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 study the cellular apoptosis and telomerase activity in bladder cancer before and after treatment with cell wall skeleton of bacillus Calmett Guerin(BCG CWS) and interleukin 2(IL 2). Methods The cellular apoptosis and telomerase activity of 33 cases of bladder cancer tissues were detected by terminal deoxynucleotidyl transferase mediated dUTP biotin nick end labeling(TUNEL) and telomeric repeat amplification protocol(TRAP) assay both before and after treated with BCG CWS and IL 2. Results The apoptosis index for bladder cancers before and after treatment with BCG CWS and IL 2 was (35.6?12.7)% and (79.1?11.3)% respectively, the apoptosis index being obviously increased after the treatments, P

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 investigate the clinical characteristics of adrenal incidentaloma and explore the management strategies for this disease. Methods:The clinical data of adrenal neoplasm patients admitted in The First Affiliated Hospital and Cancer Center of Sun Yat-sen University from January 2001 to January 2013 were analyzed retrospectively. Results:The data of 667 patients with adre-nal incidentaloma were analyzed. Adenoma was the most common tumor in 511 cases with pathological results (240/511, 47%). Fur-thermore, the pathologic results indicated that 18%(90/511) of these cases were pheochromocytoma and 8%(41/511) were adreno-cortical carcinoma. Of the 511 cases, 266 had≤4 cm tumors, and 245 had>6 cm tumors. In cases with≤4 cm tumors, 260 (98%) had benign tumors, and 183 of these cases underwent laparoscopic adrenalectomy. In cases with>6 cm tumor, 91 cases (37%) had malig-nant tumors, and 162 of these cases underwent open adrenalectomy. Conclusion:The suggested cut-off size for adrenal incidentalo-ma diagnosis is 4 cm. Laparoscopic adrenalectomy is the recommended management strategy for small (≤4 cm) and nonfunctional ad-renal incidentaloma.

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 estimate the feasibility of QOL score in functional assessment of or-thotopic neobladder after radical cystectomy. Methods Questionnaire survey,QOL score sheet and urodynamic examination were done in 22 patients with orthotopic neobladder.Investigations were fo-CUS on the micturition interval during daytime and nighttime.Micturition time,degree of incontinence and their relationship with QOI.scores and urodynamic parameters wete also analyzed. ResuIts There were 3,6,7,1,2,3 and 0 cases which QOI.score were 0 to 6 accordingly.In the dav time,2 patients complained a light incontinence while 1 patient of moderate incontinence.In the nighttime.3 patients had the complaint of moderate incontinence while 4 patients of light incontinence.The average daytime mlcturltlon interval was 136 min(45-210 rain).The average maximum urinary flow rate,maximal urethral closure pressure and postvoid residual were 12.9 ml/s(2.7-22.1 ml/s),69.3 cm H2O(33-114 em H20)and 91.8 ml(5-300 m1)respectively.QOL scores had D.sitive correlation with the degree of incontinence during daytime and nighttime(daytime:r-0.510,P=0.015,night time:r=0.911,P<0.001).The QOL scores had negative correlation with daytime micturition inter-val(r=-0.749,P<0.001).The factors which influenced the QOL scores included the maximaI ure-thral closure pressure,postvoid residual and the maximum urinary flow rate. Conclusions QOL score reflects the patients"continent ability,subjective feelings on quality of life.It is correlated with the common urodynamic parameters.QOI.score might be used as a new index to estimate the function of orthotopic neobladder.

Objective To investigate the techniques of laparoscopic retroperitoneal lymph node dissection(LRPLND)through extraperitoneal approach. Methods Seven non-seminomatous germ cell testicular tumor(NSGCT)patients of clinical stage Ⅰ underwent LRPLND through extraperitoneal approach.The average age was 31(27-39 years old),the average weight was 62 kg(weight 58-72 kg).Pathological examination revealed 2 testis mixed carcinoma(major of embryonal carclnoma and seminoma),2 yolk sac tumor,1 ehoriocarcinoma,2 teratoma with seminoma.Two of them were in right side,and 5 in left.All the chest X-ray,abdominal CT and bone scanning of them were normal before operation.All patients were general anesthetized.Three or 4 trocars were placed,from 2 of them two gasbags were used to expand the retroperitoneal space at volume of 800-900 ml.The retroperitoneal fat was cleared off from the surface of Gerota's fascia to iliac fossa and the plane spance betwwwn anterior rena fascia and posterior peritoneum was separated In the same way the Plane between dorsal renal and the surface of psoas major and quadratus lumborum unto iliae lossa was exposed.Abdominal aorta or vena cava was exposed,then divided and dissected free from surfaee of psoas maior.The conflux of renal vein and testicular vein at the deep face of renal artere(left)was exposed,then testicular vein was ligated and divided it at its end.Fat and lymph tissue between ureter and vessels was dissected to the crotch of abdominal aorta or inferior vena cava.The primary inguinal incision of testectomy was then excided.Normal antegrade ejaculation recovered in 1 month postoperatively. Results The initial 2 operations were converted to open way as the peritoneum were penetrated largely.The other 5 operations were successful.The average operating time was 285 min(245-350 min),intraoperative blood loss was 100-250 ml.Four patients'pathologic results accorded with clinical staging,and 2 positive lymph nodes were found in the other one.The average number of lymph node resected was 25.6 counts(22-31).Follow-up for 3-20 months,chest X-ray and abdominal CT revealed no evidence of recurrence or distant metastasis,and serum tumor markers were in normal range.Normal antegrade ejaculation recovered in 1 month postoperatively. Conclusions The technique through extraperitoneal approach could be applied for LRPLND.It might be an approach for diagnosis and treatment of stage Ⅰ NSGCT.

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.