Oleic acid promotes cell invasion through an integrin-linked kinase signaling pathway in renal cell carcinoma.

The change of fatty acid composition has been regarded as an indicator of altered lipid metabolism during human tumourigenesis, but the details are still unclear. We have previously demonstrated a monounsaturated fatty acid (MUFA) named oleic acid (OA) was involved in renal cell carcinoma (RCC) cell growth, as an extracellular signaling molecule to regulate 786-O cell proliferation via the integrin-linked kinase (ILK) pathway. In this study, we further observe the effects of OA on cell invasion of RCC and the potential mechanism by which OA worked was determined. The transwell invasion assay showed OA increased cell invasion of RCC in a dose-dependent manner. Western blotting results indicated ILK, COX-2, and MMP-9 proteins were involved for their high expressions and these effects were reversed when down-regulating the expression of ILK by special siRNA. The MMPs inhibitor GM6001 could weaken the abilities of OA on RCC cells invasion. These results suggested MUFA indeed affected cell invasion of RCC, which was depended by the regulation of ILK pathway.

Removal of a broken acupuncture needle in retroperitoneum by laparoscopy: a case report.

BACKGROUND: Acupuncture is a famous traditional medicine in China, but the complications caused by broken acupuncture needles have been rarely reported. It seems easy to remove the foreign matters usually, but things become difficulty in special issues. Here, we reported a recently encountered case to provide an important teaching point of treating a chronically retained broken needle in retroperitoneum. CASE PRESENTATION: A 42-year-old man presented with a chronically retained broken needle in his body after acupuncture therapy two years ago. However, due to the discomfort at the left back recently and ordinary inconvenience such as security check, he came to our hospital for minimally invasive surgery. He was introduced to our department because the broken needle had migrated from subcutaneous to adipose tissue in retroperitoneum during the two years. Considering the position of the broken needle, the patient was performed by laparoscopy in general anesthesia. The operation time was about 31 min and there were only three 7 mm incisions in the left lateral abdominal wall. The X-ray exam was performed to confirm that the broken needle was removed integrally. The patients begun normal activity at 6 h after surgery and was discharged on the second day after surgery. CONCLUSIONS: Acupuncture is widely used for pain treatment in China, but how to handle the complication of acupuncture needle broken in body are rarely reported. Laparoscopy will be the reasonable choice for treating needles broken in retroperitoneum.

[Management of female urethral obliteration with the rotary excision appliance].

OBJECTIVE: To describe a new technique using the rotary excision appliance for the treatment of female urethral obliteration and to evaluate the effect of the management. METHODS: Between October 2000 and July 2013, 5 cases of female urethral obstruction (age from 23 to 65 years, time to treatment from 3 to 60 months, obliteraion length from 0.5 to 1.8 cm) were managed using the rotary excision appliance and the patients had been followed up. RESULTS: After a mean of 32.4 months (range: 5 to 75 months) of follow-up, normal micturation had been achieved in all the patients. The maximal urinary flow rate (MFR) ranged from 15 to 28 mL/s (mean 20.6 mL/s). Three patients were continent and 2 patients had slight incontinence. CONCLUSION: The rotary excision appliance is a useful instrument for the management of female urethral obliteration. Our Long-term follow-up provides further support for use of this technique by demonstrating that urethral continuity can be established without increased incidence of stricture formation or incontinence.

Penile replantation: report of two cases and review of the literature.

Penile amputation and successful replantation is very uncommon, and there is no routine standardized procedures for dealing with this medical condition. Here we report two cases of penile amputation and replantation involving different degrees of vascular insult leading to different pathogenesis, clinical presentation, surgical approach and prognosis. This report described the microsurgical procedure and postoperative care using bipedicled scrotal flap to achieve successful engraftment and function. A review of the published data and future methods to increase success of such surgical procedures is provided.

[Association between HPV DNA and disease specific survival in patients with penile cancer].

OBJECTIVE: To examine the prevalence of human papilloma virus (HPV) in penile squamous-cell carcinomas (SCCs), explore the relationship between HPV and clinicopathological variables and determine its value for predicting disease-specific survival. METHODS: We retrospectively collected clinicopathological data of 28 patients with penile squamous cell carcinomas from 2000 to 2009 at Beijing Cancer Hospital, Beijing Hospital and Peking University People's Hospital. Polymerase chain reaction (PCR) was used to detect the presence of HPV DNA in tumor specimens. Regular follow-ups were conducted. Disease-specific survival plots were drawn with the Kaplan-Meier method and compared with the Log-Rank test. Cox proportional hazard analysis was applied to assess the independent effects of several prognostic factors on survival. RESULTS: HPV DNA was detected in 7/28 samples. After sequencing, all 7 samples were confirmed to be HPV-16 type. The median follow-up period was 60 (6-150) months. By the time of analysis, 8/28 patients died. HPV DNA was not significantly associated with age, pathological grading, pathologic T stage or lymph node metastasis (P = 0.191, 0.165, 1.000, 0.639 respectively). Cox multivariate regression analysis indicated that lymph node status (HR = 5.5, P = 0.023) was an independent predictive factor of disease specific survival, followed by pathological T classification (HR = 11.0, P = 0.035) . The 5-year disease-specific survival in patients with HPV DNA positive was higher than that in those with HPV DNA negative (67% vs 58%) . But survival had no significant differences (P = 0.431). CONCLUSIONS: Higher pathologic T stage and lymph node metastasis are independent prognostic factors for worse survival. And mortality does not increase markedly in penile cancer patients with HPV DNA positive.

[Penile cancer and human papillomavirus infection].

Human papillomavirus (HPV) infection is one of the major risk factors for penile cancer. This article presents an overview on the biological characteristics of HPVs, HPV infection in penile cancer, possible carcinogenic mechanisms of HPV, prognostic value of HPV in penile cancer, and HPV vaccine.

[Replantation of amputated penis in Chinese men: a meta-analysis].

OBJECTIVE: To evaluate the methods for the replantation of the amputated penis in Chinese men. METHODS: We performed a meta-analysis on the domestic literature relating replantation of the amputated penis, particularly its successful methods published from 1964 to January 2012. RESULTS: We identified 109 reports on 111 cases of replantation of the amputated penis that met the inclusion criteria, including 103 adults and 8 children. The mean age, warm ischemia time and total ischemia time were 29 +/- 11 years (range 2 - 56 years), 5.2 +/- 5.7 hours (range 0 - 38 hours) and 6.3 +/- 5.7 hours (range 1 - 38 hours). Fifty-three of the cases were treated by microsurgery and 44 by non-microsurgery. Complications occurred in 81 (73%) of the cases, including ED in 14 cases, urethral stricture in 16, urinary fistula in 8, skin necrosis in 58 and skin sensory abnormality in 31. The incidences of ED, urethral stricture and urinary fistula exhibited significant differences between the microsurgery and non-microsurgery groups of the partial amputation patients (P < 0.05). The incidence of ED was correlated negatively with the number of anastomosed dorsal nerves (r = -0.3, P = 0.05), anastomosis of dorsal veins (r = -0.2, P = 0.02) and anastomosis of arteries (r = -0.2, P = 0.03), but positively with skin sensory abnormality (r = 0.4, P < 0.01), that of urethral stricture negatively with the anastomosis of dorsal nerves (r = -0.2, P = 0.02) and arteries (r = -0.2, P = 0.016), but positively with the anastomosis of corpus cavernosum (r = 0.3, P = 0.01), that of skin necrosis negatively with the total number of anastomosed blood vessels (r = -0.2, P = 0.04), and that of complications negatively with the number of anastomosed dorsal nerves (r = -0.3, P = 0.01), dorsal veins (r = -0.2, P = 0.04), arteries (r = -0.2, P = 0.023) and micro-anastomosis (r = -0.3, P < 0.05). CONCLUSION: Early micro-anastomosis of the most possible penile dorsal veins, arteries and dorsal nerves is essential for the survival of the replanted penis and reduction of complications, and therefore can be regarded as a "standard" method for penile replantation in China.

[Differences of urodynamic tests between patients of detrusor hyperactivity with impaired contractility with and without bladder outlet obstruction and effect of anticholinergic medications in these patients].

OBJECTIVE: To explore the differences of urodynamic parameters and lower urinary symptoms between detrusor hyperactivity with impaired contractility (DHIC) patients and DHIC patients with bladder outlet obstruction (BOO) and evaluate the effects and risks of anticholinergic medications in these patients. METHODS: A retrospective analysis was performed in 56 DHIC patients at our hospital between February 2000 to February 2011. Among them, 19 patients were complicated with BOO. Urodynamic studies were conducted and lower urinary symptoms assessed in all patients. Then the urodynamic parameters and lower urinary symptoms scores were compared between the DHIC and DHIC plus BOO patients. Among them, 27 received anticholinergic medications and there were 11 BOO patients. After 2-month anticholinergic medications, the differences of lower urinary symptom score were analyzed and anticholinergic-induced retention was also investigated. RESULTS: As compared with the DHIC patients, the DHIC plus BOO patients had a higher post-voiding residual urine (70 (23 - 106) vs 20 (10 - 81) ml, P = 0.02), higher total international prognostic scoring system (IPSS) score (25.6 ± 3.9 vs 22.1 ± 4.1, P = 0.00) and higher total voiding symptom score (15.3 ± 2.9 vs 11.8 ± 3.3, P = 0.00). After 2-month anticholinergic medications, the IPSS score of DHIC plus BOO patients decreased from 25.7 ± 4.6 to 23.6 ± 4.9 (P = 0.01), 2/11 patients developed urinary retention. The IPSS scores of DHIC patients decreased from 22.8 ± 4.7 to 21.4 ± 4.6 (P = 0.01) and none had urinary retention. CONCLUSIONS: The DHIC plus BOO patients have more aggravated bladder empting and more severe lower urinary symptoms especially during voiding phase. Anticholinergic medications may alleviate the lower urinary symptoms in DHIC and DHIC plus BOO patients. But anticholinergic-induced retention is common among the DHIC plus BOO patients.

[Aggressiveness and extent of prostatic inflammation relates with serum PSA levels in type IV prostatitis].

OBJECTIVE: To investigate the relationship of the histopathologic grade and extent of prostatic inflammation with the level of serum PSA in patients with type IV prostatitis. METHODS: We performed transrectal ultrasound-guided prostate biopsy for 120 patients suspected of prostate cancer and included in this study only those with benign prostate hyperplasia (BPH) and prostatitis (n = 46), excluding the cases with prostate cancer and those with BPH but no prostatitis. We evaluated the relationship between prostatic inflammation and serum PSA levels based on the three-grade pathohistologic criteria for the extent, location and aggressiveness of prostatic inflammation. The serum tPSA levels, fPSA levels, % fPSA, and PSAD were compared among different groups. RESULTS: As for the extent of inflammation, 35 of the 46 included cases were grade I (tPSA: [8.46 +/- 4.09] microg/L; fPSA: [1.75 +/- 0.93] microg/L; PSAD: 0.15 +/- 0.11), 7 were grade II (tPSA: [15.26 +/- 5.26] microg/L; fPSA: [2.54 +/- 0.72] microg/L; PSAD: 0.26 +/- 0.07) and 4 were grade III (tPSA: [21.05 +/- 7.58] microg/L; fPSA: [3. 19 +/- 1.13] microg/L; PSAD: 0.42 +/- 0.19), with statistically significant differences among the three groups in the levels of tPSA (P = 0.001), fPSA (P = 0.008) and PSAD (P < 0.001). Regarding the location of inflammation, 19 cases were grade I, 17 were grade II and 10 were grade II, with no significant differences in tPSA, fPSA and %fPSA among the three grades (P > 0.05). As for the aggressiveness of inflammation, 32 cases were grade I (tPSA: [8.37 +/- 4.07] microg/L; fPSA: [1.76 +/- 0.93] microg/L; PSAD: 0.14 +/- 0.11), 10 were grade II (tPSA: [13.30 +/- 5.69] microg/L; fPSA: [3.27 +/- 2.21] microg/L ; PSAD: 0.25 +/- 0.06) and 4 were grade III (tPSA: [21.05 +/- 7.58] microg/L; fPSA: [3.19 +/- 1.13] microg/L; PSAD: 0.42 +/- 0.19), with statistically significant differences among the three grades in the levels of tPSA (P = 0.002), fPSA (P = 0.024) and PSAD (P < 0.001). The extent of inflammation was positively correlated with the levels of tPSA (r = 0.6, P < 0.001), fPSA (r = 0.5, P = 0.001) and PSAD (r = 0.6, P < 0.001), and so was the aggressiveness of inflammation (tPSA: r = 0.5, P < 0.001; fPSA: r = 0.4, P = 0.008; PSAD: r = 0.7, P < 0.001), but a negative correlation was found between the aggressiveness of inflammation and %fPSA (r = -0.4, P = 0.013). CONCLUSION: The aggressiveness and extent of prostatic inflammation in asymptomatic prostatitis patients are significantly correlated with the level of serum PSA, which may help pathologists to avoid unnecessary repeated biopsies for patients with high-grade prostatitis.

GPNMB overexpression is associated with extensive bone metastasis and poor prognosis in renal cell carcinoma.

Glycoprotein non-metastatic protein B (GPNMB) promotes bone metastasis (BM) in various types of cancer. However, GPNMB expression and its function in patients with renal cell carcinoma (RCC) and BM is still unknown. Therefore, the clinical significance of GPNMB and its biological function in RCC with BM was investigated in the present study. A total of 31 patients with RCC and BM were retrospectively collected. The association between GPNMB protein expression level on the primary tumor and the clinicopathological characteristics of the patients was analyzed. Kaplan-Meier analysis was used to investigate the association between GPNMB expression and the prognosis of the patients. The effects of GPNMB inhibition on cell proliferation, migration and invasion in RCC cells were investigated using short hairpin (sh)RNA. High GPNMB expression level was significantly associated with the number (P=0.001) and the extent of BM (P=0.001), Fuhrman grade (P=0.037), and ERK expression level (P=0.003) of the primary tumor. In addition, GPNMB overexpression was significantly associated with poor prognosis with respect to overall survival time (P=0.001). Furthermore, a specific shRNA sequence targeting the GPNMB gene was constructed and transduced into the ACHN cell line, using a lentivirus vector to obtain a stable cell line with low mRNA expression level of GPNMB. Low GPNMB expression level inhibited RCC cell proliferation, which was measured using a Cell Counting Kit-8 assay. Cell migration and invasion ability was significantly decreased in GPNMB knockdown RCC cells compared with that in cells transduced with the negative control shRNA. In addition, the protein expression levels of phosphorylated ERK were lower in the GPNMB shRNA-transduced ACHN cells compared with those in the control cells. Therefore, these results suggested that GPNMB plays an important role in tumor progression in RCC with BM. Furthermore, it might serve as a predictive marker for BM and as a poor prognostic factor in RCC with BM. GPNMB downregulation suppressed the proliferation, migration and invasion of the RCC cells, which may be mediated through the inhibition of the ERK signaling pathway.

[Analysis of lower urinary tract symptoms in patients with lumbar disk herniation].

OBJECTIVE: To evaluate the characteristic and clinical significance of lower urinary tract symptoms (LUTS) caused by lumbar disk herniation. METHODS: A total of 80 male patients from February 2000 to April 2010 in our hospital with lumbar disk herniation underwent an urodynamic test. And they were divided into the normal bladder function group (Group A), the early-stage of bladder dysfunction group (Group B) and the late-stage of bladder dysfunction group (Group C) according to the urodynamic results. LUTS in these patients were assessed by the international prostate symptom score (IPSS) and quality of life (QOL) questionnaire. The results were analyzed statistically among these three groups. RESULTS: In Groups A (n=30), B (n=22) and C (n=28), the total IPSS scores were 9.4±4.6, 11.3±3.3 and 15.0±3.4 while the QOL scores 2.1±1.1, 2.2±1.0 and 3.4±1.3 respectively. The total voiding symptom scores were 3.8±2.7, 6.2±2.6 and 10.4±3.1 respectively and the differences were significant (all P<0.05). The total storage symptom scores were 5.6±3.4, 5.1±2.9 and 4.6±2.3 in 3 groups respectively and the difference was insignificant (P>0.05). Between Groups A and B, the differences of total voiding symptom score were significant (P<0.01) while those of the total IPSS and QOL score were insignificant (both P>0.05). Between Groups B and C, the differences of the total IPSS, QOL score and total voiding symptom score were significant (all P<0.05). CONCLUSIONS: The LUTS caused by lumbar disk herniation are notable during the late stage of bladder dysfunction. As one typical early manifestation, the voiding symptom may aid an early diagnosis of the disease.

[Clinical comparison of flexible endoscopic realignment with traditional open realignment].

OBJECTIVE: To evaluate the clinical value of flexible endoscopic realignment for posterior urethral disruption as compared with traditional open realignment. METHODS: A total of 58 patients suffering posterior urethral disruption in Beijing Jishuitan Hospital from January 2003 to May 2009 were examined. Twenty-three patients (Group A) were performed with flexible endoscopic realignment and 35 patients (Group B) were performed with traditional open realignment. The operation duration and post-operative complications were compared between two groups. RESULTS: All operations were successfully performed. The operative duration was significantly shorter in Group A than that in Group B [(29 +/- 10) min vs (58 +/- 11) min, P = 0.000]. Also, the patients in Group A had a significantly decreased rate of stricture and false urethral passages formation (17.4% vs 42.9%, 0 vs 20%, both P < 0.05). There were no significant difference in urinary infection, repeat procedures, incontinence and impotence between two groups (P > 0.05). CONCLUSION: As compared with traditional open realignment, flexible endoscopic realignment has the advantages of short operation duration, lesser trauma and fewer complications. Therefore it is an excellent method for the treatment of urethral injury.

[Analysis of relation between types of bony metastasis and PSA and tumor differentiation of prostate cancer].

OBJECTIVE: To analyze the relationship between radiological characteristics of bony metastasis and PSA, Gleason score (GS) for prostate cancer patients. METHODS: The investigators collected the clinical data of 44 patients with prostate cancer bony metastasis and divided them into 3 groups based upon the radiological characteristics of bony metastasis. The 3 groups were osteoblast group, osteoclast group and mixed group. RESULTS: The mean age of patients was 70 years old. There were 33 cases (75.00%), 9 cases (20.45%) and 2 cases (4.55%) in osteoblast group, osteoclast group and mixed group respectively. The mean total serum PSA values were 590.3+/-177.0 microg/L, 249.0+/-66.6 microg/L and 156.5+/-42.1 microg/L in osteoblast group, osteoclast group and mixed group respectively. No statistic significance was found for the difference of total PSA in 3 groups. Mean GS in osteoblast group was 7.4 (6-10). Twenty-two cases (66.7%) were of a medium-high differentiation (GS7). Mean GS in osteoclast group was 8.0 (6-10). Among which, 3 cases (33.3%) were of a medium-high differentiation while 6 cases (66.7%) of a low differentiation. Statistic significance was found for the difference of GS in 2 groups. Two cases in mixed group were assigned 8 of GS. CONCLUSION: There is no confirmed correlation between types of bony metastasis and total serum PSA for prostate cancer patients. But the tumor differentiation reflected by Gleason score may affect the type of bony metastasis.

Transurethral resection of the prostate stricture management.

For more than nine decades, transurethral resection of the prostate remains the gold standard for the surgical treatment of lower urinary tract symptoms due to benign prostatic obstruction. The occurrence of urethral strictures after transurethral resection of the prostate is one of the major late complications and has been reported as the leading cause of iatrogenic urethral strictures in patients older than 45 years who underwent urethroplasty. Although several postulations have been proposed to explain the urethral stricture after transurethral resection of the prostate, the exact etiology of urethral stricture after TURP is still controversial. Suggested etiological factors of urethral stricture formation after transurethral resection of the prostate include infection, mechanical trauma, prolonged indwelling catheter time, use of local anesthesia, and electrical injury by a stray current. One single treatment option is not appropriate for all stricture types. The management of urethral stricture following transurethral resection of the prostate includes minimally invasive endoscopic methods, including urethral dilation and direct visual incision, or open surgical procedures with varying urethroplasty techniques. Although scientific studies focusing on urethral strictures after transurethral resection of the prostate are relatively limited and sparse, we can apply the principles of urethral stricture management before making decisions on individual stricture treatment.

[Impact of disease duration of lumbar disk herniation on bladder dysfunction].

OBJECTIVE: To analyze the association between the disease duration and bladder dysfunction in lumbar disk herniation patients. METHODS: The urodynamic parameters of 85 lumbar disk herniation patients with different disease duration, 26 with the duration < 1 year (Group A), 31 with the duration of 1 - 5 years (Group B), and 28 of the duration > 5 years (Group C), were retrospectively analyzed. RESULTS: The average post-voiding residual volume of Group A was 50 ml, significantly lower than those of Groups B and C (80 ml and 120 ml respectively, both P < 0.05) with significant difference between Groups B and C too (P < 0.05). The average maximum cystometric capacity of Group A was (375 +/- 147) ml, significantly higher than those of Groups B and C [(481 +/- 184) ml and (562 +/- 173) ml respectively, both P < 0.05] and there was significant difference between Groups B and C too (P < 0.05). The average volume at the first desire to void of Group A was (220 +/- 88) ml, significantly lower than those of Groups B and C [(247 +/- 132) ml and (356 +/- 199) ml respectively, both P < 0.05], however, there was no significant difference between Groups A and B (P > 0.05). There were no significant differences in the maximum flow rate, maximum detrusor pressure, and bladder compliance among the three groups (all P > 0.05). CONCLUSION: Prolonged disease duration of lumbar disk herniation worsens the bladder function.

[Urodynamic analysis of the chronic impairment of cauda equina caused by lumbar disk herniation].

OBJECTIVE: To evaluate the urodynamic characteristics of the chronic impairment of cauda equina caused by lumbar disk herniation. METHODS: Clinical data and urodynamic parameters of 67 male patients with lumbar disk herniation were retrospectively analyzed. Lower urinary obstruction was excluded from the cohort using the Lin-PURR analysis. Patients were divided into group A (normal detrusor function), group B (detrusor underactivity) and group C (detrusor areflexia) according to the detrusor contraction function analyzed in Lin-PURR. Clinical data and urodynamic parameters were analyzed statistically between these groups. RESULTS: The category of the detrusor contraction function had a significant effect on the urodynamic parameters. There were significant differences in the maximum flow rate (Q(max)), maximum pressure (P(max)), pressure at the maximum flow (P(det Qmax)) and post-voiding residual urine (PVR) among group A, B and C. There were significant differences in the first sensation volume of the bladder and the maximum cystometric capacity between group A and C, B and C, but no significance was found between group A and B. There was no significant difference in age, disease duration, and compliance of the bladder among 3 groups. CONCLUSIONS: Urodynamic study is important in exploring the severity of the chronic impairment of cauda equina caused by lumbar disk herniation. Detrusor areflexia and loss of bladder sensory indicate more severe degree of impairment of the cauda equine. Q(max) and PVR are helpful in early diagnosis of the chronic impairment of cauda equina.

[Biocompatibility of extracellular matrix of homologous fascia lata as material for renal trauma repair].

OBJECTIVE: To study the biocompatibility of extracellular matrix (ECM) of homologous fascia lata, so as to identify whether this material can be used in repair of renal trauma. METHODS: The fascia latae of 2 dogs were stripped and underwent treatment of decellularizing liquid, DNAse, RNAse, etc. so as to produce ECM. Twenty Kunming mice were randomly divided into 2 equal groups to be injected with the extractive liquid of the ECM or normal saline. 4, 24, 48, and 72 hours later the mice were observed so as to examine the toxicity of the ECM. Mouse fibroblasts of the line L929 were cultured. ECM was added into the suspension of the cells, and 2, 4, and 7 days later the relative growth rate (RGR) of the cells was observed by MTT method. The left kidneys of 10 dogs were cut by knife so as to establish kidney injury models, and the wounds were covered by prepared ECM pieces immediately. 1 and 2 weeks, and 1, 2, and 4 months after the operation respectively the dogs were killed and light microscopy and electron microscopy were conducted to observe the condition of the wounds. RESULTS: No abnormal situation was found in the mice after the extractive liquids of the ECM was injected into their bodies at any time point. MTT method showed that no obvious cytotoxicity was seen in the L292 cells, the RGR levels 2, 4, and 7 days were 112%, 96%, and 97% respectively, and the cytotoxic grade were 0, 1, and 1 respectively. No obvious infiltration of inflammatory cells into the local site of renal repair could be seen, only mild adhesion to the surrounding tissues was found at different time-points after operation. CONCLUSION: With good biocompatibility, ECM of homologous fascia lata may be used as an ideal tissue-engineering material for renal repair.

[Extracellular matrix of xenogenic femoral fascia for the repair of renal trauma].

OBJECTIVE: To study the effect of extracellular matrix of xenogenic femoral fascia in repair of renal trauma. METHODS: Twelve adult dogs were used and randomly assigned to 6 groups, and the animals were sacrificed separately in 1 and 2 weeks 1,2,4 and 8 months after renal repair operations. The examinations of blood and urine routine, blood urea nitrogen and creatinine, electrolyte and serum renin were performed before and after operations at various times. The creatinine clearances of affected and contralateral normal kidneys were evaluated before death and the local areas of renal repair were studied by light and electron microscopy. RESULTS: Bleeding was stopped completely after the entire patch was sutured, and only mild adhesions to around tissues were found in various times after operations. As time passed, the repair patch was replaced by smooth neocapsule like normal renal capsule. CONCLUSION: Extracellular matrix of xenogenic femoral fascia might be an ideal tissue engineering material for renal repair.

Efficacy of α-blocker in improving ureteral stent-related symptoms: a meta-analysis of both direct and indirect comparison.

OBJECTIVE: To critically evaluate the efficacy of an α-blocker in improving ureteral-stent-related symptoms and preliminarily investigate the difference between different types of α-blockers. METHODS: Relevant randomized controlled trials were identified through searching PubMed, the Cochrane Library, Embase, and other sources. After quality assessment and data abstraction, direct comparison based on the Ureteral Stent-related Symptom Questionnaire (USSQ) between α-blockers and control was performed by RevMan 5.3. Indirect comparison between different types of α-blockers was performed by ITC 1.0. Sensitive and subgroup analyses were used to handle important clinical factors. RESULTS: Sixteen randomized controlled trials containing 1,489 cases were included. Compared with control, α-blockers significantly reduced the overall urinary symptom, pain index, general health index, and scores related to sexual matters, while no significant difference was found in work performance and additional problem scores. Subgroup analysis showed that the duration of stent insertion, patient's age, stent size, and the type of α-blocker had the potential to influence the outcomes. Through indirect comparison, we found alfuzosin and terazosin to be better than tamsulosin in pain relief and general health improvement. CONCLUSION: α-Blocker was effective in treating ureteral stent-related symptoms, as it improved the major indexes of USSQ post-insertion or post-removal. Alfuzosin and terazosin seemed to be better than tamsulosin, which needs further verification because of the lack of direct comparison currently.

Comparative efficacy of tamsulosin versus nifedipine for distal ureteral calculi: a meta-analysis.

OBJECTIVE: The aim of this study was to systematically compare the therapeutic effect and safety of tamsulosin with nifedipine in medical expulsive therapy for distal ureteral calculi. METHODS: Databases, including PubMed, EMBASE, the Cochrane Library, and Clinical Trial Register Centers, were comprehensively searched. Relevant randomized controlled trials (RCTs) were selected, and quality assessment was performed according to the Cochrane Handbook. RevMan software was used to analyze the outcome measures, which consisted of expulsion rate, expulsion time, and complications. RESULTS: Twelve RCTs consisting of 4,961 patients were included (tamsulosin group, 2,489 cases; nifedipine group, 2,472 cases). Compared with nifedipine, tamsulosin significantly increased the expulsion rate (risk ratio =1.29, 95% CI [1.25, 1.33], P<0.0001) and reduced the expulsion time (standard mean difference =-0.39, 95% CI [-0.72, -0.05], P=0.02). Regarding safety, tamsulosin was associated with fewer complications than nifedipine (risk ratio =0.45, 95% CI [0.28, 0.72], P=0.0008), and further subgroup analysis showed that tamsulosin was associated with a lower risk of both mild and moderate-to-severe complications. CONCLUSION: On the bias of current evidence, tamsulosin showed an overall superiority to nifedipine for distal ureteral calculi <10 mm in aspects of expulsion rate, expulsion time, and safety. Tamsulosin was supposed to be the first drug to be recommended to patients willing to receive medical expulsive therapy.