Protective effect of pioglitazone on kidney injury in diabetic rats

OBJECTIVES@#To investigate the protective effect of pioglitazone on kidney injury in diabetic rat model and its mechanisms.@*METHODS@#Forty healthy Sprague Dawley rats were selected and randomly divided into five groups, with 8 rats in each group. Group A served as control group and were administered with sterile citrate buffer (i.p.) as placebo. Groups B, C, D and E rats were injected (i.p.) with streptozotocin to induce type I diabetes. Diabetic rats in Group B were intragastrically administered with sterile saline solution alone. Groups C, D and E rats were intragastrically given pioglitazone hydrochloride suspension at doses of 10, 20, 30 mg/kg per day, respectively. After eight weeks of treatment, all rats were anesthetized and blood was withdrawn from the abdominal aortic for detection of hemoglobin A1c, serum creatinine (SCr) and blood urea nitrogen (BUN) levels. Rats were then sacrificed and the left kidney was excised for calculation of kidney hypertrophy index (KHI), observation of renal pathological changes using light microscope and electron microscope. Mean glomerular cross-sectional areas (MGA), mean glomerular volume (MGV), glomerular basement membrane thickness and foot process fusion ratio were calculated. RT-PCR was employed for detection of podocalyxin (PCX) protein expression.@*RESULTS@#Results showed that levels of hemoglobin A1c, BUN, SCr in Groups B, C, D and E rats were significantly higher than those in Group A (P<0.05), while BUN and SCr levels in rats of Groups C, D and E were significantly lower than those in Group B (P<0.05). KHI, MGA and MGV levels were significantly higher in Groups B, C, D and E rats than those in Group A (P<0.05); KHI and MGA levels in Group B rats were significantly higher than those in Groups C, D and E (P<0.05) and MGV in Groups D and E was significantly lower than that in Groups B and C (P<0.05). Histology study showed normal glomerulus structure, morphology, volume, endothelial cells and mesangial cells as well as clear glomerular capillary in Group A rats. Renal mesangial matrix proliferation and expansion of glomerulus cavities in Groups B, C, D and E were observed. However, damage degree in Groups C, D and E were more moderate than that in Group B.@*CONCLUSIONS@#Pioglitazone can reduce kidney damage in diabetic rats, which may be attributed to its role in increasing glomerular PCX protein expression and inhibiting urinary excretion of PCX, and its effect is dose dependent.

Comprehensive treatment of stage-lllb testicular non-seminomatous germ cell tumor: a case report and review of the literature / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the comprehensive treatment of stage-IIIb testicular non-seminomatous germ cell tumor (NSGCT) based on the chemotherapy with cisplatin, etoposide and bleomycin (BEP) and nerve-sparing laparoscopic retroperitoneal lymph node dissection (nsLRPLND).</p><p><b>METHODS</b>We reported a case of stage-IIIb testicular NSGCT, analyzed the clinical data and treatment methods and reviewed the relevant literature.</p><p><b>RESULTS</b>The patient underwent chemotherapy with etoposide (0. 18 g/d for the first 3 days), cisplatin (30 mg/d for the first 5 days), and bleomycin (30 mg/d on day 2, 9 and 16) for 3 cycles, followed by nsLRPLND. Both chemotherapy and surgery were successfully performed. The operation time was 175 min, with intraoperative blood loss of 50 ml, but no severe perioperative complications. No recurrence and distant metastasis were found during the 6-month follow-up after surgery.</p><p><b>CONCLUSION</b>The comprehensive treatment based on BEP chemotherapy and nsRPLND can be used as an option for stage-IIIb testicular NSGCT.</p>

Dauricine can inhibit the activity of proliferation of urinary tract tumor cells

OBJECTIVE@#To explore the anti-tumor effects of asiatic moonseed rhizome extraction-dauricine on bladder cancer EJ cell strain, prostate cancer PC-3Mcell strain and primary cell culture system.@*METHODS@#The main effective component-phenolic alkaloids ofMenispermum dauricum was extracted and separated from asiatic moonseed rhizome by chemical method. MTT method was used to detect dauricine anti-tumor effect.@*RESULTS@#Dauricine had an obvious proliferation inhibition effect on the main tumor cells in urinary system. The minimum drug sensitivity concentration was between 3.81-5.15 μg/mL, and the inhibition ratio increased with the increase of concentration.@*CONCLUSIONS@#Dauricine, the main effective component extracted from asiatic moonseed rhizome, had a good inhibition effect on tumor cells in urinary system. At the same time, Dauricine has certain inhibition effects on the primary cultured tumor cell.

UPOINT: a novel phenotypic classification system for chronic prostatitis/chronic pelvic pain syndrome / 中华男科学杂志

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common condition obsessing urologists and patients. It is also known as a heterogeneous syndrome, with varied etiologies, progression courses and responses to treatment. Based on the deeper insights into its pathogenesis and re-evaluation of its clinical trials, a novel phenotypic classification system UPOINT has been developed, which clinically classifies CP/CPPS patients into six domains: urinary (U), psychosocial (P), organ-specific (O), infection (I) , neurologic/systemic (N) and tenderness of pelvic floor skeletal muscles (T), and directs individualized and multimodal therapeutic approaches to CP/CPPS. This review systematically summarizes the theoretical foundation, clinical characteristics of UPOINT and treatment strategies based on the UPOINT phenotypic classification system.

One-stage urethroplasty with pedicled scrotal skin flap for hypospadias / 中华男科学杂志

<p><b>OBJECTIVE</b>To summarize the experience in one-stage urethroplasty with pedicled scrotal skin flap for hypospadias, and improve its therapeutic effect.</p><p><b>METHODS</b>We retrospectively analyzed the clinical data of 310 cases of hypospadias (except coronal hypospadias) treated by one-stage urethroplasty with pedicled scrotal skin flap. All the patients were followed up for 6 to 24 months.</p><p><b>RESULTS</b>No postoperative complications were observed except urinary fistula, which occurred in 12.6% of the patients. Postoperative fistula formation was associated with the type of hypospadias, the length of the urethral defect and postoperative comprehensive medication, but not with the stent indwelling time after surgery. Most of the fistulae were located at the base of the penis.</p><p><b>CONCLUSION</b>One-stage urethroplasty with pedicled scrotal skin flap is a simple and effective option for all types of hypospadias except the coronal type, and postoperative treatment is very important.</p>

Combination therapy of biofeedback with electrical stimulation for chronic prostatitis/chronic pelvic pain syndrome / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the effect of the combination therapy of biofeedback with electrical stimulation on chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) through clinical trials.</p><p><b>METHODS</b>A total of 140 cases of diagnosed CP/CPPS were randomly divided into a control group (n = 20), a biofeedback group (BF, n = 40), an electrical stimulation group (ES, n = 40), and a biofeedback plus electrical stimulation group (BF + ES, n = 40). The latter three groups were treated by corresponding methods 5 times a week for 2 weeks, while the controls left untreated. After the treatment, all the patients were followed up for 30 days. The NIH chronic prostatitis symptom index (NIH-CPSI) scores and the results of uroflowmetry were obtained and compared before and after the treatment.</p><p><b>RESULTS</b>Compared with the control group, the scores on pain, urinary symptoms and quality of life (QOL) and the total NIH-CPSI scores were obviously decreased (P < 0.05), and the maximum flow rate (MFR) markedly improved (P < 0.05) in the BF, ES and BF + ES groups after the treatment, with significant differences between the former two and the latter one (P < 0.05), but not between the BF and ES groups (P > 0.05), nor in the control group before and after the treatment (P > 0.05).</p><p><b>CONCLUSION</b>The combination therapy of biofeedback with electrical stimulation has a synergistic effect on CP/CPPS by alleviating pain and urinary symptoms, improving QOL and elevating MFR.</p>

Inflammatory myofibroblastic tumor of the prostate: a case report and review of the literature / 中华男科学杂志

<p><b>OBJECTIVE</b>To discuss the diagnosis and treatment of inflammatory myofibroblastic tumor (IMT) of the prostate.</p><p><b>METHODS</b>We retrospectively analyzed the clinical data of a case of IMT of the prostate and reviewed relevant literature. The patient was a 62-year-old man, who was twice referred to the local hospital for recurrence of dysuria. He was diagnosed as with benign prostatic hyperplasia (BPH) and twice underwent transurethral resection of the prostate (TURP). But frequent recurrence of dysuria followed postoperatively, for which he came to our hospital and received another TURP and transurethral resection of the bladder tumor (TURBT). Pathological findings showed chronic inflammation of the bladder, papillary hyperplasia with mild dysplasia in regional urothelial and IMT of the prostate. Six months later, the patient came again to our hospital for recurrence of dysuria. Computed tomography revealed a large mass in the bladder.</p><p><b>RESULTS</b>The patient underwent laparoscopic bladder radical resection and ileal conduit diversion, simultaneously with pelvic lymph node dissection. The pathological examination confirmed it to be an IMT of the prostate with the bladder but not regional lymph nodes involved. An 11-month follow-up showed neither local recurrence nor distant metastasis.</p><p><b>CONCLUSION</b>IMT of the prostate is a rare borderline lesion, whose diagnosis is very difficult and mainly depends on pathological findings. IMT of the prostate is liable to recur and even invade the bladder. Radical resection is recommended for patients with large and recurrent tumors, and close follow-up is strongly warranted.</p>

Chronic prostatitis with non-neurogenic detrusor sphincter dyssynergia: diagnosis and treatment / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the features of chronic prostatitis with non-neurogenic detrusor sphincter dyssynergia (NNDSD) and the effects of pelvic floor biofeedback in the treatment of the disease.</p><p><b>METHODS</b>We included in this study 113 male patients, aged 15 - 48 (mean 36) years and diagnosed as having chronic prostatitis for 1 -2 (mean 1.2) years based on such typical symptoms as frequent micturition, urgent micturition, voiding pain, difficult void, etc, that lasted over 3 months, and the score > or = 1 on the first and second parts of NIH-CPSI. Urethritis, interstitial cystitis, urethral stricture and neurogenic bladder were excluded. All the patients underwent urodynamic examinations for the uroflow curve, Q(max), Pdet. max and MUCP. Biofeedback was carried out for those with non-neurogenic detrusor sphincter dyssynergia, and the effects were evaluated at 10 weeks.</p><p><b>RESULTS</b>Twenty-one (18.6%) of the 113 cases were found to be NNDSD. Biofeedback treatment achieved obvious decreases in Q(max) (8.2 +/- 4.1), Pdet. max (125.1 +/- 75.3), MUP (124.3 +/- 23.3) and MUCP (101.5 +/- 43.6), as compared with 15.1 +/- 7.3, 86.3 +/- 54.2, 65.4 +/- 23.0 and 43.5 +/- 16.7 before the treatment (P < 0.05). Statistically significant differences were observed between pre- and post-treatment scores on voiding pain (4.0 +/- 2.0 vs 2.2 +/- 1.7), urination (7.9 +/- 2.1 vs 2.2 +/- 1.9), life impact (9.6 +/- 2.7 vs 2.9 +/- 2.6) and total scores (21.7 +/- 4.8 vs 8.4 +/- 4.6) (P < 0.05).</p><p><b>CONCLUSION</b>Chronic prostatitis patients with LUTS may have NNDSD, which is urodynamically characterized by low Q(max), high intra-bladder pressure and increased urethral pressure in some patients. Urodynamic examinations may contribute to definite diagnosis and appropriate choice of treatment. Pelvic floor biofeedback has satisfactory short-term effects in the treatment of these patients.</p>

Clinical features and minimally invasive treatment of prostatic utricle cyst / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the clinical characteristics, diagnostic methods and minimally invasive treatment of prostatic utricle cyst.</p><p><b>METHODS</b>We retrospectively analyzed the clinical data of 9 cases of prostatic utricle cyst, of whom 5 presented with frequent or urgent micturition, 3 with difficult urination or thinning urinary stream, and the other 1 with hemospermia. All the cases underwent ultrasonography and MRI. Transurethral cyst deroofing was performed for 3 of the patients with smaller cysts close to the prostatic urethra, and laparoscopic excision of the prostatic utricle was conducted for the other 6 with bigger cysts behind the prostatic urethra.</p><p><b>RESULTS</b>The duration of transurethral cyst deroofing ranged from 30 to 50 min and intraoperative bleeding was 20 -70 ml; the mean time of laparoscopic excision of the prostatic utricle was 100 - 150 min and intraoperative bleeding was 30 -50 ml. All the patients were followed up for 3 - 12 months, which revealed normal penile erection and ejaculation, and no urinary tract irritation or difficult urination.</p><p><b>CONCLUSION</b>Ultrasonography and MRI are excellent imaging modalities for accurate depiction of prostatic utricle cyst. Transurethral cyst deroofing is valuable for prostatic utricle cyst close to the prostatic urethra. Laparoscopic excision of the prostatic utricle, owing to its safety, effectiveness, minimal invasiveness, fewer complications and rapid recovery, can be used as the first option for the treatment of prostatic utricle cyst.</p>

Holmium: YAG laser lithotripsy under ureteroscopy for treating urinary caluli combined with acute renal failure / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the therapeutic effect and safety of holmium:YAG laser lithotripsy for treating ureteral calculi combined with acute renal failure.@*METHODS@#Ureteroscopic holmium: YAG laser lithotripsy was used in 13 cases of ureteral calculi.@*RESULTS@#After the operation the serum Bun and Cr levels in the patients decreased to different degrees or returned to normal and the stone free rate was up to 92.3% (12/13).@*CONCLUSION@#The ureteroscopic holmium:YAG laser lithotripsy can be the first choice for the upper urinary tract obstruction associated with acute renal failure,due to its safety and efficiency. It can also deal with the double sites of ureteral diseases.

Cause and treatment of dysuria post trans-urethral resection of prostate / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the cause and treatment of dysuria post trans-urethral resection of prostate (TURP).@*METHODS@#The clinical data and the treatment of 22 cases of dysuria post TURP were analyzed retrospectively.@*RESULTS@#All cases including 3 cases of glandular and extraneous material residual, 5 cases of urethrostenosis, 7 cases of bladder neck contracture, and 7 cases of detrusor muscle weakness, were cured after the treatment.@*CONCLUSION@#The main causes of dysuria post TURP were glandular residual, urethrostenosis, bladder neck contracture, and detrusor muscle weakness. Correct preoperative diagnosis and treatment during/post operation are the key to the prevention of dysuria post TURP.

Therapeutic effect of harnal and proscar in treating benign prostatic hyperplasia / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the therapeutic effect of harnal and proscar in treating benign prostatic hyperplasia (BPH).@*METHODS@#Two hundreds and twenty-two patients with BPH were randomly assigned into 2 groups:harnal (0.2 mg/d) group (n = 112) and proscar (5 mg/d) group (n = 108). American Urologic Association Symptom Index (AUA-SI) scores, the maximal urinary flow rate (Qmax) and prostatic volume were analyzed in the 2 groups.@*RESULTS@#After 12 weeks of treatment, 54.5% of the harnal group improved in AUA-SI score; 54.6% of the proscar group improved in AUA-SI score; and there was no significant difference between the 2 groups (P > 0.05). After 24 weeks of treatment, the proscar group (79.6%) had a greater improvement in AUA-SI score than the harnal group (64.3%) (P < 0.05); Qmax in the 2 groups was significantly increased than that before the treatment, and it is proportional to the therapeutic time. The prostatic volume in 2 groups had no significant change.@*CONCLUSION@#Harnal and proscar can significantly improve BPH symptoms and the urinary flow rate. The therapeutic effect of harnal and proscar has their own characteristics.

Study on the correlation between Mta-1 expression and ER,u-PA/PAI-1,MVD in bladder transitional cell carcinoma / 中华泌尿外科杂志

Objective To investigate the expression of Mta-1 in bladder transitional cell carcinoma (BTCC)and to analyze its correlation with the clinical staging,pathologic grading,metastasis and recur- rence,and to explore the possible molecular mechanisms.Methods Samples of 42 cases of BTCC and 12 normal bladder mueosa tissues were examined with immunohistochemical analysis for the expression of Mta- 1,ER,u-PA and PAI-1.Endothelial cells were stained by anti-CD34,and microvascular density(MVD)of carcinoma tissue was calculated.The correlation of Mta-1 expression with the invasion,metastasis,angiogene- sis and recurrence of BTCCs was analyzed;and the correlation of Mta-1 expression with ER,u-PA,PAI-1,and MVD was also analyzed.Results The positive rate of Mta-1 expression in BTCCs was 73.8%(31/42) , while it was 0.0% in normal bladder mucosa tissues(P＜0.01).The expression level of Mta-l increased with the higher clinical stages and pathologic grades of BTCCs;it was higher in recurrence group(100.0% , 15/15)than in non-recurrence group(59.3%,16/27),and high in metastasis group(100.0%,14/14) than in non-metastasis group(60.7%,17/28)(P＜0.05).The expression level of ER increased with the lower clinical stages and pathologic grades of BTCCs;the positive rate of ER expression was 0.0% in 14 ca- ses with metastasis and was 53.6% in 13 of 28 cases without metastasis(P＜0.05);and the rate was 6.7% in 1 of 15 cases with recurrence and 44.4% in 12 of 27 cases without recurrence(P＜0.05).Negative cor- relation was found between Mta-1 and ER expression(r=-0.739,P＜0.01).The positive rate of u-PA ex- pression(59.5%,25/42)was significantly higher in BTCCs than that in normal bladder mucosa tissues (16.7%,2/12)(P＜0.05).Positive correlation was found between u-PA and Mta-1 expression(r= 0.875),while negative correlation was found between u-PA and PAI-1 expression(r=-0.535).The posi- tive rate of PAI-1 expression in normal bladder mucosa tissues(50.0%,6/12)was significantly higher than that in BTCCs(19.0%,8/42)(P＜0.05).In addition,negative correlation was found between PAI-1 and Mta-1 expression(r=-0.706).And positive correlation was found between MVD in BTCCs marked by an- ti-CD34 and Mta-1 expression(r=0.683).Conclusions Mta-1 is highly expressed in BTCCs,and it correlates closely with tumor pathologic grades,clinical stages,recurrence and metastasis.Mta-1 up-regulates the expression of u-PA and down-regulates that of PAI-1,which is associated with invasion and metastasis and acts as an angiogenic mediator in BTCCs.A negative correlation is found between Mta-1 and ER in inva- sion and metastasis of BTCCs.

Chronic prostatitis during puberty and the effects of pelvic floor biofeedback therapy / 中华泌尿外科杂志

Objective To investigate the features of chronic prostatitis during puberty(CPP)and the effects of pelvic floor biofeedback therapy.Methods Totally,25 CPP children (mean age,16 years) and 15 children (mean age,16 years) with normal lower urinary tract as controls were included.In CPP group,NIH-CPSI scores were evaluated,expressed prostatic secretions (EPS) were examined,and bacterial culture was done;and CPP patients were categorized based on the definitions of NIH types.In both groups, urodynamic examination was performed,including evaluation of uroflow curve,maximum flow rate (Q_(max)), post-voiding residual urine (PVR),detrusor-sphincter dyssynergia (DSD),maximum detrusor pressure (P_(det,max))and maximum urethral closure pressure (MUCP).CPP patients underwent biofeedback therapy, and 10 weeks later the effects were assessed.Results In CPP group,NIH typing showedⅡ,ⅢA andⅢB in 1,3 and 21 cases,respectively.Before treatment in CPP and control groups,the incidence of staccato voiding (20 cases vs 1 case),DSD (22 cases vs 1 case),Q_(max)(10.7?3.7 vs 15.0?4.3ml/s),PVR (7.7?4.1vs 3.2?2.6ml),P_(det,max)(115.1?33.6vs 76.8?16.6cm H_2O)and MUCP(176.5?45.7 vs 86.2?28.5cm H_2O)all showed significant differences between the 2 groups(P＜0.05).In CPP group,the differences in pain(4.6?2.2 vs 2.1?1.6),urination (7.9?2.0vs 2.2?1.7),life impact (9.4?2.2vs 2.6?2.1)and total scores(22.0?5.2vs 7.0?4.2) of NIH-CPSI and Q_(max)(10.7?3.7 vs 14.9?5.6) between pre-and post-biofeedback were significant (P＜0.05).Conclusions The main type of CPP is categoryⅢB.The primary symptom is voiding disorder,which leads to greater psychological stress in patients.Children with CPP have pelvic floor dysfunctions and multiple abnormal urodynamic param- eters.The short-term effect of biofeedback strategies for CPP is satisfactory.