| Objective: Benign prostatic hyperplasia (BPH) is one of the most common diseases in aged male. Its incidence has been going up with advancing age. Two groups of clinical symptoms are caused by BPH— bladder irritative symptoms and obstructive symptoms . The bladder irritative symptoms include urinary frequency, urgency, nocturia and urge incontinence. Detrusor instability (DI) is one of major reasons which cause the irritative symptoms. The obstructive symptoms include urinary hesitancy, straining, decreased force of urination, dribbling, urinary retention and overflow incontinence. The damage of contractile function of detrusor muscle is the major reason of these symptoms. Now there are many investigations to approve that the growth factors playing important roles in the proceeding of BPH. But what we know is very poor about the relationship between the growth factors and the changes of detrusor muscle after BPH. Nerve growth factor (NGF) plays an important role in maintaining the autonomic innervation of many organs. Increased levels of NGF and high-affinity NGFR-TrkA have been reported in the bladder tissues of obstructed animal bladders. Our present study aims at investigating the changes of NGF and TRKA in human bladder smooth muscle in BOO due to BPH and their implication by detect the expression of NGF and TRKA in the level of protein.Materials and Methods: Our study included 15 cases of bladder cancer and 54 patients with BPH. All patients were divided into three groups according to hisconclusion of urodynamic investigation, a control group, an obstructive detrusor stability group and an obstructive detrusor instability group. The control group contained 15 aged male patients of bladder cancer without BOO and DI by urodynamic investigation. The obstructive detrusor stability group contained 33 patients of BPH. There were 21 cases of BPH in the obstructive instability group. There were no significant differences among the mean ages of the three groups. According to the recommandations of the International Consensus Committee on BPH (ICC-BPH), patients with BPH performed basic initial evaluations (history, physical examination, digital rectal examination, urinalysis, serum PSA and renal function assessment) and recommanded diagnostic tests (uroflowmetry, residual volume, ultrasonography and urodynamic study). All patients had undergone an opening surgery of bladder and two small pieces of detrusor muscle were cut from the edge of the incision on the anterior bladder wall during the operation. The samples were taken into formaldehyde for a RT-PCR exam and an immunohistochemical study.1. RT-PCR: The total cellular RNA was extracted from bladder detrusor tissues. The electrophoresis of formaldehyde gel was done for each sample to ensure the integrity of RNA. A reverse transcription polymerase chain reaction (RT-PCR) was performed to examine NGFmRNA. The aliquots of the amplified DNA by polymerase chain reaction were electrophoresed on 1.5% agarose gel and visualized by ethidium-bromide fluorescence. Observed and took photo under xeno-viovet transmission apparatus. A reverse transcription polymerase chain reaction(RT-PCR) for P -actin was also done. The signals were quantified by using Scientific Imaging Systems. The NGFmRNA expression levels of bladder smooth muscle cells in the control group, the obstructive detrusor stability group and the obstructive instability group were estimated based on the counts obtained.2. Immunohistochemical study: The immunohistochemical analysis for NGF and TrkA were performed by using streptavidin biotin horseradish peroxidase staining in the control group, the obstructive detrusor stability group and the obstructive detrusor instability group. Replacing the primary antibody with PBS made the negativecontrast.The statistical analyses were performed using the software of SPSS 12.0 statistical package. P value less than 0.05 was regarded as significant.Results:The RT-PCR and immunohistochemical study indicated that NGF and TrkA were expressed in cytoplasm of bladder smooth muscle cells.1. The RT-PCR study indicated that NGFmRNA was expressed in bladder detrusor of three groups of patients. The expression levels of NGFmRNA were 0.997±0.182 in the control group, 1.947±0.310 in the obstructive detrusor stability group and 2.477±0.166 in the obstructive instability group. There were significant differences among the three groups(P<0.01) .The expression level of NGFmRNA in the obstructive instability group was higher than that in the obstructive stability group and in the control group. The NGFmRNA level in the obstructive stability group was higher than that in the control group.2. The NGF expression of bladder detrusor in the control group was 40% negative position, 60% weak positive and no moderate, and 15.2% negative position,54.5% weak positive, 30.3% moderate positive in the obstructive detrusor stability group and 38.5% weak positive, 61.9% moderate positive in the obstructive instability group. There was no strong positive in all three groups. The expression levels of NGF in the obstructive detrusor stability group and in the obstructive instability group were significantly increased compared with that in the control group, the difference reached statistical significance (P<0.01). And there was significant difference between the obstructive detrusor stability group and the obstructive instability group (P < 0.05).3. The TrkA expression of bladder detrusor in the control group was 40% negative positive, 33.4% weak positive, 13.3% moderate positive, 13.3% strong positive and 12.1% negative positive, 12.1% weak positive, 54.5% moderate positive, 21.3% strong positive in the obstructive detrusor stability group and 9.5% weak positive, 42.9% moderate positive, 47.6% strong positive in the obstructive instability group. The expression levels of TRKA in the obstructive detrusor stability group andobstructive instability group were significantly increased compared with which in the control group, the difference reached statistical significance (P<0.01). And there was significant difference between the obstructive detrusor stability group and the obstructive instability group (P < 0.05).4. Correlation between the levels of NGF and TrkA is significant at the 0.05 level (2-tailed), the correlation coefficient is 0.247. Conclusion:1. The expression levels of NGF and NGFmRNA in bladder detrusor were elevated in the patient of BOO due to BPH.2. The expression level of TrkA was elevated in the patient of BOO due to BPH and the correlation between the levels of NGF and TrkA is significant at the 0.05 level (2-tailed), the correlation coefficient is 0.247.3. The elevated expressiones of NGF and TrkA were correlated with detrusor instability (DI) due to BOO.4. This study investigated potential mechanisms of the changes of bladder detrusor associated with BOO due to BPH. It will provide a new idea for clinical treatment and researching new drugs.Objective: To investigate the feasibility and results of different approach laparascopy in the urological disease surgery .To compare the clinical results of laparoscopic and open surgery. On the basis of clinical application ,we improve the traditional laparoscopic instruments.Material and method:A total 226 cases of urological laparoscopic surgery were retrospectively analyzed, including laparoscopic varicocelectomy(l2leases), undesended testicle exploration (2cases), renal cyst decompression (37cases), ureter lithotomy (4cases), nephrectomy( Meases ), and adrenalectomy(48cases). Meanwhile the clinical data of 270 cases with open surgery , included open varicocelectomy(152cases), renal cyst decompression(38ases), and nephrectomy(70cases), were also analyzed. The were 7 cases were transformed to open surgery, varicocelectomy was 2cases, renal cyst 2cases, ureter stone lease, and nephrectomy 2cases. The advantage and disadvantage of Different surgical approaches (transperitoneal, retroperitoneal, and trans-lateral-peritoneal) were evaluated.Equipment and instruments: Wolf (German), Stryker (USA), Olympus (Japan) laparoscopy.The lapascopy system include camera, monitor, automatic peumoperineal machine, high frequency electronic coagulator and sucking and drainaging system, Trocar, grasper, holder,scissor, acupuncture and clip appHer.Ultrasonic scissor,hand port and Endo-cut were applied on demand.We developed our own instrument in practice: K Dilation pipe composed of 16F catheter and medical glove;2> Plastic bag and glove bag for organ taking out, plasticbag for major organ(e.g. kidney)and glove bag for minor organ(adrenal gland);3N Inside urinary incisivor;^ Forceps with gauze substitute for fan-shaped retractor.Methods:Surgical approach: transperitoneally, retroperitoneally, trans-lateral-peritoneally Laparoscopic manipulator space establishment: 1) Transperitoneal approach: we have an arc incision below the umbilicus and Vessel needle was inserted, CO2 pneumoperitoneum was then established routinely. Trocar was inserted openly when abdominal adhesion was speculated.2) Retroperitoneal approach: We have a horizontal incision below the 12th costal apex and injected 800-1200ml into a glove to establish a retroperitoneal space. Other 3-5 Trocars were put in the subcostal margin (ante-sacrospinalis ,posterior axillary line(sub- iliac crest),anterior axillary line(sub-iliac crest), 2-3cm medial to the anterior axillary line.3)Trans-lateral-peritoneum: The patient was obliquely fixed in the operational table and peumoperitoneum was set up in supine position.Then the patient was rotated to obliquely supine position(70-80 degree) and other Trocars was introduced on demand.If Endo-cut was imperative, another Trocar(12mm) was introduced.Statistical analysis: Have a comparative analysis of the operating time, hospital stay, amount of bleeding, drainage amount with T test. Compare the proportion of use of antalgesic between two groups with x2 test. P value less than 0.05 was regarded as significant.Results: High ligation of spermatic vein: the operation tiir^ the hospital stay and cost of the hospitalicatio^ use of antalgesic, in Laparoscopy and open surgery group were 26.90min^ 3.5d,5979RMB,27cases;41.36min> 6.86d,3693.02RMB, 72cases respectively. The laparoscopy group were significantly less than open group in the operating time ,hospitalication days and use of antalgesic(P<0.05).Total cost of the hospitalication has no significant difference (p>0.05) .Laparoscopic undescended testis exploration: Testis were not found in both cases. The operation time of one case was 90 min, without drainage tube, and the testis was not found in abdominal cavity. The stump of efferent tube was founded behind thesigment, the patient were discharged 5 d after operation. Another case, the operation time was 15 min, the patient was discharged 2 d after operation, without complications oLaparoscopic renal cyst decompression: The operating time^ average blood loss, drainage after operation > the hospital stay and cost of the hospitalication, use of antalgesic, were 120min, 25.2min> 82.5miiK 6.3days, 5979RMB, Meases in Laparoscopy group and 94.9min, 57.2min, 185.4min, 9.5days, 6371RMB, 48cases in open group. The average blood loss, drainage after operation, hospitalization days and use of antalgesic of laparoscopy group were significantly less than those of open surgical group(p<0.05). The operating time and cost of the hospitalication had no significant difference (p>0.05) °Laparoscopic ureter lithotomy: There were 4 cases.One case was converted to open surgery. 2 cases underwent through retroperitoneum. The operating time of this 2 cases were respectively 140minN 130min, and the amount of drainage were respectively 70ml, 30ml, and the postoperative hospitalization days were 9days,7days respectively. 1 case conducted through lateral personally, the operating time was 150min, drainage volume was 50ml and discharged 4 days after operation.Laparoscopic nephrectomy: 11 cases were accepted pure nephrectomy. The operating time, average blood loss, drainging amount after operation, recovery of intestinal function , the hospitalization days and total cost of the hospitalization n use of antalgesic in Laparoscopic group and open surgery group were 162minN 25ml, 92min, 241k 5days, 13206.8RMB, 6cases and 112min, 105ml, 220min, 481k 12 days, 25 cases respectively. The average blood loss, drainage after operation, recovery time of intestinal function, the days after operation, use of antalgesic in laparoscopic group were significant less than open group(p<0.05).The operating time and total cost of the hospitalization have no signafficiant difference (p>0.05 ) .Laparoscopic adrenalectomy: All the operations have been success. The operating time, average blood loss> drainage amount after operation recovery of intestinaling function ^ the days and cost of the hospitalization > use of antalgesicwere 140.5muu 39.2mk 72mk 27.21k 4.8days, 16380RMB> 30cases and 104.8min> 89.2mK 160.5mK 51.61k 9.9days^ 12156 RMB> 119cases respectively.The average blood loss > recovery of bowel function ^ the days after operation, use of antalgesic in laparoscopic group were significant less than open group(p<0.05). The operating time and total cost of the hospitalization had no significant difference (p>0.05) . Conclusions:1. Laparoscopic surgery in urology has the same value as open operation, with less wound, less pain, shorter hospitalization, cosmetic effects and rapid recovery.2. In some simple operation, such as internal spermatic vein high ligation, laparoscopic operation is better than open surgery in operating time and the days in hospital after operation.3. In some complex cases, such as Laparoscopic adrenalectomy and nephrectomy, with the development of instruments and the skill of manipulate, most of operating's time could be equal to or shorter than open operation. Other preponderance superior to open operation: shortage of hospitalization time, cost and the resume of normal activities.4.Retroperitoneal Laparoscopic surgery for urologic operation, like kidney, adrenal, or middle and upper ureter disease, has a little advantages as compared to transperitoneal approach.
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