in a rabbit model. MATERIALS AND METHODS: Rabbit UECs were collected by biopsy from adult rabbit urethra and seeded onto the outer layer of a mesh biodegradable urethral stent. The growth of UECs in cell-scaffolds was assessed by scanning electron microscopy, immunohistochemical and fluorescence staining. In all, 32 male New Zealand rabbits were used, with either PTUS or uninjured, as a control group. Cell-seeded stents were implanted into the rabbits strictured urethra. The histological and immunohistochemical findings were assessed after death at 1, 2, 8, 12 and 24 weeks, respectively. The reconstruction and function were evaluated by urethroscopy and retrograde urethrography. RESULTS: The cultured UECs adhered to the stent and grew well. Immunohistochemistry showed that the cells were stained positively for cytokeratin. At 4 weeks, vs 2 weeks, the thickness of the papillary projections of the epithelium decreased and inflammatory cell infiltration diminished. At 24 weeks the injured urethra was completely covered by integrated regeneration of three to five layers of urothelium. There was no evidence of voiding difficulty, stricture recurrence or other complications. CONCLUSIONS: The unbraided mesh biodegradable urethral stent with autologous UECs seemed to be feasible for treating PTUS in the rabbit urethra, and provides a hopeful avenue for clinical application allowing reconstruction of PTUS.

[Relationship between serum prostate-specific antigen levels and body mass index in Beijing men over 50 years of age].

OBJECTIVE: To investigate the relationship between body mass index (BMI) and serum prostate specific antigen (PSA). METHODS: A cross-sectional study was performed at community of Beijing in men over 50 years old. Height, weight and PSA (both serum TPSA and FPSA) were assessed in 1573 men. According to the redefined World Health Organization (WHO) criterion for Asia Pacific Region, BMI was categorized as light weight (BMI < 18.5 kg/m2), normal (18.5 kg/m2 < or = BMI < 23.0 kg/m2), overweight (23.0 kg/m2 < or = BMI < 25.0 kg/m2), obese (25.0 kg/m2 < or = BMI < 30.0 kg/m2) and severe obese (BMI > or = 30 kg/m2). SPSS 13.0 was used in BMI and PSA statistical analysis. RESULTS: Mean age was (64 +/- 10) years, mean BMI (24 +/- 3) kg/m2, PSA median 1.0 (0.6 - 1.9) microg/L and mean prostate volume(30 +/- 18) ml. BMI classification: low weight 54 cases (3.43%), normal weight 441 (28.04%), overweight 423 patients (26.89%), obesity 597 patients (37.95%) and severe obesity 58 (3.69%). We adjusted the low weight group and severe obesity group into normal group and obesity group respectively for small sample capacity. After adjustment, there was no significance difference (P = 0.75) between PSA level of normal group and that of obesity group. However, the PSA level of normal group and overweight group versus obesity group respectively, there were significant differences (P = 0.002, 0.010). After adjusting for age and prostate volume, the correlation between BMI and PSA was negative. BMI showed no significant correlation with PSA in different age groups. CONCLUSION: BMI and PSA were negatively correlated. BMI should be considered as a factor (esp. for obese or severe obese) in man undergoing prostate cancer screening.

[Histopathologic analysis of 2 micron continuous wave laser for the partial cystectomy of bladder urothelial carcinoma].

OBJECTIVE: To observe the histopathologic characteristics of 2 micron continuous wave laser transurethral partial cystectomy for the treatment of bladder tumor. METHODS: A total of 54 patients with 65 bladder tumors underwent 2 micron laser via transurethral by caudal or surface anesthesia from October 2007 to December 2008. It included 41 male and 13 female cases, and the age ranged from 27 to 81 years old with a mean of (66.2 +/- 12.4) years old. The operation evaporated and exsected the wall of urinary bladder, including tumor, submucosa and all muscular layers. Specimens were sent for pathology examination. The histomorphologic changes of raw surfaces were observed 1 week, 1 month, 3 months, 6 months and 1 year postoperation by cystoscopic and pathologic examinations. RESULTS: All the patients tolerated in the operation. Clinical stages of the tumor: T1 for 42 cases, T2 for 12 cases. All cases were followed-up for 1 to 14 months, with a mean of 8.5 months. Tumor recurrences were found in 2 cases, no one had recurrence in situ. The tumor, submucosa and all muscular layers can be resected completely by 2 micron continuous wave laser transurethral partial cystectomy. Pathologic staging can be judged correctly. The umbilication raw surface were infiltrated by fibrous connective tissue and chronic inflammatory cells 1 week postoperation. The umbilication changed shallow and transitional epithelial cells began to cover it 1 month postoperation. The umbilication disappeared and transitional epithelial cells cover the raw surface 3 months postoperation. There was no difference between the raw surface and normal bladder mucosa. CONCLUSIONS: 2 micron continuous wave laser for the treatment of bladder tumor can get the same clinical result as partial cystectomy. The pathologic staging can be judged correctly by the specimens.

[Initial experience of partial cystectomy in treatment of bladder tumor by 2 microm continuous wave laser].

OBJECTIVE: To analyze the clinical characteristics of partial cystectomy in treatment of bladder tumor by 2 microm continuous wave laser. METHODS: A total of 18 patients with 21 bladder tumors treated by 2 microm laser via transurethral under sacral block. The diameters of tumors were between 1-3 cm. In the operation, we vaporized and cut whole wall of bladder, dissected the muscular layers from connective tissue, and sent them for pathology inspection. We reviewed these following variables: operation time, blood loss, complications during and after the operation, pathology staging of the tumor and follow-up visit. RESULTS: All the patients were tolerated in the operation. The mean operative time was (7.4 +/- 3.3) min (range, 5-12 min). Blood loss in the operation was minimal. No patient experienced an obturator nerve reflection or a hemorrhage after the operation. One case has urine leakage. The pathology staging of the tumors were as follows: T1 stage 15 cases, total 18 tumors; and T2 stage 3 cases, total 3 tumors. The followup periods were between 3 to 6 months, and the mean period was 4.5 months. There was no recurrence in situ. CONCLUSIONS: The 2 microm laser not only can vaporize and cut the wall of bladder finely, but also can dissect the muscular layers from connective tissue efficiently. So it can be partial cystectomy in the treatment of bladder tumor.

[Analyze the change of bladder tumor cells in irrigating solution after partial cystectomy by 2 microm continuous wave laser].

OBJECTIVE: To summarize the change of bladder tumor cells in irrigating solution after partial cystectomy by 2 microm continuous wave laser. METHODS: From May 2008 to December 2008, a total of 30 patients of bladder cancer, the diameters of tumors from 0.5 to 3.0 cm. The diameter being regarded as the standard, patients were divided into two groups, 10 cases in group A (diameter < 2.0 cm) 20 cases in group B (diameter >or= 2.0 cm). The pre-operative pathologic histology diagnoses of all patients by biopsy were bladder urothelial carcinoma. Partial cystectomy by 2 microm continuous wave laser was given in operation. Due to the patients in group a with smaller tumors, the tumors were washed out of the bladder through the sheath of cystoscope directly. In group B, the larger tumors were cut into blocks by laser in the bladder, and washed out. After removing the tumors and debris, bladder irrigation was performed with about 150 ml solution for 5 times, then irrigating solution was centrifuged and numbered respectively before cellular pathology examination. RESULTS: In group A, there were no tumor cells but epithelial cells and red blood cells could be seen in 8 cases. In the other 2 cases, a small amount of integrity and shape broken tumor cells could be seen in the No.1 and No.2 piece. There was no tumor cell in No.3, No.4, and No.5 pieces. In group B, tumor cells can be seen in No.1, No.2 and No.3 pieces in 14 cases, but cell density decreased gradually. There was no tumor cell in No.4, No.5 pieces, and tumor cells can be seen in No.1 to No.4 pieces for another 6 cases, and cell density also decreased gradually, there was no tumor cell in No.5 piece. CONCLUSION: After the surgery, 5 times of bladder irrigation in all cases of partial cystectomy by 2 microm continuous wave laser can reduce the remnants of the bladder tumor cells effectively.

Photoselective laser vaporization prostatectomy for acute urinary retention in China.

PURPOSE: To assess the clinical efficacy and safety of photoselective laser vaporization of the prostate (PVP) in the treatment of patients with acute urinary retention (AUR) secondary to benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: Forty-two patients (mean age 72 +/- 5 years, range 65-89) with AUR because of BPH were treated with a prospective trial of PVP with the potassium-titanyl-phosphate (KTP) laser. The treatment outcome was evaluated with subjective and objective tests at 1, 3, 6, and 12 months after PVP using the International Prostate Symptom Score (IPSS), disease-specific quality of life (QoL) score, postvoid residual (PVR) urine volume, and maximum urinary flow rate (Qmax). The International Index of Erectile Function questionnaire and a self-designed ejaculatory questionnaire were completed at different follow-up times to determine patient satisfaction and changes in sexual function. RESULTS: After preliminary urine drainage and adequate preoperative preparation, PVP was performed and bladder outlet obstruction was effectively relieved. The mean prostate volume was 62.5 +/- 11.7 cc, and the mean residual volume with retention was 650 mL (range 240-1200 mL). Mean operative time was 28.6 +/- 5.7 minutes. Mean catheterization duration was 5.6 days (range 3-14 d). There was significant subjective improvement of symptoms and objective improvement in urinary flow rates at 12 months. The mean IPSS and QoL score decreased significantly (P < 0.05). Mean PVR volume also decreased. The mean Qmax was 16.2 +/- 4.6 mL/sec after treatment. Only two patients had recurrent urinary retention during follow-up. There were no intraoperative or postoperative adverse events. CONCLUSIONS: The early clinical results suggest that the PVP is a promising safe, effective, and less-invasive treatment with minimal morbidity for patients with urine retention secondary to BPH.

[Continuous wave laser of 2 microm for bladder tumor treatment].

OBJECTIVE: To analyze the clinical characteristics of 2 microm continuous wave laser vaporization resection for the treatment of bladder tumors. METHODS: A total of 56 patients with 68 bladder tumors underwent 2 microm laser vaporization resection via a transurethral cystoscope under caudal anesthesia. In the operation, the wall of the urinary bladder was vaporized and cut, the muscular layers were removed, and then the specimens were sent for pathological inspection separately. The following variables were recorded: operation time, blood loss, complications during and after the operation, pathology staging of the tumors, and follow-up visit time. RESULTS: All patients endured the operation. The mean surgery time was 8.8 +/- 3.3 minutes (range, 4 to 15 minutes). Blood loss was minimal, no patient experienced an obturator nerve reflection, or a hemorrhage after the operation. The pathology staging of the tumors were as follows: 40 cases (total 47 tumors) were T1 stage; 16 cases (total 21 tumors) were T2 stage. The follow-up periods were between 12 to 17 months, and the mean period was 14.5 months. Tumor recurrences were found in 3 cases, and one patients suffered two recurrences, the total recurrence rate was 5.3%. There was no primary recurrence. CONCLUSIONS: The 2 microm continuous wave laser is a new, safe and efficacious method for the treatment of bladder tumors. Because the 2 microm laser can vaporize and cut the muscular layers of the bladder finely, it can not only treat superficial bladder tumors efficiently, but also treat some types of invasive tumors of the bladder.

[Expression of apoptosis inhibitor gene Livin in prostate cancer and its clinical implication].

OBJECTIVE: To study the expression of Livin, an apoptosis inhibitor gene, in prostate cancer, and to investigate its clinical and pathological implications. METHODS: The expressions of Livin were detected in 62 cases of neoplastic prostate tissues and 10 cases of normal prostate tissues by RT-PCR and immunohistochemistry (SP method). RESULTS: The Livin gene was highly expressed in neoplastic prostate tissues, but not in normal ones. Positive expression of Livin proteins was observed in 37 of the 62 (59.7%) tumor samples and accounted for 28.6%, 60.0% and 83.3% in the high, middle and low differentiation prostatic carcinoma groups respectively, with significant difference between the high and low groups. Livin positivity was also significantly correlated with tumor stages, increasing with tumor progression. CONCLUSION: Livin may play an essential role in prostate carcinogenesis and serve as a marker for the prognosis of prostate cancer.

[DNA damage induces BRCA1 distribution alteration in prostate cancer cell lines].

OBJECTIVE: To investigate the role of the tumor suppressor gene BRCA1 in response to DNA damage and to confirm that the function of the BRCA1 protein is regulated by a variety of mechanisms including transcriptional control, phosphorylation and protein-protein interaction. METHODS: With the human breast cell line MCF7 as the positive control, we determined the subcellular distribution of BRCA1 in the prostate cancer cell lines LNCaP, DU145 and PC3 by immunohistochemical staining and Western blotting analyses. RESULTS: BRCA1 was present in the prostate cancer cell lines LNCaP, DU145 and PC3. Ionizing radiation induced BRCA1 nuclear export, increasing from 14% to 40% in the cytoplasma (P < 0.01) and decreasing from 46% to 21% in the nuclei (P < 0.01). This DNA damage-induced BRCA1 nuclear export occurred only in the p53 wild-type but not in the p53 mutant cell line. The apoptosis rate of LNCaP cells was as high as 40% after nuclear export, with an obvious increase of cleaved caspase-3, which was correlated with BRCA1 nuclear-cytoplasmic shuttling. CONCLUSION: Cytoplasmic relocalization of the BRCA1 protein may be a mechanism whereby the BRCA1 function is regulated in response to DNA damage. Its induction of a higher rate of cell apoptosis indicates BRCA1 to be another good biomarker for the treatment of prostate cancer.