THe insulin-like growth factor(IGF) system,a very important polypeptide growth hormone,has been found to have some relation with primary adrenocortical tumorigenesis and modulates its growth.This article reviews the general biological characteristics of IGF and the relations of the IGF system with the normal adrenal cortex and primary adrenocortical tumor.It also and discuss the clinical meaning of its possible presence in the primary adrenocortical tumor.

Objective To explore the diagnosis and treatment of adrenal black adenoma . Methods From June 2002 to July 2014, 7 patients with adrenal tumors were treated with retroperitoneal laparoscopic partial adrenalectomy in our hospital .During the operation all the patients were placed in healthy lateral decubitus position .Three trocars were introduced into the lumbar region:below the 12th rib along the anterior and posterior axillary lines , and 2 cm beyond superior iliac spine on the middle axillary line .The retroperitoneal space was established with homemade balloon-expanding devices .Afterwards , the tumors were removed by using a harmonic scalpel. Results All the tumors were resected completely .The average operation time was 60 min (range, 34-90 min) and the average blood loss in the operation was 70 ml (range, 20 -200 ml) without blood transfusion.The drainage tubes were removed on the 3rd or 4th postoperative day and the patients were discharged on the 6th or 7th postoperative day .They were pathologically diagnosed as adrenal black adenoma . Two patients manifested the Cushing ’ s syndrome and 3 patients showed hypertension , all of which were recovered to normal postoperatively .No recurrence or metastasis was noted during a follow-up for 12-24 months (mean, 18 months). Conclusions Adrenal black adenoma, without specific clinical features, is a rare kind of adrenocortical adenoma .The confirmative diagnosis depends on pathological results .Retroperitoneal laparoscopic surgery is a minimally invasive, safe and effective technique for adrenal black adenoma , which provides favorable prognosis .

A total of 92 patients with benign prostatic hyperplasia (BPH) were subjected to modified Madigan prostatectomy (MPC) for a much satisfactory effect in open prostatectomy surgery. Exposing anterior prostatic urethra near the bladder neck and conjunct cystotomy modified the MPC procedure. This modified procedure preserved prostatic urethra intact and could also deal with intracystic lesions at the same time. The intact of prostatic urethra was kept completely or largely in 86 cases. The amount of blood loss during modified procedure was less. The mean operative time was 105 min. Seventy patients had been followed up for 3-24 months. The postoperative average Qmax was 19. 2 ml/s. The cystourethrography revealed that the urethra and bladder neck were intact in 10 patients postoperatively. Furthermore, the prostatic urethra was obviously wider after modified MPC. The modified MPC can reduce the occurrence of urethra injury and enlarge the MPC indications. The modified technique is easy to perform with less complications and much satisfactory clinical result.
Follow-Up Studies ; Postoperative Complications/*prevention & control ; Prostatectomy/*methods ; Prostatic Hyperplasia/*surgery ; Retrospective Studies ; Urethra/injuries

To evaluate the safety and efficacy of transrectal high-intensity focused ultrasound (HIFU) in the treatment of benign prostatic hyperplasia (BPH), serial studies were conducted in 150 BPH patients before and 30 min, 1, 2, 6 and 12 month(s) after Sonablate-500 HIFU treatment. A silicon-coated indwelling 16F latex catheter was placed during the determination of the therapy zone. Preoperative and postoperative evaluations were made by using the international prostate symptom score (IPSS), quality of life (QOL), uroflowmetric findings and transrectal ultrasound, and incidence of complications. The cystourethrography was done in 23 patients within 1 year postoperatively. The results showed that after HIFU treatment, IPSS and QOL scores were significantly decreased at 1, 2, 6 and 12 month(s) (P<0.01). Maximum urine flow rate (6.0 to 17.2 mL/s, P<0.01), PVR (75.0 to 30.3, P<0.01) and prostatic volume (65.0 to 38.1 mL, P<0.05) were significantly improved 12 months after the operation. Recurrent urinary retention (n=2) and urethrorectal fistula (n=1) occurred at the 15(th) postoperative day. The duration of the HIFU prostate ablation was 25-90 min. The mean time for an indwelling catheter was 3-19 days. These data demonstrate that treatment of BPH with Sonablate-500 HIFU is safe and effective.
Prostatic Hyperplasia/diagnosis ; Prostatic Hyperplasia/*therapy ; Ultrasound, High-Intensity Focused, Transrectal/adverse effects ; Ultrasound, High-Intensity Focused, Transrectal/instrumentation ; Ultrasound, High-Intensity Focused, Transrectal/*methods

The congenital stricture (idiopathic urethral stricture) mostly lies in the anterior urethra and mainly occurs in boys. Hemangioma is the most common symptom of the idiopathic urethral stricture. Acquired strictures are due to four main causes. latrogenic urethral stricture is mainly caused by performing the transurethral resection, prostate, cystoscopy, prolonged catheterization, hypospadias repair and prostatectomy and so on. Bacteriuria is especially nosocomial with post operative infection in urethral strictures. Virus such as condylomata is another cause. Lichen sclerosis is a chronic progressive inflammatory condition of unknown cause and has the development of urethral strictures. Blunt anterior urethral injury is commonly associated with perineal straddle injury, while posterior urethral injury is accompanied pelvic fracture, penetrating injuries predominantly comes from gunshots involve both anterior and posterior urethra. Urethral injuries in children and females are rare. Here, we mainly investigated the causes of idiopathic and acquired urethral stricture.

Objective To report the experience in managing complex posterior urethral obliteration with dartos island skin flap. Methods 32 patients with complex posterior urethral obliteration were treated with dartos island skin flap substitution urethroplasty.Partial resection of the inferior pubic synphysis was needed to facilitate high proximal placement of the flap. Results The outcome was excellent in 31 (97%).Including subsequent procedures,the over all 3 months～7 years fllowup investigations were carried out in 27 patients.Urinary flow rates of more than 15 ml/s (for adults) and 8 ml (for children) could be achieved in 25 of 27 patients.Two patients with urinary flow decreased required further reconstruction.The hairy pouch formed within scrotal skin flap was noted in two patients. Conclusions Dartos island skin flap urethroplasty is a highly effective 1-stage method of reconstructing complex posterior urethral obliteration.

Objective To summarized the management of Fournier’s gangrene. Methods This series included 16 patients with Fournier’s gangrene (all male;mean age,51 years).Of them,13 cases had scrotal gangrene and 3 had dermal gangrene of penis.Bacterial culture was performed in 14 cases and 9 were positive.All the 16 patients underwent surgical treatment including incisions,aggressive debridement,drainage,irrigation,and antibiotic therapy;of them 4 patients received hyperbaric oxygen therapy. Results Thirteen patients underwent phase Ⅱ suture and recovered.Three patients died;of them 2 died of septicemia and 1 elderly patient who had earlier developed renal dysfunction died of multi-organ failure. Conclusions Mangement of Fournier’s gangrene primarily consists of early and aggressive debridement,administration of broad-spectrum antibiotics and sufficient local drainage if available,hyperbaric oxygen therapy may be used to promote the healing of tissue wound.

Objective To evaluate the clinical effectiveness of the Invance sling in treating children incontinence caused by neurogenic sphincteric incompetence. Methods Two children were treated with Invance sling for their neurogenic sphincteric incompetent incontinence because of congenital myelodysplasia.Both were male,aged of 9 and 10,respectively. Results Two patients were followed up of 12 and 14 months.Both patients micturated once each 2～4 hours with 1～2 episode of incontinence by chance in the daytime and without urinary pad.The maximum bladder capacities were 163 ml and 223 ml pre-operatively and those were 164 ml and 230 ml post-operatively,the retrograde maximum urethral pressures or retrograde leak point pressures were 37 cmH_2O and 27 cmH_2O pre-operatively while those were 45 cmH_2O and 37 cmH_2O post-operatively,maximum urethral closing pressures were 37 cmH_2O and 26 cmH_2O pre-operatively while those were 40 cmH_2O and 37 cmH_2O post-operatively,the functional urethral lengths were 2.5 cm and 3.0 cm pre-operatively while those were 3.5 cm and 4.0 cm post-operatively,the post-voiding residual urine volumes were 40 ml and 30 ml pre-operatively while those were 6 ml and 25 ml post-operatively.Post-operative voiding cystourethrography demonstrated that it was pressed to narrow at the suspended in the bulbous urethra segment. Conclusions The sling in treating children neurogenic sphincteric incompetent incontinence is simple,mini-invasive.It can increase the urethral resistance and continence better.But it has specific indication and should be applied prudently.

Objective To study the treatment of middle and lower ureteral stone with polyp by pneumatic lithotripter under ureterscopy. Methods 56 cases of middle and lower ureteral stone with polyp treated from Feb-ruary 2000 to August 2002 were retrospectively analyzed. Results All patients were successfully operated on and no complication occurred. Conclusions Middle and lower ureteral stone with polyp can be treated by pneumatic lithotripter under ureterscopy.

Objective To study the clinical application of a self-made needle-shaped ureteroscopic electrotome in the treatment of ureteral stricture. Methods Sixty-seven patients with ureteral stricture (24 cases of stricture after ureterlithotomy, 39 cases of ureteral polyp and 4 cases of congenital stricture) were operated on by using self-made needle-shaped electrotome under ureteroscope. Results The operating time was 10~30 min and the intraoperative blood loss was 5~20 ml. Follow-up for 3 months showed effective results in 53 cases (79 1%), improved in 10 cases (14 9%) and unresponsive in 4 (6 0%). No severe complications emerged. Conclusions Application of self-made needle-shaped ureteroscopic electrotome in the management of ureteral stricture gives simple performance.