Laparoscopic total adrenalectomy has become the standard treatment for adrenal mass. Meanwhile, there has been a growing trend toward laparoscopic adrenal-sparing surgery worldwide to avoid the risk and potential complications of adrenal insufficiency. The objectives of this study were to describe a retroperitoneoscopic adrenal tumor enucleation technique, to assess the clinical outcomes of this technique in the treatment of 20-40 mm nonsecreting adrenal tumor (NAT) with low potential of malignancy, and to provide a feasible choice for patients who have preference on resection. This study was a retrospective analysis of 61 patients with low potential of malignancy in 20-40 mm NAT identified at the first imaging examination or during follow-up. All patients were scheduled for planned enucleation adrenalectomy by a single surgeon between July 2016 and December 2020 in Xuanwu Hospital, Beijing, China. In all patients, retroperitoneoscopic surgery was performed via a retroperitoneoscopic process for all the patients. The crucial techniques of enucleation are presented in the video. Safety and feasibility factors of enucleation technique were measured for this study. No blood transfusion or organ injury was registered during the operation. The median operation time was 75 min, and the median blood loss was 35 mL. All operations were successfully performed without open conversion. A total of 58 patients received successful enucleation surgery. Three cases were converted to retroperitoneoscopic total adrenalectomy. In this study, surgical outcomes of retroperitoneoscopic enucleation adrenalectomy as a method to remove adrenal tumors were assessed. This procedure is a feasible and safe technique with the added benefit of preserving the remaining functional adrenal tissue.

BACKGROUND:An increasing amount of evidence has indicated that microRNAs (miRs) are involved in most biological conditions, including the neurogenic bladder (NB). However, to our knowledge, no studies have investigated these miR expressions in spinal cord-injured (SCI) rat NB. The goal of the study was to explore the miR expression profile in the SCI rat NB by next-generation sequencing (NGS).METHODS:Female Wistar rats underwent spinal cord transection at T9-10 and were randomly divided into the SCI-1, SCI-2 and SCI-3 groups (n=5 for each group) whose bladder tissues were collected 1, 2, and 4 weeks after transection, respectively. The normal rats were used as the normal control (NC) group. MiRs microarray assays were used to detect the differentially expressed miRs between the groups by NGS, which was then verified by quantitative real-time polymerase chain reaction (qRT-PCR). Those significantly differently expressed miRs were analyzed with Gene Ontology categories and Kyoto Encyclopedia of Genes and Genomes bioinformatical analyses.RESULTS:Compared with the NC group, 96, 28 and 51 miRs were downregulated in the rats' bladder in the SCI-1, SCI-2, and SCI-3 groups, respectively, and 133, 49, and 76 miRs were upregulated respectively. Specifically, miR-21-5p was the most significantly upregulated miR in all SCI groups. Also, 121 miRs (SCI-1 vs. SCI-2), 98 miRs (SCI-1 vs. SCI-3), and 26 miRs (SCI-2 vs. SCI-3) were of significantly different expression. Furthermore, a large set of genes implicated in essential signaling pathways were targeted by these miRs, including PI3K-Akt, MAPK, Rap1, and cGMP-PKG signaling pathways, along with the tight junction and metabolic pathways.CONCLUSIONS:This is the first demonstration of differentially expressed miRs, which may potentially serve as new molecular targets in the SCI rat NB.

Background Transurethral seminal vesiculoscopy (TSV) is a safe and effective method for intractable hemospermia. It uses a natural cavity, is fast, involves little trauma, and boasts a low incidence of complications. Because uncontrollable penile erection during general anesthesia will severely influence the surgical operation or even damage the endoscope, spinal anesthesia was applied more on TSV. But spinal anesthesia extends the length of stay in the hospital and brings patients unnecessary discomfort. As the TSV is a quick recovery operation, we should think about a more suitable mode for these patients. Methods A total of 141 patients received TSV between January 2015 and July 2019: 81 patients received day surgery under caudal block (group A), and 60 received inpatient surgery under spinal anesthesia (group B). Operative time, postoperative hospital stay, hemospermia remission rate, magnetic resonance imaging (MRI) remission rate are compared. Visual analog scale (VAS) scores of groups were taken and compared at 2 time points: when there was pain during surgery (T1) and at the end of surgery (T2). Surgical methods of two groups are the same. Results The mean operative time of two groups are 34 min (group A) and 32 min (group B), and there was no statistical difference. Postoperative hemospermia remission rates are both 100% at 3 months, which at 6 months are 60% and 48%, and there was no statistical difference. MRI remission at 3 months are 72% and 57%, which has no statistical difference. Postoperative complications were mild in two groups like hematuria and dysuria which can relieve within one day, and there were no severe complications. Intraoperative pain was present in 18.5% (15/81) of group A. Their highest VAS score was 3 points, indicating mild pain, which did not influence the surgical process or postoperative recovery. The postoperative VAS scores were similar between the 2 groups. Group A did not require postoperative hospitalization, whereas the average postoperative hospitalization in group B was 2 days. Conclusions Seminal vesiculoscopy can be performed as a day surgery under caudal block, which has obvious advantages in accelerating postoperative recovery and shortening the hospital stay.

OBJECTIVES: Minimally invasive paracentetic suprapubic cystostomy is a technique that should be learned by all surgical trainees and residents. This study aimed to develop a self-made training model for paracentetic suprapubic cystostomy and placement of the suprapubic catheter and then to evaluate its effectiveness in training fourth-year medical students. METHODS: Medical students were divided into an experimental group receiving comprehensive training involving literature, video, and model use and a control group receiving all the same training protocols as the experimental group except without hands-on practice using the model. Each student’s performance was video-recorded, followed by subjective and objective evaluations by urology experts and statistical analysis. RESULTS: All students completed the surgical procedures successfully. The experimental group’s performance scores were significantly higher than those of the control group (median final performance scores of 91.0 vs. 86.8, respectively). Excellent scores were achieved by more students in the experimental group than in the control group (55% vs. 20%), and fewer poor scores were observed in the experimental group than in the control group (5% vs. 30%). CONCLUSIONS: Based on its cost-effectiveness, reusability, and training effectiveness, this paracentetic suprapubic cystostomy training model is able to achieve goals in teaching practice quickly and easily. Use of the model should be encouraged for training senior medical students and resident physicians who may be expected to perform emergent suprapubic catheter insertion at some time.

载脂蛋白A-I(Apo A-I)是高密度脂蛋白(HDL)的主要结构和功能蛋白,主要功能是负责HDL的组装,并通过把多余胆固醇从外围组织运送到肝脏(反向胆固醇运输),进而发挥抗动脉粥样硬化的作用.血浆Apo A-I水平升高可能与恶性肿瘤发生风险呈负相关,与恶性肿瘤患者预后呈正相关.Apo A-I可能是通过调节肿瘤微环境和机体免疫反应发挥抗肿瘤作用.

Objective:To evaluate the clinical effect of transurethral resection (TUR)of bladder tumor combined with internal iliac artery chemotherapy with or without intravesical instillation therapy for muscle invasive bladder cancer (MI-BC).Methods:Seventy-one patients with MIBC were selected and treated with TUR of bladder tumor combined with in-travesical instillation therapy,with or without internal iliac artery chemotherapy (chemotherapy regimen:gemcitabine and cisplatin,GC)between February 2007 to June 2014.The bladder preservation and survival rate as well as cancer specific survival rate (CSS)and overall survival rate (OS)of the two groups were compared.Results:Seventy-one patients were followed up for 18-100 months with an average of 59 months.The two-year bladder preserved rate in TUR+GC group and TUR group was 92.9% and 79.3%,respectively (P<0.05).The one-year DFS in TUR+GC group and TUR group was 83.3% and 58.6%,and the 2-year DFS was 78.6% and 62.1% for 2 years,respectively (P<0.05).The 2-year cancer CSS in TUR+GC group and TUR group was 92.9% and 82.8%,respectively (P>0.05).The 2-year OS in TUR+GC group and TUR group was 88.1% and 82.8%,respectively (P>0.05).Conclusions:TURBT and intra-vesical instillation therapy combine with internal iliac artery chemotherapy for MIBC may have better outcome at recur-rence-free survival,bladder preserved rate,DFS than the treatment without internal iliac artery chemotherapy,and there was no difference in OS and CSS.

目的 研究B超引导下经皮肾肿瘤穿刺活检对于小体积肾占位(SRMs)的诊断价值及其和术后病理结果的吻合度,为临床治疗起指导作用.方法 通过对54例小体积肾占位患者(肿物直径≤4 cm)采用B超引导经皮穿刺活检,记录穿刺的有效诊断率、与肿物切除术后病理结果的吻合度、并发症发生率.结果 总体穿刺诊断有效率94.4％,并且与切除肿瘤术后病理吻合度可达94％.恶性肿瘤占80.4％.并发症发生率6％,并且均为自限性.结论 B超引导下经皮肾肿瘤穿刺活检对于小体积肾占位有高诊断准确率.对于临床小体积肾占位的术前诊断十分安全,其中良性肿瘤检出率接近20％,可以避免过度的手术治疗,对于临床有实用价值.

目的 探讨腹腔镜根治术对转移性前列腺癌的安全性和疗效.方法 对14例确诊骨转移或淋巴结转移的前列腺癌患者实施腹腔镜前列腺癌根治术,观察围术期指标、术后近期并发症、切缘情况、术后前列腺特异抗原(PSA)水平变化及转移灶变化等指标.结果 14例患者均顺利完成腹腔镜根治术,手术时间平均在170 min,出血量平均为400 mL,直肠损伤7％(1/14),无膀胱输尿管损伤,术后平均住院日为8d,切缘阳性率57％(8/14),严重尿漏7％(1/14),淋巴漏50％(7/14).术后随访6个月,1个月尿失禁发生率80％,3个月为50％,6个月为0％.术后3月内无内分泌治疗的情况下,PSA水平均较术前降低.结论 腹腔镜前列腺根治术切除前列腺原发灶对伴有远处转移的患者是安全可行的,这需要由丰富腔镜经验的泌尿外科医生操作,并且术前需要对手术患者进行充分的筛选.术后近期PSA水平均有不同程度下降.

Prostate cancer is a common cancer in men. Genetic variations in inflammatory response genes can potentially influence the risk of prostate cancer. We aimed to examine the association between PPARG Pro12Ala, NFKB1 -94 ins/del, NFKBIA -826C/T, COX-1 (50C>T), and COX-2 (-1195G>A) polymorphisms on prostate cancer risk. The genotypes of the polymorphisms were ascertained in 543 prostate cancer patients and 753 controls through PCR-RFLP and the risk association was evaluated statistically using logistic regression analysis. The NFKB1 -94 polymorphism was shown to decrease prostate cancer risk in both heterozygous and homozygous comparison models (odds ratios of 0.74 (95% CI = 0.58–0.96) (P=0.02) and 0.57 (95% CI = 0.42–0.78) (P<0.01), resp.). An opposite finding was observed for COX-2 (-1195) polymorphism (odds ratios of 1.58 (95% CI = 1.15–2.18) (P<0.01) for heterozygous comparison model and 2.08 (95% CI = 1.48–2.92) (P<0.01) for homozygous comparison model). No association was observed for other polymorphisms. In conclusion, NFKB1 -94 ins/del and COX-2 (-1195G>A) polymorphisms may be, respectively, associated with decreased and increased prostate cancer risk in the Chinese population.

Objective To investigate the diagnosis and treatment of bilateral sporadic renal cell carcinoma. Method From January 1995 to December 2012,11cases of bilateral sporadic renal cell carcinoma were treated in our depart-ment. Among the 11 cases,6 had synchronous and 5 had metachronous bilateral sporadic renal cell carcinoma. The tumor size was 3~7cm in diameter. 6 cases of synchronous RCC all underwent two stage operation. The treatment in-cluded unilateral radical nephrectomy( RN) plus contralateral nephron sparing surgery( NSS) for 3 cases and bilater-al NSS for 3 cases. 5 cases of metachronous RCC underwent RN for 4 cases and NSS for 1 case in first operation. The contralateral kidney underwent NSS for 5 cases. Result 1 of 11 cases had papillary adenocarcinoma and 10 cases were clear cell carcinoma. The follow-up was 6~62 months(mean 62. 9). 1 case died and 5 cases were renal fail-ure. Conclusion The goal of management is to complete tumor resection and maintain renal function. NSS is a safe and reasonable method for Bilateral Sporadic Renal Cell Carcinoma.

目的 探讨2μm铥激光尿道内切开治疗男性尿道狭窄及尿道闭锁的手术方法. 方法 使用德国LISA公司RevoLix 2μm连续波医用铥激光手术治疗系统,最大功率40 W,行手术治疗男性尿道狭窄17例,男性尿道闭锁6例.手术均在尿道镜直视下配以寻光法引导进行.后续治疗采用传统的尿道扩张方法,每周1次尿道扩张,连续10次以上,之后每月1次尿道扩张持续1年以上. 结果 平均手术时间52(35～70) min,术后4～8周拔除导尿管,患者均排尿通畅,术后配合尿道扩张巩固疗效.1例患者术后4个月时尿道扩张困难,再次行经尿道狭窄激光内切开术,术后排尿通畅. 结论 2μm铥激光尿道内切开术治疗尿道狭窄及尿道闭锁操作简便,创伤小,并发症少,疗效可靠且安全性高.

OBJECTIVE To study the expression and prognostic significance of ERG and SPINK1 expression in endocrine-treated prostatic cancer. METHODS Prostatic needle biopsies from 118 prostatic cancer patients primarily treated with endocrine therapy were reviewed. Immunohistochemical study for ERG and SPINK1 protein was carried out. RESULTS Co-expression of ERG and SPINK1 was not observed. The frequency of ERG protein expression in the 118 biopsies studied was 9.3% (11/118). The positive expression correlated with T stage (P=0.04) but not with patient age at diagnosis, prostatic specific antigen level, Gleason's score, M stage, tumor area and progression-free survival. Positive expression of SPINK1 was demonstrated in 11.0% (13/118) of the biopsies. SPINK1-positive cases carried a significantly shorter progression-free survival, as compared with SPINK1-negative cases (P=0.022). The expression was not associated with any other clinicopathologic variables. The following expression pattern showed statistically significant correlation with the clinical progress (P=0.029): ERG+/SPINK1- (11/118, 9.3%), ERG-/SPINK1+ (13/118, 11.0%) and ERG-/SPINK1- (94/118, 79.7%). CONCLUSIONS ERG and SPINK1 proteins are mutually exclusive.SPINK1 expression is associated with more aggressive clinical behavior and can serve as a prognostic biomarker in prostatic cancer.

目的:探讨新近开发的单切口尿道中段吊带术(TVT SECUR)治疗女性压力性尿失禁(SUI)的有效性及手术关键.方法:回顾分析2009～2011年共16例SUI患者资料,ALPP均大于60cmH2O,施行“H”术式,术中以示指引导保持穿刺方向及穿刺层面.术后24、48及72h采用直观模拟量表(VAS)对患者术后早期切口疼痛进行评价,3个月时门诊随访评判疗效及并发症.结果:本研究中16例手术平均24min,无尿道膀胱损伤,无阴道穿孔,无吊带暴露、无明显肢体运动障碍及局部血肿形成,无明确伤口感染及排斥反应发生.术后24小时VAS为(2.6±1.5),术后3个月随访时总有效率为93.7％(15/16),一过性并发症包括排尿困难(2/16),急迫性尿失禁(5/16),泌尿系感染(4/16).结论:TVT-SECUR“H”术式治疗SUI,操作简单,安全有效,并发症少.术中手指触摸引导有利于确定穿刺方向及深度,对保证术后疗效和减少并发症具有重要意义.

Objectives To characterize the hemodynamics comparing thulium laser vaporesection of the prostate with traditional transurethral resection of the prostate. Methods A total of 80 consecutive patients with benign prostatic hyperplasia were randomly assigned into the thulium laser vaporesection of the prostate group or transurethral resection of the prostate group. Transpulmonary thermodilution hemodynamic monitoring was used before and 1h after surgery to assess patient hemodynamics. Acute complications and treatment efficiency were evaluated after surgery. Results There were no statistical differences in age, prostate volume, anticoagulants and International Prostate Symptom Score between the two groups. The postoperative Stroke Volume Index was significantly higher in the thulium laser vaporesection of the prostate group (P=0.007). The extravascular lung water and intrathoracic blood volume indices differed significantly pre- and postoperatively, and were similar in both groups. Decreases in serum sodium and hemoglobin concentrations after surgery were lower in the thulium laser vaporesection of the prostate group (P<0.01). Acute complications, and improvements in International Prostate Symptom Score and maximum urinary flow rates, were similar in both groups. Conclusions Transpulmonary thermodilution hemodynamic monitoring provides additional safety measures during surgical procedures. Thulium laser vaporesection of the prostate is associated with fewer hemodynamic changes and provides similar efficacy to transurethral resection of the prostate. Thus, it can be considered a safe and effective procedure.

Objective: Older men with obstructive urinary tract disorders in the event of a cerebral vascular accident,whether through the early symptoms or type of urinary symptoms(obstructive or irritating) to predict the cause of voiding dysfunction.Methods: 57 cases of stroke emperor complained of voiding dysfunction in elderly male patients,all patients were bladder outlet obstruction(BOO) symptoms secondary to benign prostatic hyperplasia(BPH).After a comprehensive history and physical examination,all patients underwent urodynamic studies.Findings were classified by the Abrams-Griffiths nomogram as obstruction,no obstruction or equivocal.Results: The average age of the patients was 70 years old(54-87).Patients were grouped according to the presenting voiding complaints(purely irrita-tive in 42 percent,purely obstructive in 34 percent or mixed in 24 percent).In 51 patients(89 percent) the onset of symptoms paralleled the occurrence of the cerebrovascular accident.Detrusor hyperreflexia was noted in 82 percent of the patients.There was no statistically significant difference in the occurrence of detrusor hyperreflexia among the 3 symptom groups.Pressure-flow analysis clearly showed ob-struction in 24 patients(63 percent),no obstruction in 9(24 percent) and equivocal results in 5(13 percent) according to the A-G nomo-gram.There was no statistically significant difference in the incidence of obstruction among the 3 symptom groups.Conclusions: Elderly male patients presented symptoms can not predict bladder outlet obstruction or detrusor hyperreflexia,After stroke,the incidence of void-ing dysfunction symptoms significantly increase,which suggests that the cerebrovascular accident induced voiding dysfunction in the face of preexisting bladder outlet obstruction may exacerbate the symptoms of the latter condition or vice versa.

Objective To evaluate the safety and feasibility of minimally invasive percutaneous nephrolithotomy(MPCNL) for patients with upper ureteral incarcerated stones in a semi-supine position.Methods We performed MPCNL at semi-supine position(45 degrees) on 61 patients with upper ureteral incarcerated stones.A ureteral catheter was inserted retrogradely preoperation,the shoulder and haunch of the patients were supported with a soft pad.Ultrasonic-guided puncture and a F16 to F18 channel was made for ureteroscopic lithotripsy with holmium laser.Results Lithotripsy was successfully completed in all the 61 cases without conversion to open surgery.The intraoperative blood loss was 20-150 ml(75 ml in average).The operation time ranged from 35 to 105 min with a mean of 60 min.One-session stone-clearance rate was 93.4%(57/61).The patients were followed up for 1-6 months(mean,3 months),during which B-ultrasonography or KUB showed no residual stones.Conclusions With semi-supine position,patients feel comfortable during MPCNL.Ultrasonic-guided can increase the success rate of puncture,and avoid complications so that to increase stone-clearance rate in the first session.

OBJECTIVE To explore the therapeutic response and toxicity of neoadjuvant hormonal therapy in (125)I permanent seed implantation for prostate cancer and validate the clinical efficacy of neoadjuvant hormonal therapy. METHODS A total of 165 patients with T1c-T3b prostate cancer received transperineal ultrasound-guided (125)I permanent seed implantation and neo-adjuvant hormonal therapy (NHT). Their median age was 79 years (range: 65 - 88). They were randomized into 2 groups: group A (n = 90, 3-month NHT before (125)I permanent seed implantation for prostate cancer 0 and group B (n = 75, (125)I permanent seed implantation). The prostate surface antigen (PSA) response rate, the change of prostate volume and the toxicities of urinary system and sexual function were observed. RESULTS The median PSA decreased to 0.38 (0.01 - 6.56) µg/L from 26.50 (3.56 - 150.00) µg/L after a 3-month neoadjuvant hormonal therapy and the median prostate volume dropped from 29.33 (23.62 - 65.21) ml from 46.38 (19.28 - 128.10) ml during a follow-up period of 24 months. After brachytherapy, the PSA level was maintained at a relatively low level (median number of 0.62 µg/L and 2.56 µg/L in groups A and B respectively). And 6 and 9 patients suffered from acute urinary retention after brachytherapy in groups A and B respectively. CONCLUSION Neoadjuvant hormonal therapy can reduce the volume of prostate before brachytherapy and serum PSA in a short time. The toxicities of urinary system, gastrointestinal tract and sexual function should be examined by further randomized control studies. A long-term observation is needed for the PSA-free survival rate.

目的 探讨少见的前列腺癌类型的临床病理学特点.方法 采用免疫组化EnVision两步法对45例少见前列腺癌类型标本进行染色,回顾性分析其穿刺活检标本的临床资料.结果 302例前列腺癌穿刺活检标本中发现45例(14.9%)少见类型,患者年龄56～86岁,血清PSA值2.8～100 ng/ml.对45例标本进一步观察组织学特征检出导管腺癌4例;尿路上皮癌1例;基底细胞癌1例.在39例前列腺腺泡癌组织学变异型中发现萎缩型3例、假增生型11例、泡沫样腺体型13例、印戒细胞型12例.这些少见的前列腺癌类型通常和经典的前列腺腺泡癌共存,其中仅有5例为单一形态.结论 少见前列腺癌类型的临床病理特点和经典的前列腺腺泡癌有所不同,提高对其病理形态学的认识水平并正确理解有利于诊断及鉴别诊断,为患者选择合适的治疗手段.

Objective: Summary of the clinical and pathological features of renal huge angiomyolipoma associated with tuberous sclerosis,diagnosis,treatment and prognosis.Methods: We analysed a rare case of huge renal angiomyolipoma associated with tuberous sclerosis clinical features,histopathologic features,and diagnosis,treatment,and reviewed relevant literature in recent years.Results: Patients with laparotomy in our hospital,the right kidney huge tumor resection,Pathological examination shows of AML.Good recovery in patients after surgery,symptoms improved significantly,liver and kidney function is normal.After 3 months to review CT: left kidney district preoperative unchanged,the right kidney area no recurrence.Conclusions: For a giant kidney AML with TSC patients,surgery is still available as treatment options,but its long-term prognosis remains to be seen.

<正>前列腺增生可致肾衰竭前列腺增生症是一种良性病变,前列腺癌为恶性病变。两者可以同时存在,但互相之间没有因果关系。前列腺增生症所引起的症状首先是尿频、夜间排尿次数增多。病变进一步发展则会使膀胱的形态和功能受到损坏,随之发生急慢性尿潴留并继发膀胱结石和尿路感染。