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Bladder outlet obstruction (BOO) is a type of chronic disease that is mainly caused by benign prostatic hyperplasia. Previous studies discovered the involvements of both serum/glucocorticoid‐regulated kinase 1 (SGK1) and activated T cell nuclear factor transcription factor 2 (NFAT2) in the proliferation of smooth muscle cells after BOO. However, the relationship between these two molecules is yet to be explored. Thus, this study explored the specific mechanism of the SGK1‐NFAT2 signaling pathway in mouse BOO‐mediated bladder smooth muscle cell proliferation in vivo and in vitro. In vivo experiments were performed by suturing 1/2 of the external urethra of female BALB/C mice to cause BOO for 2 weeks. In vitro, mouse bladder smooth muscle cells (MBSMCs) were treated with dexamethasone (Dex) or dexamethasone + SB705498 for 12 h and were transfected with SGK1 siRNA for 48 h. The expression and distribution of SGK1, transient receptor potential oxalate subtype 1 (TRPV1), NFAT2, and proliferating cell nuclear antigen (PCNA) were measured by Western blotting, polymerase chain reaction, and immunohistochemistry. The relationship between SGK1 and TRPV1 was analyzed by coimmunoprecipitation. The proliferation of MBSMCs was examined by 5‐ethynyl‐2′‐deoxyuridine and cell counting kit 8 assays. Bladder weight, smooth muscle thickness, and collagen deposition in mice after 2 weeks of BOO were examined. Bladder weight, smooth muscle thickness, the collagen deposition ratio, and the expression of SGK1, TRPV1, NFAT2, and PCNA were significantly increased in mice after 2 weeks of BOO. Compared with the control, 10 μM Dex promoted the expression of these four molecules and the proliferation of MBSMCs. After inhibiting TRPV1, only the expression of SGK1 was not affected, and the proliferation of MBSMCs was inhibited. After silencing SGK1, the expression of these four molecules and the proliferation of MBSMCs decreased. Coimmunoprecipitation suggested that SGK1 acted directly on TRPV1. In this study, SGK1 targeted TRPV1 to regulate the proliferation of MBSMCs mediated by BOO in mice through NFAT2 and then affected the process of bladder remodeling after BOO. This finding may provide a strategy for BOO drug target screening. [ABSTRACT FROM AUTHOR]

Bladder outlet obstruction (BOO), which is primarily caused by benign prostatic hyperplasia, is a common chronic disease. However, previous studies have most commonly investigated BOO using the acute obstruction model. In the present study, a chronic obstruction model was established to investigate the different pathological alterations in the bladder between acute and chronic obstruction. Compared with chronic obstruction, acute obstruction led to increased expression of proliferating cell nuclear antigen and interleukin-1β, which are markers of proliferation and inflammation, respectively. Furthermore, increased fibrosis in the bladder at week 2 was observed. Low pressure promoted mice bladder smooth muscle cell (MBSMC) proliferation, and pressure overload inhibited cell proliferation and increased the proportion of dead MBSMCs. Further investigation using serum/glucocorticoid regulated kinase 1 (SGK1) small interfering RNAs indicated that low pressure may promote MBSMC proliferation by upregulating SGK1 and nuclear factor of activated T-cell expression levels. Therefore, the present study suggested that acute obstruction led to faster decompensation of bladder function and chronic bladder obstruction displayed an enhanced ability to progress to BOO. [ABSTRACT FROM AUTHOR]

Background and Purpose Retroperitoneal lymph node dissection (RPLND) is still the most sensitive and specific method for the detection of malignant tumor and mature teratoma in stage II nonseminomatous testicular carcinoma after chemotherapy. Acceptance of this operation, however, has decreased because of the morbidity associated with the open approach. To reduce the morbidity and to improve the acceptance of RPLND, laparoscopy has been introduced. In this study, we describe our experiences with laparoscopic RPLND for stage II testicular carcinoma after chemotherapy.Methods Sixteen patients underwent 17 laparoscopic RPLND after chemotherapy for clinical stage IIA-III nonseminomatous testicular cancer. Patients with post-chemotherapy residual masses >1 cm and normalization of tumor markers were considered for the procedure. Our dissection field included the resection of the residual tumor as well as the ipsilateral template.Results Laparoscopic RPLND was completed in all patients. Operative time ranged from 125 to 370 minutes (mean 240 ± 56 min). No transfusions were required, and no intraor postoperative complications occurred because of the procedure. A bleomycin-induced interstitial pneumonia developed in one patient. After a mean follow-up period of 26 ± 11 months (range 4 to 38), two disease recurrences were observed.Conclusion Laparoscopic RPLND after chemotherapy is a feasible and oncologically safe procedure. However, the technique is challenging and should only be performed in selected patients with low residual tumor volume. [ABSTRACT FROM AUTHOR]

Background and Purpose In recent years, mini-percutaneous nephrolitholapaxy (mini-PCNL) has gained popularity because of its reduced invasiveness. To improve clinical outcomes further, research is ongoing in selected centers. Important areas of interest include extravasation into the retroperitoneal space, acute absorption syndrome, and septicemia. The aim of this experimental study was to test a new 18F nephroscope sheath specially designed to decrease intrapelvic pressure during mini-PCNL whatever the irrigation pressure. In addition, the hydrodynamic effects of this device can be used for suction and removal of the stone fragments, in contrast to a standard Amplatz sheath.Materials and Methods In a fresh, perfused cadaveric porcine kidney model, the new sheath was compared with a conventional sheath (control) with closed and open Luer-Lok outflow under increasing irrigation pressure. Intrarenal pressure peaks were measured with a urodynamic workstation. The irrigation fluid was marked with an ink that stains only endoluminal surfaces, and a post-measurement histopathologic work-up was performed to evaluate the changes on a morphologic level.Results Closing of the control sheath resulted in an increase in the intrapelvic pressure to a maximum of 136 cm H2O. Using the new sheath with a constant output flow made possible by its open proximal end, the maximal intrapelvic pressure remained low at 20 cm H2O, even when the inflow pressure reached 125 cm H2O. The ink distribution on the hematoxylin and eosin-stained slides reflected the results of the pressure measurements.Conclusions Newly designed nephroscope sheaths with an open proximal end, such as the one described here, decrease the intrapelvic pressure compared with a closed outflow system. As a result, strict fluid control during the intervention is not necessary. [ABSTRACT FROM AUTHOR]

Electrosurgery is the use of radio-frequency electric current for the cutting of biological tissue e.g. for resection of tumour tissue. In this work, the optical emission of plasma being generated during the electrosurgical procedure is investigated with a high resolution echelle spectrometer to find differences between tumour tissue and normal renal tissue in a pre-clinical ex vivo study. Trace elements like zinc, iron, copper and cadmium are present in the tissue spectra as well as the electrolytes magnesium, calcium, sodium and potassium and some diatomic molecules such as hydroxyl radical, cyano radical, dicarbon, nitrogen monohydride and molecular nitrogen which are mainly dissociated from polyatomic molecules. With the atomic emission line of cadmium at 228.8 nm the treated tissue can be differentiated in tumorous and healthy tissue with correct assignment of 95% for tumour tissue and 92% for normal renal tissue. [ABSTRACT FROM AUTHOR]

Purpose To achieve better hemostasis after mini-percutaneous nephrolitholapaxy (mini-PCNL), we developed a new application device that can be used to close the renal-access tract with gelatin matrix hemostatic sealant (GMHS).Patients and Methods After mini-PCNL was performed on 11 patients, a Double-J ureteral stent was placed antegrade. After retraction of the 18F Amplatz sheath out of the collecting system under vision without irrigation, the urothelium collapsed. The 15F metal applicator with a 10F working channel was then inserted and GMHS injected during further retraction of both the device and the Amplatz sheath. The skin was closed with Steri-strips.Results The renal parenchymal tract of the mini-PCNL can be sealed in 15 to 50 seconds. Postoperatively, no urinoma was observed. All patients had an uneventful follow-up.Conclusion Closing the track of the mini-PCNL with the new application device and GMHS is a safe, easy, and quick alternative to the common nephrostomy tube. [ABSTRACT FROM AUTHOR]