Technical considerations and outcomes for ileal ureter replacement: a retrospective study in China.

BACKGROUND: Ileal ureter replacement is an alternative treatment for various length ureter defects. We present our experience and outcome of ileal ureter replacement in China. METHODS: We retrospectively collected data of patients who underwent ileal ureter replacement between January 2010 and January 2015. We reviewed the medical history, indications for surgery, operative data, perioperative data, and outcomes. Besides, follow-up data included symptom, urine routine test, serum creatinine, serum electrolyte status, and radiographic test. RESULTS: There were 23 patients who underwent ileal ureter replacement by the same surgeon. Twenty patients were performed unilateral ileal ureter replacement, two patients underwent a combination of ileal ureter replacement and Boari flap-psoas hitch, and one received bilateral ileal ureter replacement. Among these patients, the main cause leading to surgical treatment was iatrogenic injuries (n = 15), especially urinary surgery procedure (n = 11). The median follow-up time was 45 months. There were 6 early complications and 6 late complications after operation. Only one patient suffered from small bowel-related complication and was cured by conservative treatment. Only the patient who underwent bilateral ileal ureter replacement had metabolic acidosis. And 22 patients (95.7%) had a good renal function. CONCLUSIONS: Ileal ureter replacement is an efficacious and safe procedure for the therapy of long ureteral defects. With appropriate technical considerations, the complication rate may decrease.

LncRNA HULC promotes epithelial and smooth-muscle-like differentiation of adipose-derived stem cells by upregulation of BMP9.

AIMS: Adipose-derived stem cells (ADSCs), a source of mesenchymal stem cells, are able to differentiate into numerous cell lineages, including epithelial and smooth muscle cells. The use of ADSCs in tissue engineering technology has become the most promising therapeutic approach for urethral reconstruction. This study aimed to explore the effect of lncRNA highly upregulated in liver cancer (HULC) on the induction of ADSCs to differentiate into epithelial and smooth-muscle-like cells. METHODS: ADSCs were isolated from a male dog, and the expression of HULC in ADSCs was overexpressed by transfection with HULC expressing vector lentivirus. The transfected ADSCs were then incubated with 5 µM ATRA or 2.5 ng/ml TGF-ß1 and 5 ng/ml PDGF-BB for 21 days. The expression of epithelial differentiation and smooth-muscle-like differentiation markers were monitored. Besides, cross-regulation between HULC and BMP9 was detected in the differentiated epithelial cells and smooth-muscle-like cells. RESULTS: HULC increased cell viability of ADSCs, but has no impact on ADSCs apoptosis. HULC promotes ADSCs to differentiate into epithelial and smooth-muscle-like cells, as evidenced by the increases in the expression of Uroplakin-II, AE1/AE3, α-SMA, SM-MHC, Calponin, and SM-22α. In addition, HULC could positively regulate BMP9, and BMP9 silence abolished HULC-promoted ADSC's differentiation. Furthermore, HULC activated Wnt/ß-catenin pathway while deactivated Notch pathway. CONCLUSION: HULC was demonstrated to be a promoter during the epithelial and smooth-muscle-like differentiation of ADSCs via the BMP9/Wnt/ß-catenin/Notch network. This study provides the first in vitro evidence that HULC-based therapy could be a valuable approach to promote urethral reconstruction.

Knockdown of mediator subunit Med19 suppresses bladder cancer cell proliferation and migration by downregulating Wnt/ß-catenin signalling pathway.

Mediator complex subunit 19 (Med19), a RNA polymerase II-embedded coactivator, is reported to be involved in bladder cancer (BCa) progression, but its functional contribution to this process is poorly understood. Here, we investigate the effects of Med19 on malignant behaviours of BCa, as well as to elucidate the possible mechanisms. Med19 expression in 15 BCa tissues was significantly higher than adjacent paired normal tissues using real-time PCR and Western blot analysis. Immunohistochemical staining of 167 paraffin-embedded BCa tissues was performed, and the results showed that high Med19 protein level was positively correlated with clinical stages and histopathological grade. Med19 was knocked down in BCa cells using short-hairpin RNA. Functional assays showed that knocking-down of Med19 can suppress cell proliferation and migration in T24, UM-UC3 cells and 5637 in vitro, and inhibited BCa tumour growth in vivo. TOP/FOPflash reporter assay revealed that Med19 knockdown decreased the activity of Wnt/ß-catenin pathway, and the target genes of Wnt/ß-catenin pathway were down-regulated, including Wnt2, ß-catenin, Cyclin-D1 and MMP-9. However, protein levels of Gsk3ß and E-cadherin were elevated. Our data suggest that Med19 expression correlates with aggressive characteristics of BCa and Med19 knockdown suppresses the proliferation and migration of BCa cells through down-regulating the Wnt/ß-catenin pathway, thereby highlighting Med19 as a potential therapeutic target for BCa treatment.

Cathelicidin LL37 Promotes Epithelial and Smooth-Muscle-Like Differentiation of Adipose-Derived Stem Cells through the Wnt/ß-Catenin and NF-κB Pathways.

Ureter reconstruction is a difficult procedure in urology. Adipose-derived stem cells (ADSCs), along with multipotency and self-renewal capacity, are a preferred choice for tissue engineering-based ureteral reconstruction. We explored the synergic role of cathelicidin LL37 (LL37) in epithelial and smooth-muscle-like differentiation. ADSCs were separated from adipose tissues of mouse and characterized by flow cytometry. The ADSCs were then stably transfected with pGC-FU-GFP (pGC) or pGC containing full-length LL37 (pGC-LL37), respectively. Cell viability and apoptosis were respectively estimated in the stably transfected cells and non-transfected cells. Then, qRT-PCR and Western blot analysis were used for determinations of epithelial marker expressions after induction by all-trans retinoic acid as well as smooth-muscle-like marker expressions after induction by transforming growth factor-ß1. Then, possibly involved signaling pathways and extracellular expression of LL37 were detected. Cell viability and apoptosis were not changed after LL37 overexpression. Expression levels of epithelial and smooth-muscle-like markers were significantly upregulated by LL37 overexpression. Moreover, expressions of key kinases involved in the Wnt/ß-catenin pathway as well as epithelial marker were upregulated by the LL37 overexpression, while it was reversed by Wnt/ß-catenin inhibitor. Likewise, expressions of key kinases involved in the nuclear factor κB (NF-κB) pathway as well as smooth-muscle-like markers were upregulated by LL37 overexpression, which was reversed by NF-κB inhibitor. LL37 was found in the culture medium. LL37, which could be released into the medium, had no impact on cell proliferation and apoptosis of ADSCs. However, LL37 promoted epithelial and smooth-muscle-like differentiation through activating the Wnt/ß-catenin and NF-κB pathways, respectively.

MicroRNA-294 Promotes Cellular Proliferation and Motility through the PI3K/AKT and JAK/STAT Pathways by Upregulation of NRAS in Bladder Cancer.

In our study we examined the role of microRNA-294 (miR-294) in bladder cancer and related mechanisms. Real-time polymerase chain reaction (RT-PCR) was performed to determine the expression level of miR-294. Western blot was used to determine the expression of NRAS, mainly factors in the PI3K/AKT and JAK/STAT pathways. Cell counting kit-8 assay, clonogenic assay, wound-healing assay, transwell and flow cytometry were used to explore, respectively, cell proliferation, survival, migration, invasion, and apoptosis of bladder cancer cell line T24. The expressions of miR-294 in bladder cancer cells including J82, HT1376, T24, and SW780 were significantly increased compared to those in human bladder epithelium cells (both HCV29 and SV-HUC-1). The proliferation rate, surviving fraction, migration, and invasion of T24 cells in miR-294 mimetic transfected group were significantly increased, while they were significantly decreased by miR-294 inhibitor transfection. Moreover, miR-294 suppression could increase the apoptotic rate of T24 cells. In addition, drug resistance of T24 cells to cisplatin was increased in miR-294 mimetic-treated group, while it was decreased by miR-294 inhibitor compared to empty control. Overexpression of miR-294 could upregulate NRAS expression in T24 cells and activate PI3K/AKT and JAK/STAT pathways. We found that miR-294 expression was positively related with proliferation and motility of T24 cells. Moreover, miR-294 suppression could promote the sensitivity of T24 cells to cisplatin. We also found miR-294 could upregulate NRAS and activate the PI3K/AKT and JAK/STAT pathways in T24 cells.

Minimally invasive treatment of renal transplant nephrolithiasis.

PURPOSE: Urolithiasis is a rare complication of renal transplantation, and there is limited evidence to guide treatment. Management of stones in the transplanted kidney can be challenging. We present our experience in treating upper urinary tract (UUT) allograft lithiasis using minimally invasive procedures, with the aim of demonstrating their efficacy and safety in renal transplant recipients. METHODS: The records of 1615 patients undergoing kidney transplantation and follow-up in our center between August 2000 and July 2014 were reviewed. The mode of presentation, donor type, onset time, immunosuppression protocol, stone character, therapeutic intervention and outcomes of those with UUT allograft lithiasis were recorded. Extracorporeal shock wave lithotripsy (SWL), flexible ureteroscopy (F-URS) and percutaneous nephrolithotomy (PCNL) were used in the management of these calculi. Stone composition was analyzed after the procedure. RESULTS: Nineteen renal transplant recipients (1.2 %, nine males and ten females) were found to have UUT allograft calculi. Of these, five underwent SWL (26.3 %), four had F-URS combined with lithotomy forceps extraction or holmium laser disruption (21.1 %), six had PNCL (31.6 %), one submitted to F-URS after two failed sessions of SWL (5.3 %), one combined PCNL and F-URS (5.3 %), and two spontaneously of stones (10.5 %). All patients were rendered stone-free with a combination of treatments, and none required a blood transfusion. CONCLUSIONS: The incidence of calculi in the transplanted kidney is low. Minimally invasive procedures are safe and effective means of removing allograft calculi.

Endovascular repair of a transplant renal artery anastomotic pseudoaneurysm using the snorkel technique.

Renal artery pseudoaneurysms after renal transplantation are extremely uncommon and are able to cause severe complications such as aneurysm rupture or renal allograft loss. Treatment often leads to transplant nephrectomy. We successfully treated a transplant renal artery pseudoaneurysm with covered stents, which resulted in well-preserved renal function.

Application of self-retaining bidirectional barbed absorbable suture in retroperito- neoscopic partial nephrectomy.

OBJECTIVE: To investigate the safety and feasibility of self-retaining bidirectional barbed absorbable suture application in retroperitoneoscopic partial nephrectomy. MATERIALS AND METHODS: From Sep 2011 and Aug 2012, 76 cases of retroperitoneoscopic partial nephrectomy were performed at our hospital. The patients were divided into two groups: self-retaining barbed suture (SRBS) group (n = 36) and non-SRBS group (n = 40). There was no significant difference in age, sex, tumor size and location between the two groups. Clinical data and outcomes were analyzed retrospectively. RESULTS: All 76 cases of retroperitoneoscopic partial nephrectomy were successfully performed, without conversion to open surgery or serious intraoperative complications. In the SRBS group, the suture time, warm ischemia time and operation blood loss were significantly shorter than that of non-SRBS group (p < 0.01), and operation time and hospital stay were shorter than that of non-SRBS group (p < 0.05). CONCLUSIONS: The application of self-retaining bidirectional barbed absorbable suture in retroperitoneoscopic partial nephrectomy could shorten suture time and warm ischemia time, with good safety and feasibility, worthy of being used in clinic.

Bioinformatics-Based Identification of Potential Hypoxia-Related Genes Associated With Peyronie's Disease.

Hypoxia is one of the most important predisposing conditions for Peyronie's disease (PD) and the pathogenetic mechanism is yet to be completely elucidated. This study applied bioinformatic approaches to select candidate hypoxia-related genes involved in the pathogenesis of PD. The Gene Expression Omnibus (GEO) data set GSE146500 was introduced to compare the transcriptional profiling between normal and PD samples. The differential expression of hypoxia-related gene was determined with R software. On the selected candidate genes, further functional analyses were applied, including protein-protein interactions (PPIs), gene correlation, gene ontology (GO), and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway. A total of 66 candidate genes (24 candidates overexpressed in PD and 42 showing reduced expression in PD) were distinguished according to the differential expression between human fibroblast cells from normal and PD patients. The interactions among these candidate genes were recognized according to PPI analysis. The functional enrichment analyses revealed the potential modulatory functions of the candidate genes in some major biological processes, especially in glycolysis/gluconeogenesis and carbon metabolism. The findings would facilitate further study on the pathogenesis of PD, which might consequently promote the improvement of clinical strategies against PD.

[70 degrees recumbent position transperitoneal laparoscopy for treatment of upper urinary tract transitional cell carcinoma].

OBJECTIVE: To study the effect of 70 degrees recumbent position transperitoneal laparoscopy for treatment of upper urinary tract transitional cell carcinoma (TCC). METHODS: From May 2004 to January 2007, 70 degrees recumbent position transperitoneal laparoscopy combined with urethral resectoscope was used to treat 31 cases of upper urinary tract transitional cell carcinoma. At the same time titanium clip to occlude the two extremities of ureter tumor was used, extracting specimen by oblique incision of lower quadrant. RESULTS: All operations were finished successfully, no one was turned to open surgery; mean operation time was 140 min, mean blood loss 80 ml, mean hospital stay time 8 d, without complications of urine leakage and intestinal fistula and so on. CONCLUSIONS: 70 degrees recumbent position transperitoneal laparoscopy for resection of whole kidney and ureter is worth of general clinical application because it could provide large space for operation, simplify the treatment of renal pedicle vessels, decrease operation risk, reduce operation trauma and offer early recovery. But its effect on tumor spread and recurrence will still need long term follow-up.

[Laparoscopic radical cystectomy for 43 patients with invasive bladder carcinoma].

OBJECTIVE: To report initial experience with laparoscopic radical cystectomy in 43 patients with invasive bladder carcinoma. METHODS: From December 2003 to October 2006, 29 men and 14 women underwent laparoscopic radical cystectomy with extracorporeal-assisted urinary diversion for transitional cell carcinoma of the bladder (n=40), adenocarcinoma (n=2) and squamous cell arcinoma (n=1). We report the specific technical details and present initial results of our series. RESULTS: The mean operative time of laparoscopic radical cystectomy with pelvic lymph node dissection was 195.4 min, the mean blood loss 273.7 ml, and the transfusion rate 6.9%. Two procedures converted to open techniques. Lymphadenectomy detected lymph node metastasis in three patients. CONCLUSIONS: We demonstrate that the combination of laparoscopic radical cystectomy and extracorporeal urinary diversion is possible and remains a safe, feasible, and repeatable surgical technique. The laparoscopic surgery with extracorporeal urinary reconstruction is emerging as a viable alternative to open radical cystectomy while characterized by less trauma, short recovery time and low complications. Intermediate oncologic outcomes are encouraging and comparable to those of open series. To determine the oncologic outcome long-time follow-up will be necessary.

Clusterin promotes growth and invasion of clear cell renal carcinoma cell by upregulation of S100A4 expression.

BACKGROUND AND OBJECTIVE: Clusterin promotes cell proliferation, motility and invasiveness in human renal cell carcinoma (RCC) cells but the underlying molecular mechanisms of this action are largely unknown. The aim of this study was to investigate the effects of clusterin on cancer cell growth, invasion and S100A4 expression and to determine the effects of clusterin on in vitro cell proliferation and migration and in vivo tumour growth in RCC cells. METHODS: We have established stable transfectants of highly invasive Caki-1 human RCC cells with expression of clusterin shRNA targeting clusterin (Caki-1/clusterin shRNA). We also established stable transfectants of 786-O human RCC cells with expression of clusterin cDNA plaismid (786-O/clusterin cDNA). Clusterin and S100A4 expression was detected by reverse transcription (RT) PCR and western blot assay; Caki-1/clusterin shRNA and 786-O/clusterin cDNA clones were subjected to in vitro-invasion assays. Cell viability and cell growth was assessed in MTT and clonogenic assay. Specific small interfering RNA was employed to down-regulate S100A4. The expression plasmid for S100A4 (pCMV-S100A4) was used to upregulate S100A4. Caki-1/clusterin shRNA clones were injected subcutaneously in nude mice to determine tumour growth and cancer cell invasiveness in vivo. Xenograft tumour tissues were assessed by immunohistochemistry and frozen tissues were used for the detection of S100A4 and clusterin. RESULTS: Overexpression of clusterin increased cell invasiveness; and targeting clusterin reduced cell invasiveness in vitro. This increase in cell invasiveness was mediated by S100A4. Targeting clusterin decreased cell proliferation and down-regulated cellular S100A4 levels in Caki-1 cells; Overexpression of clusterin increased cell proliferation and up-regulated cellular S100A4 levels in 786-O cells; Stable Caki-1/clusterin shRNA transfectants produced smaller xenograft tumours containing reduced S100A4 protein levels in vivo. Stable 786-O/clusterin cDNA transfectants produced larger xenograft tumours containing increased S100A4 protein levels in vivo. CONCLUSION: Our results indicate that clusterin promotes growth and invasion in RCC cells in vitro and in vivo through upregulation of S100A4; And targeting clusterin confers growth inhibitory and anti-invasive properties in RCC cells in vitro and in vivo through a down-regulation of S100A4. These findings provide the rationale for future oncostatic strategies aimed at suppressing clusterin-mediated signal transduction pathways as a novel therapeutic approach in human RCC.

Laparoscopic radical cystectomy with extracorporeal ileal conduit urinary diversion for treatment of Chinese bladder cancer patients.

PURPOSE: To present our experience in laparoscopic radical cystectomy with extracorporeal urinary diversion for treatment of Chinese bladder cancer patients. METHODS: Between January 2003 and November 2005, 41 men and 5 women with organ-confined muscle-invasive transitional cell carcinoma of the bladder underwent laparoscopic radical cystectomy with the Bricker-type urinary diversion. The age range was 36-71 years. Laparoscopic radical cystectomy and bilateral pelvic lymphadenectomy were performed using five fan-shaped ports by a transperitoneal approach. An ileal conduit diversion was created through the site of specimen retrieval which was the second port at the region of the right pararectus. RESULTS: 46 radical cystectomies with Bricker-type ileal conduits were performed. No conversion to open surgery was necessary. Mean operating time was 220 min (range 120-249 min) for laparoscopic radical cystectomy and 75 min (range 65-120 min) for creating the ileal conduits. Mean estimated blood loss was 276 ml (range 155-567 ml). Two of the 46 patients needed blood transfusion (400 ml each). Mean days to ambulation and oral intake was 4.1 (range 3-5 days) and 3.5 (range 3-6 days), respectively. Mean hospital stay was 17.6 days (range 12-35 days). Mean follow-up was 6.1 months (range 3-19 months). Histopathological examination of the specimens revealed stage T2N0M0 in 18 cases, T3aN0M0 in 14, T3bN0M0 in 9 and T3bN1M0 in 5 (TNM staging). WHO grading: G1 in 2 cases, G2 in 26 cases and G3 in 18 cases. Pelvic metastases appeared in one case and 44 patients are alive and free of disease. Intravenous pyelogram at 3 weeks postoperatively shows no evidence of upper urinary obstruction in 45 patients. CONCLUSION: Despite technical difficulties, laparoscopic radical cystectomy with Bricker-type urinary diversion is feasible. With more experience in the surgical technique, laparoscopic radical cystectomy with extracorporeal urinary diversion can become an alternative treatment of choice in the selected patients with organ- confined bladder cancer in China.

[Laparoscopically ureteroplasty in treatment of congenital obstructive megaureter in childhood: report of 3 cases].

OBJECTIVE: To explore the technique and efficacy of laparoscopic ureteroplasty in treatment of congenital obstructive megaureter in childhood. METHODS: Three children with congenital obstructive megaureter, all male, aged 7 approximately 24, underwent laparoscopic surgery. The dilated ureter was dissected and cut off near the place connecting the ureter and the bladder by laparoscopy. A double J tube was placed in the free ureter and connected with the urinary catheter by 7 - 0 wire. Then the free ureter was sutured with the bladder mucosa by laparoscopy. RESULTS: The operation duration was 80 to 200 min and blood loss was 30 to 50 ml. No complication developed. The double J was removed 10 days after the operation. Follow-up for 4 approximately 24 months showed good ureter drainage in all 3 cases without any infection, obstruction and hydrops. CONCLUSION: Laparoscopic surgery to treat megaureter in childhood has the benefits of slight injury and fast recovery in a short-time follow-up.

A Preclinical Study of Cell-seeded Tubularized Scaffolds Specially Secreting LL37 for Reconstruction of Long Urethral Defects.

AIM: We constructed a new artificial, long tubular acellular matrix, seeded with autologous progenitor cells transfected with the sequence to produce the antibiotic peptide LL37 and another two common seeding cells, which might be adopted for patients requiring repair of long segment of the urethra. MATERIALS AND METHODS: Autologous endothelial progenitor cells transfected by lentiviral vectors expressing antibiotic peptide LL37, as well as urothelial and smooth muscle cells from New Zealand white male rabbits, were cultured and seeded onto preconfigured acellular collagen-based tubular matrices (3 cm in length). Artificial conduits were created again in New Zealand white male rabbits and, then, evaluated by immunohistochemistry after 8 weeks. RESULTS: Cell-seeded tubularized collagen scaffolds were found to be effective in repairing long urethral defects, whereas scaffolds without cells led to poor tissue development and structures. CONCLUSION: The artificial tissue engineered tubularized scaffolds combined with genetic methods resulted in vascularized autologous grafts, which may potentially be used for urethroplasty in patients requiring repair of a long segment of the urethra.

Combination of laparoscopic and open procedure in dismembered pyeloplasty: report of 51 cases.

BACKGROUND: Laparoscopic dismembered pyeloplasty with less trauma than open surgery is commonly performed for ureteropelvic junction obstruction despite a longer operating time and a long learning curve. We describe in this paper a new technique, which combines laparoscopic and open procedure in dismembered pyeloplasty, that we have developed in 51 patients and achieved excellent results. METHODS: The surgical procedure can be divided into two steps: laparoscopic dissection of the renal pelvis and proximal ureter transperitoneally; then accomplishing the pyeloplasty through the extended port incision above the ureteropelvic junction as in open surgery. RESULTS: All 51 operations were successful without conversion to open surgery. No intraoperative complications were observed. The operating time was 40 minutes to 90 minutes with an average of 57.5 minutes. The estimated blood loss was 15 ml to 30 ml with an average of 21.2 ml. Aberrant artery vessel and primary stricture as the cause of ureteropelvic junction obstruction was noted in 2 and 49 patients, respectively. Thirty-nine patients had fever to differing extents in the 4 days postoperation and no severe infection was observed. Four patients had urinary leakage with their drains being retained for 6 days, 6 days, 5 days or 8 days after the operation. The mean followup was 10.8 months (range 3 months to 36 months). The followup showed good results with symptom resolution in all the patients. Renal ultrasonography demonstrated that the average separation of the collecting systems decreased from preoperative 2.7 cm (range 2.0 cm to 4.7 cm) to postoperative 1.5 cm (range 1.0 cm to 2.3 cm). Excretory urography at 3 months postoperatively showed improved drainage. Of the 51 patients, 35 underwent two or more excretory urograms, demonstrating stable renal function, improved drainage and no evidence of recurrent obstruction. At the last followup visit, each patient was doing well. CONCLUSIONS: Combination of laparoscopic and open procedure in dismembered pyeloplasty offers a simpler, timesaving method in a minimally invasive fashion with low morbidity for patients with ureteropelvic junction obstruction. Ensuring quality of repair, the method provides a minimally invasive alternative with good results. It is worth future clinical application.

[Laparoscopic aid in upper urinary reconstructive operation].

OBJECTIVE: To evaluate the efficacy and feasibility of laparoscopic aid in upper urinary reconstructive operation. METHODS: Fifty-eight patients with ureteropelvic junction obstruction, 5 patients with upper ureter polypous, 2 patients with upper ureter stenosis, and 13 patients with upper ureter lithiasis underwent upper urinary reconstructive operation with laparoscopic aid described as follows:an incision 1 cm long was made, a 10 mm trocar and a 30 degrees laparoscope were wt in, the part with lesion was isolated and resected, and then pyeloplasty or end-to-end anastomosis of ureter was performed. RESULTS: The mean operative time was 33 minutes (25-45 minutes). The mean blood loss was 20 ml (15-25 ml). Complications such as urinary leakage and infection were observed. The double J stent was removed at 1 month after the operation. Follow-up for 3 to 15 months in 20 cases showed alleviation of hydronephrosis. CONCLUSION: An effective and safe method with less wound and operative time, combination of laparoscopic aid and open surgery in upper urinary reconstructive operation helps avoid difficult laparoscopic operation, does not increase trauma of the abdominal wall, and is worth promoting clinically.

[Extraperitoneal laparoscopic radical prostatectomy (report of 5 cases)].

OBJECTIVE: To discuss the clinical experience of laparoscopic radical prostatectomy by extraperitoneal approach. METHODS: Five patients with localized prostate cancer underwent laparoscopic radical prostatectomy by extraperitoneal approach. The surgical procedure included the excision of the prostate, seminal vesicles, ampulla ductus deferentis and part of the bladder neck, followed by urethrovesical anastomosis. RESULTS: All the operations were successful. The mean operation time was 350 minutes (ranging from 270 to 420 mm); the mean estimated blood loss was 480 ml (ranging from 250 to 600 ml). The bowel activity was recovered with 48 hours after surgery. The patients were ambulant between the 2nd and 3rd postoperative days. The mean hospital stay was 8. 5 days (ranging from 7 to 12 days). The 3-8 months follow-up found no incontinence of urine; of the 3 preoperatively potent patients, 2 were able to have sexual intercourse; strictured stoma was reported in only 1 case. CONCLUSION: The extraperitoneal laparoscopic radical prostatectomy, keeping the procedure out of the peritoneal cavity, with small incision and rapid recovery, may be considered as a promising surgical method for patients with localized prostate cancer.

The complete mitochondrial genome sequence of the prostate adenocarcinoma rat R3327.

The prostate adenocarcinoma of the Copenhagen rat (R3327) is recognized as a suitable model for human prostate carcinoma. In this study, we sequenced its complete mitogenome and total length of the genome was 16,310 bp (GenBank Accession Number KM820831). It contains 13 protein-coding genes, 2 ribosomal RNA genes, and 22 transfer RNA genes. This mitochondrial genome sequence will provide new genetic resource into prostate adenocarcinoma disease.