Teratomas on the palate and tongue with cleft palate: a case report / 华西口腔医学杂志

Teratomas is a germ cell tumors, which is rare in the upper palatal and lingual. This article presents a patient with teratomas on the palate and tongue accompanied with cleft palate. The clinical manifestations and histopathological characteristics of teratomas are discussed according to relevant literatures.

[Management of calyceal diverticular calculi with stenotic infundibulum by flexible ureteroscopic holmium laser infundibulectomy and lithotripsy].

OBJECTIVE: To evaluate the efficacy and safety of flexible ureteroscopic holmium laser lithotripsy in treating calyceal diverticular calculi with stenotic infundibulum and to present our initial experience. METHODS: From Nov. 2012 to Nov. 2014, 10 patients with stone-bearing calyceal diverticulum and stenotic infundibulum underwent flexible ureteroscopic holmium laser lithotripsy in our hospital, including 3 female patients and 7 male patients with an average age of 36.9 years (range: 20 to 62 years). There were 6 patients with right side while 4 patients with left side calyceal diverticular calculi. The average cumulative stone size was (1.33±0.43) cm. Five patients underwent extracorporeal shock wave lithotripsy (ESWL) before hospital admission but no stone was discharged. All the patients received intravenous urography (IVU) and CT-urography (CTU) preoperatively and underwent double-J stents placement 2 weeks before operations. A digital-fiber flexible ureteroscopy and 200 µm holmium laser fiber were used for treatment. Surgeries began with routine flexible ureteroscopy and methylene blue injection was used to identify the small ostium of infundibulum. Then infundibulectomy followed by lithotripsy was performed. All the patients receive double-J stents placement and traditional Chinese medicine for 1 to 3 months after operations. The stone clearance was estimated by kidney ureter bladder (KUB) within 3 months' follow up. RESULTS: The locations of calyceal diverticulum were upper pole in 7 patients, and interpolar regions in 4 patients. The average operation time was (123.7±59.6) min, and the average estimated blood loss was (29.3±32.1) mL. Successful flexible ureteroscopic holmium laser infundibulectomies were performed in all the 10 patients. Success rate was 100%. The stone clearance rates for 1 and 3 months after surgery were 50.0% and 80.0%, respectively, which were observed by KUB follow-up. Two patients had serious post-operative fever (>38.0 °C) in coexistence with chills. The mobidity of urosepsis was 20.0%. No major complications were identified. CONCLUSION: In selected patients, calyceal diverticular calculi with stenotic infundibulum can be treated safely and efficiently with flexible ureteroscopic homium laser lithotripsy. CTU and IVU should be completed preoperatively for calyceal diverticulum location and technique difficulty prediction. Retrograde methylene blue injection can be used to identify the ostium during surgery. And prolonged post-operation stone clearance was observed.

[Effect and impact of holmium laser versus thulium laser enucleation of the prostate on erectile function].

OBJECTIVE: To compare the effect and impact of holmium laser enucleation of the prostate (HoLEP) and 120-W thulium: YAG vapoenucleation of the prostate (ThuVEP) on erectile function in the treatment of benign prostatic hyperplasia (BPH). METHODS: We retrospectively analyzed 93 cases of symptomatic BPH treated by HoLEP or 120 W ThuVEP. We made comparisons between the two groups of patients in the baseline and postoperative clinical and surgical indexes as well as their IPSS, quality of life (QOL), maximum flow rate (Qmax), postvoid residual urine volume (PVR), and IIEF-EF scores before surgery and during the 12-month follow-up. RESULTS: ThuVEP, in comparison with HoLEP, achieved a significantly shorter operation time ([57.6 +/- 12. 8] vs. [70.4 +/- 21.8] min, P = 0.001) and a higher laser efficiency ([0.71 +/- 0.18] vs. [0.62 +/- 0.19] g/min, P = 0. 021). At 1, 6, or 12 months of follow-up, no significant differences were observed in IPSS, OOL, Omax, and PVR between the two groups (P > 0.05). Both the HoLEP and ThuVEP groups showed low incidences of complications and remarkably improved IIEF-EF scores at 12 months postoperatively, but with no significant differences (both P > 0.05). However, in those with relatively normal erectile functions before operation, the mean IIEF-EF score was reduced from 22.8 +/- 2.2 preoperatively to 21.0 +/- 2.7 after HoLEP, (P = 0.036). CONCLUSION: Both HoLEP and 120W ThuVEP are effective and safe in the treatment of BPH. Compared with HoLEP, 120 W ThuVEP has even a higher laser efficiency. However, neither can significantly improve erectile function, and HoLEP may have a short-term negative impact on the relatively normal erectile function of the patient.

Efficacy and safety of 120-W thulium:yttrium-aluminum-garnet vapoenucleation of prostates compared with holmium laser enucleation of prostates for benign prostatic hyperplasia.

BACKGROUND: This study compared the efficacy and safety between 120-W thulium:yttrium-aluminum-garnet (Tm:YAG) vapoenucleation of prostates (ThuVEP) and holmium laser enucleation of prostates (HoLEP) for patients with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). METHODS: A retrospective analysis of 88 consecutive patients with symptomatic BPH was carried out, who underwent either 120-W ThuVEP or HoLEP nonrandomly. Patient demographics and peri-operative and 12-month follow-up data were analyzed with the International Prostate Symptom Score (IPSS), quality of life (QoL) score, maximum flow rate (Qmax), postvoid residual urine volume (PVR), and rates of peri-operative and late complications. RESULTS: The patients in each group showed no significant difference in preoperative parameters. Compared with the HoLEP group, patients in the 120-W ThuVEP group required significantly shorter time for laser enucleation (58.3 ± 12.8 min vs. 70.5 ± 22.3 min, P = 0.003), and resulted in a significant superiority in laser efficiency (resected prostate weight/laser enucleation time) for 120-W Tm:YAG laser compared to holmium:YAG laser (0.69 ± 0.18 vs. 0.61 ± 0.19, P = 0.048). During 1, 6, and 12 months of follow-ups, the procedures did not demonstrate a significant difference in IPSS, QoL score, Qmax, or PVR (P > 0.05). Mean peri-operative decrease of hemoglobin in the HoLEP group was similar to the ThuVEP group (17.1 ± 12.0 g/L vs. 15.2 ± 10.1 g/L, P = 0.415). Early and late incidences of complications were low and did not differ significantly between the two groups of 120-W ThuVEP and HoLEP patients (P > 0.05). CONCLUSIONS: 120-W ThuVEP and HoLEP are potent, safe and efficient modalities of minimally invasive surgeries for patients with LUTS due to BPH. Compared with HoLEP, 120-W ThuVEP offers advantages of reduction of laser enucleation time and improvement of laser efficiency.

[Endoscopic therapy combined antegrade percutaneous approach and retrograde transurethral approach for ureteral obstruction after kidney transplantation].

OBJECTIVE: To evaluate the method and efficacy of endoscopic therapy combined with antegrade percutaneous approach and retrograde transurethral approach for ureteral obstruction after kidney transplantation. METHODS: Eight cases were analyzed retrospectively who received endoscopic therapy combined with antegrade percutaneous approach and retrograde transurethral approach when they had been diagnosed with ureteral obstruction in the transplant kidney from February 2007 to March 2013 in Department of Urology, Peking University Third Hospital. The cases included three males and five females, with the average age being 44 years (30-64 years). The interval between ureteral obstruction and kidney transplantation ranged from one month to 12 months. Four cases presented with increased serum creatine, two with anuria and two with urinary leakage. The stricture site was located in ureter terminal part in seven cases, and middle part in 1 case. In three cases, percutaneous nephrostomy were carried out immediately while endoscopic therapy combined with antegrade percutaneous approach and retrograde transurethral approach were carried out later. The remaining five cases were treated simultaneously. RESULTS: The average serum creatine decreased from (237±43) µmol/L to (121±29) µmol/L (P<0.05) after the therapy. No perioperative complications occurred. Two urinary fistula healed. Six cases were treated successfully with two cases that failed followed by percutaneous nephrostomy. The ureteral obstruction recurred in one case after six months with recurrence rate of 17% (1/6). CONCLUSION: Endoscopic therapy combined with antegrade percutaneous approach and retrograde transurethral approach is an effective therapeutic approach to treat ureteral obstruction in transplant kidney which shows good clinical results.

Marginal living donor in kidney transplantation: experience in a Chinese single center.

BACKGROUND: Living donor kidney transplantation is becoming popular in China, whereas, in clinical situations, some kidney donors may be sub-optimal, namely marginal living donor. The present study aimed to evaluate the safety and efficacy of marginal living donor kidney transplantation in a Chinese single center. METHODS: Between January 2001 and December 2009, 888 kidney transplantations were performed in our center; 149 were living donor kidney transplantations. The living donors and recipients were followed up regularly after the operation. Of the living donors, 30 donors were marginal, who were older than 60 years or suffered from kidney anomaly or some benign diseases. Among the non-marginal living kidney transplantations, 58 donors and recipients had complete perioperative and follow-up data. We compared the marginal and non-marginal living donor kidney transplantations with regard to donor age, follow-up period, donor's serum creatinine at the last follow-up, recipient's serum creatinine at the last follow-up, and graft survival at the last follow-up. RESULTS: The mean age of donors in the marginal and non-marginal living donors were (55 ± 9) (37-66) and (43 ± 12) (30-59) years. The mean follow-up times of the marginal and non-marginal groups were (26.4 ± 13.4) months and (28.8 ± 14.8) months. The donor and recipient serum creatinine levels at the last follow-up were (1.16 ± 0.20) mg/dl and (1.30 ± 0.24) mg/dl in the marginal group, and (1.12 ± 0.32) mg/dl and (1.34 ± 0.32) mg/dl in the non-marginal group. Three recipients in the marginal group and five recipients in the non-marginal group had acute rejection episodes during the first year. Actuarial 3-year graft survival was 96.7% in the marginal group and 100% in the non-marginal group. No significant differences were detected between the two groups with regard to these data. CONCLUSION: Utilization of highly selective marginal living donors can be a safe, feasible, and effective way for the treatment of patients with end stage renal disease.

[Laparoscopic nephron-sparing surgery for treatment of complex cystic renal lesions].

OBJECTIVE: To evaluate the feasibility, efficacy and safety of laparoscopic partial nephrectomy for complex renal cystic lesions. METHODS: A retrospective cohort study was conducted on the clinical data of 27 patients with complex renal cystic lesions treated by laparoscopic partial nephrectomy from May 2008 to April 2011 in Peking University Third Hospital. According to the Bosniak classification, 7 cases were lesions of grade IIF, 11 of grade III, and 9 of grade IV. The mean diameter of cystic lesions was (3.58±0.75) cm, and 4 lesions were larger than 4.0 cm. RESULTS: All procedures were performed through retroperitoneal approach and successful. The mean operative time was (123.1±16.8) min, ranging from 100 min to 160 min, and the mean renal warm ischemia time was (29.7±3.5) min, ranging from 25 min to 40 min. Blood loss in the operations was from 50 mL to 110 mL, the mean being (75.5±21.8) mL. The postoperative hospital stay was 4 to 6 days, and the mean was (5.11±0.85) days. Postoperative pathological results included 10 simple renal cysts (37.0%), 2 cases of adult cystic nephroma (7.4%), 1 mixed epithelial and stromal tumor (3.7%), 13 cases of renal cell carcinoma with cystic change (48.1%), and 1 multilocular cystic renal cell carcinoma (3.7%). The results showed that 14.3% of cystic lesions of grade IIF, 45.5% of grade III and 88.9% of grade IV were malignant. In the follow-up ranging from 12 to 48 months (median 24 months), there was no case of recurrence. CONCLUSION: The differentiation between benign and malignant renal cystic lesions before surgery remains difficult. According to the Bosniak classification, radiological diagnostic findings are standardized, but still limited in the accuracy to determine the dignity of pathological entity. Laparoscopic partial nephrectomy is feasible to treat complex renal cystic lesions, and is a safe and effective minimally invasive option.

[Postoperative urinary continence and learning curve after laparoscopic radical prostatectomy].

OBJECTIVE: To evaluate urinary continence outcomes after laparoscopic radical prostatectomy (LRP), and explore the learning curve for continence. METHODS: Between May 2006 and May 2011, 200 consecutive patients with clinically localized prostate cancer underwent LRP in Peking University Third Hospital, of whom 160 were performed by a single surgeon and followed up successfully. The average age was (71.9±5.5) years (their age range: 56 to 85 years). All the patients were continent before operation. Of these patients, 11 had undergone previous transurethral resection of the prostate (TURP) and the other 149 were diagnosed by transrectal prostate biopsy. No metastasis was found before surgery. The data about the patients and the operations were recorded. The time from operation till urinary continence was obtained and accessed by interviews. Continence was defined as the use of no pad and no urinary leakage or loss of a few drops occasionally. The patients were divided into 4 equal groups in the 40 consecutive series to determine whether continence was statistically different in group A (1-40) as compared with the other groups. RESULTS: All the operations were performed laparoscopically without any conversion to open surgery. The mean operative duration was (230±57) min (ranging from 110 to 493 min), the median estimated blood loss was 200 mL (ranging from 30 to 1 200 mL), 12 patients (7.5%) received blood transfusions intraoperatively, and the average hospital stay after surgery was (11.8±7.9) d (ranging from 5 to 60 days). The distribution of pathologic stages was as follows: T2a 20%, T2b 16.9%, T2c 40%, T3a 15%, T3b 5.6% and T4 2.5%. The overall positive surgical margin (PSM) rate was 32.5%. The overall continence rates (no pad) were 14.4% after 1 month, 48.8% after 3 months, 77.5% after 6 months and 86.3% after 12 months. At the end of the follow-up, 21 patients (13.1%) were still incontinent . There was a significant difference in continence between the early (Group A) and later groups (P<0.05). CONCLUSION: Continence results after LRP were encouraging, which were comparable to the results in previously published open series. Continence could be improved with increasing surgical experience, and it takes 40-50 cases to reach a plateau for surgeons who have some experiences of laparoscopic operations.

[Joint therapy of native upper tract transitional cell carcinoma ipsilateral to a transplanted kidney by retroperitoneoscopic nephroureterectomy combined with a midline lower abdominal transperitoneal excision].

OBJECTIVE: To present the preliminary experience of the operative procedure and clinical outcomes of retroperitoneal laparoscopic nephroureterectomy (RPLNU) with a midline lower abdominal transperitoneal incision for native upper urinary tract transitional cell carcinoma (UUT-TCC) ipsilateral to a transplanted kidney. METHODS: In the study, 15 renal recipients with native UUT-TCC ipsilateral to a transplanted kidney were operated on with RPLNU via a midline lower abdominal transperitoneal incision between November 2005 and January 2009. Retroperitoneal laparoscopic nephrectomy was performed first and followed by cystoscopic excision of ipsilateral ureteral orifice with bladder cuff. A 6-8 cm midline lower abdominal incision was made. The distal ureter was dissected transperitoneally into the intramural segment and extracted completely. The intact specimen was removed manually via the same incision. The cystostomy was generally sutured. RESULTS: The mean operation time was 253 minutes. The mean estimated blood loss was 245 mL. Three patients needed blood transfusion. No open conversion was required during the retroperitoneoscopic nephrectomy. Two of the patients suffered from minor complications. The pathological findings confirmed UUT-TCC in all the patients with 9 of the pelvises and 9 of the ureters. Five of the patients were involved with bladder TCC. With the mean follow-up of 35 months, none of them had retroperitoneal recurrence or distant metastasis, 2 of the 5 patients with bladder TCC had recurrence in bladder and 4 had contralateral native UUT-TCC after the first unilateral nephroureterectomy. CONCLUSION: RPLNU with a midline lower abdominal transperitoneal incision may be a safe and feasible alternative for native UUT-TCC ipsilateral to a transplanted kidney with satisfactory oncologic outcomes.

[Protective effect of heat shock protein 70 and magnesium sulfate supplementation on renal ischemia reperfusion injury].

OBJECTIVE: To investigate whether there is a protective mechanism in exogenous magnesium ions supplement in renal ischemia reperfusion injury(IRI ), and to study the expression of heat shock protein 70 (HSP70) and HSP70-mRNA in the reperfusion injury. METHODS: A total of 90 male Japanese white rabbits (1.8-2.0 kg) were divided into three groups: ischemia reperfusion group (I-R), MgSO4 pretreatment group and sham operation group. The right kidney was cut through median abdominal incision to make solitary kidney model. The left renal artery was blocked for 1 h in I-R group and MgSO4 group. 2.5% MgSO4 1 mL/(kg×h) was given through ear vein before the artery was blocked and during the blockeage in the MgSO4 group. the kidney cortex tissue was taken 1, 2, 4, 24, 48 and 72 h after reperfusion. Immunohistochemical examination was used to determine the HSP70 expression. A modified quantitative Real time-PCR was used to quantitate HSP70-mRNA in the three groups. Pathological examination was also used to confirm the results. RESULTS: Real time-PCR showed that HSP70-mRNA began to increase at the end of 1 h, and reached the peak at the end of 2 h in both I-R and MgSO4 groups, but expression in I-R group which was remarkably higher than that in the MgSO4 group at the end of 2 h and 4 h ( P<0.05). HSP70-mRNA levels decreased rapidly at the end of 24 h. In I-R group, moderate HSP70 expression could be seen in the proximal tubules during immunohistochemical examination after reperfusion for 24 h and 48 h. By contrast, there was weak HSP70 expression in the MgSO4 group 24 h and negative 48 h after reperfusion. Epithelial shedding, border brush, inflammatory cell infiltration and protein casts were serious after 24 to 48 h reperfusion, while only slight tubular cell shedding and necrosis could be found in the MgSO4 group at the matched time. CONCLUSION: Magnesium supplement can significantly relieve the renal ischemia reperfusion injury. It can inhibit the upregulated expression of HSP70 and HSP70-mRNA in vivo, which demonstrates that the expression of HSP70 is not necessary in the protective mechanism.

[Efficacy and safety of transumbilical single-port laparoscopic radical nephrectomy].

OBJECTIVE: To evaluate the efficacy and safety of transumbilical single-port laparoscopic radical nephrectomy. METHODS: The clinical data of laparoscopic radical nephrectomy performed from June 2010 to October 2010 in Peking University Third Hospital were analyzed retrospectively. In the study, 10 patients underwent transumbilical single-port laparoscopic radical nephrectomy (LESS) and 15 received retroperitoneal laparoscopic radical nephrectomy. The data on general presentation, tumor size, tumor location, operative time, blood loss, complications, Visual Analog Pain Scale (VAPS), postoperative hospital stay, pathological results were collected to compare between the two groups. Our homemade single-site equipment was used in the LESS approach and the kidney was dissociated after being cut off the renal vessel and extracted through the umbilical incision. The retroperitoneal approach followed the standard surgical procedures, and the specimens were removed from the extended incision. RESULTS: All the procedures were completed without conversion to open radical nephrectomy. Compared with traditional laparoscopic surgery, the operative time (P=0.001) and VAPS (P=0.002) showed significant difference in LESS group,and no difference was noted in other factors (P>0.05). There was no secondary bleeding, wound infection, intestinal obstruction, incision hernia and other severe postoperative complications. The follow-up of 6 to 10 months showed no local recurrence. CONCLUSION: Transumbilical single-port laparoscopic radical nephrectomy is feasible, effective and safe. It gives a more mini-invasive and cosmetic option for young or female patients.

Correlation between coagulation function, tumor stage and metastasis in patients with renal cell carcinoma: a retrospective study.

BACKGROUND: The coagulation function in carcinoma patients is abnormal, but in renal cell carcinoma the extent and relationships of coagulation function remain unclear. This study retrospectively investigated the relationships between coagulation function, clinical stage and metastasis in patients with renal cell carcinoma. METHODS: A total of 350 consecutive patients admitted to our Urology Department from 2004 to 2010 were diagnosed with renal cell carcinoma by histopathologic examination and were included in this study. A total of 231 cases of renal benign tumors were considered as the control group. Fibrinogen, prothrombin time, activated partial thromboplastin time and international normalized ratio were evaluated in all subjects. Tumor size, clinical stage, lymph node metastasis, and distant metastasis were evaluated using radiologic imaging, intraoperative findings, and histological studies. RESULTS: The preoperative plasma fibrinogen levels of patients with renal cell carcinoma ((383.9 ± 146.7) mg/dl) were significantly higher than those of the control group ((316.7 ± 62.0) mg/dl) (P < 0.01). We divided the renal cell carcinoma group into stages Ia, Ib, II, III, and IV. The fibrinogen values were (315.6 ± 64.6) mg/dl, (358.3 ± 91.1) mg/dl, (465.6 ± 164.7) mg/dl, (500.0 ± 202.1) mg/dl, and (585.8 ± 179.7) mg/dl, respectively. There were no significant differences in fibrinogen values between stage Ia and control groups. However, results of other stages showed significant differences when compared to control group values (P < 0.01). Using the cutoff value of 440 mg/dl, which defines hyperfibrinogenemia, plasma fibrinogen levels had a positive predictive value of 39.8% and a negative predictive value of 93.3% for predicting distant metastasis, with a sensitivity of 64.7% and specificity of 83.3%. CONCLUSIONS: Preoperative plasma fibrinogen levels are elevated in patients with renal cell carcinoma with distant metastasis or lymph node metastasis. Potential metastasis is more likely if the tumor size larger than 4 cm. Increased preoperative plasma fibrinogen levels, especially hyperfibrinogenemia, may be an indicator of metastasis.

[Improve recovery of urinary continence following laparoscopic radical prostatectomy: a clinical report of 51 cases].

OBJECTIVE: To present the clinical results of 51 patients of clinically localized prostate cancer treated by laparoscopic radical prostatectomy, especially recovery of urinary continence. To analysis how to improve recovery of urinary continence. METHODS: From February 2004 to March 2008, we performed LRP on 51 patients. All patients were diagnosed by pathological result preoperatively. T1a-1b 4 cases (8%), T1c 15 cases (29%), T2a 7 cases (14%), T2b 5 cases (10%), T2c 20 cases (39%). RESULTS: Forty-nine cases were treated by LRP successfully. There were two cases converted to open surgery. Urine leaking happened in 3 cases, but recovered without intervention. Urinary catheter duration was 14 - 45 days (mean 16 days). Six months and 12 months after LRP, incontinence happened 7/39 cases (17.9%) and 5/20 cases (25%) respectively. Complete incontinence happened in one case. The ratio of incontinence happened in the first 20 cases and the following 31 cases were 6/20 (30%) and 7/31 (22%) respectively. There were two cases had rectal injury. Both cases underwent colostomy. Duration of follow up were from 3 - 53 months (mean 17 months). Two cases recurred. One of them was treated with hormone therapy, the other one died of operation for lung metastasis. Other patients' serum total PSA were less than 0.2 microg/L. CONCLUSIONS: Extraperitoneal laparoscopic radical prostatectomy is efficient and safe approach for localized prostate cancer. The correct handling of pubic prostatic ligaments, external urethral sphincter and neurovascular bundle are important for recovery of urinary continence. And so does the experience of LRP.