Zhishun Xu

Safety and efficacy of holmium laser resection for primary nonmuscle-invasive bladder cancer versus transurethral electroresection: single-center experience.

OBJECTIVES To assess the safety and efficacy of holmium laser resection for primary, clinically nonmuscle-invasive, bladder cancer (HoLRBT) compared with standard transurethral resection of bladder tumor (TURBT). METHODS The data from a total of 212 consecutive patients with primary nonmuscle-invasive bladder cancer were collected in this study. These patients were treated by holmium laser resection (HoLRBT group) or transurethral electroresection (TURBT group) and were divided into 2 groups. The patients in each group were stratified into 3 risk subgroups (low, intermediate, and high risk) according to the prognostic factors for recurrence using the European Association of Urology guidelines. The intraoperative complications and postoperative characteristics of the HoLRBT and TURBT groups were compared. Efficacy, indicated by the recurrence-free survival in the overall group and stratified subgroups, was analyzed and compared using the Kaplan-Meier technique and the log-rank test. RESULTS The patient demographics and tumor characteristics in the 2 groups were comparable. HoLRBT was superior to TURBT in terms of intraoperative complications and postoperative catheterization time (P < .001). Recurrence-free survival after HoLRBT was similar to that after TURBT (P = .283). CONCLUSIONS Our results have indicated that HoLRBT is a feasible, safe, and effective alternative for the management of primary, clinically nonmuscle-invasive, bladder cancer compared with TURBT, with similar recurrence-free survival and fewer perioperative complications. It also can provide sufficient material for the pathologic evaluation.

Relationship Between Patient Age and Superficial Transitional Cell Carcinoma Characteristics

OBJECTIVES To evaluate the relationship between patient age and the characteristics of superficial transitional cell carcinoma. METHODS The clinical and pathologic records of 576 patients were retrospectively reviewed. The patients were classified into three groups: those 40 years or younger, those 41 to 59 years old, and those 60 years or older. The transitional cell carcinoma characteristics of three groups were analyzed to define the relationship, if any, with age. RESULTS The male/female ratio was 4.1:1, 3.6:1, and 2.3:1 in the three age groups, with significant differences between the 60 years or older group and the 40 years or younger group and 41 to 59 year group (P <0.05). The percentage of patients with poorly differentiated tumor increased with increasing age, and a significant difference was found between the 60 years or older group and the 40 years or younger and 41 to 59 year groups (P <0.05). The overall recurrence rate was 34.2% at 12 months and 40.8% at 24 months. The nonrecurrence rate was significantly greater in those 40 years or younger compared with those 60 years or older in all three risk groups (P <0.05). CONCLUSIONS The results of our study have shown that the percentage of female patients with bladder cancer increases with increasing age and that elderly patients are more likely to present with poorly differentiated bladder cancer. Also, the recurrence-free survival rate decreased with increasing age.

Y-27632 improves the erectile dysfunction with ageing in SD rats through adjusting the imbalance between nNo and the Rho-kinase pathways.

We investigated whether the effect of Y‐27632 to improve the erectile function in SD rats was associated with the degree of the imbalance between nNOS and the Rho‐kinase pathways. Western blot analysis was used to evaluate nNOS and Rho‐kinase protein expression in 10 young and 10 old SD rats. Imbalance value between nNOS and Rho‐kinase protein levels was obtained by subtracting nNOS from Rho‐kinase. A 5‐V stimulus was given in SD rats before and after the administration of 200 nmol kg−1 of Y‐27632 intracavernosally and ICP/MAP was recorded. The improvement of erectile function induced by Y‐27632 was expressed as the margin of ICP/MAP after and before the administration of Y‐27632. In young rat group, the contents of nNOS and Rho‐kinase protein were 1.7 ± 0.15 and 1.8 ± 0.14 respectively. In old rat group, the nNOS protein decreased to 1 ± 0.15, and in contrast, the Rho‐kinase protein increased to 2.6 ± 0.2. The imbalance value between nNOS and Rho‐kinase was 0.2986 ± 0.1109 and 1.5961 ± 0.1206 in young and old rat groups. The improvement of erectile function induced by Y‐27632 was 0.0500 ± 0.0294 and 0.3420 ± 0.660 in young and old rat groups. In all rats, the correlation coefficient between the imbalance value of nNOS and Rho‐kinase and the improvement of erectile function was 0.649, P < 0.01. In conclusion, this study suggested that impaired erectile function with ageing in SD rats be associated with the imbalance between nNO and Rho‐kinase activity and Y‐27632 could improve the erectile function in old SD rats through adjusting this imbalance.

E-Cadherin Tissue Expression and Urinary Soluble Forms of E-Cadherin in Patients with Bladder Transitional Cell Carcinoma

Objective: To investigate the clinical significance of E-cadherin (E-CD) expression in human bladder transitional cell carcinoma (TCC) tissue and soluble forms of E-cadherin (sE-CD) in the urine of patients with TCC. Materials and Methods: One hundred and two specimens of bladder TCC and 10 normal bladder tissues were stained immunohistochemically with anti-E-CD monoclonal antibody. The urinary sE-CD from 59 subjects with TCC or controls was measured with enzyme-linked immunosorbent assay (ELISA). All results were analyzed statistically between groups. Results: The expression of E-CD in bladder TCC correlated well with grade and stage but had no significant correlation with the size or number of the tumors. Normal expression rate of E-CD is significantly higher in primary than in recurrent tumors. The level of urinary sE-CD was higher in patients with TCC than in normal controls or patients with benign disorders of the urinary system. Urinary sE-CD levels were strongly correlated with tumor grade but showed no significant correlation with the stage, size and number of the tumors. The urinary sE-CD level is significantly higher in the recurrent group than in the primary group. Conclusions: Expression of E-CD in the tissue of TCC and the urinary level of sE-CD are very closely associated with the biological behaviors of bladder TCC.

Alterations of Urine TGF-β1 and bFGF following Bladder Outlet Obstruction: A Predictor for Detrusor Contractibility?

Objectives: To investigate the alterations of urine transforming growth factor-β1 (TGF-β1) and basic fibroblast growth factor (bFGF) following bladder outlet obstruction (BOO) in rats and to determine their correlation with the impaired detrusor contractibility. Methods: Wistar rats were divided into control, 2-week BOO 6-week and BOO groups. Impaired detrusor contractibility was quantified by measuring detrusor contraction force (DCF) of detrusor strip stimulated by carbachol. The enzyme-linked immunosorbent assay method was used to determine the urine levels of the 2 factors. Correlation analysis was conducted between DCF and urine levels of the 2 factors to see if there was an association between them after BOO. Results: DCF was found to be significantly lower in the 6-week BOO group than in the 2-week BOO and control groups. There is no significant difference regarding urine TGF-β1 between the 2-week BOO and control groups (p > 0.05). Urine TGF-β1 level in the 6-week BOO group was significantly higher than in the 2-week BOO (p < 0.05) and control groups (p < 0.05). There existed a negative correlation between DCF and urine TGF-β1 (p < 0.05). Conclusions: In an animal model, our results have suggested the potential role of urine TGF-β1 as a noninvasive biomarker to predict detrusor contractibility after BOO.

Are TGF-β1 and bFGF Correlated with Bladder Underactivity Induced by Bladder Outlet Obstruction?

Background: Transforming growth factor-β1 (TGF-β1) and basic fibroblast growth factor (bFGF) are the two most important growth factors that have been found. Previous studies have indicated that the above two factors play an important role in the physiological growth, response to injury and the following fibrous proliferation of the bladder. Therefore, they may be related to the detrusor underactivity due to bladder outlet obstruction (BOO). The aim of this study is to investigate the relationship between them. Materials and Methods: 29 evaluable Wistar rats were divided into three groups: control group, BOO 2 weeks group and BOO 6 weeks group. After successful models, we measured excised bladder mass, detrusor contraction force (DCF) in vitro stimulated by carbachol of four different concentrations (10–5, 10–4, 10–3 and 10–2 mM). Simultaneously, the expression of TGF-β1 mRNA and bFGF mRNA in detrusor specimens was detected by reverse transcription polymerase chain reaction (RT-PCR) analysis. Additionally, we analyzed the correlation between DCF and the detrusor mRNA expression of the two factors to determine whether they are associated with the detrusor contraction response when BOO occurs. Results: Bladder mass increased steadily and significantly with the progression of the BOO. While at the point of 10–4 and 10–3 mM carbachol concentration, DCF in the BOO 2 weeks group was higher, no significant differences were found at the point of 10–5 and 10–2 mM carbachol concentration when compared to the control group. DCF was found to be significantly lower in the BOO 6 weeks group than in the BOO 2 weeks group and control group at all points of carbachol concentration. TGF-β1 mRNA expression of the detrusor was found to be higher only in BOO 6 weeks. However, there was a steady and significant increase of bFGF mRNA expression with the aggravation of BOO. Correlation analysis demonstrated that there was a significant moderate negative correlation between DCF in vitro and the level of TGF-β1 mRNA. Meanwhile, a significant high negative correlation was acquired between the DCF and bFGF mRNA level. Conclusion: DCF in the severe BOO group is remarkably impaired. There is a sustained rise of bFGF mRNA expression in detrusor with the progression of BOO, but TGF-β1 mRNA expression increase becomes evident only in the decompensation stage. Significant negative correlations are found between DCF in vivo and the expression of TGF-β1 mRNA, bFGF mRNA. Additionally, DCF correlates negatively with the bladder mass statistically after BOO.

A logistic regression model for predicting malignant pheochromocytomas

It is well known that no single histological feature is diagnostic for malignant pheochromocytomas (PCCs). So we developed a logistic model based on a series of clinical and pathological features to predict malignance in PCCs, and evaluated its diagnostic performance. In all 130 cases with malignant or benign PCCs, 15 predictive variables were observed and entered in the logistic regression analysis in a backward stepwise way. The diagnostic performance of this logistic model was evaluated by calculating the area under the receiver operating characteristic (ROC) curve. In logistic analysis, of the 15 variables entered in the logistic regression analysis, 9 were retained in the model. High cellularity had the highest odds ratio (OR), followed by spindle cell (>10% of tumor volume), atypical mitotic figure, periadrenal adipose tissue invasion, mitotic figures [>3/10 high-power field (HPF)], cellular monotony, capsular invasion, vascular invasion, and central or confluent tumor necrosis. High cellularity, spindle cell (>10% of tumor volume) and atypical mitotic figure were selected to built a logistic model. This model had the area under the ROC curve of 0.927 (95% confidence interval 0.883–0.971). The application of the model can benefit the clinical management decision for patients with PCCs. We still emphasize, however, that a clinical prospective evaluation is needed to confirm its actual value.

Citrate in expressed prostatic secretions has the feasibility to be used as a useful indicator for the diagnosis of category IIIB prostatitis.

Introduction: Normal human prostatic secretion is remarkably rich in citrate (EPS-citrate). Prostate inflammation will result in reduction of EPS-citrate level. So EPS-citrate was determined to investigate whether EPS-citrate level was also decreased in category IIIB prostatitis and whether it is feasible for EPS-citrate to be used as a diagnostic marker for category IIIB prostatitis. Materials and Methods: 21 category II outpatients, 25 category IIIA outpatients, 25 category IIIB outpatients and 21 normal controls without any prostatic diseases were included. All category II, IIIA and IIIB outpatients had not received any management. The EPS-citrate was determined by high-performance liquid chromatography. Results: The mean EPS-citrate values were 3.32 ± 0.79, 3.41 ± 0.88, 4.37 ± 0.77 and 8.55 ± 1.20 mg/ml in groups II, IIIA, IIIB and normal controls, respectively. Compared to normal controls, the EPS-citrate levels were significantly decreased in category II, IIIA and IIIB patients. Furthermore, there was no overlap of EPS-citrate values between category IIIA and IIIB patients and the normal control group. Conclusions: The EPS-citrate level is decreased in category IIIB prostatitis and it is feasible for EPS-citrate to be used as a useful diagnostic indicator for category IIIB prostatitis.

Clinical Significance of Urodynamic Analysis in Patients with Benign Prostatic Enlargement Complicated with Diabetes Mellitus

Aim: To compare the bladder dysfunction associated with benign prostatic enlargement (BPE) in patients with and without diabetes mellitus (DM) by urodynamic study. Materials and Methods: The records of 166 first-visit BPE patients were reviewed. Patients were divided into two groups: concomitant group (CG) – 74 patients with BPE complicated with DM, and single group (SG) – 92 isolated BPE patients. Urodynamic findings of the two groups were analyzed. Results: In the clinical data, increased postvoiding residual urine volume (PVR) appeared more often in CG (p < 0.05). In the urodynamic findings, significantly higher maximum cystometric capacity (MCC), incidence of impaired bladder sensation, bladder compliance and detrusor overactivity existed in CG (p < 0.05). In addition, the maximum detrusor pressure during voiding (Pdetmax) and the incidence of bladder outlet obstruction (BOO) were significantly higher in SG (p < 0.05). Conclusions: Impaired bladder function is more severe in patients with BPE complicated with DM than those isolated BPE patients. Urodynamic study can provide objective data on diagnosis of voiding dysfunction in BPE patients with and without DM, and it is helpful for doctors to choose better clinical intervention.

Aggressive fibromatosis in the urological system - Report of two adult patients and review of the literature

Aggressive fibromatoses (AF) are locally aggressive neoplasms that do not metastasize but are frequently associated with one or more recurrences and subsequent associated morbidity. AF in the urological system is quite rare and has mainly been described in single case reports or as isolated cases in a large series of extra-abdominal desmoid tumors. We report 2 cases of AF in the bladder and scrotum, and provide a review of similar published cases.