Objective To study and to analyse the cause of laparoscopic adrenalectomy failure and its complications. Methods 8 of 19 laparoscopic adrenalectomies were converted to open surgery .The cause of failure and its complications were analysed. Results The causes to convert to open surgery were:bleeding of right middle suprarenal vein in 1,adrenal tumor was sheltered of cauda pancreatis in 1,left adrenal cyst was sheltered by spleen in 1,CO 2 pneumoperitoneal pressure can not be maintained during the procedure in 2,tumers could not be found in 2,the telescopic port was inserted into musculus psoas major in the retroperitoneal approach and the bleeding influenced the operation field in 1.3 patients had high fever after operations and 1 had an abscess in the adrenal bed.Reactive pleuritis occurred in 1. Conclusions Fine technique and experiences were needed for laparoscopic procedures and good team work between the operators was very important.Complications were often associated with the initial cause that led to the laparacospic adrenalectomy failure.Laparoscopic adrenalectomy via the retroperitoneal approach has been easier than that via the transperitoneal approach.

Objective To study the diagnosis, treatment, and prognosis of implantation metastasis to abdominal incision after open operation for bladder carcinoma. Methods 10 cases of implantation metastasis to abdominal incision after open operation for bladder carcinoma encountered from 1985 to 1999 were retrospectively studied,nine being male and 1 female.The average age was 52.7 years. Results These were 6 transitional cell carcinoma (all were grade G 3),2 transitional cell carcinoma with squamous carcinoma or adenocarcinoma,1 squamous carcinoma,and 1 adenocarcinoma.The diameter of the metastasis lesion was 1.4～11.5 cm?1.0～6.9 cm.The treatments included total cystectomy with resection of metastasis,TURBt with resection of metastasis,urinary diversion with chemotherapy and/or radiotherapy, resection of metastasis with chemotherapy and/or radiotherapy, and chemotherapy and/or radiotherapy alone.7 of the 10 died of the carcinoma,the survival times being 4～41 months (average 13 months).Only 1 patient survived for 41 months.Whereas the others died within 14 months.3 patients are still alive for 5～9 months with no recurrence. Conclusions The differentiation of the cancer cells of implantation metastasis is usually bad and often accompanied by squamous followed by carcinoma or adenocarcinoma.Total cystectomy with resection of the metastasis followed by chemotherapy and/or radiotherapy might prolong the survival time, but the prognosis is usually poor.

Objective To examine the efficacy and safety of Urocalun in treatment of calculus in ureter. Methods Sixty patients with calculus in the ureter were treated.The diameters of the stones were less than 1 cm.The patients were assigned to receive Urocalun orally,450 mg each time,3 times a day. Results Five weeks after Urocalun administration,the calculi were eliminated in 45 cases (75%).The calculi descended in 10 cases (17%).The positions of calculi remained unchanged in the rest 5 cases (8%).Four patients (7%) had mild uncomfortableness in stomach,nausea or thirsty after Urocalun administration. Conclusions Urocalun is effective for eliminating the calculus in ureters.

Objective To explore the appropriate time to block adrenal androgens in endocrine therapy of prostate cancer.Methods An human androgen-dependent prostate carcinoma xenograft model in SCID mice was established with LNCaP cells.Firstly,the serum PSA and tumor volume of 2 groups (castrated and not castrated) were measured on the 1,4,7,10,14,17,21,28,35,42,49 and 56 day to determine the recurrent time of prostate cancer after castration.Secondly,3 different groups of castration and adrenalectomy at the same time,adrenalectomy in recurrence after castration and sham adrenalectomy in recurrent after castration,were set to measure the serum PSA and tumor volume on the 1,4,7,10,14,17,21,28,35,42,49 and 56 day.The tumor tissues of 5 groups were harvested to measure testosterone concentration,and tumor progress in these groups was compared.Results The recurrence time was 14 days in castrated group,21 days in group with castration and adrenalectomy at the same time and 35 days in group with adrenalectomy in recurrence after castration.The testosterone concentration in tumor tissues was (2.69± 0.21) pmol/g in the group with castration and adrenalectomy at the same time,and (2.16±0.13) pmol/g in the group with adrenalectomy in recurrence after castration,and the difference was significant (P＜0.05).Conclusion Compared with the therapy of castration and adrenalectomy at the same time,the therapy of adrenalectomy in recurrence after castration may have slower progress course in prostate cancer.

Objective To establish age specific reference ranges of serum total prostatic specific antigen (T PSA) and to investigate the relationship between T PSA,free PSA (F PSA) and ratio of F PSA/T PSA(F/T) with age in benign prostatic hyperplasia (BPH) patients. Methods 913 consecutive cases were studied retrospectively.In all of them with the age ranged from 30 to 89, serum T PSA and F PSA levels were assayed.All the patients were suspected to be BPH or PCa,103 being diagnosed as PCa on biopsy under B ultrasound and the other 810 being BPH. Results The incidence rate of PCa was 11.3% in this group.Serum T PSA and F PSA levels were positively correlated with the age ( r=0.22,P

Objective To study effects of tethered spinal cord on functions of bladder and urethra. Methods Thirty six patients with tethered spinal cord were evaluated by video urodynamic studies. Filling phase function of bladder was evaluated by compliance of bladder and the presence of vesicoureteral reflux; voiding phase function of bladder was evaluated by maximal detrusor pressure; the synergy between detrusor and external urethral sphincter and continence of urethra were evaluated by voiding study with synchronous X ray image and pressure flow plot. Results 50% patients was diagnosed as detrusor areflexia with low compliance bladder, which was the main type of neurogenic bladder for patients with tethered spinal cord. And 22% was diagnosed as detrusor hyperreflexia. The incidence (83%)of damage of kidney function in patients with detrsusor areflexia and low compliance was significantly higher than patients with detrusor hyperreflexia ( P

Objective To analysis the impact of ? blocker therapy on symptoms of benign prostatic hyperplasia(BPH). Methods 148 cases of BPH patients had been treated with ? blocker for 4 weeks. Symptom score, uroflowmetry and post voiding residual urine were recorded and analyzed. Results After 4 weeks of treatment, the IPSS, uroflowmetry and residual volume were improved significantly, P 0.1. Conclusions Reduction of symptoms and improvements of uroflowmetry in BPH patients treated with ? blocker.might be initiated through different mechanisms.

Objective To compare the serum PSA (T PSA and F/T PSA ratio) between patients of benign prostatic hyperplasia (BPH) and prostate cancer (PCa). Methods We studied retrospectively 810 cases of BPH and 103 cases of PCa consecutively from November of 1996 to June of 1999 and compared the differences of T PSA level and F/T ratio between these two kinds of diseases. Results In BPH patients,serum T PSA 10 ng/ml were 71.7%, 22.1 % and 6.2% respectively while these were 10.7%,17.5% and 71.8% in PCa patients ( P 10 ng/ml(0.110 ng/ml.

Objective To evaluate urinary nuclear matrix protein(NMP 22) as an adjuvant diagnostic marker for transitional cell carcinoma of the upper urinary tract. Methods 24 patients with transitional cell carcinoma of the upper urinary tract and 20 patients with benign urinary diseass were evaluated with urinary NMP 22(cutoff level 10U/ml) and voided urinary cytology.NMP 22 was determined using a commercial test kit. Results The sensitivity and specificity of NMP 22 were 87.5% and 85.0% respectively whereas these of cytology were 58.3% and 95.0%. Conclusions Urinary NMP 22 might be an useful adjuvant diagnostic marker for transitional carcinoma of the upper urinary tract.

Objective Study the efficacy and safety of epristeride, a new uncompetitive 5?-reductase inhibitor, in the treatment of benign prostatic hyperplasia(BPH). Methods A multicentral opened clinical trial was conducted. 2 006 BPH patients were enrolled in the trial, in which 5mg epristeride was orally administered twice a day. Results After 4 months therapy, IPSS score was averagely decreased 6.12(28.8%) ( P