Urinary Surgery Institute

The Department of Urinary Surgery  was founded in early 1940s, more than 60 years so far. Under the leadership of former academic leaders and well-known professors including Huang Zheng, Xie Tong, Xu Qinjun, Tang Xiaoda, Zhang Xianyou, Tan Jianming and Xia Shujie, now it has become one of the most prestigious disciplines in Shanghai and even the nation after several years of efforts, especially the construction of key medical discipline for three cycles in succession in recent 16 years. It has created its own characteristics and domestic leading advantages in minimally invasive endoscopic operation of urinary surgery, renal transplantation, dialysis therapy for end-stage renal diseases and other basic research, and event reaches to world-leading level in the research and clinical work of some fields.

The General Hospital is one of the first hospitals to introduce the concept of minimally invasive surgical treatment and to conduct minimally invasive treatment of urinary surgery. In 1947, then Director of the Department of Urinary Surgery Prof. Huang Zheng returned from Germany took the lead in performing the transvesical enucleation of the prostate on pubis through a small incision. Now there are more than 10000 cases in total, which lays a foundation for the basic concept of minimally invasive treatment for prostate of minimally invasive urology in China. Over the past three decades, it has become an operation which has to be learned by the class for further studies of national urinary surgery in Shanghai for popularization. In early 1960s, Prof. Xie Tong first made a research on selective renal arteriography and artificial control of urination, becoming a pioneer in researching renal interventional examination and urodynamics. In 1970s, it put forward the theory on the mechanism of chyluria created from "back flow of lymph", which clarifies the vague idea on chyluria.

It started the experimental research on renal transplantation and hematodialysis in 1972, performed clinical haemodialysis in 1974 and made clinical renal transplantation from corpse in 1976. Therefore, it is one of the first hospitals to conduct renal transplantation and hematodialysis to treat end-stage renal diseases. In 1980, it took the lead in making research on tissue typing for renal transplantation. In 1984, it became the first department which applies cyclosporine A in clinical practice and established the detection system for blood concentration of cyclosporine A, which significantly promotes the development of renal transplantation in China and makes it reach the world-leading level. In 1988, "Chinese Dialysis & Transplantation Association" was founded by Prof. Xie Tong. In 1995, urinary surgery became the first batch of leading key discipline of Shanghai. It has completed construction of three consecutive cycles under the leadership of Prof. Xie Tong, Prof. Tang Xiaoda and Prof. Xia Shujie. In 2005, the Urinary Surgery Institute of Shanghai Jiao Tong University was founded under the leadership of Prof. Xia Shujie. With the strong support of the predecessors and leader from the Andrology Department, Andrology Branch of Chinese Medical Doctor Association was established under the leadership of Prof. Xia Shujie in 2014. In addition, Prof. Xia Shujie served as the Assistant Editor of AJA and set up an Editorial Department of AJA in Shanghai General Hospital, which instills new vitality for the development of andrology. In recent years, the discipline has had a good development in clinical medical service, scientific research, teaching and construction of sub-discipline.

1. Clinical Medical Service

The Department of Urinary Surgery has three inpatient areas with 140 fixed beds in both the southern and northern parts of the Hospital. In recent three years, it has outpatients and emergency patients about 120000 persons and inpatients about 4923 persons each year.

(1) In prostatic and control of micturition surgery, minimally invasive endoscope treatment technology has been applied for 25 years. In 2001, it took the lead in performing the minimally invasive holmium laser enucleation of the prostate (HoLEP) in China.

In 2004, it developed the thulium laser resection of prostate-tangerine technique to treat BPH, i.e. simulate the fingers of the surgeon with laser knife to peel off the hyperplastic prostate tissue from the capsule of prostate like an orange, cut the prostate tissue into pieces with the powerful thulium laser and take it out through the urethra. Bleeding seldom occurs during operation, which greatly improves operation safety and effectiveness. Primary works have been published on EU magazine (IF13.938) and received high praise from the academic circles of the world. Prof. Stavros Gravas, F1000 scholar of the world, pointed out that the "thulium laser resection of prostate-tangerine technique" created by Prof. Xia Shujie led the treatment of BPH with laser to bottom out. "The research on comparison between the new method firstly created in world and the traditional method achieves good clinical effect", commented by German prof. Seitz. The Department now has completed 1660 clinical cases. More than 40 relevant organizations have visited and learned from our hospital, including those from France, German, Taiwan, China and Hong Kong, China. Prof. Xia Shujie was invited to demonstrate how to perform a operation and make academic report at International Society of Urology Congress (SIU), WCE, Urological Association of Asia Congress, Annual Meeting for Laser of Eastern Asia. He was also invited to perform operations at Cochen Hospital of Université Paris Descartes, University Hospital, Basel of Switzerland and Hong Kong area. At present, our hospital has completed more than 300 cases of prostatic diseases treated with laser each year and this figure increases year by year. Thus, we have gained rich experience in processing prostate whose volume exceeds more than 200g and anticoagulant therapy for cardiovascular diseases. In addition, we have new insight in understanding of repair the wound of prostate with laser and protection of erectile function.

Screening and diagnosis of prostatic cancer and minimally invasive operative treatment with laparoscope is another advantage and feature which develops rapidly of the Department of Unitary Surgery of our hospital. In 2002, it completed the first transperitoneal laparoscopic radical prostatectomy (TLRP). Now the patient is still living and in good health with well-controlled micturition. Presently, it has performed more than 100 operations. Besides, it also performed laparoscopic radical prostatectomy with the sexual nerve in and between the fascia reserved. This operation is able to keep the patients' sexual and control of micturition function while completely removing the tumor so as to guarantee their living quality after operation. One good result is that erection was recovered when the urinary catheter was removed only ten days after operation. In particular, some advanced devices like 3D laparoscope were introduced, which creates great benefit for surgeons. Ultrasonic elastography is able to find the minimal prostatic neoplasm at early stage, which significantly improves the detection rate of cancer and accuracy of diagnosis.

(2) In urinary calculus, it first performed the percutaneous renal ureteroscope holmium laser and pneumatic lithotripsy positioned by B-ultrasound which is minimally invasive to treat the complicated renal calculus in 2002 and achieved good clinical effect. The research on removal of calculus with flexible endoscope for kidney got a national patent. In consideration of the perioperative risk produced by urogenous septicopyemia, it timely made the research on upper urodynamics and prevention of urogenous septicopyemia and put forward a set of technical method. Over the past several decades, no patient died from urogenous septicopyemia which is treated with PCNL. It also brought forward the emergency processing method for stripping of mucous membrane of ureter caused by ureteroscope.

(3) In urological oncology, totally laparoscopic total cystectomy plus reconstruction of bladder with ileum, renal tumor resection by super selective obstruction of renal artery with nephron reserved, laparoscopic radical nephrectomy, pyelolithotomy & ureterolithotomy and pyeloplasty were performed. It is able to perform difficult urologic surgical procedures, which improves the cure rate of urinary tumor. It can conduct radical nephrectomy by taking the intravenous tumor embolus out under extracorporeal circulation support, radical nephrectomy by systematic lymphadenectomy, expansion of lymphadenectomy plus radical cystectomy for the patients with carcinoma of urinary bladder at middle and advanced stage which produces good treatment effect and adrenal or ectopic giant pheochromocytoma resection.

(4) Renal transplant, a traditional advantage of the Department of Urinary Surgery of our hospital, is the core component of Shanghai Organ Transplantation Center (in Shanghai General Hospital). The types of organ transplantation include cadaveric renal transplantation, autotransplantation of kidney, relative kidney transplantation, liver-kidney transplantation, pancreas-kidney transplantation and kidney-adult islet cells transplantation. Up to now, total kidney transplantation quantity reaches to more than 2200 cases and the annual transplantation quantity is about 100 cases. The youngest and oldest recipients are 11 and 72 years old, respectively. The survival rate of person/kidney in one year is 97.4%/93.2%, that in five years 86.6%/72.2%and that in 10 years 65.7%/55.1%. The maximum survival time of the transplanted kidney has exceeded 29 years. Its comprehensive technical index maintains at domestic leading position and international advanced level.

2. Scientific Research and Honors & Awards

The discipline made a great deal of scientific researches in prostatic diseases, urological oncology, minimally invasive endoscopic operation, female stress incontinence, cause of hypospadias in children, tissue engineering, androgen receptor isoforms and prostatic diseases, dialysis therapy for end-stage renal diseases and immunity and gene typing of renal transplantation. It forms a leading scientific research direction represented by immunity and gene typing of renal transplantation and androgen receptor related research. It won one project of National Key Technologies R&D Program of China during the "8th Five-Year Plan" Period, one project of National Key Technologies R&D Program of China during the "9th Five-Year Plan" Period, one project of National Key Technology R&D Program during the "12th Five-Year Plan" Period, 31 projects of National Natural Science Foundation of China, more than 100 scientific research tasks allocated by the Ministry of Health, Ministry of Science and Technology, Science and Technology Commission of Shanghai Municipality, Ministry of Education, Health Bureau and scientific research fund more than RMB 70 million. It has published more than 350 academic papers on international and domestic journals including over 70 SCI articles; wrote nine monographs as a chief editor and participated in writing 21 monographs. It got 12 invention patents and utility model patents. It was awarded one Second Prize for National Science and Technology Progress (research and clinical application of gene tying for organ transplantation of Chinese Han population, 2001); in recent years, it attaches importance to the application, development and popularization of new minimally invasive technology for urinary surgery and research on prevention of complications, relevant achievement of which was awarded one First Prize for Science and Technology Progress of Shanghai Municipality (development and application of new minimally invasive laser technology for urinary surgery, 2010), one First Prize for Huaxia Medical Science and Technology Progress(2013), one First Prize for Endoscopics Medical Science and Technology Progress(2009), Second Prize for Science and Technology Progress of Excellent Achievement for Scientific Research for Colleges and Universities awarded by the Ministry of Education, Second Prize for Chinese Medical Science and Technology Progress and more than 20 awards above the third class at municipal, provincial and ministerial level.

3. Teaching

The Department of Urinary Surgery of the Affiliated No. 1 People's Hospital of Shanghai Jiao Tong University became one of the first disciplines entitled to grant doctor's degree as approved by the State Council in 1988. Now it has doctoral (post-doctoral) degree station and master degree station. At present, it has seven doctoral supervisors and ten supervisors for master students. It cultivated more than 100 master graduates, 34 doctoral graduates and nine postdoctors in succession. Now it has eight doctoral candidates and 23 master degree candidates. There are 112 medical workers, of which those with master's degree account for 95.8%. It has 39 doctors, including 12 chief physicians, 13 associate chief physicians and 14 attending doctors. It is the training base for resident physicians of Shanghai Municipality, national experimental base for clinical drugs, training base for endoscope of the Ministry of Health and Urinary Surgery Institute of Shanghai Jiao Tong University. It undertook the tasks of teaching and cultivating undergraduates, master students and doctoral students from Fudan University Shanghai Medical College, Shanghai Jiao Tong University School of Medicine, Zhejiang University School of Medicine and Nanjing Medical University.

The discipline has established a friendship relationship with the disciplines of the well-known universities in the US, France and Switzerland. It maintains a collaborative relationship with Linyi People's Hospital of Shandong and Guizhou Provincial People's Hospital to jointly cultivate postdoctors. In recent five years, it won many honors successively such as Excellent Teacher of Shanghai Jiao Tong University School of Medicine (Xia Shujie), Excellent Young Teacher (Sun Xiaowen) and Excellent Course of Shanghai Jiao Tong University School of Medicine. In the Department, three persons were awarded Excellent Graduate of Shanghai Jiao Tong University and four persons awarded Excellent Graduate of Shanghai Jiao Tong University School of Medicine. The reading report meeting for postgraduates and clinical academic report meeting which are held once a week significantly promote and improve the postgraduates' clinical and scientific research level to a large extent.

4. Prospect and Planning

In 2012, the discipline won the project of construction of "key clinical specialty" and RMB 30 million was provided by Shanghai Municipal Commission of Health and Family Planning for the project of construction of "top priority" clinical discipline. The discipline established the Department of Urological Oncology, Department of Urinary Calculus, Department of Prostate, Department of Renal Transplantation, Department of Andrology and Department of Uroclepsia under the leadership of the Clinical Medical Center, Department of Urinary Surgery as required by the Ministry of Health for construction of key clinical specialty. It has arranged the physicians above Sub-senior professional titles of the discipline for development in a certain sub-discipline so that the discipline will be constructed in a professional and refined manner.

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