泌尿男生殖系多原发癌的诊治

目的:提高对同时发生的泌尿男生殖系多原发癌(MPMN)的诊断与治疗水平。方法:回顾性分析20例MPMN患者资料。20例均行手术治疗,其中4例晚期前列腺癌合并浅表性膀胱癌行TURBT+TURP,8例浸润性膀胱癌合并早期前列腺癌行根治性膀胱前列腺全切,4例浸润性膀胱癌合并局部晚期前列腺癌,行膀胱部分切除术+化疗及内分泌治疗。2例肾癌合并晚期前列腺癌均行根治性肾切除+内分泌治疗。1例肾癌伴膀胱癌行肾癌根治+TURBT。1例肾癌合并浸润性膀胱癌行肾癌根治+根治性膀胱全切。结果:病理诊断移行细胞癌18例,前列腺癌18例,肾透明细胞癌3例,乳头状肾癌1例。平均随访36(10～48)个月,12例平均生存23个月,8例无瘤生存。结论:泌尿男生殖系同时性MPMN易漏诊,早发现并采用手术为主的综合治疗可显著提高患者生存期,多瘤共存非预后不良的标志。     

男生殖系肿瘤

我国泌尿男生殖系统肿瘤地发病率中膀胱癌、肾癌、前列腺癌居前三位，阴茎癌的发病率则由建国初期的第二下降到目前的第四位，睾丸肿瘤则仍居第五位。就男生殖系统肿瘤的发病率而言，前三位的排位是前列腺癌、阴茎癌、睾丸肿瘤。现以这三种肿瘤为主，介绍临床科研方面主要进展。前列腺癌前列腺癌发病率已由５０年代的０２／１０万人口升至９０年代的１２～３４／１０万人口，６０年代仅占泌尿男生殖系肿瘤的３３％，７０年代已达６５％，但与欧美国家的１０２／１０万人口发病相比，我国前列腺癌发病率仍然较低，但有逐渐增高趋势…     

DNA甲基化在泌尿系统肿瘤中的研究及应用

肾癌、膀胱癌和前列腺癌是常见的三种泌尿系统恶性肿瘤,其中膀胱癌曾经是最常见的泌尿男生殖系肿瘤,近年来肾癌和前列腺癌的发病率也显著上升.2005年,这3种肿瘤均已列入上海市男性恶性肿瘤发病率前10位.因此,这3种泌尿系统肿瘤的发病机制、诊断及治疗的研究成为泌尿外科的研究热点.     

2012年全国泌尿男生殖系统肿瘤学术会议热点报道

由中国抗癌协会泌尿男生殖系肿瘤专业委员会主办,中华医学会泌尿外科学分会协办,广州军区武汉总医院承办的第七届泌尿男生殖系统肿瘤学术会议于2012年4月6～8日在武汉成功召开。7日下午进行了专家组病例讨论,主要讨论了肌层膀胱癌的治疗、中央型小肾癌治疗的选择、前列腺癌根治手术方式的选择及优势如何?在讨论过程中,专家     

《临床泌尿外科杂志》2001年各期重点

第1期良性前列腺增生第2期泌尿男生殖系肿瘤第3期腔道泌尿外科和内窥镜第4期泌尿系结石的外科治疗第5期泌尿男生殖系结核第6期泌尿系肿瘤 第7期良性前列腺增生第8期肾积水和肾上腺疾病第9期泌尿外科疾病的诊断第10期泌尿外科疾病的治疗第11期肾、输尿管结石第12期新技术、新经验及其他     

“2017山东省泌尿肿瘤高峰论坛暨山东省肾上腺外科数据库联盟成立会议”圆满成功

2017年3月10日-12日"2017山东省泌尿肿瘤高峰论坛(GU-山东,2017)"暨"山东省肾上腺外科数据库联盟成立会议"于山东大厦顺利召开,并取得圆满成功.本次会议内容以泌尿男生殖系肿瘤为主,包括肾上腺肿瘤论坛、肾癌论坛、膀胱癌论坛、前列腺癌论坛等内容,并成立了"山东省肾上腺外科数据库联盟".     

在我国推行前列腺癌规范化治疗的意义

前列腺癌的发病率在美国居男性恶性肿瘤之首（36％），占男性死亡原因的第二位（男性癌症相关死亡率的13％）。虽然其在我国人口中的发病率相对较低，但随着我国经济的不断发展，人民生活水平的不断提高，饮食构成和生活习惯与西方的差别在不断缩小，近年来我国前列腺癌的发病率呈现明显的增高趋势。前列腺癌的发病率和死亡率在我国几大城市中将可能成为男性恶性肿瘤的前三位和泌尿男生殖系肿瘤第一位。     

中国前列腺癌死亡现状及流行趋势分析

目的 探讨我国前列腺癌死亡现状及流行趋势. 方法 收集整理全国肿瘤登记中心1998-2008年登记的前列腺癌数据,包括前列腺癌死亡率、0～ 74岁男性累积死亡率、死亡构成和年龄别死亡率.分城乡统计,分析城市及农村男性的前列腺癌死亡现状和趋势. 结果 2008年,中国男性前列腺癌死亡率为4.07/10万,0～ 74岁前列腺癌累积死亡率为0.18％,占中国男性恶性肿瘤死亡构成的1.78％.城市男性前列腺癌死亡率(4.69/10万)约为农村(1.75/10万)的2.7倍.年龄别死亡率结果显示70岁以上中国男性的前列腺癌居男性泌尿生殖系肿瘤死亡率第1位.1998-2008年中国男性前列腺癌死亡率的年均增长率为8.44％,城市男性前列腺癌死亡率增长幅度高于农村,分别为2.49/10万和0.96/10万,但城市男性前列腺癌死亡年均增长率低于农村男性,分别为7.86％和8.28％.随时间推移,在前列腺癌死亡病例的年龄构成中,高年龄组比重明显上升. 结论 近年来,我国前列腺癌的死亡率呈现持续增长趋势,前列腺癌正成为严重影响我国男性健康的泌尿系恶性肿瘤.     

50年泌尿男生殖系肿瘤发病和构成情况的变迁

的　探讨我国泌尿男生殖系肿瘤 5 0年发病情况的变迁。　方法　以北京大学泌尿外科研究所建所前后 5 0年间各时期泌尿男生殖系各器官肿瘤所占比例的变化为依据 ,对各种肿瘤发病情况进行评估。　结果　 195 1～ 2 0 0 0年间泌尿外科住院病人 2 85 2 1例 ,其中肿瘤 73 3 5例。前后2 5年泌尿男生殖系肿瘤住院病人分别占住院病人的 19.5 %和 2 8.2 %。 80年代后肾肿瘤、前列腺癌所占比例呈直线上升趋势 ,肾肿瘤从 10 .4 %上升至 2 8.7% ,前列腺癌从 3 .3 %上升至 13 .4 %。 (可能和诊断技术进步、人口老龄化和环境变化有关 ,前列腺癌和脂肪摄入量增加关系密切。)肾肿瘤及前列腺癌比例大幅上升。　结论　我国 2 0年的经济发展对泌尿男生殖系肿瘤的构成产生了巨大影响     

前列腺癌诊断和治疗的现状

前列腺癌在欧美国家是常见的恶性肿瘤,占美国男性癌肿的第二位,居癌肿死亡率的第三位。发病率随年龄而增长,40岁以下者罕见,但80岁以上者尸解检出率可高达50%。据国内资料统计,70年代前列腺癌的发病率较60年代增长70%,居泌尿男生殖系恶性肿瘤增长率的首位。随着人类寿命的延长,其发病率势必进一步增加,应给与必要的重视。近年来,国外对前列腺癌的诊断及治疗均有较大进展,现概述如下:     

National burden of disease of urinary organs--an epidemiological consideration

Diseases of urinary organs are quite important from the standpoint of public health as the frequent cause of death, disease, defect, disability, discomfort, dissatisfaction and destitution (7D). From 1979 to 1984, 82,071 persons died from diseases of urinary organs in Japan. Of these 14.4, 11.9 and 8.5% were deaths from cancers of prostate, urinary bladder and kidney, respectively. Mortality from these diseases, is on the increase in recent years. Deaths due to kidney insufficiency, both acute and chronic, are also on the increase. Series of epidemiological studies revealed selected risk factors enhancing the risk of occurrence of each of these diseases, e.g., cigarette smoking and meat intake for bladder cancer, drinking of hard liquor and lesser consumption of green-yellow vegetables for prostatic cancer, lesser consumption of soybean paste soup for chronic nephritis. Obviously these diseases are a heavy burden to the nation, the effective planning and implementation of primary and secondary prevention programs are urgently necessary.     

Urologic cancer mortality in France]

In 1989, 14,150 men died from urological cancer in France: 64% of these deaths were due to prostatic cancer, which represents the second highest cause of male cancer mortality in France. Deaths from urological cancer are mainly observed after 50 years of age, with a frequency which increases very rapidly with age, except for testicular cancer for which one out of every two deaths occurs between 20 and 45 years of age. Between 1968 and 1989, increased mortality was observed in males due to prostate cancer and kidney cancers, whereas a decreased mortality was observed for testicular cancer, especially in males between 20 and 45 years of age. Mortality was stable for bladder cancer and cancer of the penis. In females during the same period, mortality was stable for cancer of the kidney and bladder. During the period 1979 to 1984, a significant increase in mortality due to bladder cancer was observed in certain Northern departments and those surrounding the Mediterranean basin, although the mortality for other cancer sites is generally lower in this latter region. A significant increase in mortality was also observed for cancer of the kidney in Auvergne and in Alsace-Lorraine. Regarding prostatic cancer, geographical variations are minor and no particular region with an increased or decreased mortality could be identified.     

Clinical statistics on inpatients and operations at the Department of Urology, the Center for Adult Diseases, Osaka, 1984-1988

Statistical observation on inpatients and operations at our department between January 1984 and December 1988 revealed the following results: 1) The total number of inpatients was 1962 (male: 1658, female: 304). The most frequent diseases were bladder cancer (30.0%), benign prostatic hypertrophy (19.2%), prostatic cancer (10.6%) and renal cancer (6.7%). 2) The total number of operations was 1699. The most frequent operations were transurethral resection (TUR) of bladder tumor (22.8%), TUR prostate (20.7%), TUR biopsy (6.5%) and total cystectomy (5.4%).     

Hydronephrosis and renal deterioration in the elderly due to abnormalities of the lower urinary tract and ureterovesical junction

The geriatric population presents a unique challenge to the health care provider. The incidence of common lower urinary tract disorders, such as benign prostatic hypertrophy (BPH), prostate cancer and incontinence increase dramatically with aging. In their more severe forms, these disorders may predispose to hydronephrosis and ultimately to renal deterioration. This review of lower urinary tract and ureterovesical junction (UVJ) physiology and pathophysiology, will focus on: (1) anatomic UVJ obstruction from prostate cancer, or severe bladder hypertrophy, (2) functional obstruction from compression or stretching of the UVJ during bladder distention from urinary retention, and (3) bladder decompensation in the female. We will present a diagnostic and treatment algorithm and discuss future trends in the geriatric population. Clearly, the geriatric health care provider always must considerthe lower urinary tract when confronted with acuterenal deterioration, because prompt diagnosis and treatment of significant, lower-urinary-tract disease can maximize recovery of renal function. This revised version was published online in August 2006 with corrections to the Cover Date.     

The induction of new ductal growth in adult prostatic epithelium in response to an embryonic prostatic inductor

Tissue recombinants were prepared with a single epithelial ductal tip from adult prostate and mesenchyme from either the embryonic urogenital sinus or adult urinary bladder. Recombinants were grown in vivo beneath the renal capsule of male hosts. After 4 weeks of in vivo growth, extensive growth of arborizing ducts was apparent in recombinants composed of urogenital sinus mesenchyme and a single adult prostatic ductal tip. One-dimensional polyacrylamide gel electrophoresis indicated that these recombinants contained many of the proteins of the mature prostate. Heterospecific recombinants (rat urogenital sinus mesenchyme and mouse prostatic epithelium) showed the ductal tissue to be derived solely from the prostatic epithelium. In recombinants of a prostatic ductal tip with mesenchyme from the urinary bladder, ductal growth was absent, the ductal tip was maintained as a single, discrete, epithelial structure, and the protein composition of these recombinants more closely resembled that of the bladder. The results demonstrate that the epithelial cells of the adult prostate can participate in new ductal growth in response to an embryonic prostatic inductor. These data provide experimental evidence to support the hypothesis that human benign prostatic hyperplasia may result from the anomalous reactivation of embryonic growth potential in the adult prostate.     

Synchronous triple urogenital cancer (renal cancer,bladder cancer,prostatic cancer): a case report

A case of synchronous triple urogenital cancer, which was comprised of renal cell carcinoma of the left kidney, transitional cell carcinoma of the urinary bladder, and adenocarcinoma of the prostate, is reported. A 72-year-old Japanese male patient was referred to our outpatient clinic with the complaint of asymptomatic hematuria. At that time, his serum of level of PSA was elevated to 20 ng/ml. Cystourethroscopy showed a papillary bladder tumor and coagula through the left urinary orifice. Ultrasonography, computed tomography and magnetic resonance imaging showed a mass lesion measuring about 6 cm by 5 cm in the left kidney. Angiography showed a hypervascular lesion measuring about 6 cm by 5 cm at the same site. Double cancer, consisting of renal cell carcinoma and transitional cell carcinoma of the urinary bladder, was suspected and we performed left total nephroureterectomy, hilar lymphadenectomy, and transurethral rection of the bladder tumor, one month later. At the same time, we performed a biopsy of the prostate. Histological diagnosis was renal cell carcinoma, clear cell carcinoma and transitional cell carcinoma of urinary bladder. Histological diagnosis of the prostate biopsy was moderately differentiated adenocarcinoma. Since this case fulfilled the criteria of Warren and Gates, it was classified as synchronous triple urogenital cancer. A review of the literature revealed 17 authentic cases of triple urogenital cancer, of which 14 and 10 cases were reported as a combination of renal cancer, bladder cancer and prostatic cancer, in the world and in Japan, respectively. Furthermore, he had been exposed to the atomic bomb explosion in Hiroshima in 1945. This carcinogenic precursor may be related to the development of the triple cancer.     

Bladder urothelium in nephropathy associated with analgesics

A history of ingestion of large quantities of analgesics in patients having clinical and radiographic features of chronic interstitial nephritis leads to the diagnosis of analgesic nephropathy. In analgesic nephropathy the renal damage possibly occurs from a high concentration of analgesics and/or their metabolites. Since urinary concentrations of analgesics and their metabolites are also high, urinary bladder wall may be similarly damaged. Bladder urothelium was examined in 20 patients. Ten control patients with uremia, hypertension, or bladder neck obstruction showed normal histology. Two of the 5 patients with analgesic nephropathy had brownish pigmentation of bladder. All 5 analgesic nephropathy patients showed chronic inflammation similar to that found in 5 patients with bacterial infections. It is suggested that pigmentation of bladder wall and/or chronic inflammation of bladder mucosa of unknown etiology when found in a patient with chronic interstitial nephritis, would support the diagnosis of analgesic nephropathy.     

Cancers of the kidney and urinary tract in patients on dialysis for end-stage renal disease: analysis of data from the United States,Europe, and Australia and New Zealand

Patients on maintenance dialysis have increased risk for cancer, especially in the kidney and urinary tract. In a retrospective cohort of 831,804 patients starting dialysis during 1980 to 1994 in the United States, Europe, or Australia and New Zealand, standardized incidence ratios (SIR) with 95% confidence intervals (CI) were calculated for kidney and bladder cancers. Risks for cancers of the kidney (SIR 3.6; CI 3.5 to 3.8) and bladder (SIR 1.5; CI 1.4 to 1.6) were increased, relatively more in younger than older patients and more in female patients (kidney: SIR 4.6, CI 4.3 to 4.9; bladder: SIR 2.7, CI 2.4 to 2.9) than male patients (kidney: SIR 3.2, CI 3.0 to 3.4; bladder: SIR 1.3, CI 1.2 to 1.3). SIR for kidney cancer were raised in all categories of primary renal disease, and for bladder cancer in all but diabetes and familial, hereditary diseases. Notably high SIR occurred in toxic nephropathies (chiefly analgesic nephropathy) and miscellaneous conditions (a category that includes Balkan nephropathy), the excess of kidney cancer in these conditions being urothelial in origin. SIR for kidney cancer rose significantly, and those for bladder cancer fell (not reaching significance) with time on dialysis. There was no association with type of dialysis. The pattern of increased risk for renal parenchymal cancer in dialysis patients is consistent with causation through acquired renal cystic disease and of urothelial cancers of the kidney and bladder with the carcinogenic effects of certain primary renal diseases.     

Clinical evaluation of urinary glycyl-prolyl dipeptidyl aminopeptidase in patients with urological disease

Urinary glycyl-prolyl dipeptidyl aminopeptidase (GP-DAP) activity was measured in 18 healthy adults and 252 patients with urological diseases. The GP-DAP activity was significantly higher in patients with prostatic cancer, bladder cancer or renal cancer and also in patients with acute prostatitis or pyelonephritis than in healthy adults. GP-DAP activity was also studied during anticancerous chemotherapy and proved to be a sensitive parameter for renal damage as are urinary N-acetyl-beta-D-glucosaminidase, alanine aminopeptidase, beta 2-microglobulin, alpha 1-microglobulin, and albumin. The analysis of tissue activities suggested that GP-DAP was located not only in the renal parenchyma but also in the prostate and seminal vesicles.     

Epidemiology of urothelial carcinoma

The epithelium lining is defined as the mucosal surfaces of the renal collecting tubules, calyces and pelvis, as well as the ureter, bladder and urethra. The term “urothelium” is used to refer to these surfaces. Upper tract urothelial carcinoma is a rare subset of urothelial cancers with a poor prognosis. Urinary bladder cancer is the most common malignancy involving the urinary system. Upper tract urothelial carcinoma is more common in men than in women, with a male‐to‐female ratio of 2:1. The incidence of urinary bladder cancer is also higher in men. Cigarette smoking and occupational exposure are the main upper tract urothelial carcinoma and urinary bladder cancer risk factors, while other factors are more specific to the carcinogenesis of upper tract urothelial carcinoma (i.e. Balkan endemic nephropathy, Chinese herb nephropathy). In Egypt until recent years, urinary bladder cancer was the most frequently diagnosed cancer due to Schistosoma haematobium. Substantial knowledge exists regarding the causes of upper tract urothelial carcinoma and urinary bladder cancer, and epidemiological studies have identified various chemical carcinogens that are believed to be responsible for most cases of urothelial carcinoma. In the era of precision medicine, genetic effects might play a direct role in the initiation and progression of urothelial carcinoma.