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Animal experiment and clinical study of Argon plasma coagulator in simple enucleation for small renal cell carcinoma

Changwen ZHANG ; Yong XU ; Kuo YANG ; Baojie MA ; Baomin QIAO ; Ting ZHANG ; Wenguang FAN ; Yan LIU ; Haijie XIE ; Yang SHI

Chinese Journal of Urology.2010;31(10):662-665. doi:10.3760/cma.j.issn.1000-6702.2010.10.004

Objective To evaluate the feasibility and clinical effect of Argon plasma coagulator in simple enucleation for small renal cell carcinoma. Methods On the basis of successful performing the animal experience of coagulating therapy on the wound tissue during partial nephrectomy with Argon plasma coagulator in rabbit models, 10 cases of simple enucleation for small renal cell carcinoma with Argon plasma coagulator were accomplished. Results Both with the standard of stopping bleeding of wound tissue by Argon plasma coagulator and with the standard of re-spraying the wound tissue for 2 s after stopping bleeding using Argon plasma coagulator, the depth of wound tissue necrosis without blocking the renal pedicle is deeper than that with blocking the renal pedicle(P=0. 012 and P=0. 002, respectively).If the wound tissue was re-sprayed for 2 s after stopping bleeding by Argon plasma coagulator, the depth of the wound tissue necrosis without blocking the renal pedicle was deeper than that just with blocking the renal pedicle(P=0. 007 and P=0. 002,respectively). In the part of application in clinical, all procedures were successfully completed. The mean operative time was 163 min (range, 100-210 min) and mean blood loss was 230 ml (range, 100-400 ml). Drainage tube was pulled out 1 month after operation in 1 case for being allergic to absorbable hemostatic gauze, and the mean pulling drainage tube out time in others was 4. 2 d (range, 3-5 d). During a mean follow-up of 22 months (range, 10-38 months), no local tumor recurrence and distant metastasis was found. Conclusion Argon plasma coagulator can be used in simple enucleation for small renal cell carcinoma, and the clinical effectiveness is ideal.

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Application of fresh first morning midstream urine in cytological study of bladder cancer patients

Yue CHEN ; Yong XU ; Jin WANG ; Ranlu LIU ; Kuo YANG ; Changwen ZHANG ; Baojie MA ; Zhihong ZHANG ; Baomin QIAO

Chinese Journal of Urology.2010;31(10):700-702. doi:10.3760/cma.j.issn.1000-6702.2010.10.015

Objective To investigate the value of the application of the fresh first morning midstream urine in cytological study of bladder cancer patients. Methods The results of the fresh first and second morning midstream urine cytological studies for 52 bladder cancer patients were analyzed.Continual three urine samples and single urine sample were treated as study objects respectively. The positive rates in different tumor stages and grades were evaluated. Results The positive rate of overall 52 patients was 78. 8 % (41/52) in fresh first morning midstream urine and 80. 8% ( 42 / 52) in the fresh second morning midstream urine. While in 156 single urine samples, the positive percentages were 56.4%(88/156) and 60. 9% (95/156). The positive rates of the fresh first and second morning midstream urine were 69.7% (23/33) and 72.7% (24/33) respectively in grade 1- 2 patients, and 44.4 % (44/99) and 48. 5 % (48/99) in 99 single urine samples. The positive rates of 42 non-muscle invasive bladder cancer patients were 73. 8% (31/42) and 76.2% (32/42) in the fresh first and second morning midstream urine, while in 126 single urine samples, the positive rates were 54.8% (69/126)and 57.1% (72/126). There were no significant differences between positive rate of the fresh first and second morning midstream urine in diagnosis of bladder cancer, low grade bladder cancer and nonmuscle invasive bladder cancer. Conclusion The fresh first morning midstream urine can be used for urine cytological study in the diagnosis of bladder cancer, even in the diagnosis of low stage and low grade bladder cancer.

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Safety and efficacy of Holmium laser resection for primary non-muscle invasive bladder cancer versus transurethral electroresection

Mingjin ZOU ; Yuhai ZHAO ; Yaofeng ZHU ; Benkang SHI ; Hui HAN

Chinese Journal of Urology.2010;31(10):691-694. doi:10.3760/cma.j.issn.1000-6702.2010.10.013

Objective To evaluate the safety and efficacy of Holmium laser resection for primary non-muscle invasive bladder cancer (HoLRBt) compared with transurethral resection of bladder tumor (TURBt). Methods Data of 212 patients with primary non-muscle invasive bladder cancer were collected retrospectively. The patients were divided into HoLRBt group(n= 101) and TURBt group (n= 111). The patients in each group were stratified into 3 risk groups (low, intermediate and high risk) according to prognostic factors for recurrence based on EAU guideline. Then, the safety of HoLRBt and TURBt groups were compared, concerning the intraoperative complications and postoperative recovery. Efficacy indicated by recurrence-free survival of the 2 groups was analyzed and compared by Kaplan-Meier technique. Results Patients' demographics including age, gender, tumor characteristics, and recurrence risk of tumor between the 2 groups were comparable(P＞0.05). No obturator nerve reflex occurred in the HoLRBt group. Meanwhile, 7 out of 111 patients in the TURBt group experienced this complication resulted bladder perforation in 3 patients. The proportion of patients needing postoperative bladder irrigation in the HoLRBt group was lower compared to the TURBt group (P＜0.05). HoLRBt was associated with shorter postoperative catheter drainage period (P＜0.05). The mean postoperative follow-up was 34 months (range 18 to 43). Recurrence-free survival after HoLRBt was similar with that of TURBt (P = 0. 283). Conclusions Compared with TURBt, HoLRBt is a feasible, safe and effective alternative for the management of primary non-muscle invasive bladder cancer with similar therapeutic efficacy and fewer perioperative complications.HoLRBt can be widely used in clinical practice in the treatment of primary non-muscle invasive bladder cancer.

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Clinical and pathologic study and evaluation of conventional prognostic parameters in 75 chromophobe renal cell carcinoma cases

Chunxiang LI ; Xusheng CHEN ; Suxiang LIU ; Qing YANG ; Xin YAO

Chinese Journal of Urology.2010;31(10):670-674. doi:10.3760/cma.j.issn.1000-6702.2010.10.006

Objective To study the clinical and pathologic features of chromphobe renal cell carcinoma (ChRCC) and to evaluate the conventional pathologic prognostic parameters in prognosis.Methods Seventy-five cases (42 males and 33 females) with pathological confirmed ChRCC (36 on the left and 39 on the right kidney) after nephrectomy during 1998 to 2009 were retrospectively analyzed. Patient's age ranged from 25 to 74 years, with a mean age of 56 years. Evaluation of conventional prognostic parameters was carried out. Kaplan-Meier survival curve was used to study the survival relationship. Results The mean tumor diameter was 7.3 cm. The majority of tumor macroscopic surface color was gray and yellow or gray and red. The majority of tumor cells were big polygon chromphobe cell or small round eosinophils. The TNM stages of these ChRCC were as follows: 30 cases in T1N0M0, 1 in T1N0M1, 26 in T2N0M0, 1 in T2N0M1, 11 in T3N0M0, 3 in T3N0M1, 1 in T3 N1 M0, 1 in T4 N0 M1 and 1 in T4 N1 M1. The pathologic grade of ChRCC was G1 in 3 cases, G2 in 24cases, G3 in 46 cases and G4 in 2 cases. All the 75 cases were followed up for 9 to 93 months (mean 44months), 7 patients died and others were alive without recurrence and metastasis. 3-year and 5-year survival rates were 93.3% and 90. 7%, respectively. The univariable analysis showed that tumor size (P=0. 028), TNM stage (P＜0. 001) were associated with tumor progression. The multivariable Cox regression model revealed that TNM stage was an independent predictor of aggressive ChRCC. Conclusions The ChRCC tumors are generally larger than other types of RCC and with a favorable prognosis. Fuhrman nuclear grade is not suitable for ChRCC. TNM stage is an independent predictor of aggressive ChRCC.

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Study on histone acetylation modulation and Akt signaling pathway inhibition by phenyhexyle isothiocyanate in prostate cancer PC3 cell line

Zhiming ZHUANG ; Xudong MA ; Yiqun HUANG ; Zhouda ZHENG ; Yacai ZHENG ; Shaohong JIANG

Chinese Journal of Urology.2010;31(10):707-709. doi:10.3760/cma.j.issn.1000-6702.2010.10.017

Objective To investigate phenyhexyle isothiocyanate (PHI) modulating histone acetylation and inhibiting Akt signaling pathway in prostate cancer cell line PC3 in vitro. Methods Apoptotic cells were measured by TUNEL assay. Histone acetylated H3, H4 and the Akt protein signaling pathway (Akt, p-Akt, mTOR, p-mTOR, p70S6K and p-p70S6K) were detected by Western blot. Results Apoptotic cells increased after exposure to PHI with concentration dependent. PHI significantly induced an accumulation of histone acetylated H3, H4. The change of Akt, mTOR, p70S6K proteins was not observed. Phosphorylation of Akt (p- Akt), mTOR (p-mTOR) and p70S6K (p-p70S6K) decreased after exposure to PHI for 7 h. Conclusions PHI can induce histone acetylation H3, H4 accumulation. PHI inhibits Akt signaling pathway resulting cell apoptosis. It might be a new anticancer agent.

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Biological significance of expression of nitric oxide synthases in neurogenic bladder

Shoulin LI ; Weixiu CHEN ; Yuli CHEN

Chinese Journal of Urology.2010;31(10):695-699. doi:10.3760/cma.j.issn.1000-6702.2010.10.014

Objective To explore the expression of nitric oxide synthases including neuronal nitric oxide synthases(nNOS), inducible nitric oxide synthases(iNOS), endothelial nitric oxide synthases (eNOS) in neurogenic bladder tissues, and analyze it's producing feature and significance. Methods There were 30 cases with neurogenic bladder(18 males, 12 females). The average age was 6.3±3.1 years. All patients appeared with myelodysplasia, urinary and fecal incontinence in different degree. Twenty-six cases were manifested with hyperreflexia bladders, and all patients were treated with surgical procedures. During operation, collected bladder tissue samples including tissues of apex vesicae and tissues of bladder neck, and all tissues were enveloped with mineral wax. All tissues were detected for nNOS, iNOS, and eNOS respectively in tissues of apex vesicae and tissues of bladder neck,and with normal bladder tissues as control group (bladder tissues of hypospadia, 10 cases), and according to clinical features, to explore the expression of NOS, and to analyze the relationship among them. Results In normal apex vesicae tissues, all cases stained with nNOS, and distributed among bundles of smooth muscles, and surface of smooth muscles and interstitial tissue, histochemica;score (HS) 2.8-4.0 and 1.2-2.7. There were no stained cells in bladder tissues of iNOS, and HS was very low, HS:0-0. 4 and 0-0.1 ;eNOS mainly distributed in interstitial tissues in rarefaction manners, and mainly in vascular endothelial cell (VEC), and smooth muscles had no stainings the most expression among them was nNOS, and mainly distributed in bladder neck tissues. In neurogenic bladder tissues, the main expression of NOS type was iNOS, and nNOS decreased significantly. eNOS mainly expressed in VEC among interstitial tissues, and had no staining in smooth muscle cells and collagenoblast and rarefaction of microvessel in bladder tissues, and microvessel density decreased significantly than normal bladder tissues. Microvessal density(MVD) in bladder tisssus (6. 8± 3.2/100per square) was less than that in normal tissues (16.7±6.3/100 per square). Conclusions In normal bladder tissues, nNOS mainly distributes in bladder neck and urethra, and nitric oxide mainly derives from nNOS. Much more matrix fibers, fewer nitrogenergic nerves, and less nNOS expression are seen in neurogenic bladder interstitial tissue. There are more iNOS expressions in bladder tissues,and NO is mainly derived from iNOS, and it may play an important role in pathological bladder tissues, especially in fibrosis of bladder wall. eNOS may be considered as angiopoietic labeling, and may evaluate the blood supply of bladder.

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Signal transducer and activator of transcription 1 and matrix metalloproteinase 3's genetic expression and their clinical significance on urothelial tumor after renal transplantation

Xiaopeng HU ; Liang REN ; Hang YIN ; Xiaoyong YANG ; Wei WANG ; Hang LIU ; Xiaodong ZHANG

Chinese Journal of Urology.2010;31(10):687-690. doi:10.3760/cma.j.issn.1000-6702.2010.10.012

Objective To investigate the signal transducer and activator of transcription 1(STAT1) and matrix metalloproteinase 3(MMP3)′s genetic expressions and their clinical significance on urothelial carcinoma after renal transplantation. Methods Fifty-one patients with urothelial carcinoma were recruited in this study. Sixteen of them who had renal transplant were in the experimental group and 35 of them without renal transplant were in the control group. All the cases had been proved postoperatively having transitional cell carcinoma by histopathological study. The human genome oligo arrays were used to analyze the gene expression spectrum of urothelial carcinoma after transplantation, aiming the STAT1 and MMP3's expression. Real time RT-PCR and immunohistochemical staining were used to compare the differences in the 2 groups. Results The experimental group showed that there were 35 genes up-regulated compared with the control group. Of them, 23had known gene function or partly known, and 12 had unknown gene function. There were 76 genes down-regulated. Of them, 46 had known gene function or partly known, and 30 had unknown gene function. After pathway analysis of the differentially expressed genes, there were 23 groups of pathways which had significant differences (P＜0.05), referring to the aspects of immunosuppressive and tumor growth. The levels of STAT1 and MMP3 expressions had significant differences between the 2groups(P＜0.05)as well. Conclusions The differential expression of urothelial tumor genes is obvious between patient who has had renal transplant and who has not. There are many aspects that are related to the tumor's growth like signaling pathways regulating proliferation, apoptosis of tumor cells, tumor angiogenesis and the tumor metastasis potential. STAT1 and MMP3 maybe become the targets of chemoprevention for post-transplantation urothelial carcinoma.

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Evaluation of a modified Chinese version of the National Institutes of Health-Chronic Prostatitis Symptom Index

Yifu LI ; Hui XIE ; Yu YANG ; Yong CAI ; Yirong YANG

Chinese Journal of Urology.2010;31(10):710-714. doi:10.3760/cma.j.issn.1000-6702.2010.10.018

Objective To revise the Chinese version of the National Institutes of Health-Chronic Prostatitis Symptom Index (CHN-NIH-CPSD), and evaluate its feasibility, reliability, validity and responsiveness. Methods The NIH-CPSI was translated into Chinese according to a standard methodology including forward-backward-forward technique. The CHN-NIH-CPSI was pre-tested in consecutive samples of 162 native-speaking Chinese chronic prostatitis(CP)patients. Ninety-five of 162 filled the index again on the same day and after 4-week therapy. Ninety-seven healthy men were included as evaluated. Results The recovery of the questionnaires was 100% and all the patients filled the index completely. The mean time to complete the questionnaire for the patient group was 5.2±2.4 (range 2 - 12) min. The split-half reliability was 0.82. For the overall index and each subscale, the test-retest reliability was 0.98, 0. 98, 0. 98, 0. 97, respectively(P＜0.01);and the Cronbach's α coefficient was 0. 61,0. 71, 0. 59, 0. 75, respectively. The confirmatory factor analysis showed good construct validity with a goodness of fit index of 0. 85 and a x2 of 124.67(P＜0. 01). Of all 162 patients, the scores of the overall index and each subscale were 23. 33±5.91. 8. 80±4.26, 5.30±2.82, 9. 23±1.90, respectively;and those of healthy controls were 1. 95±1.97, 0. 37±1.03, 0. 15±0.58, 1.42± 1.20,respectively. Of the 95 patients, the original scores were 23. 53±5.60, 9.21 ±4.04, 5.10±2.75,9.21 ±2.05, comparing with 19.47±6.36, 7.79±3.95, 3. 58±1.88, 8.11±2.50, the 4 weeks later scores. The group t-test and paired t-test showed good responsiveness. Conclusions The CHN-NIH-CPSI has high feasibility, reliability, validity and responsiveness for testing the patients with CP. It is suitable for Chinese-speaking patients and helpful for cross-cultural comparisons of men with CP in clinical and research settings.

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Summary of 1289 percutaneous nephrolithotomy cases under ultrasonic guidance for the treatment of upper urinary calculi

Qingzuo LIU ; Ke WANG ; Junjie ZHAO ; Peng ZHANG ; Jianming WANG ; Chunhua LIN ; Lin WANG ; Renhui JIANG ; Zhenli GAO

Chinese Journal of Urology.2010;31(10):683-686. doi:10.3760/cma.j.issn.1000-6702.2010.10.011

Objective To evaluate the efficacy and safety of percutaneous nephrolithotomy (PCNL) under ultrasonic guidance for the treatment of upper urinary calculus. Methods From June 2004 to July 2009, 1289 patients with upper urinary tract calculi were treated with PCNL under ultrasonic guidance, 386 cases of them were upper ureteral calculi, 463 cases were single renal calculi,355 cases were multiple renal caculi, 85 cases were staghorn calculi. Calculus size was 0.8 cm× 1.2cm-9.0 cm× 5.3 cm,mean 2. 1 cm× 3.1 cm. Nine hunderd and thirty-five cases were with hydronephrosis. Results All patients were performed PCNL successfully, without conversion to open surgery or death. Mean operation time was 90(55-220)min, mean operative blood loss was 175(60-800)ml. Thirty-one cases were given blood transfusion during operation or post operation, 14 cases were given super-selective renal artery embolism for bleeding control. 1105 cases were treated with single tract, 108 cases with double tracts, 76 cases with three tracts. Calculus clearance rate of onestage PCNL was 85.03%(1096/1289);193 cases were found with residual calculi, 67 of them were given extracorporeal shock-wave lithotripsy, 126 of them were given two-stage PCNL, calculi were removed complelety in 85 cases. Total calculus clearance rate was 91.62%(1181/1289). Conclusions PCNL under ultrasonic guidance is an effective and safe method for the treatment of upper urinary calculus with advantages of accurate positioning, high calculus clearance rate, minimal trauma, and fewer complications. The key of successful PCNL is selection of patients, grasp of operation technique, and availability of other equipements.

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Evaluation of cystic renal mass with contrast enhanced ultrasonography

Yong XU ; Sheng ZHANG ; Jinkun ZHAO ; Xiuying LI

Chinese Journal of Urology.2010;31(10):679-682. doi:10.3760/cma.j.issn.1000-6702.2010.10.010

Objective To investigate the value of contrast enhanced ultrasonography in evaluating cystic renal mass. Methods According to the imaging diagnosing standard, 29 cystic renal mass lesions were studied with contrast enhanced ultrasonography(CEUS), unenhanced ultrasonography (US), contrast enhanced CT(CECT) and then correlated their results with final histopathological results. The data were tested by receiver operating characteristic(ROC) curve. Results The area under ROC curve of CEUS and US was 0. 721, 0. 997, respectively. There was significant difference between the 2 groups (P=0. 003). The area under ROC curve of CEUS and CECT was 0. 997, 0. 997,respectively. There was no significant difference between the 2 groups (P= 1. 000). Conclusions CEUS is better than US and similar to CECT in evaluating cystic renal mass. CEUS with the Bosniak classification is useful for evaluating cystic renal mass.

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