Objective To evaluate the safety and effect of extraperitoneal laparoscopic radical prostatectomy for high-risk prostate cancer. Methods From January 2012 to August 2015, 49 patients diagnosed high-risk prostate cancer underwent extraperitoneal laparoscopic radical prostatectomy with 'sandwich' urethra reconstruction. Results None converted to open surgery and the mean operative time was (2.15 ±0.29) h, mean intraoperative blood loss was (60.25 ± 20.29) ml. No rectal injury was observed. The patients were ambulant 1 to 2 days postoperatively. Pelvic lymph nodes metastasis was found in 5 cases. Positive margin was found in 13 cases. Mild urinary incontinence oc-curred in 3 cases. Urethral stenosis occurred in 2 cases. Biochemical relapses occurred on 5 cases during the follow-ing period of 1~43 months for 46 cases. Conclusions Extraperitoneal laparoscopic radical prostatectomy is safe and effective in treatment of high-risk prostate cancer. The very key is to master the anatomy of prostate and laparoscop-ic techniques.

Objective To discuss the experience of antegrade radical retropublic prostatectomy. Methods Thirty cases of prostate cancer were treated by antegrade radical retropublie prostateeto-my. The mean age of patients was 64 years. There were 8 cases of T_1, 15 cases of T_2, and 7 cases of T_3. The surgery included following procedures: Firstly the vesical neck was divided. Then the seminal vesicle and the prostate were freed from above downward. After the urethra was separated from the prostatic apex, the proximal end of urethra was sutured to the new vesical neck. Results All the 30 laparoscopic surgeries were accomplished successfully. The mean operative time was 2.5 hours. The mean blood loss was 350 ml in the operation. No ureteral injury, rectal injury and other severe compli-cation was observed. Histopathologic study showed prostate cancer for all the cases. Four cases had positive surgical margins. All cases were followed up from 6 to 48 months (average 25 months) with-out dysuria and permanent incontinence. No death occurred. Sexual function recovered in 7/13(54%) cases after the operation. Conclusions Antegrade radical retropublic prostatectomy provides low complication, tittle bleeding and positive surgical margins. It is an effective and sale procedure to treat prostate cancer.

Objective To investigate the cause, diagnosis and management of Wunderlich's syndrome.Methods Clinical data of 13 cases of Wunderlich's syndrome were reviewed retrospectively. Results There were nine cases of tumorous disease, 2 cases of non-tumorous disease and 2 cases of unknown causes in the group. The most common cause in this series was renal angiomyolipoma. Surgical management was performed in 8 cases. Conservative treatment was adopted in the rest 5 cases. Pathological study confirmed that there were 2 cases of renal cell carcinoma, 4 cases of angiolipoleiomyoma and 1 case of congenital polycystic kidney. Conclusions The cause of Wunderlich's syndrome is complicated, renal neoplastic origin disease appears to be the most common cause. Comprehensive analysis of multiple imaging examinations and clinical features is most important in the etiological diagnosis. The appropriate management depends on the underlying etiological diagnosis and the patient's hemodynamic status. Carefully watching is required for patients who have not been made a definite etiological diagnosis.

Objective To investigate the expression of CD158b in NK cells after allogeneic kidney transplantation.Methods In 62 patients with allogeneic kidney transplantation, blood samples were collected on the day before operation, first, 7th day after operation, the moment the graft (reco)-(vered) and the acute rejection occurred. The expression of CD158b was detected in peripheral blood NK cells. The ratio of CD3~-CD16/56~+CD158b~+ was measured.Results There were 38 patients without acute rejection during the whole transplantation period. The ratio of CD3~-CD16/56~+ cells and CD3~-CD16/56~+CD158b~+ cells were stable before and after the transplantation. Twenty-four patients experienced acute rejection post-transplantation. The ratio of CD3~-CD16/56~+ cells was increased significantly after acute rejection, the ratio of CD3~-CD16/56~+CD158b~+ cells decreased significantly, and the percentage of CD3~-CD16/56~+CD158b~+ cells of total NK cells decreased significantly.Conclusion There are not too much factors interfering with the expression of CD158b in NK cells, and the ratio of CD3~-CD16/56~+CD158b~+ cells had already decreased significantly before the clinical diagnosis of (acute) rejection. Monitoring of CD158b in NK cells is more accurate and sensitive for the evaluation of immune state.

Objective To investigate the expression of insulin-like growth factor Ⅱ mRNA binding protein 3 (IMP3) in non-muscle invasive bladder cancer and its relationship with the tumor recurrence and progression.Methods IMP3 protein expression was detected by immunohistochemistry in 130 cases of nonmuscle invasive bladder cancer specimens who underwent transurethral resection the first time at Beijing Chao-Yang hospital,from October 2010 to October 2013.Besides,we analyzed 20 cases of muscle-invasive samples and 20 benign tissues adjacent to cancer as control.The 130 patients were followed up by telephone and other methods.According to the UICC-TNM standard.Survival analysis was calculated by using the Kaplan-Meier method,and the difference in survival curves was analyzed by using the log-rank test.For multiple analyses,The Cox proportional hazards regression model was used.Results The positive expression rate of IMP3 in 130 patients with non-muscle invasive bladder cancer was 59.2％ (77/130),of which 30.0％ (39/130) was weak expression,29.2％ (38/130) was strong.However there was 80.0％ (16/20) in muscle-invasive specimens,of which 20.0％ (4/20) was weak,60.0％ (12/20) was strong (P =0.011).IMP3 was not detected in all benign tissues adjacent to cancer (P ＜0.001).All the 130 patients were followed-up for 5 to 69 mnonths,45 cases experienced disease recurrence,20 patients had progressed and 12 cases died.IMP3 expression was significantly related to higher tumor stage (P ＜ 0.001),high tumor grade (P =0.014),and tumor recurrence (P =0.003).Kaplan-Meier plots and log-rank tests showed that patients with IMP3-positive tumors had a lower disease-free survival (P =0.002) and progression-free survival rate (P =0.010) than those with IMP3-negative tumors.In the multivariable Cox analysis,we found that IMP3 protein was an independent predictor of disease-free survival (P =0.010) in non-muscle invasive urothelial carcinoma of bladder.Conclusions IMP3 was not expressed in benign tissue adjacent to cancer,whereas highly expressed in bladder cancer,and high IMP3 expression is an independent prognostic factor in NMIBC that can identify the patients with a high potential to relapse.

Objective To explore the value of the LigaSure vessel sealing in laparoscopic nephrectomy surgery. Methods Laparoscopic nephreetomies were performed in 41 cases from May 2004 to December 2006 by using LigaSure, including simple nephrectomies, radical nephrectomies and nephroureterectomies. The operative time, estimated blood loss, open conversion rate, duration of postoperative drainage, total amount of postoperative drainage, postoperative hospital day as well as complication rate were recorded and analyzed retrospectively. Results All procedures were finished successfully without conversion to open surgery. No severe vascular complication or other serious complications happened. The mean operative time was 146min (range, 35-240 min) ; mean blood loss was 163ml (range, 30-450 ml); mean time for postoperative drainage was 3d (range, 1-6 d) ; mean amount of postoperative drainage was 229ml (range, 45-435 ml). The postoperative hospital staying was 6-21 d, with the average of 10 days. Conclusions The LigaSure vessel sealing system produees a consistent, reliable, permanent seal of veins, arteries, and tissue bundles. It could decrease operative time and blood loss. This new energy-based vessel-ligation device appears to be effective in advanced laparoscopic procedures.

Objective To investigate the difference of surgical efficacy between extended lymph node dissection and standard lymph node dissection in laparoscopic radical cystectomy.Methods We retrospectively analyzed 62 bladder cancer cases,icluding 52 males and 10 females patients in our hospital from January 2011 to October 2016,who underwent laparoscopic radical cystectomy and pelvic lymph node dissection.Their mean age was (62.5 ± 9.6) years,ranged from 42 to 83 years.27 cases were underwent extended lymph node dissection and 35 cases were underwent standard lymph node dissection respectively.The basic characters,operative time,intraoperative blood loss,intraoperative and postoperative complications,postoperative eating time,postoperative activity time,postoperative hospital stay,lymph nodes positive rate,lymph node density,and cancer-free survival were evaluated.Results All patients were underwent successful operation.There was no significant difference in operation time [(326.2 ± 77.5) min vs.(345.5 ± 66.8) min,P =0.297],blood loss [(198.2 ± 77.5) ml vs.(213.7 ± 160.0) ml,P =0.590],intraoperative complications (0/27 vs.5/35,F =0.063),postoperative complications (8/27 and 9/35,P =0.732),postoperative eating time[(4.8 ±2.2)d vs.(4.6 ± 1.9)d,P =0.817],postoperative activity time[(1.9 ± 0.8) d vs.(1.9 ± 0.9) d,P =0.838] and postoperative hospital stay[(15.6 ± 7.5) d vs.(16.0 ± 5.9)d,P =0.483].In this study,994 lymph nodes and 100 positive lymph nodes were dissected.There were significant differences in the number of lymph nodes dissected in the two groups (23.2 ±6.6 vs.10.5 ±3.6,P ＜0.01).40.74％ (11/27) of cases in ePLND were lymph node positive and the lymph node density was 11.7％ (73/626),which was higher than that of the sPLND group (28.57％ vs.7.34％,respectively).In regard to prognosis,the cancer-free survival rate (DFS) of ePLND group was 96％,91％,80％ and 71％ at 3,6,12 and 24 months follow-up respectively.The other group was 97％ 94％,84％,80％ correspondingly.And no significant difference was detected (P =0.546).Although there was no significant difference (P ＞ 0.05),DFS of ePLND group tended to be higher than that of sPLND group in lymph node positive subgroups.Conclusions Extended lymph node dissection and standard lymph node dissection have similar surgical safety and prognosis,and appropriate surgical procedures should be selected according to the patient's condition.

Objective:To explore the feasibility and superiority of retropubic extraperitoneal laparosco-pic simple prostatectomy with prostatic urethra preservation to treat large volume benign prostatic hyperplasia(BPH).Methods:From January 2006 to August 2009,laparoscopic simple prostatectomy with prostatic urethra preservation was performed in 45 patients with symptomatic BPH,and the age of patients was 70.5?7.2(range 47 to 83) years old.The transrectal ultrasound(TRUS) revealed BPH and calculated prostatic gland weight was 126.1?52.4(range 62 to 365) g.There were 3 cases presented with bladder calculus and 1 case presented with bladder diverticulum.The technique included retropubic extraperitoneal space produced by balloon dilation,five trocars in a reverted U shape placed,transverse prostatic capsular incision made,subcapsular plane developed,prostatic adenoma removed while prostatic urethra preserved as well as prostatic capsule sutured.Demographic,perioperative and outcome data were recorded.Results:No patient required conversion to open surgery.The mean operative time was 123.9?51.3(range 37 to 270) minutes and the estimated blood loss was 230.6?194.5(range 50 to 800) mL.Blood transfusion was not necessary in this group of patients.Bladdder irrigation was not needed except for the initial 2 cases and the average Foley catheter duration was 7.5?3.5(range 2 to 14) days.Significant improvement was noted in the maximum flow rate,the International Prostate Score Symptoms(IPSS) and the quality of life questionnaires(QOL) three months after surgery.The erectile function was preserved in all patients who were potent before surgery and the ejaculation maintained antegrade.No urinary incontinence was reported by patients.Conclusion:Laparoscopic simple prostatectomy with prostatic urethra preservation for large benign prostatic hyperplasia is feasible and reproducible.Postoperative bladder irrigation can be avoided and antegrade ejaculation is preserved.The patients have a shorter hospital stay and early return to normal activity.

Objective:To explore risk factors for positive surgical margin (PSM) after laparoscopic radical prostatectomy (LRP) in high risk prostate cancer (PCa) patients with and without neoadjuvant hormornal therapy (NHT).Methods:The clinicopathological data of 202 high risk patients who underwent LRP from January 2012 to July 2020 was retrospectively analyzed. There were 111 cases performed in Beijing Chaoyang Hospital and 91 cases in National Cancer Center. Mean age was(67.7±6.5)years, mean BMI was (25.65±3.21)kg/m 2. Median highest preoperative PSA was 20.97(11.00, 34.40)ng/ml, median preoperative prostate volume was 32.88(23.33, 46.20)ml. Among all 202 high risk PCa patients, 97 did not receive NHT(non-NHT group) and 105 received NHT(NHT group). There were significant statistical difference in term of highest PSA, preoperative prostate volume between NHT and non-NHT groups ( P<0.05), while there was no significant difference in term of age or BMI between the two groups. Among NHT patients, 80 cases accepted complete androgen blockade therapy with median course of 3 months; 3 cases accepted simple castration therapy with median course of 3 months; 22 cases accepted simple anti-androgen therapy with median course of 1 month. Risk factors for PSM after LRP in NHT and non-NHT groups were respectively explored, including age, BMI, hypertension, diabetes, history of pelvic surgery, highest PSA before puncture, ISUP before puncture, preoperative prostate volume, ISUP after LRP, postoperative pathological stage T, pathological lymph node involvement, vessel carcinoma embolus, etc. Results:PSM rate was 50.5%(49/97) and 24.8% (26/105) in non-NHT and NHT, respectively. The apex was the most common location of PSM in non-NHT group(35.1%, 34/97), while the fundus was the most common location of PSM in NHT group(14.3%, 15/105). Multiple logistic regression revealed that postoperative pathological stage T was the only independent factors affecting the PSM for high risk patients without NHT ( OR=3.814, 95% CI 1.302-11.173, P=0.015), while postoperative pathological stage T, pathological lymph node involvement, and vessel carcinoma embolus were independent risk factors affecting PSM for high risk patients with NHT ( OR=18.434, 95% CI 4.976-68.297, P<0.001; OR=7.181, 95% CI 2.089-24.689, P =0.002; OR=3.545, 95% CI 1.109-11.327, P=0.033). Conclusions:Postoperative pathological stage T was independent risk factors affecting PSM for all high risk PCa patients no matter with or without NHT, while pathological lymph node involvement, and vessel carcinoma embolus were also independent risk factors affecting PSM for high risk PCa patients with NHT.

Objective:To analyze the learning effect of laparoscopic radical cystectomy(LRC)+ modified ileal conduit(MIC).Methods:From 2014 to 2019, 42 patients underwent MIC and their clinical data was retrospectively analyzed. 34 operations were performed by surgeon 1 and 8 operations by surgeon 2. We divided the 34 patients of surgeon 1 into three groups according to their surgical sequence (group A, 1st to 12th; group B, 13th to 23th; group C, 24 th to 34 th), the 8 cases of surgeon 2 was regarded as group D. The history of abdomen surgery in the 4 groups were 0, 1, 4, 3 cases, respectively ( P<0.05). There was no significant difference of the other baseline characteristics, such as age, BMI, American Society of Anesthesiologists. Then we compared several variables between the 4 groups like operation time, time of ileal conduit construction, blood loss, complication rate, lymph node yield, surgical margin, etc. The key steps of the MIC included isolating terminal ileum when the mesentery was transilluminated, performing end-to-end reflux ureterointestinal anastomosis after the efferent loop was fixed, closing the rent of the retroperitoneum. Results:All operations were performed intracorporeally with no transition to open surgery. The operative time for group A, B, C were 330.0(320.0, 360.0)min, 300.0(250.0, 308.0)min, 270.0(216.0, 324.0)min, respectively ( P =0.010). The time of ileal conduit construction of the 3 groups were 136.5(131.3, 147.5)min, 92.0(79.0, 119.0)min, 79.0(72.0, 115.0)min, respectively ( P <0.001). In addition, the difference of the two variables above between A and B, A and C groups separately reached statistical significance ( P<0.05), while the difference between B and C groups did not ( P>0.05). Other variables, such as blood loss, complication rate, lymph node yield, surgical margin, between the 3 groups reached no statistical significance ( P>0.05). The operative time of group D was 420.0(350.0, 450.0)min, and it reached statistical significance ( P<0.05) when compared with group A. There were no significant differences in other variables, such as blood loss, complication rate, lymph node yield, surgical margin, among the 2 groups ( P>0.05). Conclusions:The learning effect of LRC+ MIC was obvious. When surgeon volume increased, the operative time decreased significantly. Variables like estimated blood loss and complication rate of the 2 surgeons did not reached significant difference, which indicated reproductivity and safety of this procedure.