Objective To verify the clinical safety and feasibility of applying laparoendoscopic single-site surgery (LESS) in the treatment of elder patients with urological tumors. Methods From August 2010 to March 2011, LESS technique was used to do prostatectomy in five cases, nephrectomy in 3 cases and adrenalectomy in four cases. Quadport was inserted through a transumbilical incision. Flexible tip 5 mm laparoscope and standard laparoscopic instruments were employed. This technique was evaluated in respects of operative time, estimated blood loss, intraoperative complications, drainage time, post-operative visual analogue pain scale (VAPS), post-operative hospital stay and pathological change. Results All the procedures in this group were completed successfully with LESS. There was no additional trocarand conversion to standard laparoscopic or open surgery. Application of Quadport reduced the clash of instruments. Carefully performing surgery and avoiding blunt dissection to reduce intraoperative bleeding is the cornerstone of success. The operative time and estimated blood loss were (192.0±76.7) min and (174.6±167.2) ml, respectively. There was no severe intraoperative complication and blood transfusion. The VAPS in the first post-operative day was (0.9 ± 1.0) minutes and the drainage time was (3.5±1.7) d while post-operative hospital stays were (7.9±3.4) d. There was no occurrence of secondary bleeding and wound infection. Conclusions LESS is a safe and feasible alternative for the treatment of urological tumors in elderly patients, but needs further clinical investigation.

ObjectiveTo verify the safety and feasibility of retroperitoneal laparoendoscopic singlesite surgery (LESS) adrenalectomy in the treatment of adrenal gland tumors or cyst.MethodsFrom Oct.2009 to Jan.2012,7 patients underwent retroperitoneal LESS adrenalectomy with Quadport technology by one surgeon.The mean patient age was 46 ( 39 - 55 ) years.The mean largest tumor diameter was 2.3 (1.8-3.6) cm.All procedures were performed through retroperitoneal approach by using Quadport,tip flexible laparoscope with 0° lens and conventional laparoscopic instruments.This technique was evaluated in respects of operative time,estimated blood loss,intraoperative complications,drainage time,visual analog pain scale (VAPS) score,post-operative hospital stay and pathological results.ResultsSeven cases of LESS adrenalectomy were completed successfully.There was no additional trocar added,no conversion to conventional laparoscopic or open approach.The mean operative time was 106 (70 - 180) min,and the mean estimated blood loss was 59 (5 -200) ml.The mean first day post-operative VAPS score was 2 (1 -3),drainage time was 2 (2 -3) d.Post-operative hospital stay was 5 (3 -6) d.No perioperative complication was observed.Pathological results showed 1 case of adrenal pheochromocytoma,5 cases of adrenal cortical adenoma and 1 case of adrenal cyst.ConclusionRetroperitoneal LESS adrenalectomy is a safe and feasible option for the treatment of adrenal tumors and cyst.

Objective To verify the safety and feasibility of applying laparoendoscopic singlesite radical prostatectomy (LESS-LRP) in the treatment of prostate cancer. Methods From Sept. to Dec. 2010, LESS-LRP was used to treat 2 early stage prostate cancer patients. The LESS-LRP was preformed through extra-peritoneal approach by using standard laparoscopic instruments and a 5 mm flexible laparoscope. This technique were evaluated in respects of operative time, estimated blood loss, intraoperative complications, drainage time, post-operative pain score (VAPS), post-operative hospital stay, pathological results and post-operative PSA levels. Results All procedures of the 2cases were completed with LESS-LRP without conversion to standard laparoscopic or open radical prostatectomy. The operative times for LESS-LRP were 280 and 285 min, estimated blood loss were 400 and 200 ml, respectively. There was no severe intraoperative complication. The drainage times were 2 and 6 d, the VAPS in the first post-operative day were 1 and 0, and post-operative hospital stay were 14 and 7 d. There was no secondary bleeding or wound infection. The 2 prostate cancer cases were all in pathological stage pT2c N0 M0. Surgical margins of the specimens were negative. The first case showed PSA of 0. 033 ng/ml 1 month after the surgery. Conclusion LESS-LRP can be an exploratory option in clinical for the treatment of prostate cancer.

Objective　To verify the safety and feasibility of applying transperitoneal laparoendoscopic single-site surgery (LESS) nephrectomy in the treatment of kidney malignant and benign diseases.Methods　From Nov.2010 to Jun.2012,we had used LESS nephrectomy technique treated four kidney tumors,one renal pelvic tumor and one atrophic kidney. Quadport was introduced into abdominal cavity through a paraumbilical incision. Conventional laparoscopic instruments,prebent laparoscopic instruments and flexible tip 5mm laparoscope were used. The standard laparoscopic transperitoneal nephrectomy technique was then performed.We evaluated this technique in respects of operative time,estimated blood loss,intraoperative complications,1st post-operative day pain (VAPS),drainage time,post-operative hospital stay and pathological results.　Results　The 6 procedures in this group were completed successfully with LESS nephrectomy. There was no additional trocar added,no conversion to conventional laparoscopic or open surgery.Application of Quadport and prebent instruments reduced the clash of instruments,both intracorporally and extracorporally.The average operative time were 181.7 (145.0 -235.0) min,average estimated blood loss were 78.3 (20.0 - 150.0) ml.There was no severe intraoperative complication.The average VAPS in the first post - operative day was 1.7 ( 1.0 - 2.0).The average drainage time was 2.8 ( 1.0 -4.0) d,post-operative hospital stays was 6.8 ( 1.0 - 10.0) d.There was no secondary bleeding or wound infection.Pathological results showed 3 cases of renal clear cell carcinoma,1 case of chromophobic carcinoma,1 case of high-grade urothelial carcinoma and 1 case of atrophic kidney.All the specimens in this group were surgical margin negative.　Conclusions　LESS nephrectomy is a safe and feasible treatment option for the treatment of kidney surgical diseases.

Objective　To evaluate the real-life clinical characteristics of benign prostatic hyperplasia (BPH) patients with moderate and severe enlarged prostate.　Methods　From February 2009 to January 2011,a prospective,non-interventional,multi-center study was conducted on 2 758 BPH patients recruited from 32 hospitals in 10 cities nationwide with the following criteria:prostate volume (PV) larger ≥30 ml and international prostate symptom score (IPSS) ≥ 8. Patient age,PV,IPSS,Qmax medical treatment patterns and physician prescription practice were recorded. The demographic information and clinic characteristics were evaluated as well.　Results　The mean patient age,PV,IPSS score and Qmax of 2 786eligible patients were 69.2 ±8.5 years (50 to 97 years),47.8 ±16.6 ml (30 to 165 ml),17.5 ±5.4 (8to 35 ) and 11.6 ± 3.6 ml/s (2 to 36 ml/s),respectively.Age subgroup analysis pointed that the mean PV and Qmax in 50 -55 years group were 42.8 ml and 13.3 ml/s compared to 49.0 ml and 11.1 ml/s in the group beyond 71 years.Both parameters had statistical significances (P ＜ 0.05 ). For 56.1％ of the patients,it was their first time coming to clinic seeking for medical advice. Of whom,22.8％ patients had taken BPH prescription medication regularly beyond two weeks.Only 31.3％ of the patients had a history of BPH shorter than one year.22.9％ and 18.3％ of the patients had a history of BPH for 1 -2 and 3 -4 years.And 27.5％　of the patients had a history of BPH related symptoms longer than five years. Only 52.6％ patients were treated with α adrenoceptor antagonists + 5-α reductase inhibitor by urologists according to the recommendation in Chinese guideline of BPH.　Conclusions　The symptoms and key parameters of moderate and severe benign prostatic hyperplasia (BPH) patients become worse and more with increased age in China.It is quite late for most patients coming to clinic seeking for their first medical advice.Furthermore,there is a huge gap between urologist prescription and the recommendation of the Chinese guideline on BPH.

Objective To evaluate the efficacy and safety of tension free vaginal tape obturator technique (TVT-O) in females stress urinary incontinence (SUI).Methods From June 2008 to May 2012,156 cases of female SUI were treated with TVT-O procedure in our hospital.The mean age is 56.3 ±13.9 years.There were 79.5％ patients who suffered simple SUI while 20.5％ patients with SUI and urge urinary incontinence (UUI).The mean follow-up time was 16.5 months.All patient’s ICI-Q-SF scores and I-QOL scores were collected.The efficacy and safety of TVT-O were analyzed.Results The mean operative time was 34 ± 11 minutes and the mean estimated blood loss were 15 ± 9 ml.One hundred and forty-five cases were cured with TVT-O (92.9％) while 8 cases were improved (5.1％).The preoperative and postoperative ICI-Q-SF symptom scores were 8.2 ± 2.1 and 0.5 ± 1.3 while the I-QOL life quality scores were 28.5 ± 10.3 and 69.8 ± 9.9 respectively.There was statistical difference between the preoperative and postoperative scores (P ＜ 0.05 ).No bladder injury was recorded during the procedures.There were two cases whose vaginal walt were injured and repaired intraoperatively.No pelvic hematoma,long-term pain,sling erosion,infection and fistula were found in all cases.Three cases ( 1.9％ ) suffered temporary urinary retention and were cured by two weeks urethral catheterization.Conclusions TVT-O technique seems to be an easy and minimally invasive procedu(r)e with less complication,which supports its safety and reliability in the treatment of female SUI.

Objective To study the characteristics of different papillary renal cell carcinoma (PRCC)subtypes and their prognosis after nephrectomy.Methods Clinical data of 14 PRCC patients(7 males,7 females)with ages ranging from 20-77 in our institute from 2005 to 2011 were retrospectively reviewed.There were 5 tumors in the left kidney and 9 tumors in the right kidney.The average maximum tumor diameter was 3.8(1.6-7.8)cm.Patients presented with gross hematuria(n =3),flank pain(n =3),palpable abdominal mass(n =1)or asymptomatic(n =7).The TNM stages were 8 T1aN0M0,2 T1bN0M0,1 T1aN0M1,1 T2aN0M0,1 T3aN0M0 and 1 T3aN1 M0.Six patients were treated with radical nephrectomy,8 cases were treated with partial nephrectomy.Results There were 6 type Ⅰ and 8 type Ⅱ PRCCs cases.In pathology,type Ⅰ PRCC showed papillae covered by small cells with scanty basophilic cytoplasm,and arranged in a single layer on the papillary basement membrane with low nuclear grade.Type Ⅱ PRCC was composed of cells with higher nuclear grade,abundant eosinophilic cytoplasm,and pseudostratified nuclei on papillary cores.There were 12 well-differentiated cases,2 moderate-differentiated cases and no poorly differentiated case.Follow-up was carried out from 12to 80 months.During the follow-up,1 patient with type Ⅰ PRCC developed multiple lung metastases 26 month after surgery and deteriorated into hepatic and bone metastases at 34 month after surgery.We offered the patient with targeted therapy and the patient was still alive.There was 1 type Ⅱ PRCC patient died with multiple metastases at 42 month after surgery.Others were still alive without local recurrence and metastasis.Conclusions PRCC is not a common subtype of renal cell carcinoma in China.Early stage PRCC patient would achieve good prognosis after treated with nephrectomy.Targeted therapy is a good treatment option for metastatic papillary renal cell carcinoma patients.

Objective To evaluate the association of prostate volume, PSAD and F/T with prostate cancer detection rate in males with a total PSA of 4?10 μg/L. Methods Clinical data of 196 patients who underwent prostate biopsy from November 2006 to September 2010 and with a PSA of 4?10 μg/L were retrospectively analyzed. The association of detection rate of prostate cancer with prostate volume, prostate specific antigen density PSAD) and free PSA/total PSA ratio ( F/T) was analyzed by Spearman coefficient, receiver operating characteristic curve and logistic regression analysis. Results The prostate volume, PSAD and F/T had a significant association with detection rate of prostate cancer ( P<0.05 for all) . The odd ratio was 0. 96, 1. 91 and 0. 02, respectively. The area under curve ( AUR ) was 0. 31, 0. 66 and 0. 63, respectively. The cancer detection rate was decreased along with the increase of prostate volume. When PSAD 0.15 ng·ml-1·ml-1 was used as the cut?off value, the sensitivity, specificity, positive prediction rate and negative prediction rate was 72. 3%, 51. 1%, 42. 3% and 21. 2%, respectively. When the patients were divided by prostate volume into <19. 9, 20?39. 9, 40?59. 9, 60?79. 9 and >80 ml subgroups, the cancer detection rate of each subgroup was 50.0%, 45.6%, 30.8%, 15.4% and 5.6%, respectively. Conclusion In patients with a total PSA of 4?10μg/L, the prostate cancer detection rate has a significant association with prostate volume, PSAD and F/T.

Objective To evaluate the association of prostate volume, PSAD and F/T with prostate cancer detection rate in males with a total PSA of 4?10 μg/L. Methods Clinical data of 196 patients who underwent prostate biopsy from November 2006 to September 2010 and with a PSA of 4?10 μg/L were retrospectively analyzed. The association of detection rate of prostate cancer with prostate volume, prostate specific antigen density PSAD) and free PSA/total PSA ratio ( F/T) was analyzed by Spearman coefficient, receiver operating characteristic curve and logistic regression analysis. Results The prostate volume, PSAD and F/T had a significant association with detection rate of prostate cancer ( P<0.05 for all) . The odd ratio was 0. 96, 1. 91 and 0. 02, respectively. The area under curve ( AUR ) was 0. 31, 0. 66 and 0. 63, respectively. The cancer detection rate was decreased along with the increase of prostate volume. When PSAD 0.15 ng·ml-1·ml-1 was used as the cut?off value, the sensitivity, specificity, positive prediction rate and negative prediction rate was 72. 3%, 51. 1%, 42. 3% and 21. 2%, respectively. When the patients were divided by prostate volume into <19. 9, 20?39. 9, 40?59. 9, 60?79. 9 and >80 ml subgroups, the cancer detection rate of each subgroup was 50.0%, 45.6%, 30.8%, 15.4% and 5.6%, respectively. Conclusion In patients with a total PSA of 4?10μg/L, the prostate cancer detection rate has a significant association with prostate volume, PSAD and F/T.

Objective To construct a scoring system of combination of procalcitonin and C-reactive protein for diagnosis of invasive bacterial diarrhea in children. Methods The clinical data of hospitalized children with acute diarrhea were retrospectively analyzed. All of the children were divided into two groups, invasive bacterial diarrhea group and nonbacterial diarrhea group. The scoring system of combination of two markers for diagnosis of invasive bacterial diarrhea in children was constructed by means of two categories logistic regression analysis using procalcitonin and C- reactive protein as parameters. In addition,receiver operating characteristic curve(ROC)was used to evaluate the diagnostic accuracy.Results One hundred ten cases of invasive bacterial diarrhea and 108 cases of nonbacterial diarrhea were included. The levels of serum procalcitonin and C-reactive protein in invasive bacterial diarrhea group were significantly higher than those in nonbacterial diarrhea group, and there were statistical difference(P all<0.05).The area under the ROC curve(AUC)of invasive bacterial diarrhea was 0.894 when the established scoring system was used, which was higher than the AUCs when either serum procalcitonin or in C- reactive protein was used (P<0.05). The best diagnostic boundary value for combination of serum procalcitonin and C- reactive protein scoring was 0.52 with a sensitivity at 80.9% and specificity at 88.9%. Conclusions The scoring system of combination of procalcitonin and C- reactive protein has good accuracy in diagnosis of invasive bacterial diarrhea in children, and can assist the early diagnosis of the disease.