PTEN-Long is a translational variant of PTEN (Phosphatase and Tensin Homolog). Like PTEN, PTEN-Long is able to antagonize the PI3K-Akt pathway and inhibits tumor growth. In this study, we investigated the role PTEN-Long plays in the development and progression of clear cell renal cell carcinoma (ccRCC) and explored the therapeutic possibility using proteinaceous PTEN-Long to treat ccRCC. We found that the protein levels of PTEN-Long were drastically reduced in ccRCC, which was correlated with increased levels of phosphorylated Akt (pAkt). Gain of function experiments showed overexpression of PTEN-Long in the ccRCC cell line 786-0 suppressed PI3K-Akt signaling, inhibited cell proliferation, migration and invasion, and eventually induced cell death. When purified PTEN-Long was added into cultured 786-0 cells, it entered cells, blocked Akt activation, and induced apoptosis involving Caspase 3 cleavage. Furthermore, PTEN-Long inhibited proliferation of 786-0 cells in xenograft mouse model. Our results implicated that understanding the roles of PTEN-Long in renal cell carcinogenesis has therapeutic significance.

Objective To investigate the clinical features of multiple primary malignancies ( MPM) in patients with kidney malignancy .Methods The clinical data of 111 patients suffered from MPM associated with kidney malignant tumor in Yantai Yuhuangding Hospital and Affiliated Yantai Hospital of Binzhou Medical College from April 1984 to December 2014 were retrospectively analyzed .Results Among the 111 cases,there were 100 cases with two primary malignancies ,9 with three cancers and 2 cases with four or five cancers.Synchronous MPM were 37 cases,and metachronous 74 cases.The interval between the first and the second primary malignancy was between 0 and 348 months,with average of 46 months and median of 16 months.One hundred and seventy-two cases were treated by operation , and 64 cases by conservative therapy.The proportion of operation from the first to the fifth cancers were 89.2%(99/111),59.5%(66/111),54.5%(6/11),50.0%(1/2),0%(0/1),respectively,with the trend of declining.Finally 95 cases (85.6%) were followed up ,with 53 cases survived and 42 cases died.From the diagnostic date of the first primary cancer,overall survival in 1 year,3 years,5 years,10 years were 97.2%,77.2%,67.8%,48.4%, respectively.Median survival time was 120 months.From the diagnostic date of the last primary cancer , overall survival in 1 year,3 years,5 years were 81.4%,53.4%,48.2%,respectively.Median survival was only 48 months.Univariate analysis showed that the cumulative survival rate was higher in patients with operation than conservative therapy ( P =0.000 ) , in metachronous group than synchronous group ( P =0.009).COX proportional hazard model showed metachronous MPM (OR=3.870,95%CI 1.702-8.801,P=0.001),aggressive operation of the first primary cancer (OR=0.107,95%CI 0.018-0.647,P=0.015) and the second cancer (OR=0.313,95%CI 0.131 -0.750, P=0.009) were independent prognostic factors. Conclusions The main treatment of MPM associated with kidney malignancy is aggressive operation, radiotherapy, chemotherapy and biological therapy are adjuvant .Early detection and early operation for MPM are beneficial for increasing the survival of the patients .

To the Editor, Here, we report our experience of eight cases of elongation of the right renal vein using donor gonadal vein during retroperitoneoscopic living donor kidney transplantation in our hospital. In living donor kidney transplantation, the left kidney is preferred as the right renal vein is shorter. Transplantation of the right kidney is technically more challenging for reimplantation of the graft due to higher venous anastomosis tension and also has a higher risk of complications. Elongation of the right renal vein is a key step in improvement of the success rate and reduction of operative complications of living donor nephrectomy. This report enrolled eight healthy donors, who were admitted between August 2013 and April 2014. Donors aged 45 9.5 yr old, including three men and five women. All donors were confirmed with single artery and vein in right kidney by MRI or CT 3-D vascular reconstruction. Donors and recipients were matched with satisfaction. All organ donations were on voluntary basis, and written informed consents were signed. The donor’s right kidney and gonadal vein were extracted through standard hand-assisted laparoscopic nephrectomy. The gonadal vein was cut longitudinally and trimmed into a patch of 6–8 cm long and 0.8–1.2 cm wide (Fig. 1). A 3to 4-cm long vessel was formed by spiral anastomosis of the patch with a similar diameter as the right renal vein, which was then anastomosed with the renal vein (Fig. 2). Conventional kidney implantation surgery was performed. Patients were followed for six months. Color Doppler ultrasound test showed the blood flow was patent in vena profunda without renal vein related complications such as hemorrhage, thrombosis, or angusty, etc. All eight donor kidneys were successfully transplanted to recipients. The perioperative parameters for donor kidney nephrectomy are shown in Table 1. The right renal vein was elongated by an average of 2.9 cm. Donors had no obvious postoperative complications. Recipients’ creatinine levels all dropped to normal range within one wk post-operation, and good graft functions were observed. In the past years, a variety of techniques have been developed for lengthening of the right renal vein, which range from iliac vein transposition to donor vein elongation (1). For deceased donors, renal vein could be elongated with postcava (2). For living donors, the elongation material included linear cutting anastomat (3), polytetrafluoroethylene graft and a variety of veins, for example, the great saphenous vein (1). Mikhalski et al. (4) first reported lengthening the right renal vein with gonadal vein. We simultaneously extracted the donor’s right kidney and gonadal vein through retroperitoneoscopy and significantly increased the length of the right renal vein, which ultimately led to good organ function without increased perior postoperative morbidity during living donor kidney transplantation. Fig. 1. A longitudinally incised gonadal vein.

Objective: To determine the efficacy and safety of a novel minimally invasive design for treating bulky vesical calculi and large benign prostatic hyperplasia (BPH) simultaneously. Methods: 76 patients with large bladder stones (>4 cm) and large BPH (≥50 cm3) were treated from August 2008 to January 2011. 38 patients (group 1) underwent transurethral cystolithotripsy followed by transurethral resection of the prostate (TURP), 38 patients (group 2) received percutaneous cystolithotripsy within a laparoscopic entrapment bag and TURP by two surgeons simultaneously. 72 patients were followed up for 1 year. Patient demographics, perioperative parameters and follow-up data were compared. Results: Patient baseline characteristics were comparable in the two groups. In group 1, 3 patients converted to open surgery and received blood transfusion, 4 patients had postoperative fever, 2 had residual stones and 1 developed urethral stricture postoperatively. In group 2, the mean total operative and the operative times for stone management were 71.6 and 30.1 min, respectively, the mean hemoglobin decrease was 0.80 g/dl, no patients received blood transfusion and no complications occurred, significantly superior to group 1. Conclusions: Percutaneous cystolithotripsy using a laparoscopic entrapment bag associated with TURP by two surgeons simultaneously is a highly effective, safe and minimally invasive method for managing large vesical calculi and large BPH.

OBJECTIVE:To compare the outcomes of renal transplantation with donor kidneys with multi-branched renal arteries.METHODS:The data about operation time, volume of intra-operational blood loss, postoperative complications, and post-operational renal function status of 251 recipients of donor kidneys with single-branched renal artery (Group A), 12 recipients of donor kidneys with double-branched renal arteries the diameter of one of which was < 2 mm or the estimated blood supply areas of one of which were < 10% (Group B), and 35 recipients of donor kidneys with renal arteries with 2 or more than 2 branches (Group C).RESULTS:The operation time was (115 +/- 34) min in Group A and was (120 +/- 31) min in Group B, both shorter than that of Group C [(133 +/- 55) min], however, not significantly. There were not significant differences in the intra-operational volume of blood loss, 1-year survival rate of patient/transplanted kidney, and post-operational creatinine level among these three groups. The complication rate was 7.6% (19/251) in Group A, 16.7% (2/12) in Group B, and 11.4% in Group C (4/35).CONCLUSION:There are not significant differences in the intra-operational status and post-operational outcomes among the operations of renal transplantation with donor kidneys with different amounts of renal arteries.

BACKGROUND:Laparoscopic dismembered pyeloplasty is technically feasible for ureteropelvic junction (UPJ) obstruction although it is still challenged by its technical difficulty and time-consuming. In this study, we compared the initial results of retroperitoneal laparoscopic pyeloplasty versus a combined laparoscopic dissection and open reconstruction through a small incision in the treatment of UPJ obstruction.METHODS:Sixty-four patients with primary UPJ obstruction underwent pyeloplasty: 32 patients underwent laparoscopic procedure and 32 patients underwent open assisted laparoscopic surgery including two steps, ie, laparoscopic dissection of the UPJ transperitoneally and then pyeloplasty via an extended small incision. The demographic data and intraoperative, postoperative and follow-up conditions of patients were compared between the two groups.RESULTS:Preoperative data were comparable in the patients of the two groups. The operative time was shorter (60.9 minutes vs 157.7 minutes, P < 0.0001) and the complication rate was lower (9.4% vs 31.3%, P < 0.05) in the open assisted group than in the laparoscopic group. The estimated blood loss (42.3 ml vs 47.8 ml), time to have normal diet (37.6 hours vs 33.8 hours), and hospital stay (6.7 days vs 6.2 days) were equivalent. The operative success rate was 97% for the open assisted group and 91% for the laparoscopic group.CONCLUSIONS:The procedure of combined small incision with laparoscopy for UPJ obstruction is technically easy, and the results are promising. It can be used as an alternative to conventional procedures.

Objective To report initial experience with laparoscopic radical cystectomy in 43 patients with invasive bladder carcinoma. Methods From December 2003 to October 2006,29 men and 14 women underwent laparoscopic radical cystectomy with extracorporeal-assisted urinary diversion for transitional cell carcinoma of the bladder(n=40),adenocarcinoma(n=2)and squamous cell arcinoma (n=1). We report the specific technical details and present initial results of our series. Results The mean operative time of laparoscopic radical cystectomy with pelvic lymph node dissection was 195.4 min,the mean blood loss 273.7 ml, and the transfusion rate 6.9%. Two procedures converted to open techniques.Lymphadenectomy detected lymph node metastasis in three patients. Conclusions We demonstrate that the combination of laparoscopic radical cystectomy and extracorporeal urinary diversion is possible and remains a safe,feasible,and repeatable surgical technique. The laparoscopic surgery with extracorporeal urinary reconstruction is emerging as a viable alternative to open radical cystectomy while characterized by less trauma,short recovery time and low complications. Intermediate oncologic outcomes are encouraging and comparable to those of open series. To determine the oncologic outcome long-time follow-up will be necessary.

Since its introduction in 1995,laparoscopic livingdonor nephrectomy（LDN）has been shown toalleviate postoperative pain,shorten hospital stay,reduceloss and improve cosmesis while hastening the recoveryof normal activities of donors.However,there has been

OBJECTIVE:To explore the technique and efficacy of laparoscopic ureteroplasty in treatment of congenital obstructive megaureter in childhood.METHODS:Three children with congenital obstructive megaureter, all male, aged 7 approximately 24, underwent laparoscopic surgery. The dilated ureter was dissected and cut off near the place connecting the ureter and the bladder by laparoscopy. A double J tube was placed in the free ureter and connected with the urinary catheter by 7 - 0 wire. Then the free ureter was sutured with the bladder mucosa by laparoscopy.RESULTS:The operation duration was 80 to 200 min and blood loss was 30 to 50 ml. No complication developed. The double J was removed 10 days after the operation. Follow-up for 4 approximately 24 months showed good ureter drainage in all 3 cases without any infection, obstruction and hydrops.CONCLUSION:Laparoscopic surgery to treat megaureter in childhood has the benefits of slight injury and fast recovery in a short-time follow-up.

Purpose: To present our experience in laparoscopic radical cystectomy with extracorporeal urinary diversion for treatment of Chinese bladder cancer patients. Methods: Between January 2003 and November 2005, 41 men and 5 women with organ-confined muscle-invasive transitional cell carcinoma of the bladder underwent laparoscopic radical cystectomy with the Bricker-type urinary diversion. The age range was 36–71 years. Laparoscopic radical cystectomy and bilateral pelvic lymphadenectomy were performed using five fan-shaped ports by a transperitoneal approach. An ileal conduit diversion was created through the site of specimen retrieval which was the second port at the region of the right pararectus. Results: 46 radical cystectomies with Bricker-type ileal conduits were performed. No conversion to open surgery was necessary. Mean operating time was 220 min (range 120–249 min) for laparoscopic radical cystectomy and 75 min (range 65–120 min) for creating the ileal conduits. Mean estimated blood loss was 276 ml (range 155–567 ml). Two of the 46 patients needed blood transfusion (400 ml each). Mean days to ambulation and oral intake was 4.1 (range 3–5 days) and 3.5 (range 3–6 days), respectively. Mean hospital stay was 17.6 days (range 12–35 days). Mean follow-up was 6.1 months (range 3–19 months). Histopathological examination of the specimens revealed stage T2N0M0 in 18 cases, T3aN0M0 in 14, T3bN0M0 in 9 and T3bN1M0 in 5 (TNM staging). WHO grading: G1 in 2 cases, G2 in 26 cases and G3 in 18 cases. Pelvic metastases appeared in one case and 44 patients are alive and free of disease. Intravenous pyelogram at 3 weeks postoperatively shows no evidence of upper urinary obstruction in 45 patients. Conclusion: Despite technical difficulties, laparoscopic radical cystectomy with Bricker-type urinary diversion is feasible. With more experience in the surgical technique, laparoscopic radical cystectomy with extracorporeal urinary diversion can become an alternative treatment of choice in the selected patients with organ- confined bladder cancer in China.

OBJECTIVE: To evaluate the efficacy and feasibility of laparoscopic aid in upper urinary reconstructive operation. METHODS: Fifty-eight patients with ureteropelvic junction obstruction, 5 patients with upper ureter polypous, 2 patients with upper ureter stenosis, and 13 patients with upper ureter lithiasis underwent upper urinary reconstructive operation with laparoscopic aid described as follows:an incision 1 cm long was made, a 10 mm trocar and a 30 degrees laparoscope were wt in, the part with lesion was isolated and resected, and then pyeloplasty or end-to-end anastomosis of ureter was performed. RESULTS: The mean operative time was 33 minutes (25-45 minutes). The mean blood loss was 20 ml (15-25 ml). Complications such as urinary leakage and infection were observed. The double J stent was removed at 1 month after the operation. Follow-up for 3 to 15 months in 20 cases showed alleviation of hydronephrosis. CONCLUSION: An effective and safe method with less wound and operative time, combination of laparoscopic aid and open surgery in upper urinary reconstructive operation helps avoid difficult laparoscopic operation, does not increase trauma of the abdominal wall, and is worth promoting clinically.