Search

To develop a urodynamic study (UDS) pattern system for aged male patients who complained of non-neurogenic lower urinary tract symptoms (LUTS) to create a reference guideline for their diagnosis and treatment by a retrospective analysis.A retrospective analysis of UDS data was carried out in 1984 male patients neurologically intact with symptoms suggestive of bladder outlet obstruction (BOO) aged older than 45 years (2002-2013). On the basis of their UDS characteristic findings, the patients were classified into 1 of 7 subgroups: equivocal or mild BOO with sphincter synergia with or without idiopathic detrusor overactivity (pattern A); equivocal or mild BOO with idiopathic sphincter overactivity (B); classic BOO with sphincter synergia (C) or overactivity (D); BOO with only detrusor low compliance (E); BOO with both detrusor underactivity and low compliance (F); and equivocal BOO with detrusor underactivity (G). The follow-up data were reviewed and analyzed thereafter.The feasibility and rationality of this system were confirmed. The distribution of 7 patterns (pattern, case number, %) was A 158, 8%; B 59, 3%; C 1059, 53.3%; D 277, 14%; E 120, 6%; F 93, 4.7%; and G 218, 11%. A-G numbers in pattern C, D, and E were 103.1-141.4, higher than other patterns (P .001), and functional pressure lengths of pattern C and D were 7.0-7.2 cm, longer than other patterns (P .001).A practical UDS pattern system for aged male patients with lower urinary tract symptoms suggestive of BOO was constructed, which can be used to optimize the diagnosis and treatment of these patients.

Objective To assess the feasibility, safety, and efficacy of transperitoneal laparoscopic excision of primary seminal vesicle benign tumors (SVBTs) and summarize our experience with surgical techniques and follow-up outcomes of this rare condition. Methods This study included 6 patients who underwent transperitoneal laparoscopic excision of primary SVBTs between June 2005 and April 2011. A 5-port transperitoneal approach was used. The ipsilateral vas deferens was identified in the upper bulge of the retrovesical peritoneal reflection through a transverse approach and was dissected inwardly and used as a guide to the seminal vesicle tumor. Endoscopic Hem-o-lok clips (Teleflex Medical) were applied to control the vascular supply to the tumor base. With the contralateral vas deferens and seminal vesicle preserved, the tumor was removed together with the vas deferens and the adjoining ipsilateral seminal vesicle. The surgical procedures were successful in all 6 patients, without conversion to open surgery. The mean duration of surgery was 70 ± 16 minutes (range, 50-100 minutes), with unremarkable blood loss of less than 50 mL. The mean postoperative hospital length of stay was 5.2 ± 1.6 days (range, 4-8 days). No intra- or postoperative complications occurred. During a mean follow-up period of 42 ± 24 months (range, 12-82 months), all patients remained asymptomatic, with preserved function as reported by the patient, and there was no evidence of recurrence. Conclusion Our study demonstrated that transperitoneal laparoscopic excision of primary SVBTs is a viable option for minimally invasive treatment of SVBT.

Objectives To report our techniques and experience with retroperitoneal laparoscopic ureteroureterostomy (LUUS) for retrocaval ureter. Methods Between January 2004 and September 2008, 7 male patients underwent retroperitoneal LUUS. A 3-port, balloon-dissecting, retroperitoneal approach was used. Follow-up studies were performed with intravenous urography and renal ultrasonography. Results All operations were completed laparoscopically, and no open conversions were required. The mean operating time was 128.6 minutes (range 97-189) and the mean anastomosis time was 36 minutes, for all cases. The mean blood loss was 20 mL (range 15-50). None of the patients required blood transfusion. No intraoperative complications occurred. Hydronephrosis in all patients was decreased substantially after surgery. Conclusions Our results have demonstrated that retroperitoneal LUUS is an excellent minimally invasive treatment option for a retrocaval ureter that can be accomplished reasonably quickly and safely.

Objectives To elucidate the mechanism of transforming growth factor (TGF)–β1 overexpression in prostate cancer cells. Methods Malignant (PC3, DU145) and benign (RWPE1, BPH1) prostate epithelial cells were used. Phosphatase activity was measured using a commercial kit. Recruitment of the regulatory subunit, Bα, of protein phosphatase 2A (PP2A-Bα) by TGF-β type I receptor (TβRI) was monitored by coimmunoprecipitation. Blockade of TGF-β1 signaling in cells was accomplished either by using TGF-β-neutralizing monoclonal antibody or by transduction of a dominant negative TGF-β type II receptor retroviral vector. Results Basal levels of TGF-β1 in malignant cells were significantly higher than those in benign cells. Blockade of TGF-β signaling resulted in a significant decrease in TGF-β1 expression in malignant cells, but not in benign cells. Upon TGF-β1 treatment (10 ng/mL), TGF-β1 expression was increased in malignant cells, but not in benign cells. This differential TGF-β1 auto-induction between benign and malignant cells correlated with differential activation of extracellular signal-regulated kinase (ERK). Following TGF-β1 treatment, the activity of serine/threonine phosphatase and recruitment of PP2A-Bα by TβRI increased in benign cells, but not in malignant cells. Inhibition of PP2A in benign cells resulted in an increase in ERK activation and in TGF-β1 auto-induction after TGF-β1 (10 ng/mL) treatment. Conclusions These results suggest that TGF-β1 overexpression in malignant cells is caused, at least in part, by a runaway of TGF-β1 auto-induction through ERK activation because of a defective recruitment of PP2A-Bα by TβRI.