Extracorporeal shock wave treatment for non-inflammatory chronic pelvic pain syndrome： a prospective, randomized and sham-controlled study

Background Chronic prostatitis/chronic pelvic pain syndrome （CP/CPPS） is a clinical syndrome characterized by pain in the perineum,pelvis,suprapubic area,or external genitalia and variable degrees of voiding and ejaculatory disturbance.The analgesic effect of extracorporeal shock wave treatment （ESWT） was an interesting phenomenon with an unclear mechanism discovered by chance in the applications for urolithiasis,on which ESWT has become an increasingly popular therapeutic approach as an alternative option for the treatment of a number of soft tissue complaints.In this study,we aimed to evaluate the feasibility and efficacy of ESWT in non-inflammatory （ⅢB） CP/CPPS.Methods Men diagnosed with ⅢB CP/CPPS were randomized to either ESWT （group 1,n=40） or the control （group 2,n=40）.Group 1 received 20 000 shock wave impulses in 10 sessions over a two-week period,whereas group 2 received only a sham procedure.The total scores and sub-domain scores of the National Institutes of Health Chronic Prostatitis Symptom Index （NIH-CPSI） for both groups were assessed at baseline,mid-treatment,end-point,and 4-week and 12-week follow-up visits.Results The mean total NIH-CPSI score of group 1 was significantly decreased from baseline at all post-treatment time points （P 〈0.01 for all）.Decreases in pain domain and quality of life （QOL） scores were also significant.In group 2,no significant decreases of total NIH-CPSI score and pain domain score were found at all post-treatment time points.At the end-point of treatment,71.1% of group 1 exhibited perceptible improvement in total NIH-CPSI compared with 27.0% of group 2 （P 〈0.001）; additionally,28.9% of group 1 exhibited clinically significant improvement compared with 10.8% of group 2 （P 〈0.01）.Moreover,a greater number of patients in group 1 at 4-week and 12-week follow-up were rated as responders （perceptible and clinically significant response） compared with group 2.Conclusion ESWT exhibits a potentially therapeutic role in the treatment of CP/CPPS.

Does urothelial cancer of bladder behave differently in young patients？

Background Bladder urothelial cancer has been diagnosed at an increasing rate among young adults in China while the clinical outcomes remain highly controversial. To optimize the management of young patients with bladder cancer, we examined whether bladder urothelial cancer in young patients behaved differently from that in the elder patients. Methods From 1994 to 2008, a database of bladder urothelial cancer patients at a major tertiary medical center was retrospectively reviewed. The clinical and pathological parameters of patients who were less than 40 years of age and a series of patients older than 40 years of age as the control group during the same period were compared. A survival analysis was performed using the Kaptan-Meier method and log-rank test, and Cox regression was performed to identify clinical parameters that affected the clinic outcomes. Results Young bladder cancer patients had a lower male-to-female ratio and were less likely to have advanced stages and high-grade cancers at the initial diagnosis. Tumors in young bladder cancer patients tended to be less multifocal at diagnosis. In addition, young patients had a lower recurrence rate and longer recurrence interval than older patients. The Kaplan-Meier curve and Log-rank test showed that young patients had significantly better cancer specific survival than old patients. The univariate and multivariate Cox regression analysis revealed that tumor grade is the sole predictor for tumor recurrence in young patients. Conclusions Young patients with bladder cancer have favorable pathological features and clinical outcomes than older patients. These findinqs ar.que for more conservative management approaches for young patients with bladder cancer.

Medical expulsion therapy for urinary calculi

C urrently, the predominant therapy for urinary calculi is minimally invasive treatment, which could reduce injury to patients while enhancing the success rate, compared to traditional open surgery. Minimally invasive treatments in urinary system include extracorporeal shock wave lithotripsy （ESWL）, percutaneous nephro- stolithotomy （PCNL）, ureteroscopic lithotripsy （URSL）, laparoscopy, and so on. Despite the relative small injury,

Screening of differentially expressed genes in the jejunum of rats with idiopathic hyperoxaluria

Background Idiopathic hyperoxaluria （IH） may be caused by increased endogenous formation or exogenous absorption of oxalic acid.Characterization of the molecular pathogenesis of IH has been hampered by the lack of an ideal animal model.We therefore established a stabile rat IH model in order to analyze variation in gene expression profile in the jejunum and to investigate the association between IH pathogenesis and exogenous absorption of oxalic acid.Methods A rat model of IH was established and three female rats with IH were assigned to the study group,while three normal rats served as controls.Total RNA was isolated from the jejunum of rats in the two groups and mRNA was purified,reversely transcribed,labeled with Cy5 or Cy3 and hybridized to 27K Rat Genome Array.Differences in gene expression profile between the 2 groups were analyzed by bioinformatics methods.Results Comparative analysis revealed that the expression of 517 genes was up-regulated and that of 203 genes was down-regulated by at least two-fold in the jejunum of rats with idiopathic hyperoxaluria.These genes are related to many functions including cell signal transduction,DNA binding and transcription,ATP binding,ion binding and transport,cell receptors,immunity,cyclins,cytoskeleton structure,and metabolic proteins.Kyoto encyclopedia of genes and genomes （KEGG） signaling pathway analysis revealed that the variations of 239 pathway functional changes are statistically significant （P 〈0.05）.Conclusions cDNA microarray can be used effectively to screen differentially expressed genes in the jejunum of rats with idiopathic hyperoxaluria. These differentially expressed genes may underlie idiopathic hyperoxaluria pathophysiology and provide a platform for further studying molecular pathogenetic mechanisms.

Natural history of benign prostate hyperplasia

Background Benign prostate hyperplasia is one of the most common diseases affecting the health of the aging males. Watchful waiting is an acceptable management strategy for benign prostate hyperplasia in which the patient is monitored by the physician but receives no active intervention. The epidemiological data on this are lacking in China. Our study was designed to evaluate the changes of signs and symptoms of patients with benign prostate hyperplasia during management by watchful waiting in China. Methods One hundred and forty-five patients with benign prostate hyperplasia aged 〉 50 years were enrolled in management by watchful waiting. All the patients were visited every 6 months and were given an International Prostate Symptom Score and Quality of Life questionnaire to complete. They also had uroflowmetry and were assessed using ultrasonography to get the volume of prostate, transition zone and amount of residual urine. The Student＇s t test, the Chi-square test, and variance analysis were used in the statistical analysis. Results All patients were visited after 6 months, the mean volume of transitional zone was found to have increased by 1.6 ml （P〈0.01）, International Prostate Symptom Score was increased by 0.8 （P〈0.01） and Quality of Life was increased by 0.2 （P〈0.01）, and there was no statistical change in other data. Among these patients, 17.9% （26/145） visited again after 12 months when the data failed to show a statistically significant difference among the three groups （0, 6, and 12 months）. Conclusions After one year＇s follow-up, the progression of benign prostate hyperplasia was slow and the clinical data did not undergo much change.