Dibutyl phthalate induces epithelial-mesenchymal transition of renal tubular epithelial cells via the Ang II/AMPKα2/Cx43 signaling pathway.

Maternal exposure to dibutyl phthalate (DBP) induces renal fibrosis in offspring. However, the specific roles of connexin 43 (Cx43) in DBP-induced renal fibrosis remain unknown. Therefore, in this study, we analysed the expression of Cx43 in renal tubular epithelial cells (RTECs) with or without DBP exposure using reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and western blotting. A small interfering RNA against Cx43 was introduced to assess its role in epithelial-mesenchymal transition (EMT) of RTECs caused by 100 µmol/L DBP. Bioinformatics analysis was conducted with AMP-activated protein kinase (AMPK)-α2 and angiotensin (Ang) II inhibitors to determine the mechanisms involved in the expression of Cx43 in HK-2 cells. RT-qPCR and western blotting revealed that DBP increased the expression of Cx43 in vitro. Moreover, Cx43 knockdown significantly alleviated DBP-induced EMT caused by DBP in HK-2 cells. Bioinformatics analysis with AMPKα2 and Ang II inhibitors revealed that DBP upregulated Cx43 expression by activating the Ang II/AMPKα2 signaling pathway. Our findings indicate that DBP induces renal fibrosis by activating Ang II/AMPKα2/Cx43 signaling pathway and EMT in RETCs, suggesting a potential target for the treatment of renal fibrosis.

Transurethral thulium laser enucleation versus resection of the prostate for treating benign prostatic hyperplasia: a retrospective study.

This study aimed to compare the clinical outcomes between transurethral thulium laser enucleation of the prostate (ThuLEP) and transurethral thulium laser resection of the prostate (ThuLRP) for treating benign prostatic hyperplasia (BPH). From May 2014 to August 2015, 212 patients underwent ThuLRP and 188 patients underwent ThuLEP. The ThuLEP group was further divided into two subgroups according to the ways the prostate was taken out. The perioperative parameters were recorded and analyzed. The international prostate symptom score (IPSS), quality-of-life (QoL) score, maximum flow rate (Qmax), and postvoid residual urine volume (PVR) in both groups were estimated and compared 3, 6, and 12 months after surgery. No significant difference was observed between the groups in terms of irrigated time, irrigated volume, catheterization time, and hospital stay. However, the significantly lower hemoglobin drop was observed in the ThuLRP group compared with the ThuLEP group. The ThuLEP group with a morcellator required a shorter operation time for patients with large prostate volume (> 60 mL) compared with the ThuLRP and ThuLEP groups without a morcellator. During 12 months of follow-up, IPSS, Qmax, QoL, and PVR improved significantly without significant differences between the groups. No severe complications were reported; however, the occurrence of transient urge incontinence was higher after ThuLEP compared with ThuLRP, and the proportion of urinary tract infection after surgery was higher in ThuLRP than in ThuLEP. ThuLRP and ThuLEP are safe and efficient for treating patients with symptomatic BPH. ThuLRP offers advantages in terms of minimal blood loss.

Use of free peritoneal and bladder mucosal grafts as ureteral mucosa substitutes for management of avulsion of the ureteral mucosa in a dog model.

BACKGROUND AND PURPOSE: Avulsion of the ureteral mucosa is one of the most serious complications of ureteroscopy and considered challenging for urologic surgeons. In this study, we developed two novel methods to reconstruct the impaired ureter. MATERIALS AND METHODS: After ureteral mucosal avulsion in a canine model, ureteral reconstruction was performed in one of three ways: free tabularized peritoneal grafts (group A, n = 6); bladder mucosal grafts (group B, n = 6); or simple stenting technique (control group [n = 3]). At postoperative week 10, evaluation with intravenous urography (IVU) was followed by harvesting of reconstructed ureter segments for pathologic analysis. RESULTS: IVU showed nonvisualization of the collecting system of the affected side and histologic evaluation showed imperforation or stenosis in all animals in the control group. IVU showed good visualization of the reconstructed ureter without stenosis in group A and in most animals in group B. There was a mild dilation but no obvious stenosis in one animal in group B. Microscopically, all the reconstructed ureteral lumens were uniformly lined with transitional epithelium. Extensive neovascularity was evident in the subepithelial layer with a streaming of fibroblasts toward the neomucosa. CONCLUSION: Replacing the avulsed mucosa in the injured ureter with tubularized peritoneal free grafts or bladder mucosal grafts may be an optimal method to manage avulsion of the ureteral mucosa.

An experimental study of tubularized peritoneal free grafts as ureteral mucosa substitutes / 中华泌尿外科杂志

Objective To investigate the feasibility of reconstruction of ureter with tubularized peritoneal free grafts for the treatment of avulsion of ureteral mucosa using animal models.Methods Twelve adult dogs were randomly divided into the reconstruction group(n=6) and the control group(n=6).Firstly,the model of avulsion of ureteral mucosa about 3-5 cm long was made.In reconstruction group,tubularized peritoneal free grafts and ureteral stents were placed in the injured ureters;and in control group,no operation was performed but to place the stents into the ureter.The curative effect was observed by IVU and histological examination 10 weeks after operation.Results In reconstruction group,IVU showed normal size and morphology of the kidneys.There was no hydronephrosis,and no obvious stricture of the part of ureter in which peritoneal free grafts were used as mucosa substitutes.In control group,IVU showed no image or only obscure enlarged outlines of the kidneys,and no image of the ureters.Atresia or severe stricture of the ureters was observed in all dogs in control group;while in reconstruction group,the peritoneal membrane was replaced by integrate transitional epithelium,and no obvious stricture was observed.Subepithelial abundant neovascularization was also seen.Conclusions For avulsion of ureteral mucosa exceeding 3 cm,placing stents only will lead to ureteral stricture or atresia,reconstruction using tubularized peritoneal free grafts as mucosa substitutes is an effective method.