ABSTRACT Background Immune cells have been linked to the initiation and progression of tumors, and their presence is often used to predict disease prognosis. However, when it comes to bladder urothelial carcinoma (BLCA), there has not been a comprehensive investigation into the function and prognostic value of different immune cell types. Methods We integrated data from more than 2300 BLCA patients across 14 public datasets. Then we analyzed the quantity of 170 different immune cell signatures using the ssGSEA algorithm. Through meta‐analysis and univariable Cox analysis, we identified prognosis‐associated immune cells and established an immune cell related prognostic signature (IRPS). We then conducted survival analyses to observe the differences in survival across different IRPS‐risk groups. Furthermore, based on the DEGs associated with IRPS, we screened for potential targeted therapeutic agents. Finally, we integrated IRPS with clinical features to establish a comprehensive prognostic index (ICPI). Results Our analysis identified 90 immune cell types that were particularly relevant to BLCA. Then we constructed and validated the IRPS, with high IRPS significantly associated with longer overall survival (HR = 0.73, 95% CI, 0.71–0.76, p < 0.001). In two independent immunotherapy cohorts (IMvigor210 and GSE78220), patients with high IRPS demonstrated significantly prolonged survival following immune checkpoint inhibitor treatment (p = 0.035, p = 0.019). Several candidate drugs targeting IRPS were identified. The ICPI, developed by integrating IRPS with clinical features, also demonstrated enhanced accuracy in prognostic analysis. Conclusions This study successfully developed and validated a prognostic signature (IRPS) based on comprehensive immune cell infiltration analysis, along with its integrated index (ICPI). IRPS/ICPI serves as an effective tool for predicting BLCA patient prognosis and guiding immunotherapy strategies, while also aiding in the identification of patient populations likely to benefit from immunotherapy.

Benign prostatic hyperplasia (BPH) is one of the most common diseases in elderly men worldwide that may result in lower urinary tract symptoms (LUTS). At present, the specific pathophysiological mechanism for BPH/LUTS LUTS remains unclear. S100 calcium binding protein A4 (S100A4), a member of the calcium binding protein family, regulates a variety of biological processes including cell proliferation, apoptosis and fibrosis. The aim of the current study was to explore and clarify the possible role of S100A4 in BPH/LUTS. The human prostate stromal cell line (WPMY-1), rat prostate epithelial cells, human prostate tissues and two BPH rat models were employed in this study. The expression and localization of S100A4 were detected by quantitative real time PCR (qRT-PCR), immunofluorescence microscopy, Western blotting and immunohistochemistry analysis. Also, S100A4 knockdown or overexpression cell models were constructed and a BPH rat model was induced with testosterone propionate (T) or phenylephrine (PE). The BPH animals were treated with Niclosamide, a S100A4 transcription inhibitor. Results demonstrated that S100A4 was mainly localized in human prostatic stroma and rat prostatic epithelium, and showed a higher expression in BPH. Knockdown of S100A4 induced cell apoptosis, cell proliferation arrest and a reduction of tissue fibrosis markers. Overexpression of S100A4 reversed the aforementioned changes. We also demonstrated that S100A4 regulated proliferation and apoptosis mainly through the ERK pathway and modulated fibrosis via Wnt/β-catenin signaling. In conclusion, our novel data demonstrate that S100A4 could play a crucial role in BPH development and may be explored as a new therapeutic target of BPH.

Lymphorrhea following retroperitoneal surgery is a challenging complication. This study aimed at exploring the efficiency, mechanisms of immunotherapeutic agent OK-432 in urological cancer-associated lymphorrhea. Intracavitary administration of OK-432 suppressed lymphorrhea after urological tumorectomy. In malignancy-related lymphorrhea, researches on OK-432 was in high-profile. Expressions of VEGFC increased in infiltrating urothelial cancer compared to superficial tumor and was correlated to immune cell infiltration. OK-432 impaired T24 cells viability and anchorage-independent growth by inhibiting Akt/NFκB-mediated VEGFC expression, while facilitated migration and tube formation of lymphatic endothelial cells by enhancing Akt/NFκB-mediated VEGFR-3 expression. OK-432 is an alternative for the lymphorrhea after urological tumorectomy by promoting VEGFR-3 mediated-lymphatic endothelial cells migration and impairing viability of cancer cells through down-regulating expression of VEGFC, and both of which were Akt/NFκB signaling dependent.

Prostate cancer poses a great threat to men’s health worldwide, yet its treatment is still limited by the unclear understanding of its molecular mechanisms. CDKL3 is a molecule with a recently discovered regulatory role in human tumors, and its relationship with prostate cancer is unknown. The outcomes of this work showed that CDKL3 was significantly upregulated in prostate cancer tissues compared with adjacent normal tissues, and was significantly positively correlated with tumor malignancy. Knockdown of CDKL3 levels in prostate cancer cells significantly inhibited cell growth and migration and enhanced apoptosis and G2 arrest of the cell cycle. Cells with lower CDKL3 expression also had relatively weaker in vivo tumorigenic capacity as well as growth capacity. Exploration of downstream mechanisms of CDKL3 may regulate STAT1, which has co-expression characteristics with CDKL3, by inhibiting CBL-mediated ubiquitination of STAT1. Functionally, STAT1 is aberrantly overexpressed in prostate cancer and has a tumor-promoting effect similar to that of CDKL3. More importantly, the phenotypic changes of prostate cancer cells induced by CDKL3 were dependent on ERK pathway and STAT1. In summary, this work identifies CDKL3 as a new prostate cancer-promoting factor, which also has the potential to be a therapeutic target for prostate cancer.

To compare a novel vacuum suction ureteroscopic laser lithotripsy (VS-URS) with traditional ureteroscopic laser lithotripsy (T-URS) for impacted upper ureteral stones and to better define the potential benefits of VS-URS. Between May 2019 and March 2021, 158 patients with impacted upper ureteral stones underwent ureteroscopic holmium-YAG laser lithotripsy. Of these, 76 underwent VS-URS and 82 underwent T-URS. In VS-URS procedures, the vacuum suction device is composed of a 5F ureteral catheter and a tee joint. The ureteral catheter is linked to the vacuum aspirator by the sidearm of the tee joint, and a 200 μm fiber is inserted through the tee joint and the ureteral catheter into the stone site for lithotripsy. When compared to the T-URS group, the VS-URS group had a shorter mean operation time (38.18 ± 6.37 min vs. 46.65 ± 5.66 min; P = 0.000), lower fever rate (3.9% vs. 14.6%; P < 0.022), less stone retropulsion (5.3% vs. 18.3%; P = 0.012), lower extra management rate (6.58% vs. 21.95%; P = 0.006), and a higher stone-free rate of the first postoperative day (88.2% vs. 72.0%; P = 0.011). There were no significant differences in stone-free rates 1 month after surgery between groups (94.7% vs. 92.7%; P = 0.748). VS-URS is an effective modality for impacted upper ureteral stones, and has a shorter operating time, lower fever rate, less stone retropulsion, and a higher primary stone-free rate compared with T-URS.

目的:分析糖尿病(DM)与前列腺增生(BPH)的相关性.方法:从Pubmed、Sciencedirect Online、Wiley Online library数据库以及手工检索出2018年6月30日之前以英语发表的关于DM及BPH相关性的研究.使用STATA软件进行Meta分析,随机效应模型用于计算混合比值比(OR)及95％置信区间(CI).结果:本次Meta分析纳入了23项研究,包含了292 001名参与者,其中BPH病例121 006例.Meta分析显示DM患者BPH发病风险明显高于非DM患者(OR=1.38,95％CI为1.24～1.54;P＜0.001).结论:糖尿病与较高的BPH发病风险显著相关.

Clear cell renal cell carcinoma (ccRCC) is the most common type of kidney tumor worldwide. Analysis of The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) databases showed that the immune-related gene (IRG) hematopoietic cell signal transducer (HCST) could provide guidance for the diagnosis, prognosis, and treatment of ccRCC. The RNA-seq data of ccRCC tissues were extracted from two databases: TCGA (https://www.cancer.gov/about-nci/organization/ccg/research/structural-genomics/tcga) and GEO (https://www.ncbi.nlm.nih.gov/geo/). Corresponding clinical information was downloaded from TCGA. Immune-related gene data were extracted from the IMMPORT website (https://www.immport.org/). Differential analysis with R software (https://www.r-project.org/) was used to obtain a prognosis model of ccRCC IRGs. The differences were combined with the clinical data to assess the usefulness of the HCST as a prognostic biomarker. Based on data obtained from the Oncomine (https://www.oncomine.org/), Human Protein Atlas (https://www.proteinatlas.org/), and PubMed (https://pubmed.ncbi.nlm.nih.gov/) databases, the expression levels of the HCST in ccRCC, clinical-pathological indicators of relevance, and influence on prognosis were analyzed. Regulation of the HCST gene in ccRCC was assessed by gene set enrichment analysis (GSEA). In TCGA/GEO databases, the high HCST expression in tumor tissues was significantly correlated to the TMN stage, tumor grade, invasion depth, and lymphatic metastasis (p < 0.05). The overall survival (OS) of patients with high HCST gene expression was significantly lower than that of patients with low HCST gene expression (p < 0.001). Multivariate Cox regression analysis suggested that the HCST expression level [hazard ratio (HR) = 1.630, 95% confidence interval (CI) = 1.042–2.552], tumor cell grade (HR = 1.829, 95% CI = 1.115–3.001), and distant metastasis (HR = 2.634, 95%, CI = 1.562–4.442) were independent risk factors affecting the OS of ccRCC patients (all, p < 0.05). The GSEA study showed that there was significant enrichment in cell adhesion, tumorigenesis, and immune and inflammatory responses in HCST high expression samples. Hematopoietic cell signal transducer expression was closely associated with the levels of infiltrating immune cells around ccRCC tissues, especially dendritic cells (DCs). In conclusion, the present study suggested that the HCST was interrelated to the clinicopathology and poor prognosis of ccRCC. High HCST expression was also closely correlated with the levels of tumor-infiltrating immune cells, especially DCs.

AIMS:Intervertebral disc degeneration (IDD) was associated with microRNA (miRNA) dysregulation. Therefore, we verified the hypothesis that miRNAs modulated IDD by affecting the insulin-like growth factor-binding protein 5 (IGFBP5)/extracellular signal-regulated kinase (ERK) signaling pathway.MATERIALS AND METHODS:The miRNA expression profiles in nucleus pulposus (NP) cells were compared between patients with IDD and controls, and miRNA microarray and quantitative real-time PCR (RT-qPCR) assays were utilized. Luciferase reporter and Western blotting assays were performed to detect the miRNA targets.KEY FINDINGS:RT-qPCR confirmed that the expression level of miR-24-3p was significantly increased in degenerative NP cells. Moreover, the miR-24-3p level was positively correlated with the disc degeneration grade, and miR-24-3p significantly induced NP cell apoptosis. IGFBP5 was determined as a target of miR-24-3p, and IGFBP5 knockdown induced effects on NP cells similar to those induced by miR-24-3p. Compared with control cells, NP cells presented with miR-24-3p overexpression or IGFBP5 downregulation via shRNAs had significantly increased p-ERK and Bax expression levels. Furthermore, in vivo analysis on IDD rat model showed that the downregulation of miR-24-3p could effectively suspend IDD.SIGNIFICANCE:These results demonstrated that miR-24-3p upregulation could promote IDD through IGFBP5 and the ERK signaling pathway.

5-hydroxymethylcytosine (5hmC) is converted from DNA methylation of cytosine (5mC) by the catalysis of TET proteins, and proposed to be involved in tumorigenesis. However, the prognostic value of 5hmC in renal cell carcinoma (RCC) is still unclear. This study aimed to define the clinical significance of 5hmC in RCC. We performed dot blot assays to measure the relative expression of 5hmC in RCC. We reviewed the clinical records of 310 RCC patients and performed immunohistochemical (IHC) staining of 5hmC. The overall survival (OS) and cancer specific survival (CSS) of all patients were recorded over a 10-year follow-up period. Effective prognostic nomograms which contained 5hmC were established to provide individualized OS and CSS in RCC. 5hmC expression level was significantly decreased in RCC tissues compared with those in the normal counterparts. Kaplan-Meier curves revealed that high 5hmC expression had a good prognostic impact on RCC patients. Cox multivariate survival analyses further indicated 5hmC was an independent prognostic factor for RCC survival. Nomograms constructed based on cox regression analysis were available to calculate the survival probability directly. Calibration curves displayed good agreements. The findings were validated with an independent external cohort included 77 RCC cases. Thus, we believe we have found a significative prognostic factor for RCC.

目的 探究高级别T1膀胱癌保留膀胱术后肿瘤复发与进展的相关影响因素.方法 回顾分析2013年1月至2016年12月在武汉大学中南医院泌尿外科接受保留膀胱手术治疗的87例高级别T1膀胱尿路上皮癌患者的临床资料.随访术后2年内肿瘤复发及进展情况,并行Cox回归分析研究相关影响因素.结果 87例患者均获得2年随访,术后2年内共有55例(63.21％)肿瘤复发,24例(27.59％)肿瘤进展.Cox回归分析结果显示,肿瘤大小、肿瘤数目、是否初发、膀胱灌注方案是影响高级别T1膀胱癌术后肿瘤复发的独立因素(P＜0.05);肿瘤大小、肿瘤数目、是否合并原位癌是影响高级别T1膀胱癌术后肿瘤进展的独立因素(P＜0.05).结论 临床工作中高级别T1膀胱癌应结合患者肿瘤大小、肿瘤数目、是否合并原位癌、是否初发等情况综合考虑治疗方案.

It is obvious that epigenetic processes influence the evolution of intervertebral disc degeneration (IDD). However, its molecular mechanisms are poorly understood. Therefore, we tested the hypothesis that IGFBP5, a potential regulator of IDD, modulates IDD via the ERK signalling pathway. We showed that IGFBP5 mRNA was significantly down-regulated in degenerative nucleus pulposus (NP) tissues. IGFBP5 was shown to significantly promote NP cell proliferation and inhibit apoptosis in vitro, which was confirmed by MTT, flow cytometry and colony formation assays. Furthermore, IGFBP5 was shown to exert its effects by inhibiting the ERK signalling pathway. The effects induced by IGFBP5 overexpression on NP cells were similar to those induced by treatment with an ERK pathway inhibitor (PD98059). Moreover, qRT-PCR and Western blot analyses were performed to examine the levels of apoptosis-related factors, including Bax, caspase-3 and Bcl2. The silencing of IGFBP5 up-regulated the levels of Bax and caspase-3 and down-regulated the level of Bcl2, thereby contributing to the development of human IDD. Furthermore, these results were confirmed in vivo using an IDD rat model, which showed that the induction of Igfbp5 mRNA expression abrogated the effects of IGFBP5 silencing on intervertebral discs. Overall, our findings elucidate the role of IGFBP5 in the pathogenesis of IDD and provide a potential novel therapeutic target for IDD.

Prostate cancer (PCa) testing is currently based on measurement of serum prostate-specific antigen levels and digital rectal examination, which are limited by a low predictive value and the adverse effects associated with overdiagnosis and overtreatment. Recent studies have reported that the abnormal expression of microRNAs (miRNAs) is associated with the mechanism underlying the development of PCa. Thus, the aim of the present study was to investigate the effects of miR-30e and its target gene, M3 muscarinic acetylcholine receptor (CHRM3), on the adhesion, migration, invasion and cell cycle distribution of PCa cells via the mitogen-activated protein kinase (MAPK) signaling pathway. The differentially expressed genes were screened in the Gene Expression Omnibus database from a gene expression microarray (GSE55945) of PCa. PCa tissues and adjacent tissues were collected from patients with PCa. The PC-3 and DU145 human PCa cell lines were treated with activator, inhibitor and siRNAs. The effects of miR-30e on cell adhesion, migration, invasion and cell cycle distribution with the involvement of CHRM3 and the MAPK signaling pathway were investigated. The bioinformatics results demonstrated that the CHRM3 gene and the MAKP signaling pathway were involved in the progression of PCa, and has-miR-30e was selected for further study. The levels of miR-30e were significantly downregulated, while the levels of CHRM3 were obviously upregulated in PCa. CHRM3 was verified as a target gene of miR-30e. Upregulation of miR-30e and downregulation of CHRM3 decreased the levels of p-P38, p-extracellular signal-regulated kinase, p-c-Jun N-terminal kinase, p-c-fos and p-c-JUN, cell adhesion, migration and invasion ability, and the number of cells in the S phase, while they increased the number of cells in the G0 and G1 phases. The findings of the present study suggest that miR-30e inhibited the adhesion, migration, invasion and cell cycle entry of PCa cells by suppressing the activation of the MAPK signaling pathway and inhibiting CHRM3 expression. Thus, miR-30e may serve as a candidate target for the treatment of PCa.

Objective: To investigate the effect of ARA55 over-expression on the prostate cancer proliferation, aggression and apoptosis; to investigate whether ARA55 can regulate the expression of TGF-beta or Smad7 in prostate cancer cells, and its relationship with estrogen receptor. Methods: The expression of ARA55, estrogen receptor alpha (ER alpha), ER beta, TGF-beta and Smad7 was detected in human prostate cancer tissues, benign prostate hyperplasia tissues and normal prostate tissues using immunochemistry. In vitro, the human prostate cancer cell lines, LNCaP and DU-145, were cultured, and transfected with pEGFP-ARA55, then the bio-behaviors of the ARA55 over-expression cells were evaluated, including the proliferation, aggression and apoptosis. Lastly, the expression of TGF-beta and Smad7 in prostate cancer cells with both ARA55 over-expression and ER beta knockout was detected by western blot. Results: The immunochemical results indicated that the expression of ARA55 was significantly lower in prostate cancer tissues than that in the benign prostate hyperplasia and normal prostate tissues. The cell experiment revealed that, both in the LNCaP cells and DU-145 cells, the proliferation and aggression of cells with ARA55 over-expression was much lower than the control groups, respectively; while the apoptosis rate of cells with ARA55 over-expression was higher than the control groups, suggesting that ARA55 could inhibit the prostate cancer proliferation and aggression. The expression of TGF-beta was decreased when the ARA55 over-expression in DU-145 cells; whereas the down-regulation of TGF-beta was eliminated, when the ER beta was knocked out in the cells with ARA55 over-expression. Conclusion: In prostate cancer, the expression of ARA55 was decreased, while the expression of ER alpha/beta, TGF-beta and Smad7 was increased. Furthermore, ARA55 could inhibit the TGF-beta level via the ER beta signaling pathway, to inhibit the cancer cell proliferation and aggression. Therefore, ARA55 could be considered as one of the treatment targets.

To compare the expression levels of androgen receptor (AR), oestrogen receptor α (ERα)and oestrogen receptor β (ERβ) in human prostate with various degrees of benign hyperplasia.

OBJECTIVE:To determine whether prostatic volumes and urinary flow changes were higher in old Chinese men with vitamin D deficiency than in those without vitamin D deficiency. METHODS:This was an observational case-control study of 224 old Chinese men. End point variables were prostatic volume, measured by transrectal ultrasound, and urinary flow, measured by urinary flowmetry. The International Prostate Symptom Score and International Index of Erectile Function score were determined. RESULTS:Two hundred and thirty-one (71.7%) out of the 322 were defined as vitamin D deficiency. The vitamin D deficiency group had a significantly higher prostate volume (42 mL vs 28 mL, P <.001), aldosterone (293 pg/mL vs 220 pg/mL, P < .001), prostate-specific antigen value (3.28 ng/mL vs 2.55 ng/mL, P < .001), and IPSS (4.47 vs 1.98, P < .001), and a significantly lower maximum urinary flow (13.44 mL/s vs 29.98 mL/s, P < .001) vs free of vitamin D deficiency group. Binary logistic regression analysis showed a strong association between the presence of vitamin D deficiency and benign prostatic hyperplasia (BPH) after adjusting for age, International Prostate Symptom Score, urination time, urinary volume, abdominal obesity, aldosterone, glucose, insulin, parathyroid hormone, and C-reactive protein (odds ratio 5.22, 95% confidence interval 1.96-12.76, P = .001). CONCLUSION:There is a relationship between the presence of vitamin D deficiency and prostate growth-associated urinary symptoms, likely attributable to their pathophysiological similarity. This study suggests that vitamin D deficiency may be a marker of BPH. Thus, it may be used as a future therapeutic target in patients with BPH. Further studies were necessary to confirm this association.

目的:探讨腹腔镜根治性前列腺切除术的疗效.方法:2009年9月-2011年9月,我科对81例早期局限性前列腺癌行腹膜外腹腔镜前列腺癌根治术.游离前列腺直肠间隙达前列腺尖部,游离膀胱前间隙及耻骨后间隙,离断膀胱颈部、耻骨前列腺韧带及尿道,重建膀胱颈并与尿道吻合.结果:81例腹腔镜前列腺癌根治术均获成功,无1例中转开放手术.手术时间100-270 min,平均150min.术中出血量100-700ml,平均210ml.需要输血5例(6.17％).标本切缘阳性5例(6.17％).术后膀胱尿道吻合口尿漏2例(2.47％),术后2周拔除导尿管,出现尿失禁8例(9.87％),其中7例(8.64％)随访6个月尿控恢复良好,1例未能恢复.81例术后随访21-45个月,平均30个月,排尿均通畅,未出现生化复发.术前41例(50.6％)有阴茎勃起功能的患者根据国际阴茎勃起功能指数(IIEF-5)评分分组进行术后变化评估.术后IIEF-5评分显著下降,各评分组间的差异无统计学意义.44例(54.3％)可通过使用药物进行性生活.结论:腹腔镜前列腺癌根治术是一种安全、有效、创伤小、并发症低、术后恢复快的手术方法.但长期疗效尚待进一步观察.

In addition to the conventional cancer treatment such as radiotherapy, chemotherapy and surgical management, nanomedicine-based approaches have attracted widespread attention in recent years. In this paper, a promising nanocarrier, magnetic nanoparticle clusters (MNCs) as porous materials which provided enough room on the surface, was developed for loading chemotherapeutic agent of doxorubicin (DOX). Moreover, MNCs are a good near-infrared (NIR) photothermal mediator. Thus, MNCs have great potential both in photothermal therapy (PTT) and drug delivery for chemo-photothermal therapy of cancer. We firstly explored the destruction of prostate cancer in vitro by the combination of PTT and chemotherapy using DOX@MNCs. Upon NIR irradiation at 808 nm, more cancer cells were killed when PC3 cells incubated with DOX@MNCs, owing to both MNCs-mediated photothermal ablation and cytotoxicity of light-triggered DOX release. Compared with PTT or chemotherapy alone, the chemo-photothermal therapy by DOX@MNCs showed a synergistically higher therapeutic efficacy.

The aims of this study were to determine if Thioredoxin reductase (TR) is detected in the serum, and to establish the sensitivity and specificity of serum TR for diagnosing prostate cancer (PC). We assessed serum TR in 380 participants in the training cohort: 160 patients with PC, 120 with benign prostatic hyperplasia and 100 healthy individuals. The validation cohort comprised 320 participants: 120 with PC, 100 with BPH and 100 healthy individuals. TR was measured in serum by ELISA by independent researchers. The patients with PC were graded using the Gleason system. Receiver operating characteristic (ROC) curves were utilized to evaluate the accuracy of biomarkers to diagnose PC. The influence of serum levels of TR on tumor grade and metastasis was performed by binary logistic regression analysis. The median levels of serum TR in PC were significantly higher than that of healthy subjects and patients with BPH (P < 0.0001). Based on the ROC curve, the optimal cutoff value of serum TR levels as an indicator for auxiliary diagnosis of PC from BPH was projected to be 8.2 U/ml, which yielded a sensitivity of 81.8% and a specificity of 68.9%, with the area under the curve at 0.862 (95% CI, 0.821-0.903). Combined model (TR and PSA) showed a significantly greater discriminatory ability as compared with those markers alone. In regres - sion analysis, after adjusting for other significant predictors, TR remained an independent metastasis predictor with an adjusted OR of 4.99 (95% CI, 2.64-8.09). Similarly, TR also was an independent High-grade tumors (HGT) predictor with an adjusted OR of 5.15 (95% CI, 2.52-9.14). Our study has demonstrated the additional benefit of TR measurement in the diagnosis of PC in the Chinese population. Further studies of the application of TR in this region may be beneficial.

Objective To compare the effectiveness of Quotient Ring and conventional circumcision. Methods 493 patients were assigned to Quotient Ring group(n=220)and conventional group(n=273). Duration of operation, amount of bleeding,wound pain,complications( wound edema and dehiscence),healing time,satisfaction rate and cost of treatment were all compared. Results All operations were successful and satisfactory. There were significant differ-ence in duration of operation,amount of bleeding,wound pain,healing time and cost of treatment between two groups (P<0. 05). There were no significant difference in complications(wound edema and dehiscence)and satisfaction rate. Conclusion Two methods are all satisfactory. Quotient Ring circumcision has the advantages of less duration of operation and amount of bleeding as well as regular cutting edge. However,it also has the disadvantages of longer heal-ing time,higher rate of wound edema and dehiscence as well as higher cost. Therefore,the aspiration of patients and their family need to be considered adequately.

Objective:To introduce our experience in using modified retroperitoneoscopic puncture site for the operation of kidney diseases.Methods:We admitted 84cases who had different kidney diseases(41male and 43female patients,46on the right side and 38on the left side,mean age(45.6±11.8)years.We designed three modified incisions according to different surgeries and specimen size and named them as follow:M1,M2and M3.Different patients could choose corresponding modified incisions for their retroperitoneoscopic surgery.The clinical data were compared with those of 75patients who had undergone the same or similar procedures using classical 3-port incisions.Results:Of the 84patients,83cases were underwent retroperitoneoscopic kidney surgery using modified puncture site.Only 1case required open conversion.The mean operative time was(72±18)min and average blood loss was(29±11)ml.No serious postperative complications and death were observed.To the choice of modified incisions,patients with chyluria,nonfunctional or atrophic kidney and renal cyst were finished by M1method,and only 6cases with huge renal carcinoma were finished by M3method.Of the rest 52cases with renal tumor,19cases were completed by M2method,and 33cases were still completed by M1method.A significant difference in favor of modified group was noted with respect to analgesia use in all three modified methods(diclofenac sodium,50∶100mg,P <0.05)and cosmetic outcome(score,8.9±2.2∶7.3±2.8,P<0.05)in M1and M2method(score,8.7±2.5∶ 7.3±2.8,P<0.05).Conclusions:Our modified retroperitoneoscopic puncture sites have more cosmetic and individual advantage and meet different kidney surgeries.