Update summarising the conclusions of the international consultation on male lower urinary tract symptoms

The International Consultation on Urological Disease have recently published comprehensive conclusions, based on evidence reviewed by eight committees, on aspects of male lower urinary tract symptoms(LUTS). In this review, we summarise the conclusions from fourof the committees, namely, the evidence regarding the epidemiology of male LUTS, patient assessment, nocturia and medical management. It is indisputable that with an expanding and ageing global population the prevalence of male LUTS is likely to increase. Therefore symptom prevention and preservation of quality of life(Qo L) feature highly in the guidelines. There are now a number of different medical options, proven to lead to significant improvements in symptom scores, flow rate and Qo L available to men with LUTS. Metaanalyses have shown the benefits for alpha blockers, antimuscarinics, 5-α reductase and phosphodiesterase-5 inhibitors. High level evidence also exists for combinations of all of the above with alpha blockers and so men with concomitant storage symptoms, prostate volume > 30 mL, PSA > 1.4 or erectile dysfunction may be considered for combination treatment of an alpha blocker with an antimuscarinic, 5-α reductase inhibitor or phosphodiesterase-5 inhibitor respectively. In an era of personalised medicine, appropriate patient selection is likely to provide the key to the most effective clinical management strategy.

Expression change of nuclear receptor corepressor (NCoR) in androgen independence prostate cancer and its clinical significance

Objective：To explore the expression of nuclear receptor corepressor （NCoR） in androgen independence prostate cancer （AIPC） and its clinical significance. Methods：The expression of NCoR and androgen receptor （AR） in prostatie tissues, from 15 cases with AIPC, 20 cases with androgen dependence prostate cancer （ADPC） and 20 cases with benign prostatic hyperplasia （BPH）, was detected by immunohistoehemistry respectively. Results：The expression of NCoR was observed mainly in the nucleus and slightly in the nucleus. The positive cell percentage of NCoR in AIPC was significantly lower than that in ADPC and BPH （P〈0. 01）. The NCoR expression was significantly lower in low differentiation prostate cancer （Pca） than that in high differentiation Pca （P〈0. 05）. The rate of NCoR expression was significantly higher in low stage Pca than that in high stage Pca （P〈0. 05）. AR, expressing in the nucleus, was found to be negative in one case of AIPC, while was strongly expressed in other cases of AIPC, and all eases of ADPC and BPH. Conclusion： The transition to AIPC of Pea may be correlated with the decrease of NCoR protein.

Tissue engineering in urethral reconstruction--an update

The field of tissue engineering is rapidly progressing. Much work has gone into developing a tissue engineered urethral graft. Current grafts, when long, can create initial donor site morbidity. In this article, we evaluate the progress made in finding a tissue engineered substitute for the human urethra. Researchers have investigated cell-free and cell-seeded grafts. We discuss different approaches to developing these grafts and review their reported successes in human studies. With further work, tissue engineered grafts may facilitate the management of lengthy urethral strictures requiring oral mucosa substitution urethroplasty.

Harnessing macrophages in thermal and non-thermal ablative therapies for urologic cancers-Potential for immunotherapy

Prostate and bladder cancers are one of the cancers occurring worldwide.In addition to radical surgery,the past decade has also focused on targeted therapy of overexpressed cancer proteins that are lethal and critical for cancer cell survival.However,targeted therapy cannot adapt for changing of cancer molecular characteristics and,ultimately,a clone that bypasses the targeted therapy emerges.This can be overcome by immunotherapy.New studies on ablative therapy of cancers show presence of immunomodulatory effect in these modalities.Tumor ablation prime the immune system for further destruction of persistent primary tumor in addition to destruction of concurrent metastatic disease and also reduce recurrence.Ablative therapies can achieve a state of increased antigenicity.Its combination with a novel macrophage targeted therapy may enhance immune priming,trafficking,and/or effector phases;thereby improving clinical outcomes.Tumor associated macrophages or M2 phenotype are now known to mediate this immunosuppressive pro-tumorigenic effect.Alteration of macrophage differentiation may enhance tumor destruction of ablative therapy.This breakthrough in immunotherapy opens up arenas for further robust clinical trials on combinatorial therapies.In the present review,we aim to elucidate the major aspects of immune stimulatory minimal invasive approaches by combining with macrophage directed pathways.

A novel rat model of seminal vesiculitis

We aimed to establish a novel rat model of seminal vesiculitis that would provide an effective approach to investigate the pathogenesis of this disease in the future. Eight male rats received the same operation, during which the root of one of the two seminal vesicles was partly ligatured with sutures and the other vesicle was left in tact. The samples of seminal vesicles were harvested on the 8th day followi ng the operation. Hematoxylin and eosi n and Mass on's trichrome stains were used to observe the histopathology and the presenee of fibrous tissue in seminal vesicles, respectively. Immunoblotting and immunohistochemistry were applied to determine the tumor n ecrosis factor-alpha and cyclooxygenase-2 levels in semi nal vesicle tissues. Real-time fluoresce nee qua ntitative polymerase chain reaction was performed to measure the gene expression levels of proinflammatory cytokines. H2O2 levels in the seminal plasma from the seminal vesicle were also measured. Hematoxylin and eosin staining suggested that there was inflammatory cell in filtration into the semi nal vesicles treated by partial root ligati on. The tumor n ecrosis factor-alpha and cyclooxygenase-2 proteins were significantly upregulated in the treated seminal vesicles. The tumor necrosis factor-alpha, cyclooxygenase, interleukin 6, and inducible nitric oxide synthase mRNA expression levels were also upregulated in the treated seminal vesicles. The H2O2 levels in the seminal plasma from seminal vesicles with partial root ligation were significantly elevated compared with those from vesicle left intact. In conclusion, partially ligating the root of the seminal vesicle via sutures in rats is an effective method to establish a seminal vesiculitis rat model.

The RFA regulatory sequence-binding protein in the promoter of prostate-specific antigen gene

To assure what sequence associated with the androgen regulation, a 15 bp region at the upstream of the ARE of prostate-specific antigen (PSA) promoter, termed RFA, was found in-dispensable for androgen receptor (AR)-mediated transactivation of PSA promoter. In transfection and CAT assays, some nucleotides substitution in RFA could significantly decrease the androgen inducibility for PSA promoter. The in vitro DNA binding assay demonstrated that RFA bound spe-cifically with some non-receptor protein factors in prostate cell nucleus, but the mutant type of RFA lost this ability, so RFA might be a novel accessory cis-element. The RFA-binding proteins were isolated and purified by affinity chromatography using RFA probes. SDS-PAGE and preliminary protein identification showed these proteins possessed sequence high homology with multifunc-tional protein heterogeneous nuclear ribonucleoprotein A1, A2 (hnRNP A1, A2). RFA-binding pro-teins possibly cooperate with AR-mediated transactivation for PSA promoter as coactivator. The study results will facilitate further understanding the mechanism and tissue specificity of PSA pro-moter.

Role of neutrophil-to-lymphocyte and platelet-tolymphocyte ratios in Peyronie’s disease: a new diagnostic approach to predict the stage of the disease?

Neutrophil-to-lymphocyte ratio(NLR)and platelet-to-lymphocyte ratio(PLR)have been associated with multiple entities and several types of cancers.They can be assumed as markers of inflammatory imbalance.The objective of this study is to evaluate the NLR and PLR in Peyronie’s disease(PD)and to establish a comparison of its values in the acute and chronic stages.We recruited patients with PD from March 2018 to March 2019.The patients enrolled underwent medical and sexual history as well as a physical examination.The values of blood count of each patient were collected both in the acute and chronic stages.Wilcoxon test was used to compare the acute and chronic stage ratios.Kruskal-Wallis test was carried out to evaluate the impact of treatments on the ratios.To identify cutoff values,we used sensibility and specificity tables and receiver operating characteristic(ROC)curves.A total of 120 patients were enrolled.Their mean age was 55.85(range:18-77)years and the mean penile curvature was 48.43°(range:10°-100°).In the acute stage,the mean NLR was 2.35 and the mean PLR was 111.22.These ratios,in the chronic stage,were 1.57 and 100.00,respectively.Statistically significant differences between acute and stable stages for both indices were found(NLR:P<0.0001;PLR:P=0.0202).The optimal cutoff for classification in acute or stable stage was 2 for NLR and 102 for PLR.According to our results,with an ordinary blood count,we could have important indications regarding the disease stage of the patient,and consequently on the most appropriate type of therapy to choose.

PSA启动子中RFA调节序列结合蛋白的初步研究

为了确定前列腺特异抗原(PSA)启动子中与雄激素调节相关的序列,发现PSA启动子ARE上游一段15 bp的区域(-396～-382 bp),是雄激素受体(AR)对PSA启动子激活所必需的,将其命名为RFA.转染和CAT分析显示该序列中某些核苷酸置换可显著降低雄激素对PSA基因启动子的诱导活性,体外竞争结合实验证实某些前列腺细胞核内的非受体蛋白因子可与其特异结合,但其突变型则丧失了这种能力,该序列可能是一个新的辅助性顺式元件.以RFA为探针,利用亲和层析分离纯化了RFA结合蛋白,SDS-PAGE和蛋白质初步鉴定结果表明,该蛋白与已知的多功能蛋白hnRNPA1,A2高度同源.RFA结合蛋白可能作为辅激活因子协同AR对PSA启动子的反式激活作用.研究结果有助于深入理解PSA启动子的作用机制和组织特异性.

Retroperitoneoscopic renal pedicle lymphatic disconnection for chyluria

Objective To report our experiences in retroperitonescopic renal pedicle lymphatic stripping for chyluria.Methods Six cases of filarial chyluria were admitted to our hospital from November 2001 to June 2002. Of these cases, 4 were men and 2 women, with age ranging from 34 to 52 years (mean, 42 years) . Diagnosis was made by using urine test for the presence of chyle and fat globule, cystoscopy, excretory urogram and retrograde pyelography. Chyluria was found on the left renal unit in 2 cases and on the right side in 4 cases. The technique of retroperitoneoscopic management of chyluria consisted of nephrolympholysis, hilar vessel stripping and ureterolympholysis.Results Operative time ranged from 69 to 120 minutes (mean, 95 minutes). Intraoperative blood loss was 50 -180 ml (mean, 85 ml). Chyluria disappeared in all patients immediately after operation. Mild hematuria occurred in 4 cases within 12 hours and disappeared at 24 hours. Subcutaneous emphysema around the lesions was found in 2 cases and was spontaneously absorbed 3 days after the treatment. There was no lymphatic leak at the lesions. The patients were discharged from the hospital 5-9 days after the treatment. All patients gained weight and their haemoglobin and serum protein increased by 13. 5 g/L and 3. 66 g/L respectively. No chyluria recurrence was reported during 1-1.6 years follow-up.Conclusions Retroperitoneoscopic renal pedicle lymphatic disconnection for chyluria is a safe, effective and efficient surgical procedure with minimal invasion, less pain, lower morbidity, short hospital stay and rapid recovery.