Objective To modify and improve the technique of continent outlet and to find an optional method of simpler construction and easier catheterization. Methods 47 patients underwent continent cecal-ascending colon urinary reservoir were followed up,among whom 37 were detenial and 10 were detubularized. All reservoirs used incisive terminal ileum being overlapped and sutured again as efferent tube. The limb was fixed between the back surface of the rectus and the pouch wall. The internal orifice of the overlapped ileum was ileocecal valve reinforced with few sutures.Its external orifice was anastomosed to the umbilicus.Urodynamic studies of the pouch and efferent limb were carried out more than 6 months postoperatively. Results All the tubes were easily catheterized with 16 F catheter.45/47 patients were completely continent during the day and 44/47 patients completely continent at night. Urodynamic study of the efferent tubes showed that the maximum close pressure with the pouch full was significantly higher than with the pouch empty( P

Objective To evaluate the detenia cecocolon urinary reservoir for 30 patients with bladder cancer after total cystectomy. Methods A detenia continent cecocolon urinary reservoir was constructed for 30 patients with bladder cancer after total cystectomy. Results The patients have been followed up for 8～40 months. The capacity of the reservoir has been 360～580 ml with a maximum pressure of 19.5～78.5 cmH 2O one year later .Good continence has been achieved during day time in 93% and at night in 90%. Unileteral ureter stenosis and slight hydronephrosis was found on ultrasonography,IVU and pouch photography in 1 case. There has been no evidence of ureter reflux or impairment of renal function and serum electrolytes have been normal in all. Conclusions Detenia continent cecocolon pouch is fairly good for urinary diversion and the technique is simpler, easier with minimal complications.

Objective To study the change of clinical and urodynamic parameters in the patients with lower urinary tract symptom (LUTS) caused by detrusor overactivity (DO). Methods Two hundred and twenty-seven patients with LUTS underwent clinical evaluation from October 2006 to December 2008, including Prostate Volume (PV), International Prostate Symptom Score (IPSS), Peak Flow rate (PF) and Residual Urine (RU) measurement. Pressure flow studies were performed. The detrusor overactivity was recorded to classify the patients into 2 groups, DO group and none DO group. The clinical and urodynamic parameters were compared between the two groups. Results Mean patient age was 70 years (range 52 to 89). According to the urodynamic results, there were 126 patients in DO group and 101 patients in none DO group. The mean patients age was older in DO group than the none DO group(P＜0.05). Adjusted by age, the PV, PF, and RU were no different between the two groups(P>0.05). The mean first sensation of bladder, bladder compliance, cystometric capacity, bladder outlet obstruction parameters, single voiding volume and max detrusor pressure during contraction were different between the two groups(P＜0.05). Conclusions The main risk factors of DO are the ageing and BOO. The non invasive parameters such as PV、 PF、 and RU could not be used to judge DO. The changes of urodynamic parameters caused by DO were hyperaesthesia of bladder、lower bladder compliance、 higher max detrusor pressure and lower max cystometric capacity. This study emphasis the importance of the urodynamic studies in the aged patients with LUTS.

Objective To analyze the efficacy and the safety of ultrasound guided multiple-spot sector stereotaxis in unipolar cooling cycle radiofrequency ablation treatment of adrenal malignant tumors.Methods 36 adrenocortical carcinoma primary or metastatic tumors were treated with ultrasound guided percutaneous radiofrequency ablation by the multiple spot sector stereotaxis in unipolar cooling cycle.All patients were performed contrast enchanced ultrasound (CEUS) 15 minutes after treatment to determine whether the tumors were completely inactivated,if did not completely inactivated based on the imaging,the same therapy can be repeated.To evaluate response,contrast-enhanced CT scans (CECT) or CEUS were obtained 1 month after the procedure,if did not completely inactivated,the same therapy can be repeated.Before and after the procedure,the blood cortisol,adrenocorticotropic hormone (ACTH) and sugar level were detected and compared respectively.Results The efficacy:in the 36 lesions,31 lesions were inactivated and 5 lesions were residual by realtime CEUS.32 lesions were inactivated and 4 lesions were residual by CECT one month after the RFA therapy.There were no significant differences between the two groups(x2 =0.127,P =0.722).The hormone level:the blood cortisol,ACTH and sugar level were recovered normal after the therapy.The complication and adverse reaction:①Pain:all the patients felt slight pain and thermal expasion of the ablation region,among them,19 patients felt obvious pain were relieved after using analgesic.② Fluctuation of heart rate:14 patients' heart rate were slowed down,it was reached to 25-55 beats per minute,0.5mg atropine was given by intravenous injection to make the heart rate return to normal.③ Fluctuation of bloodpressure:9 patients' bloodpressure were elevated in the procedure,systolic pressure was 21-28 kPa,diastolic pressure was 13-19 kPa,5 mg nicardipine was given then relieved.There was no serious complication and dead cases in all the patients.Conclusions RFA is a safe and effective procedure for the treatment of adrenal malignant tumors and has great value in clinic applications.

Objective To examine the effect of nerve sparing cystectomy technique on postoperative continence after orthotopic bladder substitution. Methods A total of 73 consecutive male patients underwent cystectomy and construction of a colonic reservoir with low pressure.Of them nerve sparing were attempted in 48 cases (study group) and non nerve sparing in 25 (control group).The patients were followed up for 3 to 28 months.Postoperative continence was compared between the 2 groups through questionnaires and urinary pad test. Results After removal of the urinary catheter the continence rate was 65% in nerve sparing group and 34% in non nerve sparing group during the day;and it was 40% and 26%,respectively,at night.The mean time from post operation to continence during the day and at night in nerve sparing group was 2 and 4 months,respectively;while it was 5 and 10 months,respectively in non nerve sparing group.Twelve months after operation,the continence rate of nerve sparing group and non nerve sparing group was 96% and 79% during the day;and it was 87% and 64% at night,respectively.Continence differed significantly between the two groups (day, P =0.002;night, P =0.001). Conclusions Nerve sparing cystectomy is associated with improved urinary continence after orthotopic bladder substitution.

Objective To study the relationship between the bladder outlet obstruction(BOO)and the area under the curve of detrusor during voiding related parameters. Methods One hundred and thirty-eight patiens with benign prostate hyperplasia(BPH) underwent clinical evaluation, including physical examination, flow rate and post-void residual volume measurement. Pressure flow studies were performed. Mean patient age was 68 years (range 56 to 82). The AG number and the LinPURR were recorded to classify the patients into 3 groups, namely unobstructed, equivocal obstructed and obstructed, as the traditional classification. Two new parameters including the area under the curve of detrusor pressure during voiding(AUCdet) and the area under the curve of detrusor pressure during voiding adjusted for voided volume(AUCdet/Vol) were calculated and compared with the traditional classification using the Linear discriminant analysis. Results According to the traditional classification, there were 33 unobstructed, 32 equivocal and 44 obstructed cases. The AUCdet and AUCder/Vol of the 3 groups were different(P＜0.001). Linear discriminant analysis showed that of the cases, 90. 9%(30/33), 43.8%(14/32) and 70. 5%(31/44) were identically categorized by the traditional and the AUCdet/Vol classifications in the unobstructed, equivocal and obstructed groups, respectively. Conclusions The area under the curve of detrusor pressure during voiding related parameters appear to be good parameters of the BOO in patients with BPH. Further studies are needed to test the reliability and validity of these new parameters.

The coagulation VIII factor (FVIII) contains eight pairs of disulfide bonds, which are involved in maintaining its structure and function. It has been demonstrated that the disulfide bond between Cys¹⁸⁹⁹/Cys¹⁹⁰³ of the A3 domain in the light chain impedes secretion. In our previous work, an engineered inter-chain disulfide in the B domain-deleted FVIII (BDD-FVIII) promoted heterodimer assembly and secretion of separately expressed heavy and light chains. In this study, we constructed two BDD-FVIII variants, one of which contains an engineered inter-chain disulfide bond (F8C) between Met⁶⁶² > Cys and Asp¹⁸²⁸ > Cys mutations and another contains an endogenous A3 domain with a disrupted disulfide bond from F8C (F8CG) by replacement of Cys¹⁸⁹⁹ and Cys¹⁹⁰³ with Gly in F8C. We explored their function and secretion. By transducing F8C and F8CG into HEK293 and COS-7 cells, the formation of disulfide bonds and the secretion and coagulation activity of the two variants in the culture media and their binding affinity for von Willebrand factor (vWF) could be observed. The results show that variants F8C and F8CG are mainly the disulfide bonded heavy and light chain dimer, while the wild type BDD-FVIII (F8) is dominated by the easily dissociated heavy and light chain dimer. The secretion and activity of F8C was significantly higher than that of F8, while the secretion and activity of F8CG was significantly higher than that of F8C. The vWF binding of the two variants is similar to F8. This indicates that the BDD-FVIII variant F8CG may be attractive molecule for protein replacement and as a transgene in gene-therapy strategies. These findings are encouraging for future studies targeting disulfide bond elimination for further enhancement of FVIII secretion.

Objective To investigate the efficacy and safety of low dose of oral desmopressin in elderly women with nocturia. Methods Eligible female patients with nocturia older than 60 years were included in this study.A total of 97 patients were randomly divided into 2 groups.Care was taken to match the patients of the two groups by age and clinical criteria.Control group (n=48 ) received liquid restriction during nighttime.Experimental group (n=49) received 0.1 mg desmopressin at bedtime and liquid restriction for 8 weeks.Patients were required to visit the outpatient clinic from the first visit,and after 4 and 8 weeks of treatment.Patients maintained flow volume charts and used diaries to record voiding data throughout the study.At each visit,all patients were evaluated by blood biochemical routine test,mean nocturnal urine volume,mean number of nocturia,mean duration of the first sleep period and sleep quality.At baseline,all the patient's blood sodium,liver and kidney function were normal. Results After 4 weeks of treatment with desmopressin,28 patients (57.1％) had less than 2 voids.15 patients (31.3％) in the control group had less than 2 voids.After 8 weeks,35 patients (71.4％) with desmopressin had less than 2 voids.16 patients (33.3％) in the control group had less than 2 voids.Compared with control group,nocturia cure rate in experimental group was significantly higher after 4 weeks and 8 weeks (P ＜ 0.05).After 8weeks,desmopressin significantly decreased mean nocturnal urine output from 590 ± 70 ml to 376 ± 50 ml (P ＜ 0.05).Mean nocturnal urine output in the control group was not significantly decreased from 600 ± 90 ml to 550 ± 60ml (P ＞0.05) ; Mean number of nocturia before and after receiving desmopressin were 2.9 and 1.6 respectively which differed significantly (P ＜ 0.05).Mean number of nocturia before and after in control group were 2.8 and 2.3 respectively with no significant difference (P ＞ 0.05).The mean duration of the first sleep period increased by 73％ (from 2.2 to 3.8 h) in the desmopressin group,compared with an increase of 19％ (from 2.1 to 2.5 h) in the control group (P ＜ 0.05).39 (79.6％) patients in demopressin group were satisfied with sleep quality compared with only 15 (31.3％) patients in control group were satisfied (P ＜ 0.05).No serious complications were found during the medication.All the patient's blood sodium,liver and kidney function remained normal during treatment. Conclusions Low does oral administration of desmopressin could be an effective and well-tolerated treatment for nocturnal polyuria in elderly women.

Objective To explore the pathological and clinical features of renal epithelioid angiomyolipoma (EAML). Methods From February 2001 to June 2010,4 cases of renal epithelioed angiomyolipoma (EAML) diagnosed in our unit were reviewed on their clinical and histopathological feathers retrospectively.The prognosis of renal EAML were evaluated according to the immunohistochemical findings.Of the 4 cases,the first case had a history of nodular sclerosis and presented a sign of hemorrage caused by the rupture of the tumor.The second case also showed a sign of hemorrage complicated with hemorrhagic shock.The third case had no symptom,but suffered from clear cell carinoma concomitantly on the other kidney.The fourth case came for consultation for his bilateral angiomyolipoma.All the 4 cases had fat composition founded in their CT scans. Results The first case was taken biopsy on the tumor of her right kidney,and lost of follow-up 6 months later.The second case undertaken radical nephrectomy,and no tumor recurrence detected after 10 months follow-up.The third case undertaken right nephron-sparing nephrectomy,and left nephron-sparing nephrectomy 6 months later.No recurrence detected during the follow-up 8 months later.Bilateral resection of the angiomyolipoma was performed on the fourth case,and a malignancy on the left kidney was deteceded 6 years later,then a radical nephrectomy was performed.But liver metastasis was founded half a year later during the follow-up.Immunohistochemcial staining of these tumors showed positive HMB45 and Melan-A but negative CK and EMA. Conclusions Renal EMAL has malignant potentiality,and the aggressiveness of it makes the close follow-up compulsive.Immunohistochemcial study is useful for diagnosis and differential diagnosis,even helpful to assess the prognosis.

Objective To study the role of B-mode ultrasound found bladder trabeculation in evaluating the degree of bladder outlet obstruction (BOO) and the bladder function in benign prostatic hyperplasia (BPH) patients.Methods Conducted prospective research to determine differences in clinical data and urodynamic parameters between BPH patients with and without bladder trabeculation diagnosed by abdominal ultrasound.Results Thirty-six BPH patients with bladder trabeculation were compared with 68 BPH patients without bladder trabeculation.The mean age was (73.7 ± 10.1 ) years for the patients with bladder trabeculation and ( 69.6 ± 6.2 ) years without bladder trabeculation, IPSS was 24.4 ± 6.6 and 22.8 ± 8.3 respectively, in which no significant differences were found ( P ＞ 0.05 ).The detrusor pressure at maximum flow rate was ( 131.7 ± 57.3 ) cm H20 and (92.1 ± 47.8 )cm H2O ) respectively.The linearized passive urethral resistance relation was 4.6 :± 1.1 and 3.5 ± 1.5 respectively, showing a significant difference ( P ＜.05 ) between the two groups.Seventy-two point two percent (26/36) of the patients with bladder trabeculation had a low compliance bladder, among whom 23.1% (6/26) of the patients had bilateral hydronephrosis with renal insufficiency.The percentage for the control group was 42.6% (29/68) and 10.3% (3/29) respectively (P ＜ 0.05).Conclusions The bladder trabeculation found by B-ultrasound in BPH patients suggests the existence of BOO and a high risk of bilateral hydronephrosis.Bladder trabeculation in patients without urinary retention suggests they are in compensation status.Relief of the obstruction is helpful to recovery of bladder function and the reduction of complications.