Objective To summarize our experience with surgical management of renal neoplasm involving inferoir veno cava.Methods We review the data of 115 patients,including 74 male patients and 41 female patients,with renal neoplasm involving venous system between March 1993 and December 2015.The mean age was 52 years old,ranging 22 to 77 years old.The tumor was found in right side in 77 cases and left side in 38 cases.There were 15 patients (13.0％) with renal vein thrombus,38 (33.1％) with infrahepatic thrombus,29 (25.2％) with low retrohepatic thrombus,20 (17.4％) with high retrohepatic thrombus,and 13 (11.3％) with supradiaphragmatic thrombus.The mean age was 52 years old,ranging 22 to 77 years old.The tumor was found in right side in 77 cases and left side in 38 cases.All patients accepted the radical nephrectomy.Primary outcomes were overall survival (OS),and cancer special survival (CSS) in patients with renal cell carcinoma (RCC) estimated by Kaplan-Meier method.Secondary outcome included operative and oncological features,past-operative complications and hospital mortality.Cox proportional hazard model was used to univariate and multivariate analysis for risk factor impacting on OS of RCC patients.Results Complete resections of renal neoplasm with tumor thrombus were achieved in 113 patients (98.3％),2 patients died intraoperatively due to the dropping of thrombus.Postoperative complication rate was 16.8％.Hospital mortality was 2.6％.Mean follow-up interval was 48 months.OS rates at 5-,and 10-year in RCC patients were 66.5％,and 61.8％,respectively.Metastasis was an independent risk factor affecting on OS (P =0.000).However,the level of thrombus was not an risk factor affecting the prognosis.Conclusions Radical resection of renal tumor and caval thrombus is an effective treatment for prolonging survival in patients with RCC extending into venous system.Retrohepatic caval tumor thrombus below or above the main hepatic vein should be dichotomized and managed respectively with diverse techniques.Metastatic rather than the level of thrombus was a risk factor impacting on RCC patient survival.

Objective To evaluate the feasibility and effect of the new biodegradable paclitaxel-eluting stents in treatment of traumatic urethral stricture.Methods Twenty-five adult New Zealand rabbits were divided into study group (n =20) and control group (n =5) according to the random number table.In study group,rabbit models of traumatic urethral stricture were developed by self-designed explosive devices.All the stents were inserted under direct vision.Reparative results were evaluated by urethroscopy,retrograde urethrogram and histological examinations at postoperative 4,8,and 12 weeks.Results In study group all the stents were smoothly inserted into the strictured urethra without the occurrence of stent migration and lithogenesis.Urethroscopy showed that the stents in study group were partially degraded at 8 weeks,mostly degraded at 12 weeks and discharged with the urine.And from the naked eye,there was no distinct difference between the repaired and normal urinary mucosa.Retro~ade urethrogram demonstrated the stents restored urethral patency.Histological examinations showed the stents minimized stent-related inflammatory reactions,uroepithelial hyperplasia and scar formation.Conclusion New biodegradable paclitaxel-eluting stents exhibiting good biocompatibility are more effective to repair urethral stricture in rabbits.

Objective To analyze the relationship between thyroid function and grades of diabetic nephropa-thy (DN).Methods One hundred and twenty patients with definite DN were classified into the four groups,and forty patients with non-DN diabetic was NDN group.Their serum albumin,blood hemoglobin,serum potassium,functional parameters of thyroid and dependability to DN were analyzed.Results The plasma albumin ofⅢ,Ⅳ and Ⅴ group were (41.3 ±3.6)g/L,(30.5 ±4.8)g/L and (28.3 ±5.9)g/L,which were lower than those of NDN group (F=11.36,P<0.05).24h urine protein ofⅢ,Ⅳ and Ⅴ were (0.48 ±0.29)g,(1.86 ±0.54)g and (1.69 ±0.67)g, which were higher than those of group NDN (F=7.12,P<0.05).Triiodothyronine(T3)ofⅢ,ⅣandⅤgroup were (0.98 ±0.38)nmol/L,(0.75 ±0.41)nmol/L and (0.60 ±0.28)nmol/L,which were lower than those of NDN group (F=7.64,P<0.05).Tetraiodothyronine(T4)of III,IV and V group were (6.06 ±1.76)nmol/L,(5.31 ±1.98)nmol/L and (4.65 ±1.87)nmol/L,which were lower than those of NDN group (F=6.83,P<0.05 ).Free Triiodothyronine (FT3)ofⅢ,Ⅳ and Ⅴ group were (4.37 ±2.12)pmol/L,(3.33 ±2.30)pmol/L and (2.91 ±1.82)pmol/L, which were lower than those of NDN group (F=7.14,P<0.05 ).Correlation analysis indicated that FT3 was an independent predictor for the severity of diabetic nephropathy.Conclusion In the patients with DN Ⅳ and Ⅴ,DN has attained a very severe status and the treatment of DN should be intensive.

Objective To establish a new canine model of ureter trauma to observe the protective effect of biodegradable ureteral stent on renal function following traumatic ureter injury. Methods A self-made device was used to make firearm fragment wounds unilaterally on the ureters in nine Beagle dogs (model group). The wounds were debrided and sutured and the results were evaluated by using intravenous pyelography (IVP) and radioactive renography at 40, 80 and 120 days postoperatively. Firearm fragment wounds were made to the bilateral ureters of nine Beagle dogs in the positive control group, in which a biodegradable stent was placed in one side and a double-J stent placed in the other side. Results In model group, hydronephrosis and hydroureter occurred and got worse postoperatively on the wounded side in all nine Beagle dogs, while none of these symptoms were found in any animals in the control group. The ratios of biodegradable stent side to double-J stent side were increased in renal patial concertration index and half time of kidney washout, but neither showed significant differences. However,vesicoureteral reflux (VUR) was not found in the biodegradable stent side, but in the double -J stent side. Conclusions A new canine model of firearm fragment wounds is successfully developed. Both the biodegradable and double-J stent play important roles in support and drainage and show no significant difference in aspects of renal uptake and half time of kidney washout. The biodegradable stent can effectively prevent VUR.

In this study, the vaporization ratio of the 2-mum laser in the prostatic tissue with benign prostatic hyperplasia was examined in vitro, to explore a technique to estimate the clearance rate of prostatic tissue during the transurethral vaporesection of the prostate. A total of 9 fresh prostatic tissue specimens were obtained by open surgery and the wet weight of the prostatic tissue were measured immediately after the sample collection. Under the simulated conditions of transurethral vaporesection of the prostate by 2-mum laser, each prostate gland was completely vaporesected into fragments with a diameter of less than 1.0 cm in vitro. After the vaporesection, the whole fragments of prostatic tissue were collected and measured. Then the lost weight of prostatic tissue, the weight of the collected prostatic tissue and the ratio of the lost weight of prostatic tissue to the wet weight of the prostate glandular organ specimen were calculated. The correlation between the weight of collected prostatic tissue and the weight of the whole glandular organ was analyzed. All the experimental procedures were carried out by one operator. Wet weight of the prostatic gland specimen and the weight of the harvested prostatic tissues after the procedure were recorded. With respect to the wet weight of prostate gland specimen, the percentage of the weight of collected prostatic tissue was (34.45+/-1.51) %, and the percentage of the lost weight of prostatic tissue was (65.55+/-1.51)%. Satisfactory linear relationship was observed between the weight of collected prostatic tissue and the wet weight of prostate gland specimen [y=3.245x-6.475 (t=15.097, P=0.000)]. It is concluded that under the simulated conditions of transurethral vaporesection of the prostate by 2-mum laser, the vaporization ratio of prostatic tissue can be calculated on the basis of the weight of collected prostatic tissue, and thereby the clearance of prostatic tissue during the formal operation by 2-mum laser could be quantitatively determined.

In this study,the vaporization ratio of the 2-μm laser in the prostatic tissue with benign prostatic hyperplasia was examined in vitro,to explore a technique to estimate the clearance rate of prostatic tissue during the transurethral vaporesection of the prostate.A total of 9 fresh prostatic tissue specimens were obtained by open surgery and the wet weight of the prostatic tissue were measured immediately after the sample collection.Under the simulated conditions of transurethral vaporesection of the prostate by 2-μm laser,each prostate gland was completely vaporesected into fragments with a diameter of less than 1.0 cm in vitro.After the vaporesection,the whole fragments of prostatic tissue were collected and measured.Then the lost weight of prostatic tissue,the weight of the collected prostatic tissue and the ratio of the lost weight of prostatic tissue to the wet weight of the prostate glandular organ specimen were calculated.The correlation between the weight of collected prostatic tissue and the weight of the whole glandular organ was analyzed.All the experimental procedures were carried out by one operator.Wet weight of the prostatic gland specimen and the weight of the harvested prostatic tissues after the procedure were recorded.With respect to the wet weight of prostate gland specimen,the percentage of the weight of collected prostatic tissue was(34.45±1.51)%,and the percentage of the lost weight of prostatic tissue was(65.55±1.51)%.Satisfactory linear relationship was observed between the weight of collected prostatic tissue and the wet weight of prostate gland specimen[y=3.245x-6.475(t=15.097,P=0.000)].It is concluded that under the simulated conditions of transurethrai vaporesection of the prostate by 2-μm laser,the vaporization ratio of prostatic tissue can be calculated on the basis of the weight of collected prostatic tissue,and thereby the clearance of prostatic tissue during the formal operation by 2-μm laser could be quantitatively determined.

Objective To sum up experience with surgical excision of isolated local recurrence for renal cell carcinoma. Methods From March 2004 to November 2007, 7 patients (five cases un-derwent radical nephrectomy and two nephron-sparing surgery) with isolated local recurrence of renal cell carcinoma were treated at our department. All patients underwent extensive surgery for local re-currence. Results The mean patient age was 42 years (range 19 to 6). The mean time to local re-currence was 23.3 months (range 12 to 54). The Mean size of the recurrent tumor was 5.2 cm(range 2.5 to 10.5). Peritoneal exploration was performed in 7 patients and 5 had complete en bloc excision of the renal cell carcinoma mass. 2 patients gross disease was excised. The mean blood loss was 1050 (150-3000) ml. Surgical complications occurred in 2 patients, iliohypogastric nerve injure in one and ileus performation in another one. All patients recovered finally. Six patients were followed and one lost follow-up. Mean follow-up time was 13(8-27) months. One patient died of metastatic disease at 22 months after excision of the renal cell carcinoma mass. Conelusion En bloc excision of isolated locally recurrent renal cell carcinoma is possible, and complete surgical resection could lead to pro-longed disease-free survival.

Objective To investigate the expression of Phosphorylated-signal transduction and activators of transcription 3 (P-STAT3) proteins in human prostate tissue from patients received re-peated biopsies. And consider the usefulness of detecting expression of P-STAT3 in early diagnosis of prostate cancer (PCA). Methods Fifty-eight patients (29 cases of PCA, and 29 cases of benign prostatic hyperplasia (BPH)) who had received repeated biopsies were involved in this study. Immu-nolabelling has been carried out on PCa patients' samples of cores from initially negative biopsies, typ-ical cores from cancer field, and other cores of the same batch biopsies showing no sign of prostate cancer. BPH patients' samples of cores from initial biopsies were set as control. All specimens were done immunohistochemistry stain with anti-P-STAT3 monoclonai antibody. The association of P-STAT3 expression in prostate tissues with the pathology result was evaluated. Results Compared with 10.3% in specimens of patients free of prostate cancer, the positive rate of anti-P-STAT3 stained in typical cores from cancer field, other cores of the same batch biopsies showing no sign of prostate cancer, and cores from initially negative biopsies, was 93.1 % (27/29), 82.8 % (24/29) and 86.2 % (25/29), respectively. There were significant differences of these values between former and laters' (X2=60.123,P=0.000). If P-STAT3 positive in tissue of initially biopsies was considered as the di-agnostic standard of prostate cancer, then it would show a relatively high sensitivity (86.2%) and specificity (89.7%). Conclusion IHC stain for P-STAT3 in prostate biopsy samples could be served as an adjunct to the current diagnostic approach to prostate biopsy for early diagnosis of pros-tate cancer.

Objective To assess the value of percutaneous balloon catheter occlusion technique for tumor thrombectomy in renal or adrenal neoplasm extending into the inferior vena cava(IVC). Methods Twelve patients with renal or adrenal neoplasm extending into retrohepatic or subhepatic IVC were diagnosed by the investigations of CT, MR1, and Doppler ultrasound. There were 7 men and 5 women with a mean age of 51 years (range, 20 to 76 years). Of these patients, 11 had renal ne-oplasm and 1 had adrenal tumor; 11 in the right and 1 in the left; 11 with retrohepatic caval thrombus (level 2a) extension and 1 with extension into the subhepatic vena cava (level 1). On the operation day, all patients had a pereutaneous preset of the balloon catheter into the IVC, at the position be-tween hepatic vein and the tip of tumor thrombus. During surgical resection, the balloon was filled via the catheter to occlude the IVC prior to vena cavotomy. Results Radical nephrectomy and resection of vena cava thrombus was successfully performed with this technique on 12 patients. There were no operative or perioperative pulmonary embolisms or deaths, no any complication. The mean postopera-tive hospital stay was 12 d (range, 9 to 15 d). Pathological investigation revealed clear cell carcinoma in 6 patients, papillary renal cell carcinoma (RCC) in 3, metastatic hepatocellular carcinoma in 1, an-gioleiomyolipoma in 1 and adrenal leiomyosarcoma in 1. The pTNM stage in 9 patients with RCC was T3b N0 M0 in 8 patients, T3b Nx M1 in I patient. The mean followup was 21±10 months (median follow-up 24 months). Four patients died of lung or liver metastasis, and the recurrence of liver cancer at 6, 9, 15, and 22 months postoperatively. Eight patients have survived for 6 to 35 months (mean 26 months). The postoperative 1-, and 3-year cancer-specific survival rates in 9 patients with RCC were 78% and 67%. Conclusions Percutaneous balloon catheter occlusion technique is a feasible, safe, and effective method for tumor thrombectomy of low retrohepatic (level 2a) or subhepatic (level 1) type in patients with renal or adrenal neoplasm extending into the IVC. Additional experience and con-tinued investigation are warranted.

Objective To evaluate the efficacy of the RevoLix 70 Watt 2 micron continuous wave laser vaporesection for treatment of large volume benign prostatic hyperplasia(BPH,＞80 g).Methods Forty-five patients with obstructive BPH were treated with 2 micron continuous wave laser vaporesection.The age ranged from 57 to 88 years with a mean of 69 years.Nine patients had acute urinary retention.Mean prostatic volume was(96±1 3)ml(ranged from 80 to 128 m1).Eight cases were given suprapubic puncture.All cases were successfully anesthetized by using epidural anesthesia.At the beginning of the operation,the distal resection border close to the verumontanum was marked and laser incisions were performed at 5 and 7 o'clock lithotomy position.Firstly,median lobe was vaporeseeted closely along capsule from bladder neck to verumontanum.Secondly,prostate at 12 o'clock was vaporesected until the capsule was reached,and both lateral lobes were dissected downward.Thirdly,the apical position was enucleated by sheath,and then prostate was vaporesected from the tissue in 12 o'clock position to the tissue at 6.It was important to follow the 2 principles:inner to extra,up to down.Transfusion rate,resection time,time of indwelling catheter,improvement in urinary flow rate(Qmax),international prostate symptom score(IPSS)and quality of life(QOL)were measured.Results AIl cases were successfully operated.except one whose left lateral lobe was left due to heavy fluctuation of heart rate and blood pressure in operation.The mean operation time was (104±12)min.Transfusions were not necessary in any patients.The catheter was indwelled for 3 to 5 d postoperatively.One case had urethral stricture 3 weeks after operation,and urinated free after 22 times urethral sounding disj unctively.All cases were followed up for 3-1 2 months.All patients were satisfied with voiding outcome,none had incontinence.Mean Qmax increased from(3.3±0.5)ml/spreoperatively to(16.5±1.5)ml/s postoperatively.IPSS decreased from 28.6±5.5 to 8.3±2.3 and QOL score decreased from 4.5±0.4 to 2.7±0.2.respectively(P＜0.01).No hemorrhage occurred after the operation.Conclusion RevoLix 2 micron continuous wave laser vaporesection for treatment of large volume BPH is a safe and effective relief therapy,and that in combination with enucleation could improve the efficiency of vaporesection.