The third CJUA annual meeting
2009

China­Japan urological association

PROGRAM＆

ABSTRACTS

Date
April 17, 2009
Venue
OKAYAMA CONVENTION CENTER
14­1 Ekimotomachi, Okayama, JapanCJUA Home­page URL: http://www.uro.jp/nichu/index.html

PROGRAM of the third CJUA annual meeting(2009.4.17

14:00 to 14:10

Okayama Japan)

Opening Address

Prof. Hiromi Kumon, President of CJUA (Japan)

14:10 to 14:50 Special Lecture
Chairman: Prof. Hiromi Kumon, Okayama University
Progress and Future of p53 Gene Therapy in China
Prof. Shan­wen Zhang, Peking University School of Oncology

14:50 to 15:50

Session I (8 minutes presentation following 4 minutes

discussion)
Chairmen: Atsushi NAGAI, Kawasaki, Japan
Xianghua Zhang, Beijing, China

1. The overactive bladder symptom score (OABSS) is a useful assessment tool forevaluating treatment­related change in clinical trials with OAB patients as wellas the overactive bladder questionnaire (OAB­q).
Yoshiyuki Ishiura NHO Kanazawa Medical Center, Japan
2. Efficacy and Safety of Tamsulosin in Chinese Patients with Lower Urinary Tract
Symptoms Associated with Benign Prostatic Hyperplasia
Xianghua Zhang

Peking University First Hospital, China

3. Efficacy and Safety of Silodosin, a Novel α1A­ Adrenoceptor Selective Antagonist
for Treatment of Benign Prostatic Hyperplasia

Ning­chen Li

Silodosin clinical study group, China

4. Influence of polymorphisms and expression of chromogranin A and endothelin­1on the development and progression of prostate cancer
Zhiyong Ma Akita University School of Medicine, Japan
5. SNP genotyping is useful for genetic predisposition for prostate cancer in Japan
Peng Huang

Okayama University, Japan

15:50to 16:50

Session II (8 minutes presentation following 4 minutes

discussion)
Chairmen: Yoshiyuki Kakehi, Kagawa, Japan
Jianbin Bi, Shenyang, China

6. Diagnosis and treatment of Renal cell carcinoma associated with vonHippel­Lindau disease
Xue Wei Renji Hospital, Shanghai Jiaotong University Medicine School, China
7. Ten­year Biochemical Disease­free Survival After High Intensity Focused
Ultrasound (HIFU) For Localized Prostate Cancer: A Comparison Of Three
Different Generation Devices
Toyoaki Uchida

Tokai University Hachioji Hospital, Japan

8. A new urinary diversion by ileal reservoir with extracorporal self­controllable
urination
Xiuheng Liu Renmin Hospital, Wuhan University, China
9. Honokiol, a natural plant product from magnolia tree, inhibits the bonemetastatic growth of human prostate cancer cells
Katsumi Shigemura Kobe University, Japan

10. Retroperitoneoscopic nephroureterectomy with transurethral bladder­cuff
excision for renal pelvic and ureteral tumors.
Liu Xiao­qiang

16:50 to 17:00

The second hospital of Tianjin medical university, China

Closing Address

Prof. Yanqun Na, President of CJUA (China)

Special Lecture
Progress and Future of p53 Gene Therapy in China
ZHANG Shan­wen
Peking University School of Oncology
Tumor suppresser gene p53 well known for its structure and function, widely
regarded as the genome guardian of cells, plays a key role in cell cycle control,
apoptosis, and inhibition of tumor cell proliferation; especially as a transcription
factor, in cellular responses to DNA damage including irradiation, hyperthermia, andcytotoxic agents.
Wild­type p53 gene promotes cell cycle arrest and apoptosis of tumor cells after
irradiation, but mutated p53 abrogates this response and induces resistance toradiation. Replacement with normal p53 gene using viral vectors results insuppression and reversal of the malignant phenotype. P53 gene transfer induces
radiosensitization: a stratege to convert a radio­resistant phenotype into aradio­sensitive one.
Adp53 is an E1 substituted replication­incompetent recombinant adenovirus
encoding the human p53 gene.
Recombinant human p53 adenovirus injection (trademarked as Gendicine) wasapproved to market by the SFDA in October 2003. Although the product is primarity
used for nasopharyngeal carcinoma and other head­and­neck cancers, and is off­label
used for cervix, pancreas, liver and other cancers at a late­stage, especially forsarcoma which cannot be easily treated by conventional methods. Adp53 is normallyinjected into solid tumors, although intra­locoregional arterial infusion, andintrathoracic /intraperitoneal infusion are also used. Now p53 gene therapy mostly in
combination with radiotherapy, hyperthermia, or chemotherapy. Up to now, morethan 3000 patients with cancer have been treated with Adp 53 in china.
Study of Clinical mechanism： Expression of p53 gene and p53 target gene assayedby immunohistochemistry (IHC) in tumor simple taken 48h after intratumoral
injection of Adp53. Up­regulation of cell cycle relative gene p21 and apoptosis
relative gene Bax and down­regulation of VEGF were observed in postinjection
tumor biopsy by using IHC. Adp53­specific p53 mRNA was detected by RT­PCR
analyses of tissue samples in 16 (94.1%) of 17 assessable samples taken 48h after
intratumoral injection of Adp53.
Clinical Study: Between Oct. 2001 to May. 2003, a randomized controlled clinical
trial on Adp53 combined with radiotherapy (GRT group) in 42 patients withnasopharyngeal carcinoma (NPC) was compared with a control group of 40 patientswith NPC treated with radiotherapy alone (RT group). In the GRT group, Adp53 wasintratumorally injected once a week for 8 weeks. Concurrent RT (70Gy in 35
fractions) was given to nasopharygeal tumor and neck lymph node. Patients andtumors were monitored for adverse events and response, respectively.
Complete response rate in the GRT group was observed at 2.73 times that of RT
group (66.7% vs. 24.4%). Six­year follow­up data showed that Adp53 significantly
increased the 5­year locoregional tumor control rate by 25.3% for patients with NPC
treated with irradiation (P=0.002). The 5­year overall survival rate and 5­year
disease­free survival rate of GRT group were 7.5% (P=0.34) and 11.7% (P=0.21)
higher than that of RT group. No dose­limiting toxicity and adverse events appeared,
except for transient fever following Adp53 administration.
15 patients with cervix cancer at a late­stage IIB (2 cases) or IIIB (13 cases) treatedby Adp 53 in combination with radiation totally got complete response. 5­year
survival rate was 85.7% higher than that of radiotherapy alone before.
p53 gene was mutated in 70% of patients with pancreas cancer induces highmalignant phenotype, high recurrent rate, and very low 5­year survival rate (only 1 to3%). So 9 patients with unresectable pancreas cancer ( 4 primary and 5 metastasis)
treated with Adp 53 in combination with radiation got a good response, mean
survival time was 13.2 months, that equate to results of surgery for patients withpancreas cancer at a early stage .
Higher incidence rate of p53 gene mutation was significantly correlated to worse
survival and successful Adp53 gene transfer synergistically inhibited growth andmetastasis in patients with bladder cancer and prostate cancer. A new strategy of
Adp53 to increase locoregional control for urology tumors should be suggested.
Relative article was published in JCO, February 2009.
Jian­ji Pan, Shan­wen Zhang*, et al. Effect of Recombinant Adenovirus­p53
Combined With Radiotherapy on Long­Term Prognosis of Advanced
Nasopharyngeal Carcinoma. Journal of Clinical Oncology, 2009, 27 (5):799­804. J.P.
and S.Z. contributed equally to the article.*Corresponding author: Shan­wen Zhang（IF15.484）Fucheng Rd, Haidian District, Beijing 100036, People’s Republic ofChinaE­mail: zhangshw4641@sina.com.

ABSTRACTS
1. The overactive bladder symptom score (OABSS) is a useful assessment tool forevaluating treatment­related change in clinical trials with OAB patients as wellas the overactive bladder questionnaire (OAB­q).
Yoshiyuki Ishiura
Masashi Iijima, Kiyoshi Koshida
Department of Urology, NHO Kanazawa Medical Center, Kanazawa, JapanAIMS OF STUDY: Overactive bladder (OAB) is characterized by symptoms ofurinary frequency and urgency, and has been shown to have significant impact on
health­related quality of life (HRQL). The overactive bladder questionnaire (OAB­q)
is a useful tool for measuring OAB­related HRQL in clinical management 1). The
overactive bladder symptom score (OABSS), which integrates four OAB symptoms(daytime frequency, nighttime frequency, urgency and urgency incontinence) into asingle score, was developed as a symptoms assessment tool 2). There was no reportthat discussed relations of OABSS and OAB­q till now. This study compared the
OABSS with the OAB­q and examined the responsiveness of anti­muscarinic
treatment. The relations with age, gender, treatment history and presence of urinary
incontinence were also examined.
MATERIALS AND METHODS: OAB was diagnosed by more than three points of
OABSS with the presence of urgency. OAB patients were treated withanti­muscarinic agent administration for 4 to 12 weeks in our out­patient clinic. The
OABSS and the OAB­q were collected at pre­ and post­treatment. The relation
between the OABSS and the OAB­q and responsiveness of anti­muscarinic treatment
were analyzed. The relation between the responsiveness of anti­muscarinic treatment
for OAB­related symptoms and HRQL disorders and the other factors such as age,gender, treatment history, presence of urinary incontinence were examined.
RESULTS: A total of 46 patients enrolled (mean age = 72.7 years, 56.5% male,
73.9% OAB wet). The average point of sum score of the OABSS, daytime frequency,nighttime frequency, urgency, and urgency incontinence before therapy was 8.3, 0.9,
2.1, 3.3, and 2.1 respectively. In a point of OAB­q subscale before therapy, theaverage of symptoms bother, coping, concern, sleep, social interaction, and HRQL
total was 29.1, 67.2, 75.4, 73.0, 82.8, and 73.8 respectively. Before therapy, the sumscore of the OABSS was significantly correlated with all OAB­q subscales except forsocial interaction. Correlation with OAB­q at pre­treatment was examined, which
was greatest for the sum score of the OABSS, followed by urgency, nighttime
frequency, urgency incontinence, and daytime frequency. The significant correlation
was seen between age and the OABSS, but not seen between age and the OAB­q.

The sum score of the OABSS was significantly decreased (6.0) after therapy.
Daytime frequency (0.7), nighttime frequency (1.6), urgency (2.3), and urgency
incontinence (1.4) were also significantly decreased. After treatment, significant
improvements occurred in all OAB­q subscales. The average of symptoms bother,
coping, concern, sleep, social interaction and HRQL total was 24.7, 74.3, 82.0, 76.9,
88.9 and 82.3 respectively. The correlation was not recognized in age and degree ofthe responsiveness of anti­muscarinic treatment for OAB­related symptoms andHRQL. The differences of the responsiveness of anti­muscarinic treatment by thegender and presence of urinary incontinence were not seen, too. OAB patients
without treatment history were significantly improved by anti­mucarinic treatment
rather than OAB patients with treatment history. As for the cases that sum score of
the OABSS improved more than two points after treatment, each subscale of the
OAB­q were improved by predominance. On the contrary, in the cases that
improvement was not seen in sum score of the OABSS after treatment, all subscalesof the OAB­q were not improved.
CONCLUDING MESSAGE: The OABSS had a significant correlation withindividual OAB­q subscales. Anti­muscarinic treatment had improved both OABSSand OAB­q.
OAB symptoms have correlation with OAB­related HRQL and symptom bother.
Both OAB­related symptoms and HRQL were improved by anti­muscarinic drug
administration. The OABSS appears to be a useful outcome measure for evaluating
treatment­related symptoms change in clinical trials and practice with OAB patients
as well as the OAB­q.
2. Efficacy and Safety of Tamsulosin in Chinese Patients with Lower Urinary Tract
Symptoms Associated with Benign Prostatic Hyperplasia
Xianghua Zhang
Department of Urology, Peking University First Hospital, Institute of Urology,
Beijing 100034, China
OBJECTIVE: To review and evaluate the efficacy and safety profile of tamsulosinin the treatment of Chinese patients with lower urinary tract symptoms (LUTS)
associated with benign prostatic hyperplasia (BPH).
DATA SOURCES: A systematic literature search of MEDLINE, China National
Knowledge Infrastructure (CNKI) and Wanfang Database for both English andChinese studies about the efficacy and safety profile of tamsulosin in the treatment ofChinese patients with LUTS/BPH through December 2008 (including an Literatureto be published soon).
RESULTS: Seven studies (1 for English and 6 for Chinese) were involved, thesestudies not only investigated the short­term and long­term efficacy and safety profile
of tamsulosin in the treatment of Chinese patients with LUTS/BPH, but also
including certain special patients such as patients concomitant hypertension andsexual dysfunction. The efficacy of tamsulosin on patients with different prostate
volumes was also investigated in one study. Tamsulosin may rapidly relieve
symptoms, improve quality of life (QOL) and urodynamics parameters of Chinese
LUST/BPH patients with all different prostate volume, and the efficacy sustained inlong­term; it also may improve sexual function of BPH patient. Tamsulosindemonstrates good safety profile in long­term, with lower incidence of overall
adverse events and almost no effect on blood pressure, could be effectively andsafely used in patients with BPH and concomitant hypertension. In two clinicalcontrolled trials, tamsulosin demonstrates better efficacy compared with finasterideand terazosin, and the incidence of adverse events for tamsulosin is obviously lower
than terazosin.
CONCLUSIONS: Tamsulosin monotherapy has a favorable efficacy and safety
profile in Chinese patients with LUTS/BPH and can be used as the initial treatment
option.
3. Efficacy and Safety of Silodosin, a Novel α1A­ Adrenoceptor Selective Antagonist
for Treatment of Benign Prostatic Hyperplasia
Ning­chen Li* Qiang Ding, Wei Zhang, Song­liang Cai, Shi­ping Chen, Yi­ran
Huang, Zhang­qun Ye, Chui­ze Kong, Yan­qun Na, Silodosin clinical study group,
China
OBJECTIVE: To study the efficacy and safety of a selective α1A­adrenoceptor
antagonist silodosin for treatment of lower urinary tract symptoms (LUTS)
associated with benign prostatic hyperplasia (BPH).
METHODS: This is a randomized, double­blind, placebo­controlled clinical studies
on silodosin. The eligible subjects with LUTS caused by BPH were assigned
randomly into silodosin group or placebo group at ratio of 2:1, receiving either 4mg
bid silodosin (8mg/day) or placebo for 12 weeks. Subjects were evaluated in 2, 4, 8
and 12 weeks of treatment. The change in the total score of the international prostate
symptom score (I­PSS) was used to assess the efficacy after 12 weeks of treatment.
The change of maximum urinary flow rate (Qmax), quality of life (QOL) score, thechange of total I­PSS score after 1 week and 2 weeks treatment were also observed.

All adverse events during the treatment period were recorded and assessed forseverity and causal relationship with taking the investigational products.
RESULTS: Totally 516 subjects were enrolled into two groups, 344 to silodosingroup and 172 to placebo group. Full analysis set (FAS), comprised 501 subjects,
with 338 in silodosin group and 163 in placebo group. There were no significant
differences among the two groups in baseline characteristics. The results showed that,compared with the placebo group, the decrease of total I­PSS in silodosin group was
significant after 12 weeks of treatment (p=0.0099), and the least square mean
between silodosin group and the placebo group was –1.45 (95% confidence
interval:–2.55;­0.35). The total I­PSS were significantly greater decreases withsilodosin than placebo from 1 week (p=0.0007) and 2 weeks (p=0.0002) after starting
treatment. The QOL score changes for silodosin group and placebo group were–1.74±1.37 and –1.40±1.31 respectively, showing statistical difference (p=0.0073).
Of the total 511 subjects evaluated for safety profile, 123 subjects reported adverse
events in the silodosin group and 39 subjects in the placebo group and the incidence
rate were 35.9% and 23.2% respectively. The incidence rates of drug­related adverse
events were 30.0% in silodosin group and 19.1% in the placebo group. The mostcommon drug­related adverse events in silodosin group were abnormal ejaculation(7.6%), dry mouth (4.4%), dizziness (3.5%) and in the placebo group were dizziness(4.2%), rash (3.0%), and dry mouth (2.4%).
CONCLUSIONS: Selective α1A­ adrenoceptor antagonist silodosin could
remarkably improve the symptoms and life quality of patients with BPH. The highefficacy and safety of silodosin in treatment for BPH patients with LUTS wereconfirmed in this Chinese population.
4. Influence of polymorphisms and expression of chromogranin A and endothelin­1on the development and progression of prostate cancer
Zhiyong Ma1, Norihiko Tsuchiya1, Takeshi Yuasa1, Takamitsu Inoue1, Teruaki
Kumazawa1, Shintaro Narita1, Yohei Horikawa1, Hiroshi Tsuruta1, Takashi Obara1,
Mitsuru Saito1, Shigeru Satoh1, Osamu Ogawa2 and Tomonori Habuchi1
1Department of Urology, Akita University School of Medicine, Akita, Japan
2Department of Urology, Graduate School of Medicine, Kyoto University, Kyoto,Japan
INTRODUCTION AND OBJECTIVE: Neuroendocrine markers, chromogranin A(CgA) and endothelin­1 (ET­1), are found to be overexpressed in prostate cancer
patients. Recently, it has been reported that CgA triggers ET­1 release, in adose­dependent manner, in human vein endothelial cells. This study investigates theinfluence of polymorphisms and expression of CgA and ET­1 on the development
and progression of prostate cancer.
METHODS: The genetic polymorphism study was conducted on 435 prostatecancer patients, 133 benign prostatic hyperplasia (BPH) patients and 115 were
controls. DNA sequencing and restriction fragment length polymorphism (RFLP)
analysis were used to check the seven polymorphisms (−1106 to −57) in the
promoter region, and the Glu264Asp polymorphism in the exon 6 region of the CgA.
Haploview software, version 3.32 (Daly Lab, MIT, Cambridge, MA) was used toevaluate the linkage disequilibrium status. Expression of CgA and ET­1 was studied
using immunohistochemical (IHC) analysis of prostate cancer specimens obtained
from 114 stage A–D1 prostate cancer patients who underwent radical retropubic
prostatectomy, and from 27 bladder cancer patients, as normal controls, who
underwent radical cystectomy.
RESULTS: Since strong linkage disequilibrium was observed among the sevenpolymorphisms in the promoter region of CgA, only −415T/C polymorphism wasanalyzed. The −415T/C polymorphism showed no relationship with the development,
progression, and prognosis of prostate cancer, or with the IHC grade of CgA andET­1. The Glu264Asp polymorphism of CgA showed a dominant effect on thedevelopment of prostate cancer. Compared to the CC genotype, the GC and GG
genotypes conferred 2.148 and 2.390 times higher risk of prostate cancer,
respectively. However, the Glu264Asp polymorphism showed no relationship with
Gleason score, progression and prognosis of prostate cancer, and CgA or ET­1 IHC
grade. BPH region in the prostate cancer specimens showed higher CgA and ET­1
IHC grade than that in the control specimens (p = 0.033, p = 0.006). The CgA IHC
grade was found to be associated with the clinical stage (p = 0.005) andprostate­specific antigen (PSA) failure (p = 0.016) after radical prostatectomy. ET­1
IHC grade was found to be associated with the Gleason score (p = 0.007).
CONCLUSIONS: The Glu264Asp polymorphism of CgA was found to be
associated with the development of prostate cancer. IHC grade of CgA and ET­1
were observed to be associated with the clinical stage and Gleason score, respectively.
Furthermore, IHC grade of CgA was found to be associated with PSA failure, afterradical prostatectomy. Thus, CgA and ET­1 may play an important role in thedevelopment and progression of prostate cancer.
5. SNP genotyping is useful for genetic predisposition for prostate cancer in Japan

Peng Huang 1, Haruki Kaku1, Jie Chen1, Akira Takao, Masami Watanabe1, Akiko
Sakai2, Takasi Saika1, Yasutomo Nasu1, Kenji Shimizu2 and Hiromi Kumon1
1Department of Urology, 2Department of Molecular Genetics, Okayama University
Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, 700
8558, Japan
We have genotyped more than 50 non­synonymous Missense­SNP of cancer­related
genes in 162 prostate cancer patients and 135 matched healthy males in Japan.
Twelve SNP of 10 genes were significantly affected the incidence of prostate cancer.
These genes included 2 DNA­repair genes, 5 tumor suppressor genes, and 1 each of
metabolizing enzyme gene, chromosome­segregation gene and apoptosis regulator
gene. Cancer­associations of these 9 of 12 SNP are novel findings. Elevenassociations included 9 high­risk and 2 protective associations, odds ratios (OR) of
which ranged between 0.42 – 12.2, and an average statistic power by the
Cochran­Armitage formula was 96% and 88% at the 0.05 and 0.01 significance level,
respectively.
Thus, our novel way of combining the risk factors of the statistically significant SNP
genotypes would be useful for clinical application to predict prostate cancer
predisposition of males in Japan and may contribute for prevention and early
detection of the disease. This strategy can be applied for other malignancies and forother ethnic populations by choosing proper SNP combinations.
Furthermore, in 2008’s competition for government Special Coordination Funds for
Promoting Science and Technology, Okayama University’s proposal of “AnAsia­wide translational research on high­risk group detection based on ms­SNP andIL­12 immunogene therapy for prostate cancer” has been adopted to consolidate
translational research infrastructure in Asia with the cooperation of top institutes in
China, Korea and Singapore.
6. Diagnosis and treatment of Renal cell carcinoma associated with vonHippel­Lindau disease
Zhang Jin, Xue Wei
Liu Dong­ming, Huang Yi­ran, Zhou Li­xin, Chen Hai­ge,
Chen Qi
Department of Urology, Renji Hospital, Shanghai Jiaotong University Medicine
School, 1630 Dong Fang Road, Shanghai, 200127, People’s Republic of China
OBJECTIVE: To present our experience about the management of RCC associatedwith von Hippel­Lindau (VHL) disease.

METHODS: Clinical data were analyzed retrospectively from 28 cases (16 males
and 12 females) with RCC associated with VHL disease, of whom 15 had bilateral
RCC and 13 had unilateral RCC. VHL germline mutation was analyzed in 25 cases.
Nephron sparing surgery (NSS) or Radical nephrectomy was performed in 24 cases.
RESULTS: VHL germline mutations were detected in 25 cases including 14
asymptomatic cases. Among 29 solid renal tumors in 9cases observed for a meantime of 43.6months (range 12 to 86 months), the median increase in tumor size was
0.531cm/ year. There were 19(65.5%) tumors >3cm at the end of follow­up but only
one developed retroperitoneum lymph nodes metastasis. A total of 87 solid tumors
were removed and 62 (71.2%) solid tumors were managed by NSS. Pathologicalresults showed 86 clear cell carcinomas (73 Fuhrman I and 12 Fuhrman II) and 1
calcified lesion. During mean follow­up of 49.5 months, local recurrence occurred in
4 cases treated with NSS; 26 patients were alive at the end of follow­up.
CONCLUSIONS: DNA testing is helpful in the earlier detection of asymptomaticpatients. Most solid renal tumors in VHL disease grow slowly. Many of the tumors >3 cm may still be indolent and do not metastasize during longer follow­up and can beobserved. NSS is effective and safe for RCCs in VHL disease.
KEYWORDS: Hippel–Lindau disease, germline mutation, renal cell carcinoma,
nephron ­sparing surgery, natural history.
7. Ten­year Biochemical Disease­free Survival After High Intensity Focused
Ultrasound (HIFU) For Localized Prostate Cancer: A Comparison Of Three
Different Generation Devices
Toyoaki Uchida1, M. Nakano1, S. Shoji1, T. Omata1, Y. Harano1, Y. Nagata1, Y.
Usui2, T. Terachi2. 1Tokai University Hachioji Hospital, Hachioji; 2Tokai University,
Isehara, JapanINTRODUCTION: HIFU is recognized as a minimally invasive treatment option
for localized prostate cancer. The purpose of the study was to assess the long­term
outcome of HIFU for prostate cancer.
METHODS: From January 1999, a total of 662 patients who received HIFU with atleast a 1­year follow­up were treated with three different types of Sonablate® (Focus
surgery, Indianapolis, USA) devices. Thirty­two patients were treated with
Sonablate® 200 (S200) from 1999 to 2001, 406 patients with Sonablate® 500 (S500)
from 2001 to 2005 and 224 patients with Sonablate® 500 version 4 (V4) from2005­2008. Biochemical failure was defined according to the criteria recommended

by the revised American Society for Therapeutic Radiology and Oncology (ASTRO),
i.e., a rise of 2 ng/ml or more above the nadir PSA, consensus panel. None of thepatients received a post­HIFU androgen deprivation or other anticancer therapy
before the documentation of a biochemical failure. The Kaplan­Meier analysis andlog­rank test were employed for the analysis.
RESULTS: The mean age, PSA and Gleason score in S200, S500, and V4 groups
were 71, 68, and 67 years, 15.4, 12.3, and 10.2 ng/ml, and 5.6, 6.3, and 6.6,
respectively. The mean operation time in S200, S500, and V4 groups were 174 min,
123 min, and 68 min, respectively. The mean operation time was shortened in V4
group (p<0.0001). The mean follow­up months in S200, S500, and V4 groups were46, 34, and 21 months, respectively. The biochemical disease­free survival rate
(BDFR) in all patients was 57% in 8 years. The BDFR in 8 years in patients with
S200 and S500 groups were 56% and 53%, and BDFR in 3 years in patients with V4
group was 83%. The BDFR in the low, intermediate, and high risk groups were100%, 53%, and 30% in S200, 69%, 48%, and 46% in S500, and 95%, 88%, and
65% in V4 group, respectively. The negative prostate biopsy rate after HIFU was
100% in S200, 79% in S500 and 93% in V4 group. Post operative urethral stricture,
epididymitis, and urinary incontinence (grade I) were noted in 20.7%, 5.7%, and1.5% of the patients, respectively. Erectile dysfunction (IIEF­5 score ≤ 7) was
observed in 40% in the S500 and in 34% in the V4 group.
CONCLUSIONS: HIFU is indicated as the primary therapy for prostate cancer forwith low­ and intermediate­risk patients (T1­T2b N0M0 disease, a Gleason scoreof≤7, a PSA level of<20 ng/mL) and those with a prostate volume of less than 40 mL.
The clinical outcome has significantly improved over the years due to technicalimprovements in the device.
8. A new urinary diversion by ileal reservoir with extracorporal self­controllable
urination
Xiuheng Liu
Xiaobin Zhang, Fan Cheng
Department of Urology, Renmin Hospital, Wuhan University, Wuhan, China
BACKGROUND: Total cystectomy and urinary diversion are the most effective
treatment for patients with invasive bladder cancer, severe bladder contraction,
vesicorectal or vesicovaginal fistula and other urological diseases. However, what is
the most satisfactory procedure for bladder substitute remains controversial. Various
types of urinary diversion including many new continent reservoir have beendeveloped, however no one is good enough to meet the needs of all patients.

Exploring more satisfactory way of urinary diversion is still the key subject ofurology.
OBJECTIVE: To investigate the feasibility and effect of the urinary diversion by
ileal reservoir with self controllable urination.
METHODS: A segment of 40 cm ileum was taken, from which, the middle 24 cm
portion was made into N shaped reservoir, the proximal 6 cm ileum was used asafferent limb. The distal 10cm ileum was pulled out off the stoma where the two skinflaps were taken and encircled the efferent ileum to constitute the urinary outflow. A
urinary controller similar to penile clamp was applied to control the urination with aballoon. Postoperative urodynamic examination of the reservoir and X ray
photography (KUB+IVU, retrograde) were taken, and body metabolic changes wereobserved.
RESULTS: The procedure was applied on 32 patients. All the patients recovered
well from the operation and were followed up for 3 to 56 months. Biochemical
detection of metabolism revealed normal levels of electrolytes, renal function andhepatic function after operation. On first month, the reservoir reached a maximum
capacity of (260 ± 60) ml, a full filling pressure of (33.2 ± 9.5) cmH2O, a maximum
urinary flow rate of (18.4 ± 5.6) ml/s, and had poor compliance without residual
urine. On 48 month, the human reservoir reached a maximum capacity of (380±90)
ml, a full filling pressure of (33±5.5) cmH2O, a maximum urinary flow rate of(24.±6.5) ml/s, and had good compliance without residual urine. Postoperative X ray
photographical examinations showed good renal function and structure, noobstruction of the ureters. Retrograde photography revealed excellent filling of thereservoirs without retrograde flow into ureter. Most of the patients can control
urination through the urinary controller, when the balloon was filled, urination
stopped, when the balloon was emptied, urine passed out as a line.
CONCLUSIONS: The new procedure has advantages of self control of urination
without the need of urine collecting bags or self catheterization, little disturbance on
metabolism, simple surgical performance and few complications.
KEYWORDS: Urinary diversion; lieum; Reservoir; Self control; Urination
9. Honokiol, a natural plant product from magnolia tree, inhibits the bonemetastatic growth of human prostate cancer cells
Katsumi Shigemura1, 2, 4, Leland WK Chung4, Jack L Abiser5, Akinobu Gotoh3,
Masuo Yamashita2, and Masato Fujisawa1

1

Department of Urology, Kobe University Graduate School of Medicine, Kobe,Japan
2
Department of Urology, Akashi Municipal Hospital
3
Laboratory of Cell and Gene Therapy Institute for Advanced Medical Sciences,
Hyogo College of Medicine, Nishinomiya, Japan
4
Molecular Urology and Therapeutics Program, Department of Urology, Winship
Cancer Institute, and 5Department of Dermatology, Emory University School of
Medicine, Atlanta, Georgia, USA.
BACKGROUND: Honokiol, a soluble nontoxic natural product derived from
Magnolia spp., was reported to induce apoptosis in caner cells. In this study, weinvestigated the effect of honokiol and the combined with docetaxel on prostatecancer (PCa) growth and its bone metastasis in experimental models.
METHODS: We investigated in vitro proapoptotic effects of honokiol on humanandrogen­dependent and ­independent PCa, bone marrow, bone marrow­derived
endothelial, and prostate stroma cells. Honokiol­induced activation of caspases wasevaluated by FACS analysis and Western blot. Mice bone was inoculated in vivo
with androgen­independent PCa, C4­2 cells and the effects of honokiol and/or
docetaxel on PCa growth in bone were evaluated. Daily honokiol (100 mg/kg) and/or
weekly docetaxel (5 mg/kg) were injected intraperitoneally for 6 weeks. PCa growth
in mouse bone was evaluated by radiography, serum prostate­specific antigen (PSA),
and tissue immunohistochemistry.
RESULTS: Honokiol inhibited cell growth tested like above through the inductionof apoptosis in all cell lines tested. In PCa cells honokiol­induced apoptosis was via
the activation of caspases 3, 8, and 9, and the cleavage of poly­adenosine
diphosphate ribose polymerase in a dose­ and time­dependent manner. Honokiol was
shown to inhibit the growth and depress serum PSA in mice harboring C4­2
xenografts in the bone and the combination with docetaxel showed additive effects
that inhibited further growth without evidence of systemic toxicity.
Immunohistochemical staining confirmed honokiol exhibited growth­inhibitory,
apoptotic, and antiangiogenic effects on PCa xenografts.
CONCLUSIONS: The combined therapy of honokiol and low­dose docetaxel may
improve patient outcome in androgen­independent prostate cancer with bonemetastasis.
10. Retroperitoneoscopic nephroureterectomy with transurethral bladder­cuff
excision for renal pelvic and ureteral tumors.

LIU Xiao­qiang ZHANG Gao­feng, WANG Yi, SUN Guang, et al.
Department of urology, the second hospital of Tianjin medical university, Tianjin
Institute of Urology, 300211, Tianjin, China
OBJECTIVE:
To report
ourexperience with retroperitoneoscopic
nephroureterectomy with excision of a bladder­cuff for renal pelvic and ureteraltumors.
METHODS: Thirty­two patients (18 women and 14 men; mean age, 68 years; age
range, 48­83 years) with upper urinary tract tumors underwent retro­peritoneal
laparoscopic nephroureterectomy with excision of a bladder­cuff. Of the 32 cases, 12with pelvic tumors and 20 with ureteral tumors; 17 cases had the tumors on the rightside and 15 on the left. Two cases had ureteral tumors combined with bladder tumors.
The needle electrode was used to circleround incise the bladder thoroughly 0.5 cm
away from the ureterostoma. Three trocars in the waist were used for dissecting thekidney; and the ureter was dissected as far distally downward. Then an incision of 6 ­10 cm was created in the waist just connect 2 of the trocars to allow dissection of the
distal ureter and bladder­cuff and intact specimen extraction.
RESULTS: The operation was successful in 31 patients. One case received open
surgery later because of duodenal leakage. The mean operative time was 3.5 h (range,2­6.5 h). The mean estimated blood loss was 163 ml (range, 25­1500 ml). Threecases received blood transfusion, the amount of blood transfusion was 400ml­600ml.
The patient’s activity recovered in 24 ­ 32 h after operation. Postoperative pathology
showed transitional cell carcinoma in 30 cases, poorly differentiated adenocarcinoma
in 1 (ureter), squamous cell carcinoma in 1(ureter). Duodenal leakage occurred in 1
patient who had had history of percutaneous nephroscope(PCN) before the operation,
open surgery was done and the leakage was repaired successful. Postoperative
vesical irrigation was performed to prevent tumor recurrence. The mean hospital stay
was 12 d. During a mean follow­up of 15 months (range, 2­36 months), 1 patientdeveloped pelvic and bladder metastasis after 2 months and was alive with the tumor.
1 patient developed bladder tumor after 2 years and was alive underwent TUR­BT .1
patient died of heart disease after 3months. The other 29 patients survived free oftumor to date.
CONCLUSIONS:
Our
data
demonstratethat
retroperitoneoscopic
nephroureterectomy for renal pelvic and ureteral tumors has shorter incision andmore rapid postoperative recovery compared with open surgery. Using resectoscope
to resect the termination of ureter allows more complete excision of the ureter.
KEYWORDS: Kidney pelvis; Ureter; Carcinoma; Laparoscopy

11. Retroperitoneal laparoscopic vs open approach o nephrectomy in T1 renal cell
carcinoma
Qing Yang
Linhui Wang
Liang Wang
Jianguo Hou
Chuanliang Xu
Yinghao Sun*
Department of Urology, Changhai Hospital, 168 Changhai Road, Shanghai, 200433,
China
INTRODUCTION: In 1990, Clayman et al. [1] were the first to perform alaparoscopic radical nephrectomy for a tumor­bearing kidney. Since then, thelaparoscopic approach has become widely accepted, with the benefits of decreased
postoperative pain, bleeding, decreased hospital stay, and faster recovery times thanwith the open approach. [2–5]. We will try to demonstrate that laparoscopic radical
nephrectomy could be the new gold standard treatment for renal cell carcinoma withthe aid of our experiences and the current reports exploring the advantages anddisadvantages of retroperitoneal laparoscopic radical nephrectomy over open surgery
in T1 RCC. Reported perioperative outcomes like operating time, blood loss,
postoperative analgesia requirement, and length of hospital stay and duration ofconvalescence had been found to be in favor of laparoscopic radical nephrectomy.
METHODS: We retrospectively analyzed the data of 352 patients who undergoingradical nephrectomy for renal cell carcinoma from Nov 2003 to Nov 2007, of these,
185 underwent retroperitoneal laparoscopic radical nephrectomy and 167 underwent
open radical nephrectomy through an extraperitoneal 11th rib flank incision.
Inclusion criteria comprised clinically organ­confined tumors of 7 cm or less in size
without concomitant lymphadenopathy or vena cava thrombus. The operation time,
hospital stay, narcotic requirement, blood loss during operation and complication
after surgery were analyzed and compared. All the cases were followed up for 6­42months and the survival rates, wound healing, and carcinoma metastasis wererecorded. Oncological follow­up data were obtained from radiological reports inclinic service and phone calls to patients or their families, and were calculated fromthe date of surgery to the date of last appointment with physician or date of death.
RESULTS: All laparoscopic procedures were completed without open conversion.
There was a statistically significant difference between retroperitoneal laparoscopic
radical nephrectomy and open radical nephrectomy in blood loss, fasting period,
length of hospital stay, the time to resume routine activities and total narcotic
requirement after surgery; The operation time was similar in the 2 groups; Allvariables (except operative duration) lower in the retroperitoneal laparoscopic radical
nephrectomy group. The follow up data shows that the overall survival was 81% vs
79% (P = 0.46), and cancer­specific survival was 91% vs 93% (P =0.68),
respectively.
CONCLUSIONS: Compared with open radical nephrectomy, Retroperitoneal
laparoscopic radical nephrectomy is associated with lower blood loss, narcotic
requirement and complications, a shorter hospital stay and earlier resumption ofroutine activities. Retroperitoneal laparoscopic radical nephrectomy for renal cancer
confers equivalent oncological outcomes to those of open surgery. Retroperitoneal
laparoscopic radical nephrectomy has become a golden standard therapy in T1 renal
cell carcinoma.
KEYWORDS: Retroperitoneal laparoscopy; minimally invasive, renal cell
carcinoma. Nephrectomy
12. Laparoscopic Partial Nephrectomy without renal artery control in 18 Patientswith renal tumor
ZHANG Yao­guang WANG Jian­ye, WAN Ben, WEI Dong
Department of Urology, Beijing Hospital, Beijing, 100730, China
PURPOSE: Hemostasis represents a primary challenge during laparoscopic partial
nephrectomy (LPN). We evaluated harmonic scalpel assisted LPN without renal hilar
vascular control in patients.
MATERIALS AND METHODS: LPN using harmonic scalpel was performed
without renal hilar vessel control in 18 Patients with renal tumor.
The renal artery was revealed and circled by tape. So if bleeding happened, the renalartery could be controlled easily and quickly. Any defects in the collect systems wereclosed by sutures and seal glue. Followup involved biochemical, radiographic
evaluation consisted of chest X­ray and CT or MRI of the abdomen at 1, 3, and 6
months and semiannually thereafter for 2 years.
RESULTS: All LPNs were completed successfully without open conversion andwithout artery control. Mean size of tumor was 3.8cm. (SD±1.5), mean operation
time were 136.5 minutes (SD± 52.1) and mean estimated blood loss were 188
ml(SD±102). Preoperaton and postoperation (3Mons) serum creatinine were 85
umol/l (SD±25) and 90 umol/l (SD±27) respectively. Hospitalization days were 3.8(SD±2.2). Pelvicaliceal suture repair was necessary in 2 of 18 kidneys (11%). In one
case unexpected lymphorrhagia led to prolonged drainage time. No blood products
were given intraoperatively but postoperative transfusion in one case. No positivemargin was reported. No positive result was found by radiographic evaluation in 24
months after operation.
CONCLUSIONS: Laparoscopic partial nephrectomy without renal artery control ispossible especially for experienced surgeons. This skill could get a very good result
for renal function recovery, blood lose and negative margin.

13. CKD as a risk factor for synchronous bladder cancer in Chinese patients withupper urinary tract urothelial carcinoma
Yu Wei
Institute of Urology, Peking University
BACKGROUND: Some studies had reported that Chinese patients with chronic
kidney disease (CKD) appeared to be at greater risk of upper urinary tract urothelial
carcinoma (UUTUC). However; to date, only limited studies analyzed the clinicalcharacteristics of the Chinese UUTUC patients with CKD. The aim of this study is to
examine CKD as a risk factor for synchronous bladder cancer in a cohort of Chinesepatients with UUTUC.
MATERIALS AND METHODS: Between 2005 and 2007, 161 patients (61 men
and 100 women, mean age 67 years, range 37­87) underwent surgical management at
our institution for pathologically proven UUTUC. We reviewed clinical, surgical, andpathological data from these patients, and used univariate and multivariate analyses
to determine prognostic variables for synchronous bladder tumor. Presence of CKD
according to preoperative markers of kidney damage, estimated glomerular filtration
rate calculated using the Modification of Diet in Renal Disease Study equation.
RESULTS: Of the 161 Chinese patients, 20 (12.4%) had simultaneous bladdertumor and UUTT. 93 patients (57.8%) had CKD. Univariate analyses showed thatpatients with CKD (p=0.008) and the history of urothelial carcinoma (p=0.001) werelikely to have synchronous intravesical disease; however, there was no significant
impact of other factors on the synchronous intravesical disease, including age, gender,
presentation (haematuria or others), tumor side, tumor location, tumor grade, lymph
node metastasis. Furthermore, CKD (HR 4.042, 95% C.I. 1.271­12.855, p=0.018)
and the history of urothelial carcinoma (HR 5.596, 95% C.I. 2.138­14.648, p<0.001)
were identified as independent predictors for the development of recurrent bladdercancer by multivariate analyses.
CONCLUSIONS: These findings suggest that the incidence of synchronous bladdercancer in Chinese patients with UUTUC is not very low. Concurrent CKD and thehistory of urothelial carcinoma are associated with greater risk of synchronous
bladder cancer in these patients.
14. Clinical implication of stone culture in percutaneous nephrolithotomy
Huang Xiao­bo
Department of Urology, Peking University People’s Hospital, Beijing 100034, China
OBJECTIVE: To evaluate the correlation between stone culture and SIRS, ascertain
the clinical implication of stone culture in PCNL.
METHODS: Clinical data of 66 patients who underwent PCNL in our department
were analyzed retrospectively. Eight risk factors including stone culture + drug
sensitivity, urine culture + drug sensitivity, age, gender, prophylactic antibiotics,
stone volume, operative time and the number of tract. Multiple statistics methods
were used for analysis to evaluate the impact of SIRS, and compare the difference
between stone culture and urine culture.
RESULTS: Univariate analysis and Multivariate logistic regression model showedthat positive stone culture was the risk factor of SIRS (p<0.05). Positive stone culture
was found in 48.48% patients, which was higher than that of urine culture (30.30%).
Fourteen patients of 21 postoperative SIRS patients were prescribed antibiotics
according to the stone culture result. And all of them recovered unevenly without
developing septic shock or MODS.
Conclusions Positive stone culture is the important risk factor of post­PCNL SIRS.
Stone culture is better than urine culture in directing postoperative antibiotics
prescription and should be routinely used.
15. Estrogen and Selective Estrogen Receptor Modulators Inhibit Cell
Proliferation in Prostate Carcinoma Cell Line PC3 Cells
Yuxi Zhang
Jianbin Bi, Zhenhua Li, Chuize Kong
Department of Urology, The First Affiliated Hospital of China Medical University,
Shenyang, China
OBJECTIVE: To examine whether estrogen, tamoxifen and raloxifene have anantiproliferative effect on and stimulates the ERK1/2, JNK and p38 cascades in PC3
cells.
MATERIALS AND METHODS: PC3 cells were treated with different
concentrations of 17β­estradiol, tamoxifen and raloxifene, and the method of MTT

was used to detect the inhibition rate. Morphology changes of apoptosis wereobserved by hoechst and TUNEL staining. The expressions of ER­α, ER­β,
P21WAF1, and cyclinD1 were detected by RT­PCR. The expressions of Bcl­2,
caspase­3, p­Bcl­2 and Bax were measured by immunohistochemical staining or
western blot.
RESULTS：Expressions of mRNA of ER­α and ER­beta were detected in PC3 cells.
A dose­dependent proliferation inhibition of 17β­estradiol, tamoxifen and raloxifene
was demonstrated in PC3. Morphology changes of apoptosis were detected in PC3
cells. The expression of Bcl­2 decreased and the expression of caspase­3 increased in
PC3 cells. 17β­estradiol and tamoxifen induced the activation of ERK1/2, JNK and
p38 in PC3 cells with different time courses. Raloxifene could only induce theactivation of ERK1/2 and p38.A G1 cell cycle arrest was induced in PC3 exposed to17β­estradiol, tamoxifen and raloxifene. Suppression p38 activation blocked thecell­cycle arrest at the G1 phase by 17beta­estradiol.
CONCLUSIONS: 17β­estradiol, tamoxifen and raloxifene induced apoptosis andG1 cell cycle arrest via MAPK in PC3 cells.
KEYWORDS: Prostate carcinoma; Estrogen; Apoptosis; 17β­estradiol; Tamoxifen;
Raloxifene