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 .

ObjectiveTo investigate the expressions and significance of insulin-like growth factor Ⅱ and basic fibroblast growth factor in adrenal disease. MethodsThe experiment was divided into groups of adrenal pheochromocytoma,corticomedullary hyperplasia,cortical adenoma,normal adrenal tissue.Every group was 15 cases.Expression of IGF-Ⅱ and bFGF were detected by immunohistochemistry in adrenal disease. ResultsThere was a significant difference among the four groups(all P＜0.05).IGF-Ⅱ and bFGF expression was higher in adrenal pheochromocytoma tissue than that of corticomedullary hyperplasia and cortical adenoma.In the normal adrenal gland group was low expression or no expression.In each group,IGF-Ⅱ and bFGF protein expression was positively correlated(all P＜0.05).There also was a positive correlation between IGF-Ⅱ and bFGF positive cell and blood pressure in adrenal pheochromocytoma,corticomedullary hyperplasia and cortical adenoma(all P＜0.05). ConclusionIGF-Ⅱ and bFGF protein were closely related to the occurrence and development of human adrenal corticomedullary hyperplasia,cortical adenoma,pheochromocytoma,and played a role in hypertension caused by them.At the same time there was a synergistic effect between the IGF-Ⅱ and bFGF protein in adrenal disease.

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 evaluate the efficacy and safety of the InVance bulbourethral sling for stress urinary incontinence in male patients.Methods Five male patients with incontinence after prostatectomy were treated with the perineal sling(InVance).The patients aged from 62 to 76 years(mean,67 years),and the history of the incontinence ranged from 2 to 6 years(average 4 years).Four of the cases were due to TURP,and one radical prostatectomy.All the cases had been failed to respond to conservative therapies.Before the procedures,urodynamic examination showed a mean abdominal leak point pressures(ALPP)at 25.5 cm H2O(20-32.5 cm H2O).Under spinal anesthesia,a 3-to 5-cm vertical incision was made between the scrotum and the anus with the patients at the lithotomy position to expose the right and left ischiopubic branches.We put the three screws with its sutures on each bone and fixed the sling.A cough test was performed systematically and ALPP was set over 60 cm H2O.Results The operation time was 50-85 min(mean,60 min)and intraoperative blood loss was 20-50 ml(average 30 ml).The catheter was removed at day 5 and none of the patients had urination difficulty.The cases were followed up for 6 to 24 months(mean,12.6 months),during which urodynamic examination showed an ALPP at 65 cm H2O(55-70 cm H2O).Among the patients,the 4 who had received TURP were cured,and the other one undergone radical prostatectomy was improved.Conclusions InVance bulbourethral sling is suitable for mild-to-middle urinary incontinence after prostatectomy.

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.

Objective To study therapeutic effects of ureteroscopic treatment for ureteral stones after failed extracorporeal shock wave lithotripsy (ESWL). Methods A total of 23 patients with ureteral stones received ureteroscopic treatment after the ESWL had failed. By using pneumatic lithotripter and self-made needle-shaped electrotome, stones were fragmented and removed, and polyps were resected. Results Two patients with stones fragmented but surrounded by granuloma tissue received a polyp resection and stone extraction.Pneumatic ballistic lithotripsy and stone removal was conducted in 16 patients with stones partly fragmented.In 4 patients with stones adherent to the ureteral wall and polyps,the polyps were removed by using self-made needle-shaped electrotome and the stones were fragmented and extracted.And in 1 patient with stones embedded beneath the ureteral mucous membrane, which was difficult to be expelled,the mucous membrane covering the stones was opened by using the needle-shaped electrotome and the stones were fragmeathed and extracted.The procedure duration was 30~55 min(mean,42 min).Re-examination 6 months postoperatively found no residual stones. Conclusions After the ESWL had failed, patients with ureteral stones can be treated ureteroscopically by using pneumatic lithotripsy and self-made needle-shaped electrotome.

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.