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Overactive bladder (OAB) is a common urological condition. First-line treatment for OAB includes behavioral therapy as well as pharmacological treatment with M-blockers and β3-adrenoceptor agonists. Patients with OAB who fail behavioral therapy and do not achieve the desired outcome after 6-12 weeks of treatment with M receptor antagonists alone or who cannot tolerate the adverse effects of oral medications are referred to as refractory OAB. patients with refractory OAB can be treated with surgical interventions such as Sacral Neuromodulation (SNM), intravesical Botulinum Toxin type A. BTX-A and Percutaneous Tibial Nerve Stimulation. Compared with other procedures, SNM is highly effective and has a low incidence of adverse effects. The author contemplates that future studies of SNM for refractory OAB could be conducted to address the overall changes in intestinal flora-urinary flora-metabolomics and urinary control-related brain structure-spinal cord functional structure-peripheral pelvic floor nerve structure.
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Objective:To discuss the clinical features of lymphoma of the male urogentioal system.Methods:The clinical data of 9 patients in Beijing Friendship Hospital from August 2014 to August 2019 reviewed, including 5 males and 4 females. The mean age of those patients was 62 years, range from 50 to 69.3 cases were diagnosed as renal tumor, 2 cases were diagnosed as bladder tumor and 4 cases were testicular tumor. 2 cases of the renal tumor presented with fever primarily(1 case with abdominal pain and weight loss) , 1 case was found renal pelvis tumor in medical checkup. 1 case of bladder lesions suffered from gross hematuria with abdominal pain and the other case with urinary frequency and urgency. All of the 4 testicular tumor cases were admitted to hospital with painless testicle mass. 5 cases were examined by CT showed low density mass with mild to moderate enhanced. Testicular tumors were detected by ultrasound showed irregular and heterogeneous mass with blood flow signals in them. 4 cases received operation and chemotherapy, 2 cases only received chemotherapy, 2 cases only received operation and 1 case didn’t receive further treatment. 1 case of 3 renal tumor cases received ultrasound-guided tumor biopsy and accepted rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisone(R-CHOP) chemotherapy. 1 renal pelvis tumor patient received laparoscopic nephroureterectomy and R-CHOP chemotherapy. 1 case received ultrasound-guided tumor biopsy and refused further treatment. Both of two bladder tumor patients accepted TURBT and refused radiotherapy and chemotherapy. For 4 testicular tumor cases, 3 patients received orchiectomy and 1 patient received ultrasound-guided tumor biopsy. 3 cases accepted R-CHOP chemotherapy, 1 case received chemotherapy and contralateral testis irradiation(specific proposals unknown). All of 4 cases received CNS prophylaxis by intrathecal injection(methotrexate 15mg, cytarabine 50 mg and dexamethasone 5 mg).Results:All 9 cases who received surgery or biopsy recovered favorably, no complications were found. The histological type of them were non-Hodgkin lymphomas. 8 of 9 cases were diffuse large B-cell lymphomas, 1 case was anaplastic large cell lymphoma. Belonged to Ann Arbor staging system, 4 cases staged Ⅰ-ⅡE and 5 cases staged ⅢE-ⅣE. 6 cases had international prognostic index(IPI) scores 0-2, 2 cases ≥3. The average follow-up time was 18 months (6-66 months). 7 cases still alive, 3 of them completed chemotherapy, 2 cases achieved complete remission(1 case was testicular lymphoma stage ⅡE IPI score 1 point and 1 case was testicular lymphoma stage ⅣE IPI score 2 points), 1 case achieved partial remission(renal pelvis lymphoma stage ⅣE IPI score 3 points). 3 cases which refused chemotherapy didn’t relapse or progress(2 cases were bladder lymphomas stage ⅠIE IPI score 1 point and 1 case was renal pelvis lymphoma stage ⅠIE IPI score 1 point). 1 case developed bacterial combine fungal pneumonia after 2 chemotherapy periods and stopped chemotherapy. 1 case of renal lymphoma( stage ⅢE IPI score 3 points) and 1 case of testicular lymphoma( stage ⅢE IPI score 2 point) died of the tumor progression of 6 months and 17 months after diagnoses.Conclusions:The main histological type of the male urogentioal system lymphoma is diffuse large B-cell lymphoma which clinical feature of it is nonspecific. Differential diagnosis should be done with other genitourinary system tumor according to clinical symptom and imaging findings. Histological diagnosis is the gold standard and R-CHOP chemotherapy is recommended as the primary treatment.
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Enterovesical fistula is gradually attracting the attention of doctors at home and abroad, its diagnosis and treatment technologies have also made great progress in recent years. The major etiologies of enterovesical fistula are intestinal diverticulitis, malignancy and Crohn′s disease. Common clinical symptoms of enterovesical fistula are pneumaturia, fecaluria and recurrent urinary tract infections. There are also some other accompanying symptoms such as gross hematuria, smelly urine, abdominal pain, etc. CT and cystoscope are the most two significant auxiliary examinations. The general treatment of enterovesical fistula is surgery. However, when it comes to enterovesical fistula caused by Crohn′s disease, drug therapy should be considered at first in most cases. By reviewing the recent published literature, this article will briefly review the progress of diagnosis and treatment of enterovesical fistula.
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Objective:Assessing the prognosis of patients with bladder urothelial carcinoma by using multiple molecular markers [epithelial-cadherin (E-cadherin), fibroblast growth factor receptor 3 (FGFR3), Jagged2, Survivin and stromal antigen 2 (STAG2)] in combination method, and compared it with the traditional method of evaluating prognosis by clinical pathological parameters.Methods:Retrospective analysis of 128 cases of bladder urothelial carcinoma patients admitted to Beijing Friendship Hospital, Capital Medical University from January 2010 to December 2016, including 102 males and 26 females; the median age was 70.5 years, ranged from 41 to 93 years. E-cadherin, FGFR3, Jagged2, Survivin and STAG2 alterations by immunohistochemistry during the first surgical treatment. The Kaplan-Meier survival curve was used to evaluate the relationship between the above markers and overall survival (OS), recurrence-free survival (RFS), progression-free survival (PFS), and clinicopathological indicators of tumors. Use Cox regression model to find the most suitable molecular markers for judging the prognosis of bladder urothelial carcinoma, and compare it with the traditional clinical staging + pathological grading method to evaluate OS to detect its sensitivity and specificity.Results:After 36.4 months of follow-up, it was found that the expressions of E-cadherin, FGFR3, Jagged2 and Survivin were all related to the OS, RFS and PFS of bladder urothelial carcinoma (all P<0.05). The expression of STAG2 was related to the TMN stage of bladder urothelial carcinoma ( P=0.047) and pathological grade ( P=0.015). Cox regression analysis showed that Survivin ( P=0.001) and Jagged2 ( P=0.037) were independent risk factors for evaluating the OS of bladder urothelial carcinoma, and Survivin ( P<0.001) and Jagged2 ( P=0.006) were independent risk factors for RFS, Survivin ( P=0.001) was also an independent risk factor for PFS. Multivariate analysis of the above molecular markers showed that the prognosis of patients with more than 3 molecular markers was better than that of independent application or the use of two of them to evaluate the prognosis ( P<0.001). The combined application of Survivin and Jagged2 to evaluate the 5-year survival rate was not less sensitive and specific than the clinical and pathological indicators (93.5% vs 77.2%, 84.7% vs 81.3%). Conclusions:Five molecular markers of E-cadherin, FGFR3, Jagged2, Survivin and STAG2 have an evaluation effect on the prognosis of bladder urothelial carcinoma, and some can independently predict the OS and RFS of patients with bladder urothelial carcinoma, however, the combined application is better than the single molecular marker to evaluate the prognosis. Compared with the traditional method of evaluating the prognosis by clinical pathological parameters, the combined application of Jagged2 and Survivin may be a better choice for evaluating the prognosis of patients with bladder urothelial carcinoma.
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Objective To discuss the major complications of urologic laparoscopic surgery.Methods From January 2004 to May 2012,2 250 urologic laparoscopic surgical procedures were performed in our institute,including radical nephrectomies (690 cases),partial nephrectomies (285 cases),simple nephrectomies (126 cases),nephrouretectomies (270 cases),renal cyst operations (281 cases),adrenalectomies (310 cases),pyeloplasties (93 cases),ureterolithotomies (48 cases),radical prostatectomies (43 cases),radical cystectomies (49 cases),donor nephrectomies (50 cases) and retroperitoneal lymph node dissection (5 cases).Medical records of each procedure were retrospectively evaluated.Intraoperative and postoperative complications were graded according to the Satava and Clavien classifications,respectively.Major complications were defined as Satava grade Ⅱ or higher,and Clavien grade Ⅲ or higher.Results Among the 2 250 laparoscopic procedures,53 major complications occurred,resulting in a major complication rate of 2.36％.Major intraoperative and postoperative complication rates were 1.16％ (26 cases) and 1.20％ (27 cases),respectively.Vascular injuries were the most common intraoperative complications (58％) while the proportion of visceral injury was the second as 42％.The most common postoperative complication was bleeding (19 cases).Among them,3 cases died of multiple organ failure after second operations.Other major postoperative complications included wound infection (2 cases),urine leakage (1 case),adrenal crisis (1 case),ileus (2 cases) and incisional hernia (Ⅰ case) and 1 death caused by pulmonary embolism.Conclusion Major complications,including death,may occur at any stages during the urologic laparoscopic surgery.
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Objective To summarize the author' s clinical experiences in the diagnosis and treatment of urachal carcinoma.Methods Thirteen cases with urachal carcinoma from 1990-2011 at Beijing Friendship Hospital affiliated to Capital Medical University were retrospectively reviewed and analyzed.Results The most common complaint was hematuria;B ultrasonic or CT scan demonstrated a parenchyma or vesica between the bladder dome and abdominal wall.Nine patients underwent extensive pattical excision of the bladder,3 paitents underwent radical resection,and 4 patients received comprihensive chemotherapy.The five-year survival rate was 30.7％.Conclusion Extensive partial excision of the bladder is recommended for urachal carcinoma.
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Objective To investigate the risk factors of sexual dysfunction in male patients with obstructive sleep apnea and hypoventilation syndrome (OSAHS).Methods One hundred and twenty-one OSAHS male patients aged 22-50 years were stratified into two groups based on scores on the rating scales of international index of erectile function-5 (IIEF-5).Patients' characteristics and polysomnography data of the sexual dysfunction group (n =56) were compared with that of the normal group (n =65).Continuous positive airway pressure(CPAP) treatment was carried out in some patients with abnormal sexual function.Results There were significant differences between the two groups in body mass index (BMI),history of hypertensive disease and diabetes mellitus,the rise of morning blood pressure,respiratory disturbance index (RDI),the longest apnea time(Tmax),the lowest oxygen saturation(LSpO2),percentage of recording time with oxygen saturation of 90％ or less(T90％),slow wave sleep(S1 + S2) over total sleep time(TST),rapid wave sleep (S3 + S4) time over TST,and rapid eye movement (REM) sleep time over TST in bivariate analysis (P ＜ 0.05).There were statistical significance of the history of diabetes mellitus,slow wave sleep (S1 + S2) over TST,RDI,and LSpO2shown in Logistics regression analysis,and ORs were 2.10 (1.17-5.01),3.52 (1.33-5.97),1.45 (1.08-2.95),and 0.86 (0.67-0.93) respectively (P ＜ 0.05).Moreover,20 OSAHS patients with sexual dysfunction were revaluated after the CPAP treatment in two months,and 14 patients returned to the normal scores.Conclusion The history of diabetes mellitus,slow wave sleep (S1 + S2) over TST,RDI,and LSpO2 were independent risk factors for sexual dysfunction in male patients with OSAHS,and treatment with CPAP could significantly improve sexual function in male patients.
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Objective To evaluate the different expression level of prostate cell carcinoma antigen (PSCA)mRNA in bladder transitional cell carcinoma(BTCC) and normal bladder tissue,additionally analyse the relationship between PSCA mRNA expression level in BTCC and different rs2294008 (C ＞ T) genotypes and various clinicopathological features,including stage and grade.Methods Real-time reverse transcriptase-polymerase chain reaction (RT-PCR) was performed on 80 BTCC samples and 38 samples of normal bladder mucosal to measure the expression of PSCA mRNA.Genomic DNA were extracted from tumour tissue to sequence to determine the rs2294008 (C ＞ T) genotypes.Results PSCA mRNA expression was detected in all samples (100％).Tumor samples had significantly higher PSCA expression (M =0.22) than normal samples (M =0.12) (P =0.038).PSCA mRNA expression level was positively correlated with advanced histological grade (G1-2 vs.G3,P =0.001).However no significant difference was detected between patients with superficial tumors (Ta or T1) and those with (≥ pT2)muscle-invasive tumors (P =0.250).There was significantly higher PSCA mRNA expression in T allele carriers than CC homozygous (P =0.001).Conclusions PSCA mRNA expression is related to the BTCC and tumor histological grade,however it is unrelated to tumor stages.PSCA mRNA expression level is higher in patients with T allele carriers than CC homozygous,suggesting T allele may increase PSCA mRNA' s expression.
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Objective To develop a nomogram which can accurately predict the disease recurrence risk after the transurethral resection of bladder tumor (TURBT) in patients with non-muscle invasive bladder urothelial carcinoma.Methods There were 317 patients in total with newly diagnosed non-muscle invasive bladder urothelial carcinoma from 1998 to 2007 enrolled in this study.The patient's gender,age,smoking history,drinking history,comorbidity of renal failure,time from diagnosis to operation,tumor size,tumor number,tumor grade,and intravesical therapy served as the predictors of the disease recurrence.Every prognosis factor were analyzed and screened through univariate and multivariate Cox proportional hazard regression statistical analysis,and the nomograms that could be used to predict the 3-year and 5-year recurrence probability after the surgery were developed.And the prediction accuracy of the nomogram had been internal validated and calibrated as well.Results Of the 317 patients,the three-year and five-year disease recurrence rates were 36.9％ (117/317) and 43.5％ (138/317),respectively.The patient's gender (RR=0.617,P=0.011),age (RR=1.369,P=0.088),tumor size (RR=1.474,P=0.030),tumor number (RR =1.663,P =0.002),tumor grade (RR =1.880,P =0.000),and comorbidity of renal failure (RR =3.646,P =0.000) had been proved to be the prognosis factors with significantly statistical difference.The predictive accuracy of the nomograms predicting the 3-year and 5-year disease recurrence after the surgery was 75.2％ and 68.3％,respectively.Conclusion The nomograms can provide individualized accurate risk estimations for patients,and therefore it can provide assured proof to formulate the individualizing treatment and follow-up protocol in clinic.
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Objective To report the author' s experience with the laparoscopic radical nephrectomy and eraluate it's saftey and therapy.Methods The retrospective analysis was performed on 600 consecutive patients undergoing laparoscopic radieal nephrectomy in the author' s institute from March 2004 to March 2012.There were 380 male and 220 female patients with the average age of 55 years (16-84 years).Five hundred and sixty cases and 40 cases underwent retroperitoneal and transperitoneal surgery respectively.The operative time,estimated blood loss,postoperative hospital stay,complications and the time of complete convalesceuce were recorded.Results Thirteen cases were converted to open surgery due to severe adhesion and severe bleeding.The mean operative time was 110 min(70-320 min).The medium estimated blood loss was 90 mL(30-830 mL) and 15 cases required blood transfusion.The mean drainage time was 50 h(36-72 h),the mean time to first oral intake was 23 h (19-43 h) and the mean postoperative hospital stay was 7 d(5.5-10 d).There were 4 patients with severe complication.Conclusion Laparscopic radical nephrectomy is safe and effective.It has been the standard therapeutic modality for localized renal cell carcinoma.
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Recently,some researches have been focused on prostate stem cell antigen and related cancers.Researches have reveled that prostate stem cell antigen is overexpressed in prostate cancer,bladder cancer and some malignant tumors in digestive system,and is highly associated with tumour genesis and progress.This review is to show the recent researches on association between prostate stem cell antigen and bladder cancer.
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There is remarkable heterogeneity in the history of the bladder cancer,which makes it essential to evaluate individualized prognosis risk of each patient.The Nomograms model is more convenient and accurate than other prognostic models,can provide significantly accurate individualized risk estimations that facilitate management decisions.The Nomograms model has been regarded as the most accurate and discriminating prognosis model to the patient of bladder cancer,and its development has a bright future.While the Nomograms Model has several weakness itself,which would be remedied through more researches and new predictors.Before Nomograms Model can be accepted in practice,we really need better evidence that they improve patient care and outcomes.
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Objective To explore the diagnosis and treatment features of tuberous sclerosis complex associated renal cell carcinoma.Methods A 22-year-old boy with a childhood history of epilepsy and mental retardation presented with a complaint of intermittent painless gross hematuria for the past 2 years.After superselective left renal artery embolization was done twice in the past year, painless gross hematuria was still repeated with 6- 10 months intervals.Physical examination showed retarded face, obesity, visible facial angiofibroma and a ditch fibroma.CT scan showed irregular lesions.The largest cross-section 14.2 cm × 9.0 cm in the left kidney was inhomogeneous enhanced from 45 - 54 HU in the plain phase to 60 - 78 HU in the contrast phase.Filling defect in the left renal vein and multiple fat-density lesions (CT value of -25 - -38 HU) with the largest cross-section 7.2 cm× 5.7 cm in the right kidney were also found in contrast CT scan.The PUBMED and CBM database were reviewed.Results Open retroperitoneal radical left nephrectomy was performed.Pathology showed renal clear cell carcinoma and renal vein thrombosis.There was no tumor recurrence or distant metastasis at 4-month follow-up.Conclusions Tuberous sclerosis complex associated renal cell carcinoma is rarely reported.Timely nephron-sparing surgery is necessary when the diagnosis is established, or radical nephrectomy is also necessary if nephron-sparing surgery is impossible.
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Objective To discuss the feasibility of laparoscopic renal surgery following kidney rupture.Methods Two patients with left kidney rupture were treated laparoscopiclly at our institution in the last 4 years. 1 operated 7 days after hemorrhage and another operated immediately. Both of them performed retroperitoneal laparoscopic nephrectomy. Results The operations succeeded, the operating time being 100～120 min, the blood loss 200～300 mL. There were no postoperative complications in all cases. Conclusion Laparuscopic exploration and extirpation offer a viable measure to treat kidney rupture.
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Objective To discuss the laparoscopic retroperitoneal dismembered pyeloplasty in the treatment of ureteropelvic junction (UPJ) obstruction. Methods From 2004 to 2007, a total of 41 consecutive patients (20 men and 21 women) with a mean age 30 years (range 12-45 years) un-derwent laparoscopic retroperitoneal dismembered pyeloplasty for UPJ obstruction. One patient had a congenital solitary kidney, 3 patients had renal calculi and 3 patients had horseshoe kidneys. Diuresis renogram and intravenous urography were performed at 3 and 6 months postoperatively, and annually thereafter. Success was defined by the absence of symptoms and improvement of intravenous urogra-phy and the diuretic renogram. Results The mean operative time was 160 min (range 95 to 300 min) with the average estimated blood loss was 35 ml (range 20 to 80 ml). There was no conversion to open surgery. Crossing vessels were found in 10 patients. Among these cases, the ureter was trans-posed anteriorly. Three patients with coexisting renal calculi were successfully had the stones re-moved. The mean hospital stay was 7.5 d (range 5 to 14 d). There were no intra-operative complica-tions. Postoperative complication was recorded in 1 patient with urine leakage. One patient developed an anastomotic stricture who took open surgery afterwards. The success rate was 97.6 % (40/41) at a mean follow-up of 28 months (range 13 to 52 months). Conclusion Laparoscopic retroperitoneal dismemebered pyeloplasty is effective and feasible.
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Objective To study the correlation between GSTM1 genetic polymorphism and bladder cancer susceptibility. Methods In a case control study, the GSTM1 genotype was assessed by a PCR based method. 69 patients with transitional cell carcinoma of the bladder and 88 controls matched for age and sex were studied. Results The frequency of GSTM1 null genotype among the bladder cancer patients was 58% compared with 41% among controls(OR=2.0, 95%CI=1.05～ 3.79 ,? 2=4.51, P
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Objective To study the clinicopathological features,diagnosis and treatment of carcinoid tumors of the urinary bladder. Methods The clinical,histopathologic data of 4 carcinoid tumors of the urinary bladder were retrospectively analysed.The bladder carcinoid was diagnosed in 3 male patients and 1 female patient with age from 54 to 79 years.All patients were presented with gross hematuria,but with no clinical manifestations of the carcinoid syndrome such as flush,tachycardia,diarrhea.Cystoscopies showed 5 mm?5 mm to 25 mm?30 mm sessile polypoid masses. Results One patient received radical cystectomy followed by radiotherapy,3 patients received partial cystectomy.Two patients died of the tumor metastasis at survival interval 5 years and 3 months,respectively;other 2 patients were still alive 19 years and 8 months following the surgical treatment.Two cases were stage Ⅱ,and other 2 cases were stage Ⅲ.Histologically,tumor cells exhibited strong argyrophilia and electron microscopy revealed characteristic dense-core granules. Immunohistochemical testing showed the cancer cell was positive for chromogranin A and keratin. Conclusions Carcinoid of the urinary bladder is uncommon,the diagnosis depends on histopathological and immunohistochemical tests.Based on the degree of infiltration,size,location,lymph node metastasis,different surgical intervention can be choosed.