Objective To improve the diagnosis and treatment of upper urinary tract hematuria. Methods A total of 121 patients with hematuria who had undergone B-utrasonography,KUB plus IVU,CT and cystoscopy were suspected of hematuria from upper urinary tract.For these cases ureterorenoscopy was performed to establish the diagnosis and to conduct specific therapies. Results The diagnostic accordance rate was 92%(111/121).Among these cases,ureteral small stones in middle and lower segments were found in 45 cases;renal pelvis and ureteral tumors in 32 cases;renal hemorrhagic diseases in 19 cases and ureteral polyps in 15 cases.19 cases who had renal hemorrhagic diseases and 10 who had no definite lesions received specific therapies were followed up for 6 to 8 months.The long-term successful rate was 79%(23/29). Conclusions The application of ureterorenoscopy for the management of upper urinary tract hematuria is quite effective and worthy of widespread application.

Clinical data of 23 patients with T2a bladder cancer admitted from March 2008 to August 2013 were retrospectively analyzed.Among 23 patients,11 cases were treated with transurethral resection (TURBT) plus arterial catheterization chemotherapy (study group) and 12 cases were treated with radical cystectomy (control group).The overall survival time and recurrence free survival time of two groups were compared.Patients in study group were followed up for 20-68 months,recurrence occurred in 5 cases (5/11),including 4 cases of invasive recurrence;patients in control group were followed up for 2 ～86 months,1 case had superficial recurrent and underwent TURBT,2 cases dead due to bladder tumor.During the course of chemotherapy,the main adverse effects were digestive reaction (7/11),fever (4/11),bone marrow suppression (2/11),symptomatic treatment was given,which was tolerated.There were no significant differences in overall survival time and recurrence free survival time between two groups (P ＞ 0.05).The quality of life of study group was better than that of control group (P ＜ 0.05).It is suggested that the arterial interventional chemotherapy combined with transurethral resection for T2a stage invasive bladder cancer has a certain curative effect with the advantage of preservation of bladder function and higher quality of life.

Objective To evaluate the direction effect of drug sensitivity test of bladder cancer and the individual choice of chemotherapy. Methods MTT was used to determine chemotherapy and all 34 patients were followed up for 6-43 months. 48 cases were based on the experience of doctors control. Results The sensitive cases were ADM19, THP16, MMC20, OPT30. The sensitive rate was epi-ADM 59.4 %, THP 47.6 %, MMC 41.2 %, OPT 88.2 %. The recurrence rate was 8.82 % in drug sensitivity group, 31.2 % in control group, the result of experiment group was perfect to the control.group. Conclusion The difference of the individual chemotherapy sensitivity is significant. The drug sensitivity test can improve the therapeutic effect of bladder cancer.

Objective To evaluate the effect of transurethral feedback microwave thermotherapy with the ProstaLund CoreTherm Device(PLFT) in high risk patients with benign prostate hyperplasia (BPH). Methods Sixty-six high risk patients diagnosed with BPH, including aged ≥80 in 32 pa-tients, hypertension in 31 patients, diabetes in 5 patients, heart failure in 8 patients, chronic obstruc-tive pulmonary disease in 8 patients, cerebral infarction in 11 patients, fracture, amputation or joint stiffness unsuitable for lithotomy position in 3 patients, abnormal blood coagulation in 4 patients, pan-creatitis in 2 patients, cardiac arrhythmia in 6 patients and malignant tumor in 3 patients, were treated with PLFT using individual power at urethral local anesthesia, resulting in coagulation necrosis in 15%-30% of prostate tissue around urethra. Meanwhile, real-time monitoring the temperature of prostate and the tissue around it was used. All patients were evaluated by comparing volume of pros-tate, maximal urinary flow (Q_max), international prostate symptom score (IPSS) and quality of life questionnaire (QOL) in pre-treatment and three months after respectively. Results All of patients well tolerated PLFT. There was bleeding lightly, infection lightly and temporary incontinence. There was no severe surgical complication. After three months, the volume of prostate reduced from 62. 2 ml to 44.5 ml; IPSS decreased from 23. 4 to 11.7; QOL decreased from 4.5 to 2.4; Q_max rised from 4, 2 ml/s to 11.2 ml/s. All differences reached significance. Conclusion PLFT is one of effective and safe treatments for patients with BPH especial BPH complicating with severe conditions.

Objective To investigate the approach and safety of minimally invasive surgical procedures treating symptomatic caliceal diverticular calculi. Methods Clinical data of 21 cases with symptomatic caliceal diverticular calculi were retrospectively reviewed. Twelve females and 9 males aged 22 to 57 years old. The average diameter of caliceal diverticulum was 3.7 cm (2.5-7.0 cm) and average diameter of calculi was 2.3 cm (0.8-3.5 cm). The patients underwent flexible ureteroscopic lithotripsy, PCNL or mPCNL, laparoscopic techniques and laparoscopy-assisted transperitoneal PCNL, respectively. Four cases underwent flexible ureteroscopic lithotripsy. PCNL (2 cases) or mPCNL(5 cases)were performed in 7 cases. Nine cases underwent laparoscopic techniques. Laparoscopyassisted transperitoneal PCNL was performed in 1 case. Results The operations were performed successfully in 21 cases. No case need to transfer to open surgery during the operation and no major complications like perforation or organic injury were noted. One case with iatrogenic arteriovenous fistula of the kidney after 1 week postoperative was cured by delayed hemorrhage 2 days later, while clinical symptoms of 2 cases with residue calculi relieved. 19 cases without residue calculi were followed up for 6 to 12 month without recurrence. Conclusions After handling indication of treatment efficiently and creating advisable therapeutic decision-making, minimally invasive surgical procedures treating symptomatic caliceal diverticular calculi appears to be effective and safe.

Objective To assess the clinical significance of serum high sensitive C-reactive protein (hs-CRP) in patients undergone prostate biopsy.Methods A total of 273 consecutive patients were enrolled,aged 44-95 years (mean,69 years).All the patients underwent prostate biopsy.The pathological findings showed 96 cases with prostate cancer (PCa) and 177 cases with benign prostate hyperplasia (BPH).The difference of hs-CRP level between patients with PCa and those with BPH was analyzed.The positive prostate biopsy rate was compared between the patients with high hs-CRP level and those with normal hs-CRP level.Logistic regression was used to evaluate the effect of factors such as hs-CRP,tPSA,PSA density,prostate volume and age on prostate biopsy.Results The medians (interquartile range) of hs-CRP were 3.22 mg/L (1.22-9.84 mg/L) in patients with PCa and 1.24 mg/L (0.55-2.76 mg/L) in those with BPH,respectively,with significant difference(P＜0.05).The positive prostate biopsy rate in patients with high hs-CRP (＞ 3 mg/L)was 55％ (51/92),higher than that in those with normal hs-CRP (≤ 3 mg/L).The odds ratio of hs-CRP was larger than that of all other factors analyzed including tPSA,prostate volume and age according to the Logistic regression analysis.Conclusions Elevated serum hs-CRP level is associated with increased positive prostate biopsy.Serum hs-CRP acts as an independent factor increasing the positive prostate biopsy rate in patients undergone prostate biopsy.

[Abstract] Objective To define the age-specific normal reference values of prostate specific antigen (PSA) and related parameters in Chinese middle-aged and elderly men.Methods From April 2007 to November 2011,serum PSAs of over 22 055 men aged more than 40 years old in our medical examination center were statistically analyzed.The men was divided into five groups by a 10-year-old interval.Total PSA (tPSA),free PSA (fPSA) and prostate ultrasound results were recorded.The free-total PSA ratio (f/t),PSA density (PSAD) and PSA velocity (PSAV) were calculated.By convention,the 95th percentile (P95)was used as the upper limit value,and the 5th percentile (P5) as the lower limit value.Results The tPSAs were positively correlated with age (r=0.349,P＜0.001).f/t was negatively correlated with age (r=-0.154,P＜0.01).Although f/t was significantly different (P＜0.001) among each age group,P5 of all groups were 0.18.PSAD was significantly different (P＜0.001) between men over and under 70 years,with P95 as 0.09 and 0.15,respectively.PSAD had a positive correlation with age (r =0.263,P＜0.01).The significant difference of PSAV raised between men over and under 60 years,with P95 as 0.21 and 0.58,respectively.PSAV was positively correlated with age (r=0.130,P＜0.01).Conclusions PSA,PSAD and PSAV are positively correlated with age,while f/t is negatively correlated with age.The normal range of f/tis 0.18-1.00 for Chinese men over 40 years old.PSAD's normal ranges are ＜0.09 and ＜0.15 in Chinese men over and under 70 years,respectively.The normal range of PSAV are ＜0.21 and ＜0.58 for Chinese men over and under 60 years,respectively.

Objective To evaluate the value of renal parenchymal volume and thickness by non-contrast spiral CT in evaluating the differential glomerular filtration rate (GFR) for chronic obstructed kidneys, and to compare the correlations between the two morphologic indices of renal parenchyma and the GFR for chronic obstructed kidneys. Methods Seventy-one patients who had a diagnosis of unilateral chronic upper urinary tract obstruction were included in this analysis. (1) The renal parenchymal volume was mea-sured by non-contrast spiral CT. Both kidneys were scanned by non-contrast spiral CT. The renal parenchymal area of each section was marked manually. Renal parenchymal volume was calculated as the sum of renal parenchymal area multiplied by the width of each section. The volume percentage of obstructed kidney (%CTvol) was also calculated. (2) Renal parenchymal thickness was measured on the first and last non-contrast CT image levels from the anterior, posterior and lateral locations of the kidney that clearly contained the collecting system. The mean of these measurements was defined as the renal parenchymal thickness. The differential renal parenchymal thickness of the obstructed kidney (%CTt) was defined as the percentage of the obstructed renal parenchymal thickness to the total renal parenchymal thickness for both kidneys. GFR was determined with 99Tcm-DTPA dynamic imaging system by Gates method. The differential GFR for obstructed kidney (%GFR) was the GFR percentage of obstructed kidney to the total GFR for both kidneys. The Pearson relation test was carried out between the %CTvol, %CTt and the %GFR respectively. Results %CTvol and %CTt correlated well with %GFR in chronic obstructed kidneys among the 71 test group patients. Pearson correlation coefficient r was 0.80 (t=11.20, P＜0.05) and 0.66 (t=7.24, P＜0.05), respectively. The linear correlation equation respectively was %GFR=0.05+0.80×%CTvol (F=125.48, P＜0.05) and %GFR=0.12+0.66×%CTt (F=52.36, P＜0.05). Conclusions Renal parenchymal volume and thickness by non-contrast spiral CT might be used as clinical practical parameters to evaluate the differential GFR for chronic obstructed kidneys. Renal parenchymal volume is more accurate than renal parenchymal thickness.

Objective To evaluate the feasibility and effectiveness of bladder-preserving local resection combined with intra-artery chemotherapy for patients with T1G3 bladder cancer.Methods Thirty five cases with T1G3 bladder cancer were analyzed retrospectively. Patients were all treated by bladder-preserving local resection combined with intra-artery chemotherapy. Results Thirty five cases were followed up. The time of follow-up ranged from 7 to 116 months,and mean time was(66.0±18.3)months.The 5 year recurrence and bladder-preserving rate were 48.6 ％(17/35)and 68.6 ％(24/35),respectively.The overall and tumor specific survival at 5 years was 77.1％ (27/35)and 82.9 ％ (29/35).The effect of bladder-preserving local resection plus intra-artery chemotherapy was satisfactory. Moreover, intra-artery chemotherapy had no obvious side effects.Conclusion Bladder-preserving local resection combined with intra-artery chemotherapy not only can retain normal bladder function, decrease in the recurrence, but also does not reduce the survival rate. It is an effective treatment for some patients with T1G3 bladder cancer instead of cystectomy over-treatment.

Objective To assess the clinical value of measuring the concentration of serum osteoprotegerin (OPG) in detecting the bone metastases in patients with prostate cancer. Methods The concentration of serum OPG in 40 patients was determined by ELISA. The data of ECT bone scan and Gleason score was collected simultaneously. The correlations between serum OPG and bone metastases, Gleason score were tested. Results The concentration of serum OPG in patients with bone metastases by ECT scan was( 16 237. 19 ±5144. 26) ng/L,which was significantly higher than the concentration in patients without bone metastases , which was (12 123.32 ±4136. 50)ng/L. There was no significant correlation between serum OPG and Gleason score. Conclusions The serum OPG has an important clinical value in prediction of prostate cancer with bone metastases. There is no significant correlation between serum OPG and the Gleason score.