Radical retropubic prostatectomy for prostate cancer with pelvic lymph node metastasis / 中华男科学杂志

Objective@#To investigate the safety and effectiveness of radical retropubic prostatectomy (RRP) with adjuvant androgen deprivation or external radiotherapy in the treatment of prostate cancer (PCa) with pelvic lymph node metastasis (PLNM).@*METHODS@#Twenty PCa patients underwent bilateral pedal lymphangiography (PLG) preoperatively, and 11 of them received lymph node aspiration for examination of the mRNA expressions of prostate-specific antigen (PSA) and prostate-specific membrane antigen (PSMA) in the lymph fluid by real-time RT-PCR. All the patients were treated by RRP with extended dissection of pelvic lymph nodes, and 3 of them by external radiotherapy in addition after recovery from urinary incontinence because of positive surgical margins, followed by adjuvant androgen deprivation therapy.@*RESULTS@#Real-time RT-PCR showed positive mRNA expressions of PSA and PSMA in the lymph fluid of the 11 patients, all pathologically confirmed with PLNM. The median intraoperative blood loss was 575 ml, with blood transfusion for 5 cases. Positive surgical margin was found in 3 cases, lymphorrhagia in 2 and urinary leakage in another 2 each. There were no such severe complications as vascular injury and rectum perforation. The patients were followed up for 6－48 (mean 42) months, during which, biochemical recurrence was observed in 12 cases at a median of 12 months postoperatively and 2 patients died at 12 and 48 months respectively.@*CONCLUSIONS@#Bilateral PLG and lymph node aspiration for examination of the mRNA expressions of PSA and PSMA in the lymph fluid help to confirm PLNM preoperatively. Radical retropubic prostatectomy with adjuvant androgen deprivation or external radiotherapy is safe and effective for the treatment of PCa with PLNM, but it should be chosen cautiously for those with Gleason 5+5.

Ureteroscopic lithotripsy using holmium laser for 187 patients with proximal ureteral stones / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Improving the success rate of ureteroscopic lithotripsy for proximal ureteral stones is the hot issue in this field. Here we reported our experience on the treatment of proximal ureteral stones.</p><p><b>METHODS</b>From 2005 to 2010, 187 consecutive patients with proximal ureteral stones who underwent ureteroscopic lithotripsy were enrolled. The initial 52 patients treated by semi-rigid ureteroscope alone were classified as group 1. The subsequent 135 patients treated by semi-rigid ureteroscope with the aid of stone basket and flexible ureteroscope were classified as group 2.</p><p><b>RESULTS</b>In group 1, the overall stone-free rate was 67.3%. By a single procedure of ureteroscopic lithotripsy using a semi-rigid instrument, patients with ureteral stones below the 4th lumbar vertebra level achieved 91.7% stone-free rate, which was only 50% in patients with stones above the 4th lumbar vertebra level. Conversion to open surgery occurred in two patients since ureteral perforation was observed. In group 2, the stone-free rate achieved 93.2% with the aid of an N-Trap basket, which was significantly higher than that of patients without the aid of the basket (51.6%). Flexible ureteroscope was subsequently used in patients with fragment migration, thus making the overall success rate in group 2 increases to 97.0%.</p><p><b>CONCLUSIONS</b>Ureteroscopic lithotripsy is a safe and efficacious treatment for proximal ureteral stones. A single procedure of ureteroscopic lithotripsy using semi-rigid ureteroscope could achieve a satisfactory stone-free rate in patients with proximal ureteral stones below the 4th lumbar vertebra level. However, patients with ureteral stones above the 4th lumbar vertebra level experienced higher stone-migration rate, which would decrease the success rate. Fortunately, the stone-free state could possibly be achieved with the aid of an N-trap basket and flexible ureteroscope.</p>

Experience in reducing intraoperative blood loss in radical retropubic prostatectomy / 中华男科学杂志

<p><b>OBJECTIVE</b>To search for an effective method of reducing intraoperative blood loss in radical retropubic prostatectomy (RRP).</p><p><b>METHODS</b>We performed RRP for 100 patients with prostate cancer, 50 (group A) with the Walsh or Poor method for handling the dorsal venous complex (DVC), and the other 50 (group B) through the following three additional procedures for hemostasis: first placing a #7 prophylactic suture in the distal position of DVC, then ligating the vascular bundle of the prostatic apex with continuous 4-0 Vicryl sutures, and lastly placing a 4-0 absorbable suture followed by freeing the neurovascular bundle (NVB) or freeing NVB before suturing the remained levator ani myofascia and the deep layer of Denovilliers' fascia above the rectal serosa with 4-0 Vicryl. We assessed the effects of the three hemostatic methods in RRP by comparing the volumes of intraoperative blood loss and transfusion, operation time and perioperative levels of hemoglobin.</p><p><b>RESULTS</b>There were no significant differences between groups A and B in age, PSA, Gleason score, clinical stage, prostate volume, operation time and perioperative hemoglobin levels (P>0.05). The volumes of intraoperative blood loss and transfusion were markedly higher in group A ([1103.00 +/- 528.03] ml and [482.00 +/- 364.60] ml) than in B ([528.00 +/- 258.96] ml and [140.00 +/- 266.28] ml) (P<0.05).</p><p><b>CONCLUSION</b>Intraoperative blood loss in RRP could be significantly decreased by placing a prophylactic hemostatic suture in the distal position of DVC, continuous suture of the vascular bundle of the prostatic apex after cutting off the urethra, and placing a fine absorbable suture above NVB or continuous suture of the remained levator ani mony fascia and the deep layer of Denovilliers'fascia above the rectal serosa with absorbable sutures after freeing NVB.</p>

Retropubic radical prostatectomy: 10 years' experience with 100 cases / 中华男科学杂志

<p><b>OBJECTIVE</b>To summarize the experience and lessons from 100 cases retropubic radical prostatectomy performed in the past 10 years.</p><p><b>METHODS</b>From July 1999 to July 2009, we performed 100 cases of retropubic radical prostatectomy, of which 84 were followed up for 3 - 120 months. We analyzed their preoperative age, PSA level, amount of intraoperative blood transfusion, operation time, urinary continence, penile erectile function, stricture of the anastomotic stoma and Qmax.</p><p><b>RESULTS</b>The mean age, PSA level, amount of intraoperative blood transfusion, operation time were 66.8 yr, 20.1 ng/ml, 585.7 ml and 198.9 min; the recovery rates of bladder control at 3, 6 and 12 months postoperatively were 65.5%, 81.7% and 92.4%, respectively. At 12 months after surgery, penile erection was restored in 19 cases (42.2%), anastomotic stoma stricture developed in 5 (5.9%), Qmax averaged 20.5 ml/min, biochemical recurrence was found in 13, and 1 died from prostate cancer.</p><p><b>CONCLUSION</b>Retropubic radical prostatectomy is a desirable procedure for the treatment of local prostate cancer, in which ligation of the puboprostatic ligament and prostatic venous plexus before cutting off the ligament helps improve urinary continence, protection of the neurovascular bundle and collateral pudendal artery contributes to the recovery of penile erectile function, and proper connection of urethral and bladder mucosa can reduce anastomotic stoma stricture. Postoperative external-beam radiotherapy for those with T3a or local lymph node metastasis could decrease biochemical recurrence.</p>

Study on micrometastases in pelvic lymph nodes detected by real-time reverse transcriptase polymerase chain reaction with clinically localized prostate cancer before radical prostatectomy / 中华外科杂志

<p><b>OBJECTIVE</b>To clarify the significance of micrometastases in pelvic lymph nodes in patients with neoadjuvant hormonal therapy (NHT) before radical prostatectomy (RP).</p><p><b>METHODS</b>Twenty-one patients with clinically localized prostate cancer who received NHT between August 2007 and March 2010 were observed. The patients were clarified into four groups: pathological examination was positive (group A), real-time PCR examination targeting prostate specific antigen (PSA) mRNA and prostate specific membrane antigen (PSMA) mRNA were positive (group B), pathological examination and real-time PCR examination targeting PSA mRNA and PSMA mRNA were both negative (group C), and the control group (group D). After a standard bipedal lymphangiography the films were reviewed carefully by an experienced radiologist. If positive lymph nodes were seen or suspected, a thin-walled 22 gauge needle were directed transabdominally under fluoroscopic control into the area of question and an aspirate was obtained. The expression of PSA and PSMA in aspirate were assessed by a fully quantitative real-time PCR. The specimens were regarded in which either PSA mRNA or PSMA mRNA were positive as showing the "presence of micrometastasis". Lymph node specimens were also stained immunohistochemically with an antibody PSA after RP.</p><p><b>RESULTS</b>Pathological examination detected lymph node metastases from 3 cases, and real-time PCR further identified lymph node micrometastases from 14 cases with no pathological evidence of nodal involvement. The expression level of PSA mRNA and PSMA mRNA were statistically significant in patients with histological confirmed lymph node metastases and micrometastases detected by real-time PCR despite the lack of histological evidence, and the expression level of PSA mRNA and PSMA mRNA in aspirate were higher than the lymph node between the group A and group B.</p><p><b>CONCLUSIONS</b>Although residual foci of atrophic prostate cancer cells in resected lymph nodes after NHT can be difficult to diagnose by pathological examination, the present results show the usefulness of quantitative real-time PCR targeting PSA and PSMA mRNA for detected micrometastatic tumour foci in pelvic lymph nodes from fine needle aspiration biopsy of lymph nodes before RP.</p>

Clinical outcomes of sexuality preserving cystectomy and Roux-y sigmoid neobladder / 中华男科学杂志

<p><b>OBJECTIVE</b>To assess the penile erectile function, urinary continence and voiding, and cancer recurrence in 18 bladder cancer patients after sexuality preserving cystectomy and Roux-y sigmoid neobladder reconstruction.</p><p><b>METHODS</b>Eighteen male patients with bladder cancer underwent sexuality preserving cystectomy and Roux-y sigmoid neobladder reconstruction, and were followed up for cancer recurrence and such clinical outcomes as erectile function and urinary continence and voiding.</p><p><b>RESULTS</b>The patients were followed up for an average of 41 months, of whom, all achieved day- and night-time urinary continence, but 2 with positive lymph nodes died of extensive metastasis at 10 and 15 months, respectively, after surgery. Among the total number, potency was maintained in 11 patients (61.1%), impaired in 2 and lost in 5, and the post-operative IIEF-5 score was (10.83 +/- 8.25) as compared with (13.72 +/- 6.39) before the operation, with a statistically significant difference (P < 0.05).</p><p><b>CONCLUSION</b>Erectile function and urinary continence are fairly good in bladder cancer patients after sexuality preserving cystectomy and Roux-y sigmoid neobladder reconstruction, and the oncological results are fairly acceptable, but still need to be confirmed by longer follow-ups and larger trials.</p>

The clinical observation of bipolar transurethral plasma kinetic resection of prostate for high risk benign prostate hyperplasia / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate therapeutic effect and reliability of bipolar transurethral plasma kinetic prostatectomy (TUPKP) for high risk level benign prostatic hyperplasia (BPH).</p><p><b>METHODS</b>A total of 230 cases of high risk of BPH were treated with TUPKP. Among them, 132 cases with the residual urine of 40 to 420 ml had accepted long term but inefficient medical therapy, 98 cases were suffered with repeating acute urinary retention. One hundred and seventy-three cases with the functional capacity>4 MET were performed the standard transurethral resection of the prostate (TURP), the other 57 cases with the functional capacity<4 MET were accepted the minimally invasive TURP. Among them 12 cases complicated with bladder stones accepted Ho: YAG lithotripsy priory. The international prostate symptom score (IPSS), The maximal urinary flow rate (Qmax) and residual urine of the 2 groups before and after operation were analyzed.</p><p><b>RESULTS</b>There was no transurethral resection syndrome occurred in both groups. After 3 to 12 months of follow-up postoperatively, the IPSS of the two groups were reduced from (21.9+/-5.7) and (23.7+/-5.0) to (4.4+/-2.3) and (5.5+/-2.4), residual urine were reduced from (61.8+/-18.4) ml and (103.9+/-77.3) ml to (13.0+/-6.2) ml and (15.8+/-6.1) ml, respectively. The Qmax was increased from (5.7+/-3.0) ml/s and (4.8+/-2.8) ml/s to (20.9+/-6.3) ml/s and (16.8+/-3.9) ml/s, there existed significant differences (P<0.01). However the IPSS, Qmax and residual urine of the standard group had progressed more obviously than the minimally invasive TURP group (P<0.05).</p><p><b>CONCLUSIONS</b>It is safe and effective to use TUPKP for treating high risk patients of BPH with classic TURP and minimally invasive TURP according to different functional capacity. When the functional capacity is more than 4 MET, the standard procedures is preferred.</p>

Application of low tension Roux-y sigmoid neobladder in urine diversion / 中华外科杂志

<p><b>OBJECTIVE</b>To assess the therapeutic effects of low tension, anti-reflux Roux-y sigmoid neobladder.</p><p><b>METHODS</b>A total of 21 patients (7 male and 14 female) were included, aged 43-87 years. All cases received radical cystectomy and low tension Roux-y sigmoid neobladder procedure for invasive bladder cancer were included in this study. The period of follow-up was from 8 to 79 months (the average was 36 months). Evaluations included urinary flow rate, post voiding residual and filling cystometry.</p><p><b>RESULTS</b>The mean maximum urinary flow rate, the voiding time and the post voiding residual were 28.1 ml/s (21.4-38.4 ml/s), 17 s(9-28 s) and 0 ml respectively. The cystometric capacity was 480 m1 (350-560 ml). The volume of desire to void was 330 ml (120-410 ml). The bladder pressure was from 14.2 to 18.6 cm H2O (the average bladder pressure was 16.4 cm H2O) at high filling volumes. The maximum voiding pressure was 45.0 cm H2O (23.6-63.4 cm H2O).</p><p><b>CONCLUSIONS</b>The Roux-y sigmoid neobladder has an adequate capacity at low pressure with a satisfactory continence, and it is an effective method for continent urinary diversion.</p>

Prevention of incontinence after radical prostatectomy / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the effect of urine control after radical retropubic prostatectomy by preserve the membranous part of sphincter urethrae and the neurovascular bundle, or to rebuild the bladder neck.</p><p><b>METHODS</b>The radical retropubic prostatectomy was performed on a total of 32 cases of prostate cancer. We preserve the membranous part of sphincter urethrae and the neurovascular bundle lateral to the prostate. We evaginate the posterior wall of the bladder adequately and make an additional folding stitch to rebuild the bladder neck.</p><p><b>RESULTS</b>The follow up is of 6-72 months. All patients could void without difficulty, no tumor recurrence and only 2 cases occurred slight incontinence. Other 30 cases regained the ability of controlling their urinations within 6 months.</p><p><b>CONCLUSIONS</b>The incontinence after radical retropubic prostatectomy could be reduced by the method of preserving the membranous part of sphincter urethrae and preserving the neurovascular bundle lateral to the prostate in operation. It could also be avoided by evaginate the posterior wall of the bladder adequately and make an additional folding stitch to the bladder neck.</p>

Primary pigmented nodular adrenocortical disease report of 5 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To study the pathology, diagnostic and therapeutic method of primary pigmented nodular adrenocortical disease (PPNAD).</p><p><b>METHODS</b>The data of 5 cases of PPNAD were analyzed retrospectively. Among the 5 cases, 2 were male and 3 were female. The range of age was from 12 to 53 years. All the 5 cases had symptoms of Cushing syndrome. The diagnose depended on the results of endocrine exams, ultrasound, CT, MR and pathological reports. All patients received operation of unilateral adrenalectomy. The therapeutic effects were determined by post-operative results, which concluded clinical symptoms and endocrine exams.</p><p><b>RESULTS</b>The follow-up time was from 4 months to 3 years. All patients' symptoms of Cushing syndrome were relieved in 6 months after operation. The endocrine exam was normal in one case and obvious improved in the other four cases. Up to now, one patient drop out of the follow-up, the other 4 cases had no evidence of recurrence.</p><p><b>CONCLUSION</b>PPNAD is a rare type of Cushing syndrome. Diagnose depends on endocrine exams and pathological results. Operation is the effective method for the disease.</p>

The analysis of the factors for postoperative blood pressure recovery of aldosterone producing adenoma patients / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the factors regarding the recovery of postoperative blood pressure of aldosterone producing adenoma (APA) patients.</p><p><b>METHODS</b>Sixty-eight patients with APA were recruited and their data including retinal blood vessel by Doppler sonography, urinary trace albumin, pathological changes of renal biopsy and the adrenal tissues around the adenoma were analyzed in order to determine the correlation between these data and postoperative durative hypertension.</p><p><b>RESULTS</b>Postoperative durative hypertension occurred in 14 cases (41.2%) with increased resistance of unilateral or bilateral central artery of retina, in 16 cases (66.7%) with increased level of urinary trace albumin. Fifteen cases underwent renal biopsy and all of them showed different pathological alterations, 11 cases (73.3%) of which presented with postoperative durative hypertension. The pathological changes of the adrenal tissues around the adenoma is either atrophy or non-atrophy (normal or hyperplasia), 8 cases (40%) and 10 cases (22.2%) of which showed postoperative durative hypertension, respectively.</p><p><b>CONCLUSION</b>The renal pathological changes and increased resistance of retinal blood vessel are the main reasons leading to postoperative hypertension in patients with APA.</p>

A long-term follow-up study of deep penile vein resection patients / 中华男科学杂志

<p><b>OBJECTIVE</b>To study the five-year postoperative effect of the ligation and resection of the deep penile vein for the patient of erectile dysfunction (ED) caused by penile venous leakage.</p><p><b>METHODS</b>Sixteen ED patients received deep penile vein ligation and resection. Observations of the penile erection had been recorded for 5 years after surgery.</p><p><b>RESULTS</b>Eight cases demonstrated erectile hypofunction after 18 months postoperatively and total ED after 21-30 months of which 6 were improved by chemotherapy, and 2 showed no improvement. Seven cases remained normal and 1 case get out of touch at the 24th month postoperatively.</p><p><b>CONCLUSIONS</b>The ligation and resection of the deep penile vein can be considered as an easy and effective method to treat patients of ED caused by penile venous leakage.</p>

Hemodynamometry of erectile dysfunction / 中华外科杂志

<p><b>OBJECTIVE</b>To study the clinical causes of the erectile dysfunction (ED).</p><p><b>METHODS</b>One hundred and thirty cases of ED were examined by hemonamometry and cavernosography with vasodilating agent. The data about penile brachial index, intracavernous pressure, maintenance flow rate, and pressure loss change were obtained and the status of the penile veins was detected.</p><p><b>RESULTS</b>Among 130 patients with ED, 39 had venous leakage including penile arterial insufficiency simultaneous venous leakage in 15 patients. Various leakage sites were observed by using cavernosography. Twenty-eight patients showed deep dorsal veins only and the remaining crural veins.</p><p><b>CONCLUSION</b>Hemodynamometry is effective to diagnose the cause of ED.</p>