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ABSTRACT: Objective: The purpose of this study was to evaluate the impact of hypokalemia on hypertension outcomes in patients with aldosterone-producing adenoma (APA) after adrenalectomy and to determine the factors affecting complete hypertension cure in a large series. Methods: Characteristics from 376 APA patients treated with adrenalectomy between 2005 and 2011 were collected from our center. Factors affecting complete hypertension cure were assessed using logistic regression. Results: At the end of follow-up, 207 (55.05%) patients were completely cured, whereas 138 (36.7%) patients were improved, and 31 (8.3%) patients remain refractory. Age (p = 0.028), >2 antihypertensive agents (p < 0.001), duration of hypertension (p < 0.001), duration of hypokalemia (p = 0.037), systolic blood pressure (p = 0.016), and level of plasma aldosterone (p < 0.001) were associated with hypertension outcomes in univariate analysis. However, multivariate logistic regression analysis showed that only duration of hypertension ≥6 years (OR = 0.496, 95% CI 0.323-0.762, p = 0.001) and level of plasma aldosterone ≥35 ng/dl (OR = 0.503, 95% CI 0.326-0.776, p = 0.002) were the significantly independent factors affecting complete hypertension cure. Conclusions: This is the largest series to show that only duration of hypertension and level of plasma aldosterone were the factors affecting complete hypertension cure after adrenalectomy for APA. This study highlights the importance of early diagnosis and early adrenalectomy.
Urologia Internationalis 03/2013; · 0.99 Impact Factor
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ABSTRACT: Increasing evidence suggests that diabetes mellitus (DM) may be associated with an increased risk of bladder cancer. To provide a quantitative assessment of this association, we evaluated the relation between DM and incidence and mortality of bladder cancer in an updated meta-analysis of cohort studies. Methods We identified cohort studies by searching the EMBASE and MEDLINE databases, through 31 March 2012. Summary relative risks (RRs) with 95% confidence intervals (CIs) were calculated with random-effects models.
A total of 29 cohort studies (27 articles) were included in this meta-analysis. DM was associated with an increased incidence of bladder cancer (RR 1.29, 95% CI: 1.08-1.54), with significant evidence of heterogeneity among these studies (p<0.001, I(2) = 94.9%). In stratified analysis, the RRs of bladder cancer were 1.36 (1.05-1.77) for diabetic men and 1.28 (0.75-2.19) for diabetic women, respectively. DM was also positively associated with bladder cancer mortality (RR 1.33, 95% CI: 1.14-1.55), with evident heterogeneity between studies (p = 0.002, I(2) = 63.3%). The positive association was observed for both men (RR 1.54, 95% CI: 1.30-1.82) and women (RR 1.50, 95% CI: 1.05-2.14).
These findings suggest that compared to non-diabetic individuals, diabetic individuals have an increased incidence and mortality of bladder cancer.
PLoS ONE 01/2013; 8(2):e56662. · 4.09 Impact Factor
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ABSTRACT: Abstract Objective: The purpose of this study was to compare the safety and efficacy of the thulium laser vaporesection and transurethral electrovaporization of the prostate for the treatment of high-risk patients with benign prostatic hyperplasia. Background data: From September 2009 to March 2011, 98 consecutive patients with symptomatic bladder outlet obstruction caused by benign prostatic hyperplasia received either thulium laser vaporesection of the prostate (n=42) or transurethral electrovaporization of the prostate (n=56) at our institution. Materials and methods: Functional follow-up included measurement of International Prostate Symptom Score, quality of life score, maximal urinary flow rate, and post-voiding residual urine volume. All complications were recorded. Results: Thulium laser vaporesection of the prostate was slightly superior to transurethral electrovaporization of the prostate in catheterization time (2.1±0.9 vs. 4.5±1.3 days, p<0.0001) and postoperative hospital stay (4.4±1.8 vs. 6.6±2.0 days, p<0.0001). Within the observation period, both groups had a significant improvement from baseline in subjective or objective success rates; however, no significant difference was found between the two groups. Peri- and postoperative complications were fewer in the thulium laser group. Conclusions: Thulium laser vaporesection of the prostate is as effective as transurethral electrovaporization of the prostate in managing high-risk patients, with sufficient tissue ablation and acceptable hemostasis, and has the advantage of less morbidity and shorter catheter time and postoperative hospital stay.
Photomedicine and laser surgery 10/2012; · 1.76 Impact Factor
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ABSTRACT: OBJECTIVE: We report on the functional outcomes and complications of the modified U-shaped ileal neobladder as a new technique following radical cystectomy. MATERIALS AND METHODS: Between January 2005 and March 2010, 56 patients (36 men and 20 women, mean age 62.3 years) with invasive bladder cancer were considered good candidates for orthotopic urinary diversion. All had radical cystectomy with bilateral pelvic lymphadenectomy and orthotopic bladder substitution by a modified U-shaped ileal neobladder reservoir. Of the patients, 49 (87.5%) had transitional cell carcinoma; 7 had squamous cell carcinoma. None of the patients had positive lymph nodes after pathologic examination of the specimen. Functional outcomes and complications were all recorded in detail. RESULTS: During the mean (range) follow-up of 26.3 (14-37) months, there were no deaths related to the procedure. Early complications developed in 15 patients, whereas 7 patients had late complications. Hyperchloremic metabolic acidosis occurred in 2 patients, but neither of them developed hypovitaminosis of B12. None of the patients had local and/or distant recurrences. The daytime continence rate was 96% and the nocturnal continence rate was 76%. The mean (SD, range) neobladder capacity and residual urine volume was 340.9 (240-450) and 22.7 (13-36) ml, respectively. The mean (SD, range) voided volume and maximum flow rate were 317.9 (226-431) and 16.2 (12.2-21.2) ml/s, respectively. Furthermore, there were no significant differences in any variables assessed in this study between men and women patients. CONCLUSIONS: The modified U-shaped ileal neobladder provides satisfactory functional outcomes and acceptable complication rate. It is considered a safe and technically feasible surgical procedure.
Urologic Oncology 06/2012; · 3.22 Impact Factor
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ABSTRACT: Emerging studies suggest a possible increased risk of bladder cancer with pioglitazone therapy. We therefore pooled data available to examine the association between pioglitazone therapy and bladder cancer in patients with diabetes.
We searched Medline and Embase to identify studies that reported the effect of pioglitazone on bladder cancer among diabetic patients. Summary effect estimates were derived using a fixed-effects meta-analysis model.
Five studies included 2,350,908 diabetic patients. Pioglitazone was associated with a significantly higher risk of bladder cancer (relative risk [RR] 1.17, 95% confidence interval (CI) 1.03-1.32, P=0.013). No relation between pioglitazone and bladder cancer was found for duration of therapy <12months and cumulative dose <28,000mg. The RR for bladder cancer in subjects with 12-24months of pioglitazone use was 1.34 (95% CI 1.08-1.66, P=0.008). The effect was even stronger for cumulative treatment duration >24months (RR 1.38, 95% CI 1.12-1.70, P=0.003). There was a significant risk for patients with cumulative dose >28,000mg (RR 1.58, 95% CI 1.12-2.06, P=0.001).
Pioglitazone treatment appears to be associated with a significantly increased risk of bladder cancer in patients with diabetes.
Diabetes research and clinical practice 06/2012; 98(1):159-63. · 2.16 Impact Factor
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ABSTRACT: PURPOSE: To demonstrate the relationships among tumour location, hydronephrosis, and tumour stage in patients with Upper Urinary Tract Urothelial Carcinoma (UUT-UC). Moreover, we want to determine whether primary tumour location is an independent predictor of prognosis in those patients. METHODS: Retrospective analysis of 251 UUT-UC patients from our centre treated with radical nephroureterectomy between 2000 and 2010. Patients who had previous radical cystectomy, preoperative chemotherapy, previous contralateral UUT-UC, multifocal tumours, or metastatic disease at presentation were excluded. Overall, 217 patients were then available for evaluation. The relationships among tumour location, hydronephrosis, and tumour stage were analysed. Tumour location was categorized as renal pelvis or ureter. Progression-free survival (PFS) and cancer-specific survival (CSS) probabilities were estimated using Kaplan-Meier and Cox regression analyses. RESULTS: Tumour location was renal pelvis in 146 cases (67 %), ureter in 71 cases (33 %). Median follow-up was 52 months. Compared with renal pelvic tumours, ureteral tumours were more likely to have hydronephrosis and to be associated with advanced stages (p < 0.001), but less likely to have haematuria. The 5-year CSS estimate was 79.3 % for renal pelvic tumours and 64.7 % for ureteral tumours (p = 0.03). The 5-year PFS probability was 68.7 % for renal pelvic tumours and 54.2 % for ureteral tumours (p = 0.02). On univariable and multivariable analysis, tumour location was an independent prognostic factor for CSS (p < 0.05). CONCLUSIONS: Ureteral tumours were associated with a worse prognosis than renal pelvis tumours. The possible hypothesis may be due partially to that ureteral tumours are more likely to have hydronephrosis and less likely to have haematuria.
World Journal of Urology 05/2012; · 2.41 Impact Factor
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ABSTRACT: The treatment of advanced urothelial cancer of the bladder has evolved substantially during recent years. Chemotherapy has been the mainstay of treatment and confers survival advantage. Despite such advances, the chemotherapy of bladder cancer is far from satisfactory due to severe side effects. Targeted therapy with novel drugs directed at specific molecular pathways opens promising new avenues to improve patient outcome. A systematic review examined the clinical data for novel targeted agents in 10 phase Ⅱ trials, with a focus on bevacizumab, aflibercept, sunitinib, sorafenib, gefitinib, lapatinib and trastuzumab. Besides, we present studies on other novel, promising targeted agents, including pazopanib, cetuximab and everolimus. Although bevacizumab and trastuzumab have shown promising results for patients with advanced bladder cancer, other targeted agents have not achieved the same clinical benefit in this disease as seen in other common epithelial cancers. Ultimately, combination targeted therapy, sequential therapy, adjuvant and neoadjuvant therapy may yield the best outcomes.
Anti-cancer agents in medicinal chemistry 05/2012;
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ABSTRACT: While more and more physicians are choosing chemotherapy for patients with bladder cancer, the current treatment is still far from satisfactory due to low response rate and severe side effects. Emerging evidence indicates that inflammatory microenvironment is involved in the pathogenesis of bladder cancer. Recent studies have also provided ample evidence that chemotherapy response is influenced by activation of major inflammatory mediators, including transcription factors, cytokines, chemokines, and COX-2. We reviewed all published literature addressing the roles of inflammatory microenvironment in bladder cancer and evaluating emerging evidence that inflammatory pathways represent potential therapeutic targets to enhance chemotherapy of bladder cancer.
Mediators of Inflammation 01/2012; 2012:528690. · 3.26 Impact Factor
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ABSTRACT: Epidemiological and experimental evidence has emerged that a dysregulated inflammation is associated with most of the tumors. Recent studies have begun to unravel molecular pathways linking inflammation and cancer. The identification of transcription factors such as NF-kappaB, STAT3, HIF-1 alpha and their gene products such as COX-2, cytokines, chemokines and chemokine receptors have laid molecular foundation for the decisive role of inflammation in carcinogenesis. Inflammation contributes to survival and proliferation of malignant cells, tumor angiogenesis, metastasis and reduced response to chemotherapy. In view of their involvement at different stages of tumor development, inflammatory pathways represent attractive targets for cancer prevention and therapy. However, advances in this field have not been fully realized, and challenge remains to obtain clinical data from patients and then to utilize this information for optimal and personalized therapy. We present evidence that targeting inflammatory pathways have a potential role to improve chemotherapy of cancer.
Cancer biology & therapy 08/2011; 12(2):95-105. · 2.64 Impact Factor
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ABSTRACT: What’s known on the subject? and What does the study add? Experimental data have shown that VDR overexpression in the duodenum and kidney cortex is a biological characteristic of genetic hypercalciuric stone-forming rats (GHS rat), and a link between idiopathic calcium stone formation and the microstatellite marker D12S339 (near the VDR locus) has been proven in humans. Our study shows that VDR can positively regulate the mRNA and protein expression of TRPV5, calbindin-D28k and PMCA1b in NRK cell lines. VDR knockdown results in a decrease in intracellular Ca²⁺ concentration in NRK cell lines. The effect of the elevated VDR level in the kidney on hypercalciuria and the underlying mechanisms need to be further addressed.
• To determine the effects of vitamin D receptor (VDR) on hypercalciuria and the mechanisms underlying such effects.
• The adenovirus vector-delivered microRNA targeting rat VDR was constructed. We infected the normal rat kidney epithelial cell line NRK (Cellbank, China) with the adenovirus and then collected the cells at 0, 48, 72, 96, 120 h after infection. The mRNA and protein levels of VDR and VDR-dependent epithelial Ca2+ transport proteins were detected using real-time polymerase chain reaction and Western blot assays, respectively. • Fluorescent Ca²⁺ indicator Fluo-4 NW (Fluo-4 NW calcium assay kit, Molecular Probes, Invitrogen, USA) and laser scanning confocal microscope (Olympus, FV500-IX71, Japan) were used to detect the cytosolic free Ca²⁺ concentration at different time points after infection.
• The mRNA and protein level of VDR, transient receptor potential vanilloid receptor subtype 5 (TRPV5), calbindin-D28k and plasma membrane Ca²⁺-ATPase (PMCA1b) in infected NRK cells was significantly lower at 72 and 96 h after infection than that in control cells. • There was no significant difference between the two groups in the mRNA and protein level of TRPV6 and the Na⁺/Ca²⁺-exchanger (NCX1). • Furthermore, VDR knockdown results in a decrease in intracellular Ca²⁺ concentration ([Ca²⁺]i) in NRK cell lines.
• Our study shows that VDR can positively regulate the mRNA and protein expression of TRPV5, calbindin-D28k and PMCA1b, but not of TRPV6 or NCX1, in NRK cell lines. VDR knockdown results in a decrease in [Ca²⁺]i in NRK cell lines. • The effect of the elevated VDR level in the kidney on hypercalciuria and the mechanisms underlying need to be further addressed.
BJU International 04/2011; 107(8):1314-9. · 2.84 Impact Factor
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ABSTRACT: To investigate the prognostic factors associated with the treatment efficacy of minimally invasive percutaneous nephrolithotomy (MPCNL) and develop a preoperative logistic regression model for predicting the stone-free rate after the initial procedure.
We retrospectively analyzed the records of 865 patients who had undergone MPCNL in our department from January 2006 to September 2009. Patient age, sex, body mass index, degree of hydronephrosis, and stone side, number, size, and location were the investigated variables. According to the treatment outcome, the patients were divided into 2 groups, those who became stone free and those who did not. Student's t test, chi-square test, and multiple logistic regression analysis were performed to determine the statistically significant variables and to develop a predictive mathematical model.
The stone-free rate after primary MPCNL was 80.1% (693 of 865). On univariate analysis, the stone number, size, and location and degree of hydronephrosis were identified as significant factors between the 2 groups. On multivariate analysis, they were also independent predictors of the surgical outcome. Next, a logistic regression model was developed using these variables to estimate the stone-free rate after MPCNL.
The results of our study have demonstrated that an increased stone number and size, location in a calix, staghorn calculus, and moderate to severe hydronephrosis were associated with decreased stone-free rates after MPCNL. We have developed a mathematical model for predicting the stone-free rate that will be helpful for patient counseling and surgeon decision-making regarding the management of upper urinary tract calculi.
Urology 02/2011; 78(1):32-6. · 2.43 Impact Factor
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ABSTRACT: We compared the efficacy and safety of percutaneous nephrolithotomy (PCNL) with different intracorporeal lithotriptors for proximal ureteral stones in patients with severe hydronephrosis.
We retrospectively analyzed the records of 192 patients with proximal ureteral calculi and severe hydronephrosis who underwent PCNL between February 2003 and December 2007. Calculi were fragmented with a pneumatic lithotriptor in 44 patients (group 1), Swiss Lithoclast Master in 54 (group 2), low-power holmium:yttrium-aluminum-garnet (YAG) laser in 56 (group 3) and high-power holmium:YAG laser in 38 (group 4). Patients were assessed about 12 months postoperatively with intravenous urography and ultrasonography for late complications. Stone size, operative time, stone-free rate, and follow-up were analyzed in each group.
Mean stone size for different groups were 16.2 +/- 2.8 mm, 16.6 +/- 2.1 mm, 16.0 +/- 2.7 mm, and 16.4 +/- 1.1 mm, respectively. Average operative time for different groups were 118 +/- 17 minutes, 81 +/- 10 minutes, 85 +/- 14 minutes, 110 +/- 16 minutes, respectively. Group 2 and group 3 showed superior outcomes of shorter operative time (P = 0.000). The overall stone-free rate was 86.5%. As stratified by lithotriptors, the stone-free rate was 81.8% in group 1, 92.9% in group 2, 88.9% in group 3, and 78.9% in group 4 (P = 0.190). No significant difference was found among the groups in terms of blood loss and postoperative hospital stay. Repeated PCNL or shockwave lithotripsy was necessary as an auxiliary procedure in 26 patients. The overall complication rate was 18.2%; most complications were minor and insignificant. During the follow-up, ureteral stricture developed in 10 patients and new renal stones developed in 4 patients.
PCNL combined with Swiss Lithoclast Master or low-power holmium:YAG laser is the preferred endourologic modality for the management of proximal ureteral calculi in patients with severe hydronephrosis.
Journal of endourology / Endourological Society 02/2010; 24(2):201-5. · 1.75 Impact Factor
