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Objective To investigate the feasibility and clinical effect of immediate ureterovesical reimplantation after ureteral rupture during laparoscopic hysterectomy. Methods From August 2010 to December 2015, 5 cases of ureteral rupture during the operation of laparoscopic hysterectomy were treated with immediate ureterovesical reimplantation under laparoscopy. Results All operations were successfully performed without transversion to open surgery. No patients with urinary leakage occurred. The mean follow-up were 21 months (range 3-60 months) . No cases with ureteral stricture were observed. Slight urine reflux was found in two patients, of whom obvious hydronephrosis and renal damage were not found. Conclusion Immediate ureterovesical reimplantation under laparoscopy is a feasible, safe and minimal invasive method for treatment of ureteral ruputure during laparoscopic hysterectomy.
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This study examined the association of polymorphisms in angiotensin II receptor genes (AT (1) R and AT (2) R) with the risk for aldosterone-producing adenoma (APA) in a Chinese Han population. Four polymorphisms including rs5182 (573T/C) in exon 4, rs5186 (1166A/C) in 3'-untranslated region (3'-UTR) in AT (1) R gene and rs5194 (2274G/A) in 3'-UTR, rs1403543 (1675G/A) in intron 1 in AT (2) R gene were detected in 148 APA patients and 192 normal subjects (serving as control) by using a MGB-Taqman probe. The distribution of genotypes of each locus was in accordance with Hardy-Weinberg Equilibrium (HWE) in the APA and control groups (P>0.05). The allele A frequency at rs5194 was significantly higher in the APA group (0.49) than in the control group (0.35) (χ (2)=12.08, P=0.001). Subjects with homozygotic genotype AA and heterozygotic genotype GA were at an increased risk for APA as compared to those with GG genotype (OR=2.66, 95% CI=1.45-4.87; OR=1.67, 95% CI=1.02-2.74). Furthermore, rs5194 single-nucleotide polymorphism (SNP) at AT (2) R gene was significantly associated with APA in additive (OR=1.64, 95% CI=1.21-2.20, P=0.001), dominant (OR=1.94, 95% CI=1.23-3.06, P=0.003), and recessive model (OR=2.01, 95% CI=1.17-3.45, P=0.01). It was concluded that rs5194 polymorphism at AT (2) R gene was associated with the risk for APA, which may constitute a genetic marker of APA.
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The expression of angiotensin II type 1 receptor (AT(1)R) and angiotensin II type 2 receptor (AT(2)R) in aldosterone-producing adenoma (APA) of the adrenal gland was detected, and their relationship with clinical indexes of APA was analyzed. The mRNA expression of AT(1)R and AT(2)R in 50 cases of APA and tissues adjacent to tumors and 12 cases of normal adrenal tissues was detected by using reverse transcriptase polymerase chain reaction (RT-PCR). The expression of AT(1)R and AT(2)R proteins in paraffin-embedded slices of tissue was detected by immunohistochemistry. The expression of AT(1)R in adenoma, tissues adjacent to tumor, and normal tissues of the adrenal gland showed no significant differences. The expression of AT(2)R in APA tissue was lower than that in normal adrenal gland tissues (P<0.05). Correlation analysis of the mRNA expression level of AT(2)R and clinical data from patients demonstrated that AT(2)R expression was negatively related to plasma aldosterone concentration (PAC) (r=-0.467, P<0.05), but positively related with plasma renin activity (PRA) (r=0.604, P<0.05). It is concluded that down-regulation of the AT(2)R expression is possibly related with the tumorigenesis of APA.
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This study aimed to determine whether aldosterone could induce vascular cell apoptosis in vivo. Thirty-two male rats were randomly divided into 4 groups: vehicle (control), aldosterone, aldosterone plus eplerenone or hydralazine. They were then implanted with an osmotic mini-pump that infused either aldosterone or the vehicle. Systolic blood pressure (SBP) was measured weekly by the tail-cuff method. After 8 weeks, plasma aldosterone concentration (PAC) and renin activity (PRA) were determined by radioimmunoassay. Aortic apoptosis was examined by TUNEL assay. The levels of cytochrome c and caspase-3 were determined by Western blotting and the expression of Bax and Bcl-2 was detected by immnuohistochemistry and Western blotting. The results showed that as compared with control group, aldosterone-infused rats exhibited: (1) an increase in SBP; (2) significantly elevated PAC with depressed PRA; (3) elevated aortic vascular cell apoptosis accompanied with higher levels of cytochrome c and activated caspase-3; and (4) significantly up-regulated Bax protein with down-regulated Bcl-2. These effects of aldosterone were significantly inhibited after co-administration with eplerenone but not with hydralazine. It was concluded that aldosterone induced vascular cell apoptosis by its direct effect on the aorta via mineralocorticoid receptors and independently of blood pressure, which may contribute to aldosterone-mediated vascular injury.
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Objective To study the role of fibulin-5 in urothelial carcinoma of bladder. Methods Fibulin-5 expression was detected in bladder cancer tissues (13 cases of G_1 and G_2, 7 cases of G_3) and normal bladder mucosa samples by Western blotting assay. Fibulin-5 cDNA was amplified by PCR and cloned into pMD-19T simple vector. The pMD-19T-Fibulin-5 vector was digested by restriction endonucleases XhoI and EcoRI to generate a XhoI-Fibulin5-EcoRI fragment that was then ligated into the identical sites in p-EGFP-Nl plasmid to synthesize p-EGFP-Fibulin-5 plasmid. The p-EGFP-Fibulin-5 plasmid was finally transfected into bladder cancer cell line 5637. The migration and invasion of untransfected, vector-transfected and fibulin-5-transfected bladder cancer cells were measured by Boyden chamber assay. Results Compared to 1. 16 ±0. 28 in the normal control, the expression of fibulin-5 protein in low grade and high grade tumors were 0. 57±0. 32 and 0. 44±0. 42(P<0. 01, respectively). However, the difference between low grade and high grade tumors was not statistically significant (P>0. 05). The successfully transfected bladder cancer cells demonstrated green fluorescent light. The migrated cell number of fibulin-5-transfected cells was 127. 6 ± 3. 1 compared with 139. 3±7. 7 for vector-transfected cells and 136. 9±5. 7 for untransfected cells (P>0. 05, respectively). In contrast, the invaded cell number of fibulin-5-transfected cells was 8. 0±3. 1 compared with 31. 5±4. 8 for vector-transfected cells and 31. 7±4. 7 for untransfected cells (P<0. 01, respectively). Conclusion Fibulin-5 is down-regulated in urothelial carcinoma of bladder and acts as a tumor suppressor gene by inhibiting the invasion of bladder cancer cells.
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Objective To develop a staged laparoscopic training program for performing the ana-tomic retroperitoneoscopic adrenalectomy(ARA), and to determine its safety and feasibility. Me-thods Five young urological doctors without previous experience in open adrenalectomy were selected third period, trainees acted as camera holder first, then performed simple operations such as laparo-scopic renal cyst unroofing. Finally, they performed 30 ARA independently under the mentor's super-vision. Pheochromocytoma was ruled out for its large tumor size and potential cardiovascular risk. The patient selection criteria were the same as those of the initial 30 cases performed by the tutor. Preope-rative data of the initial 30 ARA performed by each trainee and tutor which included gender, age, body mass index, tumor size, tumor location and pathological diagnosis of tumor were compared between trainees and the tutor. The intraoperative and postoperative data of 150 ARA in the trainees were compared with the initial 30 ARA of the tutor. These included mean operative time, estimated blood loss, length of hospital stay, conversion rate, complication rate. Qualitative and quantitative data were compared between the groups using x2 and t test statistics methods by SPSS 12.0 for Windows, except operative time, which was from a nonnormal distribution. A P value less than 0.05 was consi-dered to be statistically significant. Results Preoperative data of the initial 30 ARA performed by each trainee were marched to those of the mentor (all P>0.05). All ARA were completed successful-ly. No procedure converted to open surgery. The median operative time of the trainees was 82 min (range 59-133 min), which was less than that of the tutor [132 min (range 73-230 min), P< 0.01]. And the trainees' learning curve was flatter than their tutor's. Estimated blood loss and length of hospital stay for the 5 trainees and the tutor were 62.2±22.0 ml, 4.8±1.3 d and 63.9±21.1 ml, 4.5±1.4 d respectively. There was no significant difference between these results (both P>0.05). No major complication was observed. Though the total perioperative complication rates were no diffe-rence between the trainees and their tutor (8.0% versus 13.3%, P>0.05), intraoperative minor complication rates of the trainees (1.3%) was less than that of the tutor (10.0%, P<0.05). Con-clusion The staged laparoscopic training is safe and feasible for young urological doctor to study in performing ARA.
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Objective To study the endoscopic anatomical structures in retroperitoneal space and to share experiences of retroperitoneoscopic radical nephrectomy. Methods Between January 2006 and March 2008, a total of 85 patients underwent retroperitoneoscopic radical nephrectomy. Thirty-eight tumors were on the left kidney and 47 on the right side. The mean tumor size was 5.5± 1.7 cm in diameter (2.5 to 10.5 cm). There were 74 cases in clinical stage T1N0M0 and 11 cases in T2N0M0. Following the principle of radical nephrectomy outside the renal fascia, the whole surgical procedure was performed along "2 spaces" and "2 poles". The ventral attachment of the kidney was dissected in anterior pararenal space between peritoneum and anterior renal fascia. The dorsal attachment was dissected in anterior psoas space between posterior renal fascia and psoas fascia. The cepha-lic attachment was dissected up to the subdiaphragmatic and down to iliac fosse. During the proce-dure, important anatomic structures such as parietal peritoneum and its reflexion, anterior renal fasci-a, lateroeonal fascia, posterior renal fascia, psoas muscles, greatvessels and their branches were care-fully identified. Results One case was converted to open surgery because of severe and extensive ad-hesion of the right kidney to the adjacent tissues. The other 84 procedures were successfully comple-ted. The median operative time was 65 rain (range 50 to 165 min) and median estimated blood loss was 58 ml (range 25 to 600 ml). Of all operations, peritoneum perforation occurred in 5 cases and small vessel injuries around renal pedicles were observed in 6 cases. Major complication such as great vessel injury was not observed. Mean follow-up of all 85 patients was 10 months (range 2 to 25 months). No local recurrence and port site tumor seeding was found. Conclusion During retrope-ritoneoscopic radical nephrectomy, studying anatomical features of renal area and recognizing impor-tant anatomic structures will help to improve the safety of the surgery and reduce morbidities.
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Objective To summarise the methods for a long segmental avulsed inj ury of ureter.Methods Ureteroscopies were performed on three male patients with upper ureteral calculi and one female patient with haematuria from upper urinary tract.Ureteral calculi caused small and middle hy-dronephrosis,obstruction wasn't seen on the upper urinary tract with haematuria.The kidney on the affected side showed normal founction on IVP.Four patients were suffered from a long segmental avulsed inj uries of full-thickness of ureter from ureteroscopy in a continuous epidural anesthesia.The injuries took place in UPJ and upper ureter.The length of avutsed ureters is 20-25 cm,mean length is 24 cm. Results The ureteroscopies were altered to open operations which were ileal ureteral substi-tutions on two patients,being anastomosed the avulsed ureter wrapped by caul on one patient and nc-phrectomy on one patient under general anesthesia in an emergercy.Two ileal ureteral substitutions had reached satisfied results that were no damaged renal functions,no metabolic acidosis,no repeatly U-rinary tract infections and no complains about micturition.One patient has maintained normal renal morphology and function after thirteen years followup,the other formed stricture in the anastomosis of the proximal piece of-ileum to the renal pelvis tWO years after operation,and then improved after ante-grade dilation.The patient with being replaced back and anastomosed the avulsed ureter had compli-cated with a renal atrophy on the affected side three months after the double-J was extracted.The kid-ney showed no function on isotop nephrogram and then was ablated.The last one with nephrectomy and the one before were followed up regularly,the renal functions and blood pressures remain normal.Conclusion Ileal ureteral substitution would be a good choice and has a stable curative effect and provide a good prognosis for treating long segmental avulsed injury of ureter suffered from ureterosco PY when no available urinary tract was utilized for reconstruction.
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Objective To investigate the pathogenesis ,d iagnosis and treatment of traumatic pseudoaneurysmal-ureteral fistula. Methods A 49-year-old male patient with traumatic iliac pseu doaneurysmal-ureteral fistula was reported.The patient presented with recurrent massive hematuria,and then was diagnosed by DSA and ureteroscopy.By reviewing t he published literature on arterio-ureteral fistula, we analyzed and discussed the patient’s clinical data. Results The patient was cu red by endovascular management.The procedure was as follows.First,the right exte rnal iliac artery was dilated with balloon;then the right internal iliac artery was embolized;finally,a covered stent was placed into the right external iliac a rtery.During 18-month follow-up,no hematuria recurred. Conclusions Traumatic pseudoaneurysmal -ureteral fistula is clinically rare.Th e main symptom is massive hematuria.DSA and ureteroscopy are important means for diagnosis of the disease.Endovascular therapy with covered stents is a safe,eff icacious method for the treatment of the disease.
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AIM and METHODS: Electron cytochemical methods were used to study the changes of calcium and reactive oxygen species in rat kidney during ischemia and reperfusion period.RESULTS:By the end of 1h ischemia, intra-cellular calcium increased. There were no H 2O 2 generation at this time. In the early reperfusion period, large amount of H 2O 2 generated. At this time, there were no evident changes of intra-cellular calcium compare with 1h ischemia group. In the later reperfusion period, less H 2O 2 generated. Intra-cellular calcium increased continuously.CONCLUSION:Calcium and reactive oxygen species all participated in ischemia-reperfusion injury, but the time they participated and their effects were different.