Objective To investigate the value of the clinical application of fetal testis for the treatment of male hypogonadism.Method We have performed the testicular transplantation to cure 6 patients suffered from hypogonadism with the fetal testis as donor.Results All patients had a significantly increased level of serum testosterone and the male secondary sexual characteristics and the sexual desire were improved.The size of testis was larger than before operation.Conclusion Testis transplantation with fetal testis as donor is an effective method to cure male hypogonadism and has great value of clinical application for its weak immunogenicity.

Objective To summarize the diagnosis and therapy of traumatic rupture of bladder.Methods Between January 1987 and December 2000,the diagnosis,therapy and effect was retrospectively analyzed on 47 patients with traumatic rupture of bladder.45 cases were finally diagnosed with bladder perfusion,2 were found in urethra reunion operation because of urethra disruption.47 cases were surgically treated with open repair,35 cases with bladder fistulization and 12 only with bladder catheterization.Result 2 of 47 cases died because of shock and serious combined injury.45 were have healed,and urination recovered after surgery.Conclusions Intravesical perfusion with water of bladder and abdominal puncture are simple and reliable method to diagnose rupture of bladder.Repairing of bladder is a important measure to therapy rupture of bladder.

Objective To investigate the value of the clinical application of fetal testis transplantation with main vessel segment. Methods The testicular transplantation were performed to cure 9 patients suffered from male hyponadism with the fetal testis with main vessel segment as donor tissue. Results Except one, 8 patients had a significantly increased level of serum testosterone, the male secondary sexual characteristics and the sexual desire were improved. The size of testis was larger than before operation. Conclusion Fetal testis transplantation with main vessel segment is a effective method to cure male hyponadism and has great value of clinical application.

Objective To evaluate an ideal way to prepare the extracellular matrix of urethra. Methods An orthogonal design [L9(34)] was used in the experiment.Urethras were obtained from 37 rabbits,among which 27 segments were randomly selected and were decellularized following the orthogonal design in 9 groups.The whole experiments were repeated for 3 times.After the decellularization process,the acellularity of the ECM was examined by haematoxylin-eosin staining.The optimum way was found out through comparing the numbers of the remained cellular elements by computer image analysis.An ideal way was found by statistic analysis.Then the ECM was obtained from 10 pieces of urethras by the optimum methods.The scanning electronic microscopy was used to confirm the decellulary matrix.Subsequently,the ECM was used as a graft for replacement. In 10 rabbits,the urethral defect were replaced with the urethral ECMs. At sacrifice,10 days,3 weeks,6 weeks and 24 weeks,the grafts was taken out,and the regeneration was confirmed by the haematoxylin-eosin staining. Results ECM resulting from different dedellularization process in the urethras are different in the numbers of remaining cellular elements.There are no cellular elements in the 7th and the 9th group of the tissues.The cellular elements was not found by the scanning electronic microscopy in the ECM getting from the optimum methods.In the animals with replacement,histologic examination showed complete regeneration 24 weeks post operation. Conclusions The best way to prepare the ECM of urethra is A 3B 2C 3.

0.05).Urethroscopy showed a smooth and intact internal mucosa,wide urethral caliber and normal-appearing urethral tissue in the 2 groups. Conclusions VECM has the same regenerative process as UECM in the replacement of urethral defect.Moreover,VECM has wider source and better elasticity and mechanical properties,so VECM appears to be an ideal material for urethral replacement.

Objective To evaluate the sickle renal parenchyma incision for the removal of complex staghorn renal calculi. Methods Sickle parenchyma incision was used to remove stones in 37 patients with complex staghorn renal calculi.The procedure was as follows:the kidney was disected free and the pelvis within sinus renalis was isolated.Two rows of botton style sutures were made on the renal parenchyma with 2-0 plain catgut along mid-lower 1/3 of the dorsal surface of kidney free of vessels (Brodie's line) from the renal posterior lib to the plane of lower major calyx.The renal parenchyma was opened.Then,the incision was developed from the plane of lower major calyx through the middle major calyx to the plane of upper major calyx.The shape of this incision appeared like a sickle.The renal parenchyma and each calyx along this incision were opened and so was all the stones could then be easily removed.The calyces could well be observed. Results The calculi were completely removed in all the 37 cases.21 needed intraoperative blood transfusion and the mean amount of blood was 120 ml.KUB+IVU were normal 4 weeks postoperatively with improved hydronephrosis,no intrarenal stricture and void of residual calculi. Conclusions This procedure has the advantages of little intraoperative bleeding,slight impairment of renal function,high clearence rate and is indicated for the removal of any intrarenal pelvis complex staghorn calculi.

Objective To evaluate if the flexible ureteroscopy could treat stones located in lower calyx with the infundibulopelvic angle (IPA) less than 30°.Methods Thirty-six patients with inferior caliceal calculi on whom flexible ureteroscopic procedures were performed between November 2009 and June 2015 were reviewed.The mean age of the patients was 52.1 years (34-71),with the mean stone diameter of (1.5 ± 0.8) cm (1.2-2.6 cm).IPA was smaller than 30° in all 36 cases,which confirmed by CTU examination.IPA was less than 10° in 15 patients,between 11 ° and 20° in 13 patients and between 21 ° and 30° in 8 patients.Results The success rate was 63.9％ (23/36 patients) in patients with IPA smaller than 30° after first session of procedure,and the stone free rate reached 100％ after the second session of procedure.The mean operation duration was (95.5 ± 31.4) min(51-127 min).The mean hospital stay after operation was(4.1 ± 1.2)days (3-5 days).No major complications were recorded and no patients needed to convert to open surgery.Double J tube was removed after 4 weeks postoperatively.Patients were followed up for 4-12 months,during which ultrasound and CT scan were used for stone detection.Conclusions The small IPA (＜30°) negatively affected the SFR in the first session operation.However,its negative effect was solvable by using modern endoscopes.A complete stone clearance was achievable even in case of unfavorable anatomic conditions in experienced hand.

BACKGROUND:Urothelial cells are important seeding cells for urinary tissue engineering, but they are difficult to proliferate in vitro. Several studies have shown that bone marrow mesenchymal stem cells can differentiate into urothelial cells, but how these cells functions in vivo in epithelium generation after implantation, and the application of these cells in tissue engineering, are rarely studied. OBJECTIVE:To explore the isolation and proliferation of rabbit bone marrow mesenchymal stem cells that are induced into urothelial cells in combination with rabbit bladder acellular matrix to construct tissue-engineered grafts, and to assess the effect of the induced cells as seeding cells. METHODS:Twelve 8-week-old male New Zealand white rabbits were chosen to obtain bone marrow samples through tibia puncture, and to isolate bone marrow mesenchymal stem cells by density gradient centrifugation. Then the fourth or fifth generation of bone marrow mesenchymal stem cells were cultured in conditioned medium for 2 weeks, and then identified by PCR and immunofluorescence. After that, the induced cells were seeded on rabbit bladder acellular matrix to construct tissue-engineered grafts for bladder repairing. Another 12 rabbits served as control group, and urothelial cells combined with bladder acellular matrix was used for bladder repairing. RESULTS AND CONCLUSION:Bone marrow mesenchymal stem cells were successful y cultured and proliferated in vitro. After induction, PCR detection suggested that stem cellmarker (CD44) expression decreased, and epithelial cellmarker (UP1a) expression increased in the induced cells. Immunofluorescence staining demonstrated that the induced cells rather than bone marrow mesenchymal stem cells were positive for specific urothelial marker, UP1a. A stable continuous epithelial layer was observed on tissue-engineered grafts constructed by induced cells after 2 weeks, similar to the grafts built by urothelial cells. Induced bone marrow mesenchymal stem cells can differentiate into urothelial cells that can be used as seeding cells for urinary tissue engineering, which may be another choice out of urothelial cells.

BACKGROUND:The main way for long-segmental ureteral reconstruction may cause a lot of traumas and complications. Therefore, to seek a new repair method is urgent. OBJECTIVE:To investigate the feasibility of a tissue-engineered tubular graft for ureteral reconstruction. METHODS:Bone marrow mesenchymal stem cels and smooth muscle cels of rabbits were seeded into the two surfaces of bladder acelular matrix and cultivated for 7 days. Then the graft was used to prepare a 4-cm long tissue-engineered tubular graft, which was regarded as experimental group. Smooth muscle cels seeded onto the bladder acelular matrix was used to construct the tissue-engineered tubular graft as control group. Twenty-five New Zealand rabbits were randomly divided into experimental group (n=20) and control group (n=5), and two kinds of tubular grafts covered with omentum were implanted into the two groups, respectively, for repair of ureteral defects. Hematoxylin-eosin staining and immunohistochemical detection were performed at 2, 4, 8 weeks after implantation. RESULTS AND CONCLUSION:In the experimental group, hematoxylin-eosin staining showed epithelial coverage and muscle fibers on the lumen of tissue-engineered tubular grafts at 8 weeks after implantation; immunohistochemistry showed that anti-AE1/AE3 antibody and anti-uroplakinⅢa antibody were positive, confirming that there were mature epithelial cels on the lumen of tissue-engineered tubular grafts. In the control group, five rabbits were dead within 2 weeks after removal of ureteral scaffold, and autopsy showed scar formation inside the graft and severe hydronephrosis. These results demonstrate that it is feasible to construct the tissue-engineered tubular graft using bone marrow mesenchymal stem cels and smooth muscle cels into the bladder acelular matrix for ureteral reconstruction. Bone marrow mesenchymal stem cels can potentialy promote urothelial regeneration.

Objective To explore the underlying clinical factors and precautionary measures of fluid extravasation in patients with calyceal calculi treated by ureteroscopic holmium laser lithotripsy.Methods A retrospective review was made on clinical records of 138 patients with calyceal calculi receiving retrograde ureteroscopic holmium laser lithotripsy from May 2005 to March 2009. The relevance was studied between the occurance of fluid extravasation complications and various clinical factors using x2 test and binary Logistic regression. The clinical factors included patients' sexes, age groups (＜30 years, 30-50 years, ＞50 years), history of treatment (ESWL or open surgery) for upper urinary tract calculi, preoperative upper urinary tract infection, intraoperative placement of ureteral catheter and the length of procedure duration (＜ 50 min, 50-80 min, ＞ 80 min). Results Fluid extravasation complications occurred in 24 patients. The sexes and age groups were irrelevant to the occurance of fluid extravasation complications; while history of ESWL or open surgery and preoperative infection in upper urinary tract, without intraoperative ureteral catheter placement and long duration of procedure were responsible for the higher rates of the fluid extravasation complications.Conclusion Reasonable selection of patients and timing of operation, regular intraoperative ureteral catheter placement and control the length of procedure duration help to reduce fluid extravasation during retrograde ureteroscopic lithotripsy.