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Objective:To summarize the efficacy and safety of transurethral partial cystectomy combined with intravesical suturation in the treatment of bladder cancer.Methods:The clinical data of 28 patients with bladder cancer who were admitted in Zhengzhou People's Hospital from July 2020 to October 2021 were analyzed retrospectively. There were 22 males and 6 females, with the average age of (68.8±8.9) years old. Twenty cases were with single bladder tumor, and 8 cases were with multiple bladder tumors. The diameter of single bladder tumor measured by CT was less than 4 cm, with a median tumor diameter of 2.3(0.9, 2.8)cm. All 28 patients underwent transurethral partial cystectomy combined with intravesical suturation for the first time. Intraoperative intravesical instillation was conducted with 1 g gemcitabine. Bladder hot reperfusion treatment was performed with gemcitabine 2 g at 45℃ immediately after operation. The patients underwent reexamination with cystoscopy every 3 months after operation.Results:All the 28 patients successfully completed the operation. The average operation time was (128.3±16.3)min. No obturator nerve reflection was induced during operation. Muscularis tissue was found in all tumor pathological specimens after operation, among which 4 cases showed muscularis infiltration. Pathology of tumor basal and peripheral tissues showed tumor cell infiltration in 3 cases (1 case full-thickness infiltration, namely the incision margin was positive). The median continuous irrigation time of bladder after operation was 24.0(20.9, 25.0)h. The median time of indwelling catheter after operation was 6.5(6.0, 7.0)days, and one case developed severe bladder spasm. All patients were followed up, with a median follow-up of 7.5(4.0, 10.8) months.Postoperative recurrence occurred in 3 cases, all of which were ectopic recurrence in bladder.The 1-year recurrence rate was 10.7% (3/28).Conclusions:In the first surgical treatment of bladder cancer, transurethral partial cystectomy combined with intravesical suturation can provide accurate pathological staging, and low positive surgical margin rate. Immediate suturation of bladder wound during operation and immediate bladder perfusion chemotherapy can provide short bladder irrigation time, with few adverse reactions and low incidence of complications.
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【Objective】 To investigate the current status of incision sites to obtain intact specimens in laparoscopic nephrectomy by urologists in China, so as to provide reference for the standardized procedure. 【Methods】 During Jun.20, 2021 and Jul.4, 2021, more than 20 000 urologists in a WeChat group were surveyed with a questionnaire. The general data, incision sites and related complications were statistically analyzed. 【Results】 A total of 601 valid questionnaires were collected, covering urologists from 31 provinces, autonomous regions and municipalities. Surgical approaches: 68 urologists chose trans-abdominal approach, 432 chose posterior abdominal space approach, 101 chose both surgical approaches. Incision sites: 97 urologists chose lumbar transverse incision, 202 chose dorsal oblique incision of the waist, 119 chose ventral oblique incision, 93 chose the paramedian incision, 112 chose the lower abdominal oblique incision (Gibson), 11 chose the transverse lower abdominal incision (Pfannenstiel), 7 chose the median incision of the lower abdomen, 2 chose the median incision in the upper abdomen, 15 chose axillary midline direct incision; 399 chose to cut off the muscles, and 202 chose not to. Complications: 232 urologists reported pain after 2 weeks, 369 reported no pain; 325 reported numbness after 2 weeks, 276 reported no numbness; 66 reported incisional hernia, 535 reported no hernia. 【Conclusions】 Chinese urologists tend to choose retroperitoneoscopic nephrectomy and waist incision to obtain intact specimens. Transperitoneal laparoscopic nephrectomy has a variety of incisions for intact specimens. There is no standardized incision sites to obtain intact specimens.
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Objective To assess the association of metabolic syndrome (MetS) and low-level high density lipoprotein-cholesterol (HDL-C) with the invasion of prostate cancer (PCa) in the patients after radical prostatectomy (RP). Methods We collected and analyzed the data of 232 PCa patients treated with RP for prospective multicenter clinical study.The MetS was assessed according to NCEP-ATP Ⅲ.Patients were divided into MetS group and non-MetS group.Locally advanced PCa was defined as a pT-stage≥3.ISUP Gleason grading system (GS) were used for pathological grading.Logistic regression analyses assessed the association of MetS and its components with pathological data. Results MetS was an independent risk factor for GS≥8 after RP.Low HDL-C level was associated with locally advanced PCa.The risks of adverse pathological features increased with the number of MetS components. Conclusion Low HDL-C level and 4 or more MetS components are associated with higher risk of adverse pathological features of PCa.
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Objective To screen and verify hub genes TPM1 and CALD1 that can affect the diagnosis and prognosis of bladder cancer (BLCA). Methods We obtained gene chip expression data of 414 and 188 cases of bladder cancer from TCGA and GEO, respectively. By constructing a weighted gene co-expression network analysis (WGCNA) and identifying differentially-expressed genes between tumor tissues and normal tissues, the pivotal genes that were highly associated with bladder cancer were obtained, and the STRING database was used to construct a protein interaction network to screen out prognostic-related pivotal genes. We took 29 cases of bladder cancer samples from People's Hospital of Zhengzhou as external verification results. Results A total of 915 and 464 differentially-expressed genes were screened from the TCGA database and GSE13507, respectively. Two modules with the strongest correlation were obtained through WGCNA: the blue module (Pearson cor=0.60, P=1E-44) and the cyan module (Pearson cor=0.52, P=7E-19), and 156 intersection genes were obtained. Through protein interaction network analysis, 10 pivotal genes were screened out. TPM1 and CALD1 genes had the greatest correlation with the survival of bladder cancer patients, which was verified by external experimental verification group. Conclusion TPM1 and CALD1 are closely related to the prognosis of bladder cancer patients. They are also pivotal genes to promote tumor progression.
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Objective To investigate the effect of N-myc downstream regulated gene 2 (NDRG2) on the apoptosis of bladder cancer cells by regulating the signal transducer and activator of transcription 3(STAT3) signaling pathway.Methods The expression level of NDRG2 in human bladder cancer cell BIU-87 and immortalized cell SV-HUC-1 was detected by Western blot.NDRG2 over expression vector and empty vector control (pcDNA3.1),siRNA-NDRG2,siRNA control were transfected into BIU-87 cells.After transfected 48 h,the expression level of NDRG2,Cleaved caspase 3,STAT3,p-STAT3,JAK2,p-JAK2 were detected by Western blot,the cell proliferation and apoptosis were measured by MTT and flow cytometry.After adding inhibitor AG490 of 45 μmol/L in cultured BIU-87 cells,MTT assay was used to detect cell proliferation and flow cytometry was used to detect the cell apoptosis,Western blot to detect the expression level of Cleaved caspase 3,STAT3,p-STAT3,JAK2,p-JAK2.Results The expression level of NDRG2 in bladder cancer cells was higher than that in bladder epithelial cells.The cell survival rate of pcDNA3.1/NDRG2 group was lower than that of pcDNA3.1 group,the difference was statistically significant (P ＜ 0.01).The cell survival rate of siRNA-NDRG2 group was higher than that of siRNA control group (P＜ 0.01).The apoptosis rate of pcDNA3.1/NDRG2 group was higher than that of pcDNA3.1 group (P ＜ 0.01).The apoptosis rate of NDRG2 siRNA group was lower than that of siRNA control group (P ＜ 0.01).The level of p-STAT3 and p-JAK2 in pcDNA3.1/NDRG2 group was lower than that in pcDNA3.1 group (P＜ 0.01).The survival rate and apoptosis rate of BIU-87 cells cultured with AG490 were in agreement with the trend of pcDNA3.1/NDRG2 after transfection.Conclusions NDRG2 could promote the apoptosis of bladder cancer cells,and its mechanism may be related to STAT3 signaling pathway.
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Objective To discuss the safety and efficacy of inserting ureterovesical reimplantation by means of laparoscopy associated with six-stitch suture.Methods There was an retrospective analysis on operation videos and clinical data for 16 participants of inserting ureterovesical reimplantation by means of laparoscopy associated with six-stitch suture with the period from March in 2012 to September in 2015. And these were statistically analyzed including the operation time, intraoperative bleeding volume, postoperative drainage volume, removal time of drainage tube, admission time after operation and the incidence of postoperative complications of vesicoureteric reflux and stenosis.Results The operations of 16 participants were completed successfully without converting to open surgery. The operation time was 60 ~ 125 min (Mean time: 85 min); intraoperative bleeding volume was 20 ~ 50 ml (Mean volume: 32 ml); postoperative drainage volume was 60 ~ 400 ml (Mean volume: 106 ml); removal time of drainage tube was 3 ~ 6 d (Mean time: 4.2 d) and admission time after operation was 7 ~ 10 d (Mean time: 8.5 d). There was the follow-up with 6 ~ 18 months (Mean time: 12 months) for participants. No anastomotic stenosis was present. In addition, one participant was suffered from mild vesicoureteric relfux. And there was no aggravation during 18 months.Conclusions The inserting ureterovesical reimplantation by means of laparoscopy associated with six-stitch suture was safe and effective. It was found that the operation time was significantly shortened and the incidence of postoperative complications of vesicoureteric relfux and anastomotic stenosis was not increased. By contrast, the six-stitch suture could reduce the incidence of anastomotic stenosis.
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Objective To provide imaging anatomy basis for percutaneous nephrolithotomy ( PCNL) by measuring relative displacement and changes in anatomical position of kidney and colon under the prone and low-oblique supine positions.Methods Forty-six patients scheduled for PCNL underwent 64-slice spiral CT scan under the prone and low-arch oblique supine position before the PCNL.The horizontal distance of kidney and colon,the distance from colon and analog puncturing line,the distance between the kidney and colon were measured and compared between the 2 positions.Results The distance from colon and analog puncturing line under the low-oblique supine and prone positions were as follows,the left (26.56 ±15.36) mm versus (12.25 ±13.16) mm (t=3.527,P0.05).Conclusions The distance between colon and analog puncturing line increases in the low-arch oblique supine position,because the colon shifts to the ventral.The PCNL in low-arch oblique supine position may reduce the incidence of colon injury,and improve surgical safety.
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Objective To discuss the safety and effectiveness of the drainage of perinephric abscess with retroperitoneal laparoscopy.Methods The clinical data of 12 cases undergoing the drainage of perinephric abscess with retroperitoneal laparoscopy were analyzed retrospectively.There were 3 males and 9 females,with a mean age of 47 years.All the 12 cases presented with lumbar pain and fever,7 cases had chill,5 cases had irritative symptom of bladder,and 4 cases had nausea and vomiting.The average course was 9 d,and the average diameter was 6.4 cm.Four cases were in the left side,and 8 in the right side.The main complications included type-2 diabetes (5 cases),type-1 diabetes (1 case),kidney stones (2 cases) and systemic lupus erythematosus (1 case).All the 12 cases were treated with antibiotics.The indexes were recorded,including operative time,intraoperative blood loss,purulent fluid volume,postoperative indwelling time of the drainage tube,postoperative time of body temperature returned to normal,postoperative hospital stay,and complication rate.Results All the 12 operations were successful without peritoneal damage,kidney damage or other complications.The mean operative time was 56 (48-95) min,the mean intraoperative blood loss was 127 (60-150) ml,the mean intraoperative purulent fluid volume drawed out was 128 (120-230) ml,the mean postoperative indwelling time of the drainage tube was 9 (6-12) d,the mean postoperative time of body temperature returned to normal was 3 (2-4) d,and the mean postoperative hospital stay was 10 (7-12) d.All the patients were followed up for an average of 6.5 (6-12) months,no recurrence occured.Conclusions The drainage of perinephric abscess with retroperitoneal laparoscopy has the advantages of definite effectiveness,complete drainage,little injury and rapid recovery.The drainage of perinephric abscess with retroperitoneal laparoscopy by skilled urologists is safe.
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Objective To investigate the appropriate incision for intact specimen extraction during retroperitoneoscopic radical nephrectomy. Methods One hundred and nineteen patients in need of retroperitoneoscopic radical nephrectomy were randomized into two groups. One group of 60 patients received intact specimen extraction through a muscle-splitting abdominal incision. The second group of 59 patients received intact specimen extraction through a muscle-cutting lumbar incision. All procedures were performed by the same team of surgeons, and the intact specimens were extracted by the same surgeon. Standard operative features were measured and recorded (operative time, the time of specimen extraction, incision length, specimen weight, the time to get out of bed, the recovery time of gastrointestinal function, postoperative hospital stay, analgesia requirement, and complication rate). Results The two groups were matched in regard to patient age, body mass index, the maximum diameter of the kidney, and the stage of TNM (each P>0.05). There were significant differences between the abdominal incision group and lumbar incision group in terms of operative time (99±14 min vs 115±12 min; P=0.000), incision length (4.9±0.3 cm vs 5.3±0.4 cm; P=0.000), the time of specimen extraction (14±2 min vs 24±6 min; P=0.000), analgesia requirement (35±27 mg vs 52±29 mg; P=0.002), the time to get out of bed (20±2 h vs 21±4 h; P=0.016). The differences were not significant between the 2 groups in terms of the recovery time of gastrointestinal function (21±3 h vs 20±4 h; P=0.457), hospital stay (6±1 d vs 6±1 d; P=0.476), and specimen weight (469±181 g vs 459±169 g; P=0.776). There was no complication of incision in the 2 groups at 12 months′ follow-up (rang, 6 to 18 months). Conclusion A muscle-splitting abdominal incision for intact specimen extraction is more appropriate than a lumbar incision during retroperitoneoscopic radical nephrectomy, with small incision, little injury, short operative time, quick recovery, and less pain.
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ObjectiveTo study the anatomical characteristics of the renal pedicle and its clinical application during retroperitoneoscopic nephrectomy.MethodsThe imaging, surgical video and clinical data of 278 cases undergoing retroperitoneoscopic nephrectomy between July 2007 and September 2009 were retrospectively analyzed. The renal pedicle was found located at the psoas and the medial arcuate ligament of the diaphragm for anatomic landmark before the gap of the psoas. A statistical analysis of the mean operative time, the mean time to look for the renal pedicle, the mean intraoperative estimated blood loss, the mean time to ambulation, the mean time to resuming oral intake, the mean postoperative hospital stay day and the rate of complications was performed.ResultsAll the operations were performed successfully, with no conversion to open and blood transfusion. The mean time to find the renal pedicle was (3.5 ± 1.3 ) min, the mean operative time was (95.6 ±23.8) min, the mean estimated blood loss was (72.4 ±27.5) ml, the mean time to resuming oral intake was (2.1 ±0.7) d, the mean time to ambulation was (1.8 ±0.9) d, the mean postoperative hospital stay was (8.5 ± 2.7 ) d.ConclusionsDuring retroperitoneoscopic nephrectomy, the best anatomical space to look for the renal pedicle is the space before the psoas muscle. The exact location of the renal pedicle is under the diaphragm medial arcuate ligament about 2 - 4 cm, in the gap of the psoas muscle and the vena cava (abdominal aorta). Following this procedure could reduce the time to look for the renal pedicle, thus reducing operative time.
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Objective To explore the influence on the expression of elF4E and heparanase by antisense oligodeoxyribonucleotides (ASODN) transfection in human bladder carcinoma BIU-87 cells.Methods After transfecting the 2.5,5.O,7.5 μg/ml eIF4E ASODN into BIU-87 cells,at 24 h,48 h and 72 h,a cell control group (no transfection),a blank control group (empty liposomes) and a non-sense control group (transfected with non-sense ASODN) were established.The expression of eIF4E,HPA and mRNA were detected by in situ hybridration.The expression of eIF4 and HPA protein were detected by immunocytochemistry.SPSS 13.0 statistical software was used for statistical analysis.Results The expression quantity of eIF4E protein and mRNA were lower in the experimental groups ( protein:2.5 μg/ml ASODN treated 24 h,48 h,72 h were:3.55 ±0.52,3.52 ±0.51,3.22.±0.44 respectively; 5.0 μg/ml group:3.43 ±0.47,3.41 ± 0.46,3.19 ± 0.41 respectively ; 7.5 μg/ml group:2.36 ± 039,2.33 ± 0.37,2.05 ± 0.30 respectively.mRNA:2.5 μg/ml treated 24 h,48 h,72 h were:3.19 ±0.41,3.13 ±0.39,2.90 ±0.38 respectively ; 5.0 μg/ml group:3.07 ± 0.39,2.94 ± 038,2.27 ± 0.37 respectively ; 7.5 μg/ml group:2.22 ± 037,2.06 ± 0.30,1.95 ± 0.29 respectively.All data were less than those in the control groups (P ＜0.05).The expression quantity of HPA protein and mRNA were lower in experimental groups (protein:2.5 μg/ml ASODN treated 24 h,48 h,72 h were:4.44 ±0.55,4.40 ±0.54,3.99 ±0.52 respectively; 5.0 μg/ml group:4.41 ±0.55,4.21 ±0.53,3.77 ±0.50 respectively; 7.5 μg/ml group:4.02 ±0.52,3.98 ±0.52,2.32 ±0.37 respectively.mRNA:2.5 μg/ml treated 24 h,48 h,72 h were:4.12 ±0.51,3.75 ± 0.50,3.63 ± 0.45 respectively ; 5.0 μg/ml group:4.00 ± 0.51,3.71 ± 0.50,3.54 ± 0.44respectively ; 7.5 μg/ml group:3.87 ± 0.52,3.61 ± 0.49,2.08 ± 0.30 respectively).All data were less than in control groups ( P ＜ 0.05 ).There was a positive correlation on expression of HPA protein and eIF4E protein by inhibitory effect of eIF-4E ASODN (protein r=9.23,mRNA r=9.59,P ＜0.01).Conclusion eIF-4E ASODN might be used to inhibit the expression of eIF-4E gene and HPA gene in bladder cancer BIU-87 cells.