Analysis of three minimally invasive methods in the treatment of the fifth metacarpal neck fracture / 中国骨伤

OBJECTIVE@#To explore the effective method of applying Chinese medicine manipulative repositioning Kirschner wire fixation for minimally invasive treatment of fractures of the neck of the fifth metacarpal.@*METHODS@#From January 2018 to November 2021, 90 patients with closed fractures of the neck of the fifth metacarpal bone were treated minimally invasively with closed repositioning Kirschner wires, all fractures AO type was type A. All patients were divided into three groups according to the mode of internal fixation involving 30 cases in the crossed Kirschner's wire group, 30 cases in the transverse Kirschner's wire group, 30 patients in the intramedullary Kirschner's wire group. By comparison, gender, age, disease duration, and preoperative neck-stem angle were not significant. The postoperative fifth metacarpal neck-stem angles, postoperative fifth metacarpophalangeal joint flexion mobility and fifth metacarpophalangeal joint extension hyperextension angles were compared among three groups. The overall clinical efficacy was evaluated according to the patient outcomes of surgery-hand/arm(POS-Hand/Arm) scoring system.@*RESULTS@#All patients had 12-month follow-up and achieved bony union without malunion. There was no significant difference in the 5th metacarpal neck-stem angle, the fifth metacarpophalangeal joint flexion angle and the fifth metacarpophalangeal joint extension hyperextension angles among three groups at 12 months after surgery(P>0.05). There was no significant difference in physical activity and symptom scores in POS-Hand/Arm scores at 12 months after surgery(P>0.05), psychological status and aesthetic score among three groups(P<0.05) and between cross and transverse Kirschner wire groups(P>0.05). The three POS-Hand/Arm total scores were statistically different(P<0.05), between the crossed and transverse(P>0.05), and the intramedullary group had the highest POS-Hand/Arm scores.@*CONCLUSION@#All three techniques of Kristener's wire fixation could achieve minimally invasive treatment, and patients have need for cosmetic and early activity, and the author recommend minimally invasive intramedullary fixation with manipulative repositioned Kristen wires as the preferred procedure.

Transrectal shear wave elastography combined with transition zone biopsy for detecting prostate cancer / 中华男科学杂志

<p><b>OBJECTIVE</b>To evaluate the application of shear wave elastography (SWE) combined with transition zone biopsy in the detection of prostate cancer (PCa).</p><p><b>METHODS</b>A total of 489 patients with suspected PCa underwent transrectal ultrasonography (TRUS) and SWE-guided prostatic biopsy. We evaluated the role of SWE combined with transition zone biopsy in promoting the detection rate in comparison with the results of biopsy pathology.</p><p><b>RESULTS</b>The pathological results confirmed 221 malignant and 268 benign cases. Based on systematic biopsy, SWE combined with transition zone biopsy achieved a detection rate of 45. 19% , significantly higher than that of systematic biopsy alone (33.13%) (P < 0.05). The diagnostic sensitivity, specificity, and accuracy of SWE were significantly better than those of TRUS (P < 0.05). The mean elasticity (Emean) of SWE was remarkably higher for malignant than for benign lesions ([40.1 ± 9.5] vs [21.6 ± 8.3] kPa, P < 0.05). With 28.5 kPa as the threshold of the Emean value, the area under the ROC curve was 0. 899, and the diagnostic sensitivity and specificity were 88.71% and 86.23%, respectively.</p><p><b>CONCLUSION</b>SWE combined with transition zone biopsy could significantly improve the detection rate of prostate cancer.</p>

Methylation and protein expression of RASSF2 in prostate cancer / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the role of the epigenetic inactivation of Ras association domain family 2 (RASSF2) in the occurrence and development of prostate cancer by detecting the methylation and protein expression of RASSF2 in the tissues of prostate cancer and prostatic hyperplasia.</p><p><b>METHODS</b>We obtained genome DNA from 30 formalin-fixed paraffin-embedded specimens of prostate cancer (experimental group) and another 30 of prostatic hyperplasia (control group). We detected the methylation of RASSF2 by methylation-specific PCR (MSP) and its protein expression by immunohistochemistry.</p><p><b>RESULTS</b>The rates of RASSF2 promoter hypermethylation and the absence of its protein expression were 66.7% (20/30) and 70.0% (21/30) respectively in the experimental group, significantly higher than 6.7% (2/30) and 3.3% (1/30) in the control group (P < 0.05). The promoter hypermethylation of RASSF2 was significantly correlated with the absence of its protein expression (P < 0.05).</p><p><b>CONCLUSION</b>The epigenetic inactivation of RASSF2 is involved in the occurrence of prostate cancer, and is expected to be a target of molecular diagnosis and treatment of prostate cancer.</p>

Oral tadalafil on alternate days for erectile dysfunction that fails to respond to on-demand sildenafil: a report of 15 cases / 中华男科学杂志

<p><b>OBJECTIVE</b>To sum up the experience in administering oral tadalafil on alternate days for the treatment of erectile dysfunction (ED) that fails to respond to on-demand medication.</p><p><b>METHODS</b>We retrospectively analyzed the clinical data of 15 cases of ED treated with oral tadalafil on alternate days from September 2010 to March 2012. All the patients had failed to respond to on-demand medication of sildenafil previously.</p><p><b>RESULTS</b>After 4 weeks of tadalafil treatment, 11 (73.3%) of the cases were remarkably improved, with significant difference in IIEF-5 scores before and after treatment (P < 0.05). Transient adverse reactions were observed in the other 4 cases, including mild headache in 2, slight backache in 1, and facial flush in 1.</p><p><b>CONCLUSION</b>Oral tadalafil on alternate days is safe and effective in the treatment of ED that fails to respond to on-demand medication of sildenafil.</p>

Detection of the mutation of all the exons of the CFTR gene in Chinese men with congenital bilateral absence of the vas deferens / 中华男科学杂志

<p><b>OBJECTIVE</b>To assess the necessity of detecting the gene of cystic fibrosis transmembrane conductance regulator factor (CFTR) in Chinese men with congenital bilateral absence of the vas deferens (CBAVD).</p><p><b>METHODS</b>We detected the mutation of all the 27 exons of the CFTR gene in 9 patients with CBAVD by DNA sequencing, and compared the results using NCBI and Cystic Fibrosis Mutation Database.</p><p><b>RESULTS</b>Four novel missense mutations/variants were found in the CFTR gene of the CBAVD patients, which were submitted and accepted in the Cystic Fibrosis Mutation Database.</p><p><b>CONCLUSION</b>There are mutations or variants in the CFTR gene in Chinese men with CBAVD, and the mutational distribution is different from that in Westerners.</p>

Alternate-day oral tadalafil for erectile dysfunction with no successful intercourse at the baseline / 中华男科学杂志

<p><b>OBJECTIVE</b>To summarize the experience in the treatment of erectile dysfunction (ED) with no successful intercourse at the baseline with tadalafil.</p><p><b>METHODS</b>We retrospectively analyzed 21 cases of ED with no successful intercourse at the baseline treated with tadalafil on alternate days combined with sex guidance.</p><p><b>RESULTS</b>After 4 weeks of tadalafil treatment, 19 of the patients achieved successful sexual intercourse, and the IIEF-5 score was remarkably improved as compared with pre-medication (3.24 +/- 1.55 vs 18.95 +/- 3.02, P<0.0001). Mild adverse reactions were observed in 6 cases, including 2 cases of mild headache and 4 cases of facial blush.</p><p><b>CONCLUSION</b>Tadalafil on alternate days combined with sex guidance can significantly improve ED with no successful intercourse at the baseline.</p>

Analysis of urinary storage symptoms following transurethral resection of the prostate / 中华男科学杂志

<p><b>OBJECTIVE</b>To explore the lower urinary tract symptoms (LUTS), especially those in the urinary storage phase, following transurethral resection of the prostate (TURP), and to improve the postoperative management and patients' quality of life after TURP.</p><p><b>METHODS</b>A total of 86 patients with benign prostate hyperplasia (BPH) underwent TURP, and were interviewed on urinary symptoms at 1, 3, 7, 15 and 30 days after removal of the catheter. The patients were divided into two groups according to whether they had preoperative detrusor instability and/or compliance of the bladder (Group A) or not (Group B), and observed for the changes in IPSS scores and urinary storage symptoms after removal of the catheter.</p><p><b>RESULTS</b>Complete follow-ups were achieved in 71 cases, 28 with detrusor instability and/or compliance of the bladder and the other 43 without. Their IPSS scores on the 1st, 3rd, 7th, 15th and 30th day after removal of the catheter were 8.1 +/- 2.5, 7.2 +/- 3.1, 6.3 +/- 3.8, 5.3 +/- 4.2 and 2.4 +/- 3.4, respectively, with statistically significant differences between the 7th and the 1st as well as the 30th and the 15th day (P < 0.05), but not between the 1st and the3rd nor the 15th and the 7th day (P > 0.05). On the 1st day, the cardinal symptoms in the urinary storage phase were urinary frequency, urgency and incontinence; the scores on IPSS and urinary storage symptoms were 10.4 +/- 3.3 and 9.3 +/- 3.8 in Group A and 6.2 +/- 2.8 and 5.2 +/- 2.7 in Group B, with significant differences between the two groups (P < 0.05). After treatment with tolterodine and alpha-adrenoreceptor inhibitor, neither IPSS scores nor the scores on urinary storage symptoms showed any significant differences between Groups A and B on the 15th and 30th day (P > 0.05).</p><p><b>CONCLUSION</b>The lower urinary tract symptoms following TURP, especially those in the urinary storage phase, are correlated with preoperative bladder function, and getting improved gradually after surgery.</p>

Intracytoplasmic sperm injection for obstructive azoospermia / 中华男科学杂志

<p><b>OBJECTIVE</b>To sum up the experience in the treatment of obstructive azoospermia by intracytoplasmic sperm injection (ICSI).</p><p><b>METHODS</b>We retrospectively analyzed 107 cases of obstructive azoospermia treated by ICSI in our center from Jan. 2006 to Dec. 2008, and compared the rates of fertilization, cleavage and pregnancy between the patients with congenital bilateral absence of vas deferens (CBAVD) and those with non-CBAVD.</p><p><b>RESULTS</b>A total of 949 oocytes were injected for the 107 patients undergoing ICSI, of which 678 (71.4%) were fertilized and 605 (89.2%) cleaved, with 44 pregnancies (41.4%). Of the 442 oocytes injected for the 49 patients with CBAVD, 308 (69.6%) were fertilized and 279 (90.6%) cleaved, with 27 pregnancies (55.1%), and of the 507 oocytes injected for the 58 cases induced by inflammation or surgery, 370 (72.9%) were fertilized and 326 (88.1%) cleaved, with 17 pregnancies (29.3%). The rate of pregnancy was significantly higher in the CBAVD than in the non-CBAVD group (P < 0.01), but there were no significant differences in the rates of fertilization and cleavage between the two groups (P > 0.05).</p><p><b>CONCLUSION</b>PESA or TESE combined with ICSI is an effective approach to the treatment of male infertility induced by obstructive azoospermia, which may achieve a higher rate of pregnancy in patients with CBAVD than in those with non-CBAVD. Inflammation or surgery may not only cause the obstruction of the deferent duct, but also affect sperm quality, and consequently reduce the potentiality of embryonic development.</p>

Diagnosis and treatment of coincident vesical transitional cell carcinoma and prostate cancer: a report of 5 cases / 中华男科学杂志

<p><b>OBJECTIVE</b>To improve the diagnosis and treatment of coincident vesical transitional cell carcinoma (VTCC) and prostate cancer.</p><p><b>METHODS</b>We analyzed the clinical data of 5 cases of coincident VTCC and prostate cancer.</p><p><b>RESULTS</b>The 5 patients, at the mean age of 66.2 years, were diagnosed as having grade II - III VTCC by cystoscopy and biopsy, 1 with a history of prostate cancer, and the other 4 with prostate cancer confirmed by postoperative pathological examination. Two of the patients were treated by radical cystoprostatectomy, 1 by radical cystoprostatectomy and ileum conduit surgery, 1 by transurethral resection of bladder tumor, and the other 1 by palliative ureterocutaneostomy due to cardiopulmonary problems. The follow-up lasted 8 -26 months. One of them died of diffused metastasis 20 months after surgery, 1 survived with the tumor untreated, and the other 3 remained tumor free.</p><p><b>CONCLUSION</b>Coincident VTCC and prostate cancer is easy to be missed in diagnosis. PSA detection, rectal palpation, transrectal ultrasonography, biopsy, and cystoscopy are the main diagnostic options for this disease. Its treatment should be based on the classification and clinical staging of the two cancers. Coincident VTCC and prostate cancer does not suggest poor prognosis.</p>

Clinical analysis and management of disappointing early urination after TURP / 中华男科学杂志

<p><b>OBJECTIVE</b>To explore the etiology and management of disappointing early urination in patients with benign prostatic hyperplasia (BPH) following transurethral resection of the prostate (TURP).</p><p><b>METHODS</b>The clinical data and management of 58 cases of disappointing urination within 3 months after TURP were reviewed.</p><p><b>RESULTS</b>Of the total number of patients with disappointing early urination after TURP, 7 (12%) underwent a second operation, 6 (10%) received outpatient treatment, and the other 45 (78%) showed spontaneous improvement within 1 year with no further treatment.</p><p><b>CONCLUSION</b>The causes of disappointing early urination after TURP included bladder neck contracture, urethral stricture and urinary tract infection, which necessitate secondary treatment. And a greater proportion of the patients showed functional lability of the bladder detrusor muscle, which could be spontaneously improved within 1 year after TURP.</p>

Influence of chronic prostatitis/chronic pelvic pain syndromes on male health / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the influence of chronic prostatitis/chronic pelvic pain syndromes (CP/CPPS) on male health.</p><p><b>METHODS</b>We conducted investigations among 200 cases of CP/CPPS, aged 20 -59 years and randomly selected from 650 out-patients, using an anonymous questionnaire including such items as the patients'age, height, body weight, disease duration and treatment, the results of EPS and semen determinations, and the scores on NIH-CPSI, IIEF-5 and Symptom Checklist (SCL-90).</p><p><b>RESULTS</b>According to the 198 valid questionnaires collected, CPSI scores showed 56 (28.3%) cases to be mild, 98 (49.5%) moderate and 44 (22.2%) severe. Sperm density and motility (grade a + b) were reduced in 38 (19.2%) and 47 (23.7%) cases, respectively. IIEF-5 revealed ED in 41 (20.7%) cases, of which 58.5% were mild. Psychological abnormality was found in 94 (47.5%) cases, including anxiety, depression, sensitiveness and so on. NIH-CPSI scores were positively correlated with psychological symptoms and ED (r = 0.25, P < 0.05; r = 0.12, P < 0.05), but not significantly related with sperm density and motility (P > 0.05).</p><p><b>CONCLUSION</b>The influence of CP/CPPS is obvious on male psychology but mild on penile erection and not significant on semen. Integrated physiological and psychological therapy is recommended for the treatment of CP/CPPS.</p>

Diagnosis and treatment of priapism: a report of 15 cases / 中华男科学杂志

<p><b>OBJECTIVE</b>To improve the diagnosis and treatment of priapism.</p><p><b>METHODS</b>We analyzed the types, causes, treatment and prognosis of 15 cases of priapism. The patients ranged in age from 20 to 66 (mean 46) years, their erection lasting 10-172 (mean 28.4) hours. Among them, 6 cases resulted from in taking vaso-active agents, 1 had transitional cell carcinoma of the bladder metastasized to the penis, 2 had leukemia, 3 had a traumatic history and the other 3 had unknown causes.</p><p><b>RESULTS</b>Of the total number, 12 fell into the ischemic low-flow type and 3 the non-ischemic high-flow type. Follow-up lasted 1-26 months. In the 12 cases of the ischemic low-flow type, 7 were cured by 2-6 mg metaraminol injection at the root of the cavernous body and, when necessary, the perfusion of heparinized saline at the glans and the root of the cavernous body of the penis, and 2 achieved detumescence after glandular cavernosal shunting. The 2 cases caused by leukemia and 1 by metastasis of transitional cell carcinoma underwent penectomy, but with unfavorable prognosis. Of the 3 high-flow type cases, 1 was cured by selective embolization of the internal pudendal artery and the other 2 discharged after conservative treatment, but developed ED on follow-up.</p><p><b>CONCLUSION</b>Cavernous blood gas analysis and color duplex ultrasonography are helpful to the accurate and timely diagnosis of priapism. Cavernosal decompression and intracavernosal injection of aramine can be applied to most of the patients. If conservative treatment fails to achieve detumescence of the penis, surgery should be performed immediately for both types of priapism.</p>

Diagnosis and treatment of isolated tuberculous epididymitis / 中华男科学杂志

<p><b>OBJECTIVE</b>To improve the diagnosis and the treatment of tuberculous epididymitis.</p><p><b>METHODS</b>Retrospective studies were made of 20 cases of isolated epididymal tuberculosis defined as "tuberculosis infection affecting the epididymis without evidence of renal involvement as documented by the absence of acid fast bacilli in the urine sample and on imaging" among 35 patients with epididymal tuberculosis. Two weeks after the intensified anti-TB treatment by the combined therapy of Isoniazid + Rifampicin + Streptomycin or Ethambutol, all the patients underwent surgical removal of the tuberculous lesion, followed again by the combined therapy for 6-9 months.</p><p><b>RESULTS</b>Of the 20 cases, 16 experienced no recurrence and complications within 0.5-5 years after the surgery, 3 were found with urinary tuberculosis at 3, 3.5 and 5 years, and 1 developed tuberculous epididymitis of the other side at 3.5 years.</p><p><b>CONCLUSION</b>Isolated tuberculous epididymitis may be the sole or the initial presentation of genitourinary tuberculosis, for which timely surgery is the best option and has a good prognosis.</p>

Comparison of different drugs on the treatment of benign prostate hyperplasia / 中华外科杂志

<p><b>OBJECTIVE</b>To compare the differences of the efficacy and different therapeutic drugs on the treatment of benign prostatic hyperplasia (BPH) in order to ensure the optimal indication for different BPH patients.</p><p><b>METHODS</b>A randomized, parallel-controlled, multicenter clinical trial was conducted. From September 2002 to December 2003 906 BPH patients were enrolled into 7 therapeutic groups, including selective-adrenoceptor antagonist (terazosin, doxazosin tamsulosin and naftopidil), 5 alpha-reductase inhibitor (finasteride and epristeride) and natural product (cernilton). International Prostate Symptom Score (IPSS) and Quality of Life (QOL), uroflowmetry, total prostatic volume (TPV) and transitional zone volume and residual urine were used as efficacy criteria.</p><p><b>RESULTS</b>According to the baseline, the IPSS and Qmax were significantly correlated to the prostatic volume and transitional zone volume (P < 0.01). At average follow-up of 6 months, significant improvements in IPSS, QOL, Qmax and residual urine volume were observed in each therapeutic group, and no difference in IPSS improvement was found among the groups. Prostatic volume and transitional zone volume were significant decreased in 5alpha-reductase inhibitor groups (P < 0.05). In patients with baseline TPV greater than 35.5 cm3, the improvement of Qmax was more significant than that in patients with TPV less than 35.5 cm3 in finasteride group (P < 0.01) (5.7 ml/s and 2.2 ml/s respectively), and more significant symptomatic improvements were also found in cernilton, doxazosin and naftopidil group. In each group, the improvement of symptom were more significant in patients with IPSS higher than 20 points (P < 0.01).</p><p><b>CONCLUSIONS</b>Each drug observed in this study can improve the subjective and objective symptoms significantly for BPH patients, especially for patients with higher IPSS baseline. When using 5alpha-reductase inhibitor, prostatic volume can be decreased significantly and more obviously subjective and objective improvement can be found in the patients with TPV greater than 35.5 cm3.</p>

Surgery for BPH with impaired detrusor contractility: a report of 12 cases / 中华男科学杂志

<p><b>OBJECTIVE</b>To assess the outcome of prostatectomy simultaneously with suprapubic punctual cystostomy for BPH patients with impaired detrusor contractility.</p><p><b>METHODS</b>Twelve cases of BPH with impaired detrusor contractility were diagnosed by urodynamic examination from 2002 to 2005. The patients underwent prostatectomy simultaneously with suprapubic punctual cystostomy and were followed up for a year.</p><p><b>RESULTS</b>Nine of the patients, at the average age of 69.00 +/- 5.13 years and with a short history of LUST, were restored to normal bladder function, while the other 3, older than 78 years and with a longer LUST history, failed to respond to the treatment.</p><p><b>CONCLUSION</b>BPH patients with impaired detrusor contractility that are younger and have a shorter LUST history could benefit from prostatectomy simultaneously with suprapubic punctual cystostomy, but the older ones with a longer LUST history should be treated by suprapubic punctual cystostomy alone.</p>

Modified urethral pull-through procedure for post-trauma posterior urethral stricture / 中华男科学杂志

<p><b>OBJECTIVE</b>To evaluate the effect of the modified urethral pull-through procedure in the surgical treatment of posterior urethral stricture or obliteration caused by trauma.</p><p><b>METHODS</b>From January 2001 to June 2005, modified urethral pull-through procedures were performed in 36 patients with post-trauma posterior urethral stricture or obliteration, 25 of them with post-operation urethral stricture or obliteration after urethral realignment by traction and the other 11 treated by cystostomy at the time of initial injury. The length of the urethral stricture segment was 1.0-4.5 cm, mean 2.2 cm. The patients were aged from 17 to 59 years (mean 44.5 years).</p><p><b>RESULTS</b>All the patients were followed up for at least 1 year. Success was achieved in 34 patients, among whom 25 had good voiding and no need of dilation, 6 were cured after 3 - 6 post-operative dilations, 3 required dilation every 2 or 3 months for over a year and 2 failed. No blood transfusion was needed during the operation, and no erectile dysfunction or incontinence occurred after it.</p><p><b>CONCLUSION</b>The modified urethral pull-through procedure is effective and simple in the surgical treatment of post-trauma posterior urethral stricture or obliteration, with few complications and no consequent erectile dysfunction or incontinence.</p>