Prostate cancer (PC) is the most common malignancy in elderly men. While the majority of PC keeps an indolent biological behavior and progresses slowly, quite a few progresses very fast with poor prognosis. Urologists should take into account of patients′age, general health status and tumor pathology to make an appropriate strategy for PC clinical management. Prostate specific antigen (PSA), digital rectal examination (DRE), magnetic resonance imaging (MRI) of prostate and prostate biopsy are main tools for PC diagnosis. However, appropriate application of all kinds of diagnostic tests to prevent overdiagnosis and overtesting cannot be overemphasized, because methodological defects objectively exist. DRE is a basic examination which is able to provide valuable information for diagnosis. There are multiple therapeutic options for PC with generally similar efficacy and individual shortcoming, which stresses the importance of patients’ consents and choices. Managements of severe complications of advanced PC is critical for improving patients’ life quality.

Arab countries have long tradition of using traditional medicine which enjoys mass foundation among local people. Recently, China's import and export trade of traditional medicine products with Arab countries showed an increasing trend year by year. With the implementation of the Belt and Road Strategy, Arab countries played a more important role in China's foreign trade. With the aim of promoting the spread of traditional Chinese medicine (TCM) in Arab countries, cooperation with relevant countries shall be differentiated. The Gulf region is economically advanced with its people enjoying prosperity, where is suitable for developing TCM product and service trade. The Levant has strong advantages in traditional medicine research, where academic communication shall be frequented. Countries in north Africa enjoy profound traditional friendship with China, where are suitable for dispatching Chinese foreign aid medical team to promote TCM. Meanwhile, we are supposed to take advantage of Confucius Institute and Chinese culture centers as platforms to spread TCM culture, to strengthen cooperation with medical universities and research institutions in the target countries, to enroll more Arab students to study TCM, to develop international standard Chinese-Arabic basic nomenclature of Chinese Medicine, and to carry out Traditional Arabic & Islamic Medicine researches.

Objective To investigate the features of renal lesions in von Hippel-Lindau (VHL) disease and the surgical intervention. Methods The clinical and pathological data from 6 patients with renal lesions in a large Chinese VHL disease kindred were reviewed individually.One patient had multifocal renal cysts,and 5 patients had bilateral renal cell carcinomas and multifocal renal cysts. Results Among 10 kidneys in the 5 cases of bilateral renal cell carcinomas, nephron-sparing surgery (NSS) was performed in 5,radical nephrectomy (RN) in 3 and observation in 2.After operation,the pathological findings indicated that all solid lesions were renal clear cell carcinoma, with one malignant cyst being detected.The Fuhrman's nuclear grade of the RCC was grade Ⅰ in 14 tumors,grade Ⅱ in 6 tumors.The TNM stage was T 1N 0M 0 in 4 cases and T 2N 0M 0 in 1 case.During a mean follow-up of 47 months (range,9 to 113 months),all patients were alive without evidence of RCC recurrence and metastasis.Five patients had normal renal function and 1 patient experienced an increase in serum creatinine but without dialysis. Conclusions The renal lesions in VHL disease include both cysts and carcinomas,which are often multifocal and bilateral.Almost all the tumors are of clear cell type with a low stage and grade.Nephron-sparing surgery may be justified and effective in the management of VHL patients.

Objective To evaluate the safety and efficacy of the photoselective prostate vaporization (PVP) for the patients of benign hyperplasia of prostate (BPH) with oral anti-coagulant.Methods From September 2008 to May 2010,7 cases of BPH with oral anti-coagulant were treated by PVP,with an average age of 74 years.The prothrombin time before the surgery was (13.14 ± 0.15) s.An 100 W Green-light laser source was applied in this study.The prostate volume,operating time,blood loss,catheter indwelling time after the surgery,hospital stay,PVR,Q IPSS score were recorded.Results The mean operating time was (65 ± 22) min without active bleeding or transfusion in this cohort.The haemoglobulin concentration was intact and catheter indwelling time was (22 ± 8) h,while the hospital stay was (2.7 ± 1.2) d.The PVR,Q IPSS score were significantly improved after follow-up of 1 month (P ＜0.01).One case complicated acute urinary retention after operation in this cohort,and the catheter was removed 4 weeks after α-blocker administration.Conclusions PVP is a safe and effective surgical strategy for BPH patients with oral anti-coagulant.However,since there were relatively limited cases enrolled in this study,more randomized controlled clinical trials are needed in the near future.

Objective To evaluate the efficacy and safety of sorafenib in combination with interferon-alpha(IFN-α)as the first-line treatment in patients with advanced renal cell carcinoma.Methods Since Dec 2007 to Jun 2008,137 legal patients with advanced renal cell carcinoma (RCC)were enrolled in the trail from 22 hospitals in China.All the patients continuously received the treatment of sorafenib plus IFN-α untill disease progressed or patients were unable to tolerate.The primary end points were objective response,disease control rate and adverse effects rate.Results This interim analysis was based on the data collected from the study initiation date to 2009/3/20.The overall response rate(ORR),including complete response (CR) and partial response(PR),was 32.8%(45/137).The median follow-up time was 11.9 months,only 25 patients progressed at the cut off time.The most common adverse events were hand-foot skin reaction(48.2%),alopecia(23.4%),rash (20.4%),diarrhea(19.7 0A),fever(16.8%),lassitude(10.2%),etc.The incidence of 3 or 4 grade hand-foot skin reaction was 8.8%.Conclusions Sorafenib in combination with IFN-α as the firstline treatment in patient with advanced RCC could be effective and safe.

Objective To explore the expression and significance of N-cadherin in urothelial bladder cancer and analyse its relation to clinicpathologic and prognosis of bladder cancer.Methods The expression of N-cadherin in 145 urothelial bladder cancer and 25 normal bladder tissues was detected by immunuhistochemisty,and correlations between N-cadherin and clinicopathologic features were analysed.Results The positive rate of N-cadherin protein was significantly higher in bladder cancer than in normal bladder tissue (P＜0.01).The positive rate of N-cadherin protein was 38.6％ in G1 bladder cancer,58.4％ in G2-G3 bladder cancer,and its difference was significant (P =0.028).The expression was significantly lower in non-muscle-invasive bladder cancer than in muscle invasive bladder cancer (45.7％ vs 64.7％,P=0.029).The muscle-invasive bladder cancer patients were followed up 4-103 months.Among those,the overall survival with positive expression of N-cadherin protein was 24.2％ (8/33),and the overall survival with negative expression of N-cadherin protein was 66.7 ％ (12/18).Kaplan-Meier analysis showed the positive expression of N-cadherin was significantly associated with overall survival of patients with muscle-invasive-bladder cancer (P=0.002 2).Multivariate Cox analysis showed that N-cadherin expression was an important prognostic factor.Conclusions The expression of N-cadherin protein was high in bladder cancer.The detection of the expression of N-cadherin protein is associated with the diagnosis and prognosis of bladder cancer.

Objective To discuss the management of renal vein trauma in the percutaneous ne-phrostomy (PCN) procedure.Methods Three cases with renal vein trauma by PCN or malposition of nephrostomic catheter were reviewed.Case 1 was a patient with staghorn calculi.There was mas-sive hemorrhage after the puncture and the dilatation during PCN.Then the nephrostomy catheter was clamped.The post-operative CT scan showed the nephrostomy catheter passed the inferior vena cava to the right external jugular vein.Case 2 was a patient with a 3 cm calculus in the inferior calice of the right kidney.A massive haemorrage occurred after the dilatation by the 16 F sheath guided by ultra-sound during PCN.The nephrostomic catheter was found in the renal vein by X-ray film.Case 3 was a patient with bilateral hydronephrosis complicating chronic renal failure,which caused by the meta-static of the gastric carcinoma.After the puncture,the massive hemorrage appeared and a nephros-tomic catheter was placed and then clamped.The catheter was seen in the renal vein confirmed by the X-ray.For all 3 patients,the catheter was withdrawn carefully monitored by the X-ray until the place of the renal vein perforation during the first 24-48h.Then it was withdrawn 3 to 4 cm each time un-til reach the pelvic.Results The hemorrhage was well controlled and nobody needed the surgical in-tervention.There was no renal function aggravation in these 3 patients.Conclusions The renal vein trauma during the echo-guide PCN procedure can be treated by clamping the nephrostomy catheter and withdrawing it gradually.Thus,the surgical intervention can be avoided and this method will not im-pair the renal function.

Objective To explore the surgical approach of reducing the incontinence after radical retropubic prostatectomy with recent anatomic findings. Methods Sixteen patients with stage B prostate carcinoma received continence preserving anatomic radical retropubic prostatectomy. Results All the patients were followed up 3 months to 5 years,mean 13 months.Thirteen patients had normal voiding,two with mild stress incontinence.Only one was complicated with serious incontinence. Conclusions Identifing and preserving the external striated urethral sphincter and its innervation in performing anatomic retropubic prostatectomy will achieve postoperative urinary continence.

ObjectiveTo evaluate the efficacy and safety of combination therapy of tamsulosin and solifenacin for benign prostatic hyperplasia ( BPH ) with overactive bladder ( OAB ).Methods82 patients with OAB and coexisting BPH were randomly divided into tamsulosin group ( n = 38 ) and combination group ( n = 44). The ages were from 50 to 75 y ( averaged, 56.8 ± 8.6). Inclusion criteria: the mean frequency of micturition ≥8 times per day, the frequency of nocturia ≥2 times per day, voiding volume ＜200 ml each time; for the overactive bladder symptom score ( OA BSS), the 3 rd score ＞ 2, total score ＞ 3. The tamsulosin group accepted tamsulosin 0.2 mg once daily, the combination group accepted tansulouxin 0.2 mg and solifenacin 0.2 mg once daily. Both groups were maintained the corresponding therapy for 12 weeks.The international prostate symptom score (IPSS), Qmax, residual urine volume, OAB score and adverse reactions were recorded.ResultsThe values of IPSS ( 19.5 ±2.2 vs 15.6 ±2.4, P =0.027), the voiding symptom score ( 15.6 ± 2.4 vs 3.4 ± 1. 7, P = 0. 022) and Qmax ( 13.7 ± 3.8 vs 16.6 ± 4.1, P = 0. 034 )improved significantly after treatment in tamsulosin group ( P ＜ 0. 05 ). The values of IPSS ( 19.7 ± 2.3 vs 9.7 ± 3.0, P ＜0. 001), the storage symptom score (13.8 ± 1.9 vs 5.6 ± 1.6, P ＜0. 001 ), OABSS (10.3 ±1.8 vs 5.3 ±1.3, P ＜0.001) and Qmax(14.1 ±4.1 vs 17.2 ±3.5, P=0.027) also improved significantly after treatment in combination group ( P ＜ 0. 05 ). The values of IPSS ( 9.7 ± 3.0 vs 15.6 ±2.4, P ＜ 0.001 ), the storage symptom score (5.6 ± 1.6 vs 12.0 ± 1.6, P ＜ 0.001 ) and OABSS ( 5.3 ±1.3 vs 9.7 ± 2.7, P ＜ 0. 001 ) improved significantly in combination group than those in tamsulosin group ( P ＜0.001 ). There were no difference between two groups in values of the voiding symptom score, Qmax and residual urine volume ( P ＞ 0.05 ). The incidences of adverse reactions in tamsulosin group and combination group were 7.9％ (3/38) and 20.5％ (9/44) without significant difference. There was no acute urinary retention in both groups.ConclusionsIt is effective and safe for patients with BPH and OAB to accept combination therapy of tamsulosin and solifenacin.

Objective To investigate the expression of Oct4 protein and analyze its correlation with the clinic pathological features and prognosis of non-muscle-invasive bladder cancer.Methods The oct4 protein expression was assessed by immunohistochemical analysis in 87 specimens of bladder transitional cell carcinoma and 15 specimens of adjacent normal tissues.A correlation between Oct4 and clinic pathological features was analyzed.Results The positive rate of Oct4 protein was significantly higher in bladder cancer than that in normal bladder tissue (P＜0.01).The positive rate of Oct4 protein was 40.7％ in G1 bladder cancer,69.4％ in G2 bladder cancer and 91.7％ in G3 bladder cancer,and the differences was significant (P＜0.01).All patients were followed up for 3-78 months,and 63 of them relapsed.The expression of Oct4 protein was significantly higher in patients of recurrence than in non-recurrence (77.8％ ∶ 37.5％,P ＜ 0.01 ).21 patients of recurrence were in progression,and the expression of Oct4 protein had no significant differences between patients of progression and non-progression (71.4％ ∶65.2％,P ＞0.05).The positive rate of Oct4 protein was not related with gender,age,tumor number and size (P ＞0.05).Conclusion The detection of Oct4 protein is in favor of early detection of bladder tunor,estimation the degree of differentiation and surveillance for recurrence of superficial bladder cancer.