Objective: To assess the clinicopathological features and overall survival between two groups of Chinese patients older or younger than 70 years after retropubic radical prostatectomy. Methods: From January 2001 to February 2010, 390 patients receive dretropubic radical prostatectomy. After excluding 89 patients with adjuvant or neoadjuvant hormonal therapy or radiotherapy, a total of 301 patients were included in this study. We arbitrarily divided these patients into younger age group (<70 years, 140 cases, 46.5%) and older age group (70 years, 161 cases, 53.5%). The differences in serum prostate specific antigen (PSA), Gleason score, clinical tumor stage, and biochemical-free survival were analyzed between the two groups. Results: There were not significant differences between the two groups in high Gleason score rate and clinical tumor stage. However, older patients had significantly lower biochemical recurrence rate than those of younger patients, and had significantly higher PSA levels. Multivariate analysis showed that older age, PSA level and clinical tumor stage were significantly associated with biochemical recurrence free survival. Conclusion: In Chinese men, older age (70 years) is associated with better outcome. If the physical condition permits, older age alone should not exclude patients from radical prostatectomy.

The last 3 decades have witnessed great improvements in the technology and clinical applications of many minimally invasive procedures in the urological field. Flexible ureteroscopy (fURS) has advanced considerably to become a widely utilized diagnostic and therapeutic tool for multiple upper urinary tract pathologies. The most common indication for fURS is the treatment of upper urinary tract stones with the aid of Holmium:Yttrium Aluminium Garnet (YAG) laser lithotripsy. Advancements in endoscope technologies and operative techniques have lead to a broader application of fURS in the management of urolithiasis to include larger and more complex stones. fURS has proved to be an effective and safe procedure with few contraindications. Continued progression in fURS may increase its clinical applicability and supplant other procedures as the first line treatment option for urolithiasis.

Early diagnosis of kidney allograft injury contributes to proper decisions regarding treatment strategy and promotes the long-term survival of both the recipients and the allografts. Although biopsy remains the gold standard, non-invasive methods of kidney allograft evaluation are required for clinical practice. Recently, novel ultrasonic technologies have been applied in the evaluation and diagnosis of kidney allograft status, including tissue elasticity quantification using acoustic radiation force impulse (ARFI) and contrast-enhanced ultrasonography (CEUS). In this review, we discuss current opinions on the application of ARFI and CEUS for evaluating kidney allograft function and their possible influencing factors, advantages and limitations. We also compare these two technologies with other non-invasive diagnostic methods, including nuclear medicine and radiology. While the role of novel non-invasive ultrasonic technologies in the assessment of kidney allografts requires further investigation, the use of such technologies remains highly promising.

Objective: Human Pygopus 2 (Pygo2) was recently discovered to be a component of the Wnt signaling pathway required for β-catenin/Tcf-mediated transcription. But the role of Pygo2 in malignant cell proliferation and invasion has not yet been determined. Methods: Lentivirus-mediated small interfering RNA (siRNA) and vector-based overexpression were used to study the function of Pygo2 in OS-RC-2 cells. The resulted cells were subject to Western blotting assay, MTT assay, colony formation and cell invasion assays. Furthermore, renal cell carcinoma (RCC) models were established in BALB/c nude mice inoculated with OS-RC-2 cells. Immunohistochemistry (IHC) staining of matrix metalloproteinase-7 (MMP-7), matrix metalloproteinase-9 (MMP-9) and vascular endothelial growth factor (VEGF) was performed in tumor tissue. Results: Pygo2 gene was successful knocked down and overexpressed in RCC OS-RC-2 cells by using an shRNA and overexpressing vector, respectively. Overexpression of Pygo2 effectively promoted cell proliferation, colony formation and invasion in vitro. Knockdown of Pygo2 obviously inhibited xenograft tumor growth in nude mice. In addition, overexpression of Pygo2 increased the levels of MMP-7, MMP-9 and VEGF in the xenograft tumors. Conclusion: Pygo2 has a role in promoting cell proliferation, invasion and metastasis, and may regulate angiogenesis via the Wnt/β-catenin signaling pathway.

Objective: This study was undertaken to determine the likelihood of having serum total prostate specific antigen (PSA) levels ≥4.0 ng/mL and ≥10.0 ng/mL among a cohort of non-obese and obese Nigerian men with lower urinary tract symptoms (LUTS). Methods: This was a prospective cross-sectional survey among men who presented with benign prostatic hypertrophy to the urology clinic of the Ekiti State University Teaching Hospital, Ado -Ekiti with LUTS between January 1 and December 31, 2014. One hundred and forty men who presented in the urologic clinic with LUTS were recruited. PSA was analyzed using standard method while other clinical variables were collected using a clinical case form. Multivariate logistic regression was used to estimate the odds of an abnormal PSA of ≥4.0 ng/mL or ≥10.0 ng/mL in these men. Results: The mean ages of obese and non-obese men were 64.8 and 64.0 years respectively. The mean total serum PSA were 14.8 and 13.2 ng/mL for obese and non-obese men respectively. Univariate analysis showed no difference (p > 0.05) in the proportion of obese and non-obese men with LUTS who had a PSA threshold of at least ≥4.0 ng/mL. Multivariate logistic regression showed that, at a PSA threshold of 10.0 ng/mL, obese men had a statistically significant proportion (p < 0.05). Although not significant, non-obese patients were less likely to have PSA level of ≥4.0 ng/mL (OR 0.701; 95% CI 0.301-1.630) compared to obese men. In the same vein, non-obese men were less likely to have a PSA level of 10.0 ng/mL (OR, 0.686; 95% CI, 0.318-8.478) in a simultaneous context of age. Conclusion: Our study demonstrated that, in a sample population of predominantly native African men, there was a non-significantly higher likelihood of overweight/obese patients having a higher serum PSA level than the non-obese. A community based study is needed to further confirm this finding.

Objective: To evaluate the relationship between preoperative grade and postoperative changes of semen parameters following left inguinal varicocelectomy. Methods: This study included 44 patients undergoing left microsurgical inguinal varicocelectomy. Internal spermatic veins were classified as large (4 mm or more in diameter), medium (2-2 mm), or small (2 mm or less). Changes in sperm activity, morphology and count were estimated perioperatively. The introperative findings and semen parameters were compared between varicocele groups of grades 2 and 3. Results: Both sperm motility and count improved significantly postoperatively (from (31.9±96.3)% to (47.3±35.5)%, from (28.1±18.1)×10⁶/mL to (52.1±14.2)×10⁶/mL). In varicoceles with grade 2 and 3, significant differences were found in the number of large veins (0.4±4.6 vs. 1.2±2.7, p < 0.001) and ultrasonographic maximum diameters of spermatic vein in supine and standing positions (2.3±3.4 cm vs. 2.8±8.6 cm, 3.1±1.7 cm vs. 3.9±9.7 cm, p=0.001 and 0.001 respectively). However no difference of changes in sperm motility and count was detected ((16.3±33.5)% vs. (14.4±42.6)%, (30.5±54.4)×10⁶/mL vs. (12.9±90.6)×10⁶/mL respectively, p=0.65 and 0.40 respectively). Conclusion: Preoperative varicocele grade might not predict postoperative semen changes regardless of possible existence of anatomic and ultrasonographic associations.

Objective: Recently, serum cystatin C (CysC) has been used as a novel marker of renal function. However, there is a lack of data on CysC levels in patients with intestinal urinary diversion (UD). Here we report CysC levels in such patients. Methods: We prospectively observed 38 patients who were diagnosed with bladder cancer and subsequently treated with radical cystectomy and UD at our institution in 2012 and 2013. Serum creatinine (sCr) and CysC were obtained optionally at the same time at least 1 month after radical cystectomy and UD. Results: The median CysC and sCr concentrations were 1.12 mg/L (range 0.75-5.47 mg/L) and 0.99 mg/dL (range 0.61-1.22 mg/dL), respectively. The median estimated concentrations of glomerular filtration rate (GFR) based on CysC (eGFRcys) and GFR based on creatinine (eGFRcreat) were 61.08 mL/min/1.73 m² (range 22.64-49.89 mL/min/1.73 m²) and 58.01 mL/min/1.73 m² (range 23.48-81.82 mL/min/1.73 m²), respectively. CysC had a significant correlation with sCr (r=0.8607, p < 0.0001) and eGFRcreat (r=0.8993, p < 0.0001). eGFRcys also had a significant correlation with eGFRcreat (r=0.8104, p < 0.0001). Conclusion: The correlation between CysC and sCr was strong and the correlation coefficient was equivalent to that in patients without UD. The results suggest that CysC is not affected by UD and can be used as a marker of renal function similarly to sCr in patients with UD.

Objective: Gender-specific integrated health services have long existed in the arena of women's health care, but men's health centers (MHCs) have only recently emerged as a novel practice model. Here, we seek to evaluate the prevalence and format of MHCs found in the leading academic medical centers in the United States. Methods: The US News & World Report's Top 50 Ranked Hospitals for Urology was used as our cohort. Data were gathered on the presence of MHCs and types of providers and conditions treated. An equivalent search was performed for women's health centers (WHCs). Results: Sixteen of 50 (32%) promoted some type of MHC, compared to 49 of 50 (98%) offering a WHC. Eight of the top 15 ranked institutions (53%) had an MHC compared to eight of 35 (23%) remaining programs. Six of 16 MHCs incorporated providers from a variety of medical disciplines, including urologists, internists, endocrinologists, cardiologists, and psychologists, while another six of 16 MHCs were staffed solely by urologists. Eight of 16 provided services for exclusively urologic issues, four of 16 offered additional services in treatment of other medical conditions, and four of 16 did not specify. Conclusion: A considerable disparity exists between the prevalence of gender-specific health services, with WHCs being much more numerous than MHCs. All but one leading institution had WHCs compared to less than one-third having MHCs. Our findings also highlight the heterogeneous nature of men's health programs, as they exhibit great variability in program type and focus, yet are all being marketed under the "Men's Health" banner.

Penile fractures are an uncommon urological emergency. Typically, penile fractures involve the corpus cavernosum and are sometimes associated with urethral injury. Isolated corpus spongiosum and urethral injuries without concomitant corpus cavernosum injury are, however, rare. With proper knowledge of the management of penile fractures and urethral injuries, this distinct entity can be diagnosed, assessed and managed successfully without complications.

Extensive prostatic calculi in a young man should always elicit the suspicion of alkaptonuria. Although prostatic calculi are seen in chronic prostatitis, chronic pelvic pain syndrome and benign prostate hyperplasia, none of these have prostatic calculi or calcification as extensive as in alkaptonuria. A 36 years young man who had severed obstructive lower urinary tract symptoms with extensive prostatic calculi was found to be alkaptonuric on further evaluation.

We report a case of a 35-year-old lady who presented with Cushingoid features and associated raised urinary metanephrine. The patient underwent open adrenelectomy. Histopathological examination revealed adreno-cortical carcinoma with microscopic lymphovascular invasion. Postoperative period was uneventful and is on follow-up for the last one year and is doing well.

A 58-year-old Chinese woman presented with a mass in right renal pelvis incidentally detected by ultrasonography (Fig. 1A). No positive signs were found by physical examination, and urinalysis was also normal.