ABSTRACT
【Objective】 To investigate the efficacy of the adjustable "paper clip" techniques in the suture of dorsal vein complex (DVC) and retention of urethral function in robot-assisted laparoscopic radical prostatectomy (RALRP). 【Methods】 A total of 30 cases of prostate cancer treated with RALRP were enrolled, all of which used the adjustable "paper clip" techniques. During operation, the DVC was sewed with barbed suture, and then a reverse suture was made through two sides of the prostatic ligaments. A Hem-o-lock was used to fasten the suture, which would be flexible to control the degree of tightness for the ligature. Perioperative and follow-up data of urinary continence and symptoms were collected and analyzed. 【Results】 All operations were successful. The estimated blood loss was (123.3±80.7) mL, 53.6% patients recovered continence in 1 month, and the continence rate increased to 92.9% and 96.3% at month 3 and 6. 92.9 of patients had no risk of incontinence 3 months after surgery. 【Conclusion】 The adjustable "paper clip" techniques have advantages in reducing blood loss, maintaining clear surgical field, preserving urethral function, and improving urinary continence.
ABSTRACT
Objective:To investigate the feasibility and safety of suprapubic bladder puncture and gland fixation in transurethral enucleation of the prostate.Methods:The clinical data of 15 patients with benign prostatic hyperplasia admitted to the First Affiliated Hospital of Guangxi Medical University from January 2020 to June 2020 were retrospectively analyzed. The age was (70.27±5.35) years old, preoperative serum prostate-specific antigen (PSA) level was (3.03±1.37) ng/ml, preoperative total prostate weight was 80.3(70.49, 96.78)g, preoperative postvoid residual urine volume(PVR)was 80 (55, 108)ml, and the maximum urine flow rate (Q max) was (6.13±2.25) ml/s. The international prostate symptom score(IPSS) was 25(22, 27), quality of life (QOL)score was 5(5, 6), international erectile function index-5 (IIEF-5) score was (15.38±5.10). All 15 patients underwent conventional transurethral plasma enucleation of prostate by using the three-lobe method, and the enucleated gland was pushed into the bladder completely. Then a laparoscopic pneumoperitoneum needle was used to perform suprappubic cystipuncture, and ureteral grasping forceps were inserted through the outer sheath. The forceps were used to fix the enencied gland. A rapid harvesting electric resection was performed in the broad space of the bladder, and the Ellick was rinsed to remove the tissue fragments. Surgical indicators and complications were recorded. The improvement of subjective score (IPSS, QOL, IIEF-5) and objective index (Q max, PVR) was compared between preoperative and postoperative. Results:All the 15 operations were completed successfully and there were no complications such as blood transfusion, capsule perforation, transurethral resection syndrome, bladder injury, bladder puncture site laceration and bleeding. The weight of resected prostate tissue was 44(40, 60)g, with blood loss (79.20±18.93)ml.The time of enucleation operation was (54.13±10.88)min, with harvest cutting time (14.67±2.50)min, evisceration efficiency (0.89±0.08)g/min, harvesting efficiency (3.26±0.36)g/min, bladder irrigation time (2.47±0.52) d. The time of indwelling catheter was (3.73±0.80)d.The postoperative hospital stay was (4.40±0.91) d. Temporary urinary incontinence occurred in 1 case after operation. All patients were followed up for 6 months after operation. The IPSS score was 3(2, 3), QOL score was 0(0, 1), IIEF-5 score was (20.12±2.30), Q maxwas (21.80±2.14) ml/s and PVR was 10(5, 15)ml, which were all significantly different compared with those before surgery ( P<0.05). The symptoms of the patients were significantly improved. Conclusions:Transurethral plasma enucleation of prostate combined with suprapubic bladder puncture and fixed gland is effective in the treatment of benign prostatic hyperplasia. The subjective symptoms and objective examination of patients have been significantly improved, and no adverse operation-related complications have occurred. It is a suitable method for enucleation of prostate in units which are not equipped with transurethral tissue planer.
ABSTRACT
Objective To study the expression of kallikrein 7 (KLK7) in different prostate tissues and its clinical significance. Methods KLK7 mRNA levels in normal prostate epithelia (5 cases), benign prostat(ic) hyperplasia (BPH) epithelia (13 cases), prostate cancer and prostate cancer cell lines (8 cases) were analyzed by using semi-quantitative reverse transcription polymerase chain reaction (RT-PCR). Western blot was used to analyze the protein levels of human kallikrein 7 (hK7) in benign prostate epithelia and prostate cancer cell lines, hK7 expressions were examined in 20 normal prostate tissue specimens, 50 BPH specimens and 103 prostate cancer specimens by immunohistochemical staining.Results The mRNA levels of KLK7 in normal prostate, BPH and prostate cancer were 0.59, 0.52 and 0.02 respectively, mRNA levels of KLK7 were significantly different among the three groups (F=13.03, P＜0.01). mRNA levels of KLK7 were decreased in prostate cancers compared with that in benign hyperplastic prostate epithelial cells (P＜0.01) and in normal prostate epithelial cells (P＜0.01). No significant difference of KLK7 mRNA levels was found between normal prostate and BPH. The protein levels of KLK7 in normal prostate, BPH, DU145, LNCaP, PC3,22RV1 and BPH1 was 0.22, O. 40, 0.01, 0.05, 0, 0.03 and 0.14 respectively, hK7 protein level was down-regulated in prostate cancer cell lines compared to benign prostate epithelial cells. The expression of bK7 was observed in benign prostate epithelial cells, whereas little or no staining was observed in prostate cancer cells in immunohistochemical study, hK7 protein was detected in 13 of 20 (65%)normal prostate specimens, 38 of 50 (76%) BPH specimens and 18 of 103 (17.5%) prostate cancer specimens. The difference between the normal prostate and prostate cancer was significant (Z=-4.43, P＜0.01). The difference between BPH and prostate cancer was significant (Z=-7.77,P＜0.01) as well. However, no significant difference of hK7 protein level was found between normal prostate and BPH (Z=-1. 52, P＞0.05). Conclusions KLK7 expression level is down regulated in prostate cancer. KLK7 may play an important role in prostate cancer progression.