[Complications of laparoscopic surgery: a 11-year single institute experience].

OBJECTIVE: To analyze the complications of laparoscopic surgery for the past 11 years in the Urology Department of Peking Union Medical College Hospital. METHODS: The laparoscopic surgery of 5 386 cases from Jan. 2002 to Dec. 2012 was statistically analyzed. The patient's gender, age, surgery mode, blood loss, complications, total length of hospital stay, postoperative hospital stay and other data were analyzed. RESULTS: There were 5 386 cases in this group aged 8-86 years (the mean age: 49.0 years; 2 651 cases were male and 2 735 female). Of all the cases, 2 411 were of adrenal surgery, accounting for 44.7%, 167 of retroperitoneal tumor resection , accounting for 3.1%, 763 of radical nephrectomy surgery, accounting for 14.2%, 441 of partial nephrectomy surgery, accounting for 8.2%, 784 of renal cyst surgery, accounting for 14.6%; 279 of semi-urinary tract resection, accounting for 5.2%; 74 of renal pelvis and ureter plasty, accounting for 1.4%; 141 of radical prostatectomy surgery, accounting for 2.6%, 71 of cystectomy surgery, accounting for 1.3% and 255 of other surgery, accounting for 4.7%. The blood loss was 10-3 000 mL (average: 97.5 mL ) and the surgery requiring blood transfusion treatment involved 270 patients. The total hospital stay was 3-133 days (average: 18 days) and postoperative hospital stay was 2-35 days (average: 6.3 days). All kinds of complications occured in 346 cases (6.42%), of which 198 were of peritoneal injury, 12 of pleural injury; 72 of subcutaneous emphysema, 24 of urinary fistula, 15 of inferior vena cava injury, 6 of pancreatic fistula 10,of lymphatic fistula, 8 of wound delayed healing and 1 of, intestinal fistula. The incidence of the complications and blood transfusion showed a downward trend according to stratified analysis each year. CONCLUSION: The laparoscopic surgery coveres almost all treatment of urological diseases. The complications are different in different types of surgery at different times, but generally no serious complications occurr. The incidence of complications is in a downward trend as the laparoscopic technique level improves.

Open partial nephrectomy in solitary kidney with multiple renal cell carcinoma: a case report / 中国医学科学杂志(英文版)

Renal cell carcinoma (RCC) in a solitary kidney presents a unique clinical challenge to urological surgeons. Partial nephrectomy (PN) or nephron-sparing surgery in this condition provides good oncological and renal functional outcomes with an acceptable complication rate. Long-term renal function remains stable in most patients with solitary kidneys after a reduction of more than 50% in renal mass.PN is a surgical procedure reserved for patients with a tumor in a solitary kidney, bilateral renal tumors, or renal function impairment. The challenge of preserving renal parenchyma is significantly complicated with the discovery of multiple masses in a solitary kidney because any subsequent complications may result in a significant decline in quality of life. Particularly in the case of postoperative renal failure, dialysis becomes necessary.

[Clinical features of urological malignancies with paraneoplastic syndromes].

OBJECTIVE: To investigate the clinical features of paraneoplastic syndromes (PNS) in patients with renal, prostate and bladder cancer and conduct a brief prognostic analysis. METHODS: From 2008 to 2010, 464 patients of renal cell carcinoma (RCC) confirmed by operation and pathology were reviewed retrospectively. And 562 cases of patients with prostate cancer and 647 with bladder cancer from 2005 to 2010 were also analyzed respectively. RESULTS: Among all cases, 156(33.6%)patients were diagnosed with PNS manifesting with anemia, hypertension, fever, polycythemia, Stauffer's syndrome, fatigue, weight loss, anorexia, leukocytosis and hypercalcemia, etc. Two prostate cancer patients had the elevated levels of calcemia and blood glucose respectively. However, no specific clinical presentation in bladder cancer was found to be associated with PNS in this study. CONCLUSION: RCC is the most frequent urological malignancy with PNS. But prostate cancer with PNS is very uncommon and bladder cancer is extremely rare. Most paraneoplastic signs predicate a poor prognosis for the patients.

[Occurrence, types, and therapies of malignant tumors in recipients of renal transplantation].

OBJECTIVE: To investigate the types and therapies of malignancies in renal allograft recipients. METHODS: We retrospectively analyzed the occurrence, types, and therapies of malignancies in 498 renal allograft recipients who had received operations in Peking Union Medical College Hospital from May 1986 to October 2008. RESULTS: Among 498 renal allograft recipients, 18 patients (3.6% ) were diagnosed with malignancies, which included bladder cancer (n = 5), renal pyloric cancer or ureteric cancer (n = 4), leukemia or lymphoma (n = 3), hepatic cancer (n = 2), skin cancer, rectum carcinoma, pulmonary carcinoma and thymoma (n = 1 each). Surgical operations were performed in 10 cases, 6 of whom survived with normal renal function and had no rejection of transplanted kidneys. Three patients with bladder cancer and one patient with ureteric cancer experienced recurrences 7 to 15 months after operations; among them one bladder cancer patient died. One hepatic carcinoma patient died of pulmonary metastasis 8 months after operation. One non-Hodgkin's lymphoma patient died 11 months after chemotherapy. Five cases with advanced unresectable malignancies died 8 to 17 months after the diagnosis. CONCLUSIONS: The incidences of malignancies, especially urological epithelial carcinoma, are high in renal allograft recipients. Radical surgery of the solid malignancies is a preferred option.

[Diagnosis and treatment of primary pigmented nodular adrenocortical disease report of 4 cases].

OBJECTIVE: To study the diagnosis and treatment of primary pigmented nodular adrenocortical disease (PPNAD). METHODS: The clinical data including symptom, endocrinal examination, surgical operation and prognosis of 4 cases of PPNAD hospitalized from 2000 to 2007 were analyzed respectively, relative literature were reviewed. RESULTS: 1 case received total adrenalectomy needed adrenocortical hormone postoperatively, 3 cases responded favorably to subtotal adrenalectomy and did not need adrenocortical hormone, however, 1 case was diagnosed of thyroid carcinoma 2 years after subtotal adrenalectomy. CONCLUSIONS: PPNAD is a rare subtype of ACTH-independent Cushing's syndrome, the diagnosis is depend on symptom, endocrinal examination and pathology. Total adrenalectomy is suitable to the patients with obvious symptom; subtotal adrenalectomy to the patients with mild symptom, the lesion of other endocrinal organ must be followed up postoperatively.

[Analysis of protamine content in patients with asthenozoospermia].

OBJECTIVE: To study the significance of the change of protamine content in the management of male infertility. METHODS: Sperm nuclear proteins extracted from 199 infertile patients were analyzed by polyacrylamide gel-electrophoresis and scanning microdensitometry. RESULTS: Forty-two (21%) cases of the total number had normal sperm nuclear proteins and 157 (79%) had aberrant ones, which mainly presented the interruption of HPRR and abnormality of P2 protamine. Thirty patients were selected at random from 157 abnormal cases for clinical treatment. After the treatment, the sperm nuclear proteins were extracted and analyzed and the results demonstrated that 11 cases (36.6%) improved markedly, 5 (16.6%) restored to normal and the other 16 (46.6%) remained unchanged. CONCLUSION: There is a reduced level or selective absence or even complete selective absence of protamines in infertile patients. Protamines may act as a parameter for evaluating the treatment effect of infertile males and protamine content can be influenced by a certain or several factors.

[The evaluation of the diagnosis and treatment of 32 cases with ectopic ACTH syndrome].

OBJECTIVE: To investigate and discuss the diagnosis and treatment of ectopic ACTH syndrome. METHODS: Clinical data of 32 cases of ectopic ACTH syndrome, recruited from January 1990 to April 2003 in our hospital, was analyzed. RESULTS: All of the 32 cases presented with clinical and biochemical evidences of Cushing's syndrome. Ten cases were definitively diagnosed as ectopic ACTH syndrome by finding ectopic tumors; 4 cases were highly suspected as ectopic ACTH by blood sampling from femoral vein and infra-petrosal vein and 18 cases were suspected as ectopic ACTH by imaging examinations. Fifteen cases (47%), without identified source of ectopic hormone, were treated with bilateral or unilateral total adrenalectomy, with 1-year survival rate of 60%. Seven cases (22%), with possible source of ectopic hormone, underwent no intervention, with 1-year survival rate of 0. Ten cases underwent radical resection of tumor, 6 of which were bronchial carcinoids and 4 of which were thymic carcinoids, with 1-year survival rate of 60%. CONCLUSION: It is very difficult to localize the tumor of ectopic ACTH syndrome patients. Bilateral adrenalectomy followed by hormonal replacement is effective for most of the patients without identifying source of ectopic hormone.

[Clinic analysis of repeat prostatectomy after transurethral prostatectomy for benign prostatic hyperplasia].

OBJECTIVE: To analyze the incidence rate of repeat transurethral prostatectomy (TURP) and its probable causes after TURP for benign prostatic hyperplasia (BHP). METHODS: A retrospective study was conducted to summarize the cases who received repeat transurethral resection of prostate after TURP for benign prostatic hyperplasia in recent 20 years. The data were compared with the data of the cases who just received once TURP for BPH. RESULTS: 1225 patients received TURP for BHP from 1981 to 2001. Fifty-seven patients experienced repeat transurethral resection of the prostate after a mean interval of 3 years and 2 months with an incidence rate of 4.65%. 69.8% of which manifested repeat gross hematuria before repeat prostatectomy, with a rate significantly higher than the general gross hematuria rate and the gross hematuria rate at the first admission (P < 0.005 and P < 0.01). CONCLUSION: The incidence rate of repeat prostatectomy after TURP for BHP is 4.65%. The mean interval between the two procedures is 3 years and 2 months. Gross hematuria is one of the main causes for repeat TURP besides the low urinary tract symptoms.

[Telomerase expression in various lesions of adrenal cortex].

OBJECTIVE: To investigate the expression of telomerase in various lesions of adrenal cortex. METHODS: By autoradiography-based telomeric repeat amplification protocol, telomerase expression was detected in 36 samples of adrenocortical lesions, including 29 cases adrenocortical adenoma (8 Cushing's syndrome, 17 aldosteronism and 4 nonfunctional adenomas), 5 cases of hyperplasia of adrenal cortex (presented with Chushing' syndrome), 2 cases adrenocortical carcinoma, and 4 samples of normal adrenal cortex. RESULTS: Of the 40 samples, 2 cases of adrenocortical carcinomas had telomerase expression, and the others had no telomerase expression detected. CONCLUSIONS: No significant telomerase expression was found among different endocrine functional benign adrenocortical lesions. Telomerase expression may be used as an important marker of malignant adrenocortical tumor.