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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.

Benign prostatic hyperplasia (BPH) is a common problem among elderly males. Surgical resection of the hyperplastic tissue to relieve urinary tract obstruction remains a major option for the treatment of BPH. Operations, whether open prostatectomy, transurethral resection of the prostate, or transurethral laser resection of the prostate, will inevitably affect the sexual function of the patient. With the increased attention to patients' quality of life, more and more importance is being attached to the changes in post-BPH sexual function. This review covers the sexual function changes induced by different surgical methods and assesses the possible risk factors of BPH surgery.

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 characterize age-related cellular phenotype alterations and growth rates of human prostatic stromal cell cultures from the normal prostatic peripheral zone of young donors (PZ-young) and old donors (PZ-old)., Methods: We isolated stromal cells from 10 donors of different ages, assessed the cellular phenotypes by immunocytostaining for prolyl-4-hydroxylase, alpha-smooth muscle actin (alpha-SMA) and desmin, and analysed the ultrastructure by transmission electron microscopy (TEM). The proliferation and apoptosis of the cells were determined by Cell Counting Kit-8 assay and flow cytometry, respectively., Results: All the stromal cells were positive for prolyl-4-hydroxylase regardless of the donors' age, while alpha-SMA and desmin positive cells increased with their age. The positive expressions of alpha-SMA and desmin were (2.56 +/- 1.81)% and (0.89 +/- 0.93)% in PZ-young, and (38.89 +/- 11.22)% and (14.89 +/- 5.97)% in PZ-old (P < 0.01). The alpha-SMA- and/or desmin-positive stromal cells were morphologically large, flat and polygonal. Ultrastructural analysis showed that the cell cultures from PZ-old were richer in rough endoplasmic reticulum and golgi complexes. The stromal cells of PZ-old had a lower growth rate than that of PZ-young (P < 0.01), but there was no significant difference in the apoptosis rate between the two groups., Conclusion: Cellular phenotypes of human prostate stromal cell cultures change with the increase of age from predominantly typical fibroblasts to a mixture of fibroblasts and myofibroblasts, which might responsible for the high incidence of prostate cancer in elderly men.

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 study the different proportions of intermediate epithelial cells in human prostate cancer tissue and their clinical significance., Methods: We performed immunohistochemical staining for Cytokeratin 5 (CK5) and Cytokeratin 8 (CK8) on 60 samples of human prostate cancer, determined the proportions of intermediate epithelial cells in the cancer tissue, and classified the samples into 2 types, one with a majority of intermediate epithelial cells (CaP-INT, n = 32), and the other composed mostly of luminal epithelial cells (CaP-LUM, n = 28). Then we compared the 2 types of prostate cancer in the expression of the androgen receptor (AR), age of the patient, serum t-PSA, prostate volume, Gleason score, clinical stage, androgen resistance, and incidence of distant metastasis., Results: CaP-INT showed a significantly lower expression of AR ([24.42 +/- 11.41] %) and a higher incidence of distant metastasis (n = 14) than CaP-LUM ([77.21 +/- 10.22] % and n = 4) (P < 0.05). In the CaP-INT group, 6 of the 26 endocrinologically treated cases developed into androgen-independent prostate cancer (AIPC), while in the CaP-LUM group, only 1 out of 23 (P < 0.05). The former also showed remarkably higher clinical stages than the latter (P < 0.05), but no significant differences were found in age, serum t-PSA, prostate volume and Gleason score between the two groups (P > 0.05)., Conclusion: A higher proportion of intermediate epithelial cells may lead to increased invasiveness and metastasis of human prostate cancer.

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.

Objectives: To investigate whether androgen receptor (AR) could serve as a potential molecular target for the treatment of bladder cancer., Methods: Cell proliferation, apoptosis, and migration capacity were determined in human transitional carcinoma cell lines T24 and 253-J treated with small interfering RNA directed against AR, and expression levels of growth- and metastasis-related genes were assessed using quantitative reverse transcriptase-polymerase chain reaction. Tumor cell growth and apoptosis were also evaluated in vivo in T24 tumor-bearing nude mice receiving electroporation-assisted administration of anti-AR small interfering RNA., Results: AR expression knockdown produced increased apoptosis, decreased proliferation, and migration of bladder cancer cells. Cyclin D1, Bcl-x(L), and matrix metallopeptidase-9 gene expression were also reduced with AR knockdown, which might have contributed to the altered biological behavior of cancer cells. In vivo experiments showed that silencing AR expression, by interference aided by electroporation, significantly suppressed AR-positive bladder tumor growth with decreased cell proliferation and increased apoptotic rates., Conclusions: Downregulation of AR expression inhibits bladder cancer cell growth in vitro and in vivo, implying that its use might be a potential therapeutic target for the treatment of bladder cancer., (Copyright 2010 Elsevier Inc. All rights reserved.)

Purpose: To investigate whether peritoneal cavity could function as bioreactor to produce autologous tubular grafts for urethral reconstruction in male rabbits., Methods: 8Fr silastic tubes were implanted into peritoneal cavities of nine male rabbits. By 2 weeks, tubes were harvested and the tubular tissue covering the tubes was everted. A pendulous urethral segment of 1.5 cm long was totally excised and urethroplasty was performed with the everted tubular tissue in an end-to-end fashion. Another nine male rabbits underwent the same urethral resection and re-anastomosis as controls. Urethrography was performed at 1, 2 and 6 months postoperatively. Meanwhile, the neo-urethra were harvested and analyzed grossly and histologically., Results: Histological analysis of the tubular tissue demonstrated transversely arranged myofibroblasts embedded in homogeneous collagen bundles and an outer layer of mesothelium. The tissue was easily everted and successfully transplanted as a urethral graft. Serial urethrography indicated no stricture or diverticula formation. While all animals of the control group developed stricture. Histological analysis of the neo-urethra demonstrated normal urethral architecture by 1 month, composed of multi-layers of urothelium surrounded by smooth muscle bundles, which became increasingly organized with time. By 6 months, the neo-urethra could be hardly distinguished from native urethra both grossly and histologically., Conclusions: These results show that the autologous tissue grown within the recipients' peritoneal cavity can be used successfully for tubularized urethral reconstruction in male rabbits.

Objective: To investigate targeted degradation of the androgen receptor (AR) by chimeric molecules (DHT-PROTAC) via the ubiquitin-proteasome pathway in androgen-independent prostate cancer CA-2B cells, and explore the proliferation, secretion and apoptosis of the treated cells., Methods: C4-2B cells were treated with DHT-PROTAC, and then the expressions of the AR protein and caspase3 in the C4-2B cells were detected by immunohistochemistry and Western blot. The concentration of PSA in the supernatant was examined by ELISA. The cells were counted and their proliferation analyzed by a growth curve. The inhibitory effect on the growth of C4-2B cells was evaluated by MIT assay., Results: Compared with the control group, the DHT-PROTAC-treated group showed an obviously decreased expression of AR proteins with a significant attenuation of the band signals (P < 0.05), a 40% reduction of the AR-positive cells and a 60% decrease of the PSA concentration in the supernatant (P < 0.05). DHT-PROTAC exhibited an inhibitory effect on the C4-2B cells in a time-dependant manner (P < 0.05)., Conclusion: The chimeric molecule (DHT-PROTAC) can target the degradation of androgen receptors, reduce the secretion of PSA and repress the in vitro growth of C4-2B cells.

Background: Prostate cancer is one of the most common urogenital tumors in the world with an increasing incidence in China. Androgen deprivation therapy is the major therapeutic option for advanced prostate cancer. However, the role of androgen receptor (AR) in hormone-refractory prostate cancer still remains unclear. This work aimed to investigate the role of AR in an androgen independent prostate cancer cell line by in vitro and in vivo studies., Methods: The role of AR in the proliferation and invasion/metastasis ability of PC3-AR9 (a PC3 stable clone expressing human AR driven by natural human AR promoter) were examined with MTT assay, soft agar assay, chamber invasion assay, wound healing assay, and also with orthotopic xenograft mouse model., Results: Restoring androgen receptor in PC3 cells resulted in decreased proliferation and invasion/metastasis ability in MTT, soft agar, chamber invasion and wound healing assay. In the mouse orthotopic xenograft model, PC3-AR9 resulted in smaller primary tumors and metastasis tumors, with a lower proliferation rate and higher apoptosis rate., Conclusion: The AR might function as a tumor suppressor in PC3 cells both in vitro and in vivo.

Background: Laparoscopic dismembered pyeloplasty is technically feasible for ureteropelvic junction (UPJ) obstruction although it is still challenged by its technical difficulty and time-consuming. In this study, we compared the initial results of retroperitoneal laparoscopic pyeloplasty versus a combined laparoscopic dissection and open reconstruction through a small incision in the treatment of UPJ obstruction., Methods: Sixty-four patients with primary UPJ obstruction underwent pyeloplasty: 32 patients underwent laparoscopic procedure and 32 patients underwent open assisted laparoscopic surgery including two steps, ie, laparoscopic dissection of the UPJ transperitoneally and then pyeloplasty via an extended small incision. The demographic data and intraoperative, postoperative and follow-up conditions of patients were compared between the two groups., Results: Preoperative data were comparable in the patients of the two groups. The operative time was shorter (60.9 minutes vs 157.7 minutes, P < 0.0001) and the complication rate was lower (9.4% vs 31.3%, P < 0.05) in the open assisted group than in the laparoscopic group. The estimated blood loss (42.3 ml vs 47.8 ml), time to have normal diet (37.6 hours vs 33.8 hours), and hospital stay (6.7 days vs 6.2 days) were equivalent. The operative success rate was 97% for the open assisted group and 91% for the laparoscopic group., Conclusions: The procedure of combined small incision with laparoscopy for UPJ obstruction is technically easy, and the results are promising. It can be used as an alternative to conventional procedures.

The development of biomarkers for prostate cancer screening, detection and prognosis has greatly decreased the mortality of this disease. Recently, some new views on such biomarkers as PSMA, CK34betaE12, p63, AMACR, Pca-24, hTERT, DD3, Annexin A3 and GSTP1 methylation in prostate cancer tissue have been re-identified and investigated. Future research should focus on the combined screening of multiple biomarkers and discovery of new ones, which may possibly improve the sensitivity, specificity and accuracy of the early detection of prostate cancer.

The objective of this study was to explore the influence of ureteral stent on renal pelvic pressure by urodynamic study. 41 patients (with unilateral renal and/or ureteral calculi) after minimally invasive percutaneous nephrolithotomy (MPCNL) were placed a 4.7-Fr ureteral stent and 16-Fr nephrostomy tube. Renal pelvic pressure of these patients was measured by urodynamic study at the 5-7 days after MPCNL. Renal pelvic pressure (RPP), intraabdominal pressure (IAP), and vesical pressure (VP) during the filling and voiding phases were detected by urodynamic study with intravesical perfusion. At the baseline, intraabdominal pressure (IAP(0)) was 27.52 +/- 7.03 cmH(2)O, renal pelvic pressure (RPP(0)) was 33.07 +/- 7.04 cmH(2)O; at the maximum cystometric bladder capacity (MCBC) during the filling phase, vesical pressure (VP(vol)) was 41.61 +/- 10.34 cmH(2)O, renal pelvic pressure (RPP(vol)) was 39.44 +/- 7.33 cmH(2)O; at the maximum vesical pressure during the voiding phase, vesical pressure (VP(max)) was 74.95 +/- 12.79 cmH(2)O, renal pelvic pressure (RPP(max)) was 65.68 +/- 17.03 cmH(2)O. (1) There was a strong relationship between RPP(0) and IAP(0) (P = 0.0001); (2) There was statistical significance among RPP(0), RPP(vol) and RPP(max) (P = 0.0001); (3) RPP was higher than 40 cmH(2)O during the voiding phase, and it was obviously relevant to the VP (P = 0.0001) but not to the MCBC (P = 0.2696). RPP increased mildly during the filling phase and dramatically during the voiding phase after stenting. RPP increased higher than the level required for a backflow (40 cmH(2)O) during the voiding phase. So it was encouraged to remove the stent at earlier stage or decrease using the ureteral stent if possible.

Two-micron (thulium) laser resection of the prostate-tangerine technique (TmLRP-TT) is a transurethral procedure that uses a thulium laser fiber to dissect whole prostatic lobes off the surgical capsule, similar to peeling a tangerine. We recently reported the primary results. Here we introduce this procedure in detail. A 70-W, 2-microm (thulium) laser was used in continuous-wave mode. We joined the incision by making a transverse cut from the level of the verumontanum to the bladder neck, making the resection sufficiently deep to reach the surgical capsule, and resected the prostate into small pieces, just like peeling a tangerine. As we resected the prostate, the pieces were vaporized, sufficiently small to be evacuated through the resectoscope sheath, and the use of the mechanical tissue morcellator was not required. The excellent hemostasis of the thulium laser ensured the safety of TmLRP-TT. No patient required blood transfusion. Saline irrigation was used intraoperatively, and no case of transurethral resection syndrome was observed. The bladder outlet obstruction had clearly resolved after catheter removal in all cases. We designed the tangerine technique and proved it to be the most suitable procedure for the use of thulium laser in the treatment of benign prostatic hyperplasia (BPH). This procedure, which takes less operative time than standard techniques, is safe and combines efficient cutting and rapid organic vaporization, thereby showing the great superiority of the thulium fiber laser in the treatment of BPH. It has been proven to be as safe and efficient as transurethral resection of the prostate (TURP) during the 1-year follow-up.

Heparanase is an endo-β-glucuronidase that can selectively degrade heparan sulfate glycosaminoglycans and that has been shown to play a role in tumor progression, metastasis and tumor angiogenesis. Previous studies have demonstrated that the overexpression of heparanase in human tumors facilitates their invasive activity, thereby enhancing tumor metastatic potential. We detected the simultaneous and significantly correlated overexpression of heparanase in the tissues and urine of patients with bladder cancer. Expression of heparanase mRNA in the tissues was significantly correlated with various clinicopathological factors, such as stage, histological grade, size, number, recurrence and lymph node metastasis. This was not the case in the urine. In addition, the relapse rate was significantly higher in the patients exhibiting heparanase mRNA expression than in the patients lacking it. Heparanase at the mRNA level had greater sensitivity in the detection of bladder cancer than cytology, and specificity for the marker was relatively high. These findings suggest that the overexpression of heparanase may influence various malignant behaviors in bladder cancer, and that the RT-PCR assay for heparanase mRNA is a promising non-invasive test with high sensitivity and specificity for the diagnosis of the disease.

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.

We conducted a prospective, randomized study to evaluate whether postoperative ureteral stenting is necessary after ureteroscopic holmium laser lithotripsy. A total of 115 consecutive patients with distal or middle ureteral calculi amenable to ureteroscopic holmium laser lithotripsy were prospectively randomized into stented group (n = 58) and nonstented group (n = 57). The stent was routinely placed in the treated ureter for 2 weeks. The outcomes were measured with postoperative patient symptoms, stone-free rates, early and late postoperative complications, and cost-effectiveness. The postoperative symptoms were measured with Ureteral Stent Symptom Questionnaire (USSQ). All patients completed a 12-week follow-up. There was no significant difference between two groups with respect to the patient age, stone size, stone location and mean operative time. According to the USSQ, the symptoms of the stented group were significantly worse compared to the nonstented group (P = 0.0001). In the stented group, two patients had high fever for 1 week after the operation, stent migration was found in two patients, and the stents had to be removed earlier in five patients because of severe pain or hematuria. The cost of the stented group was significantly higher than the nonstented group. The stone-free rate was 100% in both groups. No hydronephrosis or ureteral stricture was detected by intravenous pyelogram in the 12th week postoperative follow-up. In conclusion, we believe that routine stenting after ureteroscopic intracorporeal lithotripsy with the holmium laser is not necessary as long as the procedure is uncomplicated for distal or middle ureteral calculis less than 2 cm.

Objective: Thulium laser resection of the prostate-tangerine technique (TmLRP-TT) is a transurethral procedure that uses thulium laser fiber to dissect whole prostatic lobes off the surgical capsule, similar to peeling a tangerine. To our knowledge we report the first prospective, randomized study comparing TmLRP-TT and standard TURP for symptomatic BPH., Methods: From November 2004 to December 2005, 100 consecutive BPH patients were randomized for surgical treatment with TmLRP-TT (n=52) or TURP (n=48). All patients were preoperatively assessed with subjective symptoms score, International Index of Erectile Function questionnaire, and complete urodynamic evaluation. Preoperative and perioperative parameters at 1-, 6-, and 12-mo follow-up were also evaluated. All complications were recorded., Results: TmLRP-TT was significantly superior to TURP in terms of catheterization time (45.7+/-25.8h vs. 87.4+/-33.8h, p<0.0001), hospital stay (115.1+/-25.5h vs. 161.1+/-33.8h, p<0.0001), and drop in hemoglobin (0.92+/-0.82 g/dl vs. 1.46+/-0.65 g/dl, p<0.001), whereas it required equivalent time to perform (46.3+/-16.2 vs. 50.4+/-20.7 min, p>0.05). TmLRP-TT and TURP resulted in a significant improvement from baseline in terms of subjective symptoms scoring and urodynamic finding, but no significant difference was found between the two groups. Late complications were also comparable., Conclusions: TmLRP-TT is an almost bloodless procedure with high efficacy and little perioperative morbidity. TmLRP-TT is superior to TURP in safety and is as efficacious as TURP in 1-yr follow-up. It is a promising technology in the clinical practice field.

Objective: To determine and compare the difference of cell apoptosis and proliferation in the transition and peripheral zones in the human prostate., Methods: Seventeen normal prostate glands from organ donors were sampled from normal men according to McNeal/s zonal anatomy, and 20 hyperplastic transition zones obtained from prostatectomy specimens of BPH patients. Cell proliferation and Bcl-2 expression were assessed by immunostaining using PCNA and anti-Bcl-2 antibodies, while apoptotic bodies were specifically stained using TUNEL. Bcl-2 mRNA expression was detected by RT-PCR., Results: In the normal epithelium, the rates of cell proliferation and apoptosis were markedly decreased in the transition zone as compared with the peripheral zone. The proliferation index was significantly increased in the hyperplastic transition zone in BPH, while the apoptosis index significantly decreased in comparison with the normal prostate. Bcl-2 was significantly greater in the normal transition epithelium than in the peripheral zone, and over-expressed in the hyperplastic transition zone. There was a significant negative correlation between the Bcl-2 expression and the apoptosis of the epithelial cells in the hyperplastic transition zone (r(s) = -0.867, P < 0.01)., Conclusion: The hyperplastic transition zone may result from both an increase of cell proliferation and a failure of cell apoptosis. Increased expression of Bcl-2 may participate in the BPH process by blocking cell apoptosis.

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 discuss the treatment of advanced cancer of abdominal cryptorchidism., Methods: The combined method, including preoperation chemotherapy + surgery + postoperation radiotherapy and chemotherapy, was used to treat 12 cases of the advanced cancer of abdominal cryptorchidism and the effects were evaluated., Results: The patients recovered smoothly without complications of operation. The side effect of chemotherapy and radiotherapy was very slight. Eleven out of 12 cases were followed up. All 11 cases survived and had no recurrence., Conclusion: The results of combined method to treat advanced cancer of abdominal cryptorchidism is very perfect.

Objective: To investigate the relationship between cyclooxygenase-2 (COX-2) mRNA expression and the biological behaviors of prostate carcinoma (PCa)., Methods: The expression of COX-2 mRNA was detected by RT-PCR method in 32 samples of PCa and the COX-2/GAPDH value was determined. Seven normal prostate tissues were served as control., Results: The expression of COX-2 mRNA in normal tissue of 7 control cases was all negative. There was statistical correlation between the COX-2/GAPDH and the Gleason scores of PCa. There also showed statistical correlation between the COX-2/GAPDH and the stages of PCa., Conclusion: COX-2 mRNA play an important role in occurrence and progression of the PCa. COX-2 is a tumor marker which may be the possible prognostic factor of PCa.

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.

Purpose: Bladder carcinoma is the most common urological malignancy in China. Gene mutation may be one of causes of carcinogenesis in the cancer. We therefore investigated the mRNA expression of RTKN gene in clinic malignant bladder carcinoma and explored the relationship between the novel gene and the cancer., Methods: Total RNA was extracted from 33 surgically resected specimens of bladder carcinoma and 19 specimens of tumor-free bladder tissues. After the optimal reverse-transcription polymerase chain reaction condition was established, the mRNA expression levels of the RTKN gene in the lesions and tumor-free bladder tissues were examined semiquantitatively, and the relationships between expression levels of RTKN and clinical pathological features were analyzed., Results: The expression of RTKN gene mRNA in 33 human bladder carcinoma tissues was significantly higher than that in 19 human tumor-free bladder tissues (0.937+/-0.103 vs. 0.350+/-0.082). The average ratio of RTKN expression in neoplasms to that in tumor-free bladder tissues was 0.350+/-0.164. Based on this ratio the 33 patients were divided into three groups: a down-regulated expression group (n=2), an up-regulated expression group (n=22), and an unchanged group (n=9). Although the chi(2) test demonstrated a statistically nonsignificant differences in RTKN expression between tumor stages Ta, T(1), and T(2) overall in the 33 human bladder carcinoma, the t test showed that there were statistically significant differences between solitary and multiple tumors, between the paired group aged younger or older than 70 years in 27 de novo bladder carcinoma patients, and between the groups with tumor larger or smaller than 2.25 cm(3)., Conclusions: These results suggest that the RTKN gene is involved in bladder carcinogenesis and progression in bladder carcinoma, indicating that RTKN gene could be a molecular target in cancer therapy.

Objective: To investigate the expression of androgen receptor (AR) isoforms in normal human prostate., Methods: Fourteen normal prostatic specimens from donors, aged 25 on average (21-28 yr), were analyzed by high resolution isoelectric focusing (IEF). The expression of AR isoforms was demonstrated in all 14 normal human prostatic tissues., Results: Four types of AR isoforms were detected with isoelectric point value at 6.5, 6.0, 5.8 and 5.3 in 14 prostatic specimens. Binding of 3H-dihydrotestosterone (DHT) to these four AR isoforms was inhibited by the addition of 100-fold excess of DHT and testosterone. No effect of progesterone, estradiol and diethylstilbestrol on tritiated hormone binding was observed., Conclusions: There are four AR isoforms in normal human prostate. The expression of AR isoforms is different from one another.

Objectives: To evaluate the clinical effect of the holmium laser enucleation and morcellation of prostate (HoLEP) in the treatment of benign prostatic hyperplasia(BPH)., Methods: In the treatment of 35 BPH patients, 100 watt high-powered holmium laser set was used transurethrally and a reciprocating blade tissue morcellator was introduced via a nephroscope to enucleate and morcellate the prostatic tissue., Results: Operations in all 35 cases were successful. The average operation time was 60 +/- 23.2 (range 30-180) min. The removed prostatic tissue weighed 31 +/- 9 (range 10-56) g on average. The average catheter time was 1.5 d (from 20 h to 4 d). No blood transfusion was performed in all cases. Histopathological analysis confirmed the diagnosis of BPH in all cases. In the 3-month follow up of 32 cases, IPSS dropped from 24 +/- 6.2 to 5.6 +/- 3.6; the peak urinary flow rate(Qmax) went up from 8.5 +/- 3.9 ml/s to 22.0 +/- 7.2 ml/s; the residual volume of urine dropped from 138 +/- 125 ml to 21 +/- 15 ml. No serious complications were found., Conclusions: HoLEP is effective in treating BPH. It can completely enucleate the hyperplastic tissue with little bleeding in operation. The treatment has the advantages of short catheter time and significant clinical improvements.

Aim: To study the characteristic pattern of the age-related growth of the human prostate gland., Methods: The volume (weight) of the prostate in 1,601 males, aged from newborn to 92 years, was determined by B-ultrasonography., Results: Prostatic volume determination by B-ultrasonography in 1601 males (1301 normal subjects and 300 BPH patients) pointed out that the age-stratified growth of human prostate could be categorized into 4 life stages: (1) the first slow growing phase (from newborn to 9 years): the prostate grows slowly at a rate of 0.14 g per year; (2) the first rapid growing phase (from 10 to 30 years): the prostate grows at a rate of 0.84 g per year; (3) the second slow growing phase (from 30 to 50 years), the prostate grows at a rate of 0.21 g per year; (4) the second rapid growing phase (from 50 to 90 years): the prostate grows at one of the following rates: in one group the growth rate is of 0.50 g per year and in the other 1.20 g per year, leading to benign prostatic hyperplasia (BPH)., Conclusion: The volumes of the prostate are different in different age groups and it grows with age at different rates in four life phases. The prostate growth in phases can be expressed by the following equation: Y=19.36+1.36X'-0.58X'(2+0.33X'3), where Y = prostate volume, X = age (up to 70 years), X'=(X-35.5)/10.

Background & Objective: Studies on solid cancer(such as breast cancer, hepatocellular cancer, pancreatic cancer) indicated that the abnormal expression of nuclear transcription factor Kappa B (NF-kappa B) regulates angiogenesis and cyclin-related genes. This study was designed to investigate the expression differences of NF-kappa B and its regulated genes between human primary transitional cell carcinoma(TCCs) of bladder and non-cancer bladder mucosa and its clinical significance., Methods: Forty-three frozen sections including 30 bladder cancer and 13 non-cancer bladder mucosa were subjected to immunohistochemistry and nucleus staining for determining levels of NF-kappa B family and I kappa B alpha; Five paired cancer and non-cancer specimens were subjected to Western blot for analysis p65, an important subtype of NF-kappa B; Thirteen paired specimens were subjected to RT-PCR for determination mRNA levels of p50, p52, p65, c-Rel, RelB, I kappa B alpha, CyclinD1, IL-8., Results: Expressions of p50, p52, p65, c-Rel, RelB, I kappa B alpha, CyclinD1, IL-8 mRNAs in bladder cancer were higher than that in non-cancer bladder mucosa (P < 0.01, P < 0.05, P < 0.01, P < 0.01, P < 0.05, P < 0.05, P < 0.05 and P < 0.05, respectively). Nucelus stainings of p50, p52, p65, c-Rel, RelB were also stronger in bladder cancer(P < 0.01, P < 0.01, P < 0.01, P < 0.01 and P < 0.01, respectively). Moreover, p65 was expressed more in cancer tissue than that in non-cancer mucosa evidenced by Western blot. In bladder cancer, the ranking score differences of p52, p65, c-Rel protein between lymphatic metastasis group and non-lymphatic metastasis group were statistically significant (P < 0.01, P < 0.01, P < 0.05, respectively)., Conclusions: Compared to noncancer bladder mucosa, expressions of NF-kappa B family and its regulated genes in bladder cancer are markedly higher. NF-kappa B may be related to lymphatic metastasis.

Objectives: To investigate the androgen receptor (AR) isoforms expression in human benign and malignant prostatic tissues and LNCaP cells., Methods: Using high resolution isoelectric focusing (IEF), the different expression of AR isoforms were demosntrated in human benign and malignant prostatic tissues and LNCaP cells., Results: Data were obtained from 41 AR-positive BPH, three prostatic cancer specimens, and LNCaP cells. From these materials, three types of AR isoforms were detected with pI values at 6.5, 6.0 and 5.3. In the case of BPH tissues, 15 (36.5%) specimens expressed all the three types of isoforms at pI 6.5, 6.0 and 5.3, and 10 (24.4%) samples contained isoforms at pI 6.5 and 5.3, five (12.2%) samples indicated isoforms at pI 6.5 and 6.0, four (9.8%) showed the isoforms at pI 6.0 and 5.3. Of all the 41 specimens, two (4.9%) and two (4.9%) as well as three (7.3%) denoted the isoforme at pI 6.5, 6.0 and 5.3 respectively. As for three prostatic cancer specimens, one sample showed all the three types of AR isoforms at pI 6.5, 6.0, 5.3, but another specimen expressed at pI 6.5 and 6.0, and only one failed to indicate any types of isoforms. LNCaP cells expressed all three types of AR isoforms at pI 6.5, 6.0 and 5.3. Binding of 3H-dihydrotestosterone to these three types of isoforms was inhibited by the addition of 100-fold excess of DHT and testosterone. No effect of progesterone, oestradiol and diethylstilboestrol on tritiated hormone binding was observed., Conclusions: The expression of AR isoforms is different among various patients and different between BPH and LNCaP cells, though no clear explanation could be induced for this. These results suggest the possibility of explaining effective hormonal therapy to prostatic disease in the future.