The evaluation of early predictive factors for urosepsis in patients with negative preoperative urine culture following mini-percutaneous nephrolithotomy.

PURPOSE: To identify early predictive factors for urosepsis secondary to mini-percutaneous nephrolithotomy (MPCNL) in patients with negative preoperative urine culture (UC). METHODS: A total of 786 patients with baseline negative UC who underwent MPCNL between January 2017 and June 2019 were retrospectively analyzed. Urosepsis was defined according to the Sepsis-3 definition. Subsequently, perioperative potential risk factors were compared between non-urosepsis and urosepsis groups. RESULTS: Despite negative UC in all patients, the rate of positive stone culture (SC) was 16.0%; the rate of pelvic urine culture (PUC) was 7.5%; 23 cases (2.9%) developed urosepsis after MPCNL. Univariate analysis showed that urosepsis was associated with the female gender, BMI, stone burden, diabetes mellitus and preoperative urine test. Multivariate logistic regression analysis suggested that urine test with positive nitrite and white blood cells and leukocyte esterase (N+WBC+LE+) (OR 17.51, 95% CI 6.75-45.38, P < 0.001) and operative time > 120 min (OR 3.53, 95% CI 1.41-8.85, P = 0.007) were independent risk factors for urosepsis. Additionally, receiver operating characteristic curve analysis of N+WBC+LE+ showed that the area under the curve was 0.785 for predicting the occurrence of urosepsis. Further analysis showed that N+WBC+LE+ provided an efficient prediction of SC+/PUC+ (SC+ or PUC+) with 61.7% sensitivity and 97.3% specificity. CONCLUSIONS: In spite of the baseline negative preoperative UC, 2.9% of patients developed urosepsis after MPCNL. N+WBC+LE + was determined to be an early and efficient prediction of intraoperative bacterial status and urosepsis following MPCNL. Nevertheless, further studies are needed to confirm the results.

Klotho gene polymorphisms are associated with healthy aging and longevity: Evidence from a meta-analysis.

Klotho gene polymorphisms have been implicated in healthy aging, but inconsistences in findings from previous case-control studies have raised concerns regarding the associations between KLOTHO gene polymorphisms and susceptibility to aging-related diseases and longevity. Hence, this meta-analysis was performed. We assessed the associations between two polymorphisms (G-395 A/rs1207568 and F352 V/rs9536314) and five parameters (urolithiasis, cognitive impairment, cardiovascular disease, cancer, and longevity) by calculating pooled odds ratios with 95% confidence intervals. According to the pooled results, the G allele of the G-395 A polymorphism conferred a significantly higher risk of urolithiasis; G-395 A was related to the susceptibility to cardiovascular disease under allele, dominant, and recessive models. There was no significant association between the G-395 A polymorphism and cognitive impairment among the elderly. The F allele of the F352 V polymorphism protected against breast and ovarian cancer susceptibility. Interestingly, based on the results of the subgroup analysis, the F352 V polymorphism was associated with the overall risk of neoplasms in BRCA1 mutation carriers but not in BRCA2 mutation carriers. Moreover, the F allele played a protective role in determining human longevity. In conclusion, Klotho G-395 A polymorphisms were associated with urolithiasis and cardiovascular disease but not with cognitive impairment. Additionally, Klotho F352 V polymorphisms were associated with cancers and longevity.

LncRNA PVT1 regulates VEGFC through inhibiting miR-128 in bladder cancer cells.

Long noncoding RNA PVT1 is considered to be an oncogene in multiple cancers. Our previous studies indicated that PVT1 levels were higher in bladder cancer tissue and correlated with clinical progression and poor prognosis in bladder cancer patients. A bioinformatics analysis showed that PVT1 may regulate VEGFC expression through miR-128 as a competing endogenous RNA (ceRNA). In this study, we demonstrated that PVT1 expression levels affect the proliferation and migration ability of bladder cancer cells. Moreover, PVT1 knockdown significantly decreased the proliferation capacity of bladder cancer cells in nude mice. Luciferase assays and RNA-binding protein immunoprecipitation were performed to investigate the potential mechanism of ceRNAs in the regulation of PVT1 and VEGFC. The results showed that the increased number of PVT1 transcripts interacted directly with miR-128 to decrease miR-128 binding to the VEGFC 3'-untranslated region. This effect suppressed VEGFC mRNA degradation by miR-128. In conclusion, these results indicated that PVT1 might play a critical role in bladder cancer tumorigenesis via miR-218 and VEGFC. Therefore, PVT1 could be a new biomarker for bladder cancer diagnosis and therapy.

Comparison of suctioning and traditional ureteral access sheath during flexible ureteroscopy in the treatment of renal stones.

PURPOSE: To compare the efficiency and safety of suctioning ureteral access sheath (UAS) and traditional UAS during flexible ureteroscopy (FURS) for treatment of renal stones. METHODS: Between January 2015 and December 2017, 165 patients who had renal stones successfully underwent FURS with suctioning UAS created by connecting a channel on the tail of the suctioning UAS to a vacuum device. The outcomes of these patients were compared with those of 165 patients undergoing FURS with traditional UAS using a 1:1 scenario matched-pair analysis. The matching parameters were age, gender and stone burden. RESULTS: The baseline characteristics were homogeneous between the two groups. The suctioning UAS group had significantly higher SFR one day postoperatively (82.4% vs. 71.5%; P = 0.02), but SFR 1 month postoperatively was comparable in the two groups (P = 0.13). The incidence of overall complications was significantly higher in the traditional UAS group (24.8% vs 11.5%; P < 0.001). Regarding individual complications, the traditional UAS group was associated with a significantly higher incidence of fever (13.9% vs 5.5%; P = 0.009) and urosepsis requiring only additional antibiotics (6.7% vs 1.8%; P = 0.029). No significant difference was noted in the incidence of septic shock, hematuria, steinstrasse or ureteral stricture. The suctioning UAS group had significantly shorter operative time (49.7 + 16.3 min vs. 57.0 ± 14.0 min; P < 0.001). CONCLUSIONS: Compared to traditional UAS during FURS for treating renal stones, suctioning UAS had the advantages of higher SFR 1 day postoperatively, a lower incidence of infectious complications and a shorter operative time. Further well-designed studies are required to confirm the results.

Gemcitabine/cisplatin versus methotrexate/vinblastine/doxorubicin/cisplatin for muscle-invasive bladder cancer: A systematic review and meta-analysis.

OBJECTIVE: The objective of this study was to perform a systematic review and meta-analysis to evaluate the two most commonly used chemotherapy regimens gemcitabine plus cisplatin (GC) and methotrexate, vinblastine, doxorubicin/adriamycin, and cisplatin (MVAC) regimens for muscle-invasive bladder cancer (MIBC) patients. METHODS: We searched for all studies investigating GC and MVAC for MIBC patients in PubMed, Web of Knowledge, and the Cochrane Central Search Library. A systematic review and meta-analysis were performed. RESULTS: Our searches identified 13 studies among 2174 patients. In the meta-analysis, the pathological complete response to GC regimens was superior to MVAC regimens. No significant difference in pathological partial response was found between the two groups. GC regimens were associated with a significant decrease risk in Grade 3-4 neutropenia, mucositis, and febrile neutropenia, but a significant increase risk in Grade 3-4 thrombocytopenia. There was no significant difference in overall survival (OS), disease-specific survival (DSS) and disease-free survival (DFS) when compared GC regimens to MVAC regimens. CONCLUSIONS: GC regimens significantly improved pathological complete response compared to MVAC regimens. GC regimens were associated with a significant decrease risk in Grade 3-4 neutropenia, mucositis, and febrile neutropenia, but a significant increase risk in Grade 3-4 thrombocytopenia. There was no significant difference in OS, DSS, and DFS when compared the two regimens.

GSTM1 and GSTT1 polymorphisms are associated with increased bladder cancer risk: Evidence from updated meta-analysis.

BACKGROUND: Previous studies have indicated association between GSTM1 and GSTT1 gene polymorphisms and bladder cancer susceptibility, but the results have been inconclusive. Here, we performed a meta-analysis to investigate the association between GSTM1/GSTT1 deletion polymorphisms and bladder cancer susceptibility. METHODS: We searched for all studies investigating the association between GSTM1 or GSTT1 polymorphism and bladder cancer susceptibility in Pubmed, Web of Knowledge, and the Cochrane Central Search Library. A systematic review and meta-analysis were performed. Subgroup analyses were performed on different ethnicity, population-based and smoking status. RESULTS: Our search identified 63 studies. GSTM1 null, GSTT1 null and GSTM1/GSTT1 double-null genotypes were associated with increased risk of bladder cancer (OR: 1.36 95% CI: 1.25-1.47, P<0.01; OR: 1.13 95% CI: 1.02-1.25, P<0.01; OR: 1.84 95% CI: 1.50-2.26, P<0.01). Subgroup analyses indicated that the GSTM1-null genotype was associated with increased risk of bladder cancer in Caucasians and Asians, while the GSTT1-null genotype was associated with increased risk of bladder cancer in Caucasians. The GSTM1/GSTT1 double-null genotype was associated with increased risk of bladder cancer in Caucasians, Asians, and Africans. Stratified analyses of population-based associations indicated increased bladder cancer risk associated with GSTM1-null and GSTM1/GSTT1 double-null genotypes in hospital-based and population-based studies. GSTM1 deletion was associated with increased bladder cancer risk in both smokers and nonsmokers. Non-smokers with the GSTM1/GSTT1 double-null genotype had an increased bladder cancer risk. CONCLUSION: This meta-analysis demonstrates that the GSTM1-null, GSTT1-null, and GSTM1/GSTT1 double-null genotypes are associated with increased bladder cancer risk.

Expression of matrix Gla protein and bone morphogenetic protein 2 in renal papillary tissues in patients with calcium oxalate kidney stones / 中南大学学报(医学版)

Objective:To compare expression levels of matrix Gla protein (MGP) and bone morphogenetic protein 2 (BMP-2) in Randall's plaque of renal papillary tissues in patients with calcium oxalate kidney stones and the underlying mechanism for stone formation.Methods:A total of 30 samples of Randall's plaque in renal papillary tissues from patients with calcium oxalate kidney stones were collected from the Department of Urology of Xiangya Hospital of Central South University from April,2015 to December,2015 and served as an experimental group.Ten samples of renal papillary tissues in patients undergone renal tumor nephrectomy were collected from the same hospital and served as a control group.The expressions of MGP and BMP-2 mRNA and protein were detected by quantitative real-time PCR and Western blot.Meanwhile,immunohistochemical technique was used to observe the expressions of MGP and BMP-2 in different parts of renal papillary tissues in the 2 groups.Results:1) The mRNA expression levels of MGP in the experimental group and the control group were 0.760±0.804 and 1.365±0.348,respectively,with significant difference between them (P＜0.05).Them RNA levels of BMP-2 in the experimental group and the control group were 2.500±0.725 and 1.485±0.870,respectively,with significant difference between them (P＜0.05).The expression levels of MGP protein in the experimental group and the control group were 0.130±0.424 and 0.202±0.704,respectively,with no significant difference between them (P＞0.05).The expression levels of BMP-2 protein in the experimental group and the control group were 0.885±0.220 and 0.682±0.272,respectively,with significant difference between them (P＜0.05).T-he immunohistochemistry showed that the protein expression of MGP in the experimental group was lower than that in the control group,while the protein expression of BMP-2 in the experimental group was higher than that in the control group (both P＜0.05).Conclusion:The BMP-2 expression is increased while MGP expression is decreased in renal papillary tissues in patients with calcium oxalate kidney stones,and the formation of calcium oxalate kidney stone might be a kind ofosteogenetic reaction or ectopic calcification.

Sexual Function after Partial Penectomy: A Prospectively Study From China.

The Purpose of this study was to evaluate the sexual function after partial penectomy for penile carcinoma patients. Between January 2010 and May 2013, patients treated with partial penectomy at our institution were prospectively enrolled in this study. Sexual function (IIEF-15), age, body mass index, penile length in the flaccid state after partial penectomy (PL), treatment, having a partner and psychological factors (SAS scores and SDS scores) were assessed. Univariate and multivariate linear regression analyses were performed. 43 patients were included in our study. The median age was 56 years, and the median PL was 4 cm. The preoperative IIEF-15, SAS, SDS scores were significantly different from the postoperative scores. There was no statistically significant difference between the patients treated with partial penectomy and partial penectomy+ lymphadenectomy on IIEF-15 scores. Age was negatively associated with erectile function, sexual desire, and overall satisfaction; PL was positively associated with intercourse satisfaction; SAS score was negatively associated with erectile function, orgasmic function, sexual desire, and intercourse satisfaction. Our preliminary findings suggest that the sexual function after partial penectomy was significantly reduced. The sexual function was negatively affected by age and anxiety but positively affected by PL.

Hemostatic agents used for nephrostomy tract closure after tubeless PCNL: a systematic review and meta-analysis.

To evaluate the role of hemostatic agents used for nephrostomy tract closure after tubeless percutaneous nephrolithotomy (PCNL). A systematic review of Pubmed, Embase and Cochrane was performed. All studies that compared hemostatic agents with common methods (silk stitch or pressure dressing) were included. The analyzed outcomes were hospital stay, operative time, blood loss, transfusion rate, fever rate, and complication rate. A total of eight articles including six RCTs met our criteria. Hemostatic agents showed short hospital stay (MD -4.54, 95 % CI -6.78 to -2.36, p < 0.0001). There was no difference between hemostatic agents and common methods on operative time (MD 2.00, 95 % CI -17.32 to 21.33, p = 0.84), blood loss (MD -0.19, 95 % CI -0.41 to 0.03, p = 0.08), transfusion rate (OR 1.42, 95 % CI 0.34-5.96, p = 0.63), fever rate (OR 1.02, 95 % CI 0.33-3.12, p = 0.97) and complication rate (OR 1.02, 95 % CI 0.33-3.12, p = 0.97). Eight studies including six RCTs showed that use of hemostatic agents was safe. Hemostatic agents showed short hospital stay. There were no difference between hemostatic agents and common methods on blood loss, transfusion rate, fever rate, and complication rate.

A systematic review and meta-analysis of new onset hypertension after extracorporeal shock wave lithotripsy.

OBJECTIVE: Previous studies on the association between extracorporeal shock wave lithotripsy (SWL) and new onset hypertension have only illustrated contradictory results. In order to illustrate the association between SWL and new onset hypertension, a meta-analysis of case-control and cohort studies was conducted. METHODS: Relevant literature was searched using PubMed, EMBASE, and the Cochrane Central Search Library. A meta-analysis of the association between SWL and new onset hypertension was performed. Studies were pooled, and summary relative risk was calculated. Subgroup analyses were also conducted. RESULTS: Eleven studies were eligible for our analysis. No statistical significance was detected between SWL and new onset hypertension (RR = 1.06, 95 % CI 0.83-1.35). No association was observed when stratified analyses were performed on age, gender, study design, bilateral SWL, and different machines. CONCLUSION: Our analysis indicated that no association was found between SWL and the development of hypertension.

Foley catheter traction for hemorrhage after post-microchannel percutaneous nephrolithotomy / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the safety and effect of foley catheter traction for hemorrhage after postmicrochannel percutaneous nephrolithotomy (mPCNL).@*METHODS@#Eighty-eight patients with upper urinary calculi were collected prospectively at the Department of Urology of Xiangya Hospital of Central South University from November 2010 to June 2011. The patients underwent mPCNL, and were divided into 2 groups randomly: 45 patients with 16F foley catheter but without traction served as the control group, and the other 43 patients with 16F foley catheter traction served as the experiment group. Blood loss was estimated by the mass of hemoglobin in the draining liquid and urine during postoperative duration through the HiCN. The blood loss and bleeding time were compared in the 2 groups, and analyzed by Wilcoxon rank sum test.@*RESULTS@#There was statistical difference in the average blood loss between the control group (13.830 g) and the experiment group (7.959 g, P<0 .001). The mean bleeding time was 4 and 3 days in the control group and the experiment group respectively.@*CONCLUSION@#Foley catheter traction for mPCNL can reduce the blood loss, suggesting that Foley catheter traction is safe, effective and feasible.

Comparison of Cyberwand dual probe lithotriptor and Swiss lithoclast master in ultrasonically guided percutaneous nephrolithotomy for renal staghorn calculi / 中南大学学报(医学版)

Objective:To evaluate and compare the effciency and safety of Cyberwand dual probe lithotriptor and Swiss lithoclast master in percutaneous nephrolithotomy for renal staghorn calculi. Methods:A total of 138 patients with renal staghorn calculi were divided randomly into a Cyberwand dual probe lithotripter group (Group A, n=71) and a Swiss lithoclast master group(Group B, n=67). hTe data for operative time, blood loss volume, one-stage calculus clearance rate, hospitalization time, cost of hospitalization and complication in the two groups were collected and compared. Results: The renal access was established successfully and the one-stage percutaneous nephrolithotomy (PCNL) was performed in the 2 groups. There was no significant difference in the size of stones, the age of patients and the complications between the 2 groups before the operations. Intraoperative gravel time in the Group A was signiifcantly shorter than that in the Group B (77.14±21.39 vs 84.25±20.62, P=0.049). There was no significant difference in the one-staged stone clearance rate, blood loss volume in the operation between the 2 groups. hTe one-staged stone clearance rate in the 2 groups were 67.6%(48/71) and 70.1%(47/67) respectively, with no signiifcant difference (P=0.854). Conclusion:Two lithotrities were safe and effcient for renal staghorn calculi. But comparing with Swiss lithoclast master, Cyberwand dual probe lithotriptor is more effcient and convenient.

Screening of membrane antigen differentially expressed in androgen-dependent prostate cancer and androgen-independent prostate cancer / 中南大学学报(医学版)

OBJECTIVE@#To determine the screening of the expression of membrane proteins in androgen-dependent prostate cancer (ADPC) and androgen-independent prostate cancer (AIPC) and to explore the mechanism of membrane proteins in these two cancers.@*METHODS@#Serum samples were collected from 3 patients with ADPC and another 3 patients with AIPC. The serum was incubated with ADPC cell line LNCaP and/or AIPC cell line PC-3 and detected by immunoprecipitation and Western blot. Differentially expressed proteins between ADPC and AIPC identified by mass spectrometry were compared and their expression level and location were analyzed by immunofluorescence.@*RESULTS@#Altogether 11 membrane proteins were identifited, such as the Neural-Cadherin precursor, ER60 precursor, Claudin-4, and so on. Immunofluorescence revealed that the expression level of Claudin-4 in PC-3 cells was higher than in LNCaP cells.@*CONCLUSION@#We can use the screening method to study membrane proteins in prostate cancer. Claudin-4 may play an important role in the pathogenesis and the development of AIPC.

Diagnosis and treatment of carcinoma of renal pelvis accompanied with kidney stones / 中华泌尿外科杂志

Objective To discuss the diagnosis and treatment of carcinoma of renal pelvis ac-companied with kidney stones. Methods Twenty-one cases of carcinoma of renal pelvis with kidney stones were reviewed. The urinary stones history was from 10 d to 24 years with an average of 27 months. Four cases had recurrent fever, weight loss. Seventeen cases had gross hematuria. CT scan-ning was performed in 17 cases, which indicated 9 cases of carcinoma of renal pelvis, 4 cases of possi-ble renal mass and enlarged renal hilum lymph nodes. MRU was performed in 10 cases, which showed 9 cases of stones concomitant with carcinoma of renal pelvis. IVU indicated 13 cases of light filling of contrast and 8 cases of complete negative filling. Nine cases who had been diagnosed before surgery were performed radical nephrectomy and local lymph nodes dissection. Five cases were carried out ne-phrostomy first because of pyonephrosis, then secondary subcapsule nephrectomy was performed, 2 of them who were diagnosed with carcinoma of renal pelvis after surgery were performed with ureterecto-my and excision of bladder cuff. Three cases were performed with subcapsule nephrectomy because of dense perinephric adhesion. Three cases with complicated calculi and nonfunctional kidney were per-formed with nephroureterectomy, 2 of them who were diagnosed with carcinoma of renal pelvis were carried out with ureterectomy and excision of bladder cuff. One case who was performed PCNL under ultrasound guidance was found a mass in the renal pelvis. The pathological examination indicated ade-nocarcinoma. Radical nephrectomy and lymphadenectomy of renal hilum were performed afterwards. Resnlts Twenty-one cases were performed with pathological examination, in which there were 4 ca-ses of transitional cell carcinoma, 16 cases of squamous cell carcinoma and 1 case of adenocarcinoma. All the 21 cases were discharged after surgery. Nine of them were followed up with 4 to 28 months. Six cases were dead. The post-surgery survival time was 3 to 21 months. Two of them died of heart infarction, 4 died of metastasis. Conclusions The carcinoma of renal pelvis should be considered be-fore surgery in the patients with long history of renal calculi, hydronephrosis and infection. CT scan-ning and MRU are helpful for the diagnoses of renal calculi concomitant with carcinoma of renal pel-vis. Earlier diagnosis, earlier management of renal calculi can extend survival time of the patients with renal calculi concomitant with carcinoma of renal pelvis.

Treatment of renal calyceal stricture and atresia through antegrade percutaneous nephrostomy by Holmi-um laser / 中华泌尿外科杂志

Objective To evaluate the clinical efficacy and safety of Holmium laser in the treat ment of calyceal stricture and atresia through antegrade percutaneous nephrostomy. Methods Ante grade percutaneous nephrostomy was performed in 68 patients with calyceal stricture and atresiathrough a rigid 8/9.8 F ureteroscope. The stricture and atresia was incised in a linear fashion by theHolmium laser with a 550 mm fiber. After completion of the incision,a double J ureteral stent wasplaced for 6-8 weeks and nephrostomy tube was kept for 7 days thereafter. Patients were then fol lowed up with IVU and/or ultrasound at 3-6 month intervals. Results The mean operative timewas 90 min,ranged from 80 to 120 min. The mean postoperative hospital stay was 8 d(7-9d). Hy dronephrosis was significantly improved in 38 cases in an average follow up of 9 months (4-26 months). Repeated laser incision was performed to 4 treatment failures and all turned out to be suc cessful. Conclusions The Holmium laser treatment through antegrade percutaneous nephrostomyfor calyceal stricture and atresia has characteristics of minimal invasion,short hospital stay,good effi cacy in short term and repeated cases. This procedure to be used as the first choice for patients withgood renal function and mild hydronephrosis,especially accompanied with renal calculus.

Incision of renal calices for the treatment of complex intrarenal sinus renal calculi / 中华泌尿外科杂志

Objective To explore the effect of incision of the cervix renal calices for the treatment of complex intrarenal sinus renal calculi. Methods 52 cases of complex intrarenal sinus renal calculi with upper and/or lower calyx serious hydrops treated by incision of the cervix renal calices were studied.There were 38 men and 14 women.The mean age was 43 years (range,21 to 70 years).The mean diameter of the stones was 4.2 cm. Results The stones were totally removed in 44 cases.8 cases with residual stones were treated by percutaneous nephrolithotomy. The residual stones were totally removed in 4 cases while other 4 cases accepted further treatment with extracorporeal shock wave lithotripsy (ESWL).No blood transfusion and postoperative bleeding were observed.24 cases were followed up of 0.5 to 4 years.KUB plus IVU were conducted postoperatively which showed improved hydronephrosis.No intrarenal stricture and renal calculi recurrence were observed. Conclusions The procedure has advantages of less bleeding,preservating more renal function,less postoperative complications,which has a good application in the treatment of complex intrarenal sinus renal calculi with upper and/or lower calyx serious hydrops.