Objective To evaluate the occurrence of antiandrogen withdrawal syndrome in patients with advanced prostate cancer treated with combined androgen blockade. Methods 24 cases of advanced prostate cancer (10 in stage C and 14 in stage D) were retrospectively studied. All the patients have been treated with combined androgen blockade (bilateral orchiectomy and flutamide). After initial beneficial response to hormonal therapy (duration 7 to 36 months), the disease became progressing.Flutamide was then discontinued. Serum prostate specific antigen (PSA) levels and symptoms alterations were observed. Results Following withdrawal of flutamide, 8 patients showed a decline in PSA (mean 75%).In 6 the PSA declined more than 50%. Clinical symptoms improved in 4 patients and the prostate mass became smaller in 2. The mean duration of improvement was 4.3 months. Conclusions In patients with hormone refractory prostate cancer after initial combined androgen blockade, a trial of "antiandrogen withdrawal" is a reasonable therapeutic management prior to other more toxic therapies.

Objective To study the relationship between urinary heparin and human bladder transitional cell carcinoma(BTCC) Methods Reverse polarity capillary electrophonesis(RPCE)in a phosphate buffer was used to determine the value of urinary heparin in 19 patients with BTCC and in 9 normal individuals. Results The value of urinary heparin was (2.37?1.06)?g/L in 9 normal subjects,(1.11?0.45)?g/L in 9 patients with Ta～T 1 BTCC and (0.41?0.13)?g/L in 10 patients with T 2～T 4 BTCC. Conclusions Falling of urinary heparin in BTCC plays an important role in the occurrence and invasiveness of BTCC.

Objective To study the diagnosis accuracy and the treatment sequelae of adenocarcinoma of urinary bladder. Methods 41 cases of urinary bladder adenocarcinoma have been encountered from 1980 to 2000,all of them had undergone operation and the diagnosis being assessed on histopathology studies.There are 18 cases of primary bladder adenocarcinoma,among which 8 had undergone radical cystectomy and 10 partial cystectomy.Among 12 cases of urachal adenocarcinoma extending to the bladder,11 received extended resection.All the 11 patitents with metastatic focus in the bladder underwent local ablation. Results Urinary bladder adenocarcinoma comprised 3.2% of the bladder cancer.Thirty seven patients have been followed up for five months to ten years.The 1 year survival rate was 51.3%(19 cases),the 2 year survival rate 43.2%(16 cases) and the 5 year survival rate 21.6%(8 cases). Conclusions Radical total cystectomy is the treatment of choice for primary adenocarcinoma of bladder and extended partial cystectomy seems to be the best for urachal adenocarcinoma. Comprehension therapy should be undertaken for patients with metastatic adenocarcinoma or tumor recurrence so as to improve the survival rate.

Objective To evaluate the modified Stamey bladder neck suspension for female stress urinary incontinence. Methods 52 cases with an average age of 46 and an average stress incontinence history of 7.5 years underwent the modified Stamey procedure,18 cases being degree Ⅰ,21 degree Ⅱ and the other 13 degree Ⅲ. Results 32 cases were treated before 1994 and the outcome was evaluate at 3.6 years and 9.6 years postoperatively.There were 3 failures because of operative complication.The cure rates and failure rates at 3.6 and 9.6 years were 87.5%,68.8% and 6.2%, 21.9%,respectively.20 cases were treated after 1994 with a follow up of 4.3 years.The cure rate has been 90.0%. Conclusions The Stamey procedure yields high initial cure rates yet the latter declines with time.

Objective:To study the expression and significance of cyclinD 1 in 45 cases of transitional cell carcinoma of bladder.Methods:The expression of cyclinD 1 was detectde by immunohistochemistry(SP).Results: Expression of cyclinD 1 was found in 55.56% of TCCs and none of controls,and 78.57% of T a～T 1,11.76%of T 2～T 4.Approximately,85% of G 1,46.67% of G 2 and 10% of G 3 with the progress of tumors clinical stages and grades ,and the positive rates of cyclinD 1 expression decreased. There was no significant correlation between cyclinD 1 expression and number of lesions and postoperative reccurance.Conclusions: CyclinD 1 overexpression can play an important role in the early stage of bladder tumorgenesis.There was significant relativity between cyclinD 1 expression and the biological behaviour of bladder TCCs.

Objective To study the effect of tranilast on cyclosporine A (CsA)-induced epithelial-to-mesenchymal transition in human renal tubular epithelial cells, and investigate the mechanism of its antifibrotic effect. Methods Cultured HK-2 cells were divided into four groups: (1)In the control group, cells were treated without any medicine; (2) The cell were treated with CsA (4. 2μmol/L) for 72 h; (3) The cells were treated with a combination of CsA (4. 2 μmol/L) and tranilast (100μmol/L); (4) The cells were treated with tranilast (100 μmol/L) alone for 72 h.Morphological changes of the cells were assessed by phase-contrast microscopy. The immunofluorescence and Western blotting were adopted to detect the expression of E-cadherin, α-SMA and OPN mRNA and proteins respectively. Results Tranilast could markedly ameliorate the morphological changes of HK-2 cells stimulated by CsA. The irmmunofluorescence staining revealed the expression of E-cadherin was markedly decreased in HK-2 cells stimulated with CsA for 72 as compared with the control group, while the expression of α-SMA and OPN was significantly higher in CsA group than the control group. The expression of E-cadherin in the CsA + Tranilast group was higher than the CsA group, while the expression of α-SMA and OPN in the CsA + Tranilast group was lower than the CsA group. Western blotting showed that protein expression level of E-cadherin in CsA group was dramatically lower than that in the control group (P＜0. 05), while that of α-SMA and OPN in CsA group was significantly higher than in the control group (P＜0.05). The protein expression level of E-cadherin in HK-2 cells in the CsA + Tranilast group was markedly higher than in the CsA group (P＜0.05), and that of α-SMA and OPN in CsA + Tranilast group was significantly lower than in the CsA group (P＜0. 05). Conclusion Tranilast can block the CsA-induced epithelialto-mesenchymal transition in HK-2 cells probably by suppressing the expression of OPN.

Objective To present the experience of laparoscopic extraperitoneal radical prostatectomy and evaluate its safety and efficacy. Methods A total of 91 patients diagnosed with localized prostate carcinoma were admitted from February 2003 to June 2008. The level of serum PSA ranged from 7. 5 - 47. 0 ng/ml(mean 14. 0 ng/ml). The volume of the prostate ranged from 35 - 75 ml(mean 52 ml). Biopsy was performed before the operation and the pathological results revealed prostate carcinoma with Gleason score no more than 8. CT, MR and ECT revealed there was no lymph node or seminal vesicle involvement and there was no bone metastasis. The procedures were performed with an-tegrade techniques and pelvic lymphadenectomies were performed in 32 cases and nerve-sparings were performed in 11 cases. Results The operation duration ranged from 105 - 270 min (mean 173 min). Intraoperative blood loss was 110 - 1200 ml(mean 315 ml). Incontinence occurred in 19 cases in early stage and 18 cases recovered within 3 months. Positive surgical margin occurred in 11 cases. There was no complication of urethra stricture during 3 - 30 months' follow-up. No lymph node was involved in 32 cases with pelvic lymphadectomy. Five of the 11 cases received nerve-sparing prostatectomy had normal erectile function during the follow-up. Conclusions Laparoscopic extraperitoneal radical prostatectomy is a safe, effective and efficient surgical procedure with the minimal invasion, less morbidity and rapid recovery. Laparoscopic radical prostatectomy is emerging as an alternative to open radical prostatectomy.

Objective To report the modified liver mobilization technique in management of renal cell carcinoma with intrahepatic inferior vena cava thrombus. Methods 10 cases (7 men and 3 women at the average age of 49 years) of renal cell carcinoma with intrahepatic inferior vena cavs thrombus were reviewed.The operations were carried by using father clamp to control inferior vena cava,combined with hepatic portal blocking. Results There was no postoperative complication.The average blood loss was 800 ml.The mean hospital stay was 13 days.The time of follow-up ranged from 1 to 48 months. Conclusions The technique of using father clamp to control suprahepatic inferior vena cava combined with hepatic portal blocking is feasible for the treatment of the renal cell carcinoma with intrahepatic inferior vena cava thromhosis.

OBJECTIVETo study the diagnosis and treatment of prostate cancer after prostatectomy for benign prostatic hyperplasia (BPH).

METHODSTwelve cases of prostate cancer after prostatectomy for benign prostatic hyperplasia were reviewed and studied. The mean intervals between prostatectomy for BPH and the diagnosis of prostate cancer was 10 months to 14 years, 5.6 years on average. The main symptoms were dysuria, hematuria and pain. Serum prostate specific antigen (PSA) was elevated in 11 cases. Digital rectal examination (DRE) was abnormal in 8 cases. Three cases were in clinical stage B, 3 in stage C and 6 in stage D. Ten cases received combined androgen blockade therapy. Monotherapy with surgical castration was given to 2 cases. Three patients with urinary tract obstruction received additional treatment of TURP.

RESULTSDuring the 4 months to 8 years follow-up, 3 patients died, 6 remained stable and 2 deteriorated.

CONCLUSIONSurgery for BPH could not prevent the development of prostate cancer. PSA and DRE were the main methods for the diagnosis of this prostate cancer.

Aged ; Aged, 80 and over ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Prostate-Specific Antigen ; blood ; Prostatic Hyperplasia ; surgery ; Prostatic Neoplasms ; diagnosis ; Retrospective Studies ; Transurethral Resection of Prostate