Objective To observe the curative effect of external physical vibration lithecbole (EPVL) therapy after extracorporeal shock-wave lithotripsy (ESWL) in upper urinary calculi.Methods A total of 133 patients of upper urinary calculi with randomly divided into 2 groups after ESWL therapy during the period of 2012 October to 2013 February.The EPVL group (66 cases) used the physical vibration lithecbole treatment,and the natural lithecbole group (67 cases) used the method by drinking water,adding exercise and other natural lithecbole method.Of the EPVL group,6 of the stones were located in the upper or middle calyx,13 in renal pelvis,16 in lower renal calyx and 31 in ureter,the stone diameter was 10-15 mm.Of the natural lithecbole group,8 of the stones were located in the upper or middle calyx,17 in renal pelvis,15 in lower renal calyx and 27 in ureter,the stone diameter was 10-15 mm.The clinical data of the curative effect,side-effect,and complications were collected and analyzed systematically.Results In the EPVL group,the average times of lithagogue treatment was 2.6 times,51 patients (77％) expelled stones on the day of lithecbole,and the stone free rate in a week was 79％ (52/66).Especially,81％ (13/16) of the lower renal calyx expelled stones on the day of lithecbole,and the stone free rate in a week was 88％ (14/16).Whereas,30 patients (45％) in the natural lithecbole group expelled stones on the day of ESWL,and the stone free rate in a week was 49％ (33/67) ; the lower renal calyx stone expulsion rate on the day of ESWL was 33％ (5/15),and the stone free rate in a week was 40％ (6/15).The curative effects were significantly different between the 2 groups (P＜ 0.05).There were no serious complications in both groups.Conclusions EPVL machine can significantly promote the stone expulsion after ESWL.Compared with traditional methods,EPVL therapy has a better curative effect,especially on lower renal calyx stones.EPVL is a safe and noninvasive treatment.

Objective To evaluate the effect of mitotane as a preoperative adjuvant therapy in advanced adrenocortical carcinoma.Methods Mitotane was used in 2 patients as preoperative adjuvant therapy.Case 1,a 24-year-old woman had Cushing's symptom for 1 year and presented with edema in both legs for 1 month.Computed tomography (CT) showed a solid mass in the right adrenal.It was about 10.0 cm×7.8 cm with calcification,and the boundary of tumor was not clear.Enhanced CT scan showed heterogeneous enhancement and there was a suspicious filling defect in the inferior vena cava.Biopsy of adrenal neoplasm was made and pathological result was adrenocortical tissue.The patient was diagnosed as right adrenocortical carcinoma with tumor thrombus in vena cava.Mitotane was used for 6 months.Case 2,a 42-year-old woman who underwent left adrenal adenoma resection 9 years ago,presented with Cushing's syndrome for 2 years,and found masses in left retroperitoneal and abdominal wall for 6 months.CT showed multiple nodular soft tissues with pitting calcification and fusion in it,locating between retroperitoneal spleen and kidney.The biggest section was approximately 8 cm× 12 cm,with a largest diameter of 14 cm.Enhanced scan showed uneven density wiht CT value of about 32 HU.Nodule shadows which were obviously strengthened were found in front of the right side of the diaphragmatic muscle.And some heterogeneous enhanced nodule shadows could be seen in front of the right abdominal peritoneal and muscle layer.The patient was diagnosed as right adrenocortical carcinoma with multiple metastases.Mitotane was used for treatment for 5 months.Results Both of their Cushing's symptom were significantly improved by taking drugs.The main side effects were nausea,vomiting,dizziness,fatigue,diarrhea and so on,but all could be alleviated after drug dosage adjustment.CT reexamination showed the volume of the primary lesion and metastases were significantly reduced.The postoperative pathological report after remove of the tumor and metastases showed adrenocortical carcinoma.Followed up for 42 and 7 months,the patients had no recurrence.Conclusions Mitotane is effectiveas preoperative adjuvant therapy in adrenocortical carcinoma and metastases.It can reduce the lesions significantly,relieve the Cushing's symptom,and provide opportunity for surgical treatment.

Objective To investigate the clinical efficacy and mechanism of electrical pudendal nerve stimulation (EPNS) in treating female stress urinary incontinence.Methods Thirty-five female patients with stress urinary incontinence were enrolled from May 2006 to April 2008.The average age was (54.9±9.7) years,the duration of incontinence was (74.1 ±45.6) months,the maximum urethral closure pressure was (63.7± 15.9) cm H2O,functional urethral length was (2.34±0.72) cm and bladder neck mobility was (1.23±0.76) cm.Long acupuncture needles were deeply inserted into four sacral points,which were located by the two edges of the sacrum on a level with the fourth sacral foramina and bilaterally to the tip of the coccyx.The needles were electrified (continuous waves,a frequency of 2.5 Hz,an intensity of 45-55 mA and 60 min once) to stimulate the pudendal nerves.When EPNS was performed,perineal ultrasonographic B-mode movements of the pelvic floor muscles (PFM),M-mode curves indicating the PFM contractions,vaginal pressure (VP) and PFM electromyogram were recorded simultaneously.Results When EPNS was performed correctly,the patient felt strong PFM contractions.Simultaneous records showed:1)B-mode cranio-caudal PFM movements; 2) M-mode PFM movement curves (amplitude:about 1 mm,n=31 ; in the other four patients,the M-mode curves were not obvious) ; 3) a sawtooth curve of VP changes (2.61±1.29 cm H2O,n=34); 4) PFM myoelectric waves (amplitude:23.9±25.3 μV).If during the EPNS process the electric current was stopped or its intensity was reduced or the two lower needles were drawn back 1-2 cm,then the above ultrasonographic PFM movements and VP changes disappeared.In the 35 patients,the ICI-Q-SF score was 12.9±2.9 before treatment and decreased to 3.5±3.3 after 27.5± 11.9 sessions of treatment (P＜0.01).Twenty-five patients with ≥50％ symptom improvement at the end of treatment were followed up for 24-72 months (mean 50),and 19 cases had ≥ 50％ symptom improvement during the period of follow-up,including complete symptoms resolution in 10 cases.Conclusion EPNS can contract the PFMs and simulate PFM training to treat female stress incontinence.

Objective To investigate the significance of Qmax and residual urine in evaluation of bladder function in the patients with benign prostatic hyperplasia (BPH).Methods The clinical data of 61 patients with BPH and 20 healthy persons in control group were evaluated.Bladder function,uroflowmetry and ultrasonic residual urine measurement were performed in the 2 groups.The correlation between Q max and residual urine in BPH group was investigated.Results There was significant difference in Qmax between the BPH group and control group (8 vs.21 ml/s,u=-6.090,P=0.007).There was significant difference in residual urine between the 2 groups (60 vs.9 ml,u =-6.718,P=0.005).And there was a negtive correlation between residual urine and Qmax in BPH group (r=-0.366,P=0.009).Conclusion It is useful to measure the Qmax and residual urine in evaluation of bladder function affected by bladder outlet obstruction caused by BPH.

Objective To investigate the change and significance of regulatory T lymphocytes in peripheral blood of rats model of chronic abacterial prostatitis.Methods Twelve Wistar rats with weight of approximate 390 g were randomly divided into two groups,model group and control group.Rats in the model group was injected subcutaneously 17β-estradiol(0.25 mg/day,for 30 days) after castration to establish rat model of chronic abacterial prostatitis.Flow cytometry was applied to detect the frequency of CD+4 CD+25 cells and CD+8CD-28 cells in peripheral blood of rats after model establishment.Results Compared with control group (11.63±1.36)％,the proportion of CD+4 CD+25T lymphocytes in model group (7.90±1.74)％ significanlty decreased (P＜0.01).Compared with control group (24.64±4.76)％,the proportion of CD+8CD-28T lymphocytes in model group (17.18±2.83) ％ also significantly decreased (P＜0.01).Conclusions The changes of the ratio of CD+4 CD+25T lymphocytes and CD+8CD-28T lymphocytes in peripheral blood of rats model of chronic abacterial prostatitis provided evidences for pathogenic mechanism of regulatory T lymphocytes participating in the development of chronic abacterial prostatitis.

Objective To evaluate the treatment results and psychological changes in female patients with stress urinary incontinence (SUI) before and after TVT-O.Methods Fifty-six female patients with SUI underwent TVT-O from Nov.2011 to Mar.2012.Preoperative and postoperative International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) score,Incontinence Quality of Life Questionnaire (I-QOL) score,one hour urine pad test,Self-rating Anxiety Scale (SAS) score,and Self-rating Depression Scale (SDS) score were recorded and analyzed.Results Followed up for 3 months,the subjective satisfactory rate was 94.6％ (53/56),the objective efficiency rate was 91.1％ (51/56),and there was no recurrence in this group.Before operation and 3-month after operation,ICIQ-SF scores were 15.9±3.2(13-20) and 8.6±2.7 (4-13),t=6.02,P=0.01 ; I-QOL scores were 40.3±18.9 (33-62) and 87.6±11.2(76-102),t=6.81,P=0.01; The urine leakages in one hour urine pad test were 26.7±7.1 (9-51)g and 5.2±2.5 (1-8)g,t=7.13,P=0.00; SAS scores were 59.3±8.3 (48-72) and 42.6±4.6 (39-52),t=9.15,P =0.01; SDS scores were 57.2±5.6 (49-69) and 40.2±3.4 (36-54),t=8.63,P=0.01,respectively.No serious and long-term complication occurred.Conclusions TVT-O is a safe and effective treatment option for female SUI.This treatment can improve the quality of life and psychological status of the patients.

Objective To evaluate the safety and efficacy of QUILLTM self-retaining suture (QUILLTMSRS) in laparoscopie partial nephrectomy.Methods Sixty-three patients (39 males,24 females) with renal tumor accepted laparoscopic partial nephrectomy in Peking Union Medical Hospital from February 2012 to January 2013.The ages ranged from 38 to 75 years.The tumor sizes varied from 1.5 cm to 4.5 cm.According to the device of renorrhaphy,they were divided into 2 groups.Vicryl suture was used for renorrhaphy in 32 patients (Group 1),and QUILLTMSRS was used in 31 patients (Group 2).Renorrhaphy was performed in two layers for both groups,with a closure of deep vessels and the collecting system with 4-0 absorbable suture,followed by a running closure of the renal parenchyma and renal capsule.Demographical and perioperative parameters including age,body mass index,tumor size,R.E.N.A.L score,estimated blood loss,warm ischemic time,length of hospital stay were recorded and compared between the 2 groups.Results Renorrhaphy was successfully performed in all the 63 cases without conversion to open procedure or nephrectomy.The estimated blood loss and length of postoperative hospital stay were not significantly different between the 2 groups (P＞0.05).But warm ischemic time was significantly shorter in QUILLTM SRS group than that in Vicryl group (22.2 vs 26.7 min,P＜0.001).Conclusions QUILLTMSRS could be safe and effective for renorrhaphy in laparoscopic partial nephrectomy.It could make laparoscopic renorrhaphy easier and reduce warm ischemic time significantly.

[Abstract] Objective To define the age-specific normal reference values of prostate specific antigen (PSA) and related parameters in Chinese middle-aged and elderly men.Methods From April 2007 to November 2011,serum PSAs of over 22 055 men aged more than 40 years old in our medical examination center were statistically analyzed.The men was divided into five groups by a 10-year-old interval.Total PSA (tPSA),free PSA (fPSA) and prostate ultrasound results were recorded.The free-total PSA ratio (f/t),PSA density (PSAD) and PSA velocity (PSAV) were calculated.By convention,the 95th percentile (P95)was used as the upper limit value,and the 5th percentile (P5) as the lower limit value.Results The tPSAs were positively correlated with age (r=0.349,P＜0.001).f/t was negatively correlated with age (r=-0.154,P＜0.01).Although f/t was significantly different (P＜0.001) among each age group,P5 of all groups were 0.18.PSAD was significantly different (P＜0.001) between men over and under 70 years,with P95 as 0.09 and 0.15,respectively.PSAD had a positive correlation with age (r =0.263,P＜0.01).The significant difference of PSAV raised between men over and under 60 years,with P95 as 0.21 and 0.58,respectively.PSAV was positively correlated with age (r=0.130,P＜0.01).Conclusions PSA,PSAD and PSAV are positively correlated with age,while f/t is negatively correlated with age.The normal range of f/tis 0.18-1.00 for Chinese men over 40 years old.PSAD's normal ranges are ＜0.09 and ＜0.15 in Chinese men over and under 70 years,respectively.The normal range of PSAV are ＜0.21 and ＜0.58 for Chinese men over and under 60 years,respectively.

Objective To investigate the effects of sulforaphane (SFN) on the proliferation of prostate cancer DU145 cells and hypoxia-inducible factor-1α(HIF-lα) expression,and to explore the possibility of SFN in the prevention of prostate cancers.Methods The DU145 cells were treated with different doses and different time of SFN.The cell proliferation viability were measured by 3-(4,5)-dimethylthiahiazo (-zy1)-3,3,5-di-phenytetrazo`liumromide (MTT) proliferation and cytotoxicity assay kit.The hypoxia tumor microenvironment was stimulated by pretreating cells with 1％ O2,HIF-lα expression and vascular endothelial growth factor (VEGF) activitity were detected by Western-blot and ELISA,respectively.Results SFN had an inhibitory effect on the proliferation of human prostate cancer DU145 cells in a dose-and time-dependent manner.The cell proliferation inhibition rate exceeded 50％ in more than 20 μ mol/L SFN-treated groups after 48 hours.SFN could inhibit the expression of HIF-1α induced by 1％ O2 and VEGF activity.10 μmol/L SFN showed inhibitory effect on the expression of HIF-1α after 24 hours.20 μ mol/L SFN showed a significant inhibitory effect on the expression of HIF-1α after 12 hours.And peroxidase had synergistic inhibition on HIF-1α.Conclusions SFN can inhibit the proliferation of DU145 prostate cancer cells and HIF-lα expression.SFN can be used as a potential chemotherapeutic agent against human prostate cancer.

Objective To evaluate the clinical and pathological characteristics and treatment of small cell carcinoma of the prostate. Methods Two patients with small cell carcinoma of the prostate were reported. Case 1 was 50 year-old. He was admitted with a history of dysuria and perineal pain for 3 months. Digital rectal examination (DRE) showed that the enlarged prostate was 5. 0 cm?6. 0 cm and palpated hard and rough. Low-echo mass was shown on ultrasonography, and heterogeneous density of the prostate on CT. His serum PSA level was 0. 31 ng/ml,and fPSA level was 0.09 ng/ml. Prostate cancer was suspected by biopsy,and radical prostatectomy was performed. Case 2 was 82 year-old. The complaints consisted of dysuria and intermittent gross hematuria for 4 months. The enlarged prostate was 4. 0 cm?5. 0 cm and palpated hard and rough with multiple nodes by DRE. Low-echo mass was shown on ultrasonography, and heterogeneous density of the prostate and involvement of seminal vesicle and bladder neck on CT. His serum PSA level was 2.61 ng/ml,and fPSA level was 0.05 ng/ml. Prostate carcinoma was indicated by biopsy, and orchiectomy plus TURP was performed. Results The diagnosis of small cell carcinoma of the 2 cases were confirmed by postoperative pathology. Microscopically, the tumor cells were arranged in solid-sheet and nest structures, showing the histologic type of diffuse infiltrative carcinoma. Coagulated necrosis could be found easily. Small round or oval cells resembling lymphocytes or oat cells were the main constituents of the tumor. The nuclei were extremely hyperchromatic and scanty. The seminal vesicle and bladder neck had tumor infiltration. The immunohistochemical staining results were negative for LCA,L-26 and 34?E12,but positive for PSA,AE1/ AE3 and AR ,and suspected positive for CgA and S-100. Case 1 died of extensive lung metastasis 1 month after operation. Case 2 had retroperitoneal metastasis of the tumor 3 months after operation, and has been followed till now. Conclusions Small cell cancer of the prostate is rare but can be diagnosed properly based on clinical and pathological features. Radical prostatectomy combined with hormone and chemotherapy is reliable treatment for early stage cancer; but for late stage cancer, there is no effective treatment and the prognosis is poor.