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 .

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.

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

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.

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 summary our experiences on the clinical management of early complications caused by ureteroscopy and pneumatic lithotripsy. Methods From May 2002 to December 2007,totally 660 patients received ureteroscopy and pneumatic lithotripsy in our hospital,25 of them had surgical complications. Their clinical data were analyzed retrospectively. Results Among the 25 cases,22 patients had ureteral perforation,2 had ureteral disruptions,and 1 showed pelvic hematoma owing to ureteral perforation and injury to the ovary vein. Of the 22 cases of ureteral perforation,13 patients received lithotripsy and placement of a double J stent into the renal pelvis via the perforation site;and 4 patients underwent repair of the ureter. The other 5 of the 22 cases refused open surgery,and showed symptoms of urinary extravasation,loin pain,fever,or hematuria postoperatively;PCN was successfully completed in 3 of them but failed in the other 2,who underwent open surgery afterwards. For the 2 patients with ureteral disruptions,ureteroureteral anastomosis was performed. And in the case of pelvic hematoma,we carried out open surgery to ligate the bleeding vessels. All of the 25 patients were cured and discharged from hospital prosperously. The double J stent was withdrawn in 2 months after the operation,and 1-year follow-up showed no ureteral stenosis or obstruction by intravenous pyelography. ConclusionsPrimary management of ureteral injury by indwelling double J stent or percutaneous nephrostomy results in significantly deceased rate of re-operation. Conversion to open surgery timely can stop the incidence of other severe complications.