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Purpose: To compare the efficacy and safety of plasma kinetic enucleation of the prostate (PKEP) with holmium laser enucleation of the prostate (HoLEP) for treatment of benign prostatic hyperplasia (BPH). Methods: A total of 160 patients with indications for the surgical treatment of BPH were randomly assigned to receive either PKEP or HoLEP prospectively. Baseline characteristics, perioperative data, and postoperative outcomes of the patients were recorded. One hundred twenty-six (78.75%) patients (PKEP 64 vs HoLEP 62) completed the 3-year follow-up assessment. Results: Patients in both groups had similar baseline characteristics. Compared with PKEP, HoLEP was associated with shorter operative time as well as take-out time, lower perioperative hemoglobin decrease, and shorter bladder irrigation time, catheterization time, and hospital stay time. PKEP was superior to HoLEP in terms of the noise of the machine and hospitalization expenses. There were no significant differences in enucleating time, resected weight, and serum sodium levels. Both groups achieved satisfactory results and maintained improvement from baseline in terms of maximum urinary flow rate (Qmax), International Prostatic Symptomatic Score, quality of life, and postvoid residual at 3-year follow-up, with no significant differences between the two procedures. Except for re-catheterization rate, postoperative data such as transrectal ultrasound volume, International Index of Erectile Function-5, and follow-up scores of the flexible cystourethroscopy results, as well as the acute and mid-to long-term complications after surgery, were statistically similar. Conclusion: The 3-year follow-up data of this randomized trial confirmed that both PKEP and HoLEP were effective and safe surgical procedures for the transurethral management of BPH. HoLEP presented certain advantages compared to PKEP, such as reduced operative duration, decreased risk of blood loss, and less bladder irrigation, hospital stay time, and re-catheterization rate, whereas PKEP had lower noise and no additional laser cost. Chinese Clinical Trial Registry (ChiCTR-TRC-13004468).

To evaluate the safety and clinical efficiency of holmium laser enucleation of the prostate (HoLEP) in the treatment of small-volume BPH (SBPH) complicated by severe lower urinary tract symptoms (LUTS).We retrospectively analyzed the clinical data on 82 cases of SBPH with severe LUTS treated by HoLEP from January 2017 to December 2018. The patients were aged (65.5 ± 7.6) years, with a mean prostate volume of40 ml, a total IPSS of 24.8 ± 4.6, a QOL score of 5.2 ± 0.8, the maximum urinary flow rate (Qmax) of (7.6 ± 3.7) ml/s, and a mean PSA level of (1.8 ± 1.4) μg/L.All the operations were successfully completed, the mean operation time averaging (30.2 ± 5.0) min, enucleation time (26.7 ± 5.6) min and comminution time (3.5 ± 1.1) min, and the enucleated tissue weighing (20.3 ± 4.9) g. After surgery, the bladders were irrigated for (3.5 ± 1.9) h, with (3.0 ± 1.7) L of rinse solution, and catheterization lasted (24.8 ± 9.7) h. Histopathology revealed moderate or severe lymphocytic infiltration in 69 cases (84.1%). At 6 months after operation, significant improvement was observed in the IPSS, QOL, Qmax and PSA level compared with the baseline (P0.05). To date, no urethral stricture-related reoperation was ever necessitated.HoLEP is safe and effective for the treatment of SBPH complicated by severe LUTS and can be employed after adequate preoperative evaluation of the patient.《.

The role of high-fat diet (HFD) induced gut microbiota alteration and Ghrelin as well as their correlation in benign prostatic hyperplasia (BPH) were explored in our study. The gut microbiota was analyzed by 16s rRNA sequencing. Ghrelin levels in serum, along with Ghrelin and Ghrelin receptor in prostate tissue of mice and patients with BPH were measured. The effect of Ghrelin on cell proliferation, apoptosis, and induction of BPH in mice was explored. Our results indicated that BPH mice have the highest ratio of Firmicutes and Bacteroidetes induced by HFD, as well as Ghrelin level in serum and prostate tissue was significantly increased compared with control. Elevated Ghrelin content in the serum and prostate tissue of BPH patients was also observed. Ghrelin promotes cell proliferation while inhibiting cell apoptosis of prostate cells. The effect of Ghrelin on enlargement of the prostate was found almost equivalent to that of testosterone propionate (TP) which may be attenuated by Ghrelin receptor antagonist YIL-781. Ghrelin could up-regulate Jak2/pJak2/Stat3/pStat3 expression in vitro and in vivo. Our results suggested that Gut microbiota may associate with Ghrelin which plays an important role in activation of Jak2/Stat3 in BPH development. Gut microbiota and Ghrelin might be pathogenic factors for BPH and could be used as a target for mediation.

PlasmaKinetic electrode, holmium laser, green laser and Nd: YAG laser have been used for treating benign prostate hyperplasia (BPH). To compare the pathological changes of thermal injury by these different devices. Tissues donated by several male patients with prostate cancer who have written a consent. The tissues were diced them into small squares with 1 cm long on a side. Cutting experiments were performed in the normal temperature circulating water environment, the specimens of the prostate tissue were fixed in 4% formalin. The sections were then undergone HE and NADH-NBT staining. The penetration depths and coagulation zone of tissue after treatment were ranked as Nd:YAG laser > plasma Kinetic electrode > green light laser > holmium laser respectively. Holmium laser might have less thermal damage to tissue, although it still needs more research including clinical study. Our results will provide clinicians with some alternative basis for the application.

To evaluate the clinical effect of modified transobturator bulbourethral sling suspension (TBSS) in the treatment of stress urinary incontinence following radical prostatectomy.Seven male patients with stress urinary incontinence after radical prostatectomy were treated by modified TBSS in our hospital from June 2015 to June 2017 and the clinical data were analyzed retrospectively.The mean operation time of the 7 cases was 60－80 minutes and the mean intra-operative blood loss was 20－40 m1. The catheter was removed on the first day after surgery, and all the incisions were healed in stage Ⅰ. During a follow-up of 6－18 months, all the 7 cases were found cured, with transient acute urinary retention in 1 case and short-term perineal pain in another as post-operative complications. At 6 months after surgery, urodynamic examinations showed no statistically significant differences from the baseline in the maximum urinary flow rate (［15.0 ± 1.6］ vs ［13.7 ± 2.1］ ml/s, P0.05), urine output volume (［318.6 ± 52.1］ vs ［298.6 ± 36.3］ ml, P0.05), and postvoid residual urine volume (［11.4 ± 9.4］ vs ［7.1 ± 5.7］ ml, P0.05).Modified TBSS, with the advantages of less invasiveness, few complications, and low cost, is an effective option for the treatment of stress urinary incontinence after radical prostatectomy.

Background/Aims: To explore the effect of sulforaphane (SFN) treatment in rats through the induction of Stress Urinary Incontinence (SUI) via the Nrf2-ARE pathway. Methods: A total of 18 female rats (Sprague-Dawley) were assigned to three groups: a control group, an SUI group, and an SUI+SFN group (six rats per group). Rats in the treatment groups were induced via postpartum vaginal balloon dilation and bilateral ovariectomy. Rats in the SUI+SFN group were treated via intraperitoneal injection once per day for a total of one month. Urethral sphincter muscle histological was observed by HE and Masson staining. Peak voiding pressure and interval of micturition were measured by cystometry. Oxidative stress markers and protein expression in the Nrf2-ARE pathway were examined by immunohistochemical staining and western blotting. Results: Prolonged micturition interval and higher peak voiding pressure were observed in the SUI+SFN group. Disturbance of muscle morphology was ameliorated, muscle content was elevated, and collagen content was restrained in response to SFN treatment. The SOD, GSH-Px, and CAT activities were elevated in the SUI+SFN group compared to those in the control group. The level of cell apoptosis was decreased in SUI rats after SFN treatment; however, apoptosis was mainly located in the urethral mucosa instead of the muscle layer. SFN reduced the Bax/Bcl-2 expression ratio. Nrf2 and Nrf2 target antioxidant proteins were elevated in the SFN group. Conclusions: SFN was effective for SUI treatment via decreasing oxidative stress and activating the Nrf2-ARE pathway.

Background/Aims: Transforming growth factor-β1 (TGF-β1) plays important roles in penile corporal fibrosis and veno-occlusive dysfunction (CVOD). Angiotensin II (Ang II) is critically involved in erectile dysfunction, and blocking of Ang II is more important than inhibition of TGF-β in non-penile tissue fibrosis. However, the role of Ang II in corporal fbrosis and CVOD in a diabetic condition has not been investigated. Methods: Diabetic rats were treated with sildenafil or losartan (an Ang II antagonist) alone or in combination. Intracavernosal pressure, dynamic infusion cavernosometry, and histological and molecular alterations of the corpus cavernosum were examined. Results: Diabetic rats exhibited decreases in erectile response, severe CVOD, apoptosis, fibrosis, and activation of the TGF-β1 pathway. Treatment with sildenafil had a modest effect on erectile response and an insignificant suppressive effect on CVOD, apoptosis, fibrosis, and the TGF-β1 pathway. Although losartan greatly improved the histological and molecular changes and CVOD as compared with sildenafil, its effect on erectile response was low. The combination of sildenafil and losartan had superior effects on these parameters than did either compound alone. Conclusion: Ang II activation may be involved in apoptosis and fibrosis of the corpus cavernosum through Smad and non-Smad pathways, resulting in CVOD and ED. The low efficacy of sildenafil in a diabetic ED rat model was at least partly due to its inadequate effects on apoptosis, fibrosis, and CVOD.

// Huan Xu 1,* , Chong Liu 1,* , Meng Gu 1 , Yanbo Chen 1 , Zhikang Cai 1 , Qi Chen 1 and Zhong Wang 1 1 Department of Urology, Shanghai 9th People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China * These authors have contributed equally to this work Correspondence to: Zhong Wang, email: // Qi Chen, email: // Keywords : benign prostatic hyperplasia, holmium laser enucleation of the prostate, smoking, vascular damage, perioperative characteristics Received : August 15, 2016 Accepted : October 04, 2016 Published : October 09, 2016 Abstract Purpose: To evaluate the relationship between prostatic vessel changes induced by cigarette smoking and the perioperative outcome of holmium laser enucleation of the prostate (HoLEP). Materials and Methods: A total of 268 postoperative patients with benign prostatic hyperplasia (BPH) were prospectively analysed in our department. They were divided into two groups (smokers and non-smokers) according to smoking history. Transrectal colour Doppler ultrasound was performed to evaluate the prostate vascular changes. Pathologically, HE staining, CD31 and CD34 were analysed in prostatic section chips. Furthermore, postoperative outcomes were determined during a 6-month follow-up period. Results: The preoperative prostate volume was significantly decreased in smoking patients ( P = 0.04). CPI was significantly lower in smoking BPH patients ( P < 0.01), whereas RI was significantly increased in smokers compared with non-smokers ( P < 0.01). Histological assays revealed elevated CD34 in the smoking BPH individuals presenting an increased number of microvessels. The HoLEP duration was increased in smokers. Interestingly, we identified significantly increased overactive bladder syndrome score (OABSS) and decreased Qmax in smoking individuals during the 6-month follow-up with no difference being observed preoperatively. However, no significant difference between the groups was observed for the International Prostate Symptom Score (IPSS). Conclusions: The significantly lower CPI and higher RI values in smoking BPH patients indicated the presence of considerable vascular damage in these subjects. Moreover, cigarette smoking extended the surgical duration and prolonged the recovery period of overactive bladder (OAB) syndrome. Thus, integrated treatment should be suggested for various BPH individuals.

To investigate the diagnosis and management of penile fracture.From June 1993 to May 2017, 46 cases of penile fracture were treated in our hospital, averaging 33.5 (25－42) years of age and 3.45 (1－10) hours in duration, of which 41 occurred during sexual intercourse, 4 during masturbation and 1 during prone sleeping, 4 with hematuria, but none with dysuria or urethral bleeding. Hematoma was confined to the penis. Emergency surgical repair was performed for all the patients, 45 under spinal anesthesia and 1 under local anesthesia, 16 by coronal proximal circular incision and the other 30 by local longitudinal incision according to the rupture location on ultrasonogram. The tunica albuginea ruptures averaged 1.31 (0.5－2.5) cm in length, which were sutured in the "8" pattern for 6 cases and with the 3－0 absorbable thread for 18 cases. The skin graft or negative pressure drainage tube was routinely placed, catheters indwelt, and gauze used for early pressure dressing. In the recent few years, elastic bandages were employed for 3－5 days of pressure dressing and antibiotics administered to prevent infection. The stitches and catheter were removed at 7 days after surgery.Short-term postoperative foreskin edema occurred in 14 of the 16 cases of circular degloving incision, but no postoperative complications were observed in any of the cases of local incision. Twenty-eight of the patients completed a long-term follow-up of 49.4 (10－125) months, which revealed good erectile function, painless erection, and satisfactory sexual intercourse.For most penile fractures, local longitudinal incision is sufficient for successful repair of the tunica albuginea, with mild injury, no influence on the blood supply or lymph reflux, and a low rate complications. It therefore is obviously advantageous over circular degloving incision except when the cavernous body of urethra is to be explored, which necessitates circular degloving incision below the coronal groove.目的： 探讨阴茎折断的诊断和治疗。方法： 1993年6月至2017年5月, 我院共收治阴茎折断46例, 平均年龄33.5岁（25~42岁），病程平均3.45 h（1～10 h）。性交时发生41例,手淫4例，俯卧睡觉时发生1例。均无排尿困难及尿道口出血，4例发生了血尿，血肿局限于阴茎。45例在腰麻下行急诊手术治疗,1例局部麻醉下手术，16例采用冠状沟近侧环行切口, 30例根据B超显示的破裂位置采用局部纵形纵切口。术中发现白膜破口平均1.31 cm（0.5~2.5 cm）,6例采用丝线“8”字缝合白膜裂口, 18例改用3-0可吸收线缝合白膜。常规放置皮片或负压引流管，留置导尿，早期使用纱布加压包扎,近年使用弹力绷带加压包扎3~5 d ,应用抗生素预防感染。术后1周拆线并拔除导尿管。结果： 46 例均行急诊手术修补,术后环形脱套切口的16例患者中，14例短期内发生了包皮水肿，而采取局部切口的患者则没有任何并发症，远期随访到的28例阴茎勃起功能均保持良好，无痛性勃起，能维持满意性交。结论: 大多数阴茎折断局部纵行的小切口足以保证手术顺利完成，损伤小，不破坏血供和淋巴回流，不易发生手术并发症，相比环形脱套切口，优势明显，但如需探查尿道海绵体，应采用冠状沟下方的环形脱套式切口。.

To investigate the clinical effect of "3+1" bladder function restoration combined with holmium laser enucleation of the prostate (HoLEP) in the treatment of benign prostatic hyperplasia (BPH) with acontractile detrusor (ACD).We treated 35 BPH patients with ACD by HoLEP followed by "3+1" bladder function restoration, that is, a 3-phase bladder function training plus simultaneous 1-drug medication after surgery. We recorded and analyzed the detrusor pressure, post-void residual urine volume (PVR), maximum urinary flow rate (Qmax), International Prognostic Scoring System (IPSS) scores, quality of life (QoL), voluntary micturition, satisfaction with the bladder function, hydronephrosis, ureterectasia, renal function, and urinary tract infection of the patients before and after treatment.Compared with the base line, at 6 months treatment, the patients showed significantly increased detrusor pressure (［35.1±2.7］vs ［50.2±2.3］ cmH2O, P0.05) and Qmax (［4.2±2.7］vs ［21.1±4.1］ ml/s, P0.05) but decreases in PVR (［173.0±31.6］ vs ［30.5±12.9］ml, IPSS score (27.3±3.2 vs 5.1±1.4, P0.05) and QoL (4.1±0.8 vs 0.8±0.1, P0.05), elevated rates of voluntary urination (0% ［0/35］ vs 100% ［35/35］, P0.05), regularurination (0% ［0/35］ vs 85.71% ［30/35］, P0.05), grade Ⅰ satisfaction with bladder function (0% ［0/35］ vs 85.71% ［30/35］, P0.05), reduced rate of overflowing urinary incontinence (28.57% ［10/35］ vs 5.71% ［2/35］, P0.05), and increased percentages of normal renal function (34.29% ［12/35］ vs 85.71% ［30/35］, P0.05) and non-infection of the urinary system (17.14% ［6/35］ vs 94.29% ［33/35］, P0.05). After treatment, urination was markedly improved in 94.29% (33/35) of the patients."3+1" bladder function restoration combined with HoLEP produced a desirable effect on BPH with ACD, though its long-term effect remains to be further investigated.目的： 探讨“3+1”膀胱功能恢复法联合剜除术治疗良性前列腺增生（BPH）伴逼尿肌无力（ACD）患者的临床疗效。方法： 对我院收治的35例BPH伴ACD的患者行前列腺钬激光剜除术，术后行“3+1”膀胱功能恢复法,即3阶段膀胱功能恢复训练，同时用1种药物辅助治疗。记录并分析患者就诊时、术后3、6个月的膀胱内压、残余尿、最大尿流率、IPSS、QoL、能否自行排尿、能否有规律的排尿、膀胱功能满意等级、肾积水、输尿管扩张、肾功能、泌尿道系感染等指标。结果： 患者术前与术后６个月膀胱内压［（35.1±2.7） cmH2O vs （50.2±2.3） cmH2O,P0.05］、最大尿流率［（4.2±2.7） ml/s vs （21.1±4.1） ml/s, P0.05］较术前明显增高，残余尿［（173.0±31.6） ml vs （30.5±12.9） ml, P0.05］、IPSS［(27.3±3.2)分 vs (5.1±1.4)分, P0.05］、QoL［(4.1±0.8)分 vs (0.8±0.1)分, P0.05］较术前明显降低，均具有统计学意义（Ｐ０．０５）。术前与术后6个月对比，患者均可自行排尿（0/35，0% vs 35/35，100%，P0.05），大部分患者有了规律（排尿间隔3~4 h）的排尿（0/35，0% vs 30/35，85.71%，P0.05），膀胱满意度为I级患者显著增加（0/35，0% vs 30/35，85.71%，P0.05），充盈性尿失禁患者显著减少（10/35，28.57% vs 2/35，5.71%，P0.05），肾功能正常患者增加（12/35，34.29% vs 30/35，85.71%，P0.05），无明显泌尿系感染者显著增加（6/35，17.14% vs 33/35，94.29%，P0.05）。患者症状得到明显改善，经过“３＋１”膀胱功能恢复法后除２例仍排尿困难，其余３３例排尿得到明显改善。 结论： 通过“3+1”膀胱功能恢复法联合剜除术，对BPH伴逼尿肌无力的患者取得了良好的治疗作用, 其长期疗效有待进一步观察。.

To evaluate the effects of three different medications with tadalafil on erectile dysfunction (ED) in young men with primary sexual failure.This study included 76 male ED patients aged 21－35 years who had primary sexual failure but normal nocturnal penile tumescence and rigidity and failed to respond to psychotherapy. We randomly assigned them to receive oral tadalafil once daily, on demand, or once-daily + on-demand. After 2－3 months of treatment, we evaluated the effects based on the scores of the patients in the five domains of the International Index of Erectile Function (IIEF-5).After medication, all the patients showed significantly increased scores in the four domains of IIEF-5, namely, erectile function, orgasmic function, intercourse satisfaction, and overall satisfaction. The on-demand group achieved even higher scores in erectile and orgasmic functions but a lower score in sexual desire than the once-daily group. However, the patients in the once-daily + on-demand group exhibited more significant improvement than those in the other two in all the five domains.Once-daily + on-demand medication with tadalafil can significantly enhance the therapeutic effect on psychogenic ED in young men with primary sexual failure.目的： 评估他达拉非3种不同给药方案对初次性生活失败的年轻男性勃起功能障碍（ED）患者疗效。方法： 将夜间阴茎勃起硬度检查正常、心理治疗无效的初次性生活失败的年轻男性ED患者分为他达拉非每日小剂量口服组（每日夜间睡前1~2 h口服他达拉非5 mg）、按需治疗组（性生活前1~2 h口服他达拉非10~20 mg，根据勃起硬度调整剂量）、每日小剂量与按需治疗联合组（无性生活时每日夜间口服他达拉非5 mg，性生活当日于性生活前1~2 h一次性服用他达拉非10~20 mg、其剂量根据勃起硬度确定）共3组，分别给予相应治疗2~3个月。以国际勃起功能指数（IIEF）5个专项评分分别评估疗效。结果： 3组IIEF勃起功能、性高潮、插入满意度、总体满意度专项评分较治疗前均显著提高（P均0.05 或0.01）；按需治疗较每日小剂量治疗显著提高勃起功能和性高潮专项评分(P0.05)，但在性欲专项评分方面，其效果低于每日小剂量治疗；当给予联合治疗时，5个专项评分均得到了最佳改善(P均0.05)。结论： 由于缺乏专业的性心理治疗机构和医生，单纯心理治疗对心理性ED患者疗效较差，以每日小剂量口服联合按需服用他达拉非可明显提高初次性生活失败的年轻男性ED患者疗效。.

Background Extramammary Paget disease (EMPD) is a rare malignant dermatosis with poorly defined outcomes. We investigated clinical characteristics of invasive EMPD at different anatomic sites and by subject demographics to determine prognostic factors for overall survival (OS). Methods All patient data were collected from the Surveillance, Epidemiology, and End Results (SEER) program, 1973–2013, of the U.S. National Cancer Institute. Patients with invasive EMPD of skin, vulva/labia, vagina, scrotum/penis, or other sites were included. After excluding patients with unknown radiation status, data of 2001 patients were analyzed. Primary endpoint was EMPD mortality by anatomic sites. Independent variables included patients’ demographic data, concurrent malignancy (ie, non-EMPD related cancers), tumor size, distant metastasis, and surgery and/or radiation or not. Results Multivariate regression analysis showed that mortality was significantly higher in patients with vaginal EMPD than in patients with vulvar/labial EMPD (adjusted hazard ratio [aHR] = 3.26, p

To evaluate the long-term and flexible cystourethroscopy results of holmium laser enucleation of the prostate (HoLEP) and to compare them with those of plasmakinetic resection of the prostate (PKRP).In the long-term follow-up, variables, including the international prostatic symptomatic score, quality of life scores, maximum flow rate (Qmax), and international index of erectile function (IIEF), and the adverse events, including the need for retreatment, were specifically assessed. One hundred twenty-two HoLEP and 119 PKRP of the initial 280 patients included in this study were available, with 10 deceased and 29 lost to follow-up.We found that none of the assessable patients required reoperation for recurrent benign prostatic enlargement (BPE) in the HoLEP group, whereas two required reoperation in the PKRP group. There were no significant differences in most variables between the two groups in the long-term results. But in terms of Qmax, transrectal ultrasound prostate volume, prostate specific antigen (PSA) level, IIEF-5 score, and long-term posttrial follow-up of flexible cystourethroscopy, the HoLEP group showed better results.The long-term follow-up data of this randomized trial confirm that HoLEP and PKRP are both effective and durable surgical interventions for the treatment of lower urinary tract symptoms due to BPE. Given the clinically relevant advantages associated with HoLEP, the alternation of PSA level, sexual function, and urination can be improved.

It is still debatable whether single- or two-stage urethroplasty is a more suitable technique for treating hypospadias with severe chordee after urethral plate transection. This retrospective study evaluated these two techniques. A total of 66 patients of proximal hypospadias with severe chordee were divided into two groups according to the techniques they underwent: 32 and 34 patients underwent single-stage (Duckett) or two-stage urethroplasty, respectively. Median ages at presentation were 7.5 years and 11.0 years in single-stage and two-stage repair groups, respectively. Median follow-ups were 28.5 months (20-60 months) and 35 months (18-60 months) in the single-stage and two-stage groups, respectively. The meatus of the neourethra was located at the top of the glans in all patients. No recurrence of chordee was found during follow-up, and all patients or parents were satisfied with the penile length and appearance. Complications were encountered in eight patients in both groups, with no statistically significant differences between the two techniques. The late complication rate of stricture was higher after the single-stage procedure (18.75% vs 0%). The complication rate after single-stage repairs was significantly lower in the prepubescent subgroup (10.52%) than in the postpubescent cohort (46.15%). These results indicate that the urethral plate transection effectively corrects severe chordee associated with proximal hypospadias during the intermediate follow-up period. Considering the higher rate of stricture after single-stage urethroplasty, two-stage urethroplasty is recommended for proximal hypospadias with severe chordee after urethral plate transection.

Aims: To investigate global proteomic changes induced in CD44+CD24- stem cells isolated from the prostate cancer cell lines, LNCaP and DU145, post prolonged TGF-β treatment in order to understand underlying mechanisms that promote stemness in prostate cancer cells. Methods: CD44+CD133+α2β1Integrin+CD24- population was isolated from mock or TGF-β treated (7 days) prostate cancer cell line, LNCaP, through fluorescent activated cell sorting. Cell lysates were obtained from the ±TGF-β cell population and proteomics profiling (MS/MS) was performed by mass spectrometry. Relative enrichment or depletion in the CD44+CD24-population post-TGF-β treatment was determined relative to mock-treated CD44+CD24- cells post normalization to GAPDH expression levels. Results obtained from MS/MS were validated using immunoblotting. Functional validation of one putative regulator was performed using gain-of-function strategy to investigate its role in rendering stemness in LNCaP and DU145 cells in vitro and in promoting tumorigenicity in vivo. Results: TGF-β treatment caused significant enrichment of CD44+CD24- population in LNCaP cells (22.35 ± 0.94% in mock treated vs 95.23 ± 2.34% in TGF-β treated cells; P < 0.01), which were also positive for CD133 and α2β1Integrin. Mass spectrometry analysis of the enriched cell population revealed that sixty-three proteins were either up- or down-regulated greater than five folds, out of which the poly r(C) binding protein (PCBP)-1 was the most down-regulated (9.31 ± 0.05 folds). Ectopic overexpression of PCBP1 in LNCaP and DU145 cells not only attenuated enrichment of CD44+CD133+CD24- population in these cells following TGF-β treatment, but also significantly decreased tumorigenicity of the stem cell subset, as assessed by in vitro soft agar colony formation and in vivo xenograft assays. Conclusion: Our proteomic profiling and subsequent validation indicate that PCBP1 is central to CSCs enrichment and functionality in prostate cancer.

Objective: Most prostate cancers originate from the prostatic peripheral zone (PZ). We tested the hypothesis that the stromal cells from PZ and transitional zone (TZ) have differential effects on the ability of tumorigenesis. Methods: Stromal cells isolated from the PZ and TZ of normal human prostates mixed with DU145 cells subcutaneously injected into athymic nude mice. The volume and weight of tumors was measured and analyzing the ability of purified DU145 cells isolated from the tumors to migrate and proliferate. The expression patterns of stem cell-specific genes of these DU145 cells were examined. The C-Kit inhibitor, imatinib mesylate, was administrated to confirm the effect of stromal cells on the tumorigenesis. Results: The volume and weight of tumors were significantly higher in mice transplanted with DU145 and stromal cells from PZ. In contrast, the data was significantly lower with DU145 and stromal cells from TZ than DU145 alone. The purified DU145 cells isolated from the tumors with DU145 and stromal cells in PZ had increased ability to migrate and proliferate, and had increased expression of C-Kit. These effects of the stromal cells in the PZ on DU145 cells could be blocked using imatinib mesylate. Conclusions: Human stromal cells in the PZ promote the in vivo tumorigenesis of DU145 through up-regulating C-Kit; in contrast, the stromal cells in the TZ inhibit it through down-regulating the expression of C-Kit. The model will be useful for understanding the mechanisms by which the prostatic stem cell niche controls the tumorigeneis of prostatic cancer stem cells.

To develop a standardized scoring system, the BPH surgical scoring (BPHSS) system, to quantify the ability to predict the perioperative outcomes resulting from an enlarged prostate. There are two parts included in this study: the retrospective observational study (875 patients treated with holmium laser enucleation of the prostate, HoLEP) and the prospective observational study (111 patient underwent HoLEP). All the outcome data included the following: the basic patient preoperative characteristics, operation time (OT), pre- and post- surgery hemoglobin decrease, Na+ variation, hospital stay duration, duration of bladder irrigation, catheterization time, and hospitalization time. The BPHSS, consisting of prostatic volume (PV), prostate-specific antigen (PSA), bladder stones, intravesical prostatic protrusion (IPP), and metabolic syndrome (MetS), was observed regarding the perioperative outcomes. In the retrospective study, patients in high BPHSS group (6–8 points) showed significant increase in the OT (74.61, 95%CI = 16.98–327.84, P

The incidence of benign prostatic hyperplasia (BPH) is increasing among obese individuals, but few studies have fully explained the underlying mechanisms. We aimed to elucidate the relationship between obesity and BPH. Herein, we show that in prostatic epithelial and stromal cells, adiponectin exerts multifunctional effects including anti-proliferation, blocking of G1/S-phase progression and the promotion of apoptosis via inhibiting the MEK-ERK-p90RSK axis. Furthermore, we found that a high-fat diet (HFD) led to adiponectin deficiency and microscopic BPH in a mouse model of obesity. And an adiponectin supplement protected the obese mice from microscopic BPH. The present study provides evidence that adiponectin is a protective regulator in the development and progression of BPH and that adiponectin deficiency causally links BPH with obesity.

Micro (mi)RNAs are a group of small non-coding RNA molecules that have been demonstrated to regulate the expression of genes involved in tumorigenesis. The relevance of microRNAs in the development, progression and prognosis of prostate cancer is not fully understood. miR-155 has been implicated in the induction of breast, lung and liver cancer, but its role in prostate cancer has not been investigated. In the present study, the biological function of miR-155 was investigated in prostate cancer for the first time, to the best of our knowledge. It was demonstrated that the expression of miR-155 was upregulated in prostate cancer tissues and cell lines as determined by quantitative reverse transcription-polymerase chain reaction. Furthermore, overexpression of miR-155 promoted cell proliferation, as indicated by MTT assay. Flow cytometric analysis demonstrated that inhibition of miR-155 induced cell cycle arrest and promoted apoptosis in prostate cancer cells. In addition, western blot analysis indicated that annexin (ANX)7 was significantly downregulated in prostate cancer tissues and cells. A luciferase reporter assay indicated that ANX7 was a target of miR-155, which suggested that miRNA-155 promoted the proliferation of prostate cancer cells by regulating ANX7 expression levels.

To report the surgical management, complications and prognosis of patients with penoscrotal extramammary Paget's disease (EMPD) at different clinical stages. Between 2003 and 2008, a total of 30 male patients with penoscrotal EMPD were enrolled and evaluated. All enrolled subjects received frozen biopsy-guided local wide resection and immediate reconstruction. Patients were followed every 3 months postoperatively. Among the 30 patients who accepted and underwent frozen biopsy-guided local wide resection treatment and reconstruction, two (6.7%) cases exhibited positive margins, verified by pathological examination, and underwent re-excision after surgery. The technique of primary closure or an adjacent flap was used in 10 (33.3%) cases, split-thickness skin grafts were used in 15 (50%), and an anterolateral thigh perforator flap was used in five cases (16.7%). The postoperative complications were acceptable. The mean follow-up time was 64.9 ± 29.6 months. Of all 30 cases, 22 patients (73.3%) survived with no evidence of recurrence, four patients (13.3%) exhibited local recurrence, two patients (6.7%) exhibited both local recurrence and distant metastasis and the remaining two patients (6.7%) exhibited distant metastasis. Five patients died from metastasis or cachexia. Current surgical techniques, including primary closure, adjacent flaps, split-thickness skin flaps and anterolateral thigh perforator flaps are able to reconstruct all types of defects with acceptable complications. Some patients with negative margins went on to exhibit local recurrence, potentially due to adnexal carcinoma or internal malignancy.

We compared plasmakinetic resection with holmium laser enucleation of the prostate for the treatment of benign prostatic hyperplasia by analyzing 2-year followup data from a prospective randomized clinical trial.A total of 280 patients were randomly treated with plasmakinetic resection or holmium laser enucleation of the prostate. Perioperative and postoperative outcome data were obtained during a 2-year followup.No significant differences between the 2 surgical groups were observed in the preoperative data. Both groups displayed significant improvements after surgery. However, we identified no significant differences between the 2 groups in the 2-year followup data for I-PSS (International Prostate Symptom Score), quality of life scores or maximum flow rate values. Patients in the holmium laser enucleation group displayed a lower risk of hemorrhage, shorter bladder irrigation and catheter times, and shorter hospital stays. A larger amount of prostate tissue was retrieved in the holmium laser enucleation group, but the operation time was longer for this group than for the plasmakinetic resection group.Plasmakinetic resection and holmium laser enucleation of the prostate are effective and safe treatments for benign prostatic hyperplasia. Holmium laser enucleation of the prostate can be applied to prostates of all sizes, and involves less risk of hemorrhage, decreased bladder irrigation and catheter times, as well as reduced hospital stay. Thus, we believe holmium laser enucleation of the prostate should be proposed as a potential new gold standard surgical therapy instead of transurethral resection of the prostate for patients with benign prostatic hyperplasia.

Purpose. We evaluated the effect of sulforaphane (SFN) treatment on the function and changes of expression of Nrf2-ARE pathway in the bladder of rats with bladder outlet obstruction (BOO).Materials and Methods. A total of 18 male Sprague-Dawley rats at age of 8 weeks were divided into 3 groups (6 of each): the sham operated group, the BOO group, and the BOO+SFN group. We examined histological alterations and the changes of oxidative stress markers and the protein expression of the Nrf2-ARE pathway.Results. We found that SFN treatment could prolong micturition interval and increase bladder capacity and bladder compliance. However, the peak voiding pressure was lower than BOO group. SFN treatment can ameliorate the increase of collagen fibers induced by obstruction. SFN treatment also increased the activity of SOD, GSH-Px, and CAT compared to the other groups. The level of bladder cell apoptosis was decreased in BOO rats with SFN treatment. Moreover, SFN could reduce the ratio of Bax/Bcl-2 expression. Furthermore, SFN could activate the Nrf2 expression with elevation of its target antioxidant proteins.Conclusions. The sulforaphane-mediated decrease of oxidative stress and activation of the Nrf2-ARE pathway may ameliorate bladder dysfunction caused by bladder outlet obstruction.

OBJECTIVES To report a retrospective series of 130 Chinese patients with penoscrotal extramammary Paget's diseases (EMPD), with a long-term follow-up, and thus improve the diagnosis and therapy of this disease. PATIENTS AND METHODS The history, clinical presentation, pathology, treatment, and prognosis of 130 patients were analysed. All cases were confirmed by skin biopsy, and then the patients had local wide resection to remove the involved skin and subcutaneous tissue. The large defective wound was reconstructed using a split-thickness skin graft or local flap. RESULTS Forty-five patients were evaluated by frozen-section biopsy of the margins during surgery, five of whom had positive margins and then had an extended resection immediately. Most of these patients had local skin or adjacent scrotal flaps to cover their skin defects. Of the 130 patients, 81 had a mean (range) follow-up of 3.2 (0.5-10) years after surgery. Five of nine patients with positive margins and three (4%) of 72 with negative margins had tumour recurrence. Five patients died from metastatic disease. CONCLUSIONS Penoscrotal EMPD needs be differentiated from other chronic dermatitis. A 3 cm surgical margin should be sufficient and frozen-section pathological examinations are necessary for some complicated conditions. Skin grafts or local flaps are good for large skin defects.

To evaluate the safety and effectiveness of a modified method of holmium laser enucleation of the prostate (HoLEP)--6-o'clock tunnel HoLEP for the treatment of benign prostate hyperplasia (BPH).We included 112 cases of BPH in this study, 57 treated by 6-o'clock tunnel HoLEP (experimental group) and the other 55 by conventional HoLEP (control group). We compared the operation time, volume of the resected prostatic tissue, intraoperative blood transfusion, volume of bladder irrigation solution, postoperative hemoglobin change, and incidence of urinary incontinence between the two groups.Statistically significant differences were observed between the experimental and control groups in the operation time ([56.01 ± 8.62] min vs [68.65 ± 9.08] min), cases of intraoperative blood transfusion (0 vs 2), volume of bladder irrigation solution ([27.51 ± 3.67] L vs [36.89 ± 6.47] L), postoperative hemoglobin decrease ([10.70 ± 2.50] g/L vs [12.60 ± 3.30] g/L), and cases of postoperative stress-induced urinary incontinence (2 vs 7) (all P0.05). One-month follow-up revealed smooth urination in both groups of patients but no true urinary incontinence or secondary bleeding in either.Modified 6-o'clock tunnel HoLEP can significantly reduce the operation time, bladder irrigation, and intraoperative bleeding, and therefore can be used as a safe and effective option for the treatment of BPH.

To evaluate the safety and effect of L-carnitine combined with tadalafil in the treatment of late-onset hypogonadism (LOH) with erectile dysfunction (ED).We randomly divided 140 cases of LOH with ED aged 40 -70 years into a treatment and a control group to receive L-carnitine + tadalafil and testosterone undecanoate + tadalafil, respectively. After 8 weeks of treatment, we obtained the scores on IIEF-5 and Aging Male Symptoms (AMS), observed changes in the levels of sex hormones, analyzed the results of the routine blood test and PSA level, and evaluated the safety of medication.Finally, 110 cases were included, 60 in the treatment group and 50 in the control. After 8 weeks of medication, the IIEF-5 and AMS scores were significantly improved as compared with the baseline both in the treatment group (17.7 +/- 3.5 vs 10.2 +/- 2.7 and 36.2 +/- 6.5 vs 48.8 +/- 5.8) and in the control group (16.7 +/- 2.6 vs 9.3 +/- 2.4 and 35.8 +/- 6.6 vs 50.7 +/- 5.0) (both P0.05), with no significant differences between the two groups (P0.05). As for the safety of medication, there were no significant differences between the two groups before and after treatment (P0.05). Two patients in the control group showed a PSA level4 microg/L, which was confirmed to be caused by prostatitis during follow-up.L-carnitine combined with tadalafil is safe and effective for the treatment of LOH with ED.

We modified the conventional morcellation procedure for holmium laser enucleation of the prostate (HoLEP), and its outcomes are presented in this article.As 395 patients were included, the conventional morcellation procedure was performed in the first 100 cases (group 1, cases 1-100), and an improved procedure was used in the last 100 cases (group 2, cases 296-395). The improved morcellation process has three steps to execute. The morcellation time, collected tissue weight, morcellation rate, and associated complications were recorded.The tissue-resected weight was similar between group 1 (60.7±33.9 g) and group 2 (62.4±36.8 g). The mean morcellation time in group 1 was greater than that in group 2 (11.3±7.1 and 8.3±4.1 minutes, respectively), and the mean morcellation rate was better in group 2 than in group 1 (5.75±1.7 g/minutes in group 1 v 7.3±1.1 g/minutes in group 2). Complications, such as bladder injury, were similar in both groups.The improved morcellation procedure described in this article can be used in various situations of suction and can be performed in a more fluent manner and with better efficiency.

Rationale Gastrointestinal stromal tumor (GIST) is the neoplasm of gastrointestinal tract. Patient concerns The patient complained about the retention of urinary. Diagnoses GIST. Interventions radical prostatectomy and the imatinib therapy. Outcomes No recurrence and metastasis have been found during a 14-month follow-up. Lessons comprehensive treatment is necessary for the GIST treatment. Furthermore, we summarize a review of the literature of GIST occurring in the prostate gland treated by different methods and 4 kinds of rare diseases in prostate.

There have been many advances in the surgical treatment for benign prostate hyperplasia (BPH), moving from open surgery (retropubic and suprapubic open prostatectomy) to transurethral resection of the prostate (TURP, the historical gold standard and still the most commonly used approach), and onto endoscopic transurethral enucleation. The application of new laser and plasma technologies now allows the precise transurethral enucleation of the prostate (PTUEP). In our medical center, we have found great success using PTUEP. Many urologists have found that PTUEP reduces perioperative complications and risks during operation. It can be applied to all size prostates and can even be used with BPH patients taking anticoagulation medicine. PTUEP is quickly replacing TURP as an effective and less invasive approach to BPH surgery.

Ischemic priapism is a rare occurrence which can cause severe erectile dysfunction (ED) without timely treatment. This retrospective study reports our experience in treating prolonged ischemic priapism and proposes our further considerations. In this paper, a total of nine patients with prolonged ischemic priapism underwent one to three types of surgical shunts, including nine Winter shunts, two Al-Ghorab shunts and one Grayhack shunt. During the follow-up visit (after a mean of 21.11 months), all patients' postoperative characters were recorded, except one patient lost for death. Six postoperative patients accepted a 25-mg oral administration of sildenafil citrate. The erectile function of the patients was evaluated by their postoperative 5-item version of International Index of Erectile Function Questionnaire (IIEF-5), which were later compared with their premorbid scores. All patients had complete resolutions, and none relapsed. The resolution rate was 100%. Seven patients were resolved with Winter shunts, one with an Al-Ghorab shunt and one with a Grayhack shunt. The mean hospital stay was 8.22 days. There was only one urethral fistula, and the incidence of postoperative ED was 66.67%. Four patients with more than a 72-h duration of priapism had no response to the long-term phosphodiesterase type 5 (PDE-5) inhibitor treatment. These results suggest that surgical shunts are an efficient approach to make the penis flaccid after prolonged priapism. However, the severe ED caused by prolonged duration is irreversible, and long-term PDE-5 inhibitor treatments are ineffective. Thus, we recommend early penile prosthesis surgeries for these patients.

To investigate the effect and safety of the implantation of a new type of testicular prosthesis in the treatment of testis loss.We recruited for this study 18 patients with testis loss treated by testicular prosthesis implantation, including 10 cases of prostate cancer, 3 cases of anorchia, 2 case of orchiatrophy, 2 cases of hermaphroditism and 1 case of cryptorchidism. The prosthesis was a hollow silicone elastomer YH-G1 made in China, selected according to the volume of the scrotum and the size of the contralateral testis.Thirteen of the patients received testicular prosthesis implantation with orchiectomy, and the other 5 underwent the procedure 6 months later. The operation time of testicular prosthesis implantation was (22.6 +/- 4.6) min, ranging from 15 to 30 minutes. All the patients were discharged after 12 hours of postoperative observation, with a mean hospital stay of (1.3 +/- 0.4) days. A follow-up after 6 months revealed no complications in 17 cases. Rejection occurred in 1 case at 3 months after the implantation, ending in the removal of the prosthesis. Of the 17 successful cases, 15 were very satisfied with the size of the prosthesis, 14 with its weight, 12 with its comfortableness, and all with the appearance of the scrotum and the position of the prosthesis, while 5 found the implant too rigid.The implantation of the new home-made silicone elastomer testicular prosthesis YH-G1 was safe and effective for the treatment of testis loss, and could meet the esthetic and psychological requirements of the patient. But further observation is needed for its long-term complications and influence on the patient's quality of life.

To investigate the outcome between the primary and secondary hypospadias with severe chordee in older patients by the transverse preputial island flap (TPIF). We retrospectively analyzed 53 hypospadias patients who were performed with TPIF for urethroplasty, including 25 primary hypospadias (Group 1) and 28 secondary hypospadias (Group 2). The mean age in Group 1 was 12.12 ± 10.709 and 18.64 ± 8.727 in Group 2 (P = 0.0181). The mean follow-up time was 38.7 months (22–60 months). All of the foreskin flaps survived after the operation without necrosis. The overall complication rate was 24 % in Group 1 and 53.57 % in Group 2 (P = 0.0280). All the patients were also divided into two cohorts according to their ages in surgery. In the 0–10-yr cohort, there was a significant difference in the overall complication rate between the primary and secondary groups (P = 0.0173). But in the cases who were over 11 year old, there was no significant difference in the overall complications between two groups (P = 0.1603). Also no significant difference was found in the mean length of the urethral defect between two groups (P = 0.8312). The Duckett technique is an optional choice for some older Chinese patients undergoing primary operations, but it has a higher complication rate in those who have undergone previous failed urethroplasties. The unsatisfactory results found in the reoperative group were supposed to be linked to the older age, the lack of subcutaneous flap coverage and local scar tissue, but not to the length of the urethral defect.

A new type of testicular prosthesis made of silastic with an elliptical shape to mimic a normal testis was developed by our team and submitted for patenting in China. The prosthesis was produced in different sizes to imitate the normal testis of the patient. To investigate the effects and safety of the testicular prosthesis, 20 patients receiving testicular prosthesis implantation were recruited for this study. Follow-up after 6 months revealed no complications in the patients. All the patients answered that they were satisfied with their body image and the position of the implants, 19 patients were satisfied with the size and 16 patients were satisfied with the weight. These results show that the testicular prosthesis used in this study can meet patient's expectations. Patients undergoing orchiectomy should be offered the option to receive a testicular prosthesis implantation. The dimensions and weight of the available prosthetic implants should be further addressed to improve patient satisfaction.

To investigate the impact of penile surgery on the erectile function of the patient and to evaluate the role of small-dose vardenafil in restoring the impaired penile erection.Sixty cases of penile cavernosum surgery were equally and randomly divided into a vardenafil and a control group, the former treated 5 - 7 days after surgery with 10 mg vardenafil every other day, while the latter given vitamin E at 100 mg once a day, both for 12 weeks. The penile erectile function of the patients was evaluated with the IIEF-5 questionnaire before surgery and at 3 and 6 months after vardenafil medication.The mean IIEF-5 scores of the vardenafil group were 18.83 +/- 2.98 and 20.13 +/- 2.98 at 3 and 6 months after vardenafil medication, significantly higher than 14.21 +/- 3.62 before surgery (P0.05), while that of the control group was significantly decreased at 3 months as compared with the preoperative score (13.38 +/- 2.82 versus 15.80 +/- 3.02, P0.05). The vardenafil group showed the highest IIEF-5 score after surgery (P0.05).Long-term administration of small-dose vardenafil after penile surgery helps to restore and maintain penile erectile function.

To present the experience in using the Snodgrass technique, Duckett repair and bladder mucosa grafting for hypospadias.We retrospectively reviewed 251 cases of middle and posterior hypospadias treated by the Snodgrass technique, Duckett repair and bladder mucosa grafting from February 1997 to December 2008.The success rates of the Snodgrass technique, Duckett repair and bladder mucosa grafting were 80.3% (53/66) , 76% (19/25) and 78.9% (15/19) for middle hypospadias and 68. 3% (41/60) , 63.6% (14/22) and 88. 1% (52/59) for the posterior type without statistical significant differences (all P0.05). Bladder mucosa grafting showed a significantly higher success rate than the other two procedures in either one-stage or two-stage surgical repair of posterior hypospadias (P0.05). Duckett repair achieved a significantly higher rate of success in children under 14 years than in the older ones (P0.05).Of the three surgical options, bladder mucosa grafting is the most suitable for posterior hypospadias, and Duckett repair is recommended for children under 14 years of age.

To investigate the effects of surgery treatment on serious penile lesions and malformation.Sixty-two patients, aged from 19 to 63 years old (mean 35 ys), were included in the study. Among them, 4 patients suffered from penis partial defection were respectively treated with restoring defective penis, penis lengthening and urethroplasty; three patients with penis completely missing were treated with penis reconstruction surgery; 22 cases with serious penile curvature were treated with the 16-dot plication technique (Lue's procedure); 15 cases with penile fracture were treated with conservative treatment for 1 case and with patch penis, corpus spongiosum, and deep penile dorsal vein ligation for 14 cases; 5 cases with post-operative complications of 3-pieces of penile prosthesis, including the prosthesis perforating to the urethra, water pump failure, broken connection tube, erection angle60 degrees and failure to expansion the corpus cavernosum, were treated by taking out prostheses, urethral repair cracks, replacement of the prostheses, excision of fibrosis scar and re-implantation prostheses respectively. Four cases with penis complete amputation were treated with the penis replantation; three cases of avulsion injury were treated with the replantation and free flap skin; 6 with Paget's disease of penises were treated with the lesion free skin buried in the scrotum and penis.All these patients were followed up for 3 months to 4 years, with the average of 9 months. Among the 4 cases of penis partial defection, 2 patients were satisfied with the penile appearance and sexual function; 1 got some satisfactory and 1 was unsatisfied. Three cases with the loss of the penis completely were satisfied with both the postoperative appearance and urination, and 1 was not satisfied. Twenty-two cases of penile curvature deformities were corrected, and one case was recurrence. Fourteen of the 15 patients with penile fracture were followed, and all got the restoration of sexual function. Among them, 5 cases with post-operative complications, including mild bending, algopareunia, subcutaneous induration, poor hardness and poor sexual pleasure, were not further treated, and another case lost; Five cases with post-operative complications of three-pieces penile prosthesis were treated successfully, and 4 of their spouses were satisfied with their sexual function after operation, only 1 of their spouse not satisfied. Among four cases with complete amputation of penis, two cases of penis were replanted successfully while two necrosis. Three cases with avulsion were treated with skin grafting successfully. All 6 cases with penile Paget's disease were followed for 2 -4 years, and free skin grafts were all survival. One patient died of brain metastases 18 months after operation and five cases were disease-free survival.The patients should be treated based on the procedure of andrological and urological surgery, together with microsurgical, flap or skin graft technique. The urologist should design personalized surgical procedure. Most of the patient's penis shape and erectile dysfunction can be reconstructed by our procedures, but some patients can not achieve the desired appearance or function of penis. New approaches of the treatment ought to be developed to restore both of the shape and function for those severe injury of the penis.

To provide evidence of using the human foreskin acellular matrix graft for urethral tissue engineering. METH-ODS: The human foreskin acellular matrix graft was prepared, its safety and biocompatibility as urethral material were determined by histological observation, cytotoxicity test using primary epithelial cells and experiment in vivo.Intact cells were absent from the foreskin acellular matrix graft. The cytotoxicity test showed that the relative growth rate of the cells was between 75% and 99%, and the cytotoxicity of the foreskin acellular matrix graft was grade 1, consistent with the national standard. With the lengthening of time, the foreskin acellular matrix graft became perfectly compatible with the urothelial cells and the urethral multi-layer structure was restored to normal gradually.The human foreskin acellular matrix graft, with its low antigenicity and good biocompatibility, could be a good scaffold for urethral tissue engineering.

To study the clinical effect of Duckett's procedure of one-stage urethroplasty with the transverse preputial island flap in the treatment of hypospadias.We retrospectively studied 20 cases of hypospadias treated by Duckett's procedure of one-stage urethroplasty with the transverse preputial island flap (Group A) from 2003 to 2007. The patients ranged in age from 2 to 22 years (mean 11.3 years). Another 30 hypospadias patients aged 7 to 34 (mean 16.1) years underwent urethroplasty with mucous membrane of the bladder (Group B) in the same period. Of the 50 cases, 13 were the penile type, 33 the penoscrotal type, 2 the scrotal type, and 2 the perineal type. Catheters were indwelled in Group A, but both cystostomy and catheter indwelling were used in Group B.For Duckett's procedure, surgery succeeded in 17 cases (85%), urethra stenosis developed in 1 (5%) and urinary fistula in 2 (10%), which were successfully repaired 6 months after the operation. The mean operation frequency was 1.1 per patient. In Group B, the operation was accomplished in 2 stages and succeeded in 26 cases (86.7%), with postoperative development of urinary fistula in 3 (10%) and urethra stenosis in 1 (3.3%). The mean operation frequency was 2.1 per patient. The 2 cases of postoperative urethra stenosis were both cured by urethral sounding.Duckett's procedure of one-stage urethroplasty with the transverse preputial island flap is effective in hypospadias repair, with a success rate close to that of other types of operations and a low rate of postoperative complications. Compared with the use of mucous membrane of the bladder, it has the advantages of one-move accomplishment and gives a better penile appearance.

To recommend the successive "Z" incision and skin flaps as a method for repairing the wound in penile lengthening procedures.We performed penile lengthening surgery by successive "Z" incision for 5 patients complaining of short penis, who ranged in age from 16 to 34 years (22.4 +/- 7.2), and 3 of whom had a history of urethroplasty, circumcision and penile reconstruction, respectively. The superficial suspensory ligament and part of the deep suspensory ligament of the penis were exposed and severed to release the penis, and the "Z" skin flaps sutured in a tensionless state. Drainage was necessitated by exudation and the catheter removed in 24-48 hours. The penis was wrapped up by an elastic bandage, and the stitches taken out 8-10 days after the operation.We achieved a mean erectile length of 8.4 cm (range 7.8-9.2 cm) after the operation, as compared with 4. 8 cm (range 4.0-5.8 cm) before the surgery. Two students of the patients obviously became active and confident. No penile contraction was noted during the 12-48 months follow-up, and both the patients and their family members were satisfied with the outcomes.Compared with the V-, M- and Z-incision, the successive "Z" incision and skin flaps can yield longer penile length, solve the problem of insufficient skin flap to cover the wound and reduce such complications as skin necrosis and infection. It is well worth recommending for patients complaining of short penis because of penile abnormality, post-operation scar on the penis or circumcision.

To investigate the correlation of age and sex hormones to the total volume (TV) and transition zone volumeEighty-two men were divided into two groups with the age of 60 as the dividing line. Prostatic TV (TZV and TZV were measured with transrectal ultrasound (TRUS) and the concentrations of total testosterone (T), free testosterone (fT) and estradiol (E2) were measured with radioimmunoassay. Exponential curve regression and one-factor analysis of variance (ANOVA) were used for statistical analysis.Age was significantly correlated with TV, TZV and the TZV/TV ratio, P0.01. There was a significant positive correlation between the concentrations of fT and TZV, a negative correlation between those of E2 and TZV (P0.01), but no correlation between those of T and TZV (P0.05).The significant acceleration of the TZV of the prostate after the age of 60 is related to sex hormones.