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Gleason grading system is a critical factor for assessing the risk, making treatment decision and evaluating prognosis for patients with prostate cancer. However, it has been reported that concordance rates of Gleason score between biopsy pathology and radical prostatectomy specimen were only39%-63%, whilst postsurgical upgrade and downgrade rates were 30%-55% and 7%-20% respectively. This situation brings difficulties in performing clinical practice. This literature aimed to review relevant and updated studies in literature to summarize the concordance rate and independent predictive factors of Gleason score change from following several aspects: patient clinical characteristics, biopsy-related factors, accuracy of pathologic assignment and interpretation of pathology reports. This review also investigated how the factors influenced the Gleason score change and clinical decision-making. There were many factors influencing the Gleason score change which were roughly consistent with risk factors of prostate cancer, however, some factors were controversial. In order to provide precise evaluation of risk stratification and optimal individualized treatment, it is essential to consider the risk factors which are correlated with Gleason score change.
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Objective:To investigate the effectiveness of enhanced recovery after surgery (ERAS) concept in perioperative period of retroperitoneal laparoscopic radical nephrectomy.Methods:The clinical data of 189 patients who underwent retroperitoneal laparoscopic radical nephrectomy from October 2015 to July 2021 were retrospectively analyzed. According to different perioperative management methods, they were divided into two groups: ERAS group ( n=97) and traditional group ( n=92). Patients of ERAS group were managed by the ERAS concept during the perioperative period, patients of traditional group were managed by the traditional method during the perioperative period. First drinking time after surgery, first exhaust time, 24 h postoperative pain score, first activity time out of bed, indwelling time of urinary catheter, indwelling time of drainage tube, postoperative hospital stay, incision length and complications of pneumonia and venous thrombosis were recorded and compared between the two groups. Measurement data were expressed as mean ± standard deviation ( Mean± SD), and independent sample t-test was used for comparison between groups; count data comparison between groups was by Chi-square test or Fisher exact probability method. Results:There were no significant differences in age, gender, body mass index, tumor side, tumor diameter, maximum diameter of samples, T stage, diabetes and hypertension from between two groups ( P >0.05). In ERAS group, the time of first drinking water after surgery was (3.8±1.4) h, the time of first anal exhaust was (10.2±2.5) h, the 24 h pain score was (2.4±1.0), the time of first activity out of bed after surgery was (18.8±3.6) h, the indwelling time of urinary catheter was (19.8±3.7) h, the indwelling time of drainage tube was (3.4±0.5) d, the surgical incision length was (7.2±0.9) cm, and the postoperative hospital stay was (5.5±0.6) d. In the traditional group, the time of first drinking water after surgery was (21.2±4.2) h, the time of first anal exhaust was (20.1±4.3) h, the 24 h pain score was (5.4±1.0), the time of first activity out of bed after surgery was (32.8±7.8) h, the indwelling time of urinary catheter was (55.7±8.0) h, the indwelling time of drainage tube was (4.2±0.5) d, the surgical incision length was (13.6±1.5) cm, and the postoperative hospital stay was (7.2±1.3) d. There were statistically significant differences in these indexes between the two groups ( P<0.05). Conclusion:The clinical application of the concept of ERAS during the perioperative period can promote the rapid postoperative recovery of patients undergoing retroperitoneal laparoscopic radical nephrectomy, and can effectively reflect the minimally invase advantages of retroperitoneal laparoscopic technology.
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Cystitis glandularis is a hyperplastic disease originated from the bladder mucosa, cystitis glandularis is a rare clinical disease, there is no standard diagnosis and treatment. The etiology and pathogenesis of cystitis glandularis are still unknown, it can be diagnosed according to clinical manifestations, laboratory and auxiliary examinations, and the diagnosis of cystitis glandularis mainly depends on pathological results. Cystitis glandularis has a cancerous tendency. The clinical treatment methods of cystitis glandularis include conservative treatment, surgical treatment and surgical combined with drug therapy, but different types of treatment methods are different, and most patients are treated by surgery combined with drug perfusion of the bladder.This article will review the research progress in diagnosis and treatment of cystitis glandularis.
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Adrenal gland is one of the most common metastases from malignant tumors. Most adrenal metastases have not completely destroyed adrenal tissue, so most patients have no clinical symptoms. The main methods for the diagnosis of adrenal metastases are CT, magnetic resonance imaging and positron emission tomography. At present, there is still controversy about the treatment of adrenal metastasis of all kinds of adrenal metastases. Non-surgical treatment mainly includes chemical drug therapy, radiotherapy, interventional therapy and so on. With the development of cognition and technology, the mode and indication of surgical treatment have also changed. In this paper, the diagnosis and treatment of adrenal metastases in recent years are reviewed.
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Objective:To analyze the risk factors of stress urinary incontinence after transurethral enucleation of prostate.Methods:A retrospective analysis of the clinical data of 326 patients who underwent transurethral enucleation of prostate at the Beijing Friendship Hospital, Capital Medical University due to benign prostatic hyperplasia from March 2016 to December 2019. Patients were divided into stress urinary incontinence group ( n=78) and non-stress urinary incontinence group ( n=248) according to whether there was stress urinary incontinence one week after the catheter was removed. Age, body mass index, hypertension, diabetes, hyperlipidemia, prostate volume, the time of lower urinary tract symptoms (LUTS), total prostate specific antigen, preoperative indwelling catheter status, operation type, operation time, percentage of hemoglobin reduction and catherization time were compared between the two groups. Measurement data were expressed as mean±standard deviation ( Mean± SD), and t-test was used for comparison between groups; Chi-square test or Fisher exact probability method was used for comparison of count data between groups. Single factor and multivariate Logistic regression analysis were used to screen independent predictors. Results:Age [(73.9±7.3) years vs (69.5±7.8) years, P<0.001], body mass index [(25.6±3.0) kg/m 2vs (24.6±2.9) kg/m 2, P=0.004], the time of LUTS [(5.42±5.65) years vs (5.05±5.19) years, P=0.008], and hypertension (57.7% vs 43.6%, P=0.037), prostate volume [(77.1±33.2) mL vs (62.5±30.2) mL, P<0.001], operation time [(115.0±45.7) min vs (99.8±41.4) min, P=0.006] in stress urinary incontinence group were significantly higher than those in the non-stress urinary incontinence group, the differences were statistically significant. Age ( OR=1.05, 95% CI: 1.02-1.07, P<0.001), body mass index ( OR=1.08, 95% CI: 1.03-1.14, P=0.003), LUTS ( OR=1.21, 95% CI: 1.14-1.29, P=0.015)and prostate volume ( OR=1.11, 95% CI: 1.10-1.11, P=0.011) were independent risk factors for stress urinary incontinence after transurethral enucleation of prostate by multivariate Logistic regression analysis. Conclusion:Age≥70years, body mass index≥25 kg/m 2, LUTS during≥5 years and prostate volume≥75 mL are independent risk factors for stress urinary incontinence after transurethral enucleation of prostate.
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Objective@#To investigate the clinical features of chromophobe renal cell carcinoma (chRCC) and analyze the factors affecting its prognosis.@*Methods@#Retrospectively analyze the case data of 66 patients with chRCC admitted to Beijing Friendship Hospital, Capital Medical University from October 2003 to September 2018, including 32 males and 34 females; the average age was (53.9±13.9) years and the age range was 24-85 years. To analyze the clinical symptoms, whether have hypertension, diabetes, tumor characteristics (size, side, location), surgical methods, TNM staging and other clinical features of patients, with disease-free survival (DFS) as the study endpoint. The survival curve was drawed by the kaplan-Meier method. Survival analysis was performed using Log-rank test, and the clinical features of prognosis were analyzed by Cox regression models.@*Results@#Among the 66 patients, the mean diameter of the tumor was (5.4±3.5) cm, 17 cases were ≥7 cm, 49 cases were <7 cm; 48 cases were asymptomatic, and 18 cases were symptomatic; 45 cases in T1, 15 cases in T2, 6 cases in T3; 33 cases were underwent radical nephrectomy, 32 cases were underwent nephron sparing surgery, 1 case was under the therapy of watchful waiting. The median follow-up time was 61 months, and the DFS in 1, 5, and 10 years were 94.6%, 91.3%, and 82.2%, respectively. Log-rank results showed that the maximum diameter of the tumor was related to the T stage and the survival time of the patients (P<0.05). Cox multivariate analysis showed that T stage was an independent risk factor for DFS (HR=8.102, P=0.027).@*Conclusions@#ChRCC is a type of kidney cancer with a good prognosis. Tumor staging is more common in T1 and T2 phases, patients with higher DFS in 5 and 10 years, and T staging is an independent risk factor for DFS in patients.
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Objective To investigate the clinical features of chromophobe renal cell carcinoma (chRCC) and analyze the factors affecting its prognosis.Methods Retrospectively analyze the case data of 66 patients with chRCC admitted to Beijing Friendship Hospital,Capital Medical University from October 2003 to September 2018,including 32 males and 34 females;the average age was (53.9 ± 13.9) years and the age range was 24-85 years.To analyze the clinical symptoms,whether have hypertension,diabetes,tumor characteristics (size,side,location),surgical methods,TNM staging and other clinical features of patients,with disease-free survival (DFS)as the study endpoint.The survival curve was drawed by the kaplan-Meier method.Survival analysis was performed using Log-rank test,and the clinical features of prognosis were analyzed by Cox regression models.Results Among the 66 patients,the mean diameter of the tumor was (5.4 ±3.5) cm,17 cases were ≥7 cm,49 cases were ＜7 cm;48 cases were asymptomatic,and 18 cases were symptomatic;45 cases in T1,15 cases in T2,6 cases in T3;33 cases were underwent radical nephrectomy,32 cases were underwent nephron sparing surgery,1 case was under the therapy of watchful waiting.The median follow-up time was 61 months,and the DFS in 1,5,and 10 years were 94.6％,91.3％,and 82.2％,respectively.Log-rank results showed that the maximum diameter of the tumor was related to the T stage and the survival time of the patients (P ＜ 0.05).Cox multivariate analysis showed that T stage was an independent risk factor for DFS (HR =8.102,P =0.027).Conclusions ChRCC is a type of kidney cancer with a good prognosis.Tumor staging is more common in T1 and T2 phases,patients with higher DFS in 5and 10 years,and T staging is an independent risk factor for DFS in patients.
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Adrenocortical carcinoma is a malignant endocrine tumor.There is no unified standard for diagnosis and treatment because of the low incidence.There are two peaks in the age of onset,which are 0 to 10 years and 40 to 50 years,and the incidence of children and women is higher.The percentage of 60 to 70 ACC patients show clinical symptoms due to the excess hormone,but there are still many patients with poor clinical symptoms.The common endocrine symptoms include polycythemia,masculinity or male breast development.The prognosis of ACC is poor,and the classification and staging of the tumor and hypercortisol are associated with the prognosis.Surgical resection is the first choice,but the recurrence rate of the tumor is high and the overall survival rate is low after operation.In this paper,the clinical characteristics,diagnosis,differential diagnosis,prognosis and treatment of ACC are summarized by reviewing the past researches.
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Metabolic disease is a cluster of metabolic abnormalities,including hypertension,diabetes,obesity,dyslipidemia,hyperuricemia,etc.The incidence rate of metabolic disease has increased in recent years.Metabolic diseases are closely related to the occurrence,development and prognosis of renal carcinoma.This article aims to summarize research progress on the correlation between metabolic diseases and renal carcinoma so that we could provide valuable information for the prevention,treatment and prognosis of renal carcinoma.
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Small cell carcinoma of the kidney is an uncommon tumor with high degree of malignity,rapid progress,and most of the metastatic lesions at diagnosis.There is no specific difference between small cell carcinoma of the kidney and other renal parenchymal tumors in the clinical features and imaging findings.Diagnosis is mainly based on pathology.There is no unified guidance in the treatment,and the main ways include surgery alone,chemotherapy alone,and adjuvant chemotherapy after surgery.Targeted drugs are expected to become a new therapeutic modality for renal small cell carcinoma.In this paper,the clinical features,diagnosis and differential diagnosis,treatment and prognosis of renal smcc will be summarized through the analysis of domestic and external research progress.
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Objective To investigate the prognostic factors of renal cell carcinoma and to establish a prognostic model for patients with non-metastasis renal cell carcinoma (RCC) after operation.Methods We retrospectively reviewed the clinical data of patients with RCC who underwent radical or partial nephrectomy from January 2008 to December 2012,including 392 males (67.6％) and 188 females (32.4％),with an average age of 56 years(range 24-86 years).The average diameter of tumor was 4.8 cm (range 1.5-17.5 cm).The pathological slides of tumor tissue were reviewed by pathologist,and the tissue microarray (TMA) were constructed.The immunohistochemical staining of TMA were carried out.All patients were followed up the prognosis information of the overall survival (OS),cancer specific survival (CSS) and progression free survival (PFS).Based on these data,univariate and multivariate analysis and survival analysis were performed.Independent prognostic factors related to different follow-up endpoints of patients were screened out.A Nomogram prognostic model for RCC was established and verified.Internal validation were performed by boots value analysis.Results Among 580 cases,160 cases (27.6％) accepted nephron sparing surgery and 420 cases (72.4％) radical nephrectomy,included 514 cases (88.6％) of laparoscopic surgery and 66 cases (11.4％) of open surgery.There were 468 cases of clear cell carcinoma (80.7％),56 cases of papillary carcinoma (9.7％),32 cases of chromophobe cell carcinoma (5.5％),24 patients with other subtypes of cancer cells (4.1％).In pathological staging,stage Ⅰ,Ⅱ,Ⅲ,Ⅳ were 442 cases (76.2％),88 cases (15.2％),48 cases (8.3％),2 cases (0.3％),respectively.There were 424 cases (73.1％) with high expression of CA9,and 156 cases (26.9％) with low expression.The median followup was 66 (4-82) months,and 41 cases (7.1％) were lost of follow-up.For 3 and 5 years,OS,CSS and PFS were 83.4％,88.2％,72.4％ and 69.6％,73.0％,55.8％ respectively.Multivariate analysis showed that tumor pathological subtypes,tumor stage,tumor diameter and positive expression of carbonic anhydrase 9 (CA9) were independent prognostic factors associated with the survival of RCC patients.The Nomogram prognostic model was established by the above four factors.The established Nomogram prognostic model for RCC patients was verified by Harrell's consistency index,and the c-index of OS,CSS and PFS of RCC patients were 0.72 (95％ CI 0.69-0.75),0.77 (95％ CI 0.74-0.81),0.79 (95％ CI 0.76-0.83),respectively.Conclusions Tumor pathological subtypes,staging,tumor diameter and CA9 are independent risk factors for patients with non metastatic renal cell carcinoma.The established Nomogram prognostic model certified by internal validation should be tested by large samples and multicenter studies need tested.
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Objective To investigate the efficacy of microsurgical subinguinal varicocelectomy for unilateral varicocele.Methods One hundred and five cases with left side varicocele were enrolled from August 2012 to October 2016.Thirty one cases suffered from varicocele in Ⅱ degree,and other seventy four cases in Ⅲ degree.Clinical data including operation time,sperm quality,testosterone level,complications and natural pregnoncy rate were retrospectively analyzed.The measurement data were expressed by (x) ± s.Sperm concentration,sperm motility,the rate of sperm normal morphology and serum testosterone levels were compared before and after operation with paired t test.Results The average operative time of varieocele was (58 ± 9) minutes in the outer ring of the microscope.Compared with preoperation's,sperm concentration,sperm motility,the rate of sperm normal morphology was remarkable improved after 3 month.However,serum testosterone levels were steady.In the outpatient follow-up,there were no complications,such as orchiatrophy,hydrocele of tunica vaginalis or recurrence of varicocele.The rate of natural pregnoncy in one year was 46.7％.Conclusions Microsurgical subinguinal varicocelectomy can remarkably improve sperm quality for patients,who suffer from varicocele in Ⅱ or Ⅲ degree.The complication of microsurgical subinguinal varicocelectomy is rare.Male infertility patients resulted from varicocele will get favorable natural pregnoncy rate.
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Objective To investigate the efficacy of percutaneous renal access with balloon dilation for staghorn calculi.Methods Eighty-nine cases with PCNL were enrolled from February 2012 to March 2015.Clinical data including the time for setting the renal access, operation time, residual stone rate, complications were analyzed.Results Eighty-nine cases established nephrostomy tracts successfully.The average time for setting the renal access was (5.7 ± 1.0) min (4-8 min).The average of operation time was (62.6 ± 14.1) min (37-87min).The average of Hemoglobin decline rate was (6.3 ± 2.5)％ (2.8％-16.9％).The residual stone rate was 12.5％.Conclusions PCNL with ballon dilation is a fast, safe and effective means for staghorn calculi.It is worth using for staghorn calculi.
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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 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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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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Radiotherapy and chemotherapy have little or no effect on advanced renal cell carcinoma, leading to a poor prognosis. Several factors couLd affect the survival rate of RCC. Some RCC patients could partly respond to immunotherapy.The newly emerging targeted therapy has a dramatic tuning point in improving outcomes for RCC. Further understanding of the anti-RCC mechanisms involves in chemokine-mediated angiogenesis and RCC cell proliferation. These new agents include Sorafenib, Sunitinib, Temsirolimus, Bevacizumab, etc. Combination treatment with immunotherapy may lead to improved outcomes in this disease.
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Objective To study the clinical features,diagnosis and treatment of bladder leiomyoma.Methods The clinical data of eight patients(3 men and 5 women)with bladder leiomyoma were analyzed retrospectively.Results The median age was 42 years ( range,27 -71 years).Three patients were treated with transurethral resection of bladder tumor( TURBT),two patients underwent partial cystectomy,two patients underwent enucleation of leiomyoma,and one patient underwent laparoscopic enucleation of leiomyoma of the bladder.The patients were well with no evidence of recurrent tumor after follow-up from 10 to 75 months.Conclusion Bladder leiomyoma is rare,surgery is the treatment of choice and technique depends on tumor size and localization.The laparoscopic approach seems to be an effective alternative in this group of tumors.
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Objective To study the clinical and pathologic features of chromophobe cell renal carcinoma and to improve the diagnosis and treatment of the disease. Methods The clinical and pathologic data of 19 patients (10 men and 9 women;mean age,53 years) with chromophobe cell renal carcinoma (9 on the left and 10 on the right) were analyzed.Of the 19 cases,12 were incidentally diagnosed of renal tumor during physical examination.Gross hematuria,low back pain and discomfort and abdominal mass occurred in 7 cases. Results B-ultrasound was mainly characterized by low echo of mass with intact capsule.CT scan revealed that most of the tumors were homogeneous hypodense solid masses,which were well circumscribed.The tumors averaged 8.2 cm in diameter.By TNM staging,8 cases had T_1N_0M_0 stage tumors and 11 cases had T_2N_0M_0 stage tumors.Radical nephrectomy was performed in 17 cases,and partial nephrectomy,in 2 cases.Follow-up was available for 16 patients (mean,4.8 years;range,3 months to 16 years)who were alive without recurrence and metastasis.Pathological features were as follows.①The cross-sections of the tumors were grossly homogeneous, dark brown and solid. One case had fibrous bands coalescence in the center of the tumor.②Microscopically the tumors were composed of 2 types of cells, typical and eosinophilic types,with very distinct borders.③Immunohistochemical assay was positive for CK8 and negative for Vimentin, and Hale colloidal iron staining was positive for the carcinoma cells.④Electron microscopy showed large numbers of vesicles within the cytoplasm. Conclusions Chromophobe cell renal carcinoma is a morphologically distinctive neoplasm with no specific findings on B-ultrasound and CT examinations.The tumors are larger in most cases but usually at early TNM stages with a favorable prognosis.
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Objective To evaluate the diagnostic significance of B-ultrasound and CT in small renal tumor (≤3 cm). Methods The clinical data of 48 patients (29 men and 19 women) with small renal tumor were reviewed.Their mean age was 49 years.Of them,43 cases were asymptomatic,while 2 complained of hematuria,2 of lumbago and 1 of hematuria with lumbago.B-ultrasound, conventional CT,helical CT thin scan and intraoperative frozen section were evaluated. Results Of the 48 cases,36 of renal cell carcinoma (RCC),7 of renal angiomyolipoma (RAML),4 of oncocytic adenoma and 1 of metanephric adenoma were diagnosed by pathology after surgery.The diagnostic accuracy was 75%(36/48) for B-ultrasound,81%(39/48) for conventional CT,91%(20/22) for helical CT thin scan and 95%(19/20) for intraoperative frozen section,respectively. Conclusions Small renal tumor has high incidental rate as well as high benign rate.As the tumor is relatively smaller, it is difficult to differentiate between benign and malignant nature of the tumor by B-ultrasound and conventional CT.Helical CT thin scan and intraoperative frozen section are helpful for accurate diagnosis of the tumor.