In recent years, the research on upper urinary tract urodynamics has been developing toward digitalization, simulation and noninvasive.This article reviews the physiological mechanism, clinical application and new research progress of upper urinary tract urodynamics. Pacemaker cells are considered to be the basis of upper urinary peristalsis, but the specific mechanism remains to be further studied. The dynamic technique of upper urinary tract is widely used in clinical practice to measure the perfusion rate-pressure relationship. Whitaker test can be used as an auxiliary examination in the diagnosis of suspicious cases. Artificial intelligence, three-dimensional reconstruction and other multidisciplinary integration may be the important means for the research in the future.

目的 评价注射用头孢他啶他唑巴坦钠(3:1)及注射用头孢他啶他唑巴坦钠(5:1)治疗中、重度呼吸及泌尿系统头孢他啶耐药菌感染患者的有效性及安全性.方法 将360例患者随机分为对照组、试验1组和试验2组,每组120例,其中每组中含呼吸系统感染和泌尿系统感染各60例.对照组给予注射用头孢哌酮钠舒巴坦钠每次2.0 g,bid,静脉滴注;试验1组给予注射用头孢他啶他唑巴坦钠(5:1)每次2.4 g,bid,静脉滴注;试验2组给予注射用头孢他啶他唑巴坦钠(3:1)每次2.4 g,bid,静脉滴注.根据病情轻重程度不同,一般治疗7～14 d.比较3组患者的临床疗效和药物不良反应的发生情况.结果 在治疗呼吸系统感染方面:3组均表现出较好的疗效,试验1组、试验2组和对照组的总有效率分别为86.67％(52例/60例),90.00％(54例/60例)和91.67％(55例/60例),差异均无统计学意义(均P>0.05);试验2组的痊愈率为50.00％均显著优于对照组和试验1组(35.00％和40.00％),差异均有统计学意义(均P<0.05).在治疗泌尿系统感染方面:3组的总有效率均大于86％,显示出良好的治疗效果.试验2组在肺炎、支扩并感染、复杂性尿路感染治疗上的总有效率相对对照组和试验1组具有优势.治疗中,3组均未出现严重药物不良反应.结论 注射用头孢他啶他唑巴坦钠(3:1)治疗呼吸及泌尿系统急性细菌性感染的临床疗效确切,安全性高.

目的 通过观察尿道下裂术后尿道狭窄的不同治疗方法及效果,探讨最合适的治疗方案.方法 对2005—2016年69例尿道下裂手术后出现尿道狭窄患儿的临床资料进行回顾性分析.所有患儿随访6个月至11年,患儿发生尿道狭窄时,首先予以尿道扩张,最终以患儿排尿通畅、尿线粗、无尿道憩室为治愈标准(包括间隔时间>2个月行尿道扩张1次的轻度尿道狭窄患儿).结果 69例尿道下裂术后出现尿道狭窄患儿中,22例经间断规律尿道扩张治愈(31.88％);28例(40.58％)通过间断尿道扩张后缓解时间较短,经留置多孔硅胶软管支架治愈;13例(18.84％)采用尿道扩张及留置支架管后无改善行尿道狭窄切开,同期行尿道成形术,治愈8例,3例出现尿道狭窄,经尿道扩张治愈,2例出现尿道瘘,6个月后尿道瘘修补成功治愈;6例(8.7％)尿道探针无法通过,尿道扩张未成功,采用切除尿道瘢痕,一期预置尿道板,二期行尿道成形术,治愈4例,1例尿道瘘6个月后行尿道瘘修补术成功治愈,1例出现尿道狭窄,经尿道扩张治愈.结论 对于尿道下裂术后尿道狭窄的患儿,根据个体狭窄情况选择普通尿道扩张,或短时留置硅胶软管支架,可有效解决狭窄问题,临床效果肯定,有推广价值;尿道扩张失败的患儿应行尿道狭窄切除术,并同期或分期行尿道成形术.

Objective To observe the effects of bisphenol A (BPA) on the content of testosterone in testis of male rats and on the expressions of P450scc and 3βhydroxysteroid dehydrogenase(3β-HSD),and to explore its action mechanism. Methods Forty-eight adult male SD rats were randomly divided into 4 groups:control group,low dose group(2mg·kg-1·d-1), middle dose group (20mg·kg-1·d-1) and high dose group (200mg·kg-1·d-1),with continuous intragastric administration for 8 weeks. The serum levels of testosterone were measured in different dose groups,moreover the expression levels of P450scc and 3β-HSD protein in testicular interstitial cell were detected by immunohistochemistry. Results The testosterone levels in middle dose group and high dose group were significantly lower than those in control group(P<0.05), meanwhile,the testosterone levels were gradually decreased with the increasing of the BPA dose. The immunohistochemical image analysis showed that the average absorbance values of P450scc and 3β-HSD in the three different dose groups were obviously lower than those in control group,moreover,which in middle dose group and high dose group were significantly lower than those in control group (P <0.05). Conclusion The bisphenol A can inhibit the synthesis of testosterone and the expressions of the P450scc and 3β-HSD in testicular interstitial cells of SD rats.

Objective To analyze the feasibility and safety in application of resectoscope combined with laparoscopy in the operation treatment of paraganglioma of urinary bladder.Methods 7 cases patients with paraganglioma of urinary bladder treated in our hospital from November 2014 to August 2018 were analyzed retrospectively.There were 5 males and 2 females,average age of 31.1 years (22-37 years),average body mass index was 22.3 kg/m2 (18.3-22.5 kg/m2).All the 7 cases patients complained of dizziness and palpitation after urination,average basal systolic blood pressure was 111.8 mmHg (97-124 mmHg),the average fluctuation of systolic blood pressure before and after urination was 64.9 mmHg(28-91 mmHg),the CT and cystoscopy prompt bladder tumor,the average diameter was 2.7 cm(2.1-3.5 cm).The average of plasma norepinephrine was 706.3 pg/ml(330-997 pg/ml);the average of plasma dopamine was 101.1 pg/ml(44-145 pg/ml);the average of 24h urinary vanilmandelic acid was 13.4 mg/24h (10.3-16.1 mg/24h).All the patients has controlled the blood pressure and dilate the blood vessels with phenoxybenzamine hydrochloride,accepted the operation of resectoscope combined with laparoscopy partial cystectomy and bladder sutura per abdomen after ample dilatancy.The patients had lithotomy position with trendelenburg,preparation of gas peritoneal cavity by transabdominal,inside the resectoscope by transurethral at the same time,mutilated bladder mucosa beside 1cm at the edge of the tumor,and cut full thickness bladder wall,take the extraperitional fat as the standard procedure;we could see the cutting edge clear at this time by laparoscopy,cut off the pelvic peritoneum,extraperitional fat and the tumor.The sample placed in bladder,close the bladder with absorbable or barbed wires,take out the sample by resectoscope.Results All the 7 cases patients operation was successfully completed,no cases has been transfered to open.The average time of operation is 85.3 min(65-100 min),the average amount of bleeding is 27.9 ml(10-50 ml).The average fluctuation of systolic blood pressure is 8.7 mmHg(6-15 mmHg).Bladder washout was stopped 24h after operation,catheter was removed 1 weeks after operation.There is no obvious complications occurred.The average hospital stay is 3.7 days (3-5 days).The average pain score of 4 cases 4h after operation is 3.8 (2-5),reevaluation 24h after operation is 2.3 (1-4).The average follow-up time is 7.9 months(2-15 months).All the 7 cases patients clinical symptoms disappeared,there is no fluctuation of systolic blood pressure before and after urination,there is no recurrence of the tumor.Conclusions To the paraganglioma of urinary bladder in fundus of bladder or anterior wall of bladder,we can accurate resection tumor by resectoscope combined with laparoscopy,reduce blood pressure fluctuations,reduce the surgical trauma and the distress of patients.It is a safety and effective minimally invasive surgery.

OBJECTIVE:To evaluate the clinical efficacy and safety of Qilin Pills in the treatment of oligoasthenospermia in infertile men.METHODS:This multi-centered randomized double-blind controlled clinical trial included 216 infertile males with oligoasthenospermia, 108 in the trial group and the other 108 in the control, the former treated with Qilin Pills at the dose of 6 g tid while the latter with Wuziyanzong Pills at 6 g bid, both for 12 weeks. We examined the total sperm count, sperm motility and the count of progressively motile sperm of the patients before and at 4, 8 and 12 weeks after medication and evaluated the safety of the drug based on the adverse events and the laboratory results of blood and urine routine examinations and liver and kidney function tests.RESULTS:Compared with the baseline, the patients in the trial group showed a significant time-dependent improvement after 4, 8 and 12 weeks of medication in sperm motility (21.75% vs 27.54%, 29.04% and 32.95%, P <0.05), total sperm count (156.27 ×106 vs 177.33, 188.18 and 205.44 ×106, P <0.05), and the count of progressively motile sperm (32.08 ×10⁶/ml vs 46.33, 50.98 and 61.10 ×10⁶/ml, P <0.05). The three parameters above were also improved in the controls, but more significantly in the trial group (P <0.05).CONCLUSIONS:Qilin Pills can evidently improve the semen quality of oligoasthenospermia patients with no obvious adverse events.

Objective To evaluate the clinical efficacy and safety of microsurgical subinguinal varicocelectomy (MSV) and high retroperitoneal varicocelectomy (HRV) in the treatment of massive varicocele (VC). Methods The patients with bilateral massive varicocele were randomly divided into MSV group and HRV group. The patient age (PA), VC width (VCW), operation time (OT), intraoperative blood loss (BL), postoperative hospital stay time (HST), postoperation hydrocele incidence (HI), varicocele relapse rate (VRR), testicular atrophy rate (TAR), pregnancy rates (PR), semen concentration (SC), semen motility (SM), semen deformation rate (SDR), sperm quality improvement rate (SQIR), scrotum VAS pain score, scrotum pain relief rate relief rate (SPRR), IIEF-5 score, follicle-stimulating hormone (FSH), luteotropic hormone (LH), testosterone (T) and free testosterone (FT) in serum were analyzed retrospectively. Results There was no differences in PA, VCW, BL, SPRR, HI, TAR, preoperative SC, SM, SDR, preoperative and postoperative LH, FSH, T, FT, VAS pain score, IIEF-5 score between the two groups (P>0.05). The postoperative SC, SM, and SDR was significantly improved in the two groups (P<0.01). The postoperative PR and SQIR in the MSV group was higher than that in the HRV group (P<0.05). The postoperative VRR in the MSV group was lower than that in the HRV group (P<0.05). The OT, postoperative SC and SM in the MSV group was higher than that in the HRV group (P<0.01). The VRR in the MSV group was lower than that in the HRV group (P<0.05). The SDR and HST in the MSV group was lower than that in the HRV group (P<0.01). Conclusion MSV can improve sperm quality and increase PR with satisfactory efficacy. MSV has more advantages and fewer complications, but long-term therapeutic effect of MSV needs to be further investigated.

Objective To improve the diagnosis and therapy of acute testicular torsion. Methods The clinical data of 16 patients with 18 testicular torsion ( 2 patients with bilateral testicular torsion) were retrospectively analyzed in the follow-up of 3 years to 15 years. Results Of 16 patients, 7 patients underwent suffering testis restoration-fixation and contralateral preventative testis fixation, 7 patients suffering orchiectomy and contralateral preventative testis fixation, 1 patient bilateral orchidectomy for testicle necrosis, and 1 patient left orchiectomy and right testis restoration-fixation. The pathological examination of resected tissue samples showed testis necrosis. 16 patients were followed up for 3 years to 15 years. 1 patient without testis had lower serum testosterone level and no morning penis erection. The other 15 patients did not show significant serum testosterone abnormality. 8 patients ( 7 patients with suffering testis restoration-fixation, 1 patient with bilateral testicular torsion, left orchiectomy and right testis restoration-fixation ) with 8 suffering testis restoration-fixation had no recurrence of ipsilateral testicular torsion after surgery, in which l patient had postoperative ipsilateral slight reduction of testicular volume compared with that of the men at same age stage. 14 patients ( 7 patients with suffering orchiectomy, 7 patients with suffering testis restoration-fixation ) with 14 contralateral testicular preventive fixation had no ipsilateral testicular torsion, in which l patient had postoperative ipsilateral slight reduction of testicular volume compared with that of the men at same age stage. Semen examination was normal in 11 patients, 2 patients were diagnosed with oligospermia, 1 patients was diagnosed with asthenospermia, 1 patients was diagnosed with oligoasthenospermia, 1 patient without testis was diagnosed with azoospermia. 1 patients (1 patient with azoospermia) had no morning penis erection and severe erectile dysfunction (ED), 2 patients (1 patients with asthenospermia and 1 patients with oligoasthenospermia) had mild ED, 13 patients had no ED. 11 patients gave birth in the follow-up period. Conclusion Color doppler flow imaging is reliable for the diagnosis of acute testicular torsion. Early operative therapy is important for the survival rate of testis and its function protection.

OBJECTIVE:To investigate the effect of alpha-lipoic acid (α-LA) combined with tamoxifen citrate (TC) in the treatment of oligoasthenospermia. METHODS:From June to November 2016, we treated 60 patients with oligoasthenospermia in our Department of Andrology, 30 (the trial group) with oral α-LA (0.6 g, qd) + TC (20 mg, qd) and the other 30 (the control group) with oral L-carnitine (1g, bid) + TC (20 mg, qd). Before and after 3 months of medication, we examined the semen parameters of the patients and the levels of their seminal oxidative stress biomarkers, including methylenedioxyamphetamine (MDA) and total antioxidant capacity (TAC) in the seminal plasma. We also compared the pregnancy rate and adverse reactions between the two groups. RESULTS:Totally, 57 of the patients completed the treatment, 28 in the trial group and 29 in the control. Compared with the baseline, the patients of the trial group showed significant improvement after 3 months of medication in the semen volume (［2.50 ± 0.71］ vs ［3.37 ± 0.70］ ml, P <0.05), sperm concentration (［12.00 ± 1.65］ vs ［19.34 ± 2.04］ ×10⁶/ml, P <0.05), percentage of progressively motile sperm (PMS) (［18.01 ± 3.01］% vs ［35.41 ± 6.49］%, P<0.05), MDA level (［14.96 ± 2.76］ vs ［10.04 ± 1.04］ nmol/ml, P <0.05), and TAC in the seminal plasma (［9.83 ± 1.02］ vs ［12.25 ± 1.11］ U/ml, P <0.05), and so did the controls in the semen volume (［2.76 ± 0.67］ vs ［3.36 ± 0.93］ ml, P <0.05), sperm concentration (［11.47 ± 1.10］ vs ［17.77 ± 3.56］ ×10⁶/ml, P <0.05), percentage of PMS (［19.22 ± 1.41］ vs ［36.01 ± 5.22］ %, P <0.05), MDA level (［14.66 ± 2.75］ vs ［10.14 ± 1.01］ nmol/ml, P <0.05), and TAC in the seminal plasma (［9.84 ± 0.90］ vs ［11.14 ± 0.84］ U/ml, P <0.05). There were no statistically significant differences in the above post-medication parameters between the trial and control groups (P >0.05) except in TAC, which was markedly more improved in the former than in the latter (P <0.05), nor in the percentage of morphologically normal sperm before and after treatment in either of the two groups (P >0.05). After 3 months of treatment, 3 pregnancies were achieved in the trial group and 1 in the control (10.7% vs 3.45%, P >0.05). No obvious adverse events occurred during the treatment. CONCLUSIONS:Alpha-lipoic acid combined with tamoxifen citrate can evidently improve semen parameters in oligoasthenospermia patients by relieving oxidative stress injury.

Objective To observe the effects of adrenomedullin (ADM) on the growth and angiogenesis of transplanted 786-0 renal cell carcinoma in nude mice.Methods The mouse model of renal cancer was made by transplanting human 786-0 renal tumor cells into the nude mice subcutaneously.The subjects were divided into three groups:control group,ADM group,ADM22-52 group.Tumor formation rate was recorded and the size of tumors was measured.The pathological changes were assessed by hematoxylin and eosin (HE) staining,the expression of vascular endothelial growth factor (VEGF-A) was detected by immunohistochemistry assay in tissues,and the expression of ADM receptor and VEGF-A by Western blotting.Results HE staining showed that transplanted tumors were characterized by clear renal cell carcinoma infiltrating adenocarcinoma,and there were more necrotic areas in the tumor issues in ADM22-52 group.The size of tumors in ADM group was (2 123.50 ± 349.61)mm3 after 16 days,larger than control group and ADM22-52 group (P ＜ 0.05).Immunohistochemistry showed that the expression levels of VEGF-A in control group,ADM group and ADM22-52 group were 4.0,7.5,0.0,respectively (P ＜ 0.05).Western blotting showed that ADM receptor (ADMR) expression levels in control group,ADM group and ADM22-52 group were 0.22 ± O.03,0.28 ± 0.03,and 0.06 ± 0.01 respectively,and VEGF-A expression levels in control group,ADM group and ADM22-52 group were 0.35 ± 0.11,0.51 ± 0.04 and 0.09 ± 0.01 respectively.The expression of ADMR and VEGF-A in ADM22-52 group was significantly down-regulated (P ＜ 0.05).Conclusion ADM may promote the growth of transplanted 786-0 renal cell carcinoma in nude mice by activating the autoreceptors and also may participate the angiogenesis of renal cell carcinoma.

Purpose To evaluate the mechanisms underlying sunitinib resistance in RCC and to identify targets that may be used to overcome this resistance. Results Reanalysis of transcriptome microarray datasets (GSE64052 and GSE76068) showed that adrenomedullin expression was increased in sunitinib-resistant tumors. And adrenomedullin expression was increased in sunitinib-resistant tumor xenografts, accompanied by upregulation of phospho-ERK levels. However, blocking adrenomedullin inhibited sunitinib-resistant tumor growth. Treatment of RCC cells with sunitinib and ADM22-52 was superior to monotherapy with either agent. Additionally, adrenomedullin upregulated cAMP and activated the ERK/MAPK pathway, promoting cell proliferation, while knockdown of adrenomedullin inhibited RCC cell growth and invasion in vitro. Materials and methods We searched the Gene Expression Omnibus (GEO) database to find data regarding sunitinib-resistant RCC. These data were subsequently reanalyzed to identify targets that contribute to sunitinib resistance, and adrenomedullin upregulation was found to mediate sunitinib resistance in RCC. Then, we created an RCC mouse xenograft model. Mice were treated with sunitinib, an adrenomedullin receptor antagonist (ADM22-52), a MEK inhibitor (PD98059) and different combinations of these three drugs to investigate their effects on tumor growth. RCC cells (786-0) were cultured in vitro and treated with an ADM22-52 or PD98059 to determine whether adrenomedullin activates the ERK/MAPK pathway. Adrenomedullin was knocked down in 786-0 cells via siRNA, and the effects of this knockdown on cell were subsequently investigated. Conclusions Adrenomedullin plays an important role in RCC resistance to sunitinib treatment. The combination of sunitinib and an adrenomedullin receptor antagonist may result in better outcomes in advanced RCC patients.

Objective To explore the diagnostic value and application on hypo-vasculary small renal tumors using contrast-enhanced ultrasound. Methods All the 96 cases diagnosed with the renal masses not excluding renal tumors ( the mass<4 cm) nderwent renal-contrast enhanced ultrasound and the nature of the tumors was distinguished by perfusion and fade and high echo ring. The results of the contrast-enhanced ultrasound were compared with that of pathological diagnosis and regular follow-up. Results Among the 39 benign cases diagnosed by contrast-enhanced ultrasound, 23 cases underwent sur-gical treatment, 21 cases were proven to be benign renal tumors by pathological diagnosis, 2 cases were proved to be renal ma-lignant tumors, 16 cases without surgery were proved to be benign renal tumors by regular follow-up. In addition, among the 57 malignant cases diagnosed by contrast-enhanced ultrasound, 51 cases underwent surgical treatment, 49 cases were proved to be renal malignant tumors by pathological diagnosis, 2 cases were proved to be renal malignant tumors;6 cases without sur-gery, 2 cases were proved to be renal malignant tumors by lesion volume increase and regular follow-up, 2 cases were proved to be renal malignant tumors by the lesions with no significant alteration and regular follow-up, 2 cases were lost in follow-up when they were transferred to other hospitals. The statistical data were assessed by Chi-square tests, the sensitivity, specifici-ty, false negative rate, false positive rate, diagnostic index, Youden index, crude accuracy were 90. 24%, 96. 23%, 9. 76%, 3. 77%, 186. 47%, 86. 47%, 93. 61%, respectively. Conclusion Contrast-enhanced ultrasound in treatment of hypo-vasculary small renal tumors has high diagnostic and application value, and unnecessary surgery be avoided.

ObjectiveToinvestigatetheexpressionandsignificanceofWnt3aandLgr5inbladdercancer.Methods The expression levels of Wnt3a protein and Lgr5 protein wee detected by immunohistochemistry in 11 cases of normal tissues and 39 cases of bladder cancer tissues.The expression levels of Wnt3a mRNA and Lgr5 mRNA were detected by RT-PCR in 9 cases of normal bladder tissues and 17 cases of bladder cancer tissues.Results The results by immunohistochemistry showed the positive expression rates of Wnt3a protein were 84.6%,33.3% in bladder cancer tissues and normal bladder tissues, respectively,there were significant differences between the two kinds of tissues ( P <0.05).The positive expression rates of Lgr5 protein were 84.6%,33.3% in bladder cancer tissues and normal bladder tissues,respectively,there were significant differences between the two kinds of tissues ( P <0.05).The expression of Wnt3a was positively correlated to that of Lgr5 in bladder cancer tissues ( r =0.677, P <0.01).The results by RT-PCR showed that there was a significant difference in the ratio of optical density of Wnt3a between bladder cancer tissues and normal bladder tissues ( P <0.05),there was a significant difference in the ratio of optical density of Lgr5 between bladder cancer tissues and normal bladder tissues ( P <0.05).Conclusion The expression levels of the protein and mRNA of Wnt3a and Lgr5 in bladder cancer tissues are much higher than those in normal bladder tissues,which suggest that Wnt3a and Lgr5 may be closely related with the pathogenesis and development of bladder cancer.

目的 探讨比较经尿道等离子前列腺剜除术(PKEP)与经尿道前列腺电切术(TURP)对重度良性前列腺增生(BPH)的疗效及安全性.方法 收治BPH患者随机分为PKEP和TURP组,分别比较两组患者手术时间(OT)、术中出血(BL)、腺体切除质量(RTW)、腺体切除率(GRR),术后尿管留置时间(IUT)、膀胱造瘘管留置时间(BFUT)、住院时间(HST),以及术前术后血钠浓度(SSC)、前列腺质量(PW)、血红蛋白浓度(HGB)、残余尿(RUV)、最大尿流率(Qmax)、勃起功能国际问卷(IIEF-5)、生活质量(QOL)、国际前列腺评分(IPSS)和主要并发症.结果 两组间OT、BL、IUT、BFUT、HST、RTW、GRR、PW差值、HGB差值、SSC差值及术后PW、HGB、SSC有明显差异(P＜0.01).PKEP组患者膀胱痉挛、暂时性尿失禁、逆行射精、膀胱颈挛缩或尿道狭窄发生率明显低于TURP组(P＜0.01),PKEP组闭孔神经反射、包膜穿孔、输血、继发性出血、ED发生率稍低于TURP组(P＜0.05).两组间术后IIEF-5及IIEF-5差值有明显差异(P＜0.01).两组术后IPSS、QOL、Qmax、RUV与术前比较差异有统计学意义(P＜0.01),但两组间术前、术后及其差值比较均无明显差异(P＞0.05).结论 与TURP相比,PKEP对重度BPH具有相同的满意疗效,同时具备出血少、时间短、切除彻底及并发症少等优点,是治疗BPH有效、安全的方法.

Objective To evaluate the therapeutic effects of modified Duckett-Duplay's style and transfer and cover tunica vaginalis of testis in severe hypospadia repair. Methods Clinical data of 47 patients with severe hypospadia, whose age was from 2 to 18 years old, including 41 cases of scrotum type and 6 cases of perineum type between Dep 2008 and Jan 2012 were analyzed retrospectively. Results Total of 42 patients (89.4%) were cured in the first operation. Three patients (6.4%) with mild external orifice stricture were recovered by simple dilatafton. Two patients (4.3%) who developed urethraI fistula were managed by a second improved operation half a year after the first surgery. Conclusion The satisfactory therapeutic effect could be obtained by chosing patients properly, holding the operating skill,paying attention to protect the blood supply of skin flap, and enhancing the treatment after operation.

目的：观察行为治疗（ behavioral treatment ）结合M受体拮抗剂托特罗定（ tolterodine ）治疗良性前列腺增生（ benign prostatic hyperplasia ，BPH）患者合并夜尿增多的临床疗效。方法将前列腺增生症合并夜尿增多的患者48例，随机分为2组，其中24例患者给予行为治疗（包括生活方式干预、膀胱训练）结合M受体拮抗剂托特罗定，其余24例患者单用托特罗定治疗，应用排尿日记记录2组患者夜尿情况，并对比2组数据。结果经过1个月治疗后，行为治疗结合托特罗定组患者夜尿次数减少1?．5次（-46．9％），夜间尿量减少128 ml（-19．8％），QOL评分为2．8±1．1；单独应用托特罗定组患者夜尿次数减少0．7次（-24．1％），夜间尿量减少48 ml（-7．3％），QOL评分为3．2±1．0；治疗过程中无严重并发症出现。结论行为治疗结合M受体拮抗剂托特罗定可改善前列腺增生患者夜尿症状，提高患者生活质量。

OBJECTIVE:To investigate the clinical effect of modified Koyanagi technique with coverage by tunica vaginalis of testis in severe hypospadias.METHODS:49 cases with severe hypospadias treated from Jan. 2009 to Sep. 2011 were retrospectively studied. 25 patients underwent Koyanagi technique with coverage by tunica vaginalis of testis. 24 cases underwent one-stage Duplay + Duckett technique in the same term. The patients were followed up for 7-24 months.RESULTS:Among the 25 children treated with Koyanagi procedure, 20 cases were cured, 5 patients had postoperative complications, including urethral fistula in 3 cases,urethral stenosis in 2 cases. At the same time, in the Duplay + Duckett group, 17 cases were cured, 7 children had postoperative complications, including urethral fistula in 4 cases, and urethral stenosis in 3 cases. All the patients with urethral fistula were repaired successfully 6 months after the first surgery; The urethral stenosis were cured by dilatation within 1 to 3 months. The successful rate in the 2 groups had no significant difference(P >0.05).CONCLUSIONS:Koyanagi technique with coverage by tunica vaginalis of testis is relatively simple with similar effect as Duplay + Duckett technique for severe hypospadias.

Objectives To explore the diagnosis, clinical treatment and etiology of postoperative bleeding-caused fibrinolytic hyperfunction in 20 patients with prostate hyperplasia. Methods Clinical data of 52 BPH patients with postoperative bleeding were retrospectively analyzed. All the patients were divided into two group such as fibrinolytic hyperfunction group and non fibrinolytic hyperfunction group. Results Among 52 patients, 20 had high level of D-dimmer, the clotting time prolonging and low level of fibrinogen. They were diagnosed as fibrinolytic hyperthyroidism. All the 52 patients were cured, and no death and serious complications such as organ failure were found. There was significant difference in postoperative bleeding amount between fibrinolytic hyperfunction group and non fibrinolytic hyperfunction group (P<0.01). There was no significant difference in day of hospital stay[(7.03±0.86)d and (7.40±0.75)d, P>0.05], and no significant differences in postoperative complications and international prostate symptom score, quality of life score and Qmax between these two groups (P>0.05). Conclusion The early and proper treatment is helpful to control the condition. There are no significant differences in postoperative effect and long-term complications between two groups. Most patients with fibrinolytic hyperthyroidism can be cured by non-surgical methods.

Objective To evaluate the surgical therapy for hermaphrodites.Methods Retrospective analysis the clinical data of 14 cases of different types of hermaphrodites treated in our hospital from Jan.1995 to Dec.2012,including 4 cases of female pseudohermaphrodite,2 cases of male sex reversal syndrome,3 cases of male pseudohermaphrodite and 5 cases of true hermaphrodites.The gender selection and the following surgical treatment were provided according to patients' protopathy,age,social gender,their desires and their parents' wishes.Results Out of 14 cases,10 cases were operated to women (4 cases of female pseudohermaphrodite,1 case of male pseudohermaphrodite,5 cases of true hermaphrodites),4 patients were operated to men (2 cases of male sex reversal syndrome,2 cases of male pseudohermaphrodite).The operation is relatively easy for the patients who are operated to female,and they all have well developed secondary sexual characteristics and satisfied sexual function after 3 to l0 years of follow-up.For the 4 patients who were operated to male,their penis and testicles are well developed,and 1 case had already entered adolescent period,whose morning erection can be seen normally but no spermatorrhea detected.Further observation is necessary to decide whether he has reproductive function.Conclusions The diagnosis and treatment for children external genitalia malformations should be taken as early as possible.A reasonable choice of gender,the appropriate surgical correction,and hormone replacement therapy in some cases,are feasible treatment with satisfactory effect. Key words: Hermaphroditism; Surgical procedures, elective

Obj ective To investigate the effect of the adrenomedullin on the signaling pathway of PI3K/Akt/eNOS/VEGF in renal tumor cell.M ethods The kidney tumor cells were divided into five groups,control group,ADM group,VEGF group, ADM +VEGF receptor inhibitor group, ADM +ADM shRNA group, moreover, every group was redivided three time gradient groups (24 hours,48 hours and 72 hours).The expression levels of PI3K,Akt,eNOS, VEGF in control group and ADM group and the expression levels of P3I K,Akt, eNOS in VEGF group,ADM+VEGF receptor inhibitor group,ADM +ADM shRNA group were detected by Western Blot,respectively.Results The expressions levels of the PI3K,Akt,eNOS,VEGF in ADM groups were significantly higher than those of control group ( P <0.05) .The expression levels of PI3K,Akt,eNOS in VEGF groups and ADM+VEGF receptor inhibitor groups were significantly higher than those of control group ( P <0.05). However there were no significant differences in the expression levels of PI3K, Akt, eNOS between ADM +ADM shRNA groups and control group ( P <0.05).C onclusion ADM can activate PI3K/Akt/eNOS signaling pathway in renal tumor cell,which can not be blocked by VEGF receptor inhibitor.On one hand ADM regulates renal tumor angiogenesis by VEGF,on the other hand,by activating PI 3K/Akt/eNOS signaling pathway to participate in renal tumor angiogenesis.ADM may become a promising anti-angiogenic target in the treatment of renal tumor.