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.

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.

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.

Objective To evaluate the curative effects of retroperitoneoscopic nephroureterectomy for the treatment of carcinoma of the renal pelvis. Methods We performed retroperitoneoscopic nephroureterectomy in 22 cases of carcinoma of the renal pelvis between December 2002 and November 2005.Transurethral vesection of the ureteral orifice with bladder cuff was performed and the affected kidney was retroperitoneoscopically dissected en bloc.The dissected kidney and ureter were removed intact through a hypogastric incision.Results The operation was successfully completed in all the 22 cases.The operation time was 2~5 h(mean,4.3 h),the blood loss was 50~600 ml(mean,187 ml),and the postoperative drainage volume,50~200 ml/d(mean,120 ml/d).The drainage tube was removed at 24~48 postoperative hours. The duration of hospitalization ranged 8~13 d(mean,10 d).Pathological findings after operation showed transitional cell carcinoma in all the cases.Followup observations in the 22 cases for 1~24 months(mean,14 months) found no recurrence.Conclusions Retroperitoneoscopic nephroureterectomy in the treatment of carcinoma of the renal pelvis is feasible,effective and micro-invasive.

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 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 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 evaluate the morphological features and distribution of Cajal-like cells in the human upper urinary tract after the laparoscopic nephrectomy.MethodsFrom January 2008 to August 2008,specimens of the kidney were obtained from 23 patients after laparoscopic nephrectomy in our hospital.Each specimen included the renal calyces,renal pelvic,and proximal ureter.HE staining and CD117 immunohistochemical staining were performed.The Cajal cells harvested from normal colon were used as positive control.The cells were observed under light microscope and the distribution of the Cajal-like cells in the upper urinary tract were analyzed.ResultsThe morphology of Cajal-like cells in the human upper urinary tract were similar to those collected from the colon,both showed fusiform shape and were positive for CD117.The Cajal-like cells within the colon were located surrounding the myenteric nerve plexus between the smooth muscles,whereas the Cajal-like cells distributed in the human upper urinary tract were diffused within the lamina propria and muscles.The density of Cajal-like cells at the renal calyces,renal pelvic,and proximal ureter was 15.4?5.4/cm2,22.6?6.6/cm2,and 19.9?5.8/cm2,respectively.The density at the renal calyces was significantly lower than those in the renal pelvic and proximal ureter(P=0.000,P=0.014),whereas,no significant difference was found in density between the renal pelvic and proximal ureter(P=0.129).ConclusionsCajal-like cells exist in the human upper urinary tract with different distribution characteristics from those in the gastrointestinal tract.In the upper urinary tract,the density of the cells is various,which may be related to the functions of the different parts of the tract.

Objective To report our initial experience on the complications of retroperitoneoscopic live donor nephrectomy(RPLDN)and their managements in 117 cases.Methods From December 2003 to January 2009,117 cases of RPLDNs were carried out in our hospital.The operation was performed through 3 lumbar ports,after the kidney was liberated fully and the ureter was severed 7-8 cm under the lower pole of the kidney,the renal artery and vein were blocked with Endo-cut or Hem-o-lok and then cut off.Endo-cut was used in 3 patients and Hem-o-lok in 114 donors.Afterwards,the kidney was taken out quickly from the donor and infused with 4℃ kidney preserving fluid(HCA)immediately.We reviewed the intraoperative and postoperative complications in the donors and the grafts and the managements of the cases.Results All the 117 operations were successfully completed.No patients died during the operation or had delayed graft function recovery postoperation.No one was converted to an open surgery or needed blood transfusion during the procedure.Surgery-related complications occurred in 5 donors(4.3%)including intraoperative bleeding in 2(cured by hemostasis during the operation)and retroperitoneal hematoma in 3(cured by conservative management).Graft-related complications occurred in 8(6.8%)cases;among which extra arteries in the graft owning to endovascular stapler was found in 1 patient(who had a short common stem of the main renal artery,the three branches were anastomosed with the external iliac artery and 2 branches of internal iliac artery respectively);two graft kidneys were lacerated by laparoscopic instruments superficially and were repaired using absorbable sutures;renal subcapsular hematoma was noted in 2 grafts,capsulotomy was performed in one of them while the other received no treatment,both the cases had normal function of the transplanted kidneys;ureteral complications occurred in 3 grafts,in which vesico-urethral anastomotic leakage was developed in 10 days after withdrawal of the double J stents,they were cured by ureteral re-implantation.All the donors and recipients with complications were followed up for an average of 50 months(range 15-62 months).No other complications were found in the cases.During the follow-up,blood and urine routine,liver and renal functions,and blood glucose level are all in a normal range,abdominal B-ultrasonography revealed no abnormalities.B-ultrasonography of the implanted kidneys showed normal morphology and renal functions.Conclusions RPLDN is a safe and reliable method.Most of its complications complications may be attributed to the learning curve.Refinements in surgical techniques may decrease the rates of both donor and graft complications.

Objective To evaluate the efficacy and safety of percutaneous nephroscopic lithotripsy for the treatment of bilateral upper urinary calculi. Methods From July 2004 to December 2008,we performed percutaneous nephroscopic lithotripsy under X-ray or ultrasonic guidance for 35 patients with bilateral upper urinary calculi. Of the 35 patients,bilateral renal calculi were found in 18 patients,unilateral renal and unilateral ureteral calculus in 10,bilateral ureteral calculi in 7. Results In 35 patients (70 sides),the calculi was removed through a single tract in 49 sides,through double tracts in 18 sides,and through triple tracts in 3 sides. The mean operation time for unilateral PCNL was 66 min (ranged from 20 to 185 min). The stone-free rate was 80% (56/70) on one session. A second-look stone removal was needed in 8 laterals,and 3 laterals underwent three times of lithotomy. In three sides,a few residual renal stones were found after the first operation,but no second operation was performed. The final stone-free rate was 91.4% (64/70) in all of the cases,among which the stone-free rate was 100% (24/24) for ureteral stones and was 87% (40/46) for renal stones. In this series,no chest or abdominal injuries,intestinal perforation,or injuries to surrounding organs were detected. The patients were discharged from hospital in 5 to 30 days,and then were followed up for 3 to 6 months. During the follow-up,B-ultrasonography and KUB+IVP found no recurrence of calculi. Conclusions Percutaneous nephrolithotomy is effective and safe for bilateral upper urinary calculi. By skilled urologists in conditioned hospital,simultaneous bilateral percutaneous nephrolithotomy performed on bilateral upper urinary calculi can shorten the cycle time of treatment and hospitalization.