Retzius-sparing robot-assisted laparoscopic radical prostatectomy for early-stage prostate cancer (with video) / 中华男科学杂志

Objective@#To investigate the application of Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) in the treatment of early-stage prostate cancer.@*METHODS@#We retrospectively analyzed the clinical data about 10 cases of early-stage prostate cancer treated by RS-RARP with the Da Vinci Robot Surgical System from September to October 2016.@*RESULTS@#All the operations were successfully completed without positive surgical margins. The operation time was 170－250 min (［196±25］ min), the intraoperative blood loss was 150－500 ml (［260±128］ ml), the postoperative hospital stay was 6－7 days, and the catheterization time was 14 days. Urinary continence occurred after catheter removal in 1 patient and was recovered 1 month later.@*CONCLUSIONS@#RS-RARP is a safe, effective and reliable method for the treatment of prostate cancer and conducive to the early recovery of urinary continence.

Clinical analysis of primary hyperparathyroidism with kidney stones: 23 cases report / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the clinical characteristics of primary hyperparathyroidism (PHPT) with kidney stones.</p><p><b>METHODS</b>The clinical data of 23 cases undergoing diagnostic evaluation and surgery for PHPT combined with kidney stones between January 2004 and February 2012 was retrospectively analyzed. The 23 cases had undergone preoperative parathyroid neck color ultrasound, CT or (99)mTc-methoxy isobutyl isonitrile ((99)mTc-MIBI) diagnosis. The surgical treatment included parathyroid disease and kidney stones. The intravenous calcium, phosphorus and serum intact parathyroid hormone (iPTH) levels, 24 hours urinary calcium concentrations were measured 3 days before and 7 days after surgery.</p><p><b>RESULTS</b>There were 8 male and 15 female patients. The stone diameter were (3.2 ± 0.7) cm (range 2.1-4.0 cm). All patients did both parathyroid surgery and kidney surgery. The statistical discrepancy of serum calcium (there were (3.31 ± 0.39) mmol/L before surgery and (2.12 ± 0.18) mmol/L at 7 days after surgery, t = 11.26), serum phosphorus ((0.70 ± 0.09) and (1.21 ± 0.21) mmol/L in before and after surgery respectively, t = 10.53), iPTH (there were (28.8 ± 10.0) pmol/L before surgery and (3.6 ± 2.6) pmol/L after surgery, t = 12.83) and 24-hours urine calcium (there were (7.2 ± 3.1) mmol/d before surgery and (3.6 ± 2.5) mmol/d after surgery, t = 8.81) before and after the operation was significant (all P < 0.01). PTH concentration with serum calcium concentration correlation coefficient was r = 0.59 (P < 0.01). Eighteen patients (78.3%) had solitary parathyroid adenomas, two patients (8.7%) had multiple parathyroid adenomas, and three patients (13.0%) had multiglandular hyperplasia confirmed at surgery and histology. During follow-up, 8 patients had stone recurrence and 3 patients were did operation again to deal with renal stone within 2 years. Among them, 7 cases were normal, 1 case of parathyroid adenomas recurrence and reoperation.</p><p><b>CONCLUSIONS</b>The parathyroid operation may reduce the calculus recurrence remarkably. Early diagnosis and treatment of primary hyperparathyroidism is helpful to reduce the calculus recurrence and preserve the renal function.</p>

Mid-term follow-up results of laparoscopic radiofrequency ablation for renal cell carcinoma of T1aN0M0 stage / 中华外科杂志

<p><b>OBJECTIVE</b>To determine the effect of laparoscopic radiofrequency ablation of T1aN0M0 renal cell carcinoma (RCC) with regular follow-up.</p><p><b>METHODS</b>All patients underwent surgery from March 2006 to March 2009. Eight cases were solitary kidney. Twenty-two cases of left RCC and 18 cases of right RCC were diagnozed by ultrasonography and CT scanning.All of the cases were T1aN0M0 stage. No metastasis was found by iconography test. By ultrasound positioning, laparoscopic radiofrequency were performed on the renal tumor. All patients were followed up with eGFR and enhanced-CT.</p><p><b>RESULTS</b>All patients underwent laparoscopic radiofrequency ablation surgery successfully. The mean operation time was (101 ± 19) minutes and the mean blood loss was (90 ± 14) ml (no blood transfusion pre- and post-operation). During postoperative follow-up, enhanced CT revealed complete ablation in 39 cases (the success rate was 97.5%), and 1 residue tumor was confirmed by enhanced CT 7 days post operation. This patient was under close surveillance because of solitary kidney. No progression of the residue tumor was found during the follow-up. One case of recurrence was confirmed by enhanced CT in 6 month after operation. The 3-year recurrence rate was 2.5%. No further intervation was performed on this patient and no change was found in the recurrence area during the follow-up. Both 3-year total survival rate and 3-year cancer specific survival rate were 100%. The mean eGFR was (72 ± 9) ml/(min·1.73 m(2)) in 3 years after surgery. There was no significant difference between pre-and post-operation (P > 0.05).</p><p><b>CONCLUSION</b>Mid-term follow-up results show the effectiveness and safety of laparoscopic radiofrequency ablation in the treatment for T1aN0M0 RCC and have no negative influence on the renal function.</p>

A retrospective study comparing the clinical efficacy of laparoscopic cryoablation and partial nephrectomy for renal cell carcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To compare the clinical outcomes of laparoscopic cryoablation (LCA) and laparoscopic partial nephrectomy (LPN) in the treatment of renal cell carcinoma (RCC).</p><p><b>METHODS</b>Between April 2005 and March 2009, 47 patients were treated with minimally invasive nephron sparing surgery (LPN or LCA) for RCC. The LCA group included 18 selected primary RCC cases (14 men and 4 women, mean age 63 years). There were 6 tumors located in the left, 11 located in the right and 1 located bilaterally. The maximum diameter of tumors was 1.5 - 5.0 cm (mean: 2.9 cm). The LPN group included 29 renal tumors patients (19 men and 10 women, mean age 61 years). The maximum diameter of tumors in this group was 2.0 - 4.5 cm (mean: 2.8 cm). Changes of hemoglobin (Hb), erythrocyte sedimentation rate (ESR), serum creatinine (SCr) and glomerular filtration rate (GFR) after operations were compared between LCA group and LPN group. The operative time, average intra-operative bleeding volume, postoperative hospital stay and incidence of postoperative complications of the 2 groups were analyzed and compared.</p><p><b>RESULTS</b>The 2 surgical procedures were both successful. There was no significant change of Hb, ESR, SCr and GFR after operations in LCA group and LPN group (P > 0.05). The operative time was (94 ± 29) min and (146 ± 45) min in LCA group and LPN group, respectively. The average estimated blood loss was (37 ± 20) ml and (274 ± 69) ml. The postoperative hospital stay was (4 ± 2) d and (10 ± 2) d. These differences between the 2 groups were significant (P < 0.01). No laparoscopic operative complications were noted in LCA group. Follow-up magnetic resonance imaging (MRI) at 1, 3, and 6 months identified the punched-out, nonenhancing, spontaneously resorbing, renal cryolesion. LCA group had completed a minimum follow-up of 6 months (mean 16, range 6 to 21 months). No evidence of local or port-site recurrence was found, and no patient developed metastatic disease. 3 - 36 months' (mean 20 months) follow-up showed no recurrence of tumors or metastatic disease in LPN group.</p><p><b>CONCLUSIONS</b>LCA for RCC is an accurate and effective intervention with a relatively low incidence of complications, and is superior to LPN in operative time, intraoperative bleeding volume and postoperative recovery.</p>

Erectile function in male kidney transplant recipients and effects of different methods of renal arterial anastomosis / 中华男科学杂志

<p><b>OBJECTIVE</b>To evaluate erectile function in men with renal failure before and after kidney transplantation and the effects of different methods of renal arterial anastomosis.</p><p><b>METHODS</b>Fifty-five married males, aged 22-50 years, who had received kidney transplantation at least one year before and whose serum creatinine was under 200 micromol/L , were selected in the study. The end-to-end revascularization to the internal iliac artery was accomplished in 39 of them, and the end-to-side revascularization to the external iliac artery was conducted in 16. Their erectile function was investigated according to the International Index of Erectile Function-5 (IIEF-5) before kidney transplantation and 3, 6 and 9 months after it. The effects of different methods of renal arterial anastomosis were evaluated and hypophyseal hormones determined in 25 of them.</p><p><b>RESULTS</b>IIEF-5 was higher in the patients 3, 6 and 9 months after transplantation than before it (P < 0.05) and 6 and 9 months after transplantation than 3 months after it (P < 0.05) , so was it in the patients with less than 12 months hemodialysis than those with over 12 months (P < 0.05) and in the patients with end-to-side revascularization to the external iliac artery than those with end-to-end revascularization to the internal iliac artery (P < 0.05). The differences between the level of hypophyseal hormones and that of sex hormones before transplantation were significant (P < 0.05).</p><p><b>CONCLUSION</b>Erectile function and the level of hypophyseal hormones were improved after kidney transplantation, and the patients who received end-to-side revascularization to the external iliac artery experienced better erectile function recovery than those who underwent end-to-end revascularization to the internal iliac artery.</p>