Effectiveness and safety of tibial nerve stimulation versus anticholinergic drugs for the treatment of overactive bladder syndrome: a meta-analysis.

BACKGROUND: This meta-analysis aimed to evaluate the efficacy and safety of tibial nerve stimulation (TNS) and anticholinergic drugs (ACDs) for the treatment of overactive bladder syndrome (OAB). METHODS: Qualified studies up to November 3, 2020 were retrieved from PubMed, Embase, the Cochrane Library and Web of Science. Pooled mean differences (MDs) were calculated to evaluate the improvement of micturition frequency per day, nocturia per night, urinary urgency episodes per day, incontinence episodes per day, and voided volume each time. Odd ratios (ORs) were used to assess the discontinuation rate. RESULTS: A total of 6 RCTs including 291 patients were included. Comparing with those receiving ACDs, patients receiving TNS had a significantly better improvement of urge incontinence episodes (MD =-1.11; 95% CI: -1.66, -0.55; P<0.001), but had comparable effect on micturition (MD =-0.75; 95% CI: -1.78, 0.28; P=0.16), nocturia (MD =-1.11; 95% CI: -2.93, 0.72; P=0.23), urgency (MD =-0.57; 95% CI: -1.93, 0.79; P=0.41) and voided volume (MD =11.61; 95% CI: -3.95, 27.18; P=0.14). Moreover, TNS group had a significantly lower discontinuation rate (OR =0.13; 95% CI: 0.03, 0.51; P=0.003) during the trials. DISCUSSION: TNS is as effective as ACDs for treating OAB, but with better performance on the decrease of urge incontinence episodes. Besides, TNS appears to be more tolerable than ACDs.

[A Randomized Controlled Study of Intravesical Instillation Therapy of Bacillus Calmette-Guérin vs. Epirubicinin Treating Non-muscular Invasive Bladder Cancer].

OBJECTIVE: To explore the best treatment plan of intravesical instillation for patients with non-muscular invasive bladder cancer (NMIBC), to explore recurrence-related clinicopathological factors after intravesical instillation, and to evaluate the value of the prognosis and prediction models currently used for NMIBC patients. METHODS: Starting from 2016, patients who underwent transurethral resection of bladder tumor (TURBT) in our hospital and who received post-surgery diagnosis of having intermediate or high risks for NMIBC were enrolled in the study. They were randomly assigned to different group sat a ratio of 2∶2∶1 for receiving intravesical instillation therapy of Bacillus Calmette-Guérin (BCG) for 19 times, BCG for 15 times, and epirubicin (EPI) for 18 times. The clinicopathological data of the patients were recorded before, during and after instillation therapy, and survival curves were drawn to evaluate the effects of the three regimens, using recurrence-free survival as the endpoint. Clinicopathological data were analyzed to study the associations between various factors and post-instillation recurrence. The consistency index (c-index) was used to evaluate the predictive accuracy of the scoring model of the Spanish Urological Club for Oncological Treatment (CUETO) and the risk tables of European Organization for Research and Treatment of Cancer (EORTC). RESULTS: A total of 93 NMIBC patients (35 in the 19-time BCG group, 37 in the 15-time BCG group, and 21 in the EPI group) were included, with a median follow-up time of 33.46 months. Twenty-two patients experienced tumor recurrence and eight, tumor progression. The survival curve showed that the BCG group had better recurrence-free survival than the EPI group ( P=0.002), while the difference in recurrence-free survival between 19-time BCG and 15-time BCG groups was not statistically significant. Higher general complication rate was seen in the BCG groups compared with the EPI group (84.7% vs. 61.9%, P=0.022), but there was no grade 3-5 adverse events in any group. The c-index of CUETO scoring model and EORTC risk tables was higher than that of the prediction based solely on T stage, nuclear grade, or EAU risk stratification. In addition, the c-index in the BCG group was higher than that in the whole cohort. CONCLUSION: Among the subjects of this study, the recurrence rate of bladder cancer in the intravesical BCG instillation groups was lower than that of the epirubicin group. EORTC risk tables and CUETO scoring model exhibited higher predictive accuracies in BCG-treated patients than its performance for the whole NMIBC cohort.

Validation of the Prognostic Value of Preoperative Albumin-to-Alkaline Phosphatase Ratio in Patients with Surgically Treated Non-Metastatic Renal Cell Carcinoma.

PURPOSE: Several studies have revealed that albumin-to-alkaline phosphatase ratio (AAPR) was correlated to the survival of several cancers. To explore the impact of AAPR on the survival of non-metastatic renal cell carcinoma (RCC) patients following nephrectomy, the present study was conducted. PATIENTS AND METHODS: A total of 648 patients were enrolled in the present study. The cut-off value of AAPR was determined based on the receiver-operating characteristic (ROC) analysis. Univariate and multivariate analyses were applied to identify prognostic factors. The discrimination and calibration of models for survival outcomes were evaluated based on the concordance index (C-index), ROC analysis and calibration curve. RESULTS: The low AAPR (≤0.5) was associated with older age (P<0.001), higher T stage (P=0.002), larger tumor size (P=0.014) and tumor necrosis (P=0.003). A high AAPR was significantly correlated to better OS (hazard ratio, HR=0.61; P=0.038) and CSS (HR=0.52; P=0.013) based on multivariate analysis. Integrating AAPR with UISS or SSIGN, the C-indexes of nomogram for OS (UISS: 0.790 vs 0.765; SSIGN: 0.861 vs 0.850) and CSS (UISS: 0.832 vs 0.805; SSIGN: 0.905 vs 0.896) increased. Moreover, the nomogram for OS and CSS was established based on the multivariate analysis. The C-indexes of nomogram for OS and CSS were 0.834 (95% CI 0.794-0.874) and 0.867 (95% CI 0.830-0.904), respectively. CONCLUSION: In conclusion, the high preoperative AAPR was a favorable prognostic factor for surgically treated non-metastatic RCC patients. AAPR also could improve the predictive value of well-established models. The nomogram that incorporates AAPR had a good performance. More prospective studies with a large scale are essential to validate our findings.

[Cytoreductive Partial Nephrectomy versus Cytoreductive Radical Nephrectomy for Locally T 1 Stage Metastatic Renal Rell Carcinoma (mRCC)].

OBJECTIVE: To explore whether cytoreductive partial nephrectomy (cPN) or cytoreductive radical nephrectomy (cRN), is more beneficial for patients with locally T 1 stage metastatic renal cell carcinoma (mRCC). METHODS: We retrospectively collected the data ofthe patients with locally T 1 stage mRCC ( n=934) from the Surveillance, Epidemiology, and End Results (SEER) database. Logistic regression was conducted to identify the determinants of cPN. Propensity-score match (PSM) was used to diminish the confounder. Kaplan-Meier survival analyses was performed and multivariable Cox proportional hazards model was used to evaluate the effect of cPN and cRN on overall survival (OS) and cancer specific survival (CSS). RESULTS: Among the 934 patients, 142 (15.2%) received cPN and 792 (84.8%) received cRN. Before PSM, both OS and CSS in cPN group were better in Kaplan-Meier analysis (log rank test, each P< 0.01). In a survival analysis of propensity-score matched 141 pairs of patients, cPN was still associated with improved OS and CSS compared with cRN (log rank test, each P< 0.01). After PSM, the 2-year OS were 61.7% and 74.4%, and 5-year OS were 35.6% and 59.2% in the cRN and cPN cohorts respectively. Cox proportional hazards model confirmed cPN the independent risk factor of both OS and CSS. CONCLUSION: For mRCC patients with locally T 1 stage, cPN may gain an OS and CSS benefit compared with cRN.

Preoperative systemic immune-inflammation index predicts prognosis of patients with non-metastatic renal cell carcinoma: a propensity score-matched analysis.

BACKGROUND: A novel systemic immune-inflammation index (SII), based on the neutrophils, lymphocytes and platelet counts, is associated with the prognosis of several cancers. The present study evaluates the prognostic significance of SII in non-metastatic renal cell carcinoma (RCC). METHOD: The present study retrospectively reviewed the medical record of patients with non-metastatic RCC who underwent nephrectomy between 2010 and 2013. Receiver operating characteristic (ROC) curve analysis was performed to identify the optimal cut-off value. In addition, the propensity score matching (PSM) was performed with a matching ratio of 1:1. Univariate and multivariate Cox proportional hazards models were used to identify the prognostic factors. The results were reported by hazard ratio (HR) with 95% confidence interval (95% CI). RESULTS: A total of 646 patients were included in the final analysis. High SII group (> 529) was significantly associated with older age (P = 0.014), larger tumor (P < 0.001), higher pathological T stage (P < 0.001), higher tumor grade (P < 0.001) and more tumor necrosis (P < 0.001). Multivariate Cox regression analysis demonstrated that the higher preoperative SII was significantly associated with worse overall survival (OS) (HR = 2.26; 95% CI 1.44-3.54; P < 0.001) and cancer-specific survival (CSS) (HR = 2.17; 95% CI 1.33-3.55; P = 0.002). After PSM, elevated preoperative SII was an independent predictor of poor OS (HR = 1.78; 95% CI 1.1-2.87; P = 0.018) and CSS (HR = 1.8; 95% CI 1.07-3.03; P = 0.027). CONCLUSION: In conclusion, preoperative SII is associated with adverse factors for RCC. Furthermore, higher preoperative SII is an independent predictor of poor OS and CSS in surgically treated patients with non-metastatic RCC. More prospective and large scale studies are warranted to validate our findings.

Prognostic value of preoperative prognostic nutritional index in patients with renal cell carcinoma after nephrectomy.

PURPOSE: The present study was performed to explore the prognostic value of prognostic nutritional index (PNI) in renal cell carcinoma (RCC) patients following nephrectomy. METHODS: A total of 660 patients were included. PNI was calculated based on the following formula: serum albumin level (g/L) + 0.005 × total lymphocyte count (per mm3). Kaplan-Meier survival curve and the log-rank test were conducted. Univariate analysis and multivariate Cox regression analysis were performed to explore the prognostic factors. RESULTS: The patients in low PNI group were more likely to be older (P < 0.001), have a larger tumor (P < 0.001), higher pathological T stage (P < 0.001), positive lymph node (P = 0.038), distant metastasis (P = 0.005), higher tumor grade (P < 0.001) and tumor necrosis (P < 0.001). Multivariable analysis revealed low preoperative PNI was an independent predictor of overall survival (OS) (P = 0.034) and progression-free survival (PFS) (P = 0.004) for all patients. Besides, low preoperative PNI was also significantly associated with poor OS (P = 0.008), cancer-specific survival (CSS) (P = 0.032) and PFS (P = 0.003) for non-metastatic RCC patients. CONCLUSION: The patients with lower preoperative PNI were associated with adverse factors. Furthermore, the low preoperative PNI was also associated with inferior oncological outcomes in RCC patients who underwent nephrectomy.

Minimally Invasive Versus Open Adrenalectomy in Patients with Adrenocortical Carcinoma: A Meta-analysis.

BACKGROUND: Open surgery remains the preferred surgical treatment of adrenocortical carcinoma (ACC), while the role of minimally invasive adrenalectomy surgery (MIS) in ACC is still controversial. The present study was conducted to compare MIS with open adrenalectomy (OA) in ACC. METHODS: The Embase, PubMed, and Cochrane Library databases were comprehensively searched. The weighted mean difference (WMD), relative risk (RR), and hazard ratio (HR) were pooled. RESULTS: A total of 15 studies incorporating 2207 patients were included in the present study. MIS approaches were likely to have a comparable operation time (WMD - 17.77; p = 0.150) and postoperative complications (RR 0.74; p = 0.091) compared with OA, and were significantly associated with less blood loss (WMD - 1761.96; p = 0.016) and shorter length of stay (WMD - 2.96; p < 0.001). MIS approaches were also more likely to have an earlier recurrence (WMD - 8.42; p = 0.048) and more positive surgical margin (RR 1.56; p = 0.018) and peritoneal recurrence (RR 2.63; p < 0.001), while the overall recurrence (RR 1.07; p = 0.559) and local recurrence (RR 1.33; p = 0.160) were comparable between the two groups. Furthermore, surgical approaches did not differ in overall survival (HR 0.97; p = 0.801), cancer-specific survival (HR 1.04; p = 0.869), and recurrence/disease-free survival (HR 0.96; p = 0.791). CONCLUSIONS: In the present study, MIS approaches were likely to have a better recovery. Although MIS approaches were associated with earlier recurrence and more positive surgical margin and peritoneal recurrence, no significant differences in survival outcomes were found. OA should still be considered as the standard treatment, but MIS approaches could be offered for selected ACC cases, and performed by surgeons with appropriate laparoscopic expertise, ensuring an improved survival for patients.

The prognostic value of De Ritis (AST/ALT) ratio in patients after surgery for urothelial carcinoma: a systematic review and meta-analysis.

BACKGROUND: Recently, the De Ritis (AST/ALT) ratio has been considered as a prognostic biomarker for various malignancies. We conducted this systematic review and meta-analysis to explore the prognostic value of preoperative De Ritis ratio in patients after surgery for urothelial carcinoma. METHODS: We searched the online database Embase, PubMed and Cochrane Library up to October 2019. The hazard ratio (HR) and 95% confidence interval (CI) were extracted from the studies. RESULTS: A total of 8 studies incorporating 3949 patients were included in the quantitative synthesis. We observed that elevated preoperative De Ritis ratio is associated with inferior OS (HR = 1.97; 95% CI 1.70-2.28; P < 0.001), CSS (HR = 2.40; 95% CI 2.02-2.86; P < 0.001), RFS (HR = 1.31; 95% CI 1.11-1.54; P = 0.001), PFS (HR = 2.07; 95% CI 1.68-2.56; P < 0.001) and MFS (HR = 2.39; 95% CI 1.16-4.91; P = 0.018). Stratified by diseases, the elevated De Ritis ratio also served as an unfavorable factor. CONCLUSION: The elevated preoperative De Ritis ratio is an unfavorable factor for patients with urothelial carcinoma. In patients with BC and UTUC, the elevated preoperative De Ritis ratio is also associated with poor prognosis. But De Ritis ratio must be validated in large, independent cohorts before it can be applied widely.

MRI-targeted biopsy versus standard transrectal ultrasound-guided biopsy: a systematic review and meta-analysis of randomized controlled trials.

PURPOSE: For men with a suspicion of prostate cancer (PCa), the transrectal ultrasound-guided biopsy (TRUS-Bx) was recommended. Multi-parametric magnetic resonance imaging (mp-MRI) could be more useful to more accurately selected patients who are with a clinical suspicion of PCa and eligible for biopsy, and avoid a biopsy if the result was negative. In the present study, we compared the MRI-targeted biopsy (MRI-TBx) with TRUS-Bx. METHODS: We searched the following online database: PubMed, Embase, and Cochrane Library, and the search was updated to March 2019. RESULTS: Finally, a total of 8 randomized controlled trials (RCTs) comprising 2593 patients were enrolled in the final analysis. MRI-TBx and TRUS-Bx did not significantly differ in overall PCa (RR = 1.30; 95% CI 0.98-1.72; P = 0.067), clinically significant PCa (RR = 1.35; 95% CI 0.98-1.86; P = 0.065), and clinically insignificant PCa (RR = 0.76; 95% CI 0.40-1.46; P = 0.416). While in patients with initial biopsy, MRI-TBx had a significantly higher detection rate of overall PCa (RR = 1.40; 95% CI 1.01-1.94; P = 0.045). CONCLUSION: In the present study, we found that MRI-TBx potentially benefits the detection of overall and clinically significant PCa compared with TRUS-Bx in patients with a suspicion of PCa. Furthermore, in patients with initial biopsy, MRI-TBx had a significantly higher detection rate of overall PCa and a potentially higher detection rate of clinically significant PCa. While for patients with prior negative biopsy, we did not detect significant differences in overall and clinically significant PCa between two groups. More large and multicenter RCTs are further required.

Association of 5-alpha-reductase inhibitor and prostate cancer incidence and mortality: a meta-analysis.

BACKGROUND: 5-Alpha-reductase inhibitors (5-ARIs) have been suggested as potential chemopreventive agents for prostate cancer (PCa). This study was conducted to evaluate the effect of 5-ARIs on the incidence and mortality of PCa. METHODS: The PubMed, Embase and Cochrane Library databases were searched comprehensively from database inception to October 2019. The clinical outcomes included the incidence of overall PCa, high-grade (Gleason8-10) PCa, metastatic PCa, overall survival (OS), and cancer-specific survival (CSS). RESULTS: Overall, 23 studies were included in the present study, representing 11 cohort studies, 5 case-control studies, and 8 randomized controlled trials. The use of 5-ARIs was associated with a decreased risk of overall PCa [relative risk (RR) =0.77; 95% CI: 0.67-0.88; P<0.001] and increased risk of Gleason 8-10 PCa (RR=1.19; 95% CI: 1.01-1.40; P=0.036). In terms of metastatic PCa, there were no significant between-group differences (RR=1.23; 95% CI: 0.69-2.18; P=0.487). Furthermore, we found that prediagnostic 5-ARI usage was not associated with an increased risk of overall or prostate cancer mortality, with HRs of 1.00 (95% CI: 0.92-1.08; P=0.938) and 0.98 (95% CI: 0.80-1.21; P=0.881), respectively. CONCLUSIONS: In conclusion, while male 5-ARI users were associated with a decreased risk of overall prostate cancer and increased risk of high-grade prostate cancer (Gleason 8-10), they were not associated with an increased risk of overall or prostate cancer mortality. 5-ARIs should be recommended carefully for use as chemopreventive agents.

Minimally invasive vs open radical cystectomy in patients with bladder cancer: A systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: Minimally invasive surgical (MIS) approaches to radical cystectomy (RC) develop well in the past decades. We performed the present study to compare the perioperative outcomes, pathological outcomes, and oncologic outcomes between MIS approaches and open radical cystectomy (ORC) for bladder cancer. METHOD: We conducted a comprehensive study search up to March 2019, searching the online database Embase, PubMed and Cochrane Library. RESULTS: A total of 8 randomized controlled trials comprising 805 patients were included. We observed that MIS approaches were significantly associated with lower estimated blood loss (WMD = -343.21; 95%CI -431.34 to -255.08; P < 0.001), shorter length of stay (WMD = -0.76; 95%CI -1.28 to -0.24; P = 0.004), shorter time to flatus and diet (WMD = -0.46; 95%CI -0.64 to -0.27; P < 0.001; WMD = -0.92; 95%CI -1.58 to -0.28; P = 0.005; respectively), longer operation time (WMD = 61.38; 95%CI 34.89 to 87.88; P < 0.001), fewer 30-day overall complication (OR = 0.36; 95%CI 0.17 to 0.75; P = 0.007). And we did not detect significant difference in terms of 30-day (P = 0.278) and 90-day major complication (P = 0.899), positive surgical margins (P = 0.986), lymph node yield (P = 0.711), OS (P = 0.473), CSS (P = 0.778), RFS (P = 0.880), PFS (P = 0.324) between MIS approaches and ORC. CONCLUSION: In the present studies, we demonstrated that MIS approaches improved perioperative outcomes and had similar pathological and oncological outcomes compared with ORC. Stratified by type of MIS approaches, the results are similar. In conclusion, MIS approaches could serve as an alternative choice in patients with bladder cancer. However, long-term clinical outcomes highlight the need for future studies.

[Application of Prognostic Predication Model in Clinical Non-metastatic Renal Cell Carcinoma].

OBJECTIVE: To study and compare the practical use of three prognostic predication models in clinical non-metastatic renal cell carcinoma (RCC). METHODS: We retrospectively collected the data of 1 202 clinical non-metastatic RCC patients operated on between 1999 and 2012 at West China Hospital of Sichuan University. Survival analysis method was used to establish three prognostic prediction models including SSIGN, Leibovich and UISS based on different clinical and pathological indicators. The predictive ability was evaluated by the area under receiver operating characteristic curve (AUC). RESULTS: Of the 1 202 clinical non-metastatic RCC patients, 1 030 cases were limited RCC patients, and 172 cases were locally advanced RCC patients. The median follow-up time of the patients was 63.02 months. The 2-year and 5-year overall survival rate were 94.7% and 87.6%, respectively. The 5-year overall survival rates of patients with different clinical stages and grades were significantly different. The predictive accuracies for limited RCC of UISS, SSIGN and Leibovich model were 0.667, 0.785 and 0.758, respectively. For locally advanced RCC, the predictive accuracies of the three models were all lower than 0.6. CONCLUSIONS: SSIGN has certain predictive value in clinical non-metastatic RCC. However, for the advanced RCC, all the prognostic models demonstrate limited predictive value.

Modified Glasgow prognostic score as a prognostic factor for renal cell carcinomas: a systematic review and meta-analysis.

OBJECTIVE: The modified Glasgow prognostic score (mGPS), a combination of C-reactive protein (CRP) and albumin levels, reflects systemic inflammation and nutritional status. This score has been shown to have prognosis value for various tumors. In the present study, we evaluated the prognostic value of mGPS for patients with renal cell carcinoma (RCC). METHODS: Literature search was conducted based on PubMed, Embase, and Cochrane Central Register of Controlled Trials up to December 2018. We pooled HRs and 95% CIs to evaluate the correlation between mGPS and survival in patients with RCC. RESULTS: Twelve studies comprising 2,391 patients were included in the present study for quantitative synthesis. Our studies demonstrated that higher mGPS was significantly correlated to poor overall survival (HR=4.31; 95%CI, 2.78-6.68; P<0.001), cancer-specific survival (HR=5.88; 95%CI, 3.93-8.78; P<0.001), recurrence-free survival (HR=3.15; 95%CI, 2.07-4.79; P<0.001), and progression-free survival (HR=1.91; 95%CI, 1.27-2.89; P=0.002). Subgroup analyses also confirmed the overall results. CONCLUSION: mGPS could serve as a predictive tool for the survival of patients with RCC. In the different subgroups, the results are also consistent with previous results. In conclusion, pretreatment higher mGPS is associated with poorer survival in patients with RCC. Further external validations are necessary to strengthen this concept.

Partial nephrectomy versus ablative therapies for cT1a renal masses: A Systematic Review and meta-analysis.

OBJECTIVES: ablative techniques have been increasing as an alternative to surgical approaches, especially in patients who are unfit for surgery. This study was performed to compare oncologic and functional outcomes after partial nephrectomy (PN) and ablation for treating clinical T1a renal masses. METHODS: An electronic search was completed on the basis of PubMed, Embase and Cochrane Central Register of Controlled Trials. Studies comparing partial nephrectomy versus ablative therapies in patients with small renal masses were enrolled. RESULTS: Twenty articles incorporating 5,011 patients were eligible for the present meta-analysis. Perioperative complications were fewer in the ablation group than in the PN group (OR = 0.76; 95%CI, 0.60-0.97; P = 0.025), but ablation group was associated with increased risk of local recurrence (OR = 1.88; 95%CI, 1.29-2.72; P = 0.001) and lower OS (HR = 1.53; 95% CI, 1.16-2.00; P = 0.002). CSS and DFS were comparable in two groups. Decline of renal function at 6-month follow up was lower in ablation than PN (WMD = 3.32; 95% CI, 0.04-6.60; P = 0.047). Beside, ablation had a trend towards lower reduction of renal function of long-term follow up (WMD = 3.06; 95% CI, -2.13-8.25; P = 0.247). CONCLUSION: Compared to PN, ablation may have a significantly lower OS and higher local recurrence rates in selected patients, while CSS and DFS were comparable between the two treatments. On the other hand, ablation had a significantly decreased risk of perioperative complication and the potential advantage of long-term renal function preservation. More large randomized controlled trials are needed further to enhance the evidence of ablation in patients with small renal tumors. We believe that ablation is an attractive addition to the urologist's treatment options for small renal masses.

The prognostic value of sarcopenia in patients with surgically treated urothelial carcinoma: A systematic review and meta-analysis.

OBJECTIVE: Sarcopenia is associated with unfavorable prognosis in patients undergoing surgical treatments of the respiratory tract, gastrointestinal tract and urinary tracts. We summarized all available evidence to investigate the prognostic value of sarcopenia in patients with surgically treated urothelial carcinoma (UC). METHODS: We conducted a comprehensive study search up to January 2019, searching the online database Embase, PubMed and Cochrane Library. The hazard ratio (HR) and 95% confidence interval (CI) were extracted from the studies. RESULTS: A total of 12 research consisting of 2075 patients were enrolled in the quantitative synthesis. We observed that UC patients with sarcopenia had a worse OS (HR = 1.87; 95%CI 1.43-2.45; P < 0.001) and CSS (HR = 1.98; 95%CI 1.43-2.75; P < 0.001). Stratified by tumor, sarcopenia is also an unfavorable factor for OS and CSS in patients with upper tract urothelial carcinoma (UTUC) or urothelial carcinoma of bladder (UCB). CONCLUSION: Sarcopenia is an unfavorable factor for OS and CSS in patients with surgically treated UC. Besides, stratified by tumor, the results of patients with UTUC or UCB are consistent with previous results. More prospective studies are required to validate our findings.

[Clinical application of posterior paramedian approach in low back surgeries].

OBJECTIVE: To prospectively evaluate the clinical effects of posterior paramedian approach in nerve root decompression and reducing muscle damage in low back surgeries. METHODS: Study group included 30 cases treated from January 2007 to May 2008, DDD 8 cases, spondylolisthesis 6 cases, LDH 11 cases, Low back surgery failure re-operation 5 cases. Based on the comprehensive understanding of modern spine anatomy, we abandoned laminectomy in our procedure, applied a mid-waist skin incision, dissect to the paraspinal muscles where you could easily reach the facets by separating between the multifidus and longissimus, enlarge the canal by performing resection along ligamentum flavum and the inner broader of the articular process, remove enough tissue till you could expose the traversing root and the disc space, this method could achieve a limited but precise and effective decompression with not taking out all of the articular process. Once the anatomy mark of the pedicle is located (usually would be at the central area of the incision), pedicle screws placement would be precise and easy without struggling with muscle traction. The following procedures would be Spondylolisthesis reduction, discectomy and interbody fusion. RESULTS: Post-op patients of study group all showed significant improvement of pain symptoms, VAS reduced from 7.14 + or - 1.8, pre-op to 1.39 + or - 0.72 post-op, narrowed disc space regained height, spondylolisthesis reached anatomic reduction, no complications such as pedicle screw misplacement and nerve root damage were found, the lumbar spine regained it's physiological lordosis structure. Significant difference is discovered (P < 0.001) in statistic study concerning the rate of intractable low back pain between pre-op and post-op. CONCLUSIONS: Applying low back surgery through posterior para-median approach could directly reach the inferior/superior facets and the "soft" structures of the spinal canal, expose the exact decompression region and anatomy mark of the pedicle in the central surgical field without strong retraction on the para-spinal muscles. This approach has the advantage of lowering the surgical difficulty of implantation, reducing the risk of nerve damage and is also a minimum invasive procedure. In many cases, laminectomy is unnecessary, leaving the lamina intact could preserve the physiological anatomy of the spine.