BACKGROUND:This exploratory analysis of the CHART trial (ClinicalTrials.gov: NCT03520478) investigated prostate-specific antigen (PSA) kinetics and the correlation between PSA and survival outcomes in high-volume, metastatic, hormone-sensitive prostate cancer (mHSPC). METHODS:A total of 654 patients were randomized 1:1 to receive either rezvilutamide plus androgen deprivation therapy (ADT; n = 326) or bicalutamide plus ADT (n = 328). PSA kinetics were evaluated, and the correlation between survival and the achievement of undetectable PSA (≤0.2 ng/mL) or ≥90% PSA reduction (PSA90) was assessed. FINDINGS:The rezvilutamide group exhibited higher proportions of ≥50% PSA reduction (PSA50; 98.2% vs. 87.5%), PSA90 (88.7% vs. 63.1%), and undetectable PSA (38.3% vs. 17.7%) responses compared to the bicalutamide group by 3 months. The rezvilutamide group demonstrated superior efficacy in delaying PSA progression compared to the bicalutamide group (hazard ratio [HR] 0.21, 95% confidence interval 0.16-0.27). The achievement of undetectable PSA and PSA90 by 6 months in the rezvilutamide group was associated with prolonged overall survival (undetectable PSA, HR = 0.34; PSA90, HR = 0.22), radiographic progression-free survival (HR = 0.36, HR = 0.26), time to PSA progression (HR = 0.25, HR = 0.17), and time to castration resistance (HR = 0.34, HR = 0.23) compared to those who did not achieve these PSA milestones. Stratification by baseline PSA level revealed consistent survival improvements with rezvilutamide plus ADT across quartiles. CONCLUSIONS:PSA kinetics is a valuable prognostic factor in mHSPC treated with rezvilutamide plus ADT, and the achievement of undetectable PSA and PSA90 is associated with improved survival. These findings highlight the importance of monitoring PSA kinetics in the management of mHSPC. FUNDING:This study was funded by Jiangsu Hengrui Pharmaceuticals Co., Ltd.

Objective:To explore the safety and efficacy of radiofrequency in the treatment of overactive bladder(OAB).Methods:A prospective, multicenter, non-randomized controlled trial was conducted. Eligible patients were divided into test group and control group in Zhejiang Provincial People’Hospital, The First Affiliated Hospital of Wenzhou Medical University, and Sir Run Run Shaw Hospital affiliated to Zhejiang University School of Medicine from March 2019 to June 2020. Inclusion criteria: patients diagnosed with OAB, and bladder capacity>100ml. Exclusion criteria: pregnant and lactating women; patients with secondary OAB symptoms such as urinary tract obstruction; patients with uncontrolled urinary tract infection within 1 week; patients in stable stage by using other treatment methods; patients implanted with any nerve stimulator, cardiac pacemaker or implantable defibrillator; patients with malignant tumors, serious cardiovascular, cerebrovascular diseases, renal insufficiency or received BTX treatment in recent 12 months. The patients were allocated to test group and the control group in a ratio of 2∶1 according to the time sequence of the visit. The patients in the test group were treated with radiofrequency treatment. After entering the group, they were treated for 4 times at the 1st, 2nd, 7th and 8th week respectively. In the control group, the energy was turned off during the radiofrequency treatment. The patients were followed-up every week until the end of the 12th week. The treatment success rate [the average frequency of urination in 24 h was reduced more than 50% from the baseline or returned to the normal (≤8 times/day) or the average frequency of urgent urination in 24 h was reduced more than 50% from the baseline], the frequency of urination, urgent urination and nocturnal urination before and after treatment, the residual urine volume of the bladder, the quality of life (QOL) score and the occurrence of catheter related adverse events in two groups were compared.Results:114 patients were enrolled in the study, including 76 patients in the test group and 38 patients in the control group. There were no significant differences in the age [(44.2±12.8) vs. (41.7 ± 12.1) years old], male female ratio (13/63 vs. 4/34), average course of disease [2.0(1.2, 5.0) vs. 2.0 (1.0, 4.0) years], the frequency of urination[12.8 (10.6, 16.8) vs. 12.8 (10.3, 17.0) times], urgency urination [11.8(9.3, 15.8) vs. 11.8 (9.0, 17.0) times], nocturia [2.7 (1.3, 3.7) vs. 2.3(0.7, 3.3) times], residual urine volume of bladder [12.0 (3.0, 28.0) vs. 14.0 (3.7, 20.0) ml ] and the QOL score [5.0(4.0, 5.0) vs. 4.0(4.0, 5.0)]before the treatment between the two groups ( P>0.05). The treatment success rate in the test group was 76.3% (58/76), while 26.3% (10/38) in the control group, with a statistically significant difference ( P<0.01). There were significant differences between the test group and control group in the frequency of urination [9.7 (7.7, 12.0) vs. 12.9 (9.6, 15.7) times], urgent urination [7.3 (5.0, 10.0) vs. 11.7 (7.3, 15.3) times], nocturia [1.3 (0.7, 2.0) vs. 1.7 (1.0, 3.0) times] and the QOL score of the patients[3.0(1.0, 3.0) vs. 4.0(3.0, 4.5)]after the treatment(all P<0.05). The frequency of urination, urgency urination, nocturia, the residual urine volume and the QOL score in the test group were significantly improved ( P<0.05) after the treatment.The frequency of urination, nocturia, residual urine volume and the QOL score in the control group were improved ( P<0.05) after the treatment. 13 (11.4%) patients had catheter related adverse events. In the test group and the control group, there were 7 cases of macroscopic hemorrhage caused by the placement of instruments (5/76 vs. 2/38), 5 cases of acute urinary tract infection within 3 days (3/76 vs. 2/38), and 1 case of instrument breakage (catheter breakage) (0/76 vs. 1/38). There were no significant differences in the adverse events between the two groups ( P> 0.05). Conclusions:Radiofrequency treatment of OAB can effectively improve the symptoms of patients, improve the QOL of patients, and has low incidence of adverse events, with good efficacy and safety.

Objective: To evaluate the efficacy and safety of Hengli® Chinese botulinum toxin type A (BTX-A; 100 U) in Chinese patients with overactive bladder. Methods: This study was a multicenter, randomized, double-blind, placebo-controlled trial in Chinese patients who were inadequately managed with anticholinergic medications. Eligible patients were randomized 2:1 to receive intradetrusor injections of Hengli® BTX-A (n = 144) or placebo (n = 72). The primary endpoint was the change in the number of daily micturition episodes at week 6 from baseline. The secondary efficacy endpoints included the average frequency of urgency and urinary incontinence (UI) episodes per day, urgency score, average micturition volume per day, OABSS, and QoL score. Results: In the Hengli® BTX-A group, there was a significantly greater reduction in the average number of micturition episodes per 24 h compared with the placebo group (3.28 vs. 1.43; p = 0.003). Moreover, there was a significantly greater improvement in the daily number of urgency episodes, micturition volume and OABSS score. An increased post-void residual urine volume, dysuria, and urinary tract infection represented adverse events (AEs) in the Hengli® BTX-A group. Most AEs were mild or moderate in severity. One patient in the BTX-A group initiated clean intermittent catheterization (CIC) during treatment. Conclusion: Hengli® BTX-A treatment was well-tolerated and resulted in significant improvements in OAB symptoms among Chinese patients inadequately managed by anticholinergics. Clinical Trial Registration: http://www.chinadrugtrials.org.cn/clinicaltrials.prosearch.dhtml, Identifier: CTR20131190.

Background: A novel sacral neuromodulation system (SacralStim) which has an electrode with six contact points was recently designed. Objective: To evaluate the effectiveness and safety of the SacralStim system for treating patients with refractory overactive bladder (OAB). Design, setting, and participants: This was a multicenter, randomized, single-blind clinical trial. Patients with refractory OAB were enrolled from January 2018 to May 2020. Intervention: Participants were randomly allocated to the treatment group (SNM on) or the control group (SNM off) for a single-blind period of 12 +/- 2 wk. Outcome measurements and statistical analysis: The primary outcome was the percentage of patients with a reduction in the average number of voids/24 h of at least 50% at the 12-wk follow-up visit. Other follow-up evaluations, including voiding diary outcomes, questionnaires on Overactive Bladder Symptom Score (OABSS), quality of life (QoL), device satisfaction, and causes of adverse events (AEs), were performed over the first 48 wk after implantation. Results and limitations: The therapeutic success rate at 12 wk was 56.76% in the treatment group and 11.11% in the control group (p < 0.001). There were significant differences in voiding diary variables between the two groups, including changes in the average number of voids/24 h, micturition volume/void, and improvement in the urge incontinence ratio. No severe AEs occurred. A limitation is the sham stimulation used as a control in the study. A head-to-head study is required to make a direct comparison of devices with six and four contact points. Conclusions: This clinical trial provides strong evidence that patients with refractory OAB benefit from the novel SacralStim system. More research is required for direct comparison of the SacralStim system with traditional four-contact-point devices. Patient summary: This study confirms the effectiveness and safety of a novel SacralStim system that stimulates the sacral nerve for treatment of overactive bladder. The system has an electrode with six contact points and can provide more programming options after implantation. (c) 2022 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Objective:To assess the efficacy and safety of 100 units of botulinum toxin A (BTX-A) intradetrusor injection in patients with overactive bladder.Methods:From April 2016 to December 2018, 17 tertiary hospitals were selected to participate in this prospective, multicenter, randomized, double-blind, placebo-controlled study. Two phases of study were conducted: the primary phase and the extended phase. This study enrolled patients aged 18 to 75 years who had been inadequately managed by anticholinergic therapy (insufficient efficacy or intolerable side effects) and had spontaneous voiding with overactive bladder. Exclusion criteria included patients with severe cardiac, renal and hepatic disorders, patients with previous botulinum toxin treatment for 6 months or allergic to BTX-A, patients with urinary tract infections, patients with urinary stones, urinary tract tumors, diabetes mellitus, and bleeding tendency. Eligible patients were randomly assigned to BTX-A group and placebo control group in a ratio of 2∶1. Two groups of patients received 20 intradetrusor injections of BTX-A 100U or placebo at the depth of the submucosal muscle layer respectively under cystoscope, including 5 injections at the base of the bladder, 3 injections to the bladder triangle, 5 injections each to the left and right walls and 2 injections to the top, sparing the bladder neck. As a placebo control group, patients received same volume of placebo containing no BTX-A and only adjuvant freeze-dried preparations for injection with the same method. A combination of gelatin, sucrose, and dextran served as adjuvants. Average micturition times per 24 hours, urinary incontinence (UI) episodes per day, average micturition volume per day, OAB symptom score(OABSS), and quality of life (QOL) score were recorded at baseline and the 2nd, 6th and 12th week after treatment. The primary efficacy endpoint was the change from baseline in the average micturition times per 24 hours at the 6th week after treatment. The secondary efficacy endpoints included the change from baseline in the average micturition times per 24 hours at 2nd and 12th week, as well as the change from baseline in the OABSS, QOL score, average frequency of urgency and UI episodes per day, urgency score, average micturition volume per day at 2nd, 6th and 12th week after treatment. Patients were followed for 12 weeks to assess adverse events (AEs). After assessed at week 12, if the micturition times has decreased less than 50% compared to baseline and the patient is willing to receive retreatment, then patients could enter the extended trial phase. In that phase, patients in both groups were injected with 100 units BTX-A from 12th week onwards and then followed up the same indicators for 12 weeks.Results:216 patients were enrolled in this trial (144 cases in the BTX-A group and 72 cases in the placebo control group). Baseline characteristics such as age (47.75±14.20 in the BTX-A group and 46.39±15.55 in the control group), sex (25 male/117 female in the BTX-A group and 10/61 in the control group), and disease duration (0.51 years in the BTX-A group and 0.60 years in the control group) were balanced between the two groups( P>0.05). A marked reduction from baseline in average micturition times per 24 hours was observed in all treatment groups at the 6th week and the reduction of the two groups was statistically different ( P<0.001 and P=0.008 respectively). Compared with the baseline, the average micturition times per 24 hours at the 6th week decreased from baseline by 2.40(0.70, 4.60)times for the BTX-A group and 0.70(-1.00, 3.30) times for the placebo control group respectively, and the difference between the two groups was considered to be statistically significant ( P=0.003). The change rates of average micturition times per 24 hours from baseline at the 6th week of the two groups were (16±22)% and (8±25)% respectively, and the difference between the two groups was statistically significant ( P=0.014). Compared with the baseline, the average micturition times per 24 hours at 2nd and 12th week decreased by 2.00(0.00, 4.00)and 3.30(0.60, 5.03)for the BTX-A group, 1.00(-1.00, 3.00)and 1.70(-1.45, 3.85)for the placebo control group respectively. The difference between two groups was considered to be statistically significant ( P=0.038 and P=0.012); the changes of average urgency times per day for the BTX-A group and the control group at the 2nd, 6th and 12th week were 2.00(0.00, 4.30)and 2.40(0.30, 5.00), 3.00(0.30, 5.70)and 0.70(-1.30, 2.70), 0.70(-1.30, 3.00) and 1.35(-1.15, 3.50), respectively. There were significant differences between two groups at the 2nd, 6th and 12th week, ( P=0.010, P=0.003 and P=0.025, respectively). The OABSS of the BTX-A group and the control group at the 6th week decreased by 1.00(0.00, 4.00)and 0.50(-1.00, 2.00) compared with the baseline, and the difference between the two groups was statistically significant ( P=0.003). 47 cases of BTX-A group and 34 cases of placebo control group entered the extended trial phase, and 40 and 28 cases completed the extended trial phase, respectively. The average micturition volume per 24 hours changed by -16.60(-41.60, -0.60)ml and -6.40(-22.40, 13.30)ml, (-35.67±54.41)ml and(-1.76±48.69)ml, (-36.14±41.51)ml and (-9.28±44.59)ml, (-35.85±43.35)ml and(-10.41±40.29)ml for two groups at the 12th, 14th, 18th and 24th week, and the difference between two groups was statistically significant at each follow-up time ( P=0.01, 0.006, 0.012 and 0.016, respectively). There was no significant difference in other parameters( P>0.05). However, adverse reactions after intradetrusor injection included increased residual urine volume (27 in the BTX-A group and 3 in the control group), dysuria (21 in the BTX-A group and 6 in the control group), urinary infection (19 in the BTX-A group and 6 in the control group), bladder neck obstruction (3 in the BTX-A group and 0 in the control group), hematuria (3 in the BTX-A group and 1 in the control group), elevated alanine aminotransferase (3 in the BTX-A group and 0 in the control group), etc. During the follow-up period, there was no significant difference in the other adverse events between two groups except the increase of residual urine volume( P<0.05). In the primary trial phase, among the 27 cases with increased residual urine volume in BTA group, only 1 case (3.70%) with PVR more than 300 ml; the PVR of 3 patients in the placebo group was less than 100 ml. The increase of residual urine volume caused by the injection could be improved or disappeared with the passage of time. Conclusions:Intradetrusor injection of Chinese BTX-A improved the average micturition times per 24 hours, the average daily urgent micturition times, OABSS, and average micturition volume per time, and reduced the adverse effects in patients with overactive bladder.Chinese BTX-A at dose of 100U demonstrated durable efficacy and safety in the management of overactive bladder.

Purpose: To assess the association between intravoxel-incoherent motion diffusion-weighted imaging (IVIM) derived hypoxia and the aggressiveness of prostate cancer (PCa) and to explore its contribution to the risk stratification of PCa. Methods: Seventy-five peripheral zone (PZ) PCa patients, who underwent multiparametric MRI (mpMRI), were included in this study. Systematic ultrasound guided biopsy was used as reference. IVIM was acquired with 5 b values (b = 0 similar to 750 s/mm(2)). Apparent diffusion coefficient (ADC), pure tissue diffusion (Ds), volume fraction of pseudo-diffusion (fp), hypoxic fraction (HFDWI), hypoxia score (HSDWI) and relative oxygen saturation(rOS(DWI)), were calculated and histogram analysis was applied. Groups comparison was performed between low-intermediate-grade group (LG, the International Society of Urological Pathology (ISUP) Gleason Grade (GG) <= 2) and high-grade (HG, ISUP GG >= 3) group. The correlation between diffusion parameters and ISUP GG was assessed. Cross-validated Support Vector Machine (SVM) Classification was performed and compared with univariate ROC analysis to explore the risk stratification of PZ PCa. Results: Mean, median, and the 10th percentile of Ds differed significantly between groups (p < 0.05). Several parameters significantly correlated with ISUP grade, and the 10th percentile of Ds showed the strongest correlation (p = - 0.284). The prediction model containing IVIM derived hypoxia yielded an area under the receiver operating characteristics curve (AUC) ranging 0.749-0.786 for cross-validation. The AUCs of the SVM modeling were higher than that of any single parameter. Conclusion: IVIM derived hypoxia demonstrated significant correlation with the aggressiveness of PCa. It's supplemental to the MRI assessment of PCa with a promising stratification of risk stratification of PZ PCa.

目的:分析微通道经皮肾镜联合软镜钬激光治疗复杂性肾结石的疗效.方法:随机选取2016年8 月～2018年8月某院收治的复杂性肾结石患者60例,随机分为两组:1组30例患者接受微通道经皮肾镜联合软镜钬激光术,2组30例患者接受常规经皮肾镜碎石术.分析两组患者的术中术后指标、结石清除率、残留结石直径、术后并发症情况.结果:两组患者的手术时间、术中出血量、术后住院时间之间的差异均不显著(P＞0 .05) ;两组患者残留结石直径、结石清除率对比有显著差异(P＜0 .05).结论:对于合并狭窄盏颈的复杂性肾结石患者,微通道经皮肾镜联合软镜钬激光碎石较常规经皮肾镜碎石有优势.

Objective: To create multivariable models with readily available clinicopathologic variables for predicting the prognosis of upper tract urothelial carcinomas (UTUC). Patients and methods: We retrospectively analyzed patients diagnosed as UTUC and underwent radical nephroureterectomy in 2 high volumes, tertiary care centers. A total of 445 patients and 227 patients met the inclusion criteria were included for constructing the prediction model and external validation, respectively. Univariable and multivariable Cox regression models were used to analyze independent risk factors, and nomogram and calibration curve were constructed by R project. Results: The median follow-up for the development and external validation cohorts were 33.5 and 32.5 months, respectively. Multivariable analysis detected older age (>= 65 years), with concurrent bladder cancer at diagnosis, with both ureter and renal pelvic tumor, lymphovascular invasion, urothelial carcinoma with divergent differentiation, higher pathological grade and stage, and positive lymph node were significantly associated with poorer outcome of UTUC. The c-index of the nomogram with these above-mentioned independent risk factors to predict the cancer specific survival was 0.74 (95% CI, 0.64-0.84) and 0.73 (95% CI, 0.59-0.87) for the development cohort and external validation cohort, respectively. Conclusions: We developed and externally validated a novel and accurate nomogram with readily available clinicopathological information for predicting the cancer specific survival of UTUC. This nomogram could help clinicians stratify patients with UTUC into different risk groups with distinct prognosis by the total scores obtained from the prediction tool, thus facilitate decision-making and clinical trial designing. (C) 2018 Elsevier Inc. All rights reserved.

OBJECTIVE To evaluate the efficacy and safety of Serenoa repens among patients with benign prostatic hyperplasia (lower urinary tract symptoms/benign prostatic hyperplasia [LUTS/BPH]) in China. METHODS We conducted a double blind, placebo-controlled study of 354 patients with LUTS/BPH from 19 institutions, to evaluate the efficacy and safety of Serenoa repens. Participants were randomly assigned (1:1) into the Serenoa repens extract (320 mg) or placebo groups for 24 weeks. Primary efficacy parameters were changes in International Prostate Symptom Score and peak urinary flow from baseline to each assessment. Secondary efficacy parameters included improvement of storage symptom and voiding symptom scores, prostate volume, urinary frequency, and total prostate-specific antigen level. Other parameters assessed were quality of life score, a four-item male sexual function questionnaire score, and International Index of Erectile Function score across the consecutive double-blind visits. RESULTS Statistically significant improvement in the peak urinary flow, International Prostate Symptom Score, scores of storage symptoms and voiding symptoms, quality of life score, four-item male sexual function questionnaire score, and International Index of Erectile Function score were observed in the Serenoa repens extract group compared with those in the placebo group (P <.05). Two (1.18%) of 169 patients in the placebo group and 3 (1.89) of 159 patients in the Serenoa repens extract group experienced 1 or more adverse events. CONCLUSION The Serenoa repens extract was effective, safe, well-tolerated, and clinically and statistically superior to placebo in the target LUTS/BPH population. (C) 2019 Elsevier Inc.

目的 本研究的目的在于比较行腹腔镜根治性肾切除术(Laparoscopic radical nephrectomy,LRN)的老年局限性肾细胞癌(Local-ized renal cell carcinoma,LRCC)患者与中年患者的短期及长期结局.方法 2012年1月至2018年12月,共有58例年龄大于或等于70岁的LRCC患者(老年组)行LRN,这58例患者与同期因LRCC行LRN的109例中年患者(年龄在55～69岁之间,中年组)进行短期与长期结局的比较.结果 老年组的年龄、查尔森合并症指数及美国麻醉师协会评分高于中年组,其余的术前基线资料资料比较差异无统计学意义.老年组与中年组在手术时间、术中失血量、中转率、术后30天并发症发生率及严重程度、病理结果等短期结局方面比较差异无法统计学意义.长期随访结果表明,两组患者的肿瘤复发率类似.两组患者的总体生存率及无瘤生存率均类似.结论 LRN用于老年LRCC患者可取得与中年患者类似的短期及长期结局.

目的:探讨输尿管皮肤造口治疗晚期膀胱癌疗效.方法 :选取2010年2月～2016年2月某院诊治晚期膀胱癌58例进行研究,根据患者治疗方式分为A组(31例,输尿管皮肤造口治疗)和B组(27例,保守治疗),比较两组患者并发症及1年、3年生存率.结果 :A组患者尿潴留、尿失禁、尿路梗阻发生率显著低于B组[6.45％vs.29.63％,0.00％vs.22.22％,6.45％vs.33.33％,P<0.05];A组患者1年生存率(54.84％)、3年生存率(25.81％),B组患者1年生存率(40.74％)、3年生存率(11.11％),A组患者生存率高于B组,但比较差异无统计学意义(P>0.05).结论 :输尿管皮肤造口治疗晚期膀胱癌能降低相关并发症发生率,适当延长患者生存率.

目的:研究沉默Notch-1基因对人膀胱癌RT4细胞增殖、凋亡、侵袭和上皮间质转化等生物学行为的影响.方法:设计并构建Notch-1 shRNA,选取RT4细胞作为研究对象分别进行转染.实验细胞分为Notch-1阴性对照组(shRNA NC),Notch-1干扰组(Notch-1 shRNA).细胞转染48 h后,MTT法检测细胞增殖水平变化;Transwell检测细胞侵袭力的改变;流式细胞术检测细胞凋亡水平情况;RT-PCR和Western blot检测凋亡相关蛋白(Bax、Bid、Bcl-2)及上皮间充质转化(EMT)因子(E-cadherin、N-cadherin、Vimentin)在mRNA和蛋白水平上的改变.结果:与shRNA NC组相比,Notch-1 shRNA组细胞增殖率明显下降(t=4.629,P=0.010),侵袭力减弱(t=8.193,P=0.001),细胞凋亡率明显升高(t=–18.441,P<0.001),Bad(t=–12.521,P<0.001;t=–6.983,P=0.002)、Bid(t=–9.231,P<0.001;t=–8.871,P=0.001)、E-cadherin(t=–13.457,P<0.001;t=–5.610,P=0.005)mRNA和蛋白表达量增多,Bcl2(t=10.651,P<0.001;t=6.973,P=0.002)、N-cadherin(t=6.505,P<0.001;t=10.132,P=0.001)、Vimentin(t=9.135,P<0.001;t=5.630,P=0.005)mRNA和蛋白表达量显著降低.结论:沉默Notch-1的表达能够抑制人膀胱癌RT4细胞的增殖和侵袭迁移,促进其细胞凋亡,其机制可能与诱导Bad、Bid、E-cadherin,抑制Bcl2、N-cadherin、Vimentin的表达有关.

目的 探讨女性复杂性下尿路感染患者影像尿动力学(VUD)检查的临床意义.方法 对103例女性复杂性下尿路感染患者进行VUD检查(包括自由尿流率测定、膀胱充盈期、排尿期功能测定、同步影像显示等),并分析检查结果,以明确引起复杂性下尿路感染的病因.结果 根据VUD分析结果,103例女性复杂性下尿路感染患者患者的病因主要有3类:(1)膀胱出口梗阻78例,其中合并逼尿肌过度活动39例,逼尿肌-括约肌协同失调4例(排尿期逼尿肌收缩良好3例,逼尿肌无反射1例);(2)膀胱脱垂15例(包括中央型11例、外侧型4例),合并逼尿肌过度活动3例;(3)尿道憩室10例,伴憩室结石1例.结论 VUD检查有助于明确女性复杂性下尿路感染的病因,为临床治疗提供依据.

Purpose To assess the performance of Support Vector Machines (SVM) classification to stratify the Gleason Score (GS) of prostate cancer (PCa) in the central gland (CG) based on image features across multiparametric magnetic resonance imaging (mpMRI). Materials and methods This retrospective study was approved by the institutional review board, and informed consent was waived. One hundred fifty-two CG cancerous ROIs were identified through radiological-pathological correlation. Eleven parameters were derived from the mpMRI and histogram analysis, including mean, median, the 10th percentile, skewness and kurtosis, was performed for each parameter. In total, fifty-five variables were calculated and processed in the SVM classification. The classification model was developed with 10-fold cross-validation and was further validated mutually across two separated datasets. Results With six variables selected by a feature-selection and variation test, the prediction model yielded an area under the receiver operating characteristics curve (AUC) of 0.99 (95% CI: 0.98, 1.00) when trained in dataset A2 and 0.91 (95% CI: 0.85, 0.95) for the validation in dataset B2. When the data sets were reversed, an AUC of 0.99 (95% CI: 0.99, 1.00) was obtained when the model was trained in dataset B2 and 0.90 (95% CI: 0.85, 0.95) for the validation in dataset A2. Conclusion The SVM classification based on mpMRI derived image features obtains consistently accurate classification of the GS of PCa in the CG.

目的 探讨间质性膀胱炎患者膀胱平滑肌组织中RhoA/Rho激酶、I型胶原表达情况及相关性.方法 取临床确诊的间质性膀胱炎患者的膀胱平滑肌组织,盆腔疼痛和尿频、尿急患者症状调查表评分(PUF评分)≤1512例(低症状评分组);PUF评分>15分12例(高症状评分组).并取12例正常膀胱平滑肌组织(对照组).采用实时荧光定量RT-PCR和ELISA检测3组膀胱平滑肌组织中RhoA和Rho激酶亚型ROCK I mRNA及其蛋白、I型胶原的表达水平.对RhoA mRNA与ROCK I mRNA、RhoA蛋白与ROCK I蛋白、RhoA蛋白及ROCK I蛋白与I型胶原的表达水平行相关性分析.结果 膀胱平滑肌组织中RhoA mRNA和ROCK I mRNA的相对表达水平,高症状评分组分别为(1.00±0.18)分、(0.91±0.26)分;低症状评分组分别为(0.64±0.23)分、(0.57±0.25)分;对照组分别为(0.45±0.20)分、(0.45±0.11)分.RhoA蛋白和ROCK I蛋白的表达水平,高症状评分组分别为(52.25±7.71)ng/L、(46.63±7.97)ng/L;低症状评分组分别为(42.25±3.14)ng/L、(35.90±4.40)ng/L;对照组分别(26.89±3.08)ng/L、(24.68±3.10)ng/L.I型胶原的表达水平,高症状评分组为(551.98±74.37)μg/L;低症状评分组为(462.61±45.52)μg/L;对照组为(311.24±40.80)μg/L.3组膀胱平滑肌组织中RhoA mRNA表达与ROCK I mRNA的表达水平呈正相关关系(r=0.590,P<0.01);RhoA蛋白表达与ROCK I蛋白表达呈正相关关系(r=0.737,P<0.01);RhoA蛋白表达与I型胶原表达呈正相关关系(r=0.783,P<0.01);ROCK I蛋白表达与I型胶原表达呈正相关关系(r=0.736,P<0.01).结论 间质性膀胱炎患者膀胱平滑肌组织中RhoA/Rho激酶、I型胶原表达水平升高,两者间有正相关关系,且升高水平与疾病的症状水平有关.

Objective To explore the effects of continuous nursing on postoperative urinary incontinence in patients with prostate cancer, so as to provide clinical evidence to improve the quality of postoperative and extended nursing care.Methods A total of 120 patients with prostate cancer underwent radical prostatectomy in the First Affiliated Hospital of Wenzhou Medical University from January 2016 to January 2017, who met the inclusion criteria were recruited in the research. The patients were randomly divided into experimental group and control group by sortition randomization method, with 60 cases in each. The patients in control group were given routine discharge health education, and the experimental group received continuous nursing on the basis of routine discharge nursing. Three months after discharge, the incidence, duration, frequency and quantity of urinary incontinence in the two groups were recorded by the International Consultation on Incontinence Questionnaire Short Form (ICI-Q-SF). A self-designed prostate cancer postoperative-related knowledge questionnaire, which evaluated the patients understanding prostate cancer care, was completed by the patients of the two groups. A self-designed satisfaction questionnaire was used to evaluate and compare the satisfaction of the two groups of patients to the quality of nursing.Results The incidence rate and the duration of postoperative urinary continence in the experimental group [16.7％,(4.1±2.8) d] were significantly lower than those in the control group (χ2=9.076,t=-2.630;P<0.05). After 3 months of discharge, the score of related knowledge and the satisfaction of nursing work in the experimental group were both higher than those of the control group, and the differences were statistically significant (P<0.05).Conclusions Continuous nursing care for discharged patients after prostatectomy can enhance patients' knowledge of disease, effectively reduce the incidence of postoperative incontinence, reduce urinary incontinence duration, and improve patients' satisfaction with nursing quality.

Bladder cancer (BC) is one of the most common cancers worldwide with a high progression rate and poor prognosis. The Hippo signalling pathway is a conserved pathway that plays a crucial role in cellular proliferation, differentiation and apoptosis. Furthermore, dysregulation and/or malfunction of the Hippo pathway is common in various human tumours, including BC. In this review, an overview of the Hippo pathway in BC and other cancers is presented. We focus on recent data regarding the Hippo pathway, its network and the regulation of the downstream co-effectors YAP1/TAZ. The core components of the Hippo pathway, which induce BC stemness acquisition, metastasis and chemoresistance, will be emphasized. Additional research on the Hippo pathway will advance our understanding of the mechanism of BC as well as the development and progression of other cancers and may be exploited therapeutically.

To evaluate the clinical outcomes with a Chinese single-use fiberoptic flexible ureteroscope (YouCare Tech) from a prospective database.

Background: Although triptorelin is increasingly used in China for biochemical castration, its effects on primary prostate cancer symptoms remain unclear. This study aimed to assess the prevalence of lower urinary tract symptoms (LUTS) in Chinese prostate cancer patients and the effectiveness of triptorelin on LUTS. Methods: In this 48-week multicenter, non-interventional, prospective study, we enrolled patients with locally advanced or metastatic prostate cancer. Patients received triptorelin (15 mg) intramuscularly at baseline and at weeks 12, 24, and 36 with symptom assessment using the International Prostate Symptoms Score (IPSS). The primary endpoints were the prevalence of LUTS at baseline per IPSS categories and the percentage of patients with moderate to severe LUTS (IPSS > 7) at baseline, having at least a 3-point reduction of IPSS score at week 48. Results: A total of 398 patients were included; 211 (53.0%) and 160 (40.2%) among them had severe and moderate LUTS, respectively. Of the patients with IPSS scores available at baseline and at week 48 (n = 213), 81.2% achieved a reduction in IPSS of at least 3 points. Of the patients with moderate to severe LUTS at baseline and IPSS scores available at baseline and at week 48 (n = 194), 86.6% achieved a total IPSS reduction of at least 3 points. Conclusions: The vast majority of Chinese patients with locally advanced or metastatic prostate cancer scheduled to receive triptorelin as part of their standard treatment have severe or moderate LUTS. Triptorelin therapy resulted in sustained improvement of LUTS in these patients.

Objective To investigate the relationship between preoperative renal cortical thickness and glomerular filtration rate (GFR) before and after minimally invasive surgery in patients with unilateral upper urinary tract obstruction. Methods 63 patients with upper urinary tract obstruction from July 2015 to June 2016 were enrolled in the study, including 34 males and 29 females, age ranged from 22 to 73 years old (52.21 ± 11.56). Their operation methods included 24 cases of ureteroscopic lithotripsy and lithotomy, 21 cases with one-stage percutaneous nephrostomy + two-stage percutaneous nephrolithotomy (PCNL), 18 cases of PCNL. The abdominal enhanced CT and single photon emission computed tomography (SPECT) were measured to RCT and GFR. Then all cases were divided into group A (moderate renal impairment, 15.0 ml/min ≤ GFR < 30 ml/min), group B (severe renal damage, 7.5 ml/min ≤ GFR <15.0 ml/min) and group C (extremely severe renal injury, GFR < 7.5 ml/min) according to preoperative renal GFR, and changes of GFR before and after surgery were compared among three groups. Simple linear correlation analysis was used to analyze the correlation between preoperative RCT and other indexes in group A and B. Results 9 patients were not measured RCT because of serious hydronephrosis, 54 patients included 20 cases of RCT >10 mm, 23 cases of 5 ～ 7 mm and 11 cases of <5 mm, and the average value was (10.75 ± 4.91) mm. The preoperative RCT in group A was significantly higher than that in group B (P < 0.05). GFR at 1 and 9 months after operation in three groups were significantly higher than that before operation in the same group (P < 0.05). GFR at 1 and 9 months after operation in group A were significantly higher than that the other two groups, and GFR at 9 months after operation in group B was significantly higher than that in group C (P < 0.05), but there were no significant differences in GFR at 1 month after operation between group B and C (P > 0.05). GFR recovery value at 1 month after operation in group B was significantly lower than that in other two groups (P < 0.05), but there were no significant differences in GFR at 9 months after operation among three groups (P > 0.05). Preoperative RCT was positively correlated with preoperative GFR (r = 0.613), GFR at 1 month after operation (r = 0.697) and the recovery value (r = 0.552), GFR at 9 months after operation ((r = 0.589) and recovery values (r = 0.488), and the differences were statistically significant (P < 0.05). Conclusion Removal of upper urinary tract obstruction could recover the renal function to varying degrees, even for patients with extremely severe renal injury, who could retrieve their kidney. Preoperative RCT could be helpful in judging the renal function during operation, especially for the postoperative recovery of renal function.