Efficacy and safety study of Chinese botulinum toxin A 100U in patients with overactive bladder: a prospective, multicenter, double-blind and randomized controlled trial / 中华泌尿外科杂志

Objective:To assess the efficacy and safety of 100 units of botulinum toxin A (BTX-A) intradetrusor injection in patients with overactive bladder.Methods:From April 2016 to December 2018, 17 tertiary hospitals were selected to participate in this prospective, multicenter, randomized, double-blind, placebo-controlled study. Two phases of study were conducted: the primary phase and the extended phase. This study enrolled patients aged 18 to 75 years who had been inadequately managed by anticholinergic therapy (insufficient efficacy or intolerable side effects) and had spontaneous voiding with overactive bladder. Exclusion criteria included patients with severe cardiac, renal and hepatic disorders, patients with previous botulinum toxin treatment for 6 months or allergic to BTX-A, patients with urinary tract infections, patients with urinary stones, urinary tract tumors, diabetes mellitus, and bleeding tendency. Eligible patients were randomly assigned to BTX-A group and placebo control group in a ratio of 2∶1. Two groups of patients received 20 intradetrusor injections of BTX-A 100U or placebo at the depth of the submucosal muscle layer respectively under cystoscope, including 5 injections at the base of the bladder, 3 injections to the bladder triangle, 5 injections each to the left and right walls and 2 injections to the top, sparing the bladder neck. As a placebo control group, patients received same volume of placebo containing no BTX-A and only adjuvant freeze-dried preparations for injection with the same method. A combination of gelatin, sucrose, and dextran served as adjuvants. Average micturition times per 24 hours, urinary incontinence (UI) episodes per day, average micturition volume per day, OAB symptom score(OABSS), and quality of life (QOL) score were recorded at baseline and the 2nd, 6th and 12th week after treatment. The primary efficacy endpoint was the change from baseline in the average micturition times per 24 hours at the 6th week after treatment. The secondary efficacy endpoints included the change from baseline in the average micturition times per 24 hours at 2nd and 12th week, as well as the change from baseline in the OABSS, QOL score, average frequency of urgency and UI episodes per day, urgency score, average micturition volume per day at 2nd, 6th and 12th week after treatment. Patients were followed for 12 weeks to assess adverse events (AEs). After assessed at week 12, if the micturition times has decreased less than 50% compared to baseline and the patient is willing to receive retreatment, then patients could enter the extended trial phase. In that phase, patients in both groups were injected with 100 units BTX-A from 12th week onwards and then followed up the same indicators for 12 weeks.Results:216 patients were enrolled in this trial (144 cases in the BTX-A group and 72 cases in the placebo control group). Baseline characteristics such as age (47.75±14.20 in the BTX-A group and 46.39±15.55 in the control group), sex (25 male/117 female in the BTX-A group and 10/61 in the control group), and disease duration (0.51 years in the BTX-A group and 0.60 years in the control group) were balanced between the two groups( P>0.05). A marked reduction from baseline in average micturition times per 24 hours was observed in all treatment groups at the 6th week and the reduction of the two groups was statistically different ( P<0.001 and P=0.008 respectively). Compared with the baseline, the average micturition times per 24 hours at the 6th week decreased from baseline by 2.40(0.70, 4.60)times for the BTX-A group and 0.70(-1.00, 3.30) times for the placebo control group respectively, and the difference between the two groups was considered to be statistically significant ( P=0.003). The change rates of average micturition times per 24 hours from baseline at the 6th week of the two groups were (16±22)% and (8±25)% respectively, and the difference between the two groups was statistically significant ( P=0.014). Compared with the baseline, the average micturition times per 24 hours at 2nd and 12th week decreased by 2.00(0.00, 4.00)and 3.30(0.60, 5.03)for the BTX-A group, 1.00(-1.00, 3.00)and 1.70(-1.45, 3.85)for the placebo control group respectively. The difference between two groups was considered to be statistically significant ( P=0.038 and P=0.012); the changes of average urgency times per day for the BTX-A group and the control group at the 2nd, 6th and 12th week were 2.00(0.00, 4.30)and 2.40(0.30, 5.00), 3.00(0.30, 5.70)and 0.70(-1.30, 2.70), 0.70(-1.30, 3.00) and 1.35(-1.15, 3.50), respectively. There were significant differences between two groups at the 2nd, 6th and 12th week, ( P=0.010, P=0.003 and P=0.025, respectively). The OABSS of the BTX-A group and the control group at the 6th week decreased by 1.00(0.00, 4.00)and 0.50(-1.00, 2.00) compared with the baseline, and the difference between the two groups was statistically significant ( P=0.003). 47 cases of BTX-A group and 34 cases of placebo control group entered the extended trial phase, and 40 and 28 cases completed the extended trial phase, respectively. The average micturition volume per 24 hours changed by -16.60(-41.60, -0.60)ml and -6.40(-22.40, 13.30)ml, (-35.67±54.41)ml and(-1.76±48.69)ml, (-36.14±41.51)ml and (-9.28±44.59)ml, (-35.85±43.35)ml and(-10.41±40.29)ml for two groups at the 12th, 14th, 18th and 24th week, and the difference between two groups was statistically significant at each follow-up time ( P=0.01, 0.006, 0.012 and 0.016, respectively). There was no significant difference in other parameters( P>0.05). However, adverse reactions after intradetrusor injection included increased residual urine volume (27 in the BTX-A group and 3 in the control group), dysuria (21 in the BTX-A group and 6 in the control group), urinary infection (19 in the BTX-A group and 6 in the control group), bladder neck obstruction (3 in the BTX-A group and 0 in the control group), hematuria (3 in the BTX-A group and 1 in the control group), elevated alanine aminotransferase (3 in the BTX-A group and 0 in the control group), etc. During the follow-up period, there was no significant difference in the other adverse events between two groups except the increase of residual urine volume( P<0.05). In the primary trial phase, among the 27 cases with increased residual urine volume in BTA group, only 1 case (3.70%) with PVR more than 300 ml; the PVR of 3 patients in the placebo group was less than 100 ml. The increase of residual urine volume caused by the injection could be improved or disappeared with the passage of time. Conclusions:Intradetrusor injection of Chinese BTX-A improved the average micturition times per 24 hours, the average daily urgent micturition times, OABSS, and average micturition volume per time, and reduced the adverse effects in patients with overactive bladder.Chinese BTX-A at dose of 100U demonstrated durable efficacy and safety in the management of overactive bladder.

LMO2 in prostate stromal cells promotes prostate cancer cells proliferation and invasion through ;paracrine of IL-11 and FGF-9 / 中国癌症杂志

Background and purpose:The previous research has found that the prostate stromal cells derived from different prostate zones have distinct effect on prostate epithelial cells. We also revealed that LMO2 protein was highly expressed in PZ stromal cells (PZSCs) and prostate cancer associated fibroblasts (CAFs) compared with TZ stromal cells. This study investigated the effect of LMO2 protein in prostate stromal cells on proliferation and invasion of prostate cancer PC-3 cells and its mechanisms. Methods:Lentivirus overexpression vectors were used to establish LMO2-overexpressed prostate WPMY-1 stromal cell line. shRNA plasmids were used to suppress LMO2 in CAFs. LMO2 mRNA and protein level of both WPMY-1 and CAFs were evaluated by real-time fluorescent quantitative polymerase chain reaction (RTFQ-PCR) and Western blot. Then, PC-3 cells were co-cultured with different prostate stromal cells and the in vitro proliferation and invasion of PC-3 were measured by CCK-8 and matrigel invasion assays respectively. Results:When co-cultured with LMO2-overexpressed prostate stromal cells, both proliferation and in-vasion of PC-3 were improved. However, when co-cultured with CAFs which have inhibited expression of LMO2, the proliferation and invasion of PC-3 were reduced. The protein array proifling found that both interleukin-11 (IL-11) and ifbroblast growth factor-9 (FGF-9) were enhanced extensively in the supernatant collected from LMO2-overexpressed WPMY-1 cells. Conclusion:The expression of LMO2 in prostate stromal cells could be responsible for development of prostate cancer. Paracrine of cytokines, such as IL-11 and FGF-9, from LMO2-overexpressed stromal cells had effects on the proliferation and invasion of prostate cancer cells.

The study of selective segmental renal artery clamping aggravating pathological injury of the solitary-kidney in a porcine model / 中华泌尿外科杂志

Objective To evaluate the effect of selective segmental renal artery clamping ( SSRAC) on the solitary-kidney, providing a foundamental basis for the using of SSRAC in partial nephrectomy. Methods A total of 18 pigs were randomized equally into 2 groups according to the method of renal artery clamping such as main renal artery clamping ( MRAC) group or SSRAC group.Each case underwent right radical nephrectomy and either MRAC or SSRAC for 60 minutes on the left kidney.Serum creatinine ( SCr) and blood urea nitrogen (BUN) were measured before surgery and at 6 time points thereafter (the 1st, 7th, 14th, 21st, 28th, 90th day).Magnetic resonance imaging was performed before surgery and at 4 time points thereafter (the 1st, 7th, 28th, 90th day) and T2 relaxation time and apparent diffusion coefficient (ADC) were determined.Inflammatory cell infiltration and interstitial fibrosis were detected using renal histology on the 1st and 90th day after operation.Results SCr and BUN of the two groups increased to peak value on the 1st day, and then decreased gradually to normal on the 90th day after the operation.On the 1st day, SCr [(266.43 ±31.12)umol/l] and BUN [(13.63 ±2.54)mmol/l)] of SSRAC group were significantly lower than that of MRAC [(386.37 ±40.40)umol/l,(26.83 ±5.96)mmol/l] (P0.05) on the 7th, 14th, 21st, 28th, 90th day.In the MRAC group, the T2 relaxation time of upper, middle and lower pole of the left kidney increased and the ADC decreased on the 1st day after operation.It arrived to the peak value on the 7th day, and decreased or increased respectively from then on to normal level on the 90th day.In the SSRAC group, there were no significant changes of T2 relaxation time and ADC in the upper and middle pole of left kidney (P>0.05), but it was similar to that in the MRAC group for lower pole.On the 1st, 7th, 28th day after operation, the T2 relaxation time of upper and middle pole of the left kidney in the MRAC group [(45.50 ±1.87),(51.82 ±2.27), and(40.37 ±1.93)ms ) ] were significantly higher than those in the SSRAC group [(36.67 ± 1.33),(35.15 ±1.27), and(37.48 ±1.37)ms](P0.05).On the 1st, 7th, 28th day after operation, the ADC of upper and middle pole of the left kidney in the MRAC group [(2.29 ±0.08) ×10 -3 mm2/s, (2.10 ±0.08) ×10 -3 mm2/s, (2.41 ±0.09) ×10 -3 mm2/s] were significantly lower than that of the SSRAC group [(2.69 ± 0.08) ×10 -3 mm2/s, ( 2.63 ±0.06 ) ×10 -3 mm2/s, ( 2.68 ±0.05 ) ×10 -3 mm2/s ] ( P <0.05 ) . However, on the 1st,7th, 28th, 90th day after operation, the ADC of lower pole of the left kidney in the SSRAC group [(1.93 ±0.08) ×10 -3mm2/s,(1.91 ±0.09) ×10-3mm2/s,(2.33 ±0.07) ×10 -3mm2/s, and (2.43 ±0.07) ×10 -3 mm2/s] were significantly lower than those of the MRAC group [ (2.37 ±0.05) ×10 -3 mm2/s, (2.06 ±0.07) ×10 -3 mm2/s, (2.46 ±0.09) ×10 -3 mm2/s, (2.61 ±0.08) ×10 -3 mm2/s](P<0.05).The whole left kidney in MRAC group experienced extensive tubular hydropic degeneration and limited inflammatory cell infiltration on the 1st day after operation.Moreover, renal tubular hydropic degeneration alleviated and no glomerular changes, fibrous tissue hyperplasia or inflammatory cell infiltration was found on the 90th day after operation.In SSRAC group, no changes were found in upper and middle pole of left kidney at the two time points, while the pathological injury of the lower pole of left kidney was more severe.Conclusions SSRAC has obvious protective effect on renal function in the early stage. However, compared with MRAC, the renal tissue injury in the ischemic area was more serious.Therefore, to protect renal function in partial nephrectomy, the ischemic renal area should be reduced as much as possible, even to zero-ischemic, when adopting SSRAC.

The LMO2 protein overexpressed WPMY-1 prostatic stromal cells promote proliferation and invasion of PC-3/BPH-1 prostatic epithelial cells / 中华泌尿外科杂志

Objective To investigate the effect of LMO2 gene,which is overexpressed in prostate peripheral zone than transitional zone,on proliferation and invasion of prostate cancer PC-3 cell line or normal prostate epithelial BPH-1 cell line.Methods Lentivirus overexpression system was used to establish the LMO2 protein overexpressed prostate WPMY-1 stromal cell line.The LMO2 mRNA and protein expression level of those cells was evaluated by qRT-PCR and western blot.The PC-3 or BPH-1 cells was cocultured with prostate stromal cells and the in vitro proliferation and invasion activity were detected by Cell Counting Kit-8 (CCK-8),EdU and Matrigel invasive assays.Results The stable LMO2 overexpressed prostate stromal cells WPMY-1-LMO2 was successfully established.The results of CCK-8,EdU experiments indicated the proliferation and invasion activity of PC-3 or BPH-1 cells were both enhanced through cocultured with WPMY-1-LMO2 cells.The proportion of EdU positive cells of PC-3 cultured in WPMY-1-LMO2 supernatant was (42.67 ± 6.03) ％,and the difference was significant compared with the control group (29.33 ± 3.51) ％ (P ＜ 0.05).The BPH-1 culturcd in the supernatant was (35.00 ± 2.52) ％,aud the difference was significant compared with the control group (23.33 ± 2.52) ％ (P ＜ 0.05).The number of invaded PC-3 or BPH-1 cells after co-cultured with WPMY-1-LMO2 cells was 38 ± 5 and 43 ± 3,respectively,which was significantly different compared with the control group (P ＜ 0.05).Conclusions Tbe LMO2 overexpressed prostate stromal cells could induce proliferation and invasion of PC-3 or BPH-1 cells.The propensity of benign prostatic hyperplasia and prostate cancer at different zones may probably be related to distinctive gene expression between peripheral zone and transitional zone derived stromal cells.

The timing of super-selective renal artery embolization for the treatment of renal hemorrhage after PCNL / 重庆医学

Objective To investigate the timing of super-selective renal artery embolization (SRAE) for the treatment of renal hemorrhage after percutaneous nephrolithotomy (PCNL) .Methods From June 2005 to February 2013 ,a total of 2 165 patients with upper urinary tract calculi underwent PCNL (2 384 PCNL procedures) and 16 of them suffered severe bleeding (0 .74% ) .In the 16 cases ,SRAE was used .The medical records of all the 16 cases were retrospectively analyzed .Results In 16 patients ,15 patients were successful with the first SRAE ,but 2 of them underwent an additional pure renal artery angiography (1 patient before SRAE and 1 patient after SRAE);1 healed after the second SRAE .The mean blood loss and transfusion volume were 32 .9 g/L and 250 mL before the first angiography/SRAE ,and an additional 3 .2 g/L and 0 mL before the second try .Although 1 patient died ,the oth-ers were recovered without complications .Conclusion SRAE should be adopted early for the treatment of severe renal hemorrhage after PCNL .However ,a second try should be considered for the repeated bleeding patients after the negative results of first renal artery angiography or SRAE .

Clinical effects of second biopsy and resection in patients with high risk superficial transitional cell carcinoma of the bladder / 中华泌尿外科杂志

Objective To explore the effects of second biopsy and resection on tumor recurrence and progression in patients with high risk non-muscle invasive bladder cancer. Methods The second biopsy and resections were performed 4-6 weeks after the first transurethral resection in 52 patients. Routine follow-up was done in another 71 patients. The tumor recurrence and progression rates were compared. Results Residual tumors were found in 54%(28/52) of patients underwent second biop-sy and resection, including muscle-invasive tumors in 5 patients. Two patients underwent radical cys-tectomy due to resection findings. During same period, 71 patients were routinely followed. After a median observation of 27 months, patients underwent second biopsy and resection showed lower recur-rence rate (P<0.05). The progression rate was no difference between the 2 groups(P0.05). Conclusion Second biopsy and resection may reduce recurrence rate in high risk non-muscle invasive bladder cancers, but may not change the tumor progression rate.

Treatment of upper urinary tract calculus with minimally invasive percutaneous nephrolithotomy / 中华泌尿外科杂志

Objective To assess the efficacy and safety of minimally invasive percutaneous nephrolithotomy(mPCNL)in the treatment of upper urinary tract calculus. Methods The clinical data of 368 cases of upper urinary tract calculus from 2002 to 2006, which underwent mPCNL, were retrospectively analyzed. Among 368 cases analyzed, there were 116 cases with proximal ureteral cal-culus;190 cases of nonstaghorn kidney stones, 62 cases of staghorn stones. Results There were 344 cases(93.5%)treated with one-stage operation, 24 cases(6.5%) with two-stage. Single channel was used in 856 cases(96.70%), two-channel in 12 cases(3.3%). Complete stone clearance was a-chieved in 337 kidneys, giving an overall clearance rate of 91.6%. The average operative time was 73 min. The duration of hospital stay was 4-8 d with an average of 6 d in one-stage and complete clear-ance patients. Postoperative urinary tract infection was seen in 23 patients(6.2 %). Five(1.4 %) pa-tients required blood transfusion after operation. Two patients with severe bleeding were treated with blood transfusion and super-selective arterial embolization. Conclusion mPCNL has definite efficacy in the treatment of upper urinary tract calculus with little suffering and short recovery time.

Effects of ureteral stent on renal pelvic pressure / 中华泌尿外科杂志

Objective To explore the effects of ureteral stent on renal pelvic pressure and other urodynamic parameters. Methods Forty-one patients, 28 males and 13 females, with unilateral renal calculi and/or ureteral calculi were recruited in this study. The mean patient age was 47 years old (ranging from 20 to 72 years old). All cases were placed a 4.7 F ureteral stent and 16 F nephrostomy tube after minimal invasive pereutaneona nephrolithotomy (MPCNL). There was no hydronephrosis and residual crushed stone in the ureter after MPCNL in all cases. Renal pelvic pressure, intra-abdo minal pressure, detrusor pressure, bladder pressure changes during the filling and voiding phases with intravesical perfusion flow rate of 40 ml/min were recorded and analyzed. Results At the baseline, IPP0, IAP0, DP0 and BP0 were (33.1±17.0)cm H2O, (27.5±7.0)cm H2O, (3.3±2.9)cm H2O and (30. 9±7.2)cm H2O, respectively; At the maximum cystometric capacity during the filling phase, IPPvol, IAPvol Dpvol and Bpvol were (39.4±67. 3)cm H2O, (31.1±7.3)cm H2O, (10.7±6. 6) cm H2O and (41.6±10.3)cm H2O, respectively; At the maximum bladder pressure during the voiding phase, IPPmax, IAPmax Dpmax and Bpmax were (65.7±17.0)cm H2O, (33.7±9. 7)cm H2O, (41.9±7.8)cm H2O and (75.0±12. 8)cm H2O, respectively;There were statistical significance comparing between any of IPP0, IPPvol and IPPmax(P<0. 01). 27% (11/41)patients were with the pain in kidney area at voiding IPPmax (87.1±14.6) cm H2O, which was significantly higher than IPPmax (57.8±9.5)cm H2O of asyrnptomatic group (30 patients)(P<0. 01). In all cases, the renal pelvic pressure was higher than 40 cm H2O during the voiding phase. Conclusions Renal pelvic pressure increases during the filling phase after placing the ureteral stent, especially during the voiding phase. As renal function will be damaged by the high renal pelvic pressure, we should decrease the utilization of ureteral stent if possible. It is encouraged to remove the ureteral stent as early as possible.

Treatment of proximal ureteral stones: a comparison study among extracorporeal shock wave lithotripsy, retrograde ureterolithotripsy and percutaneous ureterolithotripsy / 中华泌尿外科杂志

Objective To evaluate the effectiveness of extracorporeal shock wave lithotripsy (ESWL), retrograde ureterolithotripsy(URSL) and percutaneous ureterolithotripsy(PCL) in the treatment of proximal ureteral calculi. Methods A total of 397 patients with proximal ureteral calculi treated by ESWL,URSL or PCL ftom September 2001 to December 2005 were retrospectively analyzed. Results Among 397 patients,83 patients with a mean stone size of 1.23 cm were treated by ESW L.Of then.13 patients transferred to URSL or ureterolithotomy and the stone-free rate of ESWL 1 month later was 65.7%(46/70).TWO hundred and thirteen patients with a mean stone size of 1.21 cm were treated by URSL and 101 patients with a mean stone size of 1.50 cm were treated by PCL.The stone-free rate of URSL and PCL 1 month after the treatment was 88.2%(172/195)and 96.9%(95/98),respectively.Eighteen patients in URSL group and 3 patients in PCL group trans-ferred to ureterolithotomy.ESWL had a statistically lower stone-free rate than that of URSL and PCL (P＜0.001),both in patients with stone size≤1 cm and＞1 cm.For patients with stone size＞1 cm,PCL achieved a higher stone-free rate than URSL(P=0.005).PCL also had a higher stone-free rate than URSL in treating patients with stone size≤1 cm but there was no statistical difference between them. Conclusions ESWL can still be used as first-line treatment choice for proximal ureteral stones less than 1cm.For patients with proximal ureteral stones larger than 1cm.URSL and PCL are more proper treatment modalities since they can achieve higher stone-free rate and have acceptable low complications.

Management of primary T1G3 bladder cancer: immediate cystectomy or bladder preserving approach? / 中华泌尿外科杂志

Objective To compare the long-term outcomes in patients with newly diagnosed stage T1G3 bladder cancer treated with bladder preserving approach and intravesical instillation or im-mediate cystectomy.Methods of 113 patients with a median age of 64 years (range 27 to 88) diag-nosed with T1G3 bladder cancer from January 1993 to February 2007,81 cases were treated by tran-sureteral resection with additional intravesieal instillation and 32 were treated with immediate cystecto-my.Differences between the 2 groups in 5-year overall survival and tumor specific survival were calcu-lated using the Kaplan-Meier survival function and analyzed by the log rank test.Results of 81 pa-tients treated with organ preserving approach and postoperative intravesical instillation,53 patients developed local recurrence and 21 patients underwent deferred cysteetomy in a median 64 (range 6-140) months follow-up.The overall and tumor specific survival at 5 years was 64.2% (52/81) and 77.8%(63/81),and in those who had deferred cystectomy it was 61.9% (13/21) and 76.2% (16/21),respectively.Of the 32 patients treated with immediate cystectomy,the 5-year overall and tumor specific survival was 59.4%(19/32) and 75.0%(24/32) within a median follow-up of 62(range 4-141)months.There was no statistical difference of the 5-year overall and tumor specific survival be-tween patients treated with bladder preserving approach or immediate cystectomy.Conclusion Blad-der preserving approach and immediate eystectomy might have similar 5-year overall and tumor specific survival for primary T1G3 bladder cancers.

Expression and clinical significance of antiapoptosis gene XIAP in prostate cancer / 中华男科学杂志

<p><b>OBJECTIVE</b>To study the expression of the inhibitor of apoptosis (IAP) gene XIAP in prostate cancer and the relationship between its expression and its clinical stage or Gleason grade.</p><p><b>METHODS</b>XIAP mRNA expression was detected by RT-PCR in three prostate cancer cell lines (PC-3, DU-145, LNCaP), neoplastic prostate tissues and normal prostate tissues. Immunohistochemical SP method was used to examine the expression of XIAP protein in 56 neoplastic prostate tissue specimens.</p><p><b>RESULTS</b>XIAP gene was not expressed in normal prostate tissues, but highly expressed in prostate cancer cell lines PC-3, DU-145, LNCaP. Thirty of the 56 (53.6%) tumor samples were positive XIAP protein, and only 12 (21.5%) paratumor samples were positive XIAP protein (P < 0.01), XIAP positivity not correlated with tumor stage or Gleason grade (P > 0.05).</p><p><b>CONCLUSION</b>XIAP may be involved in the development of prostate cancer and play an important role in human prostate carcinogenesis. It is likely to be used as a target of prostate cancer therapy.</p>

Diagnosis and management of iatrogenic ureteral injury / 中华创伤杂志

Objective To analyze the characteristics of iatrogenic urerteral injury and summarize the experiences in prevention,diagnosis and treatment of iatrogenic urerteral injury. MethodsA review was made on the injurycauses,the injury locations,the treatment time,the methods of surgical procedures and the results of treatment in 17 patients with iatrogenic ureteral injury treated surgically from 1997 to 2003. Results Of 17 cases of iatrogenic ureteral injuries,gynecological,general surgical and urological procedures resulted in ureteral injuries in 12 cases (71%),four (24%) and one (6%),respectively. Of all the injuries,65% (11/17) appeared in the lower part of the ureter,18% (3/17) in the middle part of the ureter and 18% (3/17) in the upper part of the ureter. The main injury causes were ligation,partial ligation,complete transection and perforation,accounting for 29% (5/17),41% (7/17),24% (4/17) and 6% (1/17),respectively. Four cases were found during operation,nine at days 2-11 after operation and four were treated 3-6 months after injury. Treatment methods included end-to-end ureteral anastomosis in seven cases,ureteroneocystostomy in three,ureteral lithotomy in one,pure ureteral lysis in three and post-lysis double-J tube insertion in three. All patients were cured. The follow-up ranging from six months to three years showed no patients suffering from urinary tract infection,hydronephrosis or atrophy. Conclusions The location and type of injury determine the type of surgical repair. A thorough knowledge of pelvic anatomy and mastering the basic steps of diagnosis and treatment are critical for prevention and management of the iatrogenic urerteral injury.

Expression profile of apoptosis pathway-specific genes of prostate cancer cells and different apoptosis susceptibility / 中华泌尿外科杂志

Objective To determine whether altered expression of apoptosis pathway genes is related to different apoptosis susceptibility of prostate cancer cells. Methods Androgen sensitive and insensitive prostate cancer cell lines LNCaP and PC 3 were cultured and treated by etoposide,and apoptosis were determined using Hoechst 33258 staining.The cells were harvested and the total RNA was extracted.cDNA probes were prepared and labeled with biotin 16 dUTP,then hybridized to commercially available cDNA arrays including apoptosis pathway specific genes. Results Apoptosis were induced in both PC 3 and LNCaP cells by etoposide,however,PC 3 was more resistant than LNCaP.Compared with LNCaP cells,the 4 fold down regulated genes in PC 3 cells were Bcl10,CIDE A,GADD45a,RIP2,caspase 4,5 and 6,while the 4 fold up regulated gene in PC 3 cells was TRAF4.Caspase 14 and TNFR2 were most strongly expressed genes in the 2 cell lines. Conclusions The altered expressions of apoptosis pathway specific genes are related to the different apoptosis susceptibility,and this may make an important contribution to androgen insensitive state of prostate cancer cells.

An experimental study of tubularized peritoneal free grafts as ureteral mucosa substitutes / 中华泌尿外科杂志

Objective To investigate the feasibility of reconstruction of ureter with tubularized peritoneal free grafts for the treatment of avulsion of ureteral mucosa using animal models.Methods Twelve adult dogs were randomly divided into the reconstruction group(n=6) and the control group(n=6).Firstly,the model of avulsion of ureteral mucosa about 3-5 cm long was made.In reconstruction group,tubularized peritoneal free grafts and ureteral stents were placed in the injured ureters;and in control group,no operation was performed but to place the stents into the ureter.The curative effect was observed by IVU and histological examination 10 weeks after operation.Results In reconstruction group,IVU showed normal size and morphology of the kidneys.There was no hydronephrosis,and no obvious stricture of the part of ureter in which peritoneal free grafts were used as mucosa substitutes.In control group,IVU showed no image or only obscure enlarged outlines of the kidneys,and no image of the ureters.Atresia or severe stricture of the ureters was observed in all dogs in control group;while in reconstruction group,the peritoneal membrane was replaced by integrate transitional epithelium,and no obvious stricture was observed.Subepithelial abundant neovascularization was also seen.Conclusions For avulsion of ureteral mucosa exceeding 3 cm,placing stents only will lead to ureteral stricture or atresia,reconstruction using tubularized peritoneal free grafts as mucosa substitutes is an effective method.

Renal cell tumor and renal cyst(Report 64 cases) / 中国癌症杂志

Purpose:To clarify the association between renal cysts and renal cell carcinoma (RCC), we analyzed the clinical characteristics of patients with renal cell carcinoma and renal cyst. Methods:From May 1996 to January 2004, a total of 198 patients were hospitalized for renal cell carcinoma in our department, and 64 patients had both renal cysts and renal cell carcinoma (RCC). The clinical characteristics of the 64 patients were evaluated, and compared to 106 renal cell carcinoma (RCC)patients without renal cysts from the 198 patients in the same period. Results:Renal cysts were identified by preoperative ultrasonography, computerized tomography and magnetic resonance imaging in 37%(22/59)、24%(15/61) and 35%(6/17) respectively. Histopathological examination revealed renal cyst in 15 patients (23%). The sizes of renal cyst were 0.5 to 12 cm. The pathological examinations showed clear cell carcinoma in 61, chromophilic cell carcinoma in 2 and a combined type of clear cell carcinoma and chromophilic cell carcinoma in 1. Compared to RCC patients with those without renal cyst,younger and male RCC patients were easier to also have with renal cyst(P

Distribution of epidermal growth factor in transition zone and peripheral zone of human normal prostate / 中华泌尿外科杂志

Objective To investigate the regional differential expression of epidermal growth factor(EGF)in transition/peripheral zones of human normal prostate. Methods RT-PCR was used to determine semi-quantitatively the expression of EGF mRNA in 17 specimens of peripheral /central zones from normal prostates and 20 specimens of periurethral zone from BPH.EGF protein expsession was examined with Western blot. Results In normal prostate tissue,EGF mRNA level in transition zone was significant higher than that in peripheral zone (0.96?0.31 vs 0.53?0.27,respectively,P

Clinical management of T_1G_3 transitional cell carcinoma of urinary bladder / 中华泌尿外科杂志

Objective To explore the management of T 1G 3 transitional cell carcinoma of urinary bladder. Methods 67 cases of T 1G 3 transitional cell carcinoma,average age of 63,were treated with TURBt.Followed by intravesical bacillus Calmette-Guerin instillation in 59 cases and mitomycin C instillation in other 8 cases. Results Within median 47 (range 12～78) months follow-up,28 cases had recurrence.20 cases had tumors progressed to muscle invasion(T 2 or higher).16 cases had received total cystectomy and 4 cases had long-distance metastasis. 9 cases died from the tumor. Conclusions Patients who have T 1G 3 transitional cell carcinoma initially should be treated by TURBt and intravesical BCG instillation and followed rigorously.When the tumor recurs and progresses into muscle invasion,total cystectomy is preferred.

The effect of NF-?B decoy on the chemokine expression of human bladder cancer cell line / 中华泌尿外科杂志

Objective To investigate the effect of nuclear factor ?B(NF-?B)decoy on the chemokine expression in bladder cancer cell line. Methods Human bladder cancer cell line EJ,NF-?B decoy ODN were used as a NF-?B inhibitor(scrambled NF-?B decoy was used as control).NF-?B DNA binding activity was detected by electrophoretic mobility shift assay (EMSA);and p65 subunit of NF-?B was detected by RT-PCR and Western blot.Chemokines including IL-8,MCP-1,RANTES were detected by RT-PCR. Results EMSA showed that NF-?B decoy inhibited NF-?B activation induced by TNF-?.RT-PCR or Western blot test suggested that p65,IL-8,MCP-1 and RANTES were upregulated by TNF-? and downregulated by NF-?B decoy.However,mutated decoy ODN had no effect on them. Conclusions Chemokines can be detected in bladder cancer.They are activated by TNF-? and inhibited by NF-?B decoy.

Role of androgen receptor in the pathogenesis of human prostate cancer / 中国病理生理杂志

AIM: To investigate molecular mechanisms associated with the acquisition of androgen-independent growth of human prostate cancer during progression. METHODS: Upon continuously passaging, the androgen-independent LNCaP cell model was established. The expression of AR and PSA proteins in the course of prostate cancer progression was determined by Western blot. RESULTS: Upon continuous passage, the biological behavior of androgen-dependent parental LNCaP C-33 cells (passage number less than 33) was altered. LNCaP C-81 cells (passage number higher than 80) exhibited more aggressive growth and lower androgen-dependence than C-33 and C-51 cells (passage number between 33 and 80). C-81 cells secreted a higher level of PSA and the degree of DHT stimulation on PSA secretion was lower in C-81 cells than C-33 cells. The three LNCaP subclones expressed a similar level of total AR protein, but C-81 cells showed a characteristic loss of expression of the AR-B and increase in expression of the AR-A. CONCLUSION: Multiple factors, including the different expression of AR isoforms, contribute to the development of androgen-independent growth of prostatic carcinoma cells. [

Establishment of androgen-independent human prostate cancer cell strain,LNCaP C-81 / 中华泌尿外科杂志

Objective To establish and validate andro ge n-independent human prostate cancer LNCaP cell model. Methods Androgen-dependent LNCaP parental C-33 cells were maintained in a regul ar cell-culture medium,that is,phenol red-positive RPMI 1640 medium supplement ed with 10% fetal bovine serum,1% glutamine and 0.5% gentamicin.Upon continuousl y passaging,androgen-dependence of these LNCaP cells decreased gradually,thus,t he androgen-independent LNCaP cell model which derived from androgen-dependent cells was established. Results Upon continuous passage, the biological behavior of androgen-dependent parental LNCaP C-33 cells (pass age number less than 33) was altered.LNCaP C-81 cells (passage number higher th an 80) clearly exhibited more aggressive growth and lower androgen-dependence t han C-33 and C-51 cells (passage number between 34 and 81) in vitro and in viv o. Conclusions The LNCaP cell model closely recapitulate s the transition of human prostate cancer from androgen-dependent to hormone-r efractory state under the androgen nondeprived condition. This cell model may pr ovide the opportunity to understand the molecular mechanisms involved in the and rogen-independent growth of cancer cells during prostate cancer progression.