Primary retroperitoneal mucinous cystic tumour of borderline malignancy mimicking kidney duplicate: cases report and literature review.

BACKGROUND: Primary retroperitoneal mucinous cystic tumours with borderline malignancy (PRMC-BM) are rare and difficult to diagnose preoperatively. We are the first to report two cases of PRMC-BM which mimic a duplex kidney and evaluate the outcomes of different surgical procedures. CASE PRESENTATION: We describe two cases of retroperitoneal cystic tumours. Both were diagnosed with duplex kidney with hydronephrosis on computed tomography scan. The first patient underwent robot-assisted laparoscopic surgery and was found to have a retroperitoneal cystic tumour. The other patient underwent an ultrasound-guided puncture before surgery and was diagnosed with retroperitoneal lymphangioma. Retroperitoneal cystectomy was performed using an open transperitoneal procedure. The final pathologic diagnosis in both cases implies PRMC-BM. The open surgical approach was associated with a shorter operation time, less intraoperative blood loss, and protected cyst wall integrity by comparing the different surgical approaches. During follow-up, the patient in the first case had tumour recurrence six months post-surgery, and the other patient was healthy without recurrence or metastasis 12 months post-surgery. CONCLUSIONS: Primary retroperitoneal mucinous cystic tumours with borderline malignancy can be enclosed within the kidney and misdiagnosed as other cystic diseases of the urinary system. Thus, an open surgical approach may be more suitable for this type of tumour.

A case report of vesicovaginal fistula following Bevacizumab without pelvic disease and radiochemotherapy.

Background: Bevacizumab has gradually become an important adjuvant therapy for many advanced tumors including lung cancer. Although it can improve the survival of many cancer patients, it also brings many adverse reactions, including fistula formation. However, vesicovaginal fistula in the absence of pelvic lesions and radiation history has not been reported before. Case Description: We diagnosed an advanced non-small cell lung cancer patient with left pleural, bone and liver metastases in February 2017. She then received Gefitinib-targeted therapy. Ten months later, liver metastases achieved complete remission and the remaining metastases partial response. Then she received whole brain radiotherapy (30 Gy/10 F) for new brain metastases, and Oxitinib was used to replace Gefitinib. In March 2018, the patient underwent TVT-O sling surgery for stress urinary incontinence, and recovered well after the operation. The patient was treated with Bevacizumab at 400 mg once every 3 weeks in March 2019 because of the poor efficacy of Oxitinib. After using bevacizumab for 3 months, the patient complained about frequent urination, urgency, dysuria, and vaginal leakage. The presence of vesicovaginal fistula was confirmed by color Doppler ultrasound and positron emission tomography/computed tomography (PET-CT). After discontinuation of Bevacizumab, urine leakage was disappeared. Conclusions: Bevacizumab can also cause vesicovaginal fistula, even without pelvic lesions and radiotherapy. Previous pelvic surgery and foreign materials implantation may be factors that promote the formation of vesicovaginal fistula.

Clear cell sarcoma of the kidney in an adult: a case report and literature review.

Clear cell sarcoma of the kidney (CCSK) in adults is extremely rare. In fact, only 16 adult CCSK cases have been reported from 1989 to 2020 in the English language literature. The pathologic diagnosis of the disease is difficult, and the optimal treatment is still unknown. Currently, no literature review has been done on adult CCSK patients. Herein, we report the case of a 24-year-old man who presented with right flank pain for one month. The patient underwent a series of diagnostic tests, and imaging examinations revealed a large mass in his right kidney. The patient underwent retroperitoneal laparoscopic nephrectomy and regional lymphadenectomy. Pathological examination of the tumor revealed nests and cords of fairly uniform oval cells with clear cytoplasm. Immunohistochemistry showed that the tumor cells were positive for vimentin, CyclinD1, and Bcl-2 and that the sample was uniformly negative for Wilms' tumor 1 (WT1), CD34, desmin, and cytokeratin staining. Based on these histopathological and immunohistochemical results, the patient was diagnosed with CCSK. The patient subsequently refused chemotherapy and radiotherapy. During the 2-year follow-up, no recurrence or metastasis was observed. We reviewed the English language literature on adult CCSK published in the PubMed database. A pooled analysis was performed, and the results suggested that an accurate pathological diagnosis of CCSK could be achieved based on microscopy and immunohistochemistry. Nephrectomy and regional lymphadenectomy are the main treatments for adult patients with CCSK. While the value of adjuvant radiotherapy and chemotherapy remains controversial, multimodal oncologic treatment, including surgery and chemotherapy with or without radiation, may be efficacious in preventing local recurrence and distant metastases.

Transvaginal repair of vesicouterine fistulae: our experience of three cases.

INTRODUCTION AND HYPOTHESIS: Surgical repair of vesicouterine fistula (VUF) can be performed through transvaginal and transabdominal routes. Transvaginal repair of VUF has been rarely reported. This study is aimed at demonstrating the feasibility and experience of transvaginal repair of VUF, and presents a step-by-step concrete surgical technique. METHODS: We presented a video of a 36-year-old woman who developed VUF after a second cesarean section. The patient underwent a transvaginal surgical repair in the prone jackknife position. We also presented the clinical data of another two patients with VUF, and summarized the experience of all three patients in whom the same technique was performed. RESULTS: The operative times of the three patients were 120, 200, and 180 min respectively. No surgical complications were observed. After a follow-up of 2-3.5 years, none of the patients had vaginal leakage. CONCLUSION: Transvaginal repair of VUF in the prone jackknife position is a feasible and effective procedure for restoring the anatomy. However, there is still a need for well-designed studies with a large number of patients to identify the most promising approach.

Hypersensitive or Detrusor Overactivity: Which is Associated with Filling Symptoms in Female Bladder Outlet Obstructed Patients.

PURPOSE: To investigate and compare detrusor overactivity (DO) and bladder filling sensation characteristics in female bladder outlet obstruction (FBOO) patients with or without overactive bladder (OAB) symptoms. MATERIALS AND METHODS: One hundred fifty-seven FBOO patients with urodynamic testing were recruited. Pa-tients who showed urinary urgency ( ? 6 episodes/3 d), with or without urinary frequency ( ?8 voids/24 h), and urge incontinence ( ? 3 episodes/3 d) were considered to have OAB. The detrusor overactivity (DO) and bladder filling sensation measures including first sensation (FSF), first desire to void (FDV) and strong desire to void (SDV) during filling cystometry were recorded. The associations between urodynamic variables and OAB symp-toms were analysed. RESULT: FBOO patients had a high incidence (79%) of OAB. FBOO patients with OAB symptoms had significantly younger age, higher incidence of DO (19.4% versus 6.1%) (P = .051) and lower bladder volumes of FSF (180.32 ± 83.48 versus 226.18 ± 100.90 mL), FDV (269.00 ± 109.78 versus 330.45 ± 123.95 mL) and SDV (345.56 ± 135.43 versus 422.33 ± 148.40 mL) (P < .05) compared to patients without OAB. In multivariate analyses, both DO (OR = 4.83, 95% CI: 1.02-22.85, P = .047) and lower bladder volumes at FDV(OR = 2.47, 95% CI: 1.03-5.95, P = .044) and SDV (OR = 3.07, 95% CI: 1.25-7.55, P < .014) were still independently associated with OAB, after adjustment for age and other confounding factors. CONCLUSION: FBOO patients had a high incidence of OAB. Not only DO but also bladder hypersensitivity were independently associated with OAB symptoms in FBOO patients.

Increased Expression of TREK-1 K+ Channel in the Dorsal Root Ganglion of Rats with Detrusor Overactivity After Partial Bladder Outlet Obstruction.

BACKGROUND Changes in expression and activity of ion channels are important pathophysiological mechanisms underlying detrusor overactivity (DO) in partial bladder outlet obstruction (PBOO). The objective of this study was to examine the expression of TREK-1 channel in the bladder and central nervous system of DO rats. MATERIAL AND METHODS Thirty Sprague-Dawley rats were subjected to PBOO operations and those displaying non-voiding contractions (NVCs) in cystometry were classified as DO. Sham-operated rats without NVCs in cystometry served as controls. The expression and distribution of TREK-1 in the bladder, spinal cord, and dorsal root ganglion (DRG) were detected by real time-PCR, western blot, and immunohistochemistry. RESULTS TREK-1 channel expression in the DRG was significantly increased at the mRNA level (11.20±3.762 vs. 3.209±1.505, P<0.01) and protein level (2.195±0.058 vs. 1.713±0.066, P<0.01) in DO rats as compared to control rats. However, the expression of TREK-1 mRNA in the bladder (1.380±0.810 vs. 4.206±3.827, P>0.05) and spinal cord (0.764±0.357 vs. 0.696±0.188, P>0.05) was comparable between the 2 groups. Immunohistochemistry showed enhanced immunoreactive signals of TREK-1 channel in the DRG, but not in the spinal cord and bladder. CONCLUSIONS TREK-1 channel was upregulated in the DRG of DO rats after chronic PBOO, which might suppress neuronal excitability and play a protective role in bladder overactivity in PBOO.

Enhanced expression of TWIK-related arachidonic acid-activated K+ channel in the spinal cord of detrusor overactivity rats after partial bladder outlet obstruction.

BACKGROUND: Detrusor overactivity (DO) secondary to partial bladder outlet obstruction (PBOO) is closely associated with alteration of ion channels. The objective of this study is to investigate the expression of the TWIK-related arachidonic acid-activated K(+) channel (TRAAK) in the L6-S1 spinal cord of DO rats after PBOO. METHODS: Female Sprague-Dawley rats undergoing PBOO surgery were screened for DO by cystometry. Sham-operated rats served as controls. The expression of TRAAK in the L6-S1 spinal cord was detected by real-time polymerase chain reaction, western blotting and immunohistochemistry. RESULTS: DO was successfully induced after chronic PBOO in rats, with an incidence rate of 62.5 %. Compared with sham-operated rats, the expression of TRAAK in the L6-S1 spinal cord of DO rats was significantly increased at the mRNA (1.886 ± 0.710 versus 0.790 ± 0.679, P < 0.05) and protein level (0.510 ± 0.087 versus 0.255 ± 0.107, P < 0.05). Immunohistochemical staining showed increased expression of TRAAK in the dorsal horn and ventral horn of the spinal cord. CONCLUSIONS: Upregulation of TRAAK was observed in the spinal cord of DO rats after chronic PBOO, which may exert a protective effect against DO by suppressing the excitability of neurons.

Organ-sparing Surgery in Treating Patients with Liposarcoma of the Spermatic Cord: Institutional Experience and Pooled Analysis.

BACKGROUND: Liposarcoma of the spermatic cord is rare and frequently misdiagnosed. The standard therapeutic approach has been radical inguinal orchiectomy with wide local resection of surrounding soft tissues. The current trend of organ preservation in the treatment of several cancers has started to evolve. Herein we present our testis-sparing surgery experience in the treatment of spermatic cord liposarcoma and a pooled analysis on this topic. MATERIALS AND METHODS: Clinical information from patient receiving organ-sparing surgery was described. Clinical studies evaluating this issue were identified by using a predefined search strategy, e.g., Pubmed database with no restriction on date of published papers. The literature search used the following terms: epidemiology , surgery , chemotherapy , radiotherapy , testis sparing surgery, spermatic cord sarcomas/ liposarcomas. RESULTS: Patient received a complete excision of the lesion, preserving the spermatic cord and the testis. The final pathological report showed a well differentiated liposarcoma with negative surgical margins and no signs of local invasion. After 2-year of follow-up, there was no evidence of local recurrence. Since the first case reported in 1952, a total of about 200 well-documented spermatic cord liposarcoma cases have been published in English literature. Among these patients, only three instances were reported to have received an organ-sparing surgery in the treatment of spermatic cord liposarcoma. CONCLUSIONS: Radical inguinal orchiectomy and resection of the tumor with a negative microscopic margin is the recommended treatment for liposarcoma of the spermatic cord. But for small, especially well-differentiated, lesions, testis-sparing surgery might be a good option if an adequate negative surgical margin is assured.

Downregulation of TWIK-related arachidonic acid-activated K+ channel in the spinal cord of rats after complete bladder outlet obstruction.

OBJECTIVES: To study the altered expression of TWIK-related arachidonic acid-activated K(+) channel in the L6-S1 spinal cord of rats after complete bladder outlet obstruction, and to investigate the role of TWIK-related arachidonic acid-activated K(+) channel in the neurogenic mechanism of bladder dysfunction. METHODS: Female Sprague-Dawley rats were randomly divided into a complete bladder outlet obstruction group and a sham-operated control group. Cystometry was carried out and tissues of L6-S1 spinal cord were obtained for detection of TWIK-related arachidonic acid-activated K(+) channel mRNA and protein by real-time polymerase chain reaction, western blot and immunohistochemistry. RESULTS: The bladder outlet obstruction rat model was established. Real-time polymerase chain reaction, western blot and immunohistochemistry showed that the expression of TWIK-related arachidonic acid-activated K(+) channel was lower in the L6-S1 spinal cord of the bladder outlet obstruction rats, compared with the control rats. CONCLUSIONS: Downregulation of TWIK-related arachidonic acid-activated K(+) channel might enhance the excitability of the neurons and increase the sensitivity of the bladder, probably providing a new study model of overactive bladder secondary to bladder outlet obstruction.

[Transrectal ultrasonography in the etiological diagnosis of male obstructive azoospermia: analysis of 695 cases].

OBJECTIVE: To assess the role of transrectal ultrasonography (TRUS) in the etiological diagnosis of male obstructive azoospermia. METHODS: We retrospectively analyzed the clinical data and TRUS findings of 695 patients with obstructive azoospermia from January 2007 to May 2009. RESULTS: Concerning the etiology of obstructive azoospermia, the main TRUS findings included ejaculatory duct abnormality (29.2%), seminal vesicle abnormality (25.4%) and prostate midline cyst (18.5%). TRUS revealed 203 cases of ejaculatory duct dilation, 177 cases of seminal vesicle abnormality (including 108 with absence or agenesis and 51 with dilation of the seminal vesicle), and 128 cases of prostate midline cyst (including 75 with ejaculatory duct cyst and 39 with Müllerian cyst). Calcification of the verumontanum or ejaculatory duct was suspected to be the causes of obstructive azoospermia in 34 cases. However, no significant etiological abnormality was found in 153 cases. Obvious etiology was shown by TRUS in 78.0% of the patients. CONCLUSION: TRUS can clearly display the structural abnormality of the ejaculatory duct and seminal vesicle, and provide important information on the etiology of male obstructive azoospermia.

[Multivariate analysis of recurrence factors for non muscle-invasive bladder urothelial carcinomas].

OBJECTIVE: To discuss the risk factors of recurrent non-muscle-invasive bladder cancer and elucidate its clinical significance. METHODS: The retrospective survival analysis of 161 patients with non-muscle-invasive bladder cancer was performed by Kaplan-Meier method, Log-rank test and COX proportional hazard model. RESULTS: On univariate analysis, the parameters of tumor stage, tumor grade, number of tumors and previous recurrence were significant for tumor recurrence (all P < 0.05). On multivariate analysis of COX proportional hazard model, all the above risk factors remained significant for tumor recurrence. The hazard ratios were as follows: tumor stage (RR = 3.810, P = 0.001), tumor grade (RR = 2.416, P = 0.009), number of tumors (RR = 1.736, P = 0.036) and previous recurrence (RR = 1.810, P = 0.010). CONCLUSION: Tumor stage and tumor grade plays the most important role in tumor recurrence.

Metastasis to the penis in a patient with adenocarcinoma of lung, case report and literature review.

Metastasis of lung cancer to the penis is very rare; it causes various clinical symptoms seriously affecting the quality of life. Early recognition and appropriate management will likely enhance survival in these patients. Here, we report a case of penile metastasis secondary to pulmonary carcinoma along with a review of the literature. One case of penile metastasis secondary to pulmonary carcinoma was detected in a 51-year-old patient who was admitted to the First Affiliated Hospital of Sun Yat-Sen University with persistent cough along with swelling of the perineum and penis. The clinical features, diagnosis, and treatment of this disease along with a relevant literature are reviewed and discussed. A MEDLINE search was performed to identify similar reports in the literature. CT scan revealed lung mass, and a glans penis ulcer and enlargement of inguinal lymph nodes was discovered upon physical examination. CT-guided percutaneous puncture of the lung mass revealed adenocarcinoma of lung, and biopsies of the glans penis ulcer and inguinal lymph nodes confirmed metastatic adenocarcinoma. The patients received chemotherapy and died of acute pulmonary embolism in less than 2 months. Metastasis of lung cancer to the penis is extremely rare. It presents an advanced form of lung cancer, and thus survival is extremely short. Although treatment of penile metastasis is almost always palliative, early recognition may enhance survival for these patients.

[Clinical analysis of renal cell carcinoma: report of 271 cases].

OBJECTIVE: To study the diagnosis and treatment of renal cell carcinoma. METHOD: From January 1993 to December 2000 the data of 271 cases of renal cell carcinoma were reviewed. RESULTS: Ultrasonography and CT scanning were still the main diagnostic methods. Surgical operation was performed on 234 patients. Radical nephrectomy was performed on 197 patients (72.6%); Nephron sparing surgery was performed on 19 patients; Metastatic tumor resection was performed on 6 patients and other procedures for 12. The pathological results showed that 137 cases (61.4%) were clear cell carcinoma, 18 cases (8. 1%) of granular cell carcinoma, 32 cases (14. 3%) being combination of the above two varieties, 23 cases (10.3%) of renal papillary adenocarcinoma, 13 cases being renal cell of other types. And 210 cases (77.5%) had been successfully followed up. The 1, 3, 5 and 10 year survival rates were 95.3% (182/191), 88.7% (107/122), 74.7% (56/75) and 32.1% (10/31) respectively. CONCLUSIONS: Ultrasonography is the first select examination method of detecting of renal cell carcinoma, and CT scanning is the most valuable diagnostic mean. Early diagnosis and prompt radical nephrectomy or nephron sparing nephrectomy are the critical points for achieving long-term survivals of patients with renal cell carcinoma.

[Diagnosis and therapy for penile cancer: a report of 46 cases with literature review].

BACKGROUND & OBJECTIVE: Penile cancer is an uncommon malignancy, which is mainly treated by surgery, radiation and chemotherapy. This study was to investigate reasonable curative methods for penile cancer. METHODS: Medical records of 46 patients with penile cancer in the Department of Urology, The First Affiliated Hospital of Sun Yat-sen University between Jan. 1996 to Jan. 2005 were analyzed retrospectively. Forty-four patients had squamous cell carcinoma, one had Paget disease, and one had verrucous carcinoma. RESULTS: Thirty-nine patients received partial penectomy, four received total penectomy and perineal urethrostomy, one Paget disease patient received lesion resection and skin grafting, two patients did not receive surgery. Nine out of 10 patients with positive lymph node received ilioinguinal lymphadenectomy, and five received pelvic lymphadenectomy. Forty-one cases were regularly followed up for one to 10 years. The 1-, 2-, 5- and 10- year survival rates were 95.1%, 95.1%, 82.9% and 31.7%, respectively. Prognosis of patients with pelvic lymph node metastasis was poor. Two patients who had pelvic lymph node metastasis died of lung metastasis within two years after surgery. CONCLUSIONS: Partial penectomy is an appropriate and effective management for penile cancer. Lymph node metastasis is an important prognostic factor for penile cancer. Patients with ilioinguinal lymph node metastasis should receive lymphadenectomy as early as possible to improve the therapeutic effect. The prognosis is poor for patients with pelvic lymph node metastases.

[Diagnosis and therapy of metastatic tumors in the adrenal gland--a report of 21 cases].

BACKGROUND & OBJECTIVE: Recently, the occurrence of metastasis to the adrenal gland is increasing, while the early and differentiated diagnosis still remains difficult. Whether metastasis to the adrenal gland needs to be resected and when and how the resection should be done are controversial. This study was to explore the surgical indications of metastasis to the adrenal gland and the role of laparoscopic adrenalectomy in the treatment of this disease. METHODS: Clinical data of 21 patients with metastatic tumors in the adrenal gland, treated in Cancer Center of Sun Yat-sen University from Mar. 1997 to Mar. 2004, were analyzed retrospectively. Literature of the diagnosis and therapy was reviewed. RESULTS: The diagnosis rates of ultrasonography and spiral or thin-cut computed tomography (CT) were 70.0% (7/10) and 84.6% (11/13). Ten patients received adrenalectomy with negative resection margins, 4 of them received laparoscopic adrenalectomy. The patients survived for 1-67 months, with a median of 18 months. One patient was still alive 67 months after the adrenalectomy, and 2 was lost. Eleven patients received palliative operation or no treatment, 10 of them survived for 5-28 months with a median of 13 months, while 1 was lost during follow-up. The difference in survival rates between the 2 groups was not significant (P=0.346). CONCLUSIONS: Ultrasonography and CT are important diagnosis methods for metastatic adrenal cancer. No evidence of tumor invasion revealed by preoperative imaging studies, no adjacent lymphadenopathy and no extraladrenal metastasis are indications of adrenalectomy. Laparoscopic adrenalectomy is safe and effective for those well-selected patients.

[Diagnostic value of urodynamic parameters multianalysis in the evaluation of bladder outlet obstruction resulting from benign prostatic hyperplasia].

OBJECTIVE: To construct a function model that can be used in the diagnosis bladder outlet obstruction (BOO) resulting from benign prostatic hyperplasia, and to develop a diagram allowing the judgement of bladder outlet for patients with different detrusor contractility, especially with impaired one. METHODS: Urodynamic and clinical data of 131 men were analyzed retrospectively. By Logistic analysis, a function model was constructed. Based on the model, a diagram allowing the evaluation of bladder outlet was drawn. The cutoff point for diagnosing BOO with the function model and the curve was confirmed by ROC curve analysis. RESULTS: The function model (BOOI) was obtained by the formula 5.03 x residual fraction + 0.04 x PdetatQmax - 0.20 x Qmax - 0.91 + alpha (alpha = 0 for those with low pressure-low flow on P-FS, alpha = 1.42 for high pressure-low flow, alpha = -7.30 for high pressure-high flow). The cutoff point for BOOI diagnosing BOO was 0.36. When validated, the sensitivity, specificity, positive predictive value, and negative predictive value were 85.7%, 91.7%, 96.0% and 73.3% respectively. CONCLUSION: The BOOI, with an easy calculation mode, could predict the probability of BOO. The sensitivity and specificity of the criterion for the diagnosis of BOO were satisfactory. The curve we drew could help to differentiate the obstructed men with low pressure-low flow and thus benefit them by surgical relief of their obstruction.

Persistent Muellerian duct syndrome with transverse testicular ectopia.

Persistent Muellerian duct syndrome (PMDS) is a rare form of male pseudohermaphrodism without the feature of ambiguous genitalia. We present a case of PMDS with transverse testicular ectopia (TTE).

[Clinical analysis of 123 cases of transitional cell carcinoma (TCC) of upper urinary tract].

BACKGROUND & OBJECTIVE: With the development of diagnostic techniques of imaging, and application of endoscope, early diagnosis and treatment of transitional cell carcinoma (TCC) of upper urinary tract have been improved to a great extent in recent years, but still caused debates. In this article, we discussed the diagnostic and therapeutic methods of TCC of upper urinary tract. METHODS: Clinical data of 123 patients with TCC of upper urinary tract treated in our hospital from Mar. 1996 to Dec. 2003 were retrospectively analyzed. RESULTS: Ratios of final diagnosis of renal pelvic cancer (RPC) by B ultrasound, intravenous pyelogram (IVP), and computed tomography (CT) were 82.1% (46/56), 37.1% (20/54), and 88.1% (37/42), respectively; those of ureter cancer were 11.8% (4/34), 3.2% (1/31), and 93.8% (15/16), respectively. Successful retrograde pyelography could locate both kinds of carcinomas accurately. Of 123 patients, 116 underwent radical surgery, and 7 given up for metastasis or poor heart and lung function; 107(87.0%) were followed-up with a mean of 3.5 years. Three-year survival rates of patients with superficial RPC (stage T1), and invasive RPC (stages T2-T4, or N1, N2) were 94.1%, and 73.6%; 5-year survival rates were 88.2%, and 43.3%. Three-year survival rates of patients with superficial ureter cancer, and invasive ureter cancer were 100%, and 68.8%; 5-year survival rates were 80.0%, and 40.6%. Bladder tumor occurred in 29 (23.6%) patients. CONCLUSIONS: Combination of IVP and B ultrasound should be used as a routine examination for TCC of upper urinary tract. Retrograde pyelography may be used as an adjuvant examination when IVP showed negative results, CT may be used for further examination. Radical resection of kidney and ureter is the preferred treatment for this disease.