Xiaofeng Gao

Retrograde Intrarenal Surgery Versus Percutaneous Nephrolithotomy Versus Extracorporeal Shockwave Lithotripsy for Treatment of Lower Pole Renal Stones: A Meta-Analysis and Systematic Review

BACKGROUND AND PURPOSE The optimal treatment of patients with lower pole renal stones continues to be a dilemma for urologists. Retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PCNL), and extracorporeal shockwave lithotripsy (SWL) all constitute viable therapeutic options in selected patients. The aim of this study was to assess the efficacy and safety of RIRS, PCNL, and SWL in management of lower pole renal stones. METHODS A literature search was performed in July 2014 using PubMed, Embase, and Web of Science databases. Literature reviewed included meta-analysis and randomized and nonrandomized controlled studies to identify relevant studies for the meta-analysis. RESULTS Six randomized and eight nonrandomized studies were identified for analysis. PCNL provided a significantly higher stone-free rate (SFR) compared with RIRS and SWL. Furthermore, no statistical significant difference was found when PCNL was compared with RIRS and SWL for complication rate. Compared with the other two treatments, RIRS had a longer operative time and PCNL had a longer hospital stay. SWL was associated with significantly higher re-treatment rate compared with RIRS and PCNL, whereas there were no significant differences in auxiliary procedure rates among the three treatment techniques. CONCLUSION RIRS offers a relative higher SFR while it has a longer operative time. PCNL is associated with the highest SFR at the expense of the longest hospital stay. SWL is performed as an outpatient procedure with a relative shorter operative time; however, it has lower a SFR and higher re-treatment rate. The categories of complications vary while the overall complication rates are comparable among the three treatment techniques.

Testosterone and Androgen Receptor in Human Nephrolithiasis

PURPOSE We investigated the relationship of kidney calculi with plasma free and total testosterone, and androgen receptor up-regulation in the kidneys of men with nephrolithiasis. MATERIALS AND METHODS Male patients with kidney stone and healthy men were included in the study. Blood was collected in a tube containing 2% heparin in the morning. Total and free serum testosterone was measured by enzyme linked immunosorbent assay. All patients underwent percutaneous nephrostolithotomy. At the end of the procedure ultrasound guided puncture biopsy was done to acquire kidney tissue. Normal kidney tissue obtained at autopsy served as the control. Androgen receptor was detected in kidney tissue by immunohistochemistry. Stone composition was analyzed in each patient. RESULTS The study included 37 male patients 22 to 39 years old and 31 healthy men 24 to 37 years old. All calculi were composed of calcium oxalate monohydrate or calcium oxalate dihydrate and a few also contained protein or uric acid. Mean±SD serum total and free testosterone was 13.29±4.79 ng/ml and 63.23±28.58 pg/ml in patients, and 7.30±0.82 ng/ml and 35.59±24.91 pg/ml in healthy men, respectively (each p<0.001). Immunohistochemistry revealed androgen receptor up-regulation in the kidneys of patients with nephrolithiasis. CONCLUSIONS Our data suggest the important role of enhanced androgen signaling in human nephrolithiasis.

Transurethral seminal vesiculoscopy in the diagnosis and treatment of persistent or recurrent hemospermia: a single-institution experience

The diagnosis and treatment of hemospermia presents significant difficulty, especially if it persists or recurs. In this retrospective study, we assessed whether transurethral seminal vesiculoscopy is feasible and effective in the diagnosis and treatment of hemospermia. To address this complex condition, we report our experience in a population of patients treated with transurethral seminal vesiculoscopy. From February 2006 to July 2008, 72 hemospermic patients underwent transurethral seminal vesiculoscopy examination and treatment at our urology center. Transurethral seminal vesiculoscopy was performed by a 7-F or 8-F rigid ureteroscope. The endoscopic procedure was conducted through the normal anatomic route of the seminal tracts. In this series, the mean follow-up period was 21.7 months. Definite diagnosis was made for 93.1% patients, and 94.4% patients were cured or showed a decrease in their symptoms. Postoperative complications were not observed in the study. Our study proves that transurethral seminal vesiculoscopy is effective in the diagnosis and treatment of hemospermia with minimal complication.

Propensity-score matched analysis comparing robot-assisted with laparoscopic partial nephrectomy.

To compare the peri‐operative and early renal functional outcomes of robot‐assisted partial nephrectomy (RAPN) and laparoscopic partial nephrectomy (LPN) for kidney tumours.

Is endoscopic management suitable for long ureteral fibroepithelial polyps

BACKGROUND AND PURPOSE Fibroepithelial polyps of the ureter are rare benign tumors that have traditionally been managed by open exploration and resection. Endoscopic resection have been regarded as the gold standard for small lesions, while the management modality for long lesions is still controversial. We review our experience with ureteroscopic management of long (>6 cm) ureteral fibroepithelial polyps by holmium: yttrium-aluminum-garnet (YAG) laser resection. PATIENTS AND METHODS Five patients with a long ureteral fibroepithelial polyp underwent ureteroscopic resection using a holmium:YAG laser. RESULTS Endoscopic management was successful in all five patients, and no major complications resulted from the approach. The average length of stay was 3 days (range 2-5 d). The mean length of the lesions were 11 cm (range 6-16 cm). The ureteral stent was removed at 6 weeks. No recurrences were seen during a mean followup of 24.2 months (range 3-51 mos). One ureteral stricture developed at 3 months, and the patient underwent endoscopic treatment by holmium:YAG laser. CONCLUSIONS Endoscopic management of long ureteral fibroepithelial polyps is an acceptable modality with minimal morbidity and durable treatment results. The holmium:YAG laser offers the advantages of facilitating the use of a small-caliber fiber or flexible ureteroscope and allows safe destruction of the stalk and efficient removal of the entire polyp.

A propensity-score matched comparison of perioperative and early renal functional outcomes of robotic versus open partial nephrectomy.

Objectives To compare the perioperative and early renal functional outcomes of RPN with OPN for kidney tumors. Materials and Methods A total of 209 RPN or OPN patients with availability of preoperative cross-sectional imaging since 2009 at our center were included. To adjust for potential baseline confounders propensity-score matching was performed, which resulted in 94 OPNs matched to 51 RPNs. Perioperative and early renal functional outcomes were compared. Results In propensity-score matched analysis, RPN procedures were well tolerated and resulted in significant decreases in postoperative analgesic time (24 vs. 48 hr, p<0.001) and visual analog pain scale (3 vs. 4, p<0.001). Besides, the RPN patients had a significantly shorter LOS (9 vs. 11 days, p = 0.008) and less EBL (100 vs. 200 ml, p<0.001), but median operative time was significantly longer (229 vs. 182 min, p<0.001). Ischemia time, transfusion rates, complication rates, percentage eGFR decline and CKD upstaging were equivalent after RPN versus OPN. In multivariable logistic regression analysis, RPN patients were less likely to have a prolonged LOS (odds ratio [OR]: 0.409; p = 0.016), while more likely to experience a longer operative time (OR: 4.296; p = 0.001). However, the statistical significance for the protective effect of RPN versus OPN in EBL was not confirmed by examining the risk of EBL≥400 ml (OR: 0.488; p = 0.212). Conclusions When adjusted for potential selection biases, RPN offers comparable perioperative and early renal functional outcomes to those of OPN, with the added advantage of improved postoperative pain control and a shorter LOS.

Irrigation eliminates smoke formation in laser laparoscopic surgery: ex vivo results.

Backgrounds and Objectives To evaluate the desmoke effects of irrigation on surgical smoke generated during laser laparoscopic surgery using ex vivo model. Study Design/Materials and Methods A hand-piece was devised as both an irrigation tube and a laser fiber holder. The laser system used was a diode pumped continuous wave Thulium YAG laser (Lisa laser products OHG, Katlenburg-Lindau, Germany) emitting at 2.01-μm through a quartz fiber with a core diameter of 365 μm. Using a transparent container as experimental model (approximately 3 L in volume), 6 irrigation rates (0, 20, 40, 60, 80, and 100 mL/min) were tested combining with 4 laser power settings (20, 30, 40, and 50 W). To evaluate the desmoke efficiency of irrigation, lasing time with effective visibility under different combination of irrigation rates and laser powers were documented, and corresponding smoke generation rate were calculated (=3 L/lasing time). Analysis of variance was used to compare difference and significance was indicated at P<0.05. Results Calculated smoke generation rate was increased with laser power whereas decreased with irrigation rate. At 4 tested laser powers, calculated smoke generation rates were high (mean: 91.4 to 306.6 mL/s) when no water presented, but were significantly decreased (mean: 12.6 to 55.0 mL/s, P<0.001) with the lowest water flow rate (20 mL/min) and further decreased with higher rates. The proper range of irrigation rate for future clinical practice would be around 40 mL/min. Conclusions Irrigation eliminates smoke formation accompanying laser tissue irradiation. It shows promise for future application in laser laparoscopic surgery.

Radioiodine therapy for castration - resistant prostate cancer following prostate - specific membrane antigen promoter - mediated transfer of the human sodium iodide symporter

Radioiodine therapy, the most effective form of systemic radiotherapy available, is currently useful only for thyroid cancer because of the thyroid-specific expression of the human sodium iodide symporter (hNIS). Here, we explore the efficacy of a novel form of gene therapy using prostate-specific membrane antigen (PSMA) promoter-mediated hNIS gene transfer followed by radioiodine administration for the treatment of castration-resistant prostate cancer (CRPC). The androgen-dependent C33 LNCaP cell line and the androgen-independent C81 LNCaP cell line were transfected by adenovirus. PSMA promoter-hNIS (Ad.PSMApro-hNIS) or adenovirus.cytomegalovirus–hNIS containing the cytomegalovirus promoter (Ad.CMV-hNIS) or a control virus. The iodide uptake was measured in vitro. The in vivo iodide uptake by C81 cell xenografts in nude mice injected with an adenovirus carrying the hNIS gene linked to PSMA and the corresponding tumor volume fluctuation were assessed. Iodide accumulation was shown in different LNCaP cell lines after Ad.PSMApro-hNIS and Ad.CMV-hNIS infection, but not in different LNCaP cell lines after adenovirus.cytomegalovirus (Ad.CMV) infection. At each time point, higher iodide uptake was shown in the C81 cells infected with Ad.PSMApro-hNIS than in the C33 cells (P < 0.05). An in vivo animal model showed a significant difference in 131I radioiodine uptake in the tumors infected with Ad.PSMApro-hNIS, Ad.CMV-hNIS and control virus (P < 0.05) and a maximum reduction of tumor volume in mice infected with Ad.PSMApro-hNIS. These results show prostate-specific expression of the hNIS gene delivered by the PSMA promoter and effective radioiodine therapy of CRPC by the PSMA promoter-driven hNIS transfection.

Reinforcement for Percutaneous Nephrostomy Tubes with a New Technique

BACKGROUND AND PURPOSE Percutaneous nephrostomy (PCN) still plays a significant role in decompressing the renal collecting system. Percutaneous nephrostomy tubes (PNTs), however, which are flexible and may not be protected well by patients, are vulnerable to mechanical drag, although they are carefully fixed to the skin with silk suture. We developed a simple method to reinforce the nephrostomy tube against dislodgement from the skin. PATIENTS AND METHODS A total of 133 adult patients underwent ultrasonography-guided PCN; 85 patients received a conventional method to fix the tubes, while the other 48 patients received a new one. We used a rubber drainage tube, about 2 cm long, sheared longitudinally, as the outer tube to encase the nephrostomy tube, and then sutured the cutting edges together with the skin suture to reinforce the nephrostomy tube. RESULTS Compared with the 85 patients who received the conventional method, there was not any tube dislodgement after PCN in the 48 patients who received the new one at the end of 2 weeks (0 vs 7, P=0.049) and 4 weeks (0 vs 10, P=0.014) follow-up. CONCLUSIONS This is a simple, effective, and inexpensive method that can significantly decrease the dislodgement incidence of PNTs and keep them fixed well after surgery.

The molecular mechanisms of androgen receptor in nephrolithiasis.

OBJECTIVES This study aimed to investigate the molecular mechanisms of androgen receptor (AR) in nephrolithiasis. METHODS Human kidney 2(HK-2) cells were transfected with Lentiviruses expressing AR (DEC-AR), shRNA targeting AR (sh-AR) or the empty vector control using the pLEX lentiviral vector system. The expression levels of AR were measured by qRT-PCR at 72h postinfection, and cells under different treatments were collected for microarray analysis. Differentially expressed genes (DEGs) were identified using Students t-test. The protein-protein interaction (PPI) network was constructed for negatively correlated DEGs using GeneMANIA. Then, functional and pathway enrichment analysis were performed for the genes in the PPI network. RESULTS The qRT-PCR revealed that expression level of AR in DEC-AR cells was obviously increased and decreased in sh-AR cells at 72h postinfection (p<0.05). Totally, 64 negatively correlated DEGs showed lower expressions and 63 negatively correlated DEGs were up-regulated in the DEC-AR HK2 cells. Negatively correlated DEGs were significantly related to cell differentiation, response to stimulus, multicellular organismal process and multicellular organismal development. Pathway enrichment analysis revealed that DEGs mainly participated in the rheumatoid arthritis (CCL2, CSF1, IL11, LTB and MMP1), gematopoietic cell lineage (CD33, CD44, CSF1 and IL11) and TNF signaling pathway (CCL2, CSF1, MMP9 and VCAM1). Meanwhile, CD44, LAMC2 and THBS2 were significantly enriched in ECM-receptor interaction. CONCLUSION The negatively correlated DEGs, especially CCL2, CD44, MMP1 and MMP9, might play critical roles in nephrolithiasis.