Objective To discuss the curative effect and the prognosis of patients with renal cell carcinoma after laparoscopic radical nephrectomy. Methods One hundred and twenty-seven cases of renal cell carcinoma treated with laparoscopic radical nephrectomy between October 2002 and Decem-ber 2006 were reviewed. The perioperative complications and postoperative renal function were recor-ded and analyzed. Post-operative 1-year and 3-year actuarial survival rates, disease-free survival rates and tumor-specific survival rates were caculated respectively with Kaplan-Meier analysis. Quality of life(QOL) was compared before and after surgery by Karnofsky Performance Status measuring scale. Results Among the 127 patients, 107 cases were followed up of mean 23 months (4-51 months). 1-year and 3-year actuarial survival rates, disease-free survival rates and tumor-specific survival rateswere 95.6%, 95.6%; 95.8%, 95.8% and 96.8%, 96.8%, respectively. 3-year actuarial survival rate, disease-free survival rate and tumor-specific survival rate were 97.1%,98.6%, 98.6% in pT1-2 tumors, and were 90.2%, 85.6%, 90.2%in pT3a, tumors. Disease-free survival rate and tumor-spe-cific survival rate had significant differences between patients in stage pT1-2 and patients in stagepTa3a.91.6% of the patients scored the post-operative QOL above 80 by Karnofsky Performance Sta-tus measuring scale. Conclusions Patients who underwent laparoscopic radical nephrectomy have high survival rate, low complication incidence and good QOL. Post-operative survival rate is correlated with pathologic stage.

Surgical treatment is the only cure treatment for patients with inferior vena cava tumor thrombus in hepatic segment and upper hepatic segment.The accurate diagnosis of tumor thrombus is very important.In preoperative imaging examination,the abdominal enhanced CT scan and the inferior vena cava MRI scan were the best methods for the diagnosis and evaluation of the tumor thrombus in hepatic segment and upper hepatic segment.Compared with the tumor thrombus below the liver,the tumor thrombus in hepatic segment or above hepatic segment extend widely,and the operation are more difficult.For simple inferior vena cava tumor thrombus (the top of the thrombus has reached the level of hepatic vein),Retroperitoneal approach combined with transperitoneal approach should be used.Open surgery is the standard procedure for other tumor thrombus in hepatic segment and upper hepatic segment.In addition to exposure of inferior vena cava below the hepatic vein,the liver and the first hepatic hilum should be exposed.For tumor thrombus in the atrium,after the longitudinal incision of diaphragm,we use Milking technology to squeeze thrombus into inferior vena cava.Then we use catheterization technology to remove thrombus.For difficult atrial tumor thrombus,an extracorporeal circulation should be performed.The median incision in the chest should be performed to open the chest and open the pericardium and remove the tumor thrombus.Patients with tumor thrombus in hepatic segment or upper hepatic segment should be diagnosed as early as possible and they need actively treated by operation.

BACKGROUND:Cyclosporine A has shown its immunosuppressive effects and has been widely used in clinical organ transplantation.OBJECTIVE:To review the recent studies on the immunosuppressive mechanisms and the active pathway of cyclosporine A.RETRIEVAL STRATEGY:A compute-based online search of ScienceDirect Onsite,ProQuest,Springer and Ovid,based on the data from Peking University Medical Library,was undertaken for the English articles concerning with the immunosuppressive mechanism of cyclosporine A from January 1990 to December 2006,with the keywords of "cyclosporine A,mechanism/action,immunosuppression".Totally 68 articles were collected after the first trial,and the preliminary screening was conducted for the titles and abstracts.Inclusion criteria:articles related with the immunosuppressive mechanisms of cyclosporine A.Repetitive studies were excluded.Fifty accorded with the inclusive criteria,and 46 of them regarding tracheal transplantation were selected for the full-texts as the references.LITERATURE EVALUATION:Forty-six included articles included 6 ones about the clinical use and effects of cyclosporine A,and 40 involving the related studies on the molecular mechanisms of cyclosporine A.DATA SYNTHESIS:The review of literatures indicates that,the immunosuppressive mechanisms of cyclosporine A consist of:① the calcineurin/nuclear factor of activated T-cells pathway,②the activation of JNK and P38 signaling pathways,③other effects.CONCLUSION:Cyclosporine A selectively regulates the function of peripheral blood lymphocytes subgroup,blocks the activation of cytotoxic T-cells,and possibly inhibits the formation or reaction of memory T-cells.But it doesn't affect activation and proliferation of suppressive T-cells,or expression of interleukin-2 receptors,which may induce selective immunosuppression.

Objective To analyze the efficacy, safety, and learning curve of holmium laser enucleation of prostate (HoLEP). Methods From June 2014 to June 2015, there were 45 consecutive patients with benign prostatic hyperplasia who underwent HoLEP performed by one experienced urologic doctor ( having surgical experience of transurethral resection of prostate in more than 500 cases) in our hospital. The patients were divided into three groups:group A (patient 1-15), group B (patient 16-30), and group C (patient 31-45). The patient age, prostate specific antigen (PSA) and prostatic volume evaluated by ultrasound were similar among the 3 groups (P>0. 05). Clinical data including operative time, hemoglobin decrease, and catheterization duration were compared among the 3 groups. The efficiency for enucleation was calculated as prostatic volume divided by operation time. Results The average enucleation efficiency of 3 groups was 0. 34 ± 0. 14, 0. 36 ± 0. 16, and 0. 49 ± 0. 18 ml/min, respectively, with a significant difference among the 3 groups (F =4. 025, P =0. 025). The group C obtained significantly improved efficiency as comparing with the group A and group B (P=0. 013 and 0. 028, respectively). No significant difference was found in operative time, hemoglobin decrease, catheterization duration, and rate of blood transfusion and complication among the 3 groups (P>0. 05). There were several surgery-related complications, including 2 cases of conversion to TURP, 5 cases of postoperative temperature more than 38℃, 4 cases of severe stress incontinence, 1 case of bladder mucosal injury by morcellator, 1 case of urethral stricture, and 1 case of postoperative hemorrhage. It took 30 cases to overcome learning curve of HoLEP by self-taught modality. Conclusions For experienced endourologist, HoLEP can be learn by self-taught modality after 30 cases training. Cases with small prostatic volume less than 60 ml should be selected in the early stage of the learning curve.

Objective To explore the angiogenic function of EPC from peripheral blood in kidney transplanted patient and to reveal its regulative mechanism.Methods 23 chronic renal failure patients without diabetes were recruited in department of Urology Peking University Third Hospital from January 2014 to February 2015.Fasting peripheral blood mixed with heparin (20 U/mL) was collected one day before and 24 hours after kidney transplantation.We set preoperative blood as control and the postoperative blood as the experimental group.EPC from peripheral blood were isolated by density-gradient centrifugation.FACS was used to identify the EPC.The AA metabolites PGE2 in EPC cultured medium was measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS).Q-PCR and WB were used to detect the expression of endothelial markers in HUVEC cultured under the EPC conditional medium.Tube formation assay was performed to assess the angiogenic ability of HUVEC.Results EPC from kidney transplantation expressed c-kit and CD31 by FACS analysis.Multiple types of AA metabolites was detected in the conditional medium by LC-MS/MS and level of PGE2 increased into two folds after kidney transplantation, compared with that before operation(P ＜ 0.05).HUVEC highly expressed CD31 and VE-cadherin cultured under conditional medium, which were 1.5 folds compared with that before operation (P ＜ 0.01).And those cells formed more tubes than that in control group, which showed better angiogenic capacity.HUVEC, treated by PGE2, had the similar biological characteristics like the conditional culture.Conclusions EPCs in the peripheral blood form kidney transplantation patient secret the PGE2, which can enhance the capacity of angiogenesis in HUVEC.

Objective To present the primary effectiveness and morbidity of metallic ureteral stent in treating the patients with malignant ureteral obstruction .Methods The retrospective study enrolled 11 patients received metallic ureteral stent placement because of malignant ureteral obstruction at our hospital between Jul.2012 and Jan.2014.Total of 16 stents were inserted including 5 bilateral stent insertion. There were 4 males and 7 females, with a mean age of 56 years (range 28 to 88 years).Mild to moderate hydronephrosis were identified by ultrasound and CTU in all patients , including 2 recurrent fever and 1 renal colic in affected side , however serum creatinine level is normal .There were 10 patients received stents insertion through cystoscopic or nephroscopic retrograde approach and 1 through nephroscopic antegrade approach,under superficial , spinal or intravenous anesthesia .Patients were scheduled for follow-up at 6 months intervals by KUB and ultrasound and would be examined ahead of time if there were any obstructive symptoms including recurrent fever or renal colic of the affected side .Outcomes and complications were observed during follow-up.Results In total,11 patients underwent 13 operations,including 2 by staging operations.Hydronephrosis , recurrent fever and renal colic were relieved in all patients after operation , showing 100%success rate.The mean follow-up was 9 months,in which,9 patients had not reached the scheduled time (1 year) while 2 patients exceed the time limit of stent exchange because of poor physical status.During the follow-up, 1 patient died of the progression of urothelial carcinoma .Nine stents of 5 patients keep alleviating the obstruction without hydronephrosis evaluated by ultrasonography .Stents failure occurred in 6 ureters of 5 patients, including 3 encrustation and 2 migration, presenting of progressive hydronephrosis and recurrent fever . Functional restoration was achieved in one of the encrusted stent undergoing ESWL .One stent with encrustation fail to be removed and a polymer double-J stent replacement in the same side was required for drainage .The other 3 nonfunctional stents were removed and replaced by polymer double-J stents.Conclusions Ureteral obstruction secondary to extrinsic compression contributing to relatively stable malignant tumor could be treated safely and sufficiently with the resonance metallic stent . Surveillance on schedule and regularly change within 1 year is critical to achieve successful outcomes .Tumor progression with ureteral invasion as while as encrustation can cause stent failure ,and in these cases the stent should be changed every 6 months or less.

Objective To evaluate the efficacy and safety of percutaneous nephrolithotomy under ultrasonic guidance for the treatment of renal calculi. Methods Percutaneous nephrolithotomy using pneumatic or holmium laser lithotripsy under ultrasonic guidance was performed in 26 patients from January 2005 to November 2006.Among them,46 patients had single stones and 27 had multiple renal calculi.Unilateral renal calculi were found in 67 patients and bilateral calculi in 6.Staghorn calculi were identified in 11 patients.Results Of the 73 patients,a successful stone removal on one session was achieved in 57 patients,a second-look stone removal was needed in 13 patients,and 3 patients underwent three times of operation.During the operation,a single tract was used in 53 patients,double tracts in 18 patients,and three tracts in 2.A mini-invasive tract(F14～F18) was used in 47 patients,and a standard tract(F24) was established in the remaining 26 patients.The operation time was 50～160 min(mean,86 min).The stone-free rate was 96.2%(68/73),and the residual stones in other 5 patients were all

Objective To explore the operative approach, method,indication,and clinical feasibility of laparoscopic or retroperitoneoscopic treatment of ploycystic kidney.Methods The renal cyst unroofing(bilateral,9 cases;unilateral,4 cases) was performed under laparoscope(2 cases) or retroperitoneoscope(11 cases).The renal adipose capsule was dissected with a harmonic scalpel to fully visualize the whole kidney.According to preoperative positioning results,the cysts at all sizes were exposed.Then all visible cysts were unroofed or fenestrated with a margin 0.5 cm from the renal parenchyma.The cystic fluid was drawn out as much as possible.Results The operations were completed smoothly in the 13 cases.Pneumatothorax developed on the day of laparoscopic operation in 1 case,and then was cured by closed thoracic drainage.The operation time was 50～240 min(mean,139 min),and the blood loss was 10～200 ml(mean,58 ml).Patients began out-of-bed activities in 1～2 days after operation and were discharged from hospital at 3～10 days.The pathological findings were in accordance with changes of ploycystic kidney.Follow-up examinations were carried out for 1～30 months(mean,14.3 months).Back pain was relived in 8 out of 11 cases.In 3 patients with a high blood pressure,the systolic pressure was decreased by 16～19 mm Hg at 9 months after operation.Ten patients presented normal hepatic and renal functions,while the remaining 3 patients with preoperative increased creatinine levels of 194～301 ?mol/L had a drop by 20～40 ?mol/L.Conclusions Treatment of cyst unroofing under laparoscope or retroperitoneoscope is a safe and effective method in the treatment of ploycystic kidney,being worthy of clinical recommendation.

Objective To summarize the complications of retroperitoneal laparoscopic nephrectomy.Methods From November 2002 to May 2006,122 patients with renal carcinoma underwent retroperitoneal laparoscopic nephrectomy.Complications occurred in 7 patients,and the morbidity was 5.7%.One case of injury to vena spermatica converted to open surgery,the blood loss was 1000 ml with blood transfusion 800 ml.One postoperation hemorrhage of accessory renal artery which was cut off only by harmonic scalpel,leading to blood pressure decrease to 90/60 mm Hg,and a reoperation was performed and the blood loss was 600 ml with blood transfusion 400 ml.Injury of inferior vena cava by linear cutter stapler in one case,and there was no blood loss.Hemorrhage of renal artery stump after linear cutter stapler in one case and it was controlled by titanium clip.Injury of renal vein occurred in two cases and all were controlled by Hem-o-lok or titanium clip.Injury of tail of pancreas in one case and a drainage tube was placed.Results A patient with vena cava injury was followed for 30 months and no abnormality was noted.A patient with pancreas injury was followed for 1 year and nothing remarkable was noted.The other 5 cases was followed for 20-40 months,and they remained in good health.Conclusion The major complication for retroperitoneal laparoscopic surgery is injury to large blood vessels,the principle of treatment is to elevate the pressure of pneumoperitoneum up to 18-20 mm Hg and clip the blutpunkte or convert to open surgery promptly.A good drainage is necessary for the treatment of injury of pancreas.

Objective To evaluate the safety and effectiveness of the Hem-o-lok in retroperitoneal laparoscopic nephrectomy.Methods A total of 178 patients underwent retroperitoneal laparoscopic nephrectomy from November 2003 to November 2006.The operation was performed through 3 lumbar ports.The renal artery and veins were blocked with the Hem-o-lok and then severed.The ureter was cut at the site near the iliac blood vessel.For living donor nephrectomy,the kidney was taken out and infused with 4℃ kidney preserving fluid immediately.Results The operation was successfully completed in all the 178 cases and there was no conversion to open surgery.No Hem-o-lok ligating clips became dislodged.The mean operation time was 100 min(60-200 min),and the mean blood loss was 95 ml(20-200 ml).Complications included renal vein injury in 1 patient and pancreatic tail injury in 1 patient.The mean length of postoperative hospital stay was 5 days(4-8 days).Pathological results showed renal clear cell carcinoma in 65 patients,renal cystadenocarcinoma in 3 patients,renal leiomyosarcoma in 1 patient,renal lymphoma in 1 patient,renal oncocytoma in 2 patients,renal hamartoma in 2 patients,ureteral transitional cell carcinoma in 12 patients,ureteral squamous cell carcinoma in 2 patients,renal pelvis transitional cell carcinoma in 31 patients,renal pelvis xanthogranuloma in 1 patient,renal tuberculosis in 4 patients,accessory kidney in 1 patient,renal calculus in 4 patients,nephrohydrosis in 4 patients,and renal abscess in 1 patient.A total of 136 patients were followed for 1-36 months(mean,25 months),involving 64 patients followed for