Suprapubic cystostomy versus nonsuprapubic cystostomy during monopolar transurethral resection of prostate: a propensity score-matched analysis / 亚洲男科学杂志(英文版)

We aim to reassess the safety of the monopolar transurethral resection of the prostate (M-TURP) without suprapubic cystostomy at our institution over the past decade. This retrospective study was conducted in patients who underwent M-TURP at Peking University First Hospital between 2003 and 2013. A total of 1680 patients who had undergone M-TURP were identified, including 539 patients in the noncystostomy group and 1141 patients in the cystostomy group. After propensity score matching, the number of patients in each group was 456. Smaller reductions in hemoglobin and hematocrit (10.9 g vs 17.6 g and 3.6% vs 4.7%, respectively) were found in the noncystostomy group. In addition, patients undergoing surgery without cystostomy had their catheters removed earlier (4.6 days vs 5.2 days), required shorter postoperative stays in the hospital (5.1 days vs 6.0 days), and were at lower risk of operative complications (5.7% vs 9.2%), especially bleeding requiring blood transfusion (2.9% vs 6.1%). Similar findings were observed in cohorts of prostates of 30-80 ml and prostates >80 ml. Furthermore, among patients with a resection weight >42.5 g or surgical time >90 min, or even propensity-matched patients based on surgical time, those with cystostomy seemed to be at a higher risk of operative complications. These results suggest that M-TURP without suprapubic cystostomy is a safe and effective method, even among patients with larger prostates, heavier estimated resection weights, and longer surgical times.

Application of CUA Guidelines on Prostatitis in the management of chronic pelvic pain syndrome: a nationwide survey / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the application of the Chinese Urological Association (CUA) Guidelines on Prostatitis and its effects on the clinical practice patterns of diagnosing and treating chronic pelvic pain syndrome (CPPS) among Chinese urologists and andrologists.</p><p><b>METHODS</b>We conducted a questionnaire investigation on the application of the CUA Guidelines on Prostatitis among the urologists and andrologists of 173 hospitals in 21 cities of China, and performed statistical analyses on all the eligible questionnaires collected.</p><p><b>RESULTS</b>Of the 1 056 questionnaires distributed, 851 (80.6%) were eligible, of which 71.6% were from the urologists or andrologists in grade 3 hospitals, 80.7% of them with senior or intermediate professional titles and 97.5% had studied the CUA Guidelines. Most of the subjects agreed that Type III prostatitis is a clinical syndrome, whose diagnosis should exclude other conditions with similar symptoms, and whose treatment should aim at relieving pain, alleviating urination symptoms and improving the quality of life. Those who had and those who had not studied the CUA Guidelines differed in their viewpoints on CPPS as illustrated in the book. In clinical practice, the most common treatment options for CPPS were psychological therapy (80.7%), medication (80.4%) and life style adjustment (79.6%), and the most frequently used drugs were phytotherapy (80.0%), alpha-blockers (68.9%) and antibiotics (61.0%).</p><p><b>CONCLUSION</b>CUA Guidelines on Prostatitis has gained a nationwide application and promoted the standardization of the management of CPPS in China.</p>

Risk factors for interstitial cystitis/painful bladder syndrome in patients with lower urinary tract symptoms: a Chinese multi-center study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Despite 100 years of research, the continued absence of well-established risk factors impedes the diagnosis and treatment of interstitial cystitis/painful bladder syndrome (IC/PBS). We aimed to identify risk factors in patients with lower urinary tract symptoms (LUTS) without urinary tract infection or benign prostate hyperplasia in China.</p><p><b>METHODS</b>A total of 397 outpatients with LUTS presenting for care to urology clinics in several hospitals throughout China were surveyed using a standardized questionnaire and validated outcome measures. The definitions for painful bladder syndrome based on the O'Leary-Sant interstitial cystitis symptom and problem indices were used. The prevalence of possible risk factors was analyzed using the Fisher's exact test and Pearson chi-square test, and multivariate predictive models were developed using binary Logistic regression methods.</p><p><b>RESULTS</b>Of those multi-centre patients surveyed, including 174 women and 223 men, 41% (162/397) met criteria for painful bladder syndrome. There was a significant difference between women and men (55% (95/174) vs. 30% (67/223), P < 0.001). Women with IC/PBS were more likely than those without IC/PBS to report a history of gynecological infections (odds ratio (OR): 2.85; 95% confidence interval (CI): 1.32 - 6.16, P = 0.007), intake of stimulatory foods (OR: 3.52; 95%CI: 1.50 - 8.30; P = 0.004), irritable bowel (OR: 3.46; 95%CI: 1.22 - 9.80; P = 0.014) and/or anorectal disease (OR: 2.68; 95%CI: 1.12 - 6.40, P = 0.023). After adjusting for confounding factors, bladder pain was significantly associated with stimulatory foods (OR: 3.85; 95%CI: 1.58 - 9.36, P = 0.003) and anorectal disease (OR: 2.76; 95%CI: 1.09 - 7.04, P = 0.03) in women. Caffeine beverage intake (OR: 3.54; 95%CI: 1.54 - 8.12, P = 0.003) was identified the only modifiable association noted in multivariate analysis of men.</p><p><b>CONCLUSIONS</b>We found that stimulatory foods, anorectal disease and caffeine beverages are potential risk factors for IC/PBS. Further studies are necessary to determine their role in the pathogenesis of this disorder.</p>

Urodynamic analysis of dysuria in female patients / 中华外科杂志

<p><b>OBJECTIVE</b>To compare the urodynamic diagnostic types of dysuria in female patients of different age groups.</p><p><b>METHODS</b>Six hundred and sixteen female patients with dysuria were evaluated from March 1997 to July 2008. No patients had history of nervous system disease and history of lower urinary tract operations. They had detrusor pressure-flow studies and uroflowmetry. The urodynamic diagnostic types were analyzed in 3 different age groups.</p><p><b>RESULTS</b>In 3 groups of 18 - 40 years, 40 - 60 years and > or = 60 years, the diagnosis of bladder outlet obstruction (BOO) had the highest proportion (54.8%, 59.1% and 45.0% respectively). The distribution of detrusor overactivity, detrusor under-activity and normal function had no significant difference between 3 groups. The distribution of BOO and acontractile detrusor had significantly difference between 3 groups. When groups of 18 - 40 years and 40 - 60 years were combined into 18 - 60 years group and compared with the older group, the proportion of BOO, acontractile detrusor and detrusor under-activity showed significantly difference. The proportions of BOO in the two groups were 57.3% and 45.0%, acontractile detrusor 15.6% and 23.9%, detrusor under-activity 17.4% and 25.0%, respectively. The proportion of reduced bladder sensation among detrusor under-activity patients in the older group was significantly higher.</p><p><b>CONCLUSIONS</b>In the urodynamic diagnoses of voiding difficulty in female patients, bladder outlet obstruction has the highest proportion. This proportion decreases in the older patients. The proportion of acontractile detrusor and detrusor under-activity increases in the older group.</p>

Correlation of lower urinary tract symptoms with erectile dysfunction in men aged 50 years and above / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the incidence of lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) in men aged > or = 50 years and to achieve the correlation between LUTS (obstructive symptoms and stimulant symptoms) and ED.</p><p><b>METHODS</b>We investigated 245 men aged > or = 50 years and with regular sex mates using International Prostate Symptom Score (IPSS) and International Index of Erectile Function-5 (IIEF-5), designed diagnostic interrogation and medical examination, and statistically analyzed the results of IPSS, IIEF-5, LUTS and their correlation with erectile function.</p><p><b>RESULTS</b>The incidence of ED was 81.9% (140/171) among the men with LUTS, 73.1% (38/52), 82.1% (46/56) and 88.9% (56/63) respectively in the 50-59, 60-69 and > or = 70 age groups, with significant differences in IPSS, IIEF-5 (P < 0.01) and the severity of ED (P < 0.01) among different age groups. ED incidence was found significantly correlated with the severity of LUTS (r = 0.52, P < 0.01), 71.3% (57/80), 89.6% (60/67) and 95.8% (23/24) respectively in the groups of mild, moderate and severe LUTS. The mean scores on obstructive and stimulant symptoms were (3.1 +/- 3.6) and (6.8 +/- 4.9), and their correlation coefficients with IIEF-5 were r = -0.41 (P < 0.01) and r = -0.59 (P < 0.01), respectively.</p><p><b>CONCLUSION</b>The incidence of ED is high in men with LUTS and positively correlated with the severity of LUTS. Stimulant symptoms have greater influence than obstructive symptoms on the sexual life of old and middle-aged males.</p>

Natural history of benign prostate hyperplasia / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Benign prostate hyperplasia is one of the most common diseases affecting the health of the aging males. Watchful waiting is an acceptable management strategy for benign prostate hyperplasia in which the patient is monitored by the physician but receives no active intervention. The epidemiological data on this are lacking in China. Our study was designed to evaluate the changes of signs and symptoms of patients with benign prostate hyperplasia during management by watchful waiting in China.</p><p><b>METHODS</b>One hundred and forty-five patients with benign prostate hyperplasia aged > 50 years were enrolled in management by watchful waiting. All the patients were visited every 6 months and were given an International Prostate Symptom Score and Quality of Life questionnaire to complete. They also had uroflowmetry and were assessed using ultrasonography to get the volume of prostate, transition zone and amount of residual urine. The Student's t test, the Chi-square test, and variance analysis were used in the statistical analysis.</p><p><b>RESULTS</b>All patients were visited after 6 months, the mean volume of transitional zone was found to have increased by 1.6 ml (P < 0.01), International Prostate Symptom Score was increased by 0.8 (P < 0.01) and Quality of Life was increased by 0.2 (P < 0.01), and there was no statistical change in other data. Among these patients, 17.9% (26/145) visited again after 12 months when the data failed to show a statistically significant difference among the three groups (0, 6, and 12 months).</p><p><b>CONCLUSIONS</b>After one year's follow-up, the progression of benign prostate hyperplasia was slow and the clinical data did not undergo much change.</p>

Functional and histological changes in aging gerbil bladders / 上海第二医科大学学报

Objective To investigate the functional and histological changes in aging gerbil bladders.MethodsTwelve male gerbils were randomly divided into control group and aging bladder group,with 6 in each group.Experiment was conducted in gerbils of control group and aging bladder group 6 months and 24 months after normal feeding,respectively.Urodynamic examinations including irrigation volume,compliance and filling pressure of bladder were performed,bladder weight was obtained,bladder weight index was calculated,morphological observation was conducted with HE staining,ratio of amount of smooth muscle to collagen was obtained with double immunohistochemical staining,and electron microscope was used to evaluate the ultrastructure of bladder.ResultsCompared with those in control group,the irrigation volume and compliance of bladder significantly decreased in aging bladder group(P0.05).However,the bladder weight index was significantly lower in aging bladder group(P0.05).There existed degeneration in smooth muscle cells and organelles in aging bladder group.ConclusionThe function of aging bladder in gerbils is impaired,which may be related to the degeneration of bladder tissues.

Survey of lower urinary tract symptoms in community-dwelling elderly females / 上海第二医科大学学报

Objective To investigate the incidence of lower urinary tract symptoms(LUTS) and bladder function in the community-dwelling elderly females. Methods The questionnaires were administered,including complaints of LUTS,International Prostate Symptoms Score(IPSS) and quality of life assessment.Meanwhile,uroflowmetry was performed and volume of residual urine was measured. Results The total number of women surveyed was 359.According to IPSS,the prevalence of moderate to severe LUTS(IPSS≥8) was 39.0%.The prevalence in those with age of 50-59,60-69 and ≥70 years were 35.1%,46.2% and 54.8%,respectively(P=0.034).Of all the women surveyed,73.8% had predominantly irritative symptoms.The maximum flow rates(Qmax)were(24.5?11.5) mL/s,(22.7?11.0) mL/s and(14.5?8.2) mL/s,respectively for these age groups(P