The incidence of biochemical recurrence after radical prostatectomy varies significantly and depends on numerous well-known prognostic factors. It likely occurs in at least 30%~40% of patients who were diagnosed as localized disease and received radical prostatectomy. Because the clinical significance of biochemical recurrence is often unclear and other predictive factors relative to the recurrence are uncertain, it is difficult to select the best treatment for the patients who might relapse in the future. This review examines some of the issues associated with biological recurrence and attempts to shed some light on this common but controversial clinical scenario. Some treatment strategies were discussed in this article including salvage radiotherapy after radical prostatectomy, watchful waiting, and hormonal therapy.

Objective To explore the diagnostic and therapeutic methods for hemangioma in different parts of the urinary system. Methods Twenty patients with urinary hemangiomas were enrolled in this study.Of them 5 cases had hemangiomas in the kidney,2 in the ureter,10 in the bladder and 4 in urethra.Three cases (15%) had multiple hemangiomas in different parts of the body,of whom 1 case had hemangiomas concomitantly in the bladder and urethra,1 case in the bladder and neck,and 1 case in the urethra and perineum.Modalities of diagnosis before operation included B ultrasound,CT,IVU,endoscopy,et al.Surgical operations were the major treatment(95%),and only 1 patient with urethral hemangioma underwent lasar therapy. Results The pre-operation confirmed diagnosis was 0、1、9 and 4 cases for hemangiomas in kidney,ureter,bladder and urethra,respectively.For pathologic classification 13 cases were of cavernous hemangiomas,6 of capillary and 1 of racemose.With follow-up of 9 months to 16 years,recurrent bladder hemangioma was found in one patient. Conclusions The diagnoses of urinary hemangiomas mainly rely on endoscopy,but for the diagnosis of parenchyma or surface hemangioma of kidney conventional imaging examination is essential.Surgical operations were the major treatment for urinary hemangiomas,but different modalities of treatment are needed for different sites and nature of hemangiomas.

Objective To investigate the effects of partial prostatic capsula and surrounding striated sphincter sparing surgery on the function of intestinal orthotopic neobladder. Methods Total cystectomy and orthotopic intestinal neobladder was performed in 23 male patients with invasive bladder cancer. The patients were divided into classical cystectomy group (n=10) and modified cystectomy group (n=13).In the classical group the prostate was removed completely and the residual urethra was anastomosed with the neobladder using interrupted suture.In the modified group transurethral resection of the prostate preceded the cystectomy,and the prostatic capsula below the verumontanum with its surrounding striated urethral sphincter was retained.The neobladder was anastomosed with the residual capsula using continuous suture.The function of the neobladder in the 2 groups was evaluated and compared. Results The pathological classification of the 23 patients was as follows:T 2aN 0M 0,13 cases;T 2bN 0M 0,6;T 1N 0M 0,1;T 3aN 0M 0,1;T 3bN 1M 0,1;T 4aN 0M 0,1.The patients were followed up for 3 to 40 months(mean,15.7 months).In modified group,11 patients survived disease-free and 2 survived with metastasis.All the 13 patients voided well with residual volume of 0 to 70 ml.Complete urinary continence was achieved in 12 patients and the remaining one had nocturnal incontinence.In classical group,10 patients survived disease-free;of them 7 voided well with residual volume of 10 to 100 ml and the other 3 needed intermittent catheterization because of their residual urine being up to 100 to 250 ml.Complete continence was achieved in 7 patients and the other 3 were incontinent(1 with incontinence day and night,2 with nocturnal incontinence). Conclusions Partial prostatic capsula and its surrounding striated sphincter sparing surgery can improve the continence and voiding of the orthotopic neobladder.$$$$

Purpose:The aim of this study was to evaluate the clinical efficacy and toxicity of treatment with gemcitabine and cisplatin for hormone independent prostate cancer.Methods:18 cases of advanced hormone independent prostate cancers who received castration and antiandrogen medicines were confirmed to have multiple bone metastatic carcinomas by emission computed tomography(ECT), and hepatic , adrenal and intracranial metastasis were found respectively each in 1 patient, and the value of PSA(prostatic special antigen) had on ascending trend in all patients. Gemcitabine 1000 mg/m~(2) +NS 100 ml was administered by intravenous drip on days 1,8 and cisplatin 100 mg/m~(2) +NS 500 ml was administered by intravenous drip on day 1 or cisplatin 30 mg/m~(2) +NS 250 ml was administered by intravenous drip on days 1 to 5 in each 28-day cycle.Results:Levels of PSA descent to normal titer(

Objective To introduce our experience of performing posterior or anterior renal lip incision for partial nephrectomy in the treatment of renal hilum endophytic renal cell carcinoma.Methods From Jan.2010 to Jan.2014,five female patients with renal hilum tumors were treated in our institute.The median age was 54 (51-72) years.The median tumor diameter was 4.0 (2.8-4.8) cm.The median preoperative creatinine was 53.9 (52.6-75.4) μmol/L.One of them was solitary kidney with absolute indication; three cases had basic disease with relative indication; one was with selective indication.The patients were put in supine or lateral position.After general anesthesia,we preformed partial nephrectomy by cutting posterior renal lip in 3 cases and the anterior lip in 2 cases.We clamped the renal artery,opened the renal posterior or anterior lip,then dissected the tumor beside the pseudo-capsule.After removing the tumor,we used 3-0 absorption suture to control bleeding and repair the opened collecting system.Finally,we used 2-0 absorption suture to close the renal defect.Results The median operation time was 195 (155-215) min; the median renal warm ischemia time was 35 (15-70) min; the median postoperative hospital stay was 8 (7-9) d.There was no secondary bleeding and urine leakage happened.The pathological results showed that 3 cases with clear cell carcinoma,1 with papillary carcinoma and 1 with renal medullary interstitial cell tumor.All patients showed normal kidney shape.The median postoperative creatinine was 63.0 (59.4-75.4) μmol/L.After a median follow up of 24.2 mon,all patients survive without tumor recurrence.Conclusions The short-term result of posterior or anterior renal lip incision partial nephrectomy in treating endophytic renal hilum endophytic renal cell carcinoma is safe and feasible.

Objective To investigate the clinical features,diagnosis,treatment and prognosis of the renal secondary tumor.Methods From January 2000 to January 2014,the data from 31 patients,including 23 male patients and 8 female patients,with renal secondary tumors were analyzed retrospectively.Their mean age was 56 years old (ranging from 38 to 75 years old).The 31 renal secondary tumors rooted in lung cancer(n =14),lymphoma(n =5),colorectal cancer and gastric cancer(n =3),breast cancer(n =2),esophageal cancer(n =1),thyroid cancer (n =1),cervical cancer (n =1) and bladder cancer (n =1),respectively.There were 22 patients (71.0％) of renal metastasis accompany with other organs or lymph node metastasis.9 cases (29％) suffered with independent renal metastasis and 21 cases (67.7％) suffered with unilateral renal metastasis.5 cases(16.1％) were diagnosed as primary tumor with the renal metastasis at the same time,and the remaining 26 cases were found renal metastasis within 9 to 72 months after primary tumor (mean 30 months).There were only 5 patients (16.1％) with symptom.Ultrasound showed low echo range in 20 cases (65.6％) or uneven echo in 11 cases (34.4％).CT showed equal density (77.4％) in 24 cases or slightly low density shadow (22.6％) in 7 cases,most of which were endogenous,mild enhancement.10 cases (32.3％) were bilateral renal metastasis,unilateral renal multiple metastases was found in 6 cases (19.4％),and single metastasis was noticed in 15 cases (48.4％).The average diameter of the renal metastasis was 2.7 cm (ranging from 0.9 to 6.8 cm).Except 4 cases gave up the treatment,the remaining 27 cases were accepted comprehensive therapy about the primary tumor.the 9 patients with renal metastasis only were treated with chemotherapy or targeted therapy for the advanced primary tumor.Among the 9 patients,6 cases were undergone NSS or radical nephrectomy (RN) treatment.Results In 9 cases with only renal metastasis,6 cases,treated by surgery,recovered well.Postoperative pathological and immunohistochemical results confirmed the renal metastasis.Up to January 2015,the follow-up duration ranged from 2 months to 60 months [mean (22.6 ± 18.4) months].The survival time ranged from 1 month to 51 months [mean (13.2 ± 13.2) months].Among 22 cases with multiple metastasis,4 cases gave up treatment,whose average survival time was (2.0 ± 1.4) months.However,the average survival time in remaining 18 cases was (11.1 ± 4.7) months (P ＜ 0.05).In 9 cases with independent renal metastasis,the average survival time in 6 cases,accepted the procedure,was (26.2 ± 18.6) months.While,the average survival time in remaining 3 non-surgical cases,was (10.3 ± 4.0) months (P ＜ 0.05).Conclusions Renal secondary tumor was rare in clinic.Most cases have isolated lesion.Renal secondary tumor was advanced manifestation of the primary tumor,which could prolong the survival time according to the comprehensive treatment for the primary tumor.Surgical resection of the lesion before the comprehensive treatment could be chosen in the independent renal metastasis.

The clinical features of 17 patients with benign urachal masses and 30 patients with urachal carcinoma treated at Sun Yat-sen University Cancer Center were analyzed retrospectively.Univariate analysis indicated that seven parameters differed significantly between the two groups.Binary logistic regression analyses showed that the rate of gross hematuria was significantly higher (P =0.042,Exp[B] =7.889) and the rate of fatty infiltration of the Retzius space was significantly lower (P =0.006,Exp[B] =0.028) in patients with urachal carcinoma than in those with benign urachal masses.Gross hematuria and fatty infiltration of the Retzius space may be indications of malignant and benign urachal masses,respectively.

Objective To verify whether the concomitant performance of modified radical inguinal lymphadenectomy and penectomy may increase complications and compromise oncological effectiveness.Methods From June 2002 to June 2010,a total of 110 simultaneous inguinal lymphadenectomies were performed on 55 patients (mean age 49 years),including 107 modified radical lymphadenectomies,2 radical lymphadenectomies and 1 lymphadenectomy before which the sapheous vein was resected.The records of all patients were reviewed.Results Of 107 simultaneously modified radical inguinal lymphadenectomy,only 1 (0.9％) had wound infection.There were 18 ( 16.8％ ) leg lymphedema and 6 (5.6％) skin flap necrosis,postoperatively.The average number of inguinal lymph nodes dissected was 11 (3 -23 ).Overall 3-year survival was 84％.Conclusions Penile surgery combined with simultaneously modified radical inguinal lymphadenectomy could be feasible,which may have oncological control without increasing the risk of surgical complications.

Objective To report a modified radical inguinal lymphadenectomy the aim of which is to reduce the incidence of the complication of skin necrosis.Methods One hundred and twenty-six modified radical inguinal dissections were performed in 63 patients with penile carcinoma from June 2002 to June 2010.A modified radical inguinal dissection characterized by an S-shaped incision and precisely separating layers using an anatomical mark was performed.The boundaries of dissection were the same as classic radical inguinal lymphadenectomy.The incidences of complications of skin flap necrosis were retrospectively analyzed.Results The follow-up time ranged from 12 to 93 months.A total of 37 complications occurred,including 7 minimal skin necroses (5.6％),3 wound infections (2.4％),19 lymphedemas (15.1％),2 seroma formations (1.6％),5 lymphocele (4.0％),and 1 deep venous thrombosis (0.8％).There were no complications in 106 dissections (84.1％ ),and 20 dissections had one or two minor complications ( 15.9％ ).Conclusions The complication of skin necrosis related to groin dissection in patients with penile carcinoma could be reduced by using this modified inguinal dissection technique,which characterized by an S-shaped incision and precisely separating layers with using an anatomical landmark.

Objective To explore if it is essential to excise ipsilateral adrenal gland in radical nephrectomy.Methods Two hundred and sixty-three patients underwent radical nephrectomy were analyzed retrospectively.The duration of operation,bleeding volumn,complications and survival rates were compared between the adrenalectomy and adrenal preserved groups.The clinical data of the patients with adrenal gland involvement were analyzed as well.Results There were 214 clinical localized(T_(1-2)N_0M_0 )renal cell carcinoma (RCC) patients,26 local advanced RCC(T_(3-4)N_(0-2)M_0 ) patients and 23 metastatic RCC(T_(1-4)N_(0-2)M_1) patients in this study.In the 263 patients,146 cases received ipsilateral adrenal gland excisions,while 117 cases had the ipsilateral adrenal glands preserved.The duration of operation,estimated blood loss and the complications did not differ significantly between these two groups.Only 8 patients had adrenal gland involvement.The mean size of the 8 tumors was 9.7 cm and 5 of them had a diameter ≥8 cm.In the 8 patients,6 had the tumor in the upper pole and 2 had the whole kidney involved.One hundred and twenty-nine clinical stage Ⅰ and Ⅱ patients had ipsilateral adrenal excised,while only 4 (3.1%) had adrenal gland involvement.Seventeen clinical stage Ⅲ and Ⅳ patients had ipsilateral adrenal excised,and 4 (23.5%) had adrenal gland involvements.The clinical stages of these 8 patients were stage Ⅲand Ⅳ.The patients were followed up for 28 months (3-102 months).There was no significant difference of 5-year survival rates between the ipsilateral adrenal gland excised and preserved patients categorized according to pathological stage.Conclusion For patients with renal cancer larger than or equal to 8 cm,localized in upper pole of kidney or with the whole kidney involve and with a clinical stage higher or equal to Ⅲ,it is essential to excise ipsilateral adrenal gland in radical nephrectomy,otherwise the ipsilateral adrenal can be preserved.