Objective To study the juxtaglomerular cell tumor. Methods The clinical characteristics,diagnosis,surgical teratment and the prognosis of 5 patients were retrospectively studied with review of the literature. Results All the patients had hypokalemia.Peripheral serum renin levels were recorded in 4 patients and 3 of them had high levels of peripheral serum renin activity and hyperaldosteronism while these were normal in the other 1.1 patient had been preoperatively diagnosed as a right adrenal tumor with a concurrent right kidney tumor while the post-operative histopathological studied revealed normal adrenal tissue and a juxtaglomerular cell tumor of the right kidney.All patients underwent simple tumor resection.The peripheral serum renin activity,hyperaldosteronism,hypokalemia,and hypertension became normal after the tumor resection.At a mean follow-up of 58 months (range 15 to 120 months ) no tumor recurrence and hypertension has been documented. Conclusions Juxtaglomerular cell tumor is a begin tumor of kidney,being a rare, curable cause of high levels of peripheral serum renin activity,hyperaldosteronism, hypokalemia and hypertension.Differential diagnosis includes primary hyperaldosteronism and renal artery stenosis.The prognosis is good with tumor resection.

Objective To evaluate the clinical outcomes of a reformed endoscope assisted ureteral stripping technique in post renal transplant patients with renal pelvic tumor of the graft homonymy primitive kidney.Methods Seven post renal transplant patients with renal pelvic tumor of the graft homonymy primitive kidneys(2 males and 5 females)with average age of 54 years old were recruited.Standard retroperitoneal laparoscopic nephrectomies were performed for all patients after placement of a 5 F ureteral stent as the ureteral stripper. After the closure of the ureter at the lower kidney pole level with metal clips, the distal ureter was separated and the ureteral muscle layer and serous membrane layer were split. The ureter muscle layer was then tied tightly to the ureteral stent tip. The ureter and the stent were pulled out through urethra. Transurethral resection around the everted ureteral orifice was performed and the ureter was removed afterwards. The graft function, operation time,complication and estimated blood loss were recorded.Results All the 7 patients successfully underwent the operations and no major complication such as ureteral disruption, stripping embarrassment and converting to open operation happened. The mean operation time was 126 min (ranging from 105 to 160 min) and the mean blood loss was 124 ml (ranging from 80 to 160 ml). Introvesical chemotherapy with farmorubine hydrochloride was performed 3 weeks after surgery. The mean preoperation and 6 months post-operation creatinine and urea nitrogen levels were 136.5μmol/L, 138. 6μmol/L and 7.42 mmol/L, 7.80 mmol/L respectively and there was no statistical difference. There was no tumor recurrence during 6 month follow-up except one case having simultaneous bladder cancer had bladder cancer relapse 3 months after operation and required another TURBt.Conclusion The reformed endoscope assisted ureteral stripping technique is minimally invasive and convenient in the treatment of post renal transplant patients with renal pelvic tumor of the graft homonymy primitive kidney.

Objective To study the factors associated with post-operattve renal function injury after laparoscopic nephron-sparing surgery(LNSS)for tumors. Methods Fifty consecutive patients were enroned in a prospective protocol and underwent LNSS.Preoperative and postoperative renal scintigraphic scan was performed in all patients. 99 Tcm-diethylenetetraminepentacetic acid scan was performed in all patients.Linear correlation and multivariate regression model were used to analysis the factors associated with postoperative renal damage.Twenty consecutive patients associated with risk factors were followed-up.These data in GFR were monitored at the preoperative,1 week and 3 months after operation.The duration Warm ischemia was recorded. Results In selected patients,assessed by renal scintigraphy,the function of the operated kidney was reduced by a mean of 24%.Linar correlation analysis showed that there was positive correlation between the age,tumor size,duration of warm ischemia and postoperative renal function injury.Furthermore,multivariate Legression analysis revealed that the duration of warm ischemia was the independent risk factor of postoperative renal damage.Twenty consecutive patients were included in this protocol.There was a significant difference between vessel clamp time≤30 min and vessel clamp time＞30 min.Renal scan data did not reveal any significant decrease in GFR in the affected kidney at 3 months after surgery for the patients whose yesscl clamp time less than 30 min.Renal function damage could not recover in the patients over 70 years with longer than 30 min warm ischemia or with longer than 60 min warm ischemia. Conclusions This paper evaluated renal function on the affected side before and after surgery by measuring renal function with renal scintigraphy using99 Tcm-DTPA.Risk factors for renal dysfunction in the affected kidney after LPN are age over 70 years with more than 30min warm ischemia time,and a warm ischemia time longer than 60 min.

Objective To evaluate the effect of surgical treatment on patients with retroperitoneal fibrosis. Methods The medical records of 24 retroperitoneal fibrosis patients (19 men and 5 women;mean age,52 years) who had been surgically treated from January 1985 to December 2003 were retrospectively analyzed.The initial clinical presentations included low back and abdominal pain in 11 cases,acute anuresis in 5 and incidental bilateral hydronephrosis in 8.Double-J inter-ureter drainage was performed in 11 cases, among whom the procedure failed in 4 cases, and then they underwent pricking pyelostomy.After their general condition improved,ureterocutaneostomy and ureterolysis were performed in 2 cases and 1 case, respectively.Of them 1 case died of acute myocardial infarction 3 months later.Thirteen cases who had good general condition at diagnosis underwent ureterolysis. Results One patient developed renal function failure due to repeated urinary infection 3 years after operation.One died of acute myocardial infarction 3 months after operation.The other 22 patients recovered well,and their mean creatinine level decreased from 450.9?mol/L before operation to 318.2 ?mol/L (1 month) and 265.2 ?mol/L (3 months),respectively,after operation. Conclusions Prompt and appropriate relief of urinary obstruction with surgical treatment can effectively protect the renal function in patients with retroperitoneal fibrosis.

Objective To understand the ultrastructure of detrusor musculature in areflexia neurogenic bladders. Methods The detrusor secured from the anterior wall of bladders was studied and compared by means of transmission electron microscope in 11 patients with areflexia neurogenic bladder during cystomyoplasty with musculus rectus abdominis and in 7 accidentally deceased young men in autopsy. Results Ultrastructural changes of de differentiation of detrusor cells were observed in areflexia neurogenic bladders,such as inconsistent contours,malalignment and disarray.Wide separation between muscle cells with reduction of intermediate cell junction and with abundant collagen fibrils and irregular dense structures between individual cells were noted.There were also such changes as reduction of pinocytotic vesicle and mitochondria,disarray of myofilaments and malalignment of dense body,etc.,in detrusor cells.By contrast normal detrusor cells were well arranged and well distributed with consistent contours and size.The distance between muscle cells was much smaller than the abnormal specimens with proper intermediate junction.Caveolae and dense area were evenly distributed among the sarcoplasm.Organelles,myofilament and dense body were well organized in the smooth muscle cells. Conclusions The ultrastructural changes of detrusor in areflexia neurogenic bladders may be associated with relative increment of bladder outlet obstruction,which is probably due to detrusor debility from diseased nerve and sequential disequilibrium between normal detrusor and sphincter muscle of the urethra.Prophylactic management of lower intra bladder pressure may be beneficial to the prevention of ultrastructural deterioration in detrusor cells.

The perivascular epithelioid cell (PEC) is a cell type constantly present in a group of tumors called PEComas(perivascular epithelioid cell tumors). PEC expresses myogenic and melanocytic markers,such as HMB45. PEComa is a widely accepted entity now. PEComas are related to the genetic alterations of tuberous sclerosis complex (TSC), an autosomal dominant genetic disease due to losses of TSC1 or TSC2 genes. PEComas are rare in the urinary system and there are some open questions about PEComas regarding its histogenesis, the definition of epithelioid angiomyolipoma and the identification of the histological criteria of malignancy. This review provides an update on PEComas of the urinary system.

Objective To study the significance of rDNA transcription activity of peripheral blood T lymphocyte in patients with urinary tract tumors. Methods rDNA transcription activity of peripheral T lymphocyte was detected by a cell image analysis of Ag-NOR in 21 patients who were pathologically diagnosed with kidney cancer (including 6 cases of T_1N_0M_0,9 of T_2N_0M_0,4 of T_3N_0M_0 and 2 of T_4N_2M_1) and in 42 patients with bladder tumor (including 14 cases of TaN_0M_0,11 of T_1N_0M_0,1 of T_1N_0M_1,8 of T_2N_0M_0,4 of T_3N_0M_0 and 4 of T_4N_0M_0).Twenty-eight normal volunteers served as controls and 23 patients with uremia as positive controls.The peripheral blood was taken for detection of Ag-NORs in controls and in tumor patients before and after operation.The differences were compared among these groups. Results rDNA transcription activity of T cells was (8.55?1.11)%,(6.29?0.97)%,(5.44?0.68)% and (5.42? 0.68)% in controls and patients with uremia,renal and bladder tumors,respectively,showing a statistically significant difference among the normal uremia and tumor patients (P0.05).The parameters,such as TNM stages of renal and bladder tumor,the cell grades according to WHO criteria,tumor volume of the kidney,and invasion depth and recurrence frequencies of bladder tumors,had no significant correlation with rDNA transcription activity of T cells. Conclusions rDNA transcription activity of T cells may be used for monitoring the immune function in patients with kidney and bladder tumors,especially for primary screening of urinary tract tumors.

Objective To evaluate the feasibility of using pure laparoscopic radical nephrectomy and thrombectomy to treat renal tumor with renal vein and vena caval thrombus. Methods Two ca-ses o{ right renal tumor with renal vein and vena caval thrombus were reported. Contrast-enchanced CT showed renal tumor extended into renal vein and vena cava in 1 case, and filling defect was found in right renal vein and extended to vena cava in the other. Both patients received pure laparoscopic ra-dical nephrectomy and thrombectomy through retroperitoneal approach. Four trocars were placed du-ring the operation, and the renal artery was dissected before the vena cava was mobilized circumferen-tially above and below the renal vein, a faparoscopic vessel blockage clamp was used to partly occlude the vena cava containing the thrombus. The vena cava was repaired after the intact tumor thrombus was extracted. Results The tumor thrombus extended 0.3 cm and 1.0 cm above the renal vein, re-spectively. Both patients were discharged 5 d after operation. Pathological examinations showed that tumors were epithelioid renal angiomyolipoma and grade Ⅰ-Ⅱ clear cell carcinoma separately. Both patients were free of local recurrence and metastasis 5 months after operation. Conclusion Pure la- paroscopic radical nephrectomy and thrombectomy for renal tumor with vena caval and renal vein thrombus is feasible in carefully selected patients.

Objective To investigate the value of temporary balloon occlusion of the abdominal aorta in the treatment of complete placenta previa with placenta accreta. Methods From January 2015 to February 2016, 24 cases of complete placenta previa with placenta accreta were treated with temporary balloon occlusion of the abdominal aorta (the study group) before cesarean, and 24 cases of complete placenta previa with placenta accreta did not receive balloon occlusion (the control group). The operation time, intraoperative blood loss, intraoperative blood transfusion volume, the perioperative hemoglobin level, the hysterectomy rate and the related complications were compared retrospectively.Also, the hospitalization time, the blood coagulation parameters after operation, including activated partial thromboplastin time (APTT), fibrinogen (FIB), D-Dimer and reperfusion injury parameters including creatine phosphokinase (CK), creatine phosphokinase isoenzyme (CK-MB), lactate dehydrogenase (LDH) and serum creatinine were compared between the 2 groups. Results The blood loss [750 ml (400-2 000 ml) vs 2 000 ml (1 500-2 375 ml);Z=-3.214, P=0.001] and blood transfusion volume [200 ml (0-800 ml) vs 800 ml (0-1 200 ml);173, P=0.030] in the study group were lower than in the control group. The hemoglobin difference between before and after operation in the study group was lower than the control group [(12.8±13.4) g/L vs (22.9±20.1) g/L;t=-2.041, P=0.047]. In the study group, there were still bleeding in 13 cases after releasing the balloon, 5 of them received uterine artery embolization, 5 cases received uterine artery ligation, and 3 cases received uterine packing. One case had venous thrombosis in the right lower limb. Two cases (8%,2/24) in the control group had hysterectomy, while none in the study group, there was no statistical significance (P=0.489). Conclusions Temporary balloon occlusion of the abdominal aorta can effectively reduce blood loss and blood transfusion in the treatment of complete placenta previa with placenta accreta, but there is still the risk of continuing bleeding after releasing the balloon. Other methods of hemostasis might be needed.

Objective To investigate the expression and the significance of toll-like receptor 3 (TLR-3)in placenta,tumor necrosis factor-α(TNF-α)in maternal and cord blood of idiopathic fetal growth restriction(IFGR),and their correlation with the pathogenesis of symmetric and asymmetric IFGR.Methods From April 2008 to April 2009,42 primiparae of singleton pregnancy and their IFGR babies,who delivered at term through cesarean section, in the Third Affiliated Hospital of Zhengzhou University were enrolled. All subjectects were divided into symmetric IFGR group (n=20) and asymmetric IFGR group (n =22). Another 42 non-IFGR pairs were randomly selected as the control group. The polink-2 plus polymerized horseradish peroxidase (HRP) immunohistochemical method and the enzyme linked immunosorbent assay (ELISA) were applied to detect TLR-3 and TNF-α levels. Results (1) The expression of TLR-3 protein were observed in all maternal placenta of the three groups. TLR-3 essentially expressed in syncytiotrophoblasts and hofbouer cells in the symmetric IFGR and control group, but expressed mostly in hofbouer cells and less in syneytiotrophoblasts in the asymmetric IFGR group. (2) The expression of TLR-3 in the syncytiotrophoblasts of the symmetric and asymmetric IFGR group was significantly lower than in the control group (111±14 and 118±11 vs. 156 ± 9, P<0. 01). The number of TLR-3 positive in Hofbourer cell in the symmetric IFGR group was lower than the control group (8. 9±2. 8 vs 17.5±2. 8, P <0. 01 ), but the number in the asymmetric IFGR group was higher (23.8±3.7) compared with the control group (P <0. 01). (3) The TNF-α levels in the maternal and cord blood of the symmetric and the asymmetric group were higher than that of the control group [maternal : (90±10) μg/L and ( 86±11 ) μg/L vs. (73±9) μg/L;cord blood: (92±12) μg/L and (96±8) μg/L vs. (79±9) μg/L;P<0.01]. (4) Neither symmetric nor the asymmetric IFGR group showed any correlations between the maternal and cord blood levels of TNF-α (P>0. 05). (5) Significant correlation was found between the TNF-α level of the cord blood and TLR-3 expression in the placenta in both the symmetric and asymmetric IFGR group(P<0. 05),but no relationship was found between the maternal blood TNF-α level and TLR-3 expression in the placenta (P>0. 05). Conclusions The variantions of TLR-3 expression in placenta and the increased expression of TNF-α in cord blood are associated with the genesis IFGR. The reduced expression of TLR-3 may related to symmetric IFGR, while the increased TLR-3 level in hofbouer cells may lead to asymmetric IFGR.