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 evaluate the safety,efficacy,experience and techniques of percutaneous nephrostolithotomy (PCNL) in treating renal staghorn calculi.Methods The clinical data of 60 patients with staghorn renal stone who underwent PCNL were analyzed retrospectively.Results The stone free rate was 68.3％(41/60) in the first procedure.Three patients were performed a secondary procedure.The stone free rate was 73.3％ (44/60) in the second procedure.The total stone free rate was 93.3％(56/60) after the procedure of extracorporeal shock wave lithotripsy (ESWL) and ureteroscopic lithotripsy (URL).Conclusions PCNL is a safe and effective method for the staghorn renal calculi.The stone free rate may be improved with skilled operation experience and combination with ESWL and/or URL.

Objective The aim of this study was to investigate the understanding and application of the Chinese Urological Association (CUA) guidelines of Benign Prostatic Hyperplasia (BPH) (2011 edition) in Chinese urologists.Methods The survey was conducted between September,2012 and November,2012.Questionnaires designed by the CUA were used to investigate the understanding and management of BPH in CUA-registered urologists,who work in clinic for at least 20 hours per week.Data,including general characteristics of the urologists,understanding of BPH,BPH diagnosing in suspected patients,BPH treatment,and follow up,were collected.7500 questionnaires were distributed.A total of 4 897 participants responded (response rate 70.0％).86 questionnaires with incomplete information and 37 duplicate questionnaires were excluded.And 4 774 validate questionnaires were included for the analysis,finally.The mean age of those investigated urologists was (39.9±9.2) years old.Among them,3 802 (81.0％) urologists work in the tertiary hospital,878 (18.7％) urologists work in the secondary hospital and 12 (0.3％) urologists work in the other hospital.The district distribution in those urologists included 455 (9.6％) in northeast china,812 (17.1％) in north china,1 696 (35.6％) in east china,869 (18.2％) in south china,634 (13.3％) in southwest china,295 (6.2％) in northwest china.1 835 (43.8％) urologists have less than ten years working experience.1 505 (35.9％) urologists have 11 to 20 years working experience.The 21 to 20 years working experience was reported in 705 (16.8％) urologist.And the other 149 (3.5％) urologists have working experience more than 31 years.The educational background in this study included doctor degree in 732 (15.8％) urologists,master degree in 1 729 (37.4％) urologists,bachelor degree in 2 067 (44.7％)urologists and college degree in 101 (2.1％) urologists.The position composition included 834 (18.2) directors,1 371 (30.0％) deputy directors,1 605 (35.1％) attendings and 765 (16.7％) residents.The data were analyzed using rank-sum test,2 test,or Fisher's exact test.Results The understanding of BPH clinical progression and progression-associated risk factors in Chinese urologists was poor.Compared to the guidelines,the rate of consistent were only 43.4％ (2 023/4 665) and 10.2％ (477/4 660),respectively.The initial evaluation methods for suspected BPH patients were in low consistency with the guidelines (20.2％,845/4 181) and were inconsistent among different areas [66.5％ (290/436) in northeast china,64.7％ (556/859) in south china,55.6％ (158/284) in northwest china,55.1％ (922/1 672) in east china,54.7％ (435/795) in north china,48.0％ (296/617) in southwest china].The participants showed poor understanding of the primary goal of treatment for BPH (4.9％ consistent,229/4 666) and the criteria about watchful waiting (22.5％ consistent,1 051/4 674).However,the understanding of surgical indications for BPH was good (94.6％ consistent,4 410/4 663).The therapeutic effects of 5α-reductase inhibitor for BPH were acknowledged by 93.4％ (4 388/4 699) participants.The consistent rate with the guidelines of follow-up examinations was low for patients with watchful waiting (7.8％,355/4 531),medication treatment (8.4％,373/4432),and surgery (44.8％,2 105/4 702).Conclusions The understanding of the CUA BPH guidelines is poor in Chinese urologists.Target training in the specific urologists with tailored contents is necessary.

Objective To explore the correlative factors of sudden death in patients suspected with pulmonary thromboembolism (PTE) in emergency room (ER).Methods A retrospective analysis was conducted.The clinical data of 12 patients with sudden death suspected with PTE (sudden death group) in ER of the Air Force General Hospital from January 2011 to June 2014 were analyzed.The non-sudden death group included 35 patients during the same time period who were diagnosed with PTE based on findings of CT pulmonary arteriography (CTPA) and showed no sudden death in ER.Factors,including sex,age,previous operation,tumor,syncope,dyspnea,bilateral or unilateral edema of lower extremity,heart rate (HR),white blood cell count (WBC),D-dimer,arterial partial pressure of oxygen (PaO2),arterial partial pressure of carbon dioxide (PaCO2) and typical clinical manifestation of electrocardiogram (SⅠTⅢQⅢ),were compared between the two groups.The potential predictors of sudden death of PTE were analyzed by logistic regression analysis.Results Young age (years old:51.3±15.5 vs.62.3±14.4),lower PaO2 [mmHg (1 mmHg =0.133 kPa):49.9± 12.3 vs.62.7± 10.2],higher HR (bpm:122.0± 19.5 vs.89.1 ± 18.5) and higher WBC (× 109/L:13.8 ± 6.9 vs.7.2 ± 2.5) were found in sudden death group as compared with those in non-sudden death group (P ＜ 0.05 or P ＜ 0.01).There was no significant differences in D-dimer level and PaCO2 between sudden death group and non-sudden death group [D-dimer (pg/L):986 (891,3 230) vs.2089 (598,3 397),PaCO2 (mmHg):33.0 (28.6,43.4)vs.36.5 (32.9,41.0),both P ＞ 0.05].The syncope,antineoplaston treatment or tumor metastasis within 6 months,operation in previous 4 months,bilateral asymmetrical edema in sudden death group were more than those of the non-sudden death group,and chest pain was less (P ＜ 0.05 or P ＜ 0.01).Difference in gender,dyspnea and typical SⅠTⅢQⅢ in electrocardiogram were not significant between the two groups (all P ＞ 0.05).It was shown by multiple logistic regression analysis that higher HR [odds ratio (OR) =1.124,95％ confidence interval (95％CI) =1.024-1.235,P =0.014] and higher WBC (OR =1.347,95％CI =1.043-1.738,P =0.022) were identified as independent risk factors of sudden death for PTE.Conclusions Gender,dyspnea,typical S Ⅰ TⅢQⅢ in electrocardiogram,PaCO2 and D-dimer seem unrelated to sudden death of patients with PTE.Young age,chest pain,syncope,bilateral asymmetrical edema,antineoplaston treatment or tumor metastasis within 6 months,operation in previous 4 months and low PaO2 were potential predictors of sudden death according to the univariate analysis.Higher WBC and higher HR are independent risk factors of sudden death for PTE patients.

Objective To improve the effect of diagnosis and treatment in spontaneous adrenal hemorrhage. Methods Eleven cases of spontaneous adrenal hemorrhage were retrospectively summaried. Results Ten cases manifested lumbago in troubled side and 1 case was detected adrenal masses in operations of carcinoma of ureter.The functions of adrenal gland were all normal.Eleven were checked by ultrasound B of whom 3 cases had cystic masses, and strong echo of point or partition could be detected.Seven cases were manifested with low echo of masses,and 1 case of carcinoma of ureter was normal in ultrasound B before operation.Ten cases were scanned by CT.The focus was oval round shape and the border of focus was detected clearly.The value of CT ranged from 34.7 to 85.0 HU, and in 6 cases their values exceeded 50.0 HU.Among them,fluid plan could be seen in 1 case.Reinforcement CT was performed in 3 cases,and the masses were not reinforced.Three cases were scanned by MRI,and the ununion masses in area of adrenal gland were detected.There was iso signal in T1 weighted,while there was low signal in T2 weighted.Six cases underwent resection of adrenal gland; 5 cases underwent partial resection of adrenal gland and masses.The pathology of post operation were internal hemorrhage of adrenal gland medulla,and the hematoma was coated by the tissue of adrenal gland.The functions of adrenal cortex were all normal with follow up of 0.6 to 8 years. Conclusions The spontaneous adrenal hemorrhage can be diagnosed definitely by ultrasound B,CT and MRI.The symptoms of waist and abdominal pain were very distinctive with adrenal hemorrhage on both sides.The operation should be done when the adrenal hemorrhage is in one side and the hematoma exceeds 5 cm in diameter.Patrial resection of adrenal gland and hematoma should be operated for saving the normal adrenal tissues around the hematoma.

Objective To evaluate the efficacy of combination solifenacin and tamsulosin for the treatment of distal ureteral calculi after extracorporeal shock wave lithotripsy. Methods 120 patients (male:100 female:20 age:18-67 yrs) randomly assigned to 4 groups (each group 30) with the calculi diameter range from 0.5 to 1.1 cm.All patients performed extracorporeal shock wave lithotripsy (X ray oriented).The control group did not accept any medical treatment.The solifenacin group were administered solifenacin 5 mg,once per day.The tamsulosin group were administered tamsulosin 0.2 mg,once per day.The combination group were administered solifenacin 5mg,plus tamsulosin 0.2 mg,each per day.The observation duration was set at 2 weeks. Results The stone-free rate (according to KUB) within 2 weeks were 80.0％,83.3％,93.3％ and 96.7％ in the control group,solifenacin group,tamsulosin group and combination group respectively.Statistical differences were significant among the tamsulosin group,the combination group and the control group.The stone expulsion times were (7.6 + 3.7) d,(6.3 ± 2.5) d,(4.4 + 2.3) d and (3.5 ± 2.2) d in the 4 groups respectively.Statistical differences were significant among the tamsulosin group,the combination group and the control group.The uses of analgesics were 13,5,9 and 3 in the 4 groups respectively.The bladder irrtative symptoms were 12,6,4 and 4 in the 4 groups respectively.Statistical differences were also significant for the use of analgesics and relief of bladder irritation between the solifenacin group,the combination group and the control group. Conclusions Tamsulosin and solifenacin could be safe and effective for the treatment of distal ureteral calculi after extracorporeal shock wave lithotripsy.It could significantly improve the stone expulsion rate,relief the pain and improve bladder irrtative symptoms.

Objective To study the immunoreactivity of fascin and Ki-67 proteins in bladder carcinoma and the correlation between their expression and the pathological features.Methods The immunohistochemistry of fascin and Ki-67 proteins were detected in 111 cases of bladder carcinoma and 42 cases of normal bladder tissues.The correlation between their expression and the pathological features were analyzed statistically.Results There was no expression of fascin and Ki-67 in normal bladder tissues.The immunoreactivities of fascin and Ki67 were detected respectively in 94 and 92 of 111 bladder carcinomas.The immunoreactivity of fascin was correlated with TNM staging and the size of the tumor(P<0.05),and had no correlation with age,gender and pathological classification(P>0.05).The expression of fascin was positively correlated with the expression of Ki-67 in bladder carcinoma(P<0.01).Conclusion Fasicn and Ki-67 were expressed in bladder carcinoma.The combined detection of fascin and Ki-67 expression might be helpful to assess the prognosis of bladder carcinoma.Targeting the fascin and Ki-67 pathway could be a novel therapeutic strategy of bladder carcinoma.

Objective To improve the diagnosis and treatment of asymptomatic adrenal pheochromocytoma. Method The clinical data of 33 patients with asymptomatic adrenal pheochromocytoma were reviewed. Results All the patients were not preut with typical signs and symptoms of pheochromocytoma, 16 patients were found adrenal mass by routine physical examination, 15 patients presented with superior abdominal or flank pain, 1 patient was fever and 1 patient was diarrhea. Most of patients were prent with round mass with low density in the center of the tumor,5 patients had elevated level of plasma epinephrine and norepinephrine (16% ,5/31),24 hours urine CA and VMA were elevated in 6 patients (24%, 6/25) and 5 patients (20%, 5/25) respectively, 26 patients who were suspected pheochromocytoma preoperatively were treated with α-adrenergic blockade (prazosin) to control the blood pressure or with intravenous colloid fluids and blood transfusion to expand intravascular volume before operation. The tumors were removed successfully in 32 patients, and biopsy was done in 1 patient because of the serious invasion to the vena cava by the tumor. All the patients were diagnosed pheochromocytoma histopathologically,and followed up for 1 month to 7 years, no tumor recurrence. Conclusions The patients with asymptomatic adrenal pheochromocytoma have lower catecholamine excretion in their plasma and urine. Combination of modem imaging examinations are useful methods to diagnose asymptomatic adrenal pheochromocytoma. To lower the risk of operation, the control of blood pressure and the expanding of intravascular volume are important for the patients with huge adrenal mass or typical suspected appearance of pheochromocytoma.

Objective To analyze the clinical features and summarize diagnosis and therapeutic efficacy for ureteropelvic junction obstruction(UPJO). Methods Two hundred and twenty-two patients with UPJO were treated from 2000 to 2008,including 155 males and 67 females:the age rangeed from 13 to 75 and mean age was 29 years.One hundred and seventy-three cases presented with back pain;19 cases with urine infection;12 cases with abdomen bump;7 cases with macroscopic hematuria;11 cases found by B-ultrasound examine.Etiological factors included 185 patients of ureteropelvic junction stenosis;18 cases of high location of the junction;19 cases which were diagnosed UPJO due to benign oppression,including fiber cords and peculiar vessels.A total of 222 cases of surgical procedures were conducted,of them Anderson-Hynes dismembered pyeloplasty was conducted for 191 cases,fiber cords and peculiar vessels were relieved for 19,nephrectomy for 12 cases because of nonfunction. Results One hundred and ninety-one cases who underwent Anderson-Hynes dismembered pyeloplasty were all succeeded with operation.They were followed up for 6 months to 8years with a mean of 38 months.B-ultrasound and IVU showed that hydronephrosis was obviously relieved.The clinical symptoms disappeared in all cases.The levels of serum creatinine of 7 cases who had higher ereatinine recovered. Conclusion Anderson-Hynes dismembered pyeloplasty could be a good choice and effective method for the treatment of UPJO.

Objective To discuss the diagnosis and treatment of normotensive pheochromocyto-ma. Methods The clinical data of 22 patients with normotensive pheochromocytoma were reviewed. Inclusion criteria for normotensive pheochromocytoma were no previous history of hypertension and episode of symptoms suggesting high blood pressure. The blood pressure on admission was 90-130/ 60-90 mm Hg with an average of 113/72 mm Hg. Seven patients were found adrenal mass by routine ultrasonic examination. Twelve patients presented with superior abdominal or flank pain. Four pa-tients were present with fatigue, and 2 patients had fever. Headache and palpitation were found in 1 patient. Most of patients were present with large and round mass with low density area in the center of the tumor by uhrosonography and CT. Four patients had elevated level of plasma epinephrine and nor-epinephrine. 24 hours urine CA and VMA were elevated in 5 and 4 patients respectively. Seven pa-tients were prepared with infusion preoperatively to expand intravascular volume, and 2 patients were given prazosin 1.5 mg/d for 5 to 7 days. Results During the operation, seventeen patients had ele-vated blood pressure and 5 patients had no changed. One of seven patients with preoperative prepara-tion had obvious hypertension during operation, and 11 of 15 patients without preoperative preparation had obvious hypertension. The tumors were removed successfully in 21 patients. All the patients were diagnosed pheochromocytoma pathologically. Twenty-one patients had normal blood pressure with no recurrence during the follow-up from 1 month to 7 years. Conclusions The patients with normotensive pheochromocytomas may have lower catecholamine in their plasma and urine. The application of α-blockers and the expanding intravascular volume before operation could be important for the patients safe.