Objective To present our initial experience of pure laparoendoscopic single-site surgery (LESS) for radical cystectomy and bilateral pelvic lymph node dissections. Methods 10 patients with pathology confined bladder urothelial carcinoma underwent laparoendoscopic single-site radical cystectomy, including 9 males and 1 female. After a 3-4 cm lower median abdominal incision was made, quadport or homemade single multichannel port was inserted, and conventional and prebent laparoscopic instruments were utilized. The surgical procedure included bilateral pelvic lymphadenectomies, radical cystectomy and building with a sigmoid orthotopic neobladder by open surgery.Results No extra port needed, neither conversion to open or conventional laparoscopic surgery. The time of LESS procedure ranged from 130 to 330 min (mean 243 nin). Estimated blood loss ranged from 50 to 600 ml (mean 270 ml). 5 patients needed blood transfusion of 2 to 4 units. The pathologic evaluation revealed bladder urothelial carcinoma, negative margins and negative pelvic lymph node involvement. No mortality or severe complications were observed perioperatively. After followup of more than 6 months, all revealed controllable urination at daytime, while 4 revealed nocturnal incontinence and needed one or two pads during nighttime. No evidence of recurrent or metastatic disease was detected. Conclusions LESS radical cystectomy and bilateral lymphadenectomies was safe and feasible, and short-term follow-up showed good tumor control outcomes. Homemade single multichannel port made of two elastic ring and glove was simple and effective.

Objective To discuss the feasibility of percutaneous nephrolithotomy (PCNL) for treating upper urinary calculi under local anesthesia.Methods One thousand three hundred and sixty-three patients who suffered with upper urinary calculi were treated with PCNL, the puncture and tracts were created using local anesthesia and guided through ultrasound.Of the 1363 patients, 475 patients had complicated renal caluli, 520 patients had kidney pelvic calculi and 368 had upper uretere calculi.Results All of the patients successfully received PCNL under the local anesthesia.Of the 1363 patients five tracts were used in two patients, four tracts were used in four patients, three tracts were used in nine patients, double tracts were used in 25 patents and one tract was used in the remaining patients.The stone-free rate was 96.0% in the kidney pelvic calculi patients, 100.0% in the upper uretere calculi patients, and 90.1% in the complicated renal caluli patients.90.0% patients were find well throught the operation, 10.0% patients find a little pain and solved by another more 5 - 10 ml lidocaine local injection or 50 - 75 mg pethidine hydrochloride intramuscular injection.No case stop operation because of pain or position changed.All without any severe complications such as damaged of liver, spleen, thorax and intestine.Conclusion The PCNL handled under local anesthesia was simple safe and effective, deserved clinical popularizing use.

OBJECTIVETo summarize our initial experience with laparoendoscopic single-site (LESS) retroperitoneal lymph node dissection (RPLND) for treatment of nonseminomatous testicular cancer.

METHODSFrom September 2010 to June 2011, 3 patients (aged 19-27 years) with right testicle enlargement and elevated alpha-fetoprotein level underwent right radical orchidectomy. Histopathological analysis revealed nonseminomatous germ cell tumor. LESS-RPLND was performed 3 weeks after orchiectomy. The homemade port was inserted through a 3-cm right pararectal incision in the right lower quadrant for unilateral RPLND using nerve-sparing technique and modified right-sided template removal similar to those in open RPLND.

RESULTSThe operation was successfully performed with a mean operative time of 240 min and a mean estimated blood loss of 50 ml. No conversion to open or conventional laparoscopic surgery was required. No major perioperative complications were observed. For the first case, the number of lymph nodes obtained for final histopathological examination was 11, and two positive nodes were detected. For the other 2 cases, no positive nodes were detected. Chemotherapy was administered in the first case. Alpha-fetoprotein level decreased close to the baseline one week postoperatively and no relapse occurred in these cases 3 month after RPLND. Follow-up at 1 year after the surgery showed good tumor control and preservation of the sexual function.

CONCLUSIONLESS-RPLND is safe and feasible for treatment of nonseminomatous testicular cancer, and the pararectal incision provides an ideal surgical approach with good cosmetic result, but the long-term effect needs to be tested by further large population-based study.

Adult ; Follow-Up Studies ; Humans ; Laparoscopy ; methods ; Lymph Node Excision ; methods ; Male ; Neoplasms, Germ Cell and Embryonal ; surgery ; Orchiectomy ; Retroperitoneal Space ; surgery ; Testicular Neoplasms ; surgery ; Young Adult

OBJECTIVETo investigate the effect of docetaxel on the interaction between C-jun and androgen receptor (AR) in prostate cancer LNCaP cells and its androgen-independence subtype LNCaP-bic cells.

METHODSLNCaP and LNCaP-bic cells were treated with docetaxel and the changes in AR and AP-1 expression were evaluated using luciferase assay. Western blotting and immunoprecipitation assay were employed to analyze the effects of docetaxel on the expressions of C-jun and AR and their interaction.

RESULTSLuciferase assay showed that LNCaP and LNCaP-bic cells expressed higher levels of AR and C-jun after docetaxel treatment. Docetaxel induced a higher level of p-c-jun expression in LNCaP-bic cells than in the parental LNCaP cells. Western blotting showed a strong PSA protein expression in LNCaP-bic cell after docetaxel treatment. Docetaxel caused a stronger interaction between AR and C-jun in LNCaP-bic cells.

CONCLUSIONDocetaxel activates ligand-independent AR transcription, and the interaction between AR and C-jun may affect the outcome of docetaxel chemotherapy.

Cell Line, Tumor ; Humans ; Male ; Prostate ; metabolism ; Prostatic Neoplasms ; metabolism ; Proto-Oncogene Proteins c-jun ; metabolism ; Receptors, Androgen ; metabolism ; Taxoids ; pharmacology

OBJECTIVE[corrected] To evaluate the method and technique of single-port laparoscopic radical nephrectomy.

METHODSForm January 2009 to September 2011, 22 patients with renal carcinoma were treated with single-port laparoscopic radical nephrectomy. An incision about 5 cm in length was made through the umbilicus or in the postaxillary line under the 12th rib to establish the peritoneal or retroperitoneal working space. A single-port cannulation was deployed and the operation was carried out using standard and crooked laparoscopic equipment.

RESULTSThe operations were completed successfully in all the 22 cases without conversion to open surgery, but additional trocar was needed in 5 cases. The mean operative time of radical nephrectomy was 150 min (90-240 min). The mean postoperative hospital stay was 7.6 days (3-15 days). The operation left a roughly 5-cm-long scar in all the cases.

CONCLUSIONSingle-port laparoscopic radical nephrectomy is safe and feasible with good cosmetic effect and shows much potential in radical resection of renal carcinoma.

Adult ; Aged ; Female ; Humans ; Kidney Neoplasms ; surgery ; Laparoscopy ; methods ; Male ; Middle Aged ; Nephrectomy ; methods ; Young Adult

OBJECTIVETo investigate the effect of stable knockdown of DNA methyltransferase 3b (DNMT3b) on the proliferation and apoptosis of bladder cancer cells.

METHODSLentivirus expressing DNMT3b siRNA or the negative control siRNA was infected in human bladder cancer BIU-87 cells. MTT assay and flow cytometry were used to detect cell proliferation and apoptosis, respectively. The inhibitory effect of DNMT3b knockdown on xenograft tumors in nude mice was observed. Real-time PCR and Western blotting were carried out to investigate the expression level of cell apoptosis related genes. Methylation specific PCR was used to examine the methylation in the promoter region of the cell apoptosis related genes.

RESULTSThe results of real-time PCR and Western blotting showed that DNMT3b mRNA and protein level were stably knocked down in BIU-87 cells. Stable DNMT3b knockdown suppressed BIU-87 cell growth and the tumor formation ability of the cells in nude mice. DNMT3b knockdown promoted the apoptosis of BIU-87 cells, increased the mRNA and protein expression of the cell growth and apoptosis related genes including DAPK, Bax and RASSF1A, and significantly decreased the methylation of these genes.

CONCLUSIONStable DNMT3b knockdown can affect the methylation of the cell growth and apoptosis related genes to regulate their expression, which might be a possible mechanism for suppressed cell growth and enhanced apoptosis of BIU-87 cells.

Animals ; Apoptosis ; Cell Cycle ; Cell Line, Tumor ; Cell Proliferation ; DNA (Cytosine-5-)-Methyltransferases ; genetics ; Gene Knockdown Techniques ; Humans ; Mice ; Mice, Nude ; Neoplasm Transplantation ; RNA, Small Interfering ; Real-Time Polymerase Chain Reaction ; Urinary Bladder Neoplasms ; genetics ; pathology

OBJECTIVETo study the expression of OCT4 protein in bladder cancer and its correlation to the clinicopathologic features and prognosis of bladder cancer.

METHODSOCT4 mRNA and protein expression was detected in 5 bladder cancer cell lines (RT-4, Tcc-Sup, KK47, T24, and 5637) and 1 normal bladder cell lines by real-time PCR and Western blotting, respectively. Immunohistochemical analysis was used to detect the expression of OCT4 protein in 46 bladder cancer samples.

RESULTSAll the 5 bladder cancer cell lines expressed detectable levels of OCT4 mRNA and proteins, whereas the normal bladder cell line SV-HUC-1 was negative for OCT4 expression. The clinical bladder cancer tissues showed a high positivity rate of OCT4 expression (76.1%), which was not detected in normal bladder tissues. Specific OCT-4 signals were localized mainly in the nuclei of the cancer cells. The expression rate of OCT4 protein was significantly higher in bladder cancer tissue than in normal bladder epithelium (P<0.05), and showed a positive correlation to the grade of tumor differentiation and metastasis (P<0.05) but not to the patients' age, gender or TNM stage.

CONCLUSIONOCT4 protein expression is associated with tumor differentiation and metastasis in bladder cancer and may play an important role in the early diagnosis and prognostic evaluation of bladder cancer.

Cell Line, Tumor ; Humans ; Neoplasm Metastasis ; Neoplasm Staging ; Octamer Transcription Factor-3 ; metabolism ; Prognosis ; Urinary Bladder Neoplasms ; diagnosis ; metabolism ; pathology

Objective:To compare the clinical safety and the efficacy of the transurethral plasmakinetic bipolar enucleation of the prostate and diode laser enucleation of the prostate in day surgery patients.Methods:The clinical data of 99 patients with benign prostatic hyperplasia (BPH) who underwent day surgery in Zhujiang Hospital of Southern Medical University from August 2019 to August 2021 were retrospectively analyzed. Among them, 47 cases underwent transurethral plasmakinetic bipolar enucleation of the prostate (bipolar group), and 52 cases were treated with diode laser enucleation of the prostate (diode laser group). There were no significant differences in age [57.0(56.0, 61.0)years old vs. 59.0(57.0, 62.0)years old], prostate volume[(60.0±8.2)ml vs. (57.4±9.4)ml], preoperative total prostate-specific antigen (tPSA) [(1.8±0.9) ng/ml and (2.2±0.9) ng/ml], postvoid residual (PVR) [20.0(0, 40.0)ml vs. 20.0(1.3, 41.5)ml], maximum flow rate (Q max) [(9.4±2.6) ml/s vs. (9.6±1.9) ml/s], International Prostate Symptom Score (IPSS) [19.0(16.0, 21.0) vs. 19.0(18.0, 21.0)], quality of life (QOL) [5.0(4.0, 5.0)vs. 5.0(4.0, 5.0)] and International Index of Erectile Function 5 (IIEF-5) [(18.8±1.0) vs. (19.2±0.9)] score between the bipolar group and diode laser group (all P>0.05). The indexes of operation time, postoperative hemoglobin decline, blood sodium decline, bladder irrigation time, catheter indwelling time, Q max, IPSS, QOL, IIEF-5 score and so on were compared between the two groups. Results:All day surgeries were successfully completed without serious complications. The operation time of the bipolar group was less than that of the diode laser group [(57.3 ± 4.2) vs. (64.4 ± 6.3) min, P<0.001], and no statistically significant difference was found in the postoperative hemoglobin decline between the two groups [(9.8 ± 4.3) g/L vs. (8.5 ± 4.3) g/L, P=0.154]. None of the patients received transfusion treatment, and neither group of patients had severe hematuria or needed to be readmitted to hospital. There was no significant difference in the decrease of blood sodium [1.7 (1.3, 2.0) mmol/L vs. 1.7 (1.5, 1.9) mmol/L] and the postoperative bladder irrigation time [(7.7 ± 1.4)h vs. (8.0 ± 1.6)h] between the bipolar and diode laser groups ( P > 0.05). There were 8 patients in the bipolar group and 7 patients in the diode laser group who retained urinary catheter for 48-60 h due to intraoperative inflammatory changes in the prostate, and the remaining patients had their urinary catheter removed within 24 hours. The Q max of the bipolar group and the diode laser group one month after surgery were (20.4 ± 1.8) and (21.1 ± 1.7) ml/s, IPSS scores were 7.0 (7.0, 8.0) and 7.0 (7.0, 8.0), and QOL scores were 3.0 (3.0, 3.0) and 3.0 (2.0, 3.0), respectively. There were no significant differences in Q max, IPSS and QOL between the two groups (all P > 0.05). Conclusions:Transurethral plasmakinetic bipolar enucleation of the prostate is also feasible for day surgery, and the short-term postoperative Q max, IPSS, hemoglobin reduction and other indicators have no significant difference compared with diode laser enucleation of the prostate, and can achieve the same efficacy and safety as diode laser enucleation of prostate.

OBJECTIVES: To investigate the effect of progressive pre-disconnection of urethral mucosal flap during transurethral plasmakinetic enucleation of prostate (TUPEP) on early recovery of urinary continence. METHODS: Clinical data of patients with benign prostatic hyperplasia (BPH) admitted in Zhujiang Hospital of Southern Medical University during February and May 2022 were collected. All the patients underwent TUPEP, and the progressive pre-disconnection of urethral mucosal flap was performed in the procedure. The total operation time, enucleation time, postoperative bladder irrigation time and catheter indwelling time were recorded. Urinary continence was evaluated 24 h, 1 week, and 1, 3, 6 months after the removal of urinary catheter. RESULTS: All surgeries were successfully completed at one time with less intraoperative bleeding, and there were no complications such as rectal injury, bladder injury or perforation of prostate capsule. The total operation time was (62.2±6.5) min, the enucleation time was (42.8±5.2) min, the postoperative hemoglobin decrease by (9.5±4.5) g/L, the postoperative bladder irrigation time was (7.9±1.4) h, and the postoperative catheter indwelling time was 10.0 (9.2, 11.4) h. Only 2 patients (3.6%) had transient urinary incontinence within 24 h after catheter removal. No urinary incontinence occurred at 1 week, and 1, 3, 6 months after operation, and no safety pad was needed. The Qmax at 1 month after operation was 22.3 (20.6, 24.4) mL/s, international prostate symptom scores were 8.0 (7.0, 9.0), 5.0 (4.0, 6.0) and 4.0 (3.0, 4.0) at 1, 3 and 6 months after surgery, and quality of life scores at 1, 3 and 6 months after surgery were 3.0 (2.0, 3.0), 2.0 (1.0, 2.0) and 1.0 (1.0, 2.0), all of these indicators were better than those before surgery (all P<0.01). CONCLUSIONS In the treatment of BPH, the application of progressive pre-disconnection of urethral mucosal flap in TUPEP can completely remove the hyperplastic glands and promote early recovery of postoperative urinary continence with less perioperative bleeding and decreased surgical complications.
Male ; Humans ; Prostate ; Prostatic Hyperplasia/surgery* ; Transurethral Resection of Prostate/methods* ; Quality of Life ; Urinary Bladder ; Urinary Incontinence/surgery* ; Treatment Outcome