Objective To discuss the need for performing intravenous urography(IVU) in patients with non-muscle invasive bladder cancer before surgery. Methods From 1997 to 2008,1968patients were diagnosed as non-muscle invasive carcinoma of the bladder with pathological confirmation. All patients underwent ultrasonography, cystoscopy and IVU prior to surgrey. The x2 test was used for statistical analysis. Results The incidence of upper urinary tract urothelial tumors (UUTUT) was 11. 0% (216 cases). Two hundred and fifteen (13. 6%) suffered simultaneous UUTUT detected by IVU in 1528 patients with bladder cancer who had intermittent painless gross hematuria, while only 1 (0.3 %) suffered simultaneous UUTUT in 386 non-symptomatic patients (P＜0.01). Among 120 patients with bladder cancer whose upper tract was abnormal detected by ultrasonography,120 (100. 0%) suffered simultaneous UUTUT detected by IVU, and of 1848 patients who were normal in upper tract by ultrasonography, 96 (5. 2%) suffered simultaneous UUTUT detected by IVU (P＜0. 01). Of the patients with no abnormalities in upper tract by ultrasound, 37(3. 0%) suffered simultaneous UUTUT detcted by 1VU in 1247 patients with single bladder tumor,and 59 (9.8%) suffered simultaneous UUTUT in 601 patients with multiple bladder tumors (P＜0.01). Of the patients with single bladder tumor who had no abnormalities in upper tract by ultrasonography, 2 (0.2%) suffered simultaneous UUTUT detected by IVU in 822 patients with the diameter of the tumor＜1.0 cm, and 35 (8. 2 %) suffered simultaneous UUTUT in 425 patients with the diameter≥1. 0 cm (P＜0.01). Of the 1541 patients with histological G1, 48 (3.1%) suffered simultaneous UUTUT detected by IVU, and of the 427 patients with histological G2- G3, 168 (39. 3%)suffered simultaneous UUTUT (P ＜ 0. 01 ). Conclusion Patients with the following characters should undergo IVU before surgery: hematuria, abnormal upper urinary tract by ultrasonography,multifocal tumours, the diameter of the single bladder tumor≥1. 0 cm and high gradc tumors.

Objective To study the diagnosis and surgical outcomes of renal cell carcinoma with inferior vena cava tumor thrombus.Methods The clinical data from 31 cases of renal cell carcinoma with inferior vena cava tumor thrombus were retrospectively reviewed from January 2000 to December 2014.Among them,21 cases were male and 10 cases were female.The mean age ranged from 38 to 79 years,mean 57 years.The location of tumor included right renal in 29 cases and left renal in 2 cases.The distribution of the tumor thrombus was recorded as follow:level Ⅰ in 20 cases,level Ⅱ in 8 cases and level Ⅲ in 3 cases.All patients received radical nephrectomy and tumor thrombectomy.Ipsilateral subcostal oblique incision was chosen in 20 cases.Transrectus incision was chosen in 10 cases.And abdominal transperitoneal L shaped incision was chosen in 1 case.Three patients were given neoadjuvant molecular targeted therapies before operation.Results All patients accepted the operation successfully.There was no death during perioperative period.The pathological diagnosis showed clear cell carcinoma in 30 cases and chromophobe cell tumor in 1 case.The Fuhrman grading showed that 17 cases were grade Ⅱ,8 cases were grade Ⅲ and 5 cases were grade Ⅳ.Among them,the lymphatic metastasis in the renal hilum was found in 5 cases.After operation,16 patients received molecular targeted therapies,including sorafenib in 10 cases and sunitinib in 6 cases.Six patients were given autologous tumor lysate-pulsed dendritic cells co-cultured with cytokine induced killer cells treatment.The median overall survival was 44 months (range 4-60 months).The 1-,3-,and 5-year overall survival rates for all patients were 100％,52％,and 39％,respectively.There were significant differences of the overall survival rates between level Ⅰ / Ⅱ and level Ⅲ tumor thrombi(81.5％ vs 0) (P =0.012).Similar difference was noticed between Fuhrman grade Ⅱ and grade Ⅲ/Ⅳ (94.1％ vs 46.2％)(P =0.003).There was also significant difference between those with or without lymph node metastases (40.0％ vs 80.8 ％) (P =0.0 1 6).Conclusions Radical nephrectomy and tumor thrombectomy could improve the survival of patients of renal cell carcinoma with inferior vena cava tumor thrombus.The overall survival rate might be related to the tumor thrombus level,tumor grade,and local lymph node metastasis.

ObjectiveTo investigate the cause, treatment and prevention of splenic injury in radical nephrectomy for left renal cell carcinoma.MethodsThe clinical data of 27 cases of splenic injury in 458 cases of radical nephrectomy for renal cell carcinoma were retrospectively analyzed.ResultsThe injured spleen was saved in 21 cases (18 gradeⅠ injury,3 grade Ⅱ).The injured spleen was sewed up and pressed with hemostatic ganze in 7,pressed with medical sponge laid with spurting argon on biological glue in 11 and the same was carried out in 3 grade Ⅱ injury.Spleenectomy was conducted in the other 6 cases (4 grade Ⅱ injury,2 grade Ⅲ).The patients have been followed up for 6 months to 5 years.The outcome has been good in all except 1 patient died of tumor recurrence 1 month after operation.No late bleeding or adverse side effects has been noted.Conclusionssplenic injury may occur in radical nephrectomy for renal cell carcinoma especially the tumor is lasge or adhered to spleen in the upper past of left kidney.The occurrence of splenic injury is also related to the tumor stage.Attention should be called to the mentioned surgical complication.

ObjectiveTo study the expression of three protein kinase C subforms in renal cell carcinoma.MethodsThe expression of cPKC?,cPKC? Ⅱ and aPKC? in renal cell carcinoma were detected by immunohistochemical method(S-P method) and by in situ hybridization.ResultsPositive rate of cPKC? ?cPKC? Ⅱ and aPKC? was 68.4%,34.2% and 44.7% respectively in renal cell carcinoma.Positive rate of cPKC? in stage T 2～T 4 tumors was 80.9%(17/21) and 52.9%(9/17) in T 1(P 0.05).The positive expression of cPKC? in deadly cases was significantly higher than in survivers (P

Objective To study the diagnosis and management of extra-adrenal pheochromocytoma. Methods Eighteen patients with extra-adrenal pheochromocytoma were analyzed retrospectively.Among the 18 patients 13(72%) were men.The mean age at diagnosis was 30 years,with a range from 15 to 65 years.All the patients presented with hypertension.Other typical symptoms included headache and dizziness(67%),palpitation and sweating(44%),blurred vision (33%) and hematuria (28%).Of all the patients 89% were diagnosed with urine CA and VMA.Most of the tumors were located at the bladder (39%),para-aorta (28%) and renal hilus(22%). Results All the patients were treated with surgical operation including 14 total resection of tumor,1 simple resection of tumor and 3 biopsy.Two of the 18 cases were malignant according to the post-operative pathologic diagnosis.Five patients recurred 3 months to 10 years after operation. Conclusions The determination of CA and VMA in urine is valuable for the diagnosis and monitoring of postoperative recurrence.Ultrasonography and CT scanning are effective means for tumor localization.The perioperative management of controlling blood pressure and expansion of the blood volume are very important.Surgical extirpation is a good method for the effective treatment.Postoperative long-term follow up is necessary.

Objective To present the clinical and pathological features of carcinosarcoma of ureter and renal pelvis. Methods Three cases of carcinosarcoma of ureter and renal pelvis were reviewed. Results The clinical symptoms of carcinosarcomas of ureter and renal pelvis are hematuria and flank pain.The neoplasm consists of an admixture of malignant epithelial and mesenchymal elements on histological studies.The immunohistochemical studies demonstrated obvious epithelial and mesenchymal reactivity.Three patients died of the disease 8 months,14 months and 2.5 months after operation. Conclusions Carcinosarcoma of ureter and renal pelvis is a rare occurrence and is usually associated with a poor prognosis.It is sometimes difficult to make certain the diagnosis and the immunohistochemical studies are essential in pathological examinations.This lesion should be differentiated from sarcomatoid carcinoma.

Objective To understand the pathogenesis and the clinical features of the bladder soft calculi. Methods A case of bladder soft calculi with emphysematous cystitis was reported.The patient,who had underwent partial cystectomy for bladder cancer,was 53 years old with diabetes and prostate hyperplasia. E.coli was found in his urine.KUB showed negative result.B-us and cystoscopy showed bladder mass.Some of other cases were also reviewed. Results The patient underwent surgical operation,and during the procedure a multilamellar yellow/brown internal structure of the calculi was observed.It presented as something like cellulose in the pathological study.The patient received antibiotic therapy after operation for two weeks,and recovered very well. Conclusions The formation of soft calculi is typically associated with urinary infection caused by proteus species.Diabetes mellitus is believed to be the most important predisposing factor for the formation of soft calculi.In most cases, surgical manipulation is required for their removal because they are not dissolved by any means yet known, and the antibiotic therapy is necessary too.

Objective To evaluate the expression of multidrug resistance-related markers in renal pelvic and ureteral carcinoma. Methods The immunohistochemical expression of P-glycoprotein (P-gp), multidrug resistance-associated protein (MRP), lung-resistance protein (LRP) and glutathione S-transferase Pi (GST-?) were examined in 51 patients with renal pelvic or ureteral carcinoma.The correlation between the expression and some clinicopathological parameters was analyzed. Results The positive expression rate of P-gp、MRP、LRP and GST-? in renal pelvic or ureteral carcinoma was 35.3%(18/51),39.2%(20/51),58.8%(30/51) and 43.1%(22/51) respectively.The rate of P-gp positive staining was increased with the advance of tumor grade (P

Objective To study the diagnosis and treatment of some incidental tumors of the adrenal gland. Methods Incidental primary aldosteronism and incidental Cushing's syndrome were reviewed and studied. Results 9 cases of incidental primary aldosteronism have been detected,5 of which demonstrated serum potassium level near the lower limit of normal range and in other 3 lower than normal.In 4 of the cases the plasma aldosterone was higher than normal and the plasma renin level was near the lower limit of normal range.Antisterone test was effective in 3.11 incidental Cushing's syndrome were detected.Serum cortisone was higher in 3 at 8 Am and in 4 at 4 Pm.In 6 cases,ACTH was slightly lower than normal or close to the lower limit of the normal range.High dose dexamethasone suppression test was undertaken in 3 with positive result in 2.Hormone supplement has been required after adrenalectomy in 4. Conclusions Primary aldosteronism and Cushing's syndrome may be incidentally detected on clinical manifestations,laboratoty findings and imaging examination.Adrenalectomy is indicated if there is autonomous hormone secretion or the tumor is larger than 2 cm in diameter or with trend of increasing in size.

Objective To evaluate the correlation betwe en operative procedures for pelviureteral carcinoma and the occurrence of postop ertive occurrence of bladder carcinoma. Methods 94 cases of pelviureteral carcinoma with postopertive occurrence of bladder carcinoma we re retrospectively studied. Results With nephrouretectom y without cuff resection of the bladder,the postoperative occurrence of bladder carcinoma was 54.5%(6/11),being obviously higher than nephroureterectomy with pa rtial bladder resection (23.5%,12/51) or nephroureterectomy with bladder mucosal cuff resection (33.3%,3/9,P0.05).The lap between the primary ope ration and the occurrence of bladder carcinoma was usually short and the occurre nce was mostly on the same affected side.In pelviureteral carcinoma with multior gan involvement,the postopertive occurrence of bladder carcinoma was as high as 72.2%(13/15) in spite of nephroureterectomy with partial resection of the bladde r . Conclusions Cuff resection of the bladder on the same side is the key point to prevent postoperative occurrence of bladder carcinoma.T he improved bladder mucosa cuff technique is a sound procedure to prevent tumor cell implantation.