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Objective@#To assess value of immediate postoperative intravesical instillation of pirarubicin after transurethral resection (TURBT)of non-muscle invasive bladder cancer.@*Methods@#484 patients diagnosed with non-muscle-invasive bladder cancer admitted to the Second Affiliated Hospital of Kunming Medical University were divided into two groups after transurethral resection of bladder tumor. 285 patients received postoperative intravesical instillation of pirarubicin within 6 hours after the surgery, 199 patients received first instillation of pirarubicin at 10 days after the surgery, after that, all the patients received routine bladder perfusion chemotherapy. Patients who received intravesical instillation of pirarubicin within 6 hours were defined as immediate intravesical instillation group and the other patients as the control group. Based on the European Organisation for Research and Treatment of Cancer risk tables, scores of recurrence and progression of patients were calculated and then stratified into risk groups accordingly. Recurrence and progression rates of the immediate intravesical instillation group were analyzed and then compared with the corresponding reference of the risk tables.@*Results@#The 1-year and 5-year recurrence rate of patients with EORTC table scoring 0 in the immediate intravesical instillation group were significantly lower than that of the EORTC reference group (5.3% and 14.0% vs 15.0% and 31.0%, P<0.05). 1-year recurrence free rate between the immediate intravesical instillation group and the control group in patients scoring 1-4 was significantly different (81.3% vs 76.7%, P=0.014). However, 1-year recurrence free rate of the immediate intravesical instillation group was comparable with that of the control group in patients scoring 5-9, 10-17(P>0.05), which is quite close to the EORTC reference. The probability rates of 1-year and 5-year progression of the 285 patients who received immediate intravesical instillation group did not show significant difference with the EORTC reference. On multivariate analysis, previous recurrence, tumor grade G2-3, tumor multiplicity, delay of immediate intravesical instillation were independent risk factors of recurrence(P<0.05).@*Conclusions@#With the help of EORTC recurrence risk table stratifying the patients into different risk groups, our study showed that delay of immediate postoperative intravesical instillation of chemotherapy after TURBT was an independent risk factor of post-surgery recurrence of tumor. Moreover, patients with EORTC scoring 1-4 might obtain greatest benefits.
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Autophagy plays a dual role in tumor therapy.A variety of chemotherapy drugs can induce tumor autophagy by activating endoplasmic reticulum stress,and hyperactive autophagy can cause tumor cell apoptosis and plays an anti-tumor effect.Autophagy has a protective effect on tumor cells,which can maintain the survival of tumor cells and reduce the sensitivity of chemotherapy drugs by reusing the degradation of the damaged organelles.Therefore,the promotion or inhibition of autophagy modulators combined with chemotherapy drugs will have the potential for development in tumor therapy.
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Autophagy plays a dual role in tumor therapy.A variety of chemotherapy drugs can induce tumor autophagy by activating endoplasmic reticulum stress,and hyperactive autophagy can cause tumor cell apoptosis and plays an anti-tumor effect.Autophagy has a protective effect on tumor cells,which can maintain the survival of tumor cells and reduce the sensitivity of chemotherapy drugs by reusing the degradation of the damaged organelles.Therefore,the promotion or inhibition of autophagy modulators combined with chemotherapy drugs will have the potential for development in tumor therapy.
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ObjectiveTo evaluate the methods in treatment of upper urinary calculi in a low-head lithotomy with right or left lateral tilt by an ureteroscopy approach. Methods From September 2009 to May 2015, 110 patients with upper ureteral calculi (after failed ESWL) were underwent holmium laser lithotripsy by a ureteroscopy approach in a low-head lithotomy with right or left lateral tilt. Their clinical data and complications were analyzed retrospectively. Results Surgical effect of patients was satisfied with the success of gravel 91 patients, with a total rate of 82.7 %gravel. Conclusion Low-head lithotomy with right or left lateral tilt is a good body position to perform ureteroscopic lithotripsy for upper ureteral calculi. It is safe and effective.
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Objective To evaluate the risk factors of septic shock after mini-percutaneous nephrolithotripsy (mPCNL). Methods Clinical data of 1 590 cases who underwent mPCNL from January 2013 to December 2014 were retrospectively analyzed. The x2 test and logistic regression were used to identify the key risk factors for septic shock after mPCNL. Results Of the 1 590 patients, 18 patients suffered septic shock, including 6 male patients and 12 fe﹣male patients. Their mean age was (45.6 ± 13.5) years (28 ~ 69 years). White cell in urine was 100 percent, the stone diameter ranged from 1.5 to 5.0 cm, unichannel for 15 cases while multichannel for 3 cases, the operation du﹣ration ranged from 45 to 200 min, mean (87.0 ± 56.0) min. 2 in 18 cases died in multiple organ failure, the others recovered till discharged. In x2 test, female gender (P = 0.001), (+++ ~ ++++) white cells in urine (P= 0.042), un-preoperative nephrostomy drainage (P=0.041) had significant association with septic shock after mPCNL. While in multivariate analysis, female gender ( O? = 5.471, 95 % CI: 0.756~21.452, P< 0.05) and un-preoperative nephrostomy drainage (O? =3.106, 95%CI:1.283~7.907, P<0.05) were identified as independent risk factors for septic shock after mPCNL. Conclusions Female gender and un-preoperative nephrostomy drainage are the key risk factors for septic shock after mPCNL.
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Angiotensin (Ang Ⅱ),a main effector peptide of the renin-angiotensin system (RAS),mediates a hormonal action in the maintenance of blood pressure and electrolyte levels,and thus fluid homeostasis.Recent studies have implicated that it correlates with tumor growth,angiogenesis,metastasis and it has drawn more and more attention.Many studies show that Ang Ⅱ-AT1R/AT2R play crucial roles in tumor growth,metastasis,invasion and tumor angiogenesis,which are formed new targets for treating malignant tumors.
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Objective Bladder cancer , which has a high rate of recurrence and invasion , is the most common genitourinary cancer.The article was to study the effect of specific chemokine receptor CXCR 4 on invasion capacity and intraluminal implantation of human bladder cancer cells . Methods A CXCR4 specific recombinant plasmid vector (short hairpin, shRNA) was constructed to select those cells which could inhibit the expression of CXCR 4, and these cells were divided into blank control group , negative control plasmid group and recombinant plasmid group (pshRNA-CXCR4-1, pshRNA-CXCR4-2).RT-PCR and immunofluorescence technique were used to detect the mRNA and protein expression of CXCR 4 respectively .Invasion capability in vitro of the cells was evaluated by Boyden chamber .20 nude mice were randomly divided into experimental group and control group ( n=10 ) .The experimental group was established by injection of 100μL shRNA-EJ-M3 into the bladder , while the control group was established by injection of 100μL EJ-M3, aiming to detect the effect of shRNA-CXCR4 on intraluminal implantation of human bladder cancer cells . Results The CXCR4 mRNA expression of the pshRNA-CXCR4-1 group (62.05 ± 1.35) was significantly lower than that of blank control group (174.38 ±1.96, P 0.05).In immunofluores-cence experiment, the red cell amount of the pshRNA-CXCR4-1 group(32.24 ±2.23) was lower than that of the blank control group (89.61 ±4.47,P0.05).The Boyden chamber experiment showed that the number of penetrating cells of the pshRNA -CXCR4-1 group (39.67 ±8.45) was significantly lower than that of the blank control group (135.33 ±9.28, P<0.05) and that of the negative control plasmid group(123.63 ±6.36, P<0.05).As to the intraluminal implanting capability, the difference between the ex-perimental group and the control group of statistical significance (10%vs 70%,P<0.01). Conclusion CXCR4 shRNA can inhibit the expression of CXCR4 and significantly decrease the invasion capacity and intraluminal implantation of human bladder cancer cells .
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To assess the outcome of 200 men with bladder calculi [BC] and benign prostatic hyperplasia [BPH] who underwent transurethral ballistic lithotripsy [BL] as well as transurethral plasmakinetic resection of prostate [PKRP]. Retrospective study Department of Urology, The Second AffiliatedHospital of Kunming Medical University, Kunming, China In a trial at our department, we performed a retrospective analysis of the results of 200 patients who underwent endoscopic removal of BC and PKRP. BL and PKRP International Prostate symptom score [IPSS], Quality of life scores [QOL], Maximum flowrate [Qmax], Residual urine volume [RUV] and postoperative complications At two years, the results showed that IPSS, QOL, Qmax and RUV were all significantly different between preoperative and postoperative data. Urethral stricture, short-term urinary incontinence, recurrent calculi, and BPH recurrence developed in 3.5% [n=7], 5.0% [n=10], 1.0% [n=2], and 1.5% [n=3] of the 200 patients, respectively. Overall, 178 [89.0%] cases did not have any complications. Combined BL and PKRP is an effective, safe, and economical way of treating patients with BC and BPH simultaneously
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BACKGROUND: A long-term follow-up indicates that orthotopic ileal neobladder can cause acid-base balance and nutritional metabolic disorder. Otherwise, a long mesenterium is necessary to balance the tension of bladder at pelvic cavity and urinary inosculation due to a high position of ileum. On the contrary, sigmoid neobladder is near by urinary canal, and orthotopic sigmoid neobladder as a bladder substitute after radical cystectomy has few effects on acid-base balance of electrolytes, nutritional metabolism and secretion of mucus.OBJECTIVE: To compare the clinical results of these two operations basis on long-term follow-up. DESIGN: Retrospective analysis.SETTING: Department of Urinary Surgery, the Second Affiliated Hospital of Kunming Medical College.PARTICIPANTS: 164 patients with carcinoma of bladder were selected from Department of Urinary Surgery, the Second Affiliated Hospital of Kunming Medical College form January 1995 to March 2005. Ninety-six of them, including 74 males and 22 females, with age of 43-74 years and the average age of 65 years, accepted the operation of orthotopic ileal neobladder were regarded as the ileal neobladder group, and the other 68, including 64 males and 4 females, with age of 51-72 years and the average age of 62 years, accepted the operation of orthotopic sigmoid neobladder were regarded as the sigmoid neobladder group. All patients were finally diagnosed as pathological examination, and informed consent was provided by all patients. Treatment plan was approved by the local ethical committee.METHODS: ① Orthotopic ileal neobladder: Once the bladder was removed, a segment of ileum about 40-60 cm in length was isolated. In the operative procedure, the distal part of ileum which connected to the caecum often kept, the length of which was 15-20 cm. Both distal ends of the ureters were anastomosed to the homolateral not been split end of the isolated bowel. A perforation was constructed at the bottom of the pouch which served as the outlet, this outlet was then anastomosed to the proximal portion of the remaining urethra. ② Orthotopic sigmoid neobladder: After surgically removing the bladder, a part of the sigmoid colon, the length of which was 30-40 cm was isolated. Other operations were as the same as those mentioned above. MAIN OUTCOME MEASURES: Time of operation, blood loss during the procedure, length of time confined to bed, time of indwelling catheter, the ability to maintain continence and urinate, the results of urodynamic studies, and pouch related complications after operation.RESULTS: In 164 patients, 12 (7.3%) were lost to follow-up. The mean follow-up times were 46 months in the group of orthotopic ileal neobladder and 42 months in the group of orthotopic sigmoid neobladder, respectively. Blood loss during the procedure and the ability to maintain continence and urinate were similar in the two groups (P > 0.05). Compared with sigmoid neobladder group, the ileal neobladder group spent more time on operation, keeping the bed and indwelling catheter. The max volume of ileal pouch was higher than that of sigmoid pouch, and the difference was significant in statistic analysis (t=2.56-3.08, P < 0.05-0.01). Incidence of complication of ileal pouch (16.7%, 29.2%) was higher than that of sigmoid pouch (9%, 16%). The incidence in the early phase was not significantly different, but that in the late phase was significantly different (x2=5.426, P < 0.05).CONCLUSION: Compared with orthotopic ileal neobladder, sigmoid neobladder is worthy of being preferred for its shorter operative time, faster recovery and lower rate of pouch related complications.
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Clinical data of 53 patients with lower caliceal stone during August 2005 and March2007 were analyzed retrospectively.The stones were 11-35 mm in diameter.Under the guidance of X-ray.single renal tract parallel to the lower caliceal for percutaneous nephrolithotomy was established.The procedures were successful in all the patients.Fifty patients were stone free after first minimally invasive pereutaneous nephrolithotomy(MPCNL),2 were stone free following second MPCNL,1 saw residual small stones clear off spontaneously during the follow-up period.Operative time was 65-162 minutes.and blood loss was 10-200 ml.No severe complications or death occurred.MPCNL may be related with minimal invasion and fewer complications,thus provides an effective and safe way of lower caliceal stone treatment.
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Objective To evaluate the efficacy and safety of transurethral plasmakinetic resection for patients with superficial bladder tumor(SBT) complicated with benign prostate hyperplasia(BPH).Methods A total of 41 patients with SBT complicated with BPH were treated by transurethral plasmakinetic resection in our hospital.Various procedures were selected basing on the location,size,quantity of the bladder tumors,size of the prostate,and degree of adhesion around the gland.Results The opertion was completed in all of the 41 cases.The mean operation time was(67.2?25.3) min for resection of the bladder tumors and(72.3?23.2) min for the prostate.During the surgery,7 cases showed obturator nerve reflex and 2 developed bladder perforation.No patients died or had transurethral resection syndrome or rectal perforation.Six months after the operation,reexamination showed a mean IPSS of 6.2?3.7 and Qmax of(20.1?4.2) ml/s,which were significantly imporved compared with those detected before the surgery [25.3?4.1,(8.9?4.1)ml/s,t=22.209 and -12.174 respectively;and both P=0.000].The patients were followed up for 1 to 4 years,during which 9 cases showed recurent bladder tumor.Conclusions Transurethral plasmakinetic resection is safe and effective for patients with SBT complicated with BPH.The surgical procedure should be determined accordingly.
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Objective To evaluate the clinical significance of retroperitoneal laparoscopic adrenalectomy for benign adrenal tumors.Methods A total of 81 cases of retroperitoneal laparoscopic adrenalectomy from March 2002 to October 2005 was retrospectively analyzed,including 21 cases of Cushing's syndrome,57 cases of aldosterone-preducing adenoma,2 cases of adrenal pheochromocytoma,and 1 case of bilateral adrenocortical hyperplasia.Three trocars were introduced at the lumbar part and a retroperitoneal space was established by blunt dissection with the camera assembly.The tumor was removed by using a harmonic scalpel.Results The procedure was successfully completed in all the 81 cases,with an operation time of 20~140 min(mean,60 min) and an intraoperative blood loss of 20~100 ml(mean,45 ml).There was no need of blood transfusion intra-and post-operatively.Retroperitoneal hematoma occurred in 1 case post-operatively.Follow-up examinations in 37 cases for 3~18 months(mean,11 months) showed normal blood pressure,stature and laboratory findings.Conclusions Retroperitoneal laparoscopic adrenalectomy has advantages of minimal invasion,little blood loss,quick post-operative recovery,and low complication incidence.It should be considered as the first choice for treating benign adrenal tumors.
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Aim To investigate the preventive effect of nicotinylsalicylic acid(NSA) on experimental atherosclerosis in high cholesterol-fed quails. Methods Ninety one male quails were randomly divided into six groups:groupⅠ,normal control;groupⅡ,model control;group Ⅲ, NSA 150 mg?kg~(-1)?d~(-1); group Ⅳ, NSA 300 mg?kg~(-1)?d~(-1); groupⅤ, the nicotinic acid 75 mg?kg~(-1)?d~(-1) and the acetylsalicylic acid 75 mg?kg~(-1)?d~(-1); groupⅥ, the nicotinic acid 150 mg?kg~(-1)?d~(-1). The levels of TC,TG,HDL-C,LDL-C and MDA in serum were measured with biochemical method(0,4,8 wks). All of the quails were killed after 8 wks. Variables observed included aorta pathologic changed, TC and TG contents and the heart pathologic changes. Results The experimental data indicated that the high cholesterol-feeding increased the level of TC,TG,LDL-C and MDA,decreased the level of HDL-C in serum, aortic wall have obvious atherosclerosis. Data of the study demonstrated that the level of TC,TG,LDL-C and MDA were decreased,the level of HDL-C were increased by NSA in the high cholesterol-fed quails,aortic wall TC,TG were decreased by NSA,and atherosclerosis was regressed in aortic wall. Conclusion NSA has preventive effect on the experimental atherosclerosis among the high cholesterol-fed quails.
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0.05).Conclusion: The method of constructing a highly invasive subline of bladder neoplasm is reliable,and EGFP transfection does not change the biological behavior of the cells.The obtained sublines may provide a valuable experimental platform for further study on the molecular mechanisms of bladder neoplasm metastasis.
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Objective To investigate effects of CO_2 pneumoperitoneum,helium pneumoperitoneum,and laparotomy on(port-)site and visceral metastasis in BALB/c nude mice bearing human colon cancer xenografts.Methods A nude mouse model with human colon cancer LoVo cell line xenografts was used.The mice were randomly divided into four groups: CO_2 Pneumoperitoneum Group,Helium Pneumoperitoneum Group,Open Surgery Group,and Control Group.A biopsy was performed in the former 3 groups,and the Control Group received no surgical intervention. Results All the mice were sacrificed for pathological examinations.Orthotopic tumor xenograft was successfully established in all the mice of the four groups(100%,86/86).The rates of port-site metastasis were 9.5%(2/21) in the CO_2 Pneumoperitoneum Group,9.1%(2/22) in the Helium Pneumoperitoneum Group,and 19.0%(4/21) in the Open Surgery Group,respectively,without significant differences among the three groups(?~2=1.227,P=0.541).The rates of liver metastasis were 38.1%(8/21) in the CO_2 Pneumoperitoneum Group,31.8%(7/22) in the Helium Pneumoperitoneum Group,52.4%(11/21) in the Open Surgery Group,and 31.8%(7/22) in the Control Group,respectively,without significant differences among the four groups(?~2=2.543,P=0.468).Conclusions As compared with laparotomy and control groups,artificial pneumoperitoneum doesn't cause an increase of rates of port-site and visceral metastasis.Moreover,there is no significant difference between CO_2 pneumoperitoneum and helium pneumoperitoneum in rates of port-site and visceral metastasis.
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Objective To compare the clinical efficacy of orthotopic ileal neobladder versus ortho- topic sigmoid neobladder.Methods The data of 96 patients who had undergone orthotopic ileal neoblad- der and 68 patients who had undergone orthotopic sigmoid neobladder were retrospectively analyzed.The perioperative condition,urinary continence,urodynamics,and pouch-related complications were compared between the 2 groups.Results Of all the 164 patients,12(7.3%)were lost to follow-up.The mean fol- low-up was 46(2-86)months in orthotopic ileal neobladder group,and 42(4-78)months in orthotopic sigmoid neobladder group.There was no significant difference in intraoperative blood loss and postoperative urinary continence between the 2 approaches(P＞0.05).However,compared with sigmoid neobladder group,ileal neobladder group had longer operative time and postoperative recovery time,and got a bigger pouch(P＜0.05).The early and late pouch-related complication rates of ileal neohladder group were 16. 7% and 29.2%,which were higher than those of sigmoid neobladder group.During the follow-up,tumor recurred in 3 cases of ileal neobladder group,but none in sigmoid neobladder group.Conclusions Ortho- topic ileal neobladder and sigmoid neobladder are similar in operative difficulties,and both can achieve satis- factory clinical results.Compared with ileal neobladder,sigmoid neobladder has shorter operative time, quicker recovery and lower rate of pouch-related complications,thus is a preferred procedure.
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Objective To evaluate the effect of technical improvement of radical retropubic prostatectomy(RRP) for patients and reduction of complications.Methods 22 patients with clinically prostate cancer(mean age 67 years,stage B 19 cases,stage C 3 cases) underwent radical retropubic prostatectomy.During operation the dorsal vein complex,puboprostatic ligament,puborectalis sling,the neurovascular bundle,external urethral sphincter,reconstruction of the bladder neck were carefully managed.Results All the patients recovered uneventful except 2 deaths,and they survived and were followed up for a mean time of 16 months(range 1～4 years).The mean operative time was 140 minutes(range 90～220minutes) and the mean blood loss was 600mL(range 250～1500mL).16 cases received blood transfusion for 300～1200mL and no ureteral or rectal injury occurred.The urinary catheters were removed 2～3 weeks after operation.2 cases had stress incontinence 3 months later,1 case encountered urethral stricture and became well after urethral dilation,15 cases had satisfactory erectile function after operation and 3 patients had biochemical failure and endured continually chemotherapy during follow-up.Conclusions Accurate maneuver is handled according to correct anatomy can protect the apex of prostate and its surrounding tissue and reconstructing the bladder neck is helpful to reduce complications and achieve better outcome.
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Objective To evaluate the surgical method and curative effect of minimally invasive percutaneous nephrolithotomy(MPCNL) in treatment of impacted proximal ureteric calculi and giant renal pelvic calculi with moderate or severe hydronephrosis by non-imaging in localization.Methods 52 cases of calculi treated with MPCNL were studied retrospectively.Percutaneous nephrostomy was established by non-imaging in localization(naked eye) according location of kidneys,length of 12th ribs,degree of hydronephrosis and condition of calculi,and the nephropathy was extended to F16 through invasive percutaneous.Stones were taken out by ureteropyeloscopic pneumatic lithotripsy with the help of hydraulic perfusion pump.Results The operative time was 32~140min with the average of 112min.The average blood loss volume was 45mL.No severe complication occurred in the intra-or post-operative time.The rate of complete clearance of stones was 96 % in first attempt,and the residual stones passed out by themselves after the double "J" tube was pulled out in cases.The mean hospital stay was 9 days,and the mean postoperative hospital stay was 4.2 days.Conclusion To treat the impacted proximal ureteric calculi and giant renal pelvic calculi with moderate hydronephrosis or severe hydronephrosis,some skilled doctors can appropriately use the method of MPCNL by non-imaging in localization,since the method can reduce the harm by X-ray,and save medical expenses.
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Objective To elucidate the diagnosis and treatment of the bladder mixed tumor.Methods 16 cases treated from Jun 1990 to Aug 2004 were reviewed.The clinical manifestations,diagnosis,treatment and prognosis were discussed.Correlative literature was reviewed at the same time.Results 16 cases of the bladder mixed tumor accounted for 6.9% of 223 bladder tumor patients in the same period,of which 7 of 16 were transitional squamous cell carcinoma,4 transitional adenocarcinoma,3 transitional squamous adenocarcinoma and 2 squamous adenocarcinoma mixed tumor.Most of the patients had irritable bladder symptoms and hematurine.Partial cystectomy was undergone for 3 of 16 cases,total cystectomy for 10 and radical total cystectomy for 3.The main treatment was partial or total cystectomy.The overall survival rates at 1,3 and 5 years post operation were 81.3%,56.3% and 12.5% respectively.Conclusion There were higher malignancy and worse prognosis in bladder mixed tumor.Early diagnosis and therapy might prolong survival.Radical total cystectomy seems to be the best method of treatment.
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Objective To evaluate the surgical method and curative effect of minimally invasive percutaneous nephrolithotomy(MPCNL) in treatment of impacted proximal ureteric calculi.Methods 45 cases of proximal ureteric calculi treated with MPCNL were studied retrospectively.Percutaneous nephrostomy was established under the guide of X-ray,B-ultrasound and naked eye,and the nephropathy was extended to F16 through invasive percutaneous.Stones were taken out by ureteropyeloscopic pneumatic lithotripsy with help of hydraulic perfusion pump.Results The surgical time was 15～110 min with the average of 42 min after percutaneous nephrostomy.The average blood loss volume was 30 mL;no severe complications were occurred in the intra-or post-operative time.The rate of complete clearance of stones was 100% in first attempt.The mean hospital stay was 9 d,and the mean postoperative hospital stay was 3.5 d.Conclusion MPCNL used to treat the impacted proximal urethral calculi have satisfied effects and a lot of merits.