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.

Low-dose nonylphenol promotes the proliferation of DU-145 cells and expression of membrane estrogen receptor GPR30 in DU-145 cells / 中华男科学杂志

<p><b>OBJECTIVE</b>To observe the effects of low-dose exogenous estrogen nonylphenol (NP) on the proliferation of human prostate cancer cell lines DU-145 and the expression of the membrane estrogen receptor GPR30 in the DU-145 cells.</p><p><b>METHODS</b>We exposed DU-145 cells to different concentrations of NP for 24 hours, followed by measurement of the half maximal inhibitory concentration (IC50) of the cells by cell proliferation assay and determination of the concentration of exposure to low-dose NP. We also observed the expressions of 3 estrogen receptors (ER), including ER-alpha, ER-beta and membrane estrogen receptor GPR30, in the DU-145 cells exposed to low-dose NP by RT-PCR.</p><p><b>RESULTS</b>Cell proliferation assay showed that within a certain range of doses, NP inhibited the proliferation of the DU-145 cells with an IC50 of 46 micromol/L, a much lower dose of NP than IC50, 0.01, 0.1.1 micromol/l NP, that can promote the proliferation of DU-145 cells. The results of RT-PCR indicated that the expressions of the three ERs in the DU-145 cells were similar to those in prostate epithelial cells, and that low-dose NP promoted the expression of GPR30.</p><p><b>CONCLUSION</b>Membrane estrogen receptor GPR30 may play a role in low-dose NP promoting the proliferation of DU-145 cells.</p>

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>

Treatment of penile strangulation and sexual psychological analysis of the patients / 中华男科学杂志

<p><b>OBJECTIVE</b>To find the best treatment of penile strangulation and to analyze the sexual psychological factors of the patients.</p><p><b>METHODS</b>We retrospectively analyzed the experiences in removing foreign objects around the penis in 21 patients aged 19 - 61 years with the strangulation time varying from 10 hours to 4 days. The objects were mostly made of metal or plastics.</p><p><b>RESULTS</b>All the objects were successfully removed, 5 of them with the help of lubricant, 4 by aspirating the corpus cavernosum, 8 by shipping with pliers, 2 with the diamond-tipped dental drill, and the other 2, which virtually defied cutting, by aspirating the corpus cavernosum following degloving surgery.</p><p><b>CONCLUSION</b>In removing foreign objects around the penis, simpler methods should be given precedence over more complex ones, and for those that virtually defy cutting, the best option is degloving surgery with particular attention to the survival of the penile skin flap.</p>

Inhibitory effect of TRPV6 silencing on prostate cancer cell line LNCaP in vitro / 中华男科学杂志

<p><b>OBJECTIVE</b>To explore the effects of the TRPV6 gene silencing by small interfering RNA (siRNA) on the proliferation, cell cycle and apoptosis of human prostate cancer LNCaP cells.</p><p><b>METHODS</b>We constructed two siRNA sequences (siTRPV6-1 and siTRPV6-2) targeting the TRPV6 gene and then transfected them into LNCaP cells mediated by liposome. The transcription of TRPV6 mRNA was detected by RT-PCR, and the effects of siRNA on the proliferation, cell cycle and apoptosis of the LNCaP cells were determined by MITT and flow cytometry.</p><p><b>RESULTS</b>Both siTRPV6-1 and siTRPV6-2 significantly suppressed the expression of TRPV6 mRNA in the LNCaP cells, and the expression was decreased with the extension of time, by 73 and 77% respectively at 72 h after transcription with siTRPV6-1 and siTRPV6-2 as compared with the blank control group (P < 0.01). The proliferation inhibition rates were the highest (34.53 and 29.32%) at 48 h in comparison with 24 and 72 h (P < 0.05). The number of cells was significantly increased in the GO and G1 phases and decreased in the S phase after siTRPV transfection (P < 0.01). The apoptosis rates of LNCaP cells were 14.45 and 12.73% respectively at 48 h after transfected with siTRPV6-1 and siTRPV6-2, significant higher than in the blank control and negative control groups (P < 0.05).</p><p><b>CONCLUSION</b>TRPV6-targeted siRNA can effectively inhibit the transcription of TRPV6 mRNA, inhibit the proliferation of LNCaP cells, arrest their cycles in the G0 and G1 phases, and induce their apoptosis.</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>

Efficacy and safety of long-acting gonadotropin-releasing hormone analogue in the treatment for metastatic prostate cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of gonadotropin-releasing hormone analogue (GnRHa) triptorelin 11.25 mg 3-month sustained release formulations in the treatment of metastatic prostate cancer.</p><p><b>METHODS</b>From January 2004 to March 2006, a randomized, parallel-controlled, multicenter clinical trial was conducted. One hundred and twenty-seven patients with documented metastatic prostate cancer were randomized to receive one injection of the 11.25 mg formulation triptorelin (n = 65) or three injections at 28-day intervals of the 3.75 mg formulation (n = 62). Changes from baseline of TPSA, prostate volume, testosterone, LH, FSH, PRL and estradiol were assessed over 3 months. Changes of the metastatic lesions were also observed and evaluated. The occurrences of adverse events were evaluated as well.</p><p><b>RESULTS</b>After 3 months treatment, total PSA level decreased significantly from baseline both in 11.25 mg group and 3.75 mg group. At 30, 60 and 90 days, TPSA (median level) declined from 164.55 microg/L into 11.34, 4.12, 3.89 microg/L in 11.25 mg group, and from 101.38 microg/L into 6.88, 2.41, 2.57 microg/L in control group respectively. The patients ratio with over 90% decreasing from TPSA baseline were 78.6% and 75.5% respectively in two groups (P = 0.700). Prostate volume were also decreased significantly in both groups, median volume declined from 48.0 mm(3) into 21.5 mm(3) in 11.25 mg group and from 45.0 mm(3) into 21.0 mm(3) in 3.75 mg group. No significant differences were found between the two groups in changes of TPSA (P = 0.601) and prostate volume (P > 0.05). Both formulations were able to induce castration levels, 0.31 microg/L in 11.25 mg group and 0.26 microg/L in 3.75 mg group (P > 0.05). 13.8% and 17.7% of adverse events were recorded respectively in two groups, and no differences were found (P = 0.547).</p><p><b>CONCLUSION</b>As a new long-acting sustained release formulation, triptorelin 11.25 mg is comparable to triptorelin 3.75 mg formulation in the aspect of efficacy and safety for the treatments of metastatic prostate cancer.</p>

Relationship between the intrapelvic perfusion pressure in minimally invasive percutaneous nephrolithotomy and postoperative recovery / 中华外科杂志

<p><b>OBJECTIVES</b>To introduce the method to monitor intrapelvic perfusion pressure during minimally invasive percutaneous nephrolithotomy (MPCNL), and to observe the effect of high pressure intrapelvic perfusion on recovery.</p><p><b>METHODS</b>The end of F5 ureteral catheter and aseptic transducer were connected by self-made connecter. During the operation, 46 renal calculi cases were monitored, and the early complication, such as fever, pain index, drop of hemoglobin, the stone-free rate and hospital stay were investigated. And the relationship between the variation of pressure and recovery was studied.</p><p><b>RESULTS</b>Intrapelvic perfusion pressure ranged from 3 mm Hg (1 mm Hg = 0.133 kPa) to 50 mm Hg during the course of MPCNL. The definition of high pressure was the time of the pressure more than 30 mm Hg not less than 10 min. Postoperative fever rate, pain index, drop of hemoglobin and hospital stay in the high pressure were significantly higher than low pressure group (P< or =0.05). There was no difference of the stone-free rate in two groups.</p><p><b>CONCLUSIONS</b>During the course of MPCNL intrapelvic perfusion pressure should be monitor immediately. It should be careful to maintain the time of pressure more than 30 mm Hg less than 10 min for stable postoperative recovery.</p>

Detection of DD3 mRNA in the urine of prostate cancer patients and its clinical significance / 中华男科学杂志

<p><b>OBJECTIVE</b>To detect the differential display code 3 mRNA (DD3 mRNA) in the urine sample of patients with prostate cancer and to evaluate its clinical significance.</p><p><b>METHODS</b>DD3 mRNA in the urine collected from 48 patients with prostate cancer, 23 patients with benign prostate hyperplasia (BPH) and 9 healthy male volunteers was measured by reverse transcriptase polymerase chain reaction (RT-PCR).</p><p><b>RESULTS</b>DD3 products could not be detected in the urine samples of the BPH patients and healthy male volunteers, but could in 39/48 urine samples of the patients with prostate cancer. Significant difference was found between them (P < 0.01).</p><p><b>CONCLUSION</b>The detection of DD3 mRNA in the urine promises to be a non-invasive, simple and sensitive method for the early diagnosis and post-treatment monitoring of prostate cancer.</p>

Retroperitoneoscopic dismembered pyeloplasty in children / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the technique and the clinical efficacy of Retroperitoneoscopic dismembered pyeloplasty in children.</p><p><b>METHODS</b>Retroperitoneoscopic dismembered pyeloplasty was performed on 17 patients of pediatric ureteropelvic junction (UPJ) obstruction, age ranging from 3 - 10 years. All patients had radiographic evidence of obstruction with signs, symptoms or deterioration of renal function.</p><p><b>RESULTS</b>All of the 17 operations were performed successfully, and no serious complications occurred during and after the operations. Average operating time was 4.3 hours, which decreased with surgeon experience. Average blood loss was 38 ml, mean postoperative stay was 4.6 d. Only one case had postoperative urine leakage. With a mean follow-up of 14 months, all patients were free of obstruction on follow-up radiographic imaging.</p><p><b>CONCLUSIONS</b>Retroperitoneoscopic dismembered pyeloplasty is a safe, effective and minimally invasive procedure for treatment of UPJ obstruction in children, and it can be used as an alternative to open surgery.</p>

Using of percutaneous nephrolithotomy in pediatric urolithiasis / 中华外科杂志

<p><b>OBJECTIVE</b>To assess the safety and efficacy of percutaneous nephrolithotomy (PCNL) using ureteroscope and pneumatic intracorporeal lithotripsy in the pediatric age group.</p><p><b>METHODS</b>Twenty-two renal units in 15 patients underwent PCNL at our institute. The patients were all under 14 years old. The average age was 9 years (range 5-14 years). There were 7 bilateral, 8 multiple, and 5 staghorn calculi. The average calculus size was 2.0 (0.9-4.5) cm. The PCNL was done with an X ray-guided peripheral puncture, a planned staged approach in some cases, and minimal tract dilatation with the use of an ureteroscope and pneumatic intracorporeal lithotripsy.</p><p><b>RESULTS</b>Complete stone clearance was achieved in 20 renal units, giving an overall clearance rate of 91%. Minor pyrexia (< 39 degrees C, < 2 days) was seen in 14 patients, whereas serious pyrexia was seen in 1. The average fall in hemoglobin was 10 g/L, but none of the patients required blood transfusion.</p><p><b>CONCLUSIONS</b>It is safe and effective to cure pediatric urolithiasis with percutaneous nephrolithotomy using ureteroscope and pneumatic intracorporeal and pneumatic intracorporeal lithotripsy.</p>

Omission factors in detecting early stage prostate cancer by TRUS needle biopsy / 中华男科学杂志

<p><b>OBJECTIVE</b>To analyze and reduce the omission factors in detecting early stage prostate cancer by TRUS needle biopsy, and to improve the diagnosis of the disease.</p><p><b>METHODS</b>A total of 80 benign prostatic hyperplasia patients suspected of prostatic carcinoma underwent TRUS sextant biopsies. The pathological results being negative, the patients received transurethral resection of the prostate (TURP).</p><p><b>RESULTS</b>After TURP, 25 cases were pathologically diagnosed as prostate cancer, with an omission rate of 31.25% (25/80). Of the diagnosed cancer patients, 10 were treated by radical perineum prostatectomy, 8 by surgical castration, and 7 by medical castration.</p><p><b>CONCLUSION</b>Some tumors may fail to be detected by TRUS needle biopsy. Serial or multi-core needle biopsies can decrease the omission rate in the diagnosis of organ confined cancer.</p>

Estrogen and bone metabolism in man / 中华男科学杂志

In males, androgen can be aromatized into estrogen by aromatase. Estrogen receptors were shown to be present in male-derived human osteoblasts. For males bone is an important target tissue of estrogen. It was demonstrated that deficiency of estrogen or mutation of estrogen receptor gene in males could lead to osteopenia, even osteoporosis. Estrogens are required for the pubertal growth of bone and play important roles in maintenance of bone mass in males.

Two methods of laparoscopic varicocelectomy for the treatment of spermatic varicocele / 中华男科学杂志

<p><b>OBJECTIVE</b>To introduce two methods of laparoscopic varicocelectomy for the treatment of spermatic varicocele.</p><p><b>METHODS</b>Forty-five cases of spermatic varicocele were treated by video laparoscopic technique with two or three punch.</p><p><b>RESULTS</b>All the 45 operations were performed successfully, and no complications occurred during and after the operations.</p><p><b>CONCLUSIONS</b>Spermatic varicocele is one of the most suitable indications for video laparoscopic surgery. The two-punch technique is more advantageous than the three-punch.</p>

Clinical investigation of the treatment of children urethral calculi with pneumatic lithotripsy under ureteroscopy / 中华男科学杂志

<p><b>OBJECTIVE</b>To evaluate the therapeutic effects of pneumatic lithotripsy on children urethral calculi.</p><p><b>METHODS</b>Twenty-two cases of the male children with urethral calculi were treated with pneumatic lithotripsy under ureteroscopy.</p><p><b>RESULTS</b>All the patients were treated successfully in a single procedure. The time of lithotripsy was (5.5 +/- 2.2) minutes, and no serious complication such as obvious hematuria, infection and urethral stricture occurred.</p><p><b>CONCLUSIONS</b>It is suggested that pneumatic lithotripsy under ureteroscopy is an effective and simple way for the treatment of urethral calculi in children.</p>

Partial androgen deficiency in aging males / 中华男科学杂志

Partial androgen deficiency in aging males can be defined as a clincal condition characterized by a partial deficiency of androgen in blood and/or a decrease genomic sensitivity to testosterone or its active metabolites in target tissues. This state of hypogondism leads to a decline of physical energy, an altered state of well-being, a sexual dysfunction and various metabolic alterations. Testosterone supplement therapy can improve all these symptoms.