Clinical characteristics and endoscopic treatment of hematospermia with postcoital hematuria.

BACKGROUND: Recurrent hematospermia accompanied by postejaculatory hematuria is a very rare phenomenon, has not been well understood in the clinical setting, and usually leads to misdiagnosis and mistreatment. The aim of this study was to summarize the clinical characteristics, etiologic diagnosis, and endoscopic treatment of hematospermia with postcoital hematuria. METHODS: We collected the clinical data from 39 patients of hematospermia with postcoital hematuria, who were admitted to our hospital from May 2014 to October 2019. The etiologic diagnostic process and endoscopic surgery were analyzed retrospectively, and we observed and evaluated the efficacy and any complications during follow-up. RESULTS: The average age of the 39 patients was 44.1 years (range, 18-61 years), and the disease history ranged from 1 month to 20 years, with a median duration of 24 months. All of the patients were observed by urethrocystoscopy, which showed 38 cases of posterior urethral hemangioma (PUH) or abnormal varicose vessels, and 1 case of anterior urethral hemangioma. Of these, 18 patients underwent transurethral resection of urethral hemangioma, and 21 patients underwent transurethral electrocauterization. Postoperative follow-up ranged from 1 to 56 months, with a median of 16 months. The symptoms disappeared in 37 patients and recurred in 2 patients two to 3 months after the operation. The two recurrent patients were treated again by transurethral electrocauterization, and their symptoms then disappeared. CONCLUSIONS: PUH is the most common cause of hematospermia with postejaculatory hematuria. Herein, we demonstrated that transurethral resection or electrocauterization provides a safe, effective, and minimally invasive method for the treatment of PUH.

Development and validation of an integrated nomogram to predict personalized new baseline functional outcomes after partial nephrectomy.

BACKGROUND: The prediction of new baseline renal function after partial nephrectomy (PN) has important clinical implications. This study aimed to establish a precise personalized nomogram integrating pre-, intra- and post-operative variables to predict new baseline function after PN. METHODS: This nomogram was constructed based on 213 consecutive PN cases at a large-volume institution from 2014 to 2017 and externally validated by a prospective cohort from January to December 2018 at the same institution. Multivariate cox regression and logistic least absolute shrinkage and selection operator (LASSO) regression were used to select predictors. The performance of the nomogram was assessed by the concordance index (C-index), calibration plot, decision curve analysis and Kaplan-Meier plot. RESULTS: The average drop percent of the estimated glomerular filtration rate (eGFR) was -8.6% (-12.3%, -7.2%). Multivariate Cox regression analysis and LASSO regression revealed that age, baseline eGFR, RENAL nephrometry score, ischemia time, and AKI were independent predictive factors. These five factors were subsequently incorporated to establish an integrated nomogram, with a C-index of 0.910, excellent calibration plot and net clinical benefit. An external validation of 67 patients showed a C-index of 0.801, excellent calibration and clinical net benefit. CONCLUSIONS: Our proposed nomogram based on pre-, intra- and post-operative outcomes accurately predicts personalized new baseline eGFR after PN. The successful personalized prediction of at-risk individuals at an early stage can provide multi-professional consideration and timely management.

Microscopic replantation of completely amputated penis and testes: a case report and literature review.

OBJECTIVE: The aim of this study was to summarize in a literature review our treatment experience involving microscopic replantation in a rare case of a completely amputated penis and testes. PATIENT AND METHODS: The penis and testes were completely amputated due to self-mutilation. The 26-year-old patient immediately underwent microscopic replantation of the penis and testes after pre-operative preparation. Potent anti-infectives and anti-depressives, and microcirculation-improving hyperbaric oxygen therapy were utilized after surgery. RESULTS: The time between the amputation and surgery was about 10 h. The patient was followed for 12 months post-surgery. The replanted penis recovered and the patient could urinate normally in the standing position with a maximal urinary flow rate of 20 ml/s. The testes also survived, but their size showed obvious atrophy. The serum testosterone level at 2 months after the operation was 120 ng/dL (normal reference range: 175-781 ng/dL). Erectile function gradually recovered after androgen replacement therapy. CONCLUSION: Complete amputation of the penis and testis is very rare. Efforts should be made to perform the replantation surgery as soon as possible. Microscopic surgical techniques for elaborate vascular and neural anastomosis constitute the basis for a successful replantation. Post-operative comprehensive treatment such as strong anti-infection, analgesia, anti-depression, improvement of microcirculation, and hyperbaric oxygen is crucial for the survival and functional recovery of replanted organs.

Different RET gene mutation-induced multiple endocrine neoplasia type 2A in 3 Chinese families.

BACKGROUD: Multiple endocrine neoplasia type 2A (MEN2A) is a condition with inherited autosomal dominant mutations in RET (rearranged during transfection) gene that predisposes the carrier to extremely high risk of medullary thyroid cancer (MTC) and other MEN2A-associated tumors such as parathyroid cancer and/or pheochromocytoma. Little is reported about MEN2A syndrome in the Chinese population. METHODS: All members of the 3 families along with specific probands of MEN2A were analyzed for their clinical, laboratory, and genetic characteristics. Exome sequencing was performed on the 3 probands, and specific mutation in RET was further screened on each of the family members. RESULTS: Different mutations in the RET gene were identified: C634S in Family 1, C611Y in Family 2, and C634Y in Family 3. Proband 1 mainly showed pheochromocytoma with MTC, both medullary thyroid carcinoma and pheochromocytoma were seen in proband 2, and proband 3 showed medullary thyroid carcinoma. CONCLUSION: The genetic evaluation is strongly recommended for patients with a positive family history, early onset of age, or multiple sites of masses. If the results verified the mutations of RET gene, thyroidectomy should be undertaken as the guide for better prognosis.

Carney complex with PRKAR1A gene mutation: A case report and literature review.

RATIONALE: Carney complex (CNC) is a multiple neoplasia syndrome with autosomal dominant inheritance. CNC is characterized by the presence of myxomas, spotty skin pigmentation, and endocrine overactivity. No direct correlation has been established between disease-causing mutations and phenotype. PATIENT CONCERNS: A 16-year-old boy was admitted because of excessive weight gain over 3 years and purple striae for 1 year. Physical examination revealed Cushingoid features and spotty skin pigmentation on his face, lip, and sclera. DIAGNOSES: The patient was diagnosed as Carney complex. INTERVENTIONS: the patient underwent right adrenalectomy and partial adrenalectomy of the left adrenal gland. OUTCOME: Results of imaging showed bilateral adrenal nodular hyperplasia, multiple microcalcifications of the bilateral testes, and compression fracture of the thoracolumbar spine. Histopathological results confirmed multiple pigmented nodules in the adrenal glands. DNA sequencing revealed a nonsense mutation in the gene encoding regulatory subunit type 1-alpha of protein kinase A (PRKAR1A; c.205C > T). After the second adrenalectomy, the Cushingoid features disappeared, and cortisol levels returned to normal. LESSONS: Carney complex is a rare disease that lacks consistent genotype-phenotype correlations. Our patient, who carried a germline PRKAR1A nonsense mutation (c.205C > T), clinical features included spotty skin pigmentation, osteoporosis, and primary pigmented nodular adrenal disease. Adrenalectomy is the preferred treatment for Cushing syndrome due to primary pigmented nodular adrenal disease.

HIF2A germline-mutation-induced polycythemia in a patient with VHL-associated renal-cell carcinoma.

In this study, we report here a rare case of polycythemia and cRCC in the same patient, which may be helpful in understanding clinical features and molecular mechanisms underlying VHL-mutation-associated cRCC and polycythemia induced by germline mutation of HIF2A. Firstly, we identified a rare but well studied germline mutation resulting in polycythemia in HIF2A (c.1609G>A, p.Gly537Arg) in the blood of the patient and his daughter. Meanwhile, we identified an inactivating VHL mutation (c.391A>T, p.N131Y), as well as TP53 mutation(c.977A>T, p.E326V) and mTOR mutation(c.7498A>T, p.I2500F) in renal cancer tissue. Moreover, protein levels of VHL, HIF1A, HIF2A, EPO, and VEGF estimated by immunohistochemical staining substantiated hyperactivation of the oxygen-sensing pathway. In addition, we identified 158 somatic SNP/indel mutations, including 90 missense/nonsense/splice/stop-loss mutations by whole-exome sequencing (WES) of the tumor specimen and matched normal DNA.

Metformin represses bladder cancer progression by inhibiting stem cell repopulation via COX2/PGE2/STAT3 axis.

Cancer stem cells (CSCs) are a sub-population of tumor cells playing essential roles in initiation, differentiation, recurrence, metastasis and development of drug resistance of various cancers, including bladder cancer. Although multiple lines of evidence suggest that metformin is capable of repressing CSC repopulation in different cancers, the effect of metformin on bladder cancer CSCs remains largely unknown. Using the N-methyl-N-nitrosourea (MNU)-induced rat orthotropic bladder cancer model, we demonstrated that metformin is capable of repressing bladder cancer progression from both mild to moderate/severe dysplasia lesions and from carcinoma in situ (CIS) to invasive lesions. Metformin also can arrest bladder cancer cells in G1/S phases, which subsequently leads to apoptosis. And also metformin represses bladder cancer CSC repopulation evidenced by reducing cytokeratin 14 (CK14+) and octamer-binding transcription factor 3/4 (OCT3/4+) cells in both animal and cellular models. More importantly, we found that metformin exerts these anticancer effects by inhibiting COX2, subsequently PGE2 as well as the activation of STAT3. In conclusion, we are the first to systemically demonstrate in both animal and cell models that metformin inhibits bladder cancer progression by inhibiting stem cell repopulation through the COX2/PGE2/STAT3 axis.

Transurethral endoscopic treatment of seminal vesicle cysts (report of seven cases).

OBJECTIVE: Seminal vesicle cysts are a rare disorder of the male reproductive system. The goal of this report was to summarize the radiological manifestations and transurethral endoscopic treatment of large seminal vesicle cysts. MATERIALS AND METHODS: The clinical data of seven cases of giant seminal vesicle cysts, including their symptoms, radiological images, transurethral endoscopic treatment, and postoperative follow-up, were retrospectively reviewed. RESULTS: Computerized tomography and magnetic resonance imaging (MRI) demonstrated the cysts behind the bladder, above the prostate, and away from the midline. The lesions ranged in size from 8.26 cm × 7.98 cm × 4.85 cm to 9.27 cm × 8.95 cm × 8.15 cm. Two cases were associated with ipsilateral renal and ureteral agenesis and were classified as congenital malformations. The other five cases were simple seminal vesicle cysts thought to be secondary to acquired ejaculatory duct obstruction. All seven cases were successfully treated using transurethral endoscopic unroofing with cautery of the mucosa. All the seminal vesicle cysts were confirmed by pathologic examination. No malignant disease was found. All preoperative symptoms resolved after surgery. No complications were observed. No patient developed abnormalities of erection, ejaculation, or orgasm. No bladder or rectal injuries were noted. The seminal vesicle cysts were significantly decreased in size or absent 3-6 months after treatment. CONCLUSION: MRI best characterized seminal vesical cysts and their cause. Transurethral unroofing with cautery of the mucosa is an extension of well-accepted cystoscopic techniques. It is safe, easy to perform, and effective. It is the preferred method for the treatment of large seminal vesicle cysts.

Types and timing of therapy for vocal fold paresis/paralysis after thyroidectomy: a systematic review and meta-analysis.

OBJECTIVES: To perform a systematic literature review to evaluate the type and timing of therapy for vocal fold paresis/paralysis after thyroidectomy and develop a primary decision-making pathway. STUDY DESIGN: Meta-analysis. METHODS: Four databases and one journal were searched using the key words of "thyroidectomy," "vocal cord paresis/paralysis," and "therapy." Study quality was evaluated using the Cochrane Collaboration's risk of bias tools. Data regarding type and timing of therapy were extracted from 39 articles. Odds ratios (ORs), relative risk (RR), 95% confidence interval, and heterogeneity were recorded. Logistic regression analysis was performed to determine the relationships between timing and OR/RR. RESULTS: Among the 13 studies investigating unilateral paresis/paralysis, five focused on early therapy (0-6 months). In these studies, the OR for clinical heterogeneity was significantly higher after neurolysis than after injection laryngoplasty and voice training (Q = 17.002, I(2) = 78%, P = 0.000), and the RR for heterogeneity was significantly higher after injection laryngoplasty at ≥12 months than <12 months (Q = 9.984, I(2) = 89.9%, P = 0.002). In the 26 studies that investigated bilateral paresis/paralysis, the OR for heterogeneity was significantly higher for bilateral posterior cordectomy than for endolaryngeal laterofixation (Q = 3.510, I(2) = 71.5%, P = 0.061) and laser arytenoidectomy with posterior cordectomy (Q = 2.90, I(2) = 65.6%, P = 0.088). CONCLUSIONS: For unilateral vocal fold paresis/paralysis after thyroidectomy, we recommend absorbable mass injection laryngoplasty, voice training, and neurolysis during the first 12 months but laryngeal reinnervation after 12 months. For bilateral vocal fold paresis/paralysis, we recommend early laterofixation and combined laser arytenoidectomy with posterior cordectomy after 12 months.