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Purpose Penile erection requires integrative interactions between vascular endothelial cells, pericytes, smooth muscle cells, and autonomic nerves. Furthermore, the importance of the role played by pericytes in the pathogenesis of angiopathy has only recently been appreciated. However, global gene expression in pericytes in diabetes mellitus-induced erectile dysfunction (DMED) remains unclear. We aimed to identify potential target genes related to DMED in mouse cavernous pericytes (MCPs). Materials and Methods Mouse cavernous tissue was allowed to settle under gravity in collagen I-coated dishes, and sprouted cells were subcultivated for experiments. To imitate diabetic conditions, MCPs were treated with normal-glucose (NG, 5 mM) or high-glucose (HG, 30 mM) media for 3 days. Microarray technology was used to evaluate gene expression profiles, and RT-PCR was used to validate sequencing data. Histological examinations and Western blot were used to validate final selected target genes related to DMED. Results Decreased tube formation and increased apoptosis were detected in MCPs exposed to the HG condition. As shown by microarray analysis, the gene expression profiles of MCPs exposed to the NG or HG condition differed. A total of 2,523 genes with significantly altered expression were classified into 15 major gene categories. After further screening based on gene expression and RT-PCR and histologic results, we found that Hebp1 gene expression was significantly diminished under the HG condition and in DM mice. Conclusions This gene profiling study provides new potential targets responsible for diabetes in MCPs. Validation studies suggest that Hebp1 may be a suitable biomarker for DMED., Graphical Abstract

Summary Background Identification of high-risk localised renal cell carcinoma is key for the selection of patients for adjuvant treatment who are at truly higher risk of reccurrence. We developed a classifier based on single-nucleotide polymorphisms (SNPs) to improve the predictive accuracy for renal cell carcinoma recurrence and investigated whether intratumour heterogeneity affected the precision of the classifier. Methods In this retrospective analysis and multicentre validation study, we used paraffin-embedded specimens from the training set of 227 patients from Sun Yat-sen University (Guangzhou, Guangdong, China) with localised clear cell renal cell carcinoma to examine 44 potential recurrence-associated SNPs, which were identified by exploratory bioinformatics analyses of a genome-wide association study from The Cancer Genome Atlas (TCGA) Kidney Renal Clear Cell Carcinoma (KIRC) dataset (n=114, 906 600 SNPs). We developed a six-SNP-based classifier by use of LASSO Cox regression, based on the association between SNP status and patients' recurrence-free survival. Intratumour heterogeneity was investigated from two other regions within the same tumours in the training set. The six-SNP-based classifier was validated in the internal testing set (n=226), the independent validation set (Chinese multicentre study; 428 patients treated between Jan 1, 2004 and Dec 31, 2012, at three hospitals in China), and TCGA set (441 retrospectively identified patients who underwent resection between 1998 and 2010 for localised clear cell renal cell carcinoma in the USA). The main outcome was recurrence-free survival; the secondary outcome was overall survival. Findings Although intratumour heterogeneity was found in 48 (23%) of 206 cases in the internal testing set with complete SNP information, the predictive accuracy of the six-SNP-based classifier was similar in the three different regions of the training set (areas under the curve [AUC] at 5 years: 0·749 [95% CI 0·660–0·826] in region 1, 0·734 [0·651–0·814] in region 2, and 0·736 [0·649–0·824] in region 3). The six-SNP-based classifier precisely predicted recurrence-free survival of patients in three validation sets (hazard ratio [HR] 5·32 [95% CI 2·81–10·07] in the internal testing set, 5·39 [3·38–8·59] in the independent validation set, and 4·62 [2·48–8·61] in the TCGA set; all p Interpretation Our six-SNP-based classifier could be a practical and reliable predictor that can complement the existing staging system for prediction of localised renal cell carcinoma recurrence after surgery, which might enable physicians to make more informed treatment decisions about adjuvant therapy. Intratumour heterogeneity does not seem to hamper the accuracy of the six-SNP-based classifier as a reliable predictor of recurrence. The classifier has the potential to guide treatment decisions for patients at differing risks of recurrence. Funding National Key Research and Development Program of China, National Natural Science Foundation of China, Guangdong Provincial Science and Technology Foundation of China, and Guangzhou Science and Technology Foundation of China.

BACKGROUND This study aimed to investigate the predictive value of multislice spiral computed tomography (MSCT) perfusion imaging for the efficacy of preoperative concurrent chemoradiotherapy (CCRT) in middle-aged and elderly patients with locally advanced gastric cancer (LAGC). MATERIAL AND METHODS One-hundred twenty-six middle-aged and elderly patients with LAGC were selected. MSCT was performed before and after CCRT to obtain perfusion parameters: blood flow volume (BF), blood volume (BV), mean transit time (MTT), and permeability surface (PS). After CCRT, according to Response Evaluation Criteria in Solid Tumors (RECIST), patients were categorized into the effective group and the ineffective group. Overall survival rate was measured by Kaplan-Meier analysis. ROC curve was applied to evaluate the predictive value of perfusion parameters. Multiple logistic regression analysis was applied to analyze the association of perfusion parameters with the efficacy of preoperative treatment. RESULTS Tumor volume reduction rates of the effective and ineffective groups were 59.23±8.53% and 10.41±3.36%. BF, BV, and PS values in the effective group were significantly decreased after CCRT. ROC curves indicated high sensitivities and specificities of BF value (79.00%, 73.44%), BV value (71.00%, 75.00%), and PS value (82.30%, 90.63%). The incidence rate of weakness and anorexia in the effective group was much higher than that in the ineffective group. Patients with low BF, BV, and PS values (less their optimal cutoff values) had longer survival times than these with high BF, BV, and PS values. CONCLUSIONS MSCT might have predictive values for the efficacy of preoperative CCRT in the treatment of LAGC.

Background: To investigate the value of contrast-enhanced transrectal ultrasound (CETRUS) in reducing unnecessary biopsy during prostate cancer screening and predicting biochemical recurrence in patients with localized prostate cancer. Methods:This was a prospective study of patients suspected of prostate cancer who were evaluated with CETRUS followed by prostate biopsy. Prostate blood flow on CETRUS was graded using a 5-point scale. The relationship between CETRUS score and biopsy outcomes was analyzed; Univariate and multi-variate analyses were used to determine the probable prognostic factors with biochemical recurrence in patients with localized prostate cancer underwent radical prostatectomy. Results:A total of 347 patients were enrolled. Prostate cancer was found in 164 patients. A significant positive correlation (r = 0.69, p < 0.001) was found between CETRUS scores and prostate cancer. Using CETRUS score ≥ 2 as the threshold for biopsy could have reduced the number of biopsies by 12.1% (42/347) without missing cancer and spared 23.0% (42/183) of patients from unnecessary biopsy. 77 patients with localized prostate cancer underwent radical prostatectomy and followed up. 17 of 77 patients exhibited biochemical recurrence. The 3-year biochemical recurrence-free survival rates were 86% for patients with CETRUS low scores (≤ 3) and 59% for patients with high scores (> 3; p = 0.015). Multivariate Cox regression analysis showed that CETRUS score was an independent predictor of biochemical recurrence (HR: 7.02; 95% CI: 2.00-24.69; p = 0.002). Conclusions:CETRUS score may be a useful tool to reduce unnecessary biopsy during prostate cancer screening and predict biochemical recurrence of localized prostate cancer after radical prostatectomy.

In this paper, we introduce a new research about mowing robot on obstacle avoidanceand path tracking controlling theoretically and practically, and propose the mowing control methodwhich based on computer vision. Lawn images collected by camera, through the extraction ofprogramming dealing with lawn, obstacles and boundary characteristics to achieve edge separation.Through special processing algorithm to determine boundary arises and obstacles location, size andspeed of the robot, with real-time capturing and processing. This paper gives the complete imagerecognition processing, and analyzes several methods of image filtering and edge detection, andproposes simple control algorithm for obstacle avoidance, and applies MATLAB for obstacleavoidance simulation. The results show that: the method can correctly identify the obstacles andboundaries, through the output about location, size of the obstacles and boundary, border slope andspeed of the robot to control robot mower. Most importantly, that computer vision applying in themowing robot itself is an innovation.

The paper introduces the structure and functional modules of the cutting tools information integrated system technology. We can manage the information on cutting tools efficiently by using the system. According to process feature we may select the appropriate cutting tools and the optimized cutting parameters .The system has the advantage of good generality, flexible application and fine opening. By using it, the efficiency of selecting tools and cutting parameters can be greatly improved.

Hydroforming is a new deforming technology , Many of numerical analyzes of bulge forming processes have concentrated exclusively on the behavior of the deforming tube . Finite element models have been developed to simulate stroke-controlled tube , with particular emphasis on the state of stress and deformation of the work piece in the paper . The effects of using internal pressure alone and combined internal pressure and axial compressive load were investigated and it was found that the development of the location of maximum strain was dependant on the type of loading used.

Prostate cancer is a highly prevalent disease in older men of the western world. MicroRNAs (miRNAs) are small RNA molecules that regulate gene expression via posttranscriptional inhibition of protein synthesis. To identify the diagnostic potential of miRNAs in prostate cancer, we downloaded the miRNA expression profile of prostate cancer from the GEO database and analysed the differentially expressed miRNAs (DE-miRNAs) in prostate cancerous tissue compared to non-cancerous tissue. Then, the targets of these DE-miRNAs were extracted from the database and mapped to the STRING and KEGG databases for network construction and pathway enrichment analysis. We identified a total of 16 miRNAs that showed a significant differential expression in cancer samples. A total of 9 target genes corresponding to 3 DE-miRNAs were obtained. After network and pathway enrichment analysis, we finally demonstrated that miR-20 appears to play an important role in the regulation of prostate cancer onset. MiR-20 as single biomarker or in combination could be useful in the diagnosis of prostate cancer. We anticipate our study could provide the groundwork for further experiments.

OBJECTIVES To study the feasibility, safety, and effect of transperitoneal laparoscopic heminephrectomy in the duplex kidney. METHODS From December 2003 to January 2008, 18 patients with urinary tract duplex anomalies underwent laparoscopic heminephrectomy using a transperitoneal approach. The sites of surgery consisted of 6 right upper, 2 right lower, 9 left upper, and 1 left lower heminephrectomy. Follow-up studies were performed using renal ultrasonography in all patients. RESULTS All patients underwent laparoscopic surgery successfully without conversion to open surgery or intraoperative complications. The mean operative time was 142.8 minutes (range 90-195). The mean estimated blood loss was 196.1 mL (range 20-600), and the mean hospital stay was 6.1 days (range 4-10). In 1 patient, a minor postoperative urine leak resolved spontaneously with prolonged catheter drainage. The radiologic assessment showed normal ipsilateral renal growth in 18 patients at a mean follow-up of 25.8 months. CONCLUSIONS Our initial clinical experience suggests that laparoscopic heminephrectomy using a transperitoneal approach for the duplex kidney is feasible, safe, and effective. Therefore, the transperitoneal approach for moiety excision, which offers a technically simple approach for complete ureterectomy, is recommended.

Renal paratransplant hernia is an uncommon and potentially fatal complication of renal transplantation. In this condition, bowel herniates through a defect in the peritoneum over the transplanted kidney and becomes trapped. Six cases have been reported previously, and we herein report three cases encountered in 668 kidney recipients. Abdominal pain and distention with or without vomiting were the main symptoms, presenting within 4 days after surgery. Abdominal CT scan confirmed the presence of bowel obstruction and paratransplant hernia. All three patients underwent emergent laparotomy, and resection of necrotic bowel was required in one patient who died of multiple organ failure 1 week after laparotomy. Renal paratransplant hernia is uncommon and potentially fatal, thus, prompt diagnosis and early surgical intervention are critical. Additionally, meticulous surgical technique during transplantation may help avoid this complication.

The insufficient information about the mechanism of EDM process affects decision-making related to operation, parameter adjustment, and automatic control. Without a thorough understanding of the process dynamical features, it is difficult to determine a suitable model to describe such processes. This research employs the chaotic analytical techniques to determine the level of complexity of an EDM process; the correlation dimension method. With the understanding of the process complexity and its composition by correlation dimension analysis, a well-defined model is proposed. Finally, by using this model structure and size, an online time-varied predictive model was developed and verified by another experiment.

Clear cell renal cell carcinomas (ccRCCs) display divergent clinical behaviours. Molecular markers might improve risk stratification of ccRCC. Here we use, based on genome-wide CpG methylation profiling, a LASSO model to develop a five-CpG-based assay for ccRCC prognosis that can be used with formalin-fixed paraffin-embedded specimens. The five-CpG-based classifier was validated in three independent sets from China, United States and the Cancer Genome Atlas data set. The classifier predicts the overall survival of ccRCC patients (hazard ratio=2.96−4.82; P=3.9 × 10−6−2.2 × 10−9), independent of standard clinical prognostic factors. The five-CpG-based classifier successfully categorizes patients into high-risk and low-risk groups, with significant differences of clinical outcome in respective clinical stages and individual ‘stage, size, grade and necrosis' scores. Moreover, methylation at the five CpGs correlates with expression of five genes: PITX1, FOXE3, TWF2, EHBP1L1 and RIN1. Our five-CpG-based classifier is a practical and reliable prognostic tool for ccRCC that can add prognostic value to the staging system., Using molecular markers is a useful way to predict the prognosis of cancer patients. Here, Wei et al. describe a five gene methylation signature that can predict the prognosis of renal clear cell cancer and validate its use in multiple patient cohorts.

Retroperitoneoscopic partial nephrectomy (RPN) is one of the standard methods for treating T1-stage renal carcinoma, which has a narrow operational space and a difficult surgical procedure. The aim of this study was to examine the safety and feasibility of renal-rotation techniques in RPN. Between April 2012 and June 2014, the renal-rotation technique in RPN was performed in 22 male and 16 female patients, aged between 31 and 75 years (mean, 52 years), with stage T1N0M0 renal-cell carcinoma. In 29 cases the tumor was located at the ventral side of the kidney, including 22 cases at the renal hilum, and in nine cases the tumor was located at the inferior pole of the kidney. The tumor size was between 1.5 and 4.6 cm (mean, 2.8 cm). The results showed that, in all 38 cases, the procedure was successfully accomplished without conversion to open surgery. There were no intraoperative complications and only three cases of postoperative complications. The surgery duration was between 45 and 116 min (mean, 59 min); blood loss was between 10 and 120 ml (mean, 40 ml) and no patients required a blood transfusion. The average kidney ischemia time was 21 min (range, 15–38 min). No patients had local recurrence or metastasis after follow-up of between one and 26 months. In conclusion, the application of the renal-rotation technique in RPN for tumors located at the ventral side, renal hilum or at the inferior pole of the kidney is safe and feasible and worth wider clinical application.

OBJECTIVES We sought to evaluate the advantages of an inguinal incision in extracting the kidney during retroperitoneal laparoscopic live-donor nephrectomy. MATERIALS AND METHODS From May 2008 to June 2011, fifty-eight cases of retroperitoneal live-donor nephrectomy were performed at our hospital; all data were analyzed retrospectively. All donors were grouped in a test group (n=32, inguinal incision) or a control group (n=26, lumbar incision) according to the selected graft retrieval incision. Donors were compared with regard to operative time and warm ischemia time, operative blood loss, hospital stay, cosmetic satisfaction, and incision complications. RESULTS All 58 cases of retroperitoneal live-donor nephrectomy were successfully accomplished, without donor death, serious complications, and conversion to open surgery. There were no differences in mean operative time, mean blood loss, mean warm ischemic time, graft function, and 1-year graft survival rate between the groups. However, in a test group, the mean hospital stay was shorter (P < .01), and the satisfaction with cosmesis was higher (P < .01). The incidence rates of abdomen asymmetry (9/28), incision hernia (4/28), wound infection (5/28), and wound faulty union (6/28) were higher in the control group than they were in the test group. CONCLUSIONS Inguinal incision is a safe and practical graft retrieval incision in retroperitoneal laparoscopic donor nephrectomy and can be generally applied.

Erectile dysfunction is often a harbinger of cardiovascular disease. We sought to gain mechanistic insight at the cellular and molecular levels into why erectile dysfunction precedes the clinical consequences of cardiovascular disease.Diabetes was induced by intraperitoneal streptozotocin injection in 8-week-old C57BL/6J mice. At 8 weeks after diabetes induction, we determined the expression of endothelial cell-cell junction proteins and vascular endothelial permeability in the penis, heart and hind limb by systemic injection of various vascular space markers (350 Da to 2,000 kDa) or by immunohistochemical staining with antibody to oxidized low density lipoprotein. We also investigated the effect of recombinant Ang1 protein on cavernous endothelial permeability.Alterations in the integrity of the endothelial cell-cell junction, including a decrease in endothelial cell-cell junction proteins and an increase in vascular permeability to fluorescent tracers or oxidized low density lipoprotein, were prominent in the cavernous tissue of diabetic mice. In contrast, no significant changes in endothelial cell-cell junction proteins or vascular permeability were noted in heart or hind limb tissue according to the diabetic condition. Intracavernous injection of Ang1 protein, an anti-permeability factor, significantly decreased cavernous endothelial permeability to oxidized low density lipoprotein by restoring endothelial cell-cell junction proteins in diabetic mice.The incompetent cavernous endothelial cell-cell junction in the diabetic condition provides an important clue to why erectile dysfunction is highly prevalent and often precedes other systemic vascular diseases.

To investigate whether the retroperitoneal or transperitoneal approach is preferable for right-sided laparoscopic donor nephrectomy (R-LDN).We retrospectively compared the donor and recipient outcomes of R-LDNs performed with a standard transperitoneal approach (n=21) or a semi-open retroperitoneal approach (n=32).Patient demographics were similar between groups. The semi-open retroperitoneal group had shorter operative time (89.5 min vs. 105 min, p0.001), shorter WIT (102 s vs. 120 s, p0.001), and longer renal veins (2.5 cm vs. 2.2 cm, p0.001). No conversions to open procedures occurred. There were no significant differences in the blood loss, length of hospital stay, or donor complication rate between the 2 groups. All grafts functioned adequately, and there were no significant differences in graft function, first-week hemodialysis, and serum creatinine level at discharge between the 2 groups The recipient complication rate was similar between the 2 groups (9.4% vs. 9.5%, p=0.986).The semi-open retroperitoneal approach is safe and effective for R-LDN. Further study is required to evaluate long-term graft function.

Evaluate the advantages of inguinal oblique incision in extracting the kidney during laparoscopic donor nephrectomy.From April 2005 to June 2009, sixty-seven cases of transperitoneal laparoscopic live-donor nephrectomies were performed at our hospital, all data were analyzed retrospectively. All donors were grouped as a test group (n=37, inguinal oblique incision) and a control group (n=30, paramidline or subcostal incision) according to graft retrieval incision selection. Donors were compared with regard to operative time and warm ischemia time, operative blood loss, hospital stay and cosmetic satisfaction. Recipients were compared with regard to graft function and 1-year graft survival rate.All 67 cases of transperitoneal live-donor nephrectomies were successfully accomplished, without donor death, serious complications, and conversion to open surgery. There were no differences in mean operation time, mean blood loss, mean warm ischemic time, graft function, and 1-year graft survival rate between the groups. But in the test group, the mean hospital stay was shorter, P.01; and cosmetic satisfaction was higher P.01.The inguinal oblique incision is a safe and practical graft retrieval incision in live-donor nephrectomies, and can be thought to be applied generally.

Some patients with exophytic renal masses less than 4 cm and suboptimal renal function, or a solitary kidney and bilateral renal tumors are considered for laparoscopic partial nephrectomy (LPN), which is feasible for early-stage renal tumors, although it is still considered technically difficult and time consuming. Shortening the time of the operation and renal warm ischemia are required urgently. In this study, we report our initial experiences of LPN, especially with some improved surgical techniques.Between July 2005 and October 2009, 74 patients with T(1a) renal tumor were treated by LPN, 39 using transperitoneal approach and 35 using retroperitoneal approach. In all cases, the tumor was removed with a margin of 0.5 cm. We compared glomerular filtration rate (GFR) preoperatively and postoperatively, and renal warm ischemia time between traditional ligature and Hem-o-lok methods.All operations were completed successfully, and there was no conversion to open surgery. Mean operation time was 76 minutes (range, 68 - 120), mean time of renal warm ischemia was 23 minutes (range, 15 - 32), and mean blood loss was 65 ml (range, 40 - 300). No hemorrhage or urine leak was observed in two cases with the collecting system sewn. Thirteen cases used Hem-o-lok to clamp the suture instead of traditional ligature, and mean time of renal warm ischemia was (16.5 ± 2.3) minutes (range, 12 - 18). Mean postoperative hospital stay was 6.3 days (range, 5 - 12). Sixty-seven cases had renal clear cell carcinoma, six papillary renal cell carcinoma, and one renal collecting duct carcinoma. All the tumor margin specimens were negative. The mean follow-up was 30.6 months (range, 3 - 51), and no recurrence or metastasis was observed.LPN for pT(1) stage renal tumor was safe and feasible. Hem-o-lok instead of traditional ligature to clamp the suture when sewing the renal wound could shorten the warm ischemia time.

To report our initial experiences of laparoscopic partial nephrectomy (LPN) for small renal tumors.From July 2005 to December 2008, 59 patients with small renal tumors were resected by laparoscopic partial nephrectomy.All operations were successfully accomplished. Twenty-seven patients were treated via a transperitoneal approach and the other 32 cases a retroperitoneal approach. The average operative duration was 72 minutes (range: 60 -) and the average kidney ischemia time 19 minutes (range: 15 - 32). The estimated blood loss was from 20 - 50 ml and no patient needed transfusion. The collecting system closure was performed by suture in 2 patients, and no complication of hemorrhage or urine leak was found. Thirteen cases used Hemo-lok to clamp the suture instead of traditional ligature. And the mean time of renal warm ischemia was 13 minutes (range: 10 - 18). These patients included 55 with clear cell renal carcinoma, 3 with granule cell renal carcinoma and 1 with oxyphil cell renal carcinoma. All renal tumors were completely removed with a negative surgical margin. The mean postoperative hospital stay was 6.2 days (range: 5 - 10). The postoperative ECT and creatinine were normal and there was no significant difference as compared with the preoperative findings (P0.05). None patient had any local recurrence during a mean follow-up period of 24.6 months (range: 3 - 42).LPN for pT(1) stage renal tumor is both safe and feasible. Mastering the skilled laparoscopic techniques may facilitate operation. Employing Hemo-lok instead of traditional ligature to clamp the suture while sewing renal wound shortens the warm ischemia time.

To evaluate the safety of living related donors in short term after transplantation.Two hundred and fifty-one cases of living related donor kidney transplantation from May 2000 to July 2007 were analysed retrospectively. There were 117 male and 134 female aged from 22 to 72 years old, with a mean of 46.6 years old. The indexes were compared including serum creatinine (SCr), creatinine clearance (CCr), glomerular filtration rate (GFR) and quality of life before and after donation. Surgical complications were followed-up.Donors' SCr was (75.9 +/- 17.2) micromol/L before donation, (107.4 +/- 21.2) micromol/L on 7 d after donation, (130.4 +/- 58.2) micromol/L at the 1(st) month and (116.1 +/- 24.1) micromol/L at the 3(rd) month. There were significant difference between any 2 time points (P0.01). CCr was (94.4 +/- 17.5) ml/min before donation and (63.5 +/- 17.8) ml/min on 10 d after donation (P0.01). In 62 donors, total GFR was (82.4 +/- 21.8) ml/min before donation. On 10 d after donation, GFR of remaining kidney was (57.4 +/- 14.1) ml/min which was 34.7% higher than GFR of this kidney before donation (42.6 +/- 11.8) ml/min. There was no significant difference in quality of life before living related donors and non-donor populations (P = 0.116). Surgical complications included splenic rupture in 1 case, descending colon rupture in 1 case and wound infection in 5 cases.Living donor kidney transplantation is safe for donors, although part of indexes would vary within normal range during the early time after donation.

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.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.Preoperative data were comparable in the patients of the two groups. The operative time was shorter (60.9 minutes vs 157.7 minutes, P0.0001) and the complication rate was lower (9.4% vs 31.3%, P0.05) 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.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.

To report initial experience with laparoscopic radical cystectomy in 43 patients with invasive bladder carcinoma.From December 2003 to October 2006, 29 men and 14 women underwent laparoscopic radical cystectomy with extracorporeal-assisted urinary diversion for transitional cell carcinoma of the bladder (n=40), adenocarcinoma (n=2) and squamous cell arcinoma (n=1). We report the specific technical details and present initial results of our series.The mean operative time of laparoscopic radical cystectomy with pelvic lymph node dissection was 195.4 min, the mean blood loss 273.7 ml, and the transfusion rate 6.9%. Two procedures converted to open techniques. Lymphadenectomy detected lymph node metastasis in three patients.We demonstrate that the combination of laparoscopic radical cystectomy and extracorporeal urinary diversion is possible and remains a safe, feasible, and repeatable surgical technique. The laparoscopic surgery with extracorporeal urinary reconstruction is emerging as a viable alternative to open radical cystectomy while characterized by less trauma, short recovery time and low complications. Intermediate oncologic outcomes are encouraging and comparable to those of open series. To determine the oncologic outcome long-time follow-up will be necessary.

To study the effect of 70 degrees recumbent position transperitoneal laparoscopy for treatment of upper urinary tract transitional cell carcinoma (TCC).From May 2004 to January 2007, 70 degrees recumbent position transperitoneal laparoscopy combined with urethral resectoscope was used to treat 31 cases of upper urinary tract transitional cell carcinoma. At the same time titanium clip to occlude the two extremities of ureter tumor was used, extracting specimen by oblique incision of lower quadrant.All operations were finished successfully, no one was turned to open surgery; mean operation time was 140 min, mean blood loss 80 ml, mean hospital stay time 8 d, without complications of urine leakage and intestinal fistula and so on.70 degrees recumbent position transperitoneal laparoscopy for resection of whole kidney and ureter is worth of general clinical application because it could provide large space for operation, simplify the treatment of renal pedicle vessels, decrease operation risk, reduce operation trauma and offer early recovery. But its effect on tumor spread and recurrence will still need long term follow-up.

To explore the technique and efficacy of laparoscopic ureteroplasty in treatment of congenital obstructive megaureter in childhood.Three children with congenital obstructive megaureter, all male, aged 7 approximately 24, underwent laparoscopic surgery. The dilated ureter was dissected and cut off near the place connecting the ureter and the bladder by laparoscopy. A double J tube was placed in the free ureter and connected with the urinary catheter by 7 - 0 wire. Then the free ureter was sutured with the bladder mucosa by laparoscopy.The operation duration was 80 to 200 min and blood loss was 30 to 50 ml. No complication developed. The double J was removed 10 days after the operation. Follow-up for 4 approximately 24 months showed good ureter drainage in all 3 cases without any infection, obstruction and hydrops.Laparoscopic surgery to treat megaureter in childhood has the benefits of slight injury and fast recovery in a short-time follow-up.

To discuss the clinical experience of laparoscopic radical prostatectomy by extraperitoneal approach.Five patients with localized prostate cancer underwent laparoscopic radical prostatectomy by extraperitoneal approach. The surgical procedure included the excision of the prostate, seminal vesicles, ampulla ductus deferentis and part of the bladder neck, followed by urethrovesical anastomosis.All the operations were successful. The mean operation time was 350 minutes (ranging from 270 to 420 mm); the mean estimated blood loss was 480 ml (ranging from 250 to 600 ml). The bowel activity was recovered with 48 hours after surgery. The patients were ambulant between the 2nd and 3rd postoperative days. The mean hospital stay was 8. 5 days (ranging from 7 to 12 days). The 3-8 months follow-up found no incontinence of urine; of the 3 preoperatively potent patients, 2 were able to have sexual intercourse; strictured stoma was reported in only 1 case.The extraperitoneal laparoscopic radical prostatectomy, keeping the procedure out of the peritoneal cavity, with small incision and rapid recovery, may be considered as a promising surgical method for patients with localized prostate cancer.

Purpose: To present our experience in laparoscopic radical cystectomy with extracorporeal urinary diversion for treatment of Chinese bladder cancer patients. Methods: Between January 2003 and November 2005, 41 men and 5 women with organ-confined muscle-invasive transitional cell carcinoma of the bladder underwent laparoscopic radical cystectomy with the Bricker-type urinary diversion. The age range was 36–71 years. Laparoscopic radical cystectomy and bilateral pelvic lymphadenectomy were performed using five fan-shaped ports by a transperitoneal approach. An ileal conduit diversion was created through the site of specimen retrieval which was the second port at the region of the right pararectus. Results: 46 radical cystectomies with Bricker-type ileal conduits were performed. No conversion to open surgery was necessary. Mean operating time was 220 min (range 120–249 min) for laparoscopic radical cystectomy and 75 min (range 65–120 min) for creating the ileal conduits. Mean estimated blood loss was 276 ml (range 155–567 ml). Two of the 46 patients needed blood transfusion (400 ml each). Mean days to ambulation and oral intake was 4.1 (range 3–5 days) and 3.5 (range 3–6 days), respectively. Mean hospital stay was 17.6 days (range 12–35 days). Mean follow-up was 6.1 months (range 3–19 months). Histopathological examination of the specimens revealed stage T2N0M0 in 18 cases, T3aN0M0 in 14, T3bN0M0 in 9 and T3bN1M0 in 5 (TNM staging). WHO grading: G1 in 2 cases, G2 in 26 cases and G3 in 18 cases. Pelvic metastases appeared in one case and 44 patients are alive and free of disease. Intravenous pyelogram at 3 weeks postoperatively shows no evidence of upper urinary obstruction in 45 patients. Conclusion: Despite technical difficulties, laparoscopic radical cystectomy with Bricker-type urinary diversion is feasible. With more experience in the surgical technique, laparoscopic radical cystectomy with extracorporeal urinary diversion can become an alternative treatment of choice in the selected patients with organ- confined bladder cancer in China.

To evaluate the efficacy and feasibility of laparoscopic aid in upper urinary reconstructive operation.Fifty-eight patients with ureteropelvic junction obstruction, 5 patients with upper ureter polypous, 2 patients with upper ureter stenosis, and 13 patients with upper ureter lithiasis underwent upper urinary reconstructive operation with laparoscopic aid described as follows:an incision 1 cm long was made, a 10 mm trocar and a 30 degrees laparoscope were wt in, the part with lesion was isolated and resected, and then pyeloplasty or end-to-end anastomosis of ureter was performed.The mean operative time was 33 minutes (25-45 minutes). The mean blood loss was 20 ml (15-25 ml). Complications such as urinary leakage and infection were observed. The double J stent was removed at 1 month after the operation. Follow-up for 3 to 15 months in 20 cases showed alleviation of hydronephrosis.An effective and safe method with less wound and operative time, combination of laparoscopic aid and open surgery in upper urinary reconstructive operation helps avoid difficult laparoscopic operation, does not increase trauma of the abdominal wall, and is worth promoting clinically.

To introduce a new procedure of laparoscopic adrenal surgery.Thirty patients with adrenal disease underwent surgery by a 70 degrees lateral decubital trans-abdominal laparoscopic approach, which wa compared with 30 degrees decubital laparoscopic operation in 26 patients.The procedure is superior to open laparotomy. There was significant difference in average operative time (77.2 min vs. 215.7 min), blood lost volume (27.0 ml vs. 94.5 ml), and postoperative complications (13.3% vs. 46.0%). Postoperative feeding time and hospitalization time were shortened markedly.This modified technique is safe, straightforward, with a good anatomic view during operation. It could be widely adopted for the treatment of benign adrenal disease, especially pheochromocytoma.