Objective To screen the differential proteins in neonatal rat kidney at different timepoint with partial unilateral ureteral obstruction (PUUO) and verify the expression of PRDX1 in animal model and clinical hydronephrosis.Methods Two-dimensional gel electrophoresis (2-DE) and MALDI-TOF/TOF MS were employed for separating and identifying differential proteins in groups of PUUO and corresponding sham kidney tissues.Western blot and enzyme-linked immunosorbent assay (ELISA) were used for verifying the protein expression of PRDX1 in rat kidney and clinical urine samples.Results Forty-three differential proteins whose expression levels increased or decreased ＞2-fold identified by peptide mass fingerprinting were involved in regulation of actin,energy metabolism and injuries of mitochondrion,oxidative stress and endoplasmic reticulum stress,et al.In neonatal rat kidney,higher expression of PRDX1 protein in PUUO1d,PUUO 2 d and PUUO 5 d (0.836 1 ± 0.017,0.541 9 ± 0.035,0.548 8 ± 0.021 respectively) were detected by Western blot.In clinical urine samples,the expressions of PRDX1/cr.were up-regulated in hydronephrosis and decreased significantly within 1 month postoperatively (0.119 ± 0.056,0.072 ± 0.034 respectively).Conclusions Forty-three differentially expressed proteins associated with genesis and development of obstructive nephropathy have been successfully screened from PUUO and corresponding sham kidney tissues.And PRDX1 might be involved in the development and progression of obstructive nephropathy.

Congenital hydronephrosis is the main cause of childhood chronic renal disease and renal failure,which is also one of the most common anomalies in pediatric urology division.Although the operation is performed to treat obstruction,the renal function of patients get worse and worse,postoperatively.Up to date,there are lots of controversies in evaluation of hydronephrosis and treatment at prenatal and postnatal.According to recent articles,the recent examinations,evaluation system,follow-up and treatment strategies of hydronephrosis are introduced.

目的 总结分析新生儿睾丸扭转（neonatal testicular torsion，NTT）的临床特点及治疗措施。 方法 回顾性分析2009年1月至2014年12月中国医科大学附属盛京医院收治的13例NTT病例。通过医院的医疗信息管理系统，收集这些病例的临床资料和随访情况等，对这些NTT患儿的临床特点和治疗情况进行描述性分析。 结果 （1）13例日龄为1~28 d，平均8.2 d；左侧8例，右侧4例，双侧1例；急症型7例，非急症型6例。（2）急症型7例存在阴囊急症表现，彩超显示患侧睾丸血运异常，术前均诊断为NTT；5例手术（探查6睾，切除5睾，其中1例为双侧），2例拒绝手术。4例单侧睾丸扭转证实已发生睾丸坏死，切除后，对侧睾丸行预防性固定；1例为双侧睾丸扭转，但扭转程度不同，保留相对病变较轻侧睾丸。所有切除睾丸术后病理检查显示睾丸组织结构基本消失，大部分呈现出血伴坏死改变，其间可见少量残存的生精小管和输精管。（3）非急症型6例，无阴囊急症表现，彩超显示患侧阴囊内异常包块，3例MRI可见混杂信号包块。术前3例诊断为睾丸肿瘤，3例诊断为NTT。6例均行手术治疗。术中见患侧阴囊内无正常睾丸组织，为质硬、均一的肿物，与周围组织可有粘连，扭转方向及程度已分辨不清，术后病理检查可见大部分出血坏死及钙化灶，睾丸结构基本不见，术后均诊断为NTT。（4）术后随访3~12个月。所有手术病例患侧阴囊切口均愈合良好，阴囊无出血肿胀，2例保守治疗的患儿及１例双侧NTT的患儿分别在出院2和3个月复查时发现患病睾丸明显萎缩，查体可触及小而硬的包块，术后6个月随访超声显示病变睾丸演变为无血流信号的瘢痕结构。所有单侧NTT患儿随访超声检查，均未发现对侧睾丸异常改变。 结论 彩超结合临床表现可准确诊断急症型NTT，但非急症型NTT的超声影像需与睾丸畸胎瘤鉴别。对于急症型NTT，及时手术干预对挽救病变睾丸仍有意义。

Objective To improve the understanding of the implications of testicular microlithiasis(TM)in paediatric patients by summarizing the clinical characteristics of TM. Methods One hundred and eighteen boys diag-nosed as TM based on ultrasound between March 2006 and December 2014 at Shengjing Hospital Affiliated to China Medical University were retrospectively reviewed. Demographic data,imaging data,indications for ultrasound,associated inguinoscrotal pathologies and follow - up data were collected. Results There were 118 cases of patients aged from 0. 25 to 14. 00 years(averaging 7. 98 years). The indication for ultrasound included health check(22 cases),testicular discomfort(28 cases),small testes(6 cases),scrotal mass(10 cases),with history of cryptorchidism(36 cases),with history of hydrocele(15 cases). Concomitant diseases included congenital anomaly of testis in 44 cases[cryptorchidism (34 cases),testicular absence(4 cases),testicular hypoplasia(6 cases)],hydrocele of tunica vaginalis or hernia(15 cases),testicular epididymitis(12 cases),varicocele(6 cases),epididymal cyst(5 cases),testicular teratomas(2 ca-ses),adrenal cortical hyperplasia(1 case),testicular torsion(1 case),and none associated disease(32 cases). Bilateral TM was in 87 cases(the typical TM in 38 cases,limited TM in 49 cases),while unilateral TM was in 31 cases(the typi-cal TM in 8 cases,limited TM in 23 cases). Fifty - three cases were followed up for 1 month to 36 months(averaging 12. 5 months),and the condition was stable,no testicular malignancy was observed during follow - up. Conclusions The TM in children is not a rare disease. The etiology of TM is not clear and there are no special clinical symptoms. TM is often associated with testicular abnormality in pediatric patients and the correlation between children′s TM and adult testicular tumor can not be determined yet. The distribution and involving degree of TM is stable in the short term with infrequent testiculoma,but an appropriate follow - up scheme is required,especially during and after puberty.

Objective To explore the urodynamic characteristics of spina bifida occulta (SBO) children with urinal dysfunction.Methods A total of 113 patients with urinal dysfunction,48 with SBO diagnosed radiologically and 65 negative controls were recruited.The major symptoms were incontinence,increased voiding frequency and dysuria and nocturnal enuresis.Uroflowmetry was conducted for all cases.And 112 of them received invasive urodynamic examinations for analyzing the correlation between main items of urodynamics and symptoms.Results Most (46/48) of them had various abnormalities on urodynamic test.There were detrusor instability (DI,n =22),detrusor underactivity (n =21),decreased maximum flow rate (n =18,Qmax),decreased bladder capacity (n =15),increased post-void residual urine (n =12,PVR),decreased bladder compliance (BC,n =7),detrusor-external sphincter dyssynergia (n=4) and decreased urethral pressure (n=4).DI,detrusor underactivity,increased PVR and decreased bladder compliance were more often present in patients with SBO.According to the symptoms,correlation existed between incontinence and decreased Qmax and detrusor underactivity; increased voiding frequency and increased PVR; dysuria and detrusor underactivity; nocturnal enuresis and DI.Conclusions SBO children with urinal dysfunction may have various urodynamic changes.And the same clinical manifestation may have different abnormalities.And the symptoms are probably correlated with urodynamic changes.

The present report describes a 6-year-old boy with leiomyoma of the bladder and the imaging characteristics of the lesion, including images from ultrasonography, computed tomography, and the histopathologic examination. Leiomyoma of bladder is extremely rare in children. The present case, to our knowledge, represents the second reported case of bladder leiomyoma in pediatric patients since 1966. Although preoperative imaging can be useful to assess the disease extent, the final diagnosis depends on the histopathologic examination findings. Surgical excision is the ideal option to confirm the diagnosis and to treat the disorder. The prognosis is good after complete resection.

Objective To investigate the outcome and treatment of neonates bom with isolated unilateral hydronephrosis diagnosed antenatally.Methods We retrospectively reviewed the casenotes of 692 children (541males and 151 females) between january 1988 and January 2010,who had been diagnosed antenatally with isolated,unilateral hydronephrosis and the diagnosis was subsequently confirmed posmatally.The follow up time was 12 months - 22 years (mean 142 months).All patients were followed up with ultrasonography and dynamic renal imaging.Hydronephrosis was assessed and classified according to the Society of Fetal Urology (SFU) grading system.Results Stabilization occurred in all children with grade 1 hydronephrosis,in 87％ of children (155) with grade 2 hydronephrosis,and in 30％ of children (39) with grade 3 hydronephrosis.However,13％ of children (23) with grade 2 hydronephrosis,70％ of children (92) with grade 3 hydronephrosis,and 100％ of children with grade 4 hydronephrosis received surgical intervention according to our pre - detemfined criteria.107 patients (late pyeloplasty group) were treated due to a reduction in the differential renal function (DRF) to ＜40％,and 93 children (early pyeloplasty group) underwent surgery because of worsening hydronephrosis grades or failure to improve and had poor radiotracer clearance.In the early pyeloplasty groups,significant improvements were noted between postoperation and preoperation with respect to the DRF (45.8 ± 1.7％; 42.7 ± 2/％) and the ratio of the depth of the calyces to the thickness of the parenchyrna (C/P ratio) (0.7 ± 0.3; 2.0 ± 0.8,P＜0.05).The same results were seen in the late pyeloplasty group with respect to the DRF (38.4 ± 2.6％ ; 36.4 ± 3.3％ ) and C/P ratio ( 1.3 ±0.5; 2.4 ± 0.8,P＜0.05).The DRF was better in the early pyeloplasty group than the late pyeloplasty group.The improvement in DRF was significant during the first year post- operatively(48.8 ±4.3％) and became stable thereafter.The C/P ratio was inversely correlated with the DRF in the patients before and after pyeloplasty (r =- 0.26,P =0.01 ; and r =- 0.62,P =0.001,respectively).Conclusions All infants with SFU- 1 and most infants with SFU - 2 hydronephrosis do not need an invasive procedure.Although greater improvement occurred in patients with an initial DRF＜40％,the reduced DRF did not recover to the pre- deterioration level post- operatively.Earlier surgical intervention after a short period of strict clinical surveillance is beneficial for preserving renal function in patients with persistent SFU - 3 or SFU - 4 hydronephrosis.

Primary vesical varices are rare. We report a case of a 4-year-old girl who presented with recurrent gross hematuria secondary to primary vesical varices. Ultrasonography, enhanced computed tomography, and voiding cystourethrogram revealed a solid mass in the right wall of the bladder. Cystoscopy revealed a group of dilated submucosal veins and a red mass. The mass was ablated, and the histopathologic examination demonstrated varices of the bladder. Observation of the patient for 6 months postoperatively showed no recurrence of the hematuria. UROLOGY 79: 902-905, 2012. (C) 2012 Elsevier Inc.

We report a 5-year-old boy with a cystic lymphatic malformation (LM) of bladder, and the imaging characteristics of the lesion are reported. Cystic LM of the urinary system is rare, and a location in the bladder is extremely rare. The exact mechanism of the lesion that occurs in bladder is unknown. This case is different from the 3 cases reported before, for it is only presented with a palpable pelvic mass and the lesion did not penetrate full thickness of bladder. Although imaging examinations are helpful in the definition of cystic LMs, no characteristic findings are available to diagnose a cystic LM of the bladder before surgery. The diagnosis is always made after surgical intervention. Surgical excision is ideal, and an extensive operation is not warranted because the lesion is benign. Once excised completely, the prognosis of the disease is good.

Purpose: The aim of the study was to determine the outcome and management of infants with isolated hydronephrosis, detected prenatally and confirmed postnatally. Materials and Methods: Between January 1988 and January 2008, the files of 629 children (492 males and 137 females), who were diagnosed prenatally with isolated, unilateral hydronephrosis, and the diagnosis was confirmed postnatally, were retrospectively reviewed. The median follow-up time was 142 months. Serial ultrasonography and isotope diuretic renography nuclear imaging were performed. Hydronephrosis was assessed and classified according to the Society of Fetal Urology (SFU) grading system. Results: Initially, all of the children were treated conservatively. Stabilization occurred in all children with ;grade 1 hydronephrosis, in 87% of children (144) with grade 2 hydronephrosis, and in 30% of children (37) with grade 3 hydronephrosis. However, 13% of children (21) with grade 2 hydronephrosis, 70% of children (85) with grade 3 hydronephrosis, and 100% of children with grade 4 hydronephrosis received surgical intervention according to our predetermined criteria. Ninety-five patients (late pyeloplasty group) were treated for a reduction for a differential renal function (DRF) to less than 40%, and 80 children (early pyeloplasty group) underwent surgery for a DRF more than 40%, but hydronephrosis progressed to higher grades or failed to improve and had poor radiotracer clearance. Significant improvements after pyeloplasty were noted in both groups with respect to the DRF and the ratio of the depth of the calyces to the thickness of the parenchyma (C/P ratio; P < .0001). The improvement in DRF was greater in the late pyeloplasty group than the early pyeloplasty group (P = .044), whereas the improvement in the C/P ratio was greater in the early pyeloplasty group than the late pyeloplasty group (P = .001). The ipsilateral DRF was preserved in the early pyeloplasty group, whereas the ipsilateral DRF was still less than 40% in the late pyeloplasty group. The improvement in DRF was significant during the first year postoperatively and became stable thereafter. The C/P ratio was inversely correlated with the DRF in the patients before and after pyeloplasty (r = -0.257; P = .01; and r = -0.616; P = .001, respectively). Conclusions: All infants with SFU-1 and most infants with SFU-2 hydronephrosis have relatively benign conditions and do not need an invasive procedure. Although greater improvement occurred in patients with an initial DRF less than 40%, the reduced DRF did not recover to the predeterioration level postoperatively. Earlier surgical intervention after a short period of strict clinical surveillance is beneficial for preserving renal function for patients with persistent SFU-3 or SFU-4 hydronephrosis. (C) 2010 Elsevier Inc. All rights reserved.

Objective To present the experiences of diagnosis and management of unilateral dysplastic kidney in children. Methods Between 1988 and 2009,83 children including 31 boys and 52 girls aged from 45 days to 11 years old (mean age, 70 months old) underwent nephrectomy for unilateral dysplastic kidney at this center. Among these patients,30 patients complicated with ectopic ureter,15 with ureteropelvic junction obstruction (UPJO), 5 with megaureter, 9 with ureterocele, and 4 with vesico-ureteric reflux (VUR). Sixteen patients also presented abnormalities of the contralateral kidneys including UPJO was found in 6 patients,megaureter in 6,duplicative kidney in 1 and VUR in 3. Ultrasonography,excretory urography and 99mTc-DTPA renal scintigraphy were employed to examine the kidney on all patients. Enhanced computerized tomography (CT) was performed on 35 patients, and delayed enhanced three dimensional CT (3D-CT) on 39 patients. All cases underwent nephrectomy.The surgical indications were determined when patients reached to 1 of the 3 criteria: symptomatic nonfunctional dysplastic kidneys (55 cases), or asymptomatic multicystic dysplastic kidneys without any improvement during follow-up or even increasing in cysts' size (27 cases), or dysplastic kidneys with poor function and hydronephrosis (1 case). Results Ultrasonography located the dysplastic kidneys in 51 cases. IVP failed to visualize the affected kidney in all cases. Forty-four dysplastic kidneys were identified by 99mTc-DTPA renal scintigraphy. Enhanced CT located dysplastic kidney in 28 of 35 cases. Delayed enhanced 3D-CT could locate dysplastic kidney in all 39 cases. The pathology diagnosis of all resected kidneys confirmed the diagnosis of dysplastic kidney, and no malignant tissues were found.Among the 4 children with preoperative hypertension, 2 didn't have any improvement after surgery.Conclusions Delayed enhanced 3D-CT is accurate and specific to visualize the dysplastic kidneys. Ne-phrectomy is recommended to the patients with symptomatic non-functional dysplastic kidneys, or asymptomatic multicystic dysplastic kidneys. The patients' kidney function and hypertension should be closely followed up after surgery.

Lymphangioma in the bladder is extremely rare. An 8-year-old girl presented with a terminal hematuria associated with intermitted fever. Ultrasonography, computed tomogram, and retrograde urethrography showed a mass that was in the wall of the bladder. The tumor was red and found to be bulging into the bladder on the right lateral wall of the bladder by cystoscopy. A partial cystectomy was performed and histology revealed a lymphangioma of the bladder. The patient was followed up for 3 years with no evidence of recurrence. This case, to the authors' knowledge, represents the third reported case of lymphangioma of bladder.Lymphangiomas are benign, soft-tissue tumors of lymphatic origin. They rarely affect the urinary system and a location in the bladder is extremely rare. Only 2 cases of lymphangioma of the bladder have been reported worldwide since 1983. The present report describes a patient with a lymphangioma of the bladder and the imaging characteristics of the lesion are reported, including imagings of sonography, computed tomography, retrograde urethrography, and histologic examination.

OBJECTIVE:To study the expression of signal transducer and activator of transcription 3 (Stat3), hypoxia-inducible factor-1alpha (HIF-1alpha) and vascular endothelial growth factor (VEGF) in Wilms' tumor and their roles in the development of Wilms' tumor. METHODS:The expression of Stat3, HIF-1alpha and VEGF were detected by the immunohistochemical staining in 52 specimens from Wilms' tumor tissues, 47 from adjacent kidney tissues and 8 from normal kidney tissues. The expression intensity was analyzed by computer image processing. RESULTS:The expression of Stat3, HIF-1 and VEGF were significantly up-regulated in Wilms' tumor tissues compared to those in adjacent tissues and normal kidney tissues (P < 0.05). Stat3 and VEGF proteins in Wilms' tumor tissues of stage III-IV and high risk histopathology were significantly higher than those of stage I-II and low risk histopathology. The higher expression of HIF-1 in Wilms' tumor tissues was shown in tumors with high risk histopathology and tumor size > or = 6 cm. CONCLUSIONS:Increased expression of Stat3, HIF-1 and VEGF were found in Wilms' tumor tissues, and may be related to the development and angiogenesis of Wilms' tumor. Stat3 may regulate the expression of HIF-1 and VEGF, so it could be an effective target for inhibiting VEGF expression and angiogenesis of Wilms' tumor.

Objective To analyze the clinical and radiographic characterstics of ureteral polyps with hydronephrosis in children.Methods Thirteen patients with ureteral polyps and hydronephrosis were studied retrospectively.All patients underwent abdominal plain film,intravenous pyelogram(IVP)and ultrasound(US)examinations,contrast-enhanced CT scan was performed in 10 cases.Results Intermittent or recurrent abdominal pain with painless hematuria was presented in most cases.Hydronephrosis was demonstrated in radiographic images.IVP delineated the dilatation of the ureter and filling defects within the ureteral lumen in 5 cases.Computed tomography(CT)showed all abnormal changes of ureter and irregular intraluminal soft tissue masses in 6 cases.Moderate and low echoic structures were showed in ureters by US in 2 cases.Conclusion US and CT,as an important imaging modalities,can improve the diagnostic accuracy for ureteral polyps.

To better define the demographics, urothelial distribution and typical gross anatomic and radiologic appearances of fibroepithelial polyps of the ureter in children. We reviewed 15 cases of fibroepithelial polyps of the ureter with hydronephrosis from the archives of our department. Data were collected from radiographic studies, gross anatomic pathology and pathology and radiology reports and categorized by age, sex, clinical presentation, lesion size and location. The mean patient age was 9.1 years, and 80% were male. All of them presented with hematuria and/or flank pain. The polyps were located in the upper ureter or ureteropelvic junction (UPJ) and pelvis. Of the polyps, 60% were multiple polyps or filiform, and 40% were single or bilobed and 1-6 cm in size. Only four cases showed typical filling defect on intravenous urography. In five cases, sonography showed a mildly echogenic structure extending into the ureter from the renal pelvis. Enhanced CT revealed soft tissue filling UPJ or/and proximal ureter in six cases, and hydroureter was found in one case by three-dimensional (3D) image. Fibroepithelial polyps were diagnosed in all cases by postoperative histological examination. Fibroepithelial polyps are the most common benign tumors of the ureter. Congenital factor may be associated with the origin of fibroepithelial polyps in children. The preoperative diagnosis of ureteral polyps is difficult. A history of flank pain, hematuria or both, other than abdominal mass, light-to-moderate hydronephrosis with soft-tissue in UPJ or upper ureter, shown by sonography and radiological examination, may help in the diagnosis of ureteral polyps in children. Ureteral polyps should be recognized as an important etiology for hydronephrosis in children.

OBJECTIVES:To study the potential role of pelviureteral junction obstruction (PUJO) in causing progressive renal damage in children through the renal expression of epidermal growth factor (EGF) and transforming growth factor-beta1 (TGF-beta1).METHODS:The expression of EGF and TGF-beta1 was evaluated in the renal tissues of 25 children with congenital hydronephrosis by immunohistochemistry, in situ hybridization, and reverse transcriptase polymerase chain reaction techniques.RESULTS:Children with PUJO had a significant increase in TGF-beta1 and a marked reduction in EGF expression compared with controls. The TGF-beta1/glyceraldehyde phosphate dehydrogenase ratio in the hydronephrotic kidney and normal kidney was 0.53 +/- 0.13 and 0.24 +/- 0.10 respectively, and the difference was significant (P = 0.000). The EGF/glyceraldehyde phosphate dehydrogenase ratio in the hydronephrotic kidney and normal kidney was 0.15 +/- 0.06 and 0.55 +/- 0.13, respectively, and the difference was also significant (P = 0.0001). Positive correlations were found between the TGF-beta1 gene and the drainage clearance half-time (r = 0.47; P = 0.018), TGF-beta1 protein and drainage clearance half-time (r = 0.44; P = 0.028), TGF-beta1 gene and histologic grade (r = 0.53; P = 0.006), and TGF-beta1 protein and histologic grade (r = 0.76; P = 0.000). Negative correlations were found between the EGF gene and drainage clearance half-time (r = -0.59; P = 0.002), EGF protein and drainage clearance half-time (r = -0.61; P = 0.001), EGF gene and histologic grade (r = -0.58; P = 0.003), and EGF protein and histologic grade (r = -0.47; P = 0.019).CONCLUSIONS:TGF-beta1 expression was increased and EGF expression was decreased in the renal tissue after clinical PUJO. The alterations of TGF-beta1 and EGF may play a potential role in the pathogenesis of renal damage in PUJO.

BACKGROUND/PURPOSE:Heat shock proteins (HSPs) are synthesized by cells in response to various stress conditions, including carcinogenesis. Some studies also showed that they might predict clinical prognosis. The aim of this study is to detect the expression of HSP70 and HSP90alpha in children with Wilms tumor and explore its clinical significance. METHODS:The expression of HSP70 and HSP90alpha was evaluated in the tissue specimens of 30 patients (13 males and 17 females aged 5 months to 9 years with mean age of 37.4 +/- 23.9 months) with Wilms tumor by histochemistry and reverse transcriptase polymerase chain reaction techniques. According to the NWTS3 study criteria, all patients were favorable histological types, including mesenchymal type in 6, blastemal type in 12, and epithelium type in 7, and mixed type in 5. The clinical staging of the tumor included stage I in 4, stage II in 8, stage III in 12, and stage IV in 6. RESULTS:On the reverse transcriptase polymerase chain reaction study, the amount of HSP70 and HSP90alpha mRNA in the tumor tissue was lower than in the controls. The HSP70 to beta-actin ratio was 0.74 +/- 0.14 and 1.38 +/- 0.22 in the tumor tissue and the normal kidney, respectively (P < .0001). The HSP90alpha to beta-actin ratio was 0.60 +/- 0.14 and 0.96 +/- 0.15 in the tumor tissue and the normal kidney, respectively (P < .0001). On immunolabeling, the expression of HSP70 and HSP90alpha was confined to blastemal and epithelial components, whereas the tumor stroma was negative. The expression of HSP70 and HSP90alpha was mainly located in the cytoplasm of the tubular epithelial cell, mesangial cell, and endothelial cell in the normal kidney. The positive expression rates of HSP70 and HSP90alpha proteins were significantly lower in the tumor group (73.3%, 22/30; 76.7%, 23/30) than in the control group (100%, 30/30; 100%, 30/30), P = .002 and P = 0.005, respectively. Positive correlation was found between HSP70 gene and protein expression (r = 0.64, P < .0001). Positive correlation was also found between HSP90alpha gene and protein expression (r = 0.67, P < .0001). HSP70 and HSP90alpha gene and protein expression showed no correlation with its corresponding tumor stages (P > .05). The expression of HSP70 and HSP90alpha genes was significantly higher in children who survived when compared with those patients who died during the follow-up period, P = .017 and P = 0.004, respectively. The positive expression rates of HSP70 and HSP90alpha proteins were also significantly higher in children who survived (82.6%, 19/23; 87.0%, 20/23) than in those who died (42.9%, 3/7; 42.9%, 3/7), P = .037 and P = 0.016, respectively. CONCLUSIONS:The expression of HSP70 and HSP90alpha decreased in Wilms tumor and is confined to blastemal and epithelial components; it was higher in patients who survived, which suggested that they might be of prognostic value.

OBJECTIVE:To explore the management of the impalpable testis in children.METHODS:From April 2003 to August 2005, 36 children aged 20 months to 8 years with impalpable testes underwent inguinal and laparoscopy explorations. The clinical data were reviewed, including the indications of laparoscopy and inguinal explorations and the correspondence between the ultrasonic and surgicalRESULTS:Of the 36 cases (36 / 361 ) of impalpable testis (41 testes), laparoscopy and inguinal explorations revealed 18 results. testes to be vanishing ones, 21 located intra-abdominally and 2 scrotal nubbins. Manifestations were divided into 4 types according to the laparoscopic findings, and 9 testes fell into Type I, 9 Type II, 13 Type III and 10 Type IV. Orchidopexies were performed by traditional and laparoscopic techniques. The positive diagnoses by ultrasound accounted for 75% (27/36). The volumes of the contralateral testes of the cryptorchid children were larger than those with intra-abdominal testes and testicular nubbins. One case of testicular atrophy was detected by ultrasound in the follow-up period.CONCLUSION:Laparoscopy should be performed as a routine in children with impalpable testes. Children with Type II testes need not undergo inguinal exploration. Inguinal and scrotal explorations are necessary for children with Type I testes. Preoperative ultrasonic examination of the contralateral testis helps to evaluate vanishing testes or testicular nubbins.

Objective To explore the early diagnosis of testicular torsion in children. Methods The clinical data of 24 patients with testicular torsion were analyzed retrospectively. Results The patients ranged in age from 4 months to 15 years ( mean 10.3 years), 17 left and 7 right testes involved. The duration between the onset and operation varied from 1 hour to 4 months. Diagnoses were initially and correctly made in 16 cases and delayed in 8. Surgical explorations were carried out in 23 cases, and resection of the testis performed in 17. Conclusion Testicular necrosis is associated not only with the duration and degree, but also with the extent of the torsion. Color Doppler has clinical value in the early diagnosis of child testicular torsion. Timely surgical exploration should be performed for cases of acute scrotal problem suspected of child testicular torsion.