The urinary fistula is a common serious complication after renal transplantation.It can occur in any parts of the urinary tract,such as renal calices,renal pelvis,ureter and bladder.The majority of urine fistula occurred in 3 weeks after renal transplantation,may occurred in a few month later,or even half a year.According to the principles of classification of urethral damages,the urinary fistulae after kidney transplantation was classified in terms of the cause,location and extent of them.Moreover,why it was difficult to cure urinary fistulae was discussed,and the key points in the diagnosis were illuminated.The conclusion is that the only way to ensure the best treatment is determining the leaking location and selecting the optimal therapeutic schedule.Furthermore,the diagnosis of urinary fistula must include the leaking location and the classification of the simple one or complex one according to the location and extent of the fistula,which may make the diagnosis of urinary fistula after renal transplantation more accurate and standardized.

Objective To study the anti-tumor effect of mycobacterium Ag85B/IL-2 fusion protein on syngenic mice bearing bladder cancer. Methods After being implanted BTT739 bladder transitional carcinoma cells from tumor bearing mice, 80 T739 mice were divided into Ag85B protein, BCG, IL-2 and normal saline groups (n=20). Mycobacterium Ag85B/IL-2 protein was locally injected to the mice at the site of implanting tumor in the trial group, and Ag85B protein, BCG, IL-2 and normal saline to the control group mice. The weight and volume of tumor and the survival period were recorded after treatment. Results The average weight of Ag85B/IL-2 fusion protein treatment group was significantly lower than those of Ag85B, BCG,IL-2 and normal saline group (P

Objective To summarize and analyze the emergency management for acute renal failure of solitary kidney induced by upper urinary calculi. Methods A total of 78 cases of acute renal failure of solitary kidney induced by upper urinary calculi were included.The mean course was 2.8 days (range,1 to 8 days).The time from onset to emergency management was within 72 hours in 68 out of the 78 cases.10 cases were treated with percutaneous nephrostomy drainage (PCN) under the guidance of B-ultrasound;25 cases with emergent open surgery;12 cases with indwelling ureteral stent retrogradely;and 31 cases were treated with transurethral ureteroscopy ballast lithotrity. Results One died of bleeding and infection after operation.In 65 cases treated with in 72 hours after obstruction, the serum Cr level decreased from 202～885 ?mol/L to 58～130 ?mol/L;the serum BUN level decreased from 9.8～42.4 mmol/L to 2.8～7.0 mmol/L after urgent treatment during a period of 3 to 12 days,and the renal functions recovered. Conclusions The principles of management for this acute condition should be diagnosing early and promptly,releasing obstruction as soon as possible,preventing complications effectively and reserving renal functions.KUB and B-ultrasonography are the first choice of diagnostic measures.Transurethral ureteroscopy ballast lithotrity can be recommended as the first choice of emergent treatment.

Objective To analyse the clinical risk factors of multiple organ dysfunction syndrome(MODS) after renal transplantation. Methods 650 cases were retrospectively studied,and the related risk factors of patients with MODS or SIRS were analyzed by undertaking ? 2 tests Results In all of 650 cases,there were 38 cases with SIRS,and 7 cases with MODS.The study showed a significant relation between MODS with lower blood pressure(71.4%),lower blood oxygen(85.7%),severe infection(85.7%) and chronic organ failure(28.6%).The incidence for patients of MODS with more than two kinds of risk factors are obviously higher than those with two or less than two kinds of risk factors.The incidence for patients of renal failure(85.7%) and respiratory failure(71.4%) are highest in patients of organ failure. Conclusions Lower blood pressure,lower blood oxygen,severe infection and chronic organ failure are clinical risk factors to MODS.

In order to improve the Chinese medical students' ability to gain the latest medical information and adapt the development of modern medical education,we carried out bilingual teaching of Urology in undergraduate students.Based on students English level,we teach students step by step in accordance with their aptitude and build English study group.The practice shows that we will achieve better teaching effect if we sum up our experiences constantly.

Objective To investigate the changes of androgen receptor (AR) and AR mRNA of the ventral lobe, lateral lobe part 1(LP1) and lateral lobe part 2 (LP2) in the Wistar rat prostate after androgen manipulation. Methods Healthy adult male Wistar rats were randomly divided into 3 groups: control group(N), castration group(C) and androgen replacement group (T). In castration group, orchiectomy was performed through the scrotum. In androgen replacement group, testosterone propionate (2 5 mg/d) was injected subcutaneously for 14 d after castration. Expressions of AR and AR mRNA in the separate lobes of the adult Wistar rat prostate after androgen ablation and replacement were determined by immunohistochemistry and semi quantitative PCR. Results Different autoregulation of AR protein and mRNA was observed in the ventral lobe, LP1 and LP2 of rat prostate after androgen manipulation. In the ventral lobe and LP1, immunoreactive nuclear AR markedly decreased in staining intensity in the glandular epithelium 2 d after castration compared to that in the intact rats. Epithelial immunostaining continued to decline and was absent at day 7 and returned to normal level 3 d after testosterone replacement. There was a transient increase in AR mRNA demonstrated by RT PCR within 3 d and returned to control level within 7 d after castration in the ventral lobe and LP1 of rat prostate. In contrast, in LP2, the epithelial cells showed continued expressions of both AR protein and mRNA 14 d following androgen withdrawal. Conclusion These results suggest that there might be a different regulation of AR mediated by androgen in ventral lobe, LP1 and LP2 of rat prostate.

Objective To compare the efficacy of pirarubicin with other intravesical chemothera peutic agents in preventing bladder tumor recurrence. Methods Databases such as Medline,EM Base,CBMDisc and PubMed,ScienceDirect,LWW,Springer,CJFD(Chinese Journal Fulhext Data base)and Chinese Periodicals Database of Science and Technology were systematicallv searehed for controlled studies involved with intravesical pirarubicin for the treattnent of bladder cancer.Eligible studies according to inclusion and exclusion criteria were selected,then recurrence data from included studies were retrieved for a meta-analysis. Results Fifteen studies met the inclusion criteria.Of these studies 10 compared efficacy of pirarubicin with mitomycin C,and the meta-analysis based on these 10 studies showed that pirarubicin was statistically superior to mitomycin C(OR=0.41,95%CI 0.27～0.61,P＜0.01).Of 6 studies,pirarubicin was compared with thiotepa(OR=0.35,95%CI 0.11～1.13,P＞0.05),adriamyein(OR=0.15,95% CI 0.03～O.76,P＜0.05),epirubicin(OR=0.53,95% CI 0.23～1.23,P＞0.05),hydroxycamptothecin(OR=0.25,95% CI 0.10～0.64,P＜0.05)and blank control respectively,statistical analysis indicated pirarubicin was significantly better than adriamycin,hydroxycamptothecin and blank control,and not statistically different from thiotepa and epirubicin. Conclusion Pirarubicin is effective in preventing bladder tumor recurrence,with efficacy better than chemotherapeutic agents such as mitomycin C,hydroxyeamptothecin,and adriamycin,thus can be a novel optional intravescial chemotherapeutic agent for bladder cancer.

BACKGROUND: Present existed procedure protocol for urinary fistula has some limitations, which can not reflect diseased region, pathological change, or severe condition of patients, OBJECTIVE: To establish the procedure protocol for urinary fistula diagnosis and treatment following renal transplantation, in addition, to investigate its significance in clinical practice. METHODS: A total of 102 cases with urinary fistula, including 67 male and 35 female, range in age from 21 to 57 years. According to the business management mode, we have designed the "five-step procedure protocol" for the diagnosis and treatment of urinary fistula after renal transplantation. Four diagnosis steps consisting of qualitative, located, quantitative and classified, as well as one treatment step. Among 102 cases of urinary fistula, 34 were adopted conservative treatment, including 24 cases with drainage tube and retention type catheter, 10 cases with indwelling ureteric stents at tubal bladder. Other 68 cases received surgical treatment. In 47 cases with simple fistula, 36 cases received ureter/bladder replantation, 11 cases with ureteral anastomosis. Twenty-one cases with complex fistula were treated with surgical prosthesis using omentum majus after repairing. RESULTS AND CONCLUSION: Among the 34 cases receiving conservative treatment, 2 got urinary tract infection repeatedly, and 5 got the stenosis of ureterovesical anastomotic stoma. Among the 68 cases receiving surgical treatment, 2 had ureteral stoma stricture, 1 ureterovesical anastomotic stoma stricture, and 1 ureteral countercurrent. In the surgical treatment series, 3 cases died from severe pulmonary infection elicited by urinary fistula. 77 cases were available for long-term follow-up, 22 were dropped out. In the 57 cases with simple fistula were followed up for 1-10 years, the transplanted renal function was normal in 40 cases, and 17 cases suffered from chronic rejection. 20 cases with complex fistula treated with surgical prosthesis using omentum majus were followed up for 1-7 years, 19 cases were normal, 1 patient had increased creatinine, which was returned to normal after intravenous glucocorticoid therapy. The design of "qualitative, located, quantitative and classified" standard for urinary fistula diagnosis following renal transplantation, and the establishment of "five-step procedure protocol", make urinary fistula diagnosis and treatment more ordered and standard, which is more feasible for selecting optimal therapeutic scheme.

BACKGROUND: The urinary fistula rates following kidney transplantation are varying in each center, which lack of unified classification criteria and treatment standard. OBJECTIVE: To explore optimal treatments for urinary fistula following kidney transplantation by retrospective analyzing the characteristics, etiological factors and therapeutic efficacy of urinary fistula. METHODS: Totally 68 patients with urinary fistula were collected, including 42 males and 26 females, aged 21-57 years. The urinary fistula occurred at days 1-17 after operation. According to the location of urinary fistula, patients were divided into stomas fistula and ureter fistula groups. The location of fistula was determined by cystography, magnetic resonance hydrography (MRH) or operation research. In both groups, conservative treatment was first adopted, namely, placing a negative pressure drainage tube draining the wounds and placing a double-J catheter or a urinary canal in, however, if invalid, a surgical repair was performed. There were 45 patients underwent surgery. The location, onset period, therapeutic efficacies of urinary fistula was analyzed. RESULTS AND CONCLUSION: Among the 68 cases of fistula, 20(29.4%) were stomas fistula and 48 (70.6%) were ureter fistula. The onset period was (5.1±2.5) and (8.8±5.5) days after transplantation, respectively (P < 0.05). Fifteen of 20 stomas fistula (75.0%) were cured successfully by conservative treatment. Whereas, for the remaining 5 cases (25.0%), we attempted open surgery, among which 4 were cured, free of recurrence, and 1 case underwent nephrectomy because of acute rejection. For the 48 cases of ureter fisula, only 8 (16.7%) were cured by conservative treatment, but the other 40 (83.3%) must accept further open surgery, among which 35 were cured (including 6 cases of recurrent fistula). Three cases underwent nephrectomy failure of repair owing to acute rejection, besides 2 died of pulmonary infection. The achievement ratio of conservative treatment in lower fistulae was significantly higher than that of upper fistulae (P < 0.01). It is necessary to determine the location of urinary fistula following kidney transplantation. Compared to ureter fistula, stomas fistula occurred earlier with great leaked volume. Conservative treatment can first selected for stomas fistula, only if it is invalid can we resort to open surgery. However, for. ureter fistula, it is wise to adopt open surgery as soon as possible.

Objective To establish a HEK293 cell line stably and highly expressing sense and antisense Alu-Sx.Methods According to Alu subfamily Sx sequence,a pair of primers containing the sites for given restrictive endonuclease at both ends were designed and synthesized.PCR of the total DNA extracted from HEK293 cell line was performed,the products of which were cloned into a highly efficient eukaryotic expression vector pcDNA3.1/myc-His A.The recombinants were sequenced and identified by restrictive endonuclease digestion and then transfected into the HEK293 cell line by lipofectamine2000.The stable transfectants were screened by G418.Cell subclones were isolated by gradient dilution.The highly expressing clones were identified by Northern blotting.Results Eukaryotic expressing vectors stably and efficiently expressing sense and antisense Alu-Sx were constructed and cell subclones stably and efficiently expressing sense and antisense Alu-Sx were established.Conclusion Cell subclones stably and efficiently expressing sense and antisense Alu-Sx can used for our further study.