The predictive value of systemic immune-inflammation index for bone metastasis in patients newly diagnosed with prostate cancer / 中华泌尿外科杂志

Objective:To explore the predictive value of the systemic immune inflammation index (SII) for the risk of bone metastases in patients with newly diagnosed prostate cancer (PCa).Methods:From Jun. 2012 to Jul. 2019, the clinical features of 308 patients were retrospectively analyzed. For the baseline clinical data of the patients with newly diagnosed PCa, the median age was 71(65-76) years, there were 59(19.2%) patients with a positive digital rectal examination (DRE). In addition, the median serum total prostate-specific antigen (tPSA), prostate volume (PV) and prostate-specific antigen density(PSAD)were 60.55(23.55-100.00) ng/ml, 39.35(28.29-56.66)ml and 1.27(0.58-2.52)ng/(ml·cm 3), respectively. There were 33(10.7%)patients with prostate biopsy Gleason score≤6, 115(37.3%)patients with a Gleason score=7 and 160(52.0%)patients with a Gleason score≥8. The T clinical stage also obtained, including 21(6.8%)diagnosed as T 1 stage, 87(28.2%)T 2 stage, 65(21.1%)T 3stage, 135(43.9%)T 4 stage. SII was calculated by the formula platelet×neutrophil/lymphocyte, and the median(interquartile range)of SII was 458.60(300.42-727.11)/L. According to the results of bone scanning, the patients were divided into bone metastasis(146, 47.4%)and a non-bone metastasis groups(162, 52.6%). The differences in the baseline clinical characteristics between the two groups were analyzed. The risk factors of bone metastasis were analyzed by univariate and multivariate logistic regression analysis. The diagnostic efficiency of the risk factors were evaluated by receiver operating characteristic(ROC)curve. Results:The median(interquartile range)of SII was 564.78/L(333.85-961.93/L)in patients with bone metastasis which were higher than those without bone metastasis 413.01(267.63-601.79)/L( P<0.001). The median(interquartile range)of tPSA were 97.79(48.20-119.10)ng/ml in bone metastasis group and 32.56(17.89-72.70)ng/ml in non-bone metastasis group ( P<0.001). The median(interquartile range)of PSAD were 1.91(0.97-3.55)ng/(ml·cm 3)and 0.90(0.45-1.77)ng/(ml·cm 3)in these two groups( P<0.001), respectively. In bone metastasis group, there were 132(90.4%)patients with a positive DRE, yet there were only 117(72.2%) patients with a positive DRE in the other group ( P<0.001). There were 7(4.8%)patients with prostate biopsy Gleason score≤6, 50(34.2%)patients with a Gleason score=7 and 89(61.0%)patients with a Gleason score≥8 in bone metastasis group. There were 26(16.1%)patients with prostate biopsy Gleason score≤6, 65(40.1%)patients with a Gleason score=7 and 71(43.8%)patients with a Gleason score≥8 in non-bone metastasis group ( P<0.001). There were statistically significant difference between the two groups in T clinical stage( P<0.001). In bone metastasis group, there were 2(1.4%)T 1 stage, and 19(13.0%)T 2 stage, 25(17.1%)T 3stage, and 100(68.5%)T 4 stage. Comparatively, there were 19(11.7%)T 1 stage, 68(42.0%)T 2 stage, 40(24.7%)T 3stage, and 35(21.6%)T 4 stage in the other group. There were no statistically significant difference between the two groups in term of age( P=0.057) and TPV( P=0.222). Univariate and multivariate logistic regression analysis showed that tPSA( P=0.003), SII( P<0.001), T clinical stage( P<0.001)could be regarded as independent risk factors of bone metastasis of PCa. Area under the curve of SII+ tPSA was 0.770, which was higher than SII(0.653)or tPSA(0.729) alone( P<0.05). When the cut-off value was 727.72/L, the sensitivity and specificity of the diagnosis of SII alone were 38.4% and 87.7%. The sensitivity and specificity of tPSA alone were 67.1%and 75.9% when the cut-off value was 73.02ng/ml. The sensitivity was 72.6% and the specificity was 71.6% when SII and tPSA was combined. Conclusions:SII is an independent predictor of bone metastasis of newly diagnosed with PCa. , and the patients were at high risk when SII exceeded 727.72/L. The combination of SII and tPSA can improve its predictive validity for the risk of bone metastasis.

A missed diagnosis case with squamous cell carcinoma of renal pelvis / 中华泌尿外科杂志

Squamous cell carcinoma (SCC) of the renal pelvis is extremely rare and hardly to be diagnosed due to its lack of specificity in clinical manifestations and traditional imaging features. We reported a case with history of multiple operations for double kidney stones, who was admitted to our hospital twice due to "right kidney ureteral stones, left kidney complex stones, chronic renal insufficiency and urinary tract infection" . During this period, a total of 6 surgeries were performed. In the first 19-day hospitalization, right transurethral ureteroscopic lithotripsy and right percutaneous nephroscope lithotripsy(PCNL)were performed respectively. And 20 days later, the patient was admitted to hospital again for management of left complex kidney stones, and the left side PCNL was performed for 4 times within 27 days. During the two hospitalizations, no tumor was reported during the three times of contrast-enhanced CT examination of the urinary system. The patient continued to have fever after the 4th time of left PCNL, with failure of anti-infection treatment. Then, the of the left renal pelvis was considered clinically, and left nephrectomy was suggested after communication with the patient and his family members. Postoperative pathology confirmed renal pelvis SCC. After surgery, the patient’s temperature was back to normal and then discharged. The patient died 3 months after discharging due to the systemic metastasis.

Early complications after robot-assisted laparoscopic radical cystectomy and their risk factors / 中南大学学报(医学版)

To identify risk factors for early complications in patients after robot-assisted laparoscopic radical cystectomy (RARC) and a standardized reporting model to predict complications precisely and recommend reasonable prophylaxis.
 Methods: A total of 90 patients with bladder cancer, who underwent RARC in the Second Xiangya Hospital and the Third Xiangya Hospital of Central South University from January 2016 to January 2018, were enrolled for this study. Their clinical information, preoperative examination and follow-up data within 90 d after RARC were collected. Univariable and multivariable logistic regressions were performed to identify risk factors for early complications after RARC.
 Results: The overall incidence of complications within 90 d after RARC was 48.9% (44/90), including 9 cases of Clavien grade 1, 17 cases of Clavien grade 2, 4 cases of Clavien grade 3, 12 cases of Clavien grade 4, and 2 cases of Clavien grade 5. Acute renal injury (22.2%), intestinal obstruction (16.7%), urinary tract infection (14.4%) and lymphatic leakage (10.0%) were the most common complications within 90 d after the operation. Two patients (2.2%) died within 90 d after the operation. Preoperative BMI (OR=1.16, 95% CI 1.02 to 1.32), postoperative instant (≤30 min) serum creatinine (OR=1.02, 95% CI 1.00 to 1.03), and pT stage (OR=1.67, 95% CI 1.05 to 2.68) were the risk factors for early complications after RARC. 
 Conclusion: The incidence of early complications after RARC is high. Preoperative hemodialysis, correction of anemia, intraoperative protection of renal function, and early recovery after surgery are helpful to prevent early complications after RARC.

The prognostic value of neutrophil to lymphocyte ratio on prostate cancer patients treated with maximal androgen blockade / 中华泌尿外科杂志

Objective To evaluate the prognostic value of pretreatment neutrophil to lymphocyte ratio (NLR) on prostate cancer patients treated with maximal androgen blockade (MAB).Methods The clinical data of 249 prostate cancer patients treated with MAB in our hospital from October 2007 to March 2017 were retrospectively analyzed.Among all the patients,the median age was 72 years old (ranged 48 to 89 years).The BMI was 14.5-31.8kg/m2 (median 23.0 kg/m2).The PSA was 1.00-758.21 ng/ml (median 60.04 ng/ml).216 patients' tumor invaded surrounding tissues;lymph node metastasis occurred in 157 patients;and distant organ metastasis occurred in the remaining 174 patients.The Gleason score was 3-10 (median 7).Copfimary end points were progression-free survival (PFS) and cancer-specific survival (CSS).The best cutoff value of NLR was calculated by receiver operating characteristic (ROC) curve.The prognostic analysis of NLR on prostate cancer patients treated with MAB was estimated using Cox proportional hazards models and Kaplan-Meier analysis.Results The ideal cutoff value of the pretreatment NLR was 2.29 (95％ CI 0.603-0.737,P ＜0.001) determined by the ROC curve according to the survived and deceased cases at the end point of CSS,by which the 249 patients was divided into the high NLR group of 119 patients (47.8％) and the low NLR group of 130 patients (52.2％).High NLR was significantly associated with high Gleason score (P =0.019),higher clinical T stage (P =0.001),N stage (P ＜ 0.001),M stage (P ＜ 0.001) and more neutrophil count (P ＜ 0.001).The median follow-up time was 29 months (ranged 5 to 124).During this period,115 patients died,and the whole fatality rate was 46.2％.40 patients died in low NLR group (30.8％),while the figures for the high NLR group were 75 (63.0％).Kaplan-Meier analysis demonstrated that patients with NLR ≥ 2.29 had a poor outcome both in PFS (P ＜ 0.001) and CSS (P ＜ 0.001).The multivariate Cox analysis showed that NLR,Gleason score,clinical TNM stage and ECOG score were independent predictors for PFS and CSS.Conclusion Pretreatment NLR could be an independent prognostic biomarker for PFS and CSS in prostate cancer patients undergoing MAB.

Initial experience with robot-assisted laparoscopic prostatectomy for complicated cases / 中南大学学报(医学版)

Objective:To present our initial experience with robot-assisted laparoscopic prostatectomy (RALP) for complicated cases.Methods:Clinical and pathological data from 4 complicated prostate cancer cases,who underwent RALP from October to November in 2015,were analyzed retrospectively.All the cases were conducted transurethral plasmakinetic enucleation of prostate and hormonal therapy before RALP.Results:All surgeries were done successfully.The age,baseline prostatic special antigen,clinical tumor stage,operation time and estimated blood loss were 58-70 years,6.04-70.15 ng/mL,T2bT3b,210-360 min and 50-250 mL,respectively.No blood transfusion was needed.All surgical margin were negative.Conclusion:Although previous transurethral surgeries and hormonal therapies may increase the difficulty for operations,RALP is still appropriate for the complicated cases of prostate cancer.

Expression of perforin and granzyme-B in peripheral blood lymphocyte in patients with prostate cancer and the clinical significance / 中南大学学报(医学版)

OBJECTIVE@#To explore the expression of perforin and granzyme-B in peripheral blood lymphocyte (PBL) in patients with prostate cancer (PCa) and the clinical significance.@*METHODS@#The expressions of perforin and granzyme-B in PBL were detected by fluorescence quantitative reverse transcription polymerase chain reaction. The results of perforin and granzyme-B expression were compared among patients with PCa (n=60), patients with BPH (benign prostatic hyperplasia, n=40) and healthy controls (n=20).@*RESULTS@#Th e expressions of perforin and granzyme-B in patients with PCa were significantly lower than that in patients with BPH or that in the healthy controls (P<0.05), respectively. Furthermore, in PCa patients with low pathological grade, the expressions of perforin and granzyme-B in PBL was statistically higher than that in patients with high pathological grade (P<0.05). The expressions of perforin and granzyme-B in PCa patients at high clinical stage was statistically lower than that in PCa patients at low clinical stage (P<0.05).@*CONCLUSION@#The results of this study suggest that development and progression of PCa might be associated with poor immune status of patients.

A case of metastatic castration-resistant prostate cancer by abiraterone treatment / 中南大学学报(医学版)

We reviewed and analyzed the clinical data for a patient with metastatic castration-resistant prostate cancer (mCRPC) from September, 2009 to December, 2014. After the treatment with abiraterone, patient's performance status improved, pain relieved, total prostate specific antigen (tPSA) and free prostate specific antigen (fPSA) markedly decreased. tPSA or fPSA fluctuated between 
30 and 50 ng/mL or between 10 and 20 ng/mL. MRI showed the left peripheral zone reduced. MRI and bone single photon emission computed tomography (SPECT) scan showed no new metastasis. These results indicated that application of abiraterone for patient with mCRPC not only decreased prostate specific antigen (PSA) levels and tumor volume, but also blocked bone metastasis progression and enhanced pain relief.

Total cystectomy and W-shaped orthotopic ileal neobladder for bladder cancer / 中南大学学报(医学版)

Objective: To investigate the clinical effect of total cystectomy and W-shaped orthotopic ileal neobladder for bladder cancer. Methods: Total cystectomy and W-shaped orthotopic ileal neobladder were performed on 29 male patients and 3 female patients. Atfer the cystectomy, 35-40 cm terminal ileal segment was isolated to make W-shaped orthotopic ileal neobladder. Bilateral uretero-ileal anastomoses were constructed by nipple technique, urethral stump was sutured to the lowest portion of the ileal pouch. Results: All surgeries were completed successfully. Patients were able to void by increasing the abdominal pressure, daytime continence rate was 87.5% and nighttime continence rate was 78.1%. The mean neobladder capacity was 410.6 mL and the mean postvoid residual urine was22.7 mL at 6 months. After the surgery, ileal neobladder leakage occurred in 3 (9.4%) patients, mild ileus occurred in 2 (6.3%) patients, ileo-urethral anastomosis stricture developed in 1(3.1%) patient, and dysuria occurred in 3 (9.4%) patients because of the mucus.HTe complications were treated properly and satisfactory results were obtained. Erection was preserved in 5 of the 9 male patients with normal erectile function, and normal sexual function was preserved in 1 female patient who underwent uterus-sparing cystectomy. HTe mean follow-up was 15 months.One patient died of distant metastasis and pneumonia, while other patients survived without tumor. Conclusion: Total cystectomy and W-shaped orthotopic ileal neobladder have the advantages of voiding through the native urethra, satisfactory continence, low complication rates of upper urinary tract damage and electrolyte imbalance. W-shaped orthotopic ileal neobladder may be considered as the ifrst option of urinary diversion atfer cystectomy. Postoperative management should focus on complications and follow-up.

Constructing a p53-fused dual luciferase reporter and verifying its function / 中南大学学报(医学版)

Objective:To construct a p53-fused dual luciferase reporter and to test whether this reporter can mimic wild-type p53 activities in a high-throughput screen.Methods:A restriction endonuclease site was added to each terminus and the stop codon of the wild-type full-length p53 open reading frame (ORF) was removed by PCR. A restriction endonuclease site was added to each terminus and the start codon of the ifrelfy luciferase ORF was removed by PCR. The two modified ORFs were inserted upstream of the IRES-induced renilla luciferase ORF in a CMV-derived vector. hTe p53 fusion protein was expressed in cells to test its MDM2-mediated degradation, subcellular localization, and induction of p53-responsive promoter. Results:hTe p53-fused dual luciferase reporter was successfully constructed. Atfer transfection into the host cells, the reporter expressing the p53 fusion protein that was degraded by oncoprotein MDM2, was mainly located inside the nucleus, and induced the p53-responsive promoter, respectively. Conclusion:hTe p53-fused dual luciferase reporter (p53FL/IRES/RL) can identify modulators of P53 protein level in a high-throughput screen of genetic or chemical libraries.

Clinical features of acute urine retention in patients with benign prostate hyperplasia / 中南大学学报(医学版)

OBJECTIVE@#To explore the clinical features of acute urine retention (AUR) ocurring in patients with benign prostate hyperplasia (BPH).@*METHODS@#Clinical data from 548 patients diagnosed with BPH were retrospectively studied, and the clinical parameters of these patients with or without AUR were analyzed by statistical methods.@*RESULTS@#Development of AUR was found in 164 patients (29.9%). Patients' age, IPSS, maximum flow rate (Q(max)), residual urine volume, prostate volume, transition zone volume, prostate-specific antigen (PSA) density, total PSA (tPSA) and free PSA (fPSA) including the ratio of free to total PSA(f/tPSA) were significantly different in the 2 groups (P0.05). Multivariate logistic regression analysis showed that IPSS score, residual urine volume, tPSA, and Q(max) were risk factors for predicting the development of AUR.@*CONCLUSION@#BPH patient's age, IPSS, Q(max), residual urine volume, prostate volume, transition zone volume, tPSA and fPSA, and PSA density all influence the occurrence of AUR, in which symptom severity, residual urine volume, total PSA and Q(max) are the principal risk factors for prognosing AUR.

Comparison the effects of prone and modified recumbent positions on minimal invasive percutaneous nephrolithotomy / 中南大学学报(医学版)

OBJECTIVE@#To compare the safety and efficacy of prone and modified recumbent positions on minimal invasive percutaneous nephrolithotomy.@*METHODS@#A total of 62 patients with upper urinary calculi were grouped into two groups, one of which consisted of 27 patients who underwent the minimal invasive percutaneous nephrolithotomy with modified recumbent position, and the other 35 patients with prone position. There was no significant statistical difference in the age, gender and complications between the two groups before surgery (P>0.05). Duration of and blood loss during surgery, complications in the perioperative period, and the length of postoperative hospital stay were all recorded. The data were analyzed by SPSS 13.0.@*RESULTS@#Surgery was successful in all cases. There was no failure to puncture nor need to resort to open surgery. Average operation duration for the modified recumbent position group was (85.1± 25.3) min vs (97.2±30.6) min for the prone position group. Mean blood loss during the operation was (117.5± 49.7) mL vs (149.3±53.1) mL. There were no severe complications during and after surgery in the modified recumbent position group. In the prone position group, s one patient suffered pneumothorax during the operation and two suffered selective renal artery embolization because of massive hemorrhaging following the operation. There were significant differences in blood loss during surgery, in complications during the perioperative period, and in length of postoperative stay in hospital (P<0.05) between the two groups.@*CONCLUSION@#The patients are safer and more easily tolerate the minimal invasive percutaneous nephrolithotomy in the modified recumbent position than in the prone position, though the treatment efficacy of these two kinds of operation is similar. It is recommended that the modified recumbent position should be used generally in the percutaneous nephrolithotomy.

Improvement of lower urinary tract symptoms in patients with prostate cancer treated with maximal androgen blockade / 中南大学学报(医学版)

OBJECTIVE@#To investigate the timing of reaching maximum improvement of the lower urinary tract symptoms (LUTS) in patients with advanced prostate cancer treated with maximal androgen blockade(MAB), and to provide guidelines for the treatment program.@*METHODS@#We collected the data of 45 advanced prostate cancer patients complicated with lower urinary tract symptoms who were treated by MAB. The international prostate symptom score (IPSS) and maximum urinary flow rate (Qmax) were selected as indicators reflecting the degree of lower urinary tract symptoms and were observed before the MAB, 3, 6, and 9 months after the patients received MAB. We also observed the changes of prostate volume and analyzed the role of MAB in improving LUTS in patients with prostate cancer.@*RESULTS@#The IPSS and Qmax had significant difference between the 3rd month after the patients received MAB and before the MAB (P0.05). The prostate volume had significant difference in the 3rd month and the 6th month (P0.05).@*CONCLUSION@#MAB for patients with advanced prostate cancer can improve their lower urinary tract symptoms, whose main effect is presented in the 3rd months after the androgen deprivation therapy.

Clinical analysis of benign prostate hyperplasia with prostatitis / 中南大学学报(医学版)

OBJECTIVE@#To analyze the clinical features of benign prostate hyperplasia (BPH) with prostatitis and the role of prostatitis in progression of BPH.@*METHODS@#From July 2003 to Feb. 2009, 466 patients diagnosed BPH were enrolled in this study. Several items including age, history, IPSS, volume of prostate, prostatic special antigen (PSA) and related parameters, Qmax, acute urinary retention (AUR) and the way of treatment were analyzed.@*RESULTS@#A total of 423 patients were diagnosed as BPH with prostatitis (90.77%, PS/BPH group), and 43 were BPH without prostatitis (9.23%, BPH group). Compared with the BPH group, patient's history of the PS/BPH group was longer, IPSS/QOL was increased, the volume of total prostate and transitional zone were larger, maximum flow rate was decreased and risk of AUR was increased, and the proportion of BPH-related surgery was higher.There was no significant difference in patient's age, tPSA, fPSA, f/tPSA, and PSAD between the 2 groups.@*CONCLUSION@#Prostatitis may be one etiological factor for BPH. Patients with inflammation were more likely to progress clinically in terms of lower urinary tract symptoms (LUTS), acute urinary retention (AUR), or BPH-related surgery.

Real-time Rigiscan monitoring and color Doppler ultrasonography in the diagnosis of erectile dysfunction / 中南大学学报(医学版)

OBJECTIVE@#To determine the diagnostic value of real-time Rigiscan monitoring and Doppler ultrasonography following intracavernous injection of prostaglandin E1in erectile dysfunction(ED).@*METHODS@#From January 1998 to December 2007, 1 392 ED patients completed the test. PGE(1) was injected into corpus cavernosum penis near the radix penis with injection guns. After 1 or 2 minutes, the Rigiscan Plus device was used for real-time evaluation of penile rigidity. Optimal injected dosage of each patient with positive reaction was determined. Injected dosage of patients with negative reaction was gradually increased from to 60 microg. As the dosage was established, color Doppler ultrasonography was used to assess the morphodynamic features of cavernosal arteries.@*RESULTS@#Altogether 1 039 patients were positive, while 353 patients were negative by Rigiscan. In the 1 039 positive patients,663 were injected with 10 microg PGE(1), 265 patients 20 microg, 97 patients 30 microg,and 14 patients 60 microg while 89(13.4%),39(14.7%),41(42.3%),and 10(71.4%) patients were diagnosed vascular ED. Of the 353 negative patients, 267(75.64%) patients were diagnosed vascular ED. During intracavernous pharmacological testing,the more PGE(1) was used, the more vascular ED patients would be found(P<0.001).@*CONCLUSION@#PGE(1) is safe and effective for the erectile responses. The dosage of PGE(1) following intracavernous injection is related to vascular ED. Real-time Rigiscan monitoring combined with color Doppler ultrasonograph can be helpful to diagnose penile vascular diseases.

Expression of Raf kinase inhibitor protein and E-cadherin in prostate cancer tissues / 中南大学学报(医学版)

OBJECTIVE@#To detect the expression of Raf kinase inhibitor protein (RKIP) and epithelial cadherin (E-cadherin) in human prostate cancer tissues, and their correlation.@*METHODS@#We discussed the relationship between RKIP and E-cadherin and the clinical stage and pathological classification of prostate cancer by immunofluorescence histochemistry staining in the test of expression of RKIP in 26 prostate cancer tissues and 14 BPH tissues, and analyzed the correlation between them.@*RESULTS@#The expression of RKIP and E-cadherin in prostate cancer tissues was obviously lower than that in the benign prostatic hypertrophy tissues. The expression of RKIP and E-cadherin in the dys-good differentiation group (Gleason 8-10) was significantly lower than that in the good differentiation group(Gleason

A modified transperineal approach to treat posterior urethral atresia in boys / 中华泌尿外科杂志

Objective To evaluate the treatment of traumatic posterior urethral atresia in boys via a modified transperineal approach. Methods The transperineal approach was adepted in 11 cases with transecting the central perineal teadon, excising the ligaments of arcuate pubis and the traumatic scar, so that end-to-end anastomosis of urethra could be achieved with good exposure. Results 10 cases were cured after the first operation, where as one patient needed the procedure for 3 times. Conclusions The modified transperineal approach provide a good exposure for the anastomosis of urethra in boys.

One-stage repair for 205 cases of boy hypospadias with different procedures / 中华泌尿外科杂志

Objective To evaluate surgical results an d choice of various procedures for hypospadias repair in boys.323 cases of hypospa dias were treated from 1995-2002,and of these,205 boys whose average age was 5.1 years had underwent different surgical procedure for hypospadias. M ethods 205 boys with hypospadias were retrospectively analysed.MAGPA (5 cases),Mathieu(7),Onlay island flap(9) were given to boys of hypospadias wit hout chordee.Duckett procedure (127),Modified Denis-Browne (16),Bladder mucosa graft technique (16),Duckett plus Duplay techniques(25) were adopted for hypospa dias with chordee. Results There were 19 cases with uret hra fistula and 1 case with external orifice stricture of urethra.The success ra te for all cases was 90.2%,and morbidity of all complications was 9.8%.The compl ication for Duckett techniques was 7.8%(10/127),Modified Denis-Browne 12.5%(2/1 6),Mathieu 28.6%(2/7),Duplay plus Duckett 16.0%(4/25),Bladder mucosa graft techn ique 6.3%(1/16) and Onlay 11.2%(1/9). Conclusions It is suggested that a complete mastery of applications for different surgical approac h and a proper selection of various surgical methods according to individual pat ient’s condition can reduce complication of operation.