Endoscopic treatment for ureterovesical junction stenosis in patients with kidney transplantation: 13 cases report / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the safety and efficacy of endoscopic treatment for ureterovesical junction (UVJ) stenosis in patients with kidney transplantation.@*METHODS@#A retrospective study was conducted among the patients with kidney transplantation diagnosed as UVJ stenosis from 2012 March to 2018 July in Urology and Lithotripsy Center, Peking University People's Hospital. Only the patients who received endoscopic treatment were included, with staged or same-session nephrostomy followed by a retrograde ureteroscopy to evaluate the ureteral stenosis. Incisions with laser, mono- or bipolar energy, or balloon dilation were used to manage the stenosis depending on different situations. Demographic characteristics and clinical data were gathered and analyzed, including age, gender, preoperative serum creatinine, hemoglobin, operation time, success rate, postoperative serum creatinine, hemoglobin, postoperative complications rate, and long-term stenosis recurrence rate.@*RESULTS@#In this study, 13 patients were included (9 males and 4 females). All the UVJ stenoses were diagnosed with preoperative ultrasound, CT scan, MRI, or urethrography. The mean age was 45 years (range 34-57 years). The mean preoperative serum creatinine was 243 μmol/L. Four patients developed UVJ stenosis 1 month after kidney transplantation, while the rest developed long-term stenosis. Fifteen operations were performed in all, of which 14 cases were successful while one failed. The first 8 cases received first-stage nephrostomy and second-stage endoscopic management of the stenosis, while the last 7 cases received the same session surgery. The mean operation time was 95.4 min vs. 68.9 min, and the immediate success rate was 87.5% vs. 100.0% in the first 8 cases and last 7 cases, respectively. The mean decrease of postoperative hemoglobin was 0.6 g/L and mean postoperative serum creatinine was 105 μmol/L. No postoperative fever, severe hematuria, and urine leak were observed. The mean postoperative hospital stay was 2.8 days. Three patients were able to remove ureteral stents and no recurrence was found with a follow-up time of 9, 17, and 82 months. The long-term stenosis recurrence rate was 76.9% (10/13).@*CONCLUSION@#Endoscopic approach for the treatment of UVJ stenosis in patients with kidney transplantation was safe and efficient in our study cohort. However, long term stenosis recurrence rate was high and needed to be paid attention to.

Safety and efficacy of China-made sildenafil citrate in the treatment of erectile dysfunction / 中华男科学杂志

Objective@#To evaluate the safety, efficacy and tolerability of China-made sildenafil citrate (Jinge) in the treatment of ED.@*METHODS@#We conducted a multi-center, randomized, double-blind and placebo-controlled clinical trial among 222 ED patients in five urological or andrological clinics of China. The patients were randomly assigned to receive sildenafil citrate (SC, n = 111) or placebo (n = 111) for 8 weeks. We obtained and analyzed the demographic and clinical characteristics of the patients, the scores of International Index of Erectile Function (IIEF), the success rate of sexual intercourse, and the incidence of adverse events.@*RESULTS@#No statistically significant differences were found between the patients of the SC and those of the placebo group in the mean age (［47.2±11.32］ yr vs ［46.67±13.08］ yr, P>0.05), psychological etiology (27.93% vs 23.42%, P>0.05), organic etiology (21.62% vs 29.73%, P>0.05) or mixed etiology (50.45% vs 46.85%, P>0.05), nor in height, weight, nationality, or history of smoking, drinking or allergy. Compared with the placebo controls, the SC-treated patients showed significant increases in the excellence rate of effectiveness (29.91% vs 78.90%, P<0.01), success rate of sexual intercourse (29.16% vs 63.87%, P<0.01), and total effectiveness rate (34.58% vs 77.98%, P<0.01). The effectiveness rates on organic, psychogenic and mixed types ED were remarkably higher in the SC group (64.52%, 83.33%, and 82.14%) than in the placebo control (46.15%, 21.21%, and 25.00%) (P<0.01). Mild or temporary adverse events were observed in 32 cases in the SC group as compared with 13 in the placebo control.@*CONCLUSIONS@#China-made sildenafil citrate is an effective, safe and well-tolerated drug for ED of different etiologies in the Chinese population.

Analysis and clinical implication of upper urinary tract stone's bacterial spectrum / 中华外科杂志

<p><b>OBJECTIVES</b>To analyze the pathogenic bacterial's distribution and the drug resistance in the upper urinary tract stones, and to provide the information for choosing suitable antibiotics.</p><p><b>METHODS</b>Stone samples were taken for culture and for drug sensitivity test in 146 patients undergoing percutaneous nephrolithotomy between April 2007 and October 2008, and the results were analyzed.</p><p><b>RESULTS</b>Pathogens presented in 72 (49.3%) patients. There were 70 (86.4%) Gram-negative bacteria strains. Escherichia coli, Pseudomonas aeruginosa and Enterobacter cloacae were the predominant bacteria, accounted for 30.9%(25 strains), 23.5% (19 strains) and 12.3% (10 strains), respectively. There were 10 (12.3%) Gram-positive bacteria strains, the predominant bacteria was Staphylococcus epidermidis (6 strains), accounting for 7.4%. And there was 1 fungi strain (1.2%). Resistance to ampicillin/sulbactam (88.7%), ceftriaxone (81.3%) and ciprofloxacin (67.5%) was most commonly found in pathogen, and the rate of resistance to amikacin, imipenem and piperacillin/tazobactam were 8.6%, 10.0%, 10.0%, respectively. Erythromycylamine, teicoplanin, SMZ-TMP, nitrofurantoin were sensitive to Gram-positive bacteria.</p><p><b>CONCLUSIONS</b>Bacterial's distribution of upper urinary tract stones are multiple, and the majority pathogen is Gram-negative bacteria. A big variant resistance is found among different bacterium. The suitable antibiotics should be chosen according to the different bacterium in the patients who underwent percutaneous nephrolithotomy.</p>

Early and delayed castrations confer a similar survival advantage in TRAMP mice / 亚洲男科学杂志(英文版)

The most appropriate time to introduce androgen deprivation therapy for prostate cancer remains controversial. Our aim was to evaluate the effects of early versus delayed surgical castration on prostate cancer progression and survival in the transgenic adenocarcinoma of the mouse prostate (TRAMP) model. TRAMP mice were randomly divided into three groups: the early castration group (on which castration was performed at the age of 4 weeks), the delayed castration group (on which castration was performed when abdominal tumours could be palpated), and the sham-castrated group. Mice were monitored daily throughout their lives until cancer-related death or the development of an obviously moribund appearance, at which time the individual mouse was killed. Androgen receptor expression in prostate tumours was also evaluated. The results shows that the average lifespan in early castration, delayed castration and sham-castrated groups were 54.1 weeks, 59.9 weeks and 39.1 weeks, respectively. Both early castration and delayed castration conferred a statistically significant survival advantage when compared with the sham-castrated group (P<0.001). However, the difference in lifespan between the early castration group and the delayed castration group was not statistically significant (P=0.85). The increase in lifespan in the TRAMP mice that received either early or delayed castration correlated with lower G/B value (genitourinary tract weight/body weight) at death than the sham-castrated mice. In conclusion, early and delayed castrations in TRAMP mice prolonged survival to a similar extent. This finding may provide a guide for clinical practice in prostate cancer therapy.

Prostatic abscess: a report of 2 cases and meta-analysis of domestic literature in recent 10 years / 中华男科学杂志

<p><b>OBJECTIVE</b>To report 2 cases of prostatic abscess and review the current characteristics of prostatic abscess in China.</p><p><b>METHODS</b>Two cases of prostatic abscess were reported, and a meta-analysis was made of the literature from the Chinese National Knowledge Infrastructure database and Wanfang Data in recent 10 years.</p><p><b>RESULTS</b>Both the cases had a high glucose level, and one of them had received instrumental examination of the lower urinary tract prior to the problem, both with difficult defecation, severe perineal pain and high fever, with normal peripheral white blood cell count and negative urine routine. One case of abscess was confirmed by MRI, ruptured into urethra and cured by antibiotics. The other case was confirmed by transrectal ultrasound and CT and cured by transrectal ultrasound guided needle aspiration. Meta-analysis showed that the predisposed factors were diabetes mellitus, the indwelling catheter and instrumentation of the lower urinary tract. Major pathogens were staphylococci aureus and Escherichia coli. For most patients, the diagnosis was mainly established by ultrasonography and the treatment included needle aspiration or surgery.</p><p><b>CONCLUSION</b>The clinical symptoms of prostatic abscess are not typically presented and the differential diagnosis may be difficult. Imaging investigation is helpful, and transrectal ultrasonography can be used for both diagnosis and treatment.</p>

Outline of diagnosis and treatment on male sexual dysfunction / 中华男科学杂志

Sexual dysfunction is common among male adults. Here we summarized the recent papers and provided the outline of diagnosis and treatment on male sexual dysfunction.

Study on the knowledge of and attitude to sexual dysfunction in aged men / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the knowledge of and attitude to sexual dysfunction in aged men, and to discuss the status and needs of male healthcare.</p><p><b>METHODS</b>Two thousand seven hundred and twenty-eight men (40-70 years old) were surveyed on sexual dysfunction using the randomized questionnaire in Xicheng District, Beijing.</p><p><b>RESULTS</b>The prevalence of erectile dysfunction (ED) was 41.2%, and only 12.1% ED patients were to see the doctor. 52.4% aged men thought the sexual life was important or very important during the life, and 55.6% thought ED would exert negative impact on the quality of life and the partner relationship. Although 27.4% knew that ED was a kind of disease, 49.0% thought ED was a nature rule. Compare to the 41.2% ED prevalence, only 9.7% male were dissatisfied with their sexual life, and later ratio was 14.1% among the partner.</p><p><b>CONCLUSION</b>In China, the status of the knowledge of and attitude to sexual dysfunction in aged men was unsatisfactory to some extent. There is a lot of work to do especially in sexual healthcare education and improvement on diagnostic and treatment of sexual dysfunction.</p>

Advances in the treatment of erectile dysfunction by viagra / 中华男科学杂志

Viagra has become the first line drug for the treatment of erectile dysfunction since it was first introduced in 1998. Its efficacy and safety have been sidely acclaimed as being definite. This article presents a brief review about the advances in the studies of Viagra, including its therapeutic effect and safety, its protection of penile health, and its promotion of self-esteem and sexual relationship.

Prevalence and risk factors of erectile dysfunction in three cities of China: a community-based study / 亚洲男科学杂志(英文版)

<p><b>AIM</b>To determine the age-adjusted prevalence of erectile dysfunction (ED) in 3 big cities of China and to explore its potential sociodemographic, medical and lifestyle correlates.</p><p><b>METHODS</b>A cross-sectional, population-based survey was conducted in three cities of China. Structured questionnaires were administered to 2 226 men, aged 20 - 86 years, by trained interviewers.</p><p><b>RESULTS</b>The age-adjusted prevalence of ED was 28.34 % (mild 15.99 %, moderate 7.14 %, severe 5.21 %). In the men above 40, the prevalence was 40.2 %. Age was positively correlated with ED (P<0.01). Education was negatively correlated with ED (P<0.01). Spouse companionship, living condition were positively correlated with ED (P<0.01). Histories of cardiovascular disease, diabetes, and hyperlipidemia were positively correlated with ED (P<0.01). Cigarette smoking was not correlated with ED (P>0.05), while the cigarette consumption and duration were positively correlated with ED (P<0.01). Alcohol drinking is negatively correlated with ED (P<0.01). The duration of drinking was positively correlated with ED (P<0.01). Weekly alcohol consumption was not correlated with ED (P>0.05).</p><p><b>CONCLUSION</b>The prevalence of ED increased with age. Cardiovascular disease, diabetes and hyperlipidemia were positively correlated with the increased prevalence. Sociodemographic and lifestyle factors, such as education, spouse companionship, living condition, cigarette and alcohol consumption or duration also have association with the prevalence of ED.</p>

Efficacy and safety of PGE1 cream in the treatment of erectile dysfunction / 中华男科学杂志

<p><b>OBJECTIVES</b>To evaluate the efficacy and safety of PGE1 cream[Befar, NexMed Pharmaceuticals(Zhongshan) Ltd] on men with ED of various etiologies in China.</p><p><b>METHODS</b>This was a double-blind, randomized (1:1, placebo: PGE1 cream), placebo-controlled clinic study of PGE1 cream performed at Peking University Pepole's Hospital for 8 weeks. A total of 42 subjects suffered from erectile dysfunction of psychologic, organic or mixed etiology were screened and randomized, and visited occurred at weeks -4, 0, 2 and 4 weeks covering a 4-week no treatment run-in period and a 4-week period of double blind treatment.</p><p><b>RESULTS</b>At week four PGE1 cream was shown to be significantly (P < 0.01) effective over placebo in the sexual function endpoints analyses. The primary efficacy variables (Questions 3 and 4 from IIEF) revealed a statistically significant (P < 0.01) improvement over placebo along with a clinical efficacy change score with an effective rate of 63.16% on PGE1 cream vs 9.52% on placebo. The secondary efficacy variables supported the conclusion of the primary efficacy (assessing the proportion of successful attempts at sexual intercourse 68.42% on PGE1 cream vs 19.05% on placebo), and the global assessment question (treatment had improved their erections, 73.68% on PGE1 cream vs 19.05% on placebo). PGE1 cream was well tolerated when given prn. Subjects in the study had a low discontinuation rate (4.76%), only one subject (2.38%) discontinued due to adverse events. The incidence of adverse events was higher for PGE1 cream (30.00%) than for placebo (4.76%). The common adverse events were mild pain of penis and urethra.</p><p><b>CONCLUSIONS</b>PGE1 cream is an effective, safe and well-tolerated treatment in subjects with erectile dysfunction of organic, psychologic or mixed etiology.</p>

Chronic prostatitis symptom index of Chinese / 中华男科学杂志

<p><b>OBJECTIVES</b>To establish the chronic prostatitis symptom index which more suitable for Chinese to refine and standardize evaluation of current symptoms in men with "chronic prostatitis".</p><p><b>METHODS</b>The literature of previous work was reviewed to develop a symptom index instrument. There were 18 questions representing three broad categories: pain symptoms, urinary symptoms and other symptoms. To evalute the clinical utility and applicability for Chinese people of this tool, we used it in 100 patients with chronic prostatitis and 100 control patients (40 with benign prostatic hyperplasia, BPH; 30 with infertility; 30 with erectile dysfunction).</p><p><b>RESULTS</b>Of the three aspects symptoms, the primary component was pain. But pain in lower back and lower abdomen had less specificity. Pain in the rectal area was not very common but it could well distinguish patients with prostatitis from those BPH, infertility and ED. Urinary symptoms were also common. We used 5 symptom questions in urinary aspect in the last version of this index. In other symptoms, we dropped the question of uncomfortable of waist and back at last. It could not distinguish patients with prostatitis from those infertility and erectile dysfunction. Finally we analyzed the result and modified the new version of chronic prostatitis symptom index. It included 5 pain symptom questions, 5 urinary symptom questions and 2 other symptom questions. There are 12 questions in total.</p><p><b>CONCLUSIONS</b>The chronic prostatitis symptom index we developed was validated and useful in clinical practice as well as research protocols. Moreover, it was more suitable for Chinese people.</p>