What is a kidney and what function does it serve?Normally people have two kidneys located in the upper back on the right and left side. The typical adult kidney weighs 150 grams in men and 135 grams in women. The kidney's primary function is filtration of excess water, salt and waste products from the blood stream. The kidneys play an important role in regulating blood pressure and controlling the supply of calcium. In addition, the kidney makes a factor, call erythropoetin, responsible for stimulating producting of red blood cells.What is kidney cancer?Most commonly kidney tumors aremalignant or cancerous. Kidney cancer occurs whennormal kidney cells begin to grow uncontrollably. There are four main types of kidney cancer: clear cell, sarcomatoid, chromophobe and papillary. Clear cell is the most common type of kidney cancer and sarcomatoid is the most aggressive (the most likely to spread beyond kidney to other parts of the body). Benign tumors include: angiomyolipoma and oncocytoma. These non-cancerous tumors are considered benign since they do not have the capacity to grow beyond the kidney to other sites ni the body.How common is kidney cancer and who gets it?It is estimated that in the United States during the year 2001, 30,000 people will be diagnosed with kidney cancer. Kidney cancer is the 8th and 10th most common non-skin cancer among American men and women, prospectively. Kidney cancer accounts for 2 - 3% of all cancer-related deaths in the United States.How is kidney cancer diagnosed?Common symptoms related to kidney cancer include: hematuria (blood in the urine), a mass and/or pain in the flank, newly developed left-sided varicocele (swelling of veins around the testicle). Although these symptoms can be caused by kidney they are all non-specific and are usually associated with non-cancerous processes. Typically patients with kidney cancer have no symptoms and are detected incidentally by a radiographic imaging study of the abdomen obtained for unrelated reasons. The best test to diagnose kidney cancer is a contrasted CT scan of the abdomen. MRI and ultrasound exams are other commonly used tests. Since these radiographic studies are so good at diagnosing kidney cancer, a biopsy of the tumor is rarely indicated.Does kidney cancer run in families?Patients who are affected with Von Hippel Lindau disease, hereditary papillary renal cell carcinoma or Birt Hoge Dube are far more likely to get kidney cancer. These people typically develop multiple tumors in both kidneys. There is also afamilial form of kidney cancer in which several family members develop the typical form of kidney cancer. Otherwise kidney cancer is not inherited and most patients with kidney cancer are not likely to "pass it on" to their offspring.How is kidney cancer treated?Since convential chemotherapy and radiatoin are not effective for kidney cancer, the only curative therapy involves surgical removal of the tumor. Historically the standard treatment for kidney cancer was radical nephrectomy (removal of the entire kidney and adrenal gland). Today the adrenal gland is only removed for tumors that are located in the upper portion of the kidney or involve the adrenal gland. Tumors that are smaller than four centimeters can usually be traeted with a partial nephrectomy (removal of the portion of the kidney that contains the tumor while leaving the remainder of the unaffected kidney intact). For patients with a solitary kidney or kidney failure, a partial nephrectomy is performed for tumors larger than four centimeters when a sufficient amount of the unaffected kidney can be preserved.Today most radical nephrectomies are performed by a laparoscopic technique. During laparoscopic procedures, surgeons operate using a camera and instruments placed through small holes in the patient's abdomen. The surgical team views the procedure on a television screen. The kidney specimen can be removed after placing it in a protective bag and breaking it up into multiple small pieces. Alternatively, the inteact specimen can be removed through a small non-muscle cutting incision. The advantage of laparoscopic kidney removal to the patient over standard open radical nephrectomy include: less pain, shorter recovery time and better cosmesis (i.e. much smaller scar). Typically patients stay in the hosptial 1 - 2 days following laparoscoic nephrectomy and return to normal activity within 2 - 3 weeks. Several studies have shown that laparoscopic nephrectomy for kidney cancer provides the same opportunity for cure as does conventional open radical nephrectomy.The standard treatment for metastatic kidney cancer (kidney cancer that has spread beyond the kidney to other parts of the body) is immunotherapy (induces the body to fight off cancer in the same way that it fights off infection). The most effective and commonly used form of immunotherapy is IL2. Other therapies including interferon gamma are used alone or in combination with IL2. It is believed that in most cases immunotherapy is more effective after the primary kidney tumor has been surgically removed.
Female Urinary Male Urinary System SystemWho gets bladder cancer and what causes it?It is estimated that in 2001, 54,300 people (39,200 men and 15,100 women) will be diagnosed with, and 12,4000 people (8,300 men and 4,100 women) will die from bladder cancer in the United States. bladder cancer is the 4th most common non-cutaneous malignancy among men in the United States, and the 8th most common cancer among women. The incidence of bladder cancer increases with age among men and women. The typical age of presentation is in the 7th decade of life and can be seen in patients as early as the 3rd decade of life.The most significant risk factor for bladder cancer is cigarette smoking. It has been estimated that cigarette smoking accounts for approximately 60% of all bladder cancer cases, and increases bladder cancer risk by 2.5-fold. Occupation exposure can also be important risk factors for bladder cancer; aniline and and other chemical dyes, combustion gases from coal and heavy metals have all been implicated. Consumption of large quantities of phenacitin-containing analgesics can lead to bladder cancer development as long as 25 years from the time of exposure. In addition prior therapy with cytoxan (cyclophosphamide) or pelvic irradiation can likewise increase one's risk of bladder cancer. Although some have suggested that coffee and artificial sweetners may increase bladder cancer risks, this has never been conclusively shown. What is bladder cancer?The vast majority of bladder cancers diagnosed in the United States are "transitional cell" cell type (transitional cell carcinoma). Multiple grading schemes have been used; most commonly tumors ae grouped into 3 grades corresponding to low, moderate and high grade. Grade is also a strong predictor of tumor aggressiveness and the risk of disease progression. "Carcinoma in situ" (CIS) is type of transitional cell carcinoma which is characterized microscopically by a pathologist as highly atypical cells confined to the bladder lining. This pre-malignant lesion is the pre-cursor lesion to a high grade invasive bladder cancer and its presence portends a worse prognosis.Squamous cell carcinoma accounts for 5% of bladder cancers in the United States, but 80% in Egypt. Chronic infection (typically by parasites not prevalent in the US) and chronic irritation (from long term (many years) indwelling bladder catheters) may also predispose patients to development of squamous cell carcinoma. Adenocarcioma of the bladder is rare accounting for fewer than 2% of all bladder cancers. Most commonly adenocarcinoma of the bladder develops from a urachal remnant or in patients who were born with bladder exstrophy.How is bladder cancer diagnosed?The most common symptom is blood in the urine ("hematuria"), either grossly (seen by the naked eye) or microscopically. Other symptoms include symptoms of bladder irritability -- burning, frequency and urgency. In many cases, the initial suspicion of a bladder tumor is made only after microscopic traces of blood are found on a routine urinalysis. Of note, the hematuria frequenctly is intermittent and a negative urinalysis does not exclude bladder cancer. All patients with hematuria should be evaluated by urologist with a urine cytology (washing of bladder cells), cystoscopy (see below), and intravenous urogram (x-ray test).Cystoscopy (a technique performed in which urologist exams the inside of the bladder with a lighted telescope) is the primary diagnostic tool for bladder cancer, and the cystoscopic appearance of a tumor can usually provide significant clues regarding the grade and stage of the tumor. Low grade superficial tumors appear as delicate fronds while high grade invasive tumors appear like a solid mass. Initial treatment includes transurethral resection of bladder tumor (TURBT) -- that is, resection of the suspicious lesion done through the cystoscope. This is typically done in the operating room under anesthesia. Attempts are typically made to excise the entire suspicious lesion at this setting. Evaluation of the specimen confirms the diagnosis of bladder cancer and also helps in the grading of the cancer. Most importantly, the pathology evaluation of the specimen provides information on the stage of the cancer: the primary goal of staging is to determine if the cancer is "superficial" (stage Ta to T1) or "invasive" (stage T2 or higher). CT examination of the abdomen and pelvis should be obtained in patients with invasive bladder cancers to evaluate the extent of the local tumor and to determine if the cancer has spread ("metastasized") to other areas of the body. Intravenous urograms should also be obtained in patients with bladder cancer in order to exclude the presence of tumor in the kidneys (renal pelvis) or ureters.How is bladder cancer treated?Superficial DiseaseThe majority of patients with superficial tumors (stage Ta or T1) can be effectively treated with transurethral resection alonge, especially those with Ta, low grade tumors. Although T1 (superficial but into "lamina propia" layers) are technically considered non-invasive, these tumors are likely to progress to "muscle invasive" (T2) disease these patients must be followed more closely than those with Ta tumors. In certain cases of superficial tumors (high grade or T1 tumors), additional therapies may inlcude installations of medicines into the bladder (intravesical therapy with agents such as BCG, Mitomycin, or Thiotepa) which ar performed to help prevent recurrences. GCG (Bacille Calmette-Guerin) is the most effective and commonly used form of intravesical therapy: a standard course of BCG consists of 6 weekly instillations. Because bladder cancers do have a high rate of recurrences, frequent surveillance cystoscopies in the ensuing months and years are required.Invasive DiseasePatients whose cancer invades into the bladder muscle wall (stage T2 to T3) typically require surgical treatment involving the removal of the entire bladder (a radical cystectomy). A radical cystectomy should be considered a major surgery. In males, the surgery involves removal of the bladder and typically the prostate as well. In females, the surgery consists of removal of the bladder and often removal of the uterus, ovaries, fallopian tubes, and typically a partion of the vagina as well. The recurrence rate after radical cystectomy is dependant on the stage, but the overall 10-year cure rates is approximately 66%. Partial cystectomy (removal of only part of the bladder involving the tumor) is rarely performed because of high risk for local recurrence. Radiation therapy or chemotherapy for invasive cancer is not routinely performed in the United States, and is only used in certain atypical cases. Such "bladder salvage" protocols may involve an "aggressive" transurethral resectin, external beam radiation and chemotherapy individually or in combination. Outcomes with such treatments appear to be less favorable than results with radical cystectomy.After removal, the urine is then diverted into a:1.) urostomy (external collecting bag), 2.) catheterizable pouch (internal pouch made of intestines), 3.) a neobladder Neobladders (also termed "orthotopic diversions") are created out of a portion of the patient's intestine, reconfigured in an attempt to create a new bladder and reconnect it to the ureters and the urethra in attempt to restone a more normal urinary function. These diversions can be performed successfully in both men and women. Furthermore, in recent years, radical cystectomy can be accomplished with preservation of the neurovascular bundles (the nerves responsible to achieving an erection) in men and the vagina in women. Such recent surgical modifications such as neobladders and nerve-sparing procedures have allowed surgeons to perform potentially curative surgery while also minimizing morbidity and thereby lessening the impact of cystectomy on quality of life: normal urniary and sexual function can be retained despite durative therapy for invasive bladder cancer. Overall, however, the type of diversion typically depends on the extent/location of the cancer and may also depend on the patient's age, physical status, mental status, and the technical ability of the operative surgeon.Metastatic DiseaseWhen the cancer has spread outside the bladder ("metastasized"), it will often spread to adjacent lymph nodes, liver, lungs, bone or other organs. In such cases, chemotherapy is typically employed as a primary treatment. In these cases, surgery is reserved only when the patient's bladder symptoms are so severe that cystectomy become a palliative (relieve symptoms) measure.PreventionPrevention of bladder cancer comes in the form of stopping the known causes of bladder cancer. In the United States, this is primarily in the form of cessation of smoking/tobacco use. In addition, identification of any blood in the urine, warrants further evaluation by an urologist.
Mol Cell Biochem. 2011 Jan 1. [Epub ahead of print]miR-143 decreases prostate cancer cells proliferation and migration and enhances their sensitivity to docetaxel through suppression of KRAS.Laboratory of Reproductive Medicine, Department of Urology, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.AbstractMicroRNAs have been implicated in regulating diverse cellular pathways. Emerging evidence indicates that miR-143 plays causal roles in cancer tumorigenesis as a tumor suppress gene; however, its role in prostate cancer tumorigenesis remains largely unknown. The aims of this study were to verify the effect of miR-143 on proliferation and migration abilities of prostate cancer cells. The expression level of miR-143 and its target gene KRAS were measured by realtime PCR and western blotting, respectively. Effects of miR-143 in cell proliferation, migration and chemosensitivity were evaluated by MTT assay, FACS cell cycle analysis, colony formation assay, and transwell migratory assay. Our results revealed an inverse correlation of expression between miR-143 and KRAS protein in prostate cancer samples (Pearson's correlation scatter plots: R=-0.707, P
CAUSES OF MALE INFERTILITYA number of clinical conditions and disease entities can render a man infertile. The more important causes are summarised in the table. Causes of Male Infertility1.Varicocele2.Infections :a. acute : smallpox, mumps, other viral infectionsb. chronic : TB, leprosy, prostatitis3.Sexually transmitted diseases4.Idiopathic - cause unknown5.Injurya. direct : testicular or pelvic trauma, heat, irradiationb. indirect : radiotherapy, chemotherapy, environmental toxins, drugs, marijuana, tobacco, alcohol6.Undescended testes (cryptorchidism)7.Previous surgery : inguinal, scrotal, retroperitoneal, bladder neck, vasectomy8.Obstructions : congenital (aplasia), vasectomy, post-infective9.Systemic illnesses esp. hepatic, renal10.Immunologic : infection, obstruction11.Ejaculatory disturbances12.Spinal cord lesions13.Genetic, endocrine & familial disorders : Klinefelter's syndrome, Young's syndrome, cystic fibrosis, adrenal hyperplasia14.Sexual dysfunctionsSometimes, in spite of the most meticulous search, no obvious cause can be found for the infertility. This group, known as the idiopathic infertility group, constitutes a large percentage.EVALUATION OF MALE INFERTILITYThe first test in the evaluation of the infertile male is the semen analysis. This test is inexpensive, easy to perform and gives valuable information.A perfectly normal semen analysis report generally precludes a significant male factor component and investigation and treatment should be more appropriately targeted at the wife. In fact, in many countries, the first test in the evaluation of an infertile couple is the semen analysis. This is generally performed before any tests are conducted on the wife.Often, in the case of male infertility, the semen analysis is abnormal. Either the count is low (oligospermia) or sperms are altogether absent in the ejaculate (azoospermia).Sometimes, sperm motility is seriously affected (asthenospermia) and sometimes the sperms are totally immobile or dead (necrospermia). There are many other anomalies that one may find on semen analysis.When one finds anomalies in the semen analysis, the next step is to try and find a cause for it. To do this, one must perform additional investigations. Some of the other tests that may need to be performed are a semen culture, anti-sperm antibody estimation, scrotal ultrasound, hormonal assays, karyotyping, vasography etc..TREATMENTTreatment of male infertility is difficult and sometimes frustrating. Immediate results are hard to produce and persistence with therapy is required.The following modalities of treatment are generally employed.1. Medical treatment This consists of the administration of certain drugs to improve seminal quality. Clomiphene citrate, mesterolone, tamoxifen, gonadotropin injections, antibiotics, steroids etc. are commonly used.2. Surgical treatment Obstructions in the sperm conduction pathway, varicoceles, undescended testes etc. can be treated by operation. Modern microsurgical techniques are of great help. Even patients who have undergone a vasectomy in the past can have their vasectomy reversed and the tubes recanalised successfully using microsurgery.3. Assisted reproduction In many cases, neither medicines nor operations are of help. In such cases, an attempt is made in the reproductive laboratory to improve semen quality and facilitate the penetration of the sperm into the ovum. This includes sperm washing/capacitation, intra-uterine insemination (IUI), gamete intra-fallopian transfer (GIFT), in vitro fertilisation (IVF), and micro-manipulation (ICSI).Microsurgery and assisted reproduction require considerable training, skill and infrastructure.Despite the availability of so many treatment modalities, some patients remain incurable and no treatment, cheap or expensive, can improve their fertility prospects. One then has no alternative but to recommend an AID (donor insemination) or adoption.Awareness of the magnitude and importance of the male factor in infertility is relatively recent. Tremendous advances have been made in andrological research over the past few years. If not today, one can envisage in the conceivable future, a situation where all males (and females) with infertility can be completely cured.
PREMATURE EJACULATIONPremature ejaculation is an extremely common condition. Kinsey, in his landmark report, had stated that it affects as many as 75% of all men. In today's context, premature ejaculation (PE) becomes especially relevant because of the increasing emphasis on female sexual gratification. Today's woman will not take anything lying down unless it is good enough (pun intended, of course). However, premature ejaculation seems to be nature's original design. The Kama Sutra has classified PE as one among many normal ejaculatory patterns. From the standpoint of procreation of the species, prematurity of ejaculation seems to confer an evolutionary advantage. Early man lived in dangerous environs and had to finish mating in a hurry. He therefore had very little time in which to deposit his semen in the female's vagina and ensure propagation of the species. The continuation of this primitive PE streak in humans perhaps explains the preponderance of the condition in modern man. PE is hard to define because its spectrum is so vast. Some men ejaculate at the mere thought of coitus. Others seem to be able to last long enough by average standards but are yet unable to gratify their partners. Hence, attempts have been made to quantify PE objectively on the basis of timing of intercourse up to the point of ejaculation, the number of pelvic thrusts until ejaculation, partner satisfaction, etc.. Researchers have actually placed stop-watches and thrustometers in patients' bedrooms. None of these methods, however, is ideal. The current working definition of PE is the one published in the fourth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders - the DSM-IV. Briefly, the DSM-IV defines PE as "persistent or recurrent ejaculation with minimal stimulation before, during or shortly after penetration and before the person wishes it". Even this hasn't been standardized. Many additional parameters need to be looked at, and the importance of physical factors (increasingly incriminated in PE) needs to be incorporated (see Table below). PHYSICAL (NON-PSYCHOLOGICAL) CAUSESInjury to sympathetic nervous system (e.g. following surgery for abdominal aortic aneurysm) Pelvic fractures Prostatic hypertrophy and prostatitis Urethritis Diabetes Arteriosclerosis Cardiovascular disease Local genitourinary disease Local sensory impairment Polycythemia PolyneuritisDefinitions notwithstanding, PE, despite many claims to the contrary, is a difficult condition to treat. Since PE has been a human concern for centuries, every system of medicine and every culture boasts its own unique `cures' for the condition. Many of these have acquired a reputation for efficaciousness because of their strong placebo effect. Since PE is often a psychological disorder, even substances without any real pharmacological effect on the ejaculatory apparatus can work by the power of suggestion (placebo). Some decades ago, psychosexual methods of treatment gained tremendously in popularity. One such was the `start-stop' method, which was propounded by Semans and then popularized by Helen Singer Kaplan. The other was the `squeeze' technique described by Masters and Johnson. These techniques held sway for many decades, largely because of the unavailability of other treatment methods. However, it soon became clear that the initial success rates claimed with these were not sustainable and that, over time the success rates had dwindled to 25%. Besides, these techniques are very tedious to employ and unsuitable for today's space age. Today, research is centered on understanding the central and peripheral neurological control of the ejaculatory process and regulating it with drugs. The various treatment options for PE are summarised in the Table below. The current treatment of choice seems to be medication with the SSRI (Selective Serotonin Reuptake Inhibitors) and allied groups of drugs. TREATMENTOFPREMATUREEJACULATIONPharmacological therapy dopamine antagonists antidepressants anxiolytics othersTopical anesthetics Microsurgery Psychological treatment Miscellaneous agents
适应于器质性勃起功能障碍患者,经万艾可等治疗无效。Penile ImplantsA penile prosthesis (implant) is a fixed or mechanical device surgically implanted within the two corpora cavernosa of the penis, allowing erection as often as desired. Penile prosthetic implantation surgery gives good results and high satisfaction ratios with low complication rates when performed at centers of excellence. The incidence of side effects is low. Penile prostheses are available in semi-rigid, self-contained 2-piece inflatable, and 3-piece inflatable models. Newer advances in implant design have reduced the complication rates and increased satisfaction rates further.
反复复发的血精往往由于精囊炎造成的,抗菌素治疗效果差,40岁以上的患者需测定PSA排除前列腺疾病,我们研究发现,精囊炎引起的血精患者,射精管口不完全梗阻或狭窄,造成精囊内液体在射精后引流不畅及精囊内压力增高,我们通过经直肠B超或精道造影明确诊断,用精囊镜边观察边进入精囊,达到扩张射精管的作用,并冲洗精囊内液体,注入抗菌素到精囊内,效果较好,已积累30余例治疗经验。
治疗输精管梗阻,附睾梗阻造成的无精子患者,可行显微外科吻合术。
Andrologia. 2015 Feb;47(1):20-4. doi: 10.1111/and.12216. Epub 2014 Jan 6.Efficacy and safety of long-term tadalafil 5 mg once daily combined with sildenafil 50 mg as needed at the early stage of treatment for patients with erectile dysfunction.Cui H1, Liu B, Song Z, Fang J, Deng Y, Zhang S, Wang H, Wang Z.Author information1State Key Laboratory of Reproductive Medicine and Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.AbstractThis study aimed to evaluate the efficacy and safety of long-term and low-dose tadalafil combined with sildenafil as needed at the early stage of treatment for erectile dysfunction (ED). We enrolled 180 patients with ED 1 : 1 to tadalafil 5 mg once daily or once-a-day tadalafil 5 mg combined with sildenafil 50 mg as needed. The efficacy measures included the 5-item version of the International Index of Erectile Function (IIEF-5) and the Sexual Encounter Profile (SEP). The safety was assessed by observing drug tolerability and adverse events. Total IIEF-5 scores of patients with severe ED in combined medication group were significantly higher than in tadalafil alone group. Question 2 scores of IIEF-5 of patients with moderate and severe ED in combined medication group were significantly higher than in tadalafil alone group. The significant improvement in question 3 scores of IIEF-5 existed only in patients with severe ED receiving combined medication. The percentage of 'yes' responses to SEP4, SEP5 and partner's SEP3 were improved significantly in combined medication group. There was no difference between two groups in the incidence of adverse events. Our results suggest that combined medication can better improve erectile function, especially for patients with severe ED.
A New Method of Chronic and RecurrentSeminal Vesiculitis TreatmentAbstractPurpose: To investigate a new method and its effect on the procedure of dilating the ejaculatory duct andflushing the seminal vesicle with an F9 seminal vesicle scope in patients with chronic and recurrent seminalvesiculitis.Patients and Methods: Twenty-six patients with a diagnosis based to signs, laboratory detection, digital rectalexamination, and transrectal ultrasonography were involved in present study. The patients underwent a surgicalprocedure of dilating the ejaculatory duct and flushing the seminal vesicles with an F9 seminal vesicle endoscope.All patients were followed for 3 months to 1 year after treatment.Results: There were significant reductions in symptoms, signs, white blood cell and red blood cell counts onmicroscopic examination, seminal vesicles size, improvement of inner walls echo in transrectal ultrasonography,and semen culture positive rate. Moreover, all patients showed improvement.Conclusions: The present study provides a new transurethral seminal tract endoscopic technique with seminalvesicle scope through the normal anatomic tract to treat patients with chronic seminal vesiculitis. It proved to beeasily conducted with minimized complications. Further investigations are needed to confirm our results.