Objective To study the association between vitamin D status and bone mineral density(BMD) in aged people.Methods A total of 118 patients admitted in cadre department aged (77.7±11.2) years were selected from July 2010 to May 2011.The BMD at lumbar spine (L1-4) and femoral neck was measured by dual energy X-ray absorptiometry (DEXA).According to BMD,patients were divided into two groups:osteoporosis and non-osteoporosis group.The data of serum 25-hydroxy vitamin D3 [25(OH)D3]concentration,height,weight and age of patients were collected at the same time.Results The age and body mass index (BMI) in osteoporosis group were (81.6 ±5.6) years and (22.5 ± 4.0 ) kg/m2,while (79.4 ± 6.9 ) years and (24.1± 4.2 ) kg/m2 in nonosteoporosis group (t=1.80 and -2.01,P＞0.05).The concentrations of serum 25(OH)D3 in two groups were(21.6± 10.3)nmol/L and (32.0± 13.8) nmol/L,respectively(t=-4.20,P＜0.01).And there were 95.3 ％ (41/43 )and 81.3 ％ (61/75) of patients whose serum 25 (OH)D3 level were ≤50nmol/L in osteoporosis and non- osteoporosis group,respectively(x2 =4.58,P＜0.05).Furthermore,the 25 (OH) D3 level was positively correlated with BMD at femoral neck(r=0.22,P＜0.05),but not correlated with BMD at L1-4 ( r=0.18,P＞0.05).Conclusions Vitamin D status is correlated with BMD at femoral neck in aged people.

Objective To determine the relationship of bone mineral density (BMD) with age and sex hormone in elderly men. Methods The BMD in orthotope lumbar vertebra, femur neck, greater trochanter, Wards triangle region and shaft of femur were measured by dual-energy X-ray absorptiometry (DEXA), and serum testosterone (TT) and estradiol (E2) were determined by chemiluminescence in 360 elderly men. According to age and BMD, the elderly men were divided into several groups. The differences in BMD, serum TT and E2 among the groups were compared. Results There were 48 cases in osteoporosis group, 72 cases in bone mass reduction group and 240 cases in normal control group. The BMD in femur neck, greater trochanter of femur, Wards triangle region and shaft of femoral were decreased with ageing (F=3. 038,3. 029,3. 024,3. 021, respective, all P<0.05). In>80 age group, the BMD in femur neck, greater trochanter of femur, Wards triangle region and shaft of femoral were (0. 70±0. 140), (0. 682±0. 185), (0. 629±0.211), (0. 986± 0. 160)g/cm2, respectively;In 70-80 age group, they were (0. 829±0. 156), (0. 765±0. 170), (0. 698±0.187), (1. 042±0. 190) g/cm2, respectively;In 60-70 age group, they were (0. 875± 0. 138), (0. 800±0. 130), (0. 731±0. 145), (1. 071±0. 125)g/cm2, respectively. The differences in BMD of L1-4 had no statistical significance among different age groups(F=2. 988, P>0.05). There was no difference in level of serum TT among normal control group, bone mass reduction group an dosteoporosis group (F=3. 032, P>0. 05), while the level of serum E2 in the three groups were (180. 6±62. 3), (130. 5±39.9) pmol/L and (110. 5±68. 5) pmol/L, respectively. Bone mass was decreased with the decreased serum E2 level(F=3. 059,P<0. 05). Conclusions BMD is declined with ageing, and the level of serum E2 may affect the occurrence of osteoporosis in elderly men.

Objective To evaluate the feasibility of laparoscopically assisted dismembered pyeloplasty without the V-flap reconstruction.Methods A total of 13 cases of ureteropelvic junction obstruction(UPJO) underwent laparoscopically assisted dismembered pyelopasty via a small incision through the retroperitoneal approach without the V-flap pyeloplasty technique.After exposing the proximal ureter and renal pelvis to identify the UPJ obstruction,the UPJ area is then excised and the apex of the ureter is then anastomosed to the most inferior aspect of the renal pelvis. Results All the operations had been successfully completed.The operating time was 100~180 min(mean,121 min),and the intraoperative blood loss,30~100 ml(mean,70 ml).Follow-up for 3~20 months(mean,12.3 months) in 12 cases revealed a full recovery of renal functions and disappearance of hydronephrosis.Conclusions Laparoscopically assisted dismembered pyeloplasty without the V-flap reconstruction is feasible in the treatment of UPJO.

Objective To evaluate the features of pelvic lymph node metastasis and the significance of lymph node dissection in bladder cancer patients treated with radical cystcetomy. Methods The data of 77 bladder cancer patients(58 males and 19 females with mean age of 57 yrs)treated with radical eystectomy and pelvic lymph node dissection from Jan. 1990 to Dec.2008 were analyzed retrospectively.Preoperative TNM staging showed stage T1 tumor of 9 cases,stage T2 of 24 cases,stage T3 of 39 eases and stage T4 of 5 cases.The pelvic lymph nodes were divided into 5 groups according to the anatomic sites.The metastatic rate and dissected lymph node positive rate in these patients were compared. Results The metastatic rate and dissected lymph node positive rate were 27.3%(21/77)and 14.8%(233/1576),respectively.The metastatic rate in these patients from higher to lower were as follows:obturator group 19.5%(15/77),internal iliac group 19.3%(11/57),external iliac group 13.7%(10/73),common iliac group 5.3%(3/57)and presacral group 3.8%(1/26),with a significant difference in those groups,P<0.01.The dissected lymph node positive rates from higher to lower were as follows:external iliac group 23.0%(83/361),obturator group 22.1% (103/467),common iliac group 9.5%(17/179),internal iliac group 6.8%(28/411)and presacral group 1.3 % (2/158), with a significant difference in those groups, P<0.01. There was no metastasis in 9 eases with stage T, tumor. Conclusions In the radical cystectomy for the treatment of bladder cancer, it is suggested that the regional lymph nodes with higher metastatic rate should he resected accordingly, and the group with a higher metastatic rate should be dissected completely. The operation extent may be adjusted according to the result of sentinel lymph node biopsy in the obturator or presacral groups. The pelvic lymphadenectomy is not suggested in the cases of stage T1 tumor.

Objective To observe the effect of dexmedetomidine on patients′ inflammation during CPB and protective effect on kidney and liver. Methods 60 cases undergoing cardiac valve replacement under CPB were randomly divided into NS group and Dex group. Blood samples were taken before induction , before ascending aorta blocked, end of CPB, 24, 48 and 72 hours after operation. The serum level of HMGB-1, TNF-α, IL-6, BUN, Cr and ALT are tested. Blood WBC and N% are also counted. Results WBC, N% and HMGB-1, TNF-α, IL-6, BUN, Cr in Dex group significantly decreased at time point T2 ~ T6 (P < 0.05) compared with NS group. But ALT in Dex group only decreased at time point T 2 and T5 compared with NS group (P < 0.05). Conclusion Dexmedetomidine can significantly decrease inflammatory factor during CPB and improve renal function after surgery.

Objective To describe the retroperitoneal laparoscopy-assisted Anderson-Hynes dismembered pyeloplasty with small incision for the treatment of ureteropelvic junction obstruction (UPJO) and to evaluate its clinical effect. Methods Twelve cases of UPJO (8 men and 4 women;age range,5-48 years) underwent retroperitoneal laparoscopy-assisted, small incision,dismembered pyeloplasty.Of them,4 cases had severe hydronephrosis;6,intermediate;and 2,mild by B-ultrasound and urography.Nine cases had good IVU imaging and 3 had poor IVU imaging. Results All the procedures were successful.The operative time was 100-180 min (mean,127 min);the blood loss was 30-100 ml(mean,70 ml) and the postoperative hospitalization was 5-8 d (mean,5.6 d).No perioperative complication occurred.Follow-up of 3-12 months by intravenous urography and B-ultrasound showed no stricture at UPJ,and hydronephrosis was remitted and renal functions were improved. Conclusions Retroperitoneal laparoscopy-assisted Anderson-Hynes dismembered pyeloplasty with small incision is a feasible,minimally invasive and effective way to treat UPJO with less morbidity and shorter convalescence.

Radical cystectomy is widely used as a gold standard in the treatment of invasive bladder cancer. Urinary diversion is required after radical cystectomy. In all kinds of urinary diversion procedures, orthotopic neobladder is preferred by its advantages such as spontaneous voiding, avoidance of external ostomy and improvement of body image. After surgery, urinary incontinence is a common complication. In this review, we systematically outline the management of urinary incontinence in men after radical cystectomy and orthotopic neobladder. And we mainly describe the influential factors of urinary incontinence, such as preoperative diabetes, intraoperative intestinal selection and nerve preservation, and postoperative urinary tract infection. The related post-operative management of urinary incontinence that has been conducted previously is also described in detail. The aim of this study is to provide guidance for the systematic treatment of urinary incontinence in clinical practice, and to look forward to the possible future development directions of urinary incontinence treatment, such as bladder neck reconstruction and stem cell therapy.

Objective To compare two operative approaches for treatment of distal hypospadias. Methods One hundred and seven patients were recruited into the study. Group1(n=51) underwent OUPF and group2(n= 56) underwent TIPU repair. The results were analyzed with Chi-square and two Sided test. Results Operative times for OUPF and TIPU repair were (103±29) min and (92±21)min respectively (P>0.05). Fistula occurred rates were 7.8% (4/51)and 14.2% (8/56) (P>0.05). Satisfied rates for the appearance of the penis post-operation were 84.8% (39/46)and 87.8%(36/41) respectively (P>0.05). 87 patients were followed up. With mean follow-ups of 15 months (range 6 to 47) , the overall complication rates were 15.7% (8/51) and 32.1 % (18/56)(P<0. 05) for OUPF and TIPU repair. Only 4 of 51 patients (7.8%) undergoing OUPF underwent re-operations, compared to 15 of 56 patients (26.8%) undergoing TIPU repair (P<0.001). A plateau uroflow curve (vs normal bell curve)was observed in 33.3% (13/39)and 67.6(25/37) ,respectively(P<0. 001). The average flow rate was 9. 4 ml per second (range 3. 2 to 17. 1) in patients undergoing OUPF repair, compared to 6. 8 ml per second (3. 3 to 15, P<0. 05) for those undergoing TIPU repair. Mean peak flow rates were12.2 ml per second (range 3.9 to 22.9) and 8. 3 mi per second (range 3.7 to 18. 1, P<0.01) for OUPF and TIPU procedures. Conclusion OUPF is superior to TIPU in the surgical treatment of distal hypospadias.

Objective To evaluate the clinical value of the modified nerve-sparing open antegrade retropubic radical prostatectomy (MNS-ORP).Methods MNS-ORPs were performed in 30 patients with clinically localized prostate cancer.The modified technique included: endopelvic fascia was not incised, the prostate capsule was freed laterally from surrounding fasciae and dorsally;using the method of separating the peripheral fascia of the prostate, the Veil technique was applied to the open operation, that is, the modified Veil perserving nerve technology;pelvic lymph node dissections (9 regions and 5 groups) were extended;bladder neck preservation was completed;deep dorsal vein complex was bunched;jumper intussusception technology was applied for bladder and urethral anastomosis.Functional outcomes of continence and sexual function (IIEF-score) were followed-up.Results Median age of patients was 62 years old, and the level of PSA was 11.9 ng/ml.Median operating time was 150 minutes (75-240 minutes), blood loss was 350 ml (100-1 600 ml), preoperative IIEF-score was 21 scores (15-25 scores).Pathologic stage included pT1 (8 cases), pT2a (15 cases), pT2b (4 cases) and pT3a (3 cases).By Gleason score, there were 2 cases of 5 scores, 7 cases of 6 scores, 20 cases of 7 scores and 1 case of 8 scores.4 cases had positive margins including 2 cases (10.5 ％) of pT2 and 2 cases (67 ％) of pT3.There were no postoperative complications.Mean follow-up was 19 months (6-48 months).At the 1st month, 27 patients (90 ％) got full continence, and at the 3rd month, all of the patients had full continence.At the 3rd month and the 6th month, median IIEF-scores were 13 and 19 scores, respectively with baseline of IIEF-score reaching by 40 ％ (at the 3rd month) and 70 ％ (at the 6th month) of preoperative level.Conclusions MNS-ORP follows rationales of radical prostatectomy and might be considered for selected patients.Preserving all periprostatic fasciae/nerves can recover early continence and maintains potency without affecting outcomes.

Objective To evaluate the efficacy of 1-stage urethroplasty using pedicle circular fascioctaneous preputial flap for the treatment of complex anterior urthral strictures.Methods Between January 2006 and January 2013, 37 patients with complex anterior urethral stricture were treated by 1-stage urethroplasty using pedicle circular fascioctaneous preputial flap.The mean age was 41 years ( 22 -71 years) .The etiology of stricture included trauma of 13 cases, iatrogenieity of 13 cases, gonorrhea infection of 2 cases, unknown reason of 9 cases.The penile urethral stricture was found in 22 cases, the bulbourethral stricture in 9 cases, and stricture extending from penile to posterior urethra in 6 cases.The mean length of anterior urethral stricture was 8.1 cm (range 5.0-14.0 cm).A circumferential island of the preputial/distal penile skin was mobilized by the technique of preserving penile fasciocutaneous wide vascular pedicle. The pedicle is composed of two layers of the dartos and the superficial lamella of Buck′s fascia, and the flap was divided in the midventral/middorsal plane back to the penoscrotal junction to convert the circular configuration to a longitudinal trip for urethral reconstruction.The dorsal and ventral inlaid flap urethroplasty was performed in 27 cases and tubularized flap urethroplasty was performed in 10 cases.Results The mean operative duration was 3.1 h (2.5-3.5 h).The mean length of the circular fascioctaneous preputial flap was 10.4 cm (range 9.0 -14.0 cm).All the patients were followed up for mean 22 months (3 -51 months).Thirty-two cases voided well and the mean peak urinary flow rate was 22.3 ml/s (15.0-29.0 ml/s).One-stage healing achieved in 32 cases (86.5%).Recurrent stenosis was noted in 4 cases, and meatal stenosis occurred in 1 patient, who required re-operation.Re-repair succeeded in 4 cases and total success rate was 97.3% (36/37).Conclusions The pedicle circular fascioctaneous preputial flap has advantage of good blood supply and autograft for new meatus.It could be a reliable and durable method for the treatment of complex anterior urthral strictures(≥5 cm) in 1-stage urethroplasty.