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Objective: To evaluate the long-term efficacies and complications of thulium laser resection of prostate-tangerine technique (TmLRP-TT) in the treatment of benign prostatic hyperplasia (BPH)., Methods: From November 2004 to December 2009, a total of 348 BPH patients undergoing TmLRP-TT at our hospital were evaluated retrospectively for long-term efficacies and complications. The follow-up data included international prostate symptom score (IPSS), quality of life score (QOL), maximum urinary flow (Qmax) and post void urinary residual (PVR)., Results: After 4 years, IPSS decreased 70% (22.7 ± 7.7 vs 6.8 ± 5.1) , QOL decreased 65% (4.3 ± 0.7 vs 1.5 ± 1.0), Qmax increased 212% (6.0 ± 2.6 ml/s vs 18.7 ± 4.6 ml/s) and PVR decreased 83% (104.7 ± 34.3 ml vs 17.7 ± 10.7 ml). Cumulative incidences of long-term complications was 6.0% (n = 21), including a second TmLRP-TT due to BPH recurrence (n = 4, 1.2%), urethral stricture (n = 8, 2.3%) and bladder neck contracture (n = 9, 2.6%). Overall, 93% were satisfied with surgical outcomes., Conclusion: TmLRP-TT has excellent efficacies with a low rate of long-term complications. Most patients are satisfied with surgical outcomes.

Objective: To compare the speed of vaporization of human prostatic tissue with benign prostatic hyperplasia (BPH) and depth of tissue damage using 70 and 120 W 2 µm laser devices., Methods: Fresh prostatic tissue specimens were obtained from 5 patients by open prostatectomy and divided into separate groups (70 and 120 W) based on the energy of laser output (70 and 120 W respectively). Trials were performed in acryl basin containing 0.9% saline at 37 °C. And then each prostate gland in vitro was vaporizated similarly as routine transurethral 2 µm laser vaporesection. 70 W and 120 W power were applied for prostatic vaporesection. The 2 µm laser vaporization proportion and vaporesection speed were calculated postoperatively. Prostatic tissue was embedded for histological evaluation. After hematoxylin and eosin (H & E) staining and nicotinamide adenine dinucleotide-reduced (NADH) measurement, depth of coagulation zone and necrotic tissue layer were measured. The results of prostatic tissue between two groups were compared., Results: With increasing output power, the speed (mean ± SD) of vaporesection of human prostatic tissue increased from (5.21 ± 0.66) g/5 min at 70 W to (10.84 ± 1.23) g/5 min at 120 W. Significant differences existed in the speed of vaporesection, resection and vaporization between 120 W and 70 W devices (P = 0.000). The proportion of vaporization mode was 81% at 70 W and 87% at 120 W during prostatic vaporesection. There was a stable penetration/coagulation depth with increasing power output for (0.98 ± 0.13)/(0.30 ± 0.09) mm at 70 W and (0.99 ± 0.12)/(0.31 ± 0.08) mm at 120 W. There were no significant differences in penetration and coagulation depth between 120 W and 70 W (P > 0.05)., Conclusions: Both 120 and 70 W 2 µm Laser devices yield excellent performance and security in vaporizated human prostate tissue. The 120 W 2 µm laser offers significantly higher vaporesection rates than 70 W power. And vaporization mode is a predominant procedure of prostatic vaporesection.

Objective: To study the re-epithelialization of dog's prostate urethra after two-micron laser resection of the prostate (TmLRP) and the role of CK34 (CK34βE12)-positive cells in this process., Methods: TmLRP were performed in 15 elder male dogs and wound specimens harvested at Days 3, 7 and 14 respectively. Immunohistochemical staining was performed to determine the expression levels of CK34 and prostate specific antigen (PSA) in prostatic urethra urothelial cells., Results: There was no CK34-positive cells in surgical wounds after 3 days while a cluster of CK34-positive cells were found to cover surgical wounds after 7 days, and these cells attached to residual prostate tissues. At Day 14 post-operation, positive expression of CK34 was found in basal cells of newborn urothelium., Conclusion: Prostate tissues are the important organizations for re-epithelialization of prostatic urethra after benign prostate hyperplasia surgery, and CK34-positive basal cells play an important role in this process.

Objective: To explore the application of thulium laser (2 µm laser) in managing bladder cuff in nephroureterectomy for upper urinary tract urothelium carcinoma (UUT-UC)., Methods: The medical records of 56 patients undergoing nephroureterectomy at our hospital were reviewed retrospectively. The operative indicators, oncologic outcomes and clinicopathologic data were compared among the groups of open surgery (Group A), electric coagulation (Group B) and thulium laser technique (Group C). Furthermore a model of burst pressure measurement was built to measure the different burst pressures of sealing distal ureter., Results: The follow-up results: when the indicators of operative duration, intraoperative blood loss volume, removal time of drainage tube, removal time of catheter and hospital stays were compared among three groups, Group A had no statistical differences with Group B/C in terms of removal time of drainage tube and removal time of catheter. But significant statistical differences existed in terms of operative duration, intraoperative blood loss volume and hospital stays ((232 ± 52) vs (148 ± 47) and (130 ± 49) min, (358 ± 81) vs (136 ± 74) and (145 ± 70) ml, (13 ± 3) vs (11 ± 4) and (10 ± 3) d, all P < 0.05). No statistical differences existed between Groups B and C in terms of all the above indicators. Burst pressure measurement results: no statistical differences existed between Group C and B ((116 ± 21) vs (139 ± 32) cm H2O, P > 0.05)., Conclusions: For the surgical treatment of UUT-UC, thulium laser technique has no difference in operation indicators and oncologic outcomes compared to open surgery. Besides, it has the advantages of improved spatial beam quality and more precise tissue incision.

Objective: To introduce an independently developed remote-control locating device under the radiographic guidance for percutaneous nephrolithotomy (PCNL) and conduct small-scale animal experiment to test its application effect., Methods: Five experimental minipigs were selected. And an animal model of nephrolithotomy was established by implanting stones from outside the body. This locating device for PCNL was used to locate before puncture under the radiographic guidance and then begin puncturing to the target stone following the located angle., Results: Four pigs achieved single puncture after localization. During the puncture process, no obvious hemorrhage occurred. The average time from starting locating to finishing puncture was 20.7 min, the average time of locating 15.6 min and the average time of puncture 5.1 min., Conclusions: This remote-control type of locating device can improve the accuracy and safety of puncture and minimize the radioactive exposure to operators. Thus it has an excellent perspective of further development and clinical application.

Objective: To explore the expression patterns of cadherins (N-cadherin and E-cadherin) in urothelial carcinomas and understand the values of N-E cadherin switch in the predictions of postoperative recurrence and prognosis., Methods: The expressions of N-cadherin and E-cadherin were measured by immunohistochemistry in 64 transurethral bladder tumor resection (TURBT) or partial cystectomy samples (48 cases) in 2005 by the method of streptavidin-biotin peroxidase., Results: A positive expression of N-cadherin and a negative expression of E-cadherin were noted in 27 (42.2%) and 16 (25.0%) specimens respectively. Patients with more poorly differentiated bladder cancer were accompanied with a higher expression of N-cadherin and a lower expression of E-cadherin (both P < 0.05). A positive expression of N-cadherin decreased the recurrence-free and cancer-related survival rates while a negative expression of E-cadherin was correlated with a lower cancer-related survival rate (all P < 0.05). No significant association was found between the expression of E-cadherin and the recurrence-free survival rate. Furthermore, the N-E cadherin switch (a negative expression of E-cadherin and a positive expression of N-cadherin) showed a higher predictive power in both recurrence-free and cancer-related survival according to multivariate analysis (HR = 0.428, 95%CI: 0.217 - 0.845, HR = 0.098, 95%CI: 0.013 - 0.767). No significant association was found between the expressions of two cadherins and postoperative progression., Conclusion: Although the expressions of E-cadherin and N-cadherin appear to be correlated with survival outcomes in bladder cancer, N-E cadherin switch may be a better predicator for postoperative recurrence and cancer-related survival.

Objective: To explore the surgical approaches, efficacy and safety of percutaneous nephroscopic 2 µm laser incision and drainage in the treatment of peripelvic renal cysts., Methods: The peripelvic renal cysts were punctured percutaneously. A 1.5 - 4.0 cm incision was made at thin avascular area between cyst and pelvis by the 2 µm laser to connect the cyst with the renal collecting system with the help of injecting methylene blue solution into renal pelvis through ureteral catheter. The double-J tube was placed for drainage., Results: The operations were successful in all cases. There were 16 males and 15 females with a mean age of 49 years old. The operative durations ranged from 25 to 120 minutes. And no severe complications occurred. The patients were followed up for an average of 12 months (range: 3 - 36). Among them, cysts disappeared in 18 cases and diminished over 1/3 in 13 cases. There was no recurrence of peripelvic renal cyst., Conclusion: Percutaneous nephroscopic 2 µm laser incision and drainage for peripelvic renal cyst is safe, effective and mini-invasive.

Objective: To observe the influences of erectile dysfunction (ED) by age, prostate size and lower urinary tract symptom (LUTS) undergoing two micro (thulium) laser resection of prostate-tangerine technique (TmLRP-TT)., Methods: A total of 50 BPH (benign prostatic hyperplasia) patients underwent TmLRP-TT with a 70 W laser power. The patient prostate volume, international prostatic symptomatic score (IPSS), maximal flow rate and international index of erectile function (IIEF-5) were assessed preoperatively. A retrospective assessment was made after surgery and at a 6-month follow-up. They were divided into 2 groups according to prostate volume ≤ 50 or > 50 ml, age ≤ 65 yrs or > 65 yrs, IIEF-5 ≤ 20 or > 21 and IPSS ≤ 27 or > 27 respectively. The postoperative influences of erection by age, prostate size and LUTS were observed., Results: Significant differences existed between pre-operation and 6 months post-operation in terms of IPSS (25.35 ± 5.6 vs 9.52 ± 3.1, P < 0.01) and maximal flow rate (6.51 ± 1.21 vs 13.4 ± 2.7 ml/s, P < 0.01). There was no difference between pre-operation and 6 months post-operation (34 vs 32 cases, χ(2) = 0.673, P = 0.603). The patients with prostate volume >50 ml group had 9 additional ED cases while those with IPSS >27 group contained 11 fewer ED cases. There were significant differences between both groups (χ(2) = 5.255, P = 0.002; χ(2) = 11.560, P = 0.001 respectively). BPH patients aged over 65 years old were more likely to suffer ED than those under 65 years old (χ(2) = 5.882, P = 0.015). However, there was no significant difference in age in terms of suffering postoperative ED (χ(2) = 3.125, P = 0.077)., Conclusion: TmLRP-TT can significantly improve LUTS in BPH patients. The presence of large volume prostate is an independent risk factor for an increased number of ED patients after TmLRP-TT. LUTS is an independent risk factor for ED. And TmLRP-TT may improve the ED patients with severe LUTS.

Objective: To investigate the long-term efficacy of ureteral reconstruction with tubularized peritoneal free grafts for the treatment of avulsion of ureteral mucosa in animal models., Methods: The model of avulsion of ureteral mucosa was established in 12 adult dogs. Then they were divided into Group A (n = 6, length of avulsed mucosa at 4 cm) and Group B (n = 6, length of avulsed mucosa at 6 cm). And the tubularized peritoneal free grafts and ureteral stents were implanted into the injured ureters. The curative effect was observed by intravenous urethrogram (IVU) and histological examination at Week 24 post-operation., Results: Severe stenosis was observed by IVU in 1 dogs in Groups A and B respectively. In the remaining 10 dogs, IVU showed normal size and morphology of kidneys. There was no hydronephrosis. And no obvious stricture of ureteral part was observed for mucosa substitutes made of peritoneal free grafts. In all 10 dogs without stenosis of both groups, peritoneal membrane was replaced by integrated transitional epithelium. And there was no obvious stricture. Collagen fibers were arranged parallel to mucosal surface., Conclusion: For avulsion of ureteral mucosa under 6 cm, reconstruction with tubularized peritoneal free grafts as mucosa substitutes is an effective method. And its long-term efficacy is satisfactory.

Objective: To determine whether urinary connective tissue growth factor (CTGF) can be a molecular marker for chronic allograft nephropathy (CAN) in a rat model., Methods: F344 rat renal grafts were orthotopically transplanted into Lewis rats (n = 24). Lewis rats underwent sham operation as control group (n = 12). Kidney grafts were harvested at Weeks 4, 8, 12 and 16 respectively. Serum creatinine (SCr) was measured. The CAN grades were evaluated according to the Banff 97 schema. The expressions of CTGF in kidney, serum and urine were determined by Western blot and competitive indirect ELISA. Spearman correlation analysis was used to compare CTGF expression and the development of CAN., Results: The expression of CTGF in the graft group was markedly elevated in comparison with the control group. Statistics analysis of CTGF protein in kidney detected by Western blot showed significant differences between these five groups (0.33 ± 0.05 for control, 0.55 ± 0.02 for Week 4, 0.80 ± 0.03 for Week 8, 0.90 ± 0.03 for Week 12 and 1.14 ± 0.11 for Week 16, P < 0.01). Both urine and serum CTGF increased by Week 4 and maintained a high level up to Week 16. The urinary CTGF of renal allografts was (2.9 ± 0.7), (12.9 ± 3.6), (32.3 ± 11.4) and (31.0 ± 8.9) ng/mg creatinine for Weeks 4, 8, 12 and 16 respectively. The urinary levels were positively correlated with SCr, Banff scores and expression of CTGF in the graft kidney (r = 0.848, 0.874, 0.747, all P < 0.01)., Conclusions: CTGF plays a significant role in the pathological changes of CAN after kidney transplantation. Urinary CTGF has the potential as a biomarker for predicting the clinical course of CAN.

Objective: To investigate whether the location of carcinoma in situ (CIS) of bladder cancer could be macroscopically ascertained by instilling pirarubicin (THP) into urinary bladder., Methods: 50 mg of THP was dissolved into 50 ml of 5% glucose solution. And the resulting solution was instilled into urinary bladder. After 15 min, the urinary bladder was observed by a cystoscopy. The study group consisted of 51 patients with bladder cancer (37 males, 14 females) and 14 patients with hematuria (8 males, 6 females), treated at our hospital from December 2007 to June 2008., Results: The THP uptake was seen in 67 flat (non-tumorous) areas of bladder mucosa in 37 patients with bladder cancer. Of these, 11 lesions in 7 patients were confirmed to be CIS. The THP uptake was found in 2 flat (non-tumorous) areas of bladder mucosa in 14 patients with hematuria, 1 lesion in 1 patient was confirmed to be CIS. The sensitivity and specificity of THP uptake by CIS were 92.3% (12/13) and 86.7% (371/428) respectively., Conclusion: This practical method may be employed to ascertain easily the macroscopic location of CIS of bladder cancer.

Objective: To investigate the changes of intrarenal pressure in response to continuous irrigation at different pressures during ureteroscopic lithotripsy., Methods: Eleven patients with residual ureteral calculi after percutaneous nephrolithotomy (PCNL), 8 in the proximal section, 2 in the middle section, 1 in the distal section. And one patient with calculi in the distal ureteral section underwent ureteroscopic lithotripsy. Renal fistula tube was connected with a urine dynamic detector and irrigation was performed continuously through the ureteroscope at different pressures. The baseline intra-pelvic pressure (IPP(0)) and maximum intra-pelvic pressure (IPP(max)) were recorded., Results: The average IPP(0) was (16.9 +/- 3.2) cm H(2)O. The IPP levels during the ureteroscopic lithotripsy [(172.6 +/- 32.2) cm H(2)O] were all significantly higher than the IPP(0) (all P < 0.01). In response to the irrigation pump pressure of 100 mmHg, the IPP(max) during the ureteroscopic lithotripsy in the distal, middle, and proximal ureter were 74.6, 93.5, and (110.3 +/- 2.4) cm H(2)O respectively. When the irrigation pump pressure levels were 50, 100, and 200 mm Hg respectively the IPP(max) levels during the ureteroscopic lithotripsy in the proximal ureter were (51.0 +/- 4.5), (110.3 +/- 2.4), and (193.2 +/- 5.9) cm H(2)O respectively (all P < 0.01)., Conclusion: The renal pelvic pressure is significantly increased during ureteroscopic lithotripsy. High renal pelvic pressure is associated with the irrigation pressure and the position of calculi.

Objective: To construct a recombinant bacillus Calmette-Guérin vaccine (BCG) secreting human interferon alpha-2a (IFNalpha-2a)., Methods: BCG Ag85B signal sequence was amplified from the genome of BCG by using polymerase chain reaction (PCR) and cloned in E.coli-BCG shuttle-vector pMV261 to get pMS. The cDNA fragment encoding human IFNalpha-2a was amplified from the plasmid pBIFNalpha-2a by using PCR and inserted into the shuttle expression vector pMV261. The recombinant plamid pMSIFNalpha-2a was identified by restriction endonuclease digestion, PCR amplification and nucleotide sequencing. pMSIFNalpha-2a was electroporated into BCG to get rBCG. The DNA and protein expressions of IFNalpha-2a gene in rBCG were determined by PCR and Western blotting respectively. IFNalpha-2a in the culture supernatant of rBCG was detected by enzyme-linked immunosorbent assay (ELISA)., Results: The recombinant plamid pMSIFNalpha-2a was constructed successfully and confirmed by restriction endonuclease analysis, PCR detection and nucleotide sequencing analysis. pMSIFNalpha-2a was successfully transformed into BCG by electroporation and were capable of synthesizing and secreting cytokine IFNalpha-2a. Western blotting revealed that the secretive proteins could specially combine with antibody against human IFNalpha-2a. the level of IFNalpha-2a (324.57 pg/ml) in the culture supernatant of rBCG was higher than control group by ELISA assay., Conclusion: The constructed recombinant BCG strain produces and secretes human IFNalpha-2a and it will be used in the treatment of superficial bladder cancer.

Objective: To investigate the curative effects of different reconstruction methods in the treatment of avulsion of ureteral mucosa., Methods: Twenty adult dogs were randomly divided into 4 equal groups: Group III (control group in which the ureter was incised and a ureteral stent was placed therein), Group II (the ureter was incised and a ureteral mucosal avulsion about 5 cm in length was created and the avulsed mucosa was replaced to the original position and a ureteral stent was placed in addition), Group III (a piece of bladder mucosa was incised and grafted to the avulsed ureter mucosa and a ureteral stent was placed in addition), and Group IV (a tubularized peritoneal free graft and a ureteral stent were placed in the avulsed ureter). Ten weeks later intravenous pyelography (IVP) was conducted to observe the images of ureter. Then the dogs were killed and pathological examination of the reconstructed ureter was conducted., Results: IVP showed atresia and stenosis in all control group dogs. No obvious stenosis was observed in Groups II and IV. Pathological examination showed that the newly grown mucosa was similar to the normal ureter structure in Groups II and IV. In Group III one dog died, slight distension of ureter superior to the reconstructed part was found in 2 dogs, and no obvious stenosis was observed in 3 dogs., Conclusion: Orthotopic replacement and tabularized peritoneal free grafting with placement of ureter stent are effective in treatment of avulsion of ureter mucosa. Bladder mucosa can be used as selectable material.

Objective: To evaluate the safety and efficacy of thulium laser resection of prostate-tangerine technique (TmLRP) in treatment of benign prostate hyperplasia (BPH)., Methods: Thirty BPH patients, aged 74 (61-83), with a mean prostate volume of 58 ml, average international prostate symptom score (IPSS) of 19, and average maximum urinary flow (Q(max)) of 8.0 ml/s underwent TmLRP using 50 watt, 2.01 microm Tm laser. The values of hematocrit, serum sodium, potassium, and chlorine concentrations, hemoglobin, Q(max), and IPSS before and 1 and 3 months after TmLRP were compared., Results: The mean operating time was 56 minutes. No significant bleeding was found during operation. Post-operative bladder irrigation was no necessary. The urethral catheter was indwelled for 1-3 days post-operatively. There were not significant differences in values of hematocrit, serum sodium, potassium, and chlorine concentrations, and hemoglobin before and 1-3 months after the operation. One month after the operation, the Q(max) was 23.1 ml/s and IPSS was 7.9, and 3 months after the operation the was 24.7 ml/s and the IPSS was 7.1. By the end of 3-month follow-up no new cases of impotence and retrograde ejaculation had been found., Conclusion: TmLRP is a safe and efficient procedure in treatment of BPH.

Objective: To detect the expression of different genes in the transitional zone and peripheral zone of human normal prostate., Methods: Seventeen specimens of normal prostate gland were obtained from dead kidney donors and patients undergoing total cystectomy. The transitional zone and peripheral zone were isolated. Twenty specimens of benign prostate hypertrophy (BPH) were obtained from patients undergoing prostatic enucleation. The periurethral significantly hypertrophic nodules were isolated. BioDoor Chip-40S containing 6700 clones of targeting gene cDNA was used to detect the gene expression. The peripheral zone RNA samples were labeled with cy3, and the transitional zone RNA samples labeled with Cy5. The genes with the ratio average (RA) < 0.5 or > 2 were identified as differentially expressed genes, and those with a RA < 0.2 or > 4 were identified as the most significantly differentially expressed genes. RT-PCR was used to investigate semi-quantitatively the expression of epidermal growth factor (EGF) mRNA in the 17 specimens of transitional zone and peripheral zone from the 17 normal prostate glands and the 20 specimens of periurethral zone from BPH., Results: A total of 640 genes differentially expressed in transitional zone and peripheral zone were screened out (comprising 269 unknown genes and 371 known genes), of which 294 genes were expressed in the transitional zone and 346 in the peripheral zone. Fourteen genes were identified as markedly differentially expressed, among which the EGF gene was highly expressed in the central zone, and the OSF-1 (osteoblast stimulating factor-1) gene was highly expressed in the peripheral zone. RT-PCR proved that in comparison with the expression of the internal marker beta-actin gene, the expression levels of EGF in the normal transitional zone and in the periurethral zone from BPH were markedly higher than that in the peripheral zone., Conclusion: There are differently expressed genes between the peripheral zone and central zone of normal human prostate, which may be the background of different biological behavior between these zones. EGF may markedly contribute to the growth of central zone of normal prostate.