1.Effects of hyperbaric oxygen therapy on in vivo marine prostate cancer cell PC-3
Hao TANG ; Yinghao SUN ; Chuanliang XU ; Tie ZHOU ; Xu GAO ; Linhui WANG
Chinese Journal of Urology 2009;30(7):480-483
Objective To assess the effects of hyperbaric oxygen(HBO) on indolent prostate cancer on a murine model. Methods Human prostate cancer cell line PC-3 ceils were injected into 40 severe combined-immunodeficient mice. They were randomized to undergo 20 sessions of either HBO or normobarie air in standardized conditions, and observed for 4 weeks before the histological assess-ment of any palpable tumors developed. The analysis parameters included tumour volume, microvessel density, apoptosis markers (p53, p27) and proliferative index (Ki-67). Results On the 28th day af-ter tumor vaccination, the tumor volume was (425.8±13.9)mm3 in HBO group and (433.6±12.8) mm3 in normobaric air group (P>0.05). Mierovessel density and Ki-67, p53, p27 protein expression were 69.7±9.5, (55. 2±6. 7)%, (31.9±5. 3)%, (80. 4±5. 7)% in HBO group;77. 1±8. 7, (50.6±7.3)%, (30.5±4. 7)%, (85.3±6.4)% in norrnobaric air group, respectively. There were no significant differences in both groups (P>0. 05). Conclusions HBO does not accelerate the growth of indolent prostate cancer in murine model. This result suggests that HBO does not increase the risk of residual prostate cancer reactivation when it is used to manage radiation-induced hemorrhag-ic cystitis in patients treated by pelvic radiotherapy for prostate cancer.
2.Development of a porcine model for laparoscopic ureterovesical reimplantation training
Xing AI ; Guoxi ZHANG ; Zhun WU ; Baojun WANG ; Chao WANG ; Bin FU ; Tong ZANG ; Guohui ZHANG ; Xu ZHANG
Chinese Journal of Urology 2009;30(7):461-464
Objective To develop and evaluate a porcine model for laparoscopic ureterovesical reimplantation (LUR) training. Methods Ten female pigs with a mean weight of 30 kg were used and the animals were placed on supine position after anesthesia. One 10 mm port and two 5 mm ports were placed after the establishment of pneumoperitoneum. The horn of uterus was used as "ureter". A model simulating the performance of LUR was then established on the mini-pigs. Four trainees per-formed the LUR procedures on the animal models during an advanced laparoscopic urology training course, following the technique criteria exactly used in LUR. The learning curve was analyzed in terms of operation time. Results The porcine model for laparoscopic training was established suc-cessfully and 4 LUR trainings was performed on each porcine. Each trainee performed 10 LURs on the models during the training course. The operation time declined from 170±10 rain initially to 90±4 rain after the training course (P<0.01). At the end of this training, all trainees could accomplish a watertight LUR procedure on the model. Conclusions The establishment of the training model is feasible. The trainees could acquire skills needed to perform LUR in vivo based on this simple model and to develop dexterity and facility in laparoscopic manipulation of needles and sutures as well. The model provides a platform for basic techniques training of the ureteral reconstruction procedures.
3.Mouse testicular gene expression pattern differences between spermatogonial stem cell proliferative and differential stages
Xiaomin LUO ; Ci ZHANG ; Sixing YANG ; Fujin SHEN ; Linglong WANG
Chinese Journal of Urology 2009;30(7):494-497
Objective To detect the mouse testicular gene expression pattern differences be-tween spermatogonial stem cell (SSC) proliferative and differential stages and study the molecular reg-ulation mechanism in SSC proliferation and differentiation. Methods With the interval of 24 days, male Kunming mice were injected intraperitoneally with two doses of busulfan (10 mg/kg) to establish spermatogenesis regeneration models. 36 k Mouse Genome Array was used to detect the differential gene expression profiles between the stages of SSC proliferation and differentiation. Bioinforrnsties analysis was conducted in GO (gene ontology) and KEGG (Kyoto Encyclopedia of Genes and Ge-nomes) pathway to describe the potential roles that may play in spermatogonial stern cells behavior regulation. Results Nine hundred and eleven differential expression genes were identified by gene arrays in mice testes, consisting of 608 up-regulated and 303 down-regulated in SSC proliferation stage and SSC differentiation stage. The differential expression genes were classified by their biological process, molecular function and cellular component, respectively. Alterations with statistical signifi-cance (P<0.05)appeared in 84 KEG(;signal pathways, including Notch and Wnt signaling pathways which had been proved to be important for stem cell maintenance. Fifty-six differential expression genes were selected as genes related to stem cells, among which 40 genes were up-regulated, including some stem cell biomarkers(such as Cd9, StraS, hgbl-, Oct4 and Thyl)and some growth factors(such as Fgf2, Pdgfa and Csfl). Conclustion The regulation of SSC proliferation and differentiation involves inmany differentially expressed genes in various signal pathways. This study provides a molecular basis for the elucidation of the molecular mechanism behind self-renewal and differentiation of spermatogonial stem cells.
4.Expression patterns of survivin and cuspuse-3 in dissymmetric enlarged prostate
Xiaoyang LIU ; Dongwen WANG ; Xuhui ZHANG
Chinese Journal of Urology 2009;30(7):484-486
Objective To compare the different expression patterns of survivin and caspase-3 between the larger part and the smaller part of the dissymmetric enlarged prostates in BPH patients, and to clarify the role of apoptosis in BPH etiology. Methods BPH tissues from 25 patients were embedded in paraffin. The specimens constituted of two prostate parts from each patient. One part was from the larger enlarged gland and the other was from the smaller enlarged counterpart. 50 paraf-fin blocks were cut into sections and stained with survivin and caspase-3 polyclonal antibodies against human. All the data was analyzed by SPSS13.0 software. Results Survivin immunoreactivity was localized in prostatic cell nuclei. Survivin expression in larger enlarged parts (22.08±16. 33)0% was significantly higher than the smaller parts (7. 645±5. 45)%(P<0.01). Positive nuclear or cytoplasm staining was also observed in the Caspase-3 immunoreactivity. Caspase-3 expression was higher in smaller enlarged parts (51. 525±27. 27%) than in larger enlarged parts (33. 125±21.01%) (P< 0.01). Survivin expression in larger part of the enlarged prostates was inversely correlated with caspase-3 expression (r=-0. 474, P<0. 05). However, in smaller part of the enlarged prostates, the expression of the two factors had no relation (r=-0. 313,P>0. 05). Conclusions Survivin and caspase-3 expression patterns are different in the two parts of the dissymmetric enlarged prostates. These different patterns indicate apoptosis playing an important role in BPH development.
5.Single needle running suture method for urethrovesical anastomosis during laparoscopic radical prostatectomy
Xu ZHANG ; Zhenghua JU ; Chao WANG ; Xing AI ; Xin MA ; Taoping SHI ; Guoxi ZHANG ; Baojun WANG
Chinese Journal of Urology 2009;30(7):476-479
Objective To describe the single needle running suture method for the urethrovesi-cal anastomosis during laparoscopic radical prostatectomy(LRP). Methods Forty-five patients of prostate cancer underwent LRP with the single needle running suture method. The technique was initi-ated by performing a fixing suture at the posterior lip of bladder neck at 4 o' clock and tying the first knot. Another suture at the nearby position of the first suture was performed to leave the first knot outside. From 5 o' clock to 8 o' clock, sutures were performed every one o' clock to secure posterior approximation, then every two o'clock a suture. To avoid a loose anastomosis, lock sutures were per-formed every 3 sutures. After completing the full circumference, the needle was drawn at the 2 o' clock for the second knot. The needle was always driven full-thickness outside-in in the bladder neck and inside-out on the urethra. Any remaining leakage could be closed with additional interrupted su-tures. Results All urethrovesical anastomosis were completed successfully. The mean anastomosis time was 16 rain(from 12 to 25 min), and mean operative time was 132 rain (112 to 185 rain). The mean catheterization time was 9 d(7 to 14 d). Three temporal urinary leaks requiring prolonged cathe-terization were identified. Forty-four patients had total urinary control in 1 year postoperatively and no other short-term or persistent complication was found with a mean follow-up of 21 months. Conclu- sion The single needle running suture method could be a simple and safe method for urethrovesical anastomosis during LRP.
6.Robot-assisted laparoscopic radical prostatectomy: report of 16 eases
Jiangping GAO ; Xiang XUA ; Jun DONG ; Wei WANG ; Jie ZHU ; Liang CUI ; Baofa HONG ; Xu ZHANG
Chinese Journal of Urology 2009;30(7):472-475
Objective To summarize the first 16 eases in mainland China and to discuss the cli-nical experience of robot-assisted laparoseopie radical prostateetomy(RLRP). Methods Sixteen pa-tients with localized prostate carcinoma underwent RLRP with da Vinci S surgical system (Intuitive Surgical Inc.). The age of the patients was 62-76 years, average 69 years. The preoperative t-PSA level was 0.2-79. 2. Ng/ml. The volume of prostate was 9.8-232.9 ml. Fifteen patients were with biopsy-proven prostate cancer, the average Gleason score was 7(4-9). Three were T2a. N0 M0, 4 were T2b N0 M0 and 8 were T2c N0/M0 by clinical stage. One was prostatic intraepithelial neoplasm-Ⅲ. The level of t-PSA in serum and the result of urinary continence were followed up after RLRP. Results All the operations were accomplished successfully. The mean preoperative set-up time of the da Vinci surgical system was 64(60--90)min;the mean operation time was 236(190--390)rain;the mean esti-mated blood loss was 231(50-500)m.L The patients were ambulant between the 2nd and 3rd postop-erative days. Foley catheter was sueeeasfully removed on day 10 to 14, and mean hospital stay was 13 (6-19) days. Two eases had positive surgical margins, the pathological stages were both pT3b N0 M0. The average serum t-PSA was less than 0. 1 ng/ml during a median follow-up of 9(6-12) months. By the conventional definition of urinary continence (0 to 1 pads daily), 94%(15/16) and 100% (16/16)of patients were continent at 3 and 6 months, respectively. Of the patients, 75% (12/16)and 88% (14/16)had no urinary leakage(0 pads daily). Conclusions RLRP is small incision and safe. It is the direction of minimally invasive urologic surgery.
7.Application of pediculated skin flaps in the treatment of complicated long urethratresia
Linsheng CAO ; Songxi TANG ; Huiliang ZHOU ; Xueyi XUE ; Houping MAO ; Yiqi LUG ; Xi LIN ; Yong WEI ; Qingshui ZHENG ; Rui GAO ; Tao JIANG ; Yisong LU ; Jinbei HUANG ; Ning XU
Chinese Journal of Urology 2009;30(7):490-493
Objective To study the application of pediculated skin flaps in the treatment of com-plicated long urethratresia. Methods From March 1999 to May 2006, a total of 18 male patients with complicated long urethratresia were treated by using the pediculated skin flaps. The causes of urethratresia were 7 cases of postoperative pelvic fractures with posterior urethral stricture, 4 cases of transurethral intravesical chemotherapy, 3 cases of postoperative bulbar urethral stricture, 2 cases of gonorrhea, and 2 cases of long-time urethral catheter placement. Four cases were urethratresia nf cor-pus penis, 7 cases were anterior urethral obliteration, 7 cases were posterior urethral and anterior ure-thral obliteration. Urethro-perineal fistulas were found in 8 cases, posterior urethrorectal fistulas in 7 cases, false passage formations in 8 cases. The average length of urethratresia was 15.1 cm (range 8. 7 to 23. 0 cm). The urethral scar was rasected, the posterior urethrorectal fistula was repaired, and different kinds of pediculated skin flaps depending on the length of urethratreaia was used. Results All the patients were followed up for 12 to 18 months (mean 14 months). Fifteen patients voided well 3 months postoperatively, none of the urography showed stricture. The mean peak urinary flow rate was 16. 9 ml/s (range from 16. 5 to 21.7 ml/s). Of the other 3 cases, 1 case experienced difficult voi-ding due to the long and circuitous tabularized skin flap but recovered after proper shortening;1 case had restenosis for the infection of anastomosis but voided well after excision and reanastomnsis;1 casehad a urinary fistula resulting from hematoma and infection, but was successfully treated by the neo-plasty of the urinary fistula. The mean peak urinary flow rate was 17.0 ml/s (range 15.0 to 22.0 ml/s) for 17 patients 6 months postoperatively, except for one who experienced genuine urinary incon-tinence. At 9-18 months after operations, the mean peak urinary flow rate was 17.5 ml/s (range 15.8 to 22.5 ml/s) for 17 patients. Conclusion The single-stage urethroplasty based on pediculated skin flaps is a reliable and durable method for complicated long urethratresia.
8.Repairing effect of pedicle omentum in severe ureteral injury
Yubin CAI ; Hailun ZHAN ; Bin MIU ; Dan HE ; Tujie SI ; Xin GAO
Chinese Journal of Urology 2009;30(7):454-456
Objective To evaluate the repairing effect of pedicle omentum on severe ureteral in-jury. Methods Twenty healthy dogs were randomized into the experiment group and the control group. Firstly the model of severe ureteral injury was made. In experimental group, the pedicle omen-turn were used to wrap up the severe injured ureter, but which was no done in control group. Urinary fistula and ureteral necrosis were observed. At 12 weeks postoperatively,the models were re-operated to investigate whether the severe injured ureters had healed. Angiogenesis, VEGF and its receptor KDR were also examined in stoma and surrounding tissue histopathologically. Results No urinary fistula was observed in experimental group, but 2 cases in control group were dead because of recurrent abdominal cavity infection after the formation of urinary fistula. The mucosa and smooth muscle of stoma were completely regenerated, and the blood vessels were regenerated more significantly in expe-rimental group than in the control group. In experimental group, the VEGF and KDR were over-ex-pressed, and the positive cell rates were (12. 65±0. 02)% and (10. 23±0. 03)%. But in control group, the stoma were not healed, and severe ureters1 strictures were observed in all dogs. Angiogene-sis was not signifieant, the VEGF and KDR positive cell rates were (1.54±0. 03)% and (2. 654± 0.04)%, respectively. Conelusions Pedicled omentum can promote the repair of severe ureteral in-jury. The mechanism may be the over expression of VEGF and KDR in prompting angiogenesis.
9.Clinical analysis of prognosis of adrenocortical carcinoma
Chinese Journal of Urology 2009;30(7):437-440
Objective To study the clinical factors affecting the prognosis of adrenocortical car-cinoma (ACC) in order to guide the diagnosis and treatment of ACC. Methods The clinical data of 40 cases of ACC were retrospectively analyzed. The patients were diagnosed as ACC by histopatholo-gical examination after operation or biopsy, including 19 cases of nonfunctional ACC and 21 cases of functional ACC. The functional ACC included 14 cases of Cushing's syndrome, 4 cases of sexual ab-normality (3 cases of androphany and one case of male sexual precosity) and 3 cases of primary aldo-steronism. The clinical stage included 3 cases in stage Ⅰ , 10 cases in stage Ⅱ , 7 cases in stage Ⅲ, and 21 cases in stage Ⅳ. Eighteen cases underwent complete excision, 10 cases underwent palliative excision, 12 cases underwent expectant treatment (2 cases underwent arterial embolism). All patients were followed up for 2 to 121 months. The total life span and survival rate were calculated, and the dependability between life span and certain indices (tumor size, function, clinical stage and surgical treatment, etc) was compared. The results were statistically analyzed by utilizing the SPSS 11.5 soft-ware. Rank-sum test was used for the two independent samples, one-factor analysis of variance was used for multiple samples and Pearson correlation analysis was used for the correlation of two vari-ances. Results There were no statistical correlations between gender, age, sides and survival time (P>0.05). The survival time of nonfunctional ACC patients was 37.0 months, of which 11 dead ca-ses survived 11.0 months and 8 survival cases survived 73.5 months. The survival time of functional ACC patients was 11.5 months, of which 19 dead cases survived 12.2 months and 2 survival cases survived 4.8 months. The survival time of nonfunctional ACC was significantly longer than that of functional ACC (P<0. 05). The actual survival time was 66 months and 120 months in stage Ⅰ , of which both survived. The actual survival time was (44.9±40. 2) months in stage Ⅱ, of which 4 sur-vival cases survived 59.0 months. The actual survival time was(34. 5±29.8) months in stage Ⅲ, ofwhich 2 survival cases survived 42.0 months. The actual survival time was (7.1±6.7) months instage Ⅳ, of which 2 survival cases survived 8. 0 months. There was significant difference of the sur-vival time among different clinical stages(F=11. 078, P<0. 05). There was no significant difference of survival time between treatment methods[(10.04±0.0) vs (4.5±1.5) months, P>0. 05]. Con-clusions The most important influencing prognostic factors of ACC are function and clinical stage. For ACC in stage Ⅰ and Ⅱ , tumor resection is the most effective treatment, and second surgical oper-ation is recommended for local recurrence. For ACC in stage Ⅲ, radical or extensive surgical operation is recommended, and for ACC in stage Ⅳ, surgical operation has no effect on the prognosis.
10.Pure laparoscopic radical nephrectomy and thrombectomy for renal tumors with renal vein and vena caval thrombus
Wencheng LU ; Wenying WANG ; Daoxin ZHANG ; Yuwen GUO ; Jian SONG ; Fengbo ZHANG ; Ye TIAN ; Lindong DU
Chinese Journal of Urology 2009;30(7):441-443
Objective To evaluate the feasibility of using pure laparoscopic radical nephrectomy and thrombectomy to treat renal tumor with renal vein and vena caval thrombus. Methods Two ca-ses o{ right renal tumor with renal vein and vena caval thrombus were reported. Contrast-enchanced CT showed renal tumor extended into renal vein and vena cava in 1 case, and filling defect was found in right renal vein and extended to vena cava in the other. Both patients received pure laparoscopic ra-dical nephrectomy and thrombectomy through retroperitoneal approach. Four trocars were placed du-ring the operation, and the renal artery was dissected before the vena cava was mobilized circumferen-tially above and below the renal vein, a faparoscopic vessel blockage clamp was used to partly occlude the vena cava containing the thrombus. The vena cava was repaired after the intact tumor thrombus was extracted. Results The tumor thrombus extended 0.3 cm and 1.0 cm above the renal vein, re-spectively. Both patients were discharged 5 d after operation. Pathological examinations showed that tumors were epithelioid renal angiomyolipoma and grade Ⅰ-Ⅱ clear cell carcinoma separately. Both patients were free of local recurrence and metastasis 5 months after operation. Conclusion Pure la- paroscopic radical nephrectomy and thrombectomy for renal tumor with vena caval and renal vein thrombus is feasible in carefully selected patients.