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Objective:To explore the application value of enhanced recovery after surgery (ERAS) in laparoscopic radical resection of bladder cancer and ileal bladder surgery under modular operation procedures.Methods:A retrospective selection of 42 cases of laparoscopic radical radical resection of bladder cancer and ileal bladder surgery performed by the Department of Urology, General Hospital of Southern Theater Command from January 2017 to December 2019 were divided into two groups according to the different management methods adopted during the perioperative period: ERAS management group and conventional management group, each with 21 cases. Among them, patients in the ERAS management group were managed by ERAS during the perioperative period, and patients in the conventional management group were managed by conventional management during the perioperative period. The postoperative hospital stay, first exhaust time, first defecation time, first time to get out of bed, first liquid food time, postoperative visual analogue scale (VAS) score, as well as transferrin, upper arm circumference, body mass index, plasma albumin, total protein, and total protein were compared between the two groups of patients after surgery. The measurement data conforming to the normal distribution were expressed as mean±standard deviation ( Mean± SD), and the in dependent t-test was used for comparison between groups; the measurement data of non-normal distribution were expressed as the median (interquartile range) [ M( P25, P75)], the independent sample Mann-Whitney U test was used for comparison between groups; the Chi-square test was used for comparison of enumeration data between groups. Results:The postoperative hospital stay in the ERAS group was (8.9±1.8) d, the first exhaust time was (33.4±3.2) h, the first defecation time was (60.3±7.8) h, the first time to get out of bed was (23.1±6.7) h, the first liquid food time was (82.7±18.5) h and postoperative VAS was (1.3±0.6), that were significantly reduced compared with the conventional treatment group [(12.3±2.3) d, (51.4±5.2) h, (73.0±8.1) h, (34.7±8.2) h, (109.7±21.6) h, (3.6±0.8)], the difference were statistically significant ( P<0.05). In the ERAS group, the decreased value of transferrin was [0.8 (-0.4, 2.2) g/L], the decreased value of body mass index was[1.61±0.73], the decreased value of plasma albumin was [3.5±1.5 g/L], the decrease value of total protein was[10.1±5.6 g/L] and the decrease value of prealbumin was [90.5±11.3 mg/L] were significantly lower than those of the conventional management group[(1.9(0.9, 3.6) g/L, (2.32±1.05) kg/m 2, (9.6±2.0) g/L, (16.3±4.9) g/L, (131.3±7.4) g/L], and the difference were statistically significant ( P<0.05). Conclusion:Modular laparoscopic precision resection of bladder cancer and ERAS concept after ileal bladder surgery is beneficial to shorten the hospital stay, reduce postoperative pain, have less impact on the patient′s body loss and immune function, and can speed up the patient′s postoperative recovery.
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Objective:To determine the efficacy and safety of sacral neuromodulation (SNM) in incomplete spinal cord injured (SCI) subjects affected by neurogenic lower urinary tract symptoms.Methods:Clinical data of 36 patients with incomplete spinal cord injury who underwent SNM from February 2015 to April 2019 were retrospectively analyzed and were divided into group NUR (16 cases neurogenic urinary retention group) and group NOAB (20 cases of neurogenic bladder overactive group). If at least 50% clinical improvement occurred, the patient would undergo a permanent SNM procedure. The patients were evaluated by using bladder diary, postvoid residual volume measurement, frequency of clean catheterization and urodynamic parameters before and during the test, and after the permanent SNM.Results:Among the 36 patients, 21 cases (58.3%) were tested effectively and received permanent stimulator implantation, 7(19.4%) in NUR group and 14(38.9%) in NOAB group. The residual urine volume of bladder, the average number of catheterization and the average number of urination in NUR group were improved in different degrees. After operation, the symptoms of frequent urination, urgency of urination and incontinence in NOAB group were relieved to varying degrees. During the follow-up, 2 patients with urinary retention failed the treatment. After the Ⅰ phase of the contralateral S3, the curative effect was recovered. A patient were infected after operation, and the wound healed after removal of the infection.Conclusions:The SNM is safe and effective in the treatment of neurogenic lower urinary tract symptoms in some incomplete spinal cord injury patients, and is helpful to protect renal function in patients with spinal cord injury. SNM can not improve all symptoms at times, but the SNM can be considered in patients with ineffective or intolerant traditional treatment.
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Objective To evaluate the efficacy and safety of InVance bulbourethral sling for stress urinary incontinence after radical prostatectomy.Methods Six male patients with stress urinary incontinence after radical prostatectomy were treated with perineal sling (InVance) from March 2005 to March 2011,and the clinical data were analyzed.Results The operation time was 80-120 min and intra-operative blood loss was 20-50 ml.The catheter was removed at the second day after surgery.In a follow-up of 12 to 29 months,4 patients were dry,1 patient was improved,and 1 patient suffered treatment failure.There were 2 patients transient acute urinary retention and 1 patient short-term perineal pain in the main post-operative complication.In six months after the operation,urodynamic examination showed (15.9 ± 7.7) ml/s at Qmax and 0-20 ml/s at postvoid residual.Conclusion InVance bulbourethral sling for the treatment of stress urinary incontinence after radical prostatectomy appears to be safe,simple in the procedure and good effect to mild and middle incontinence.
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Objective To observe the different expressions of androgen and estrogen receptor in nucleus membrane of human prostate stromal cells under anoxic or normoxic conditions.Methods Human prostate stromal cell line WPMY-1 was cultured in vitro.At 4,8,12,24,48 h after cellswere seeded,the mRNA and protein expression of androgen receptor (AR) and estrogen receptor (ER) in prostate stromal cells were tested by RT-PCR and immunohistochemistry method,respectively.Results The exprcssions of AR and ER were significantly increased in prostate stromal cells under anoxic conditions compared with under normoxic conditions.The relative expression of AR mRNA was 0.35±0.01 in anoxic prostate stromal cells at 4 h,and increased to 1.40±0.02 at 48 h,which was higher than in normoxic prostate epithelial cells [0.27 ± 0.01 and0.36± 0.01] synchronously (t=28.182,both P ＜ 0.001).Immunohistochemistry showed significantly increased AR-positive cells under anoxic conditions as compared with under-normoxiccondition from 12 h synchronously [(33.72±4.19) per 200 cells,(23.84±1.31) per 200 cells,t=3.902,P=0.018].The expression of ER mRNA was 0.39±0.01 in prostate stromal cells at 4 h,and increased to 0.59±0.01 at 48 h under anoxic conditions,which were higher than under normoxic conditions (0.31±0.01 and 0.46±0.13) synchronously (both P＜0.001).Immunohistochemistry showed the significantly increased ER-positive cells under anoxic conditions as compared with under normoxic condition from 4 h to 48 h synchronously [(13.42±0.80) per 200 cells and (55.16±0.41) per 200 cells； (9.68±0.63) per 200 cells and (22.95±0.55) per 200 cells,t=81.130,P＜0.001].Conclusions The expression of androgen and estrogen receptors is upregulated in human prostatestromal cells under anoxic conditions.
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Objective To analyze the effect of antibiotic treatment on prostate specific antigen (PSA) derivations in patients with and without prostate cancer and to further determine if the changes of PSA values after antibiotic treatment could help to exclude inflammation in the differential diagnosis of an abnormal PSA.MethodsA total of 100 patients with lower urinary tract symptoms,a PSA level of 4 to 10 μg/L,free PSA/total PSA (fPSA/tPSA) ratio ＜ 0.25,and a negative digital rectal examination and transrectal ultrasonography were enrolled in this study.All patients received 500 mg of ciprofloxacin twice a day for 3 weeks.Free and total PSA values were measured before and after antibiotic treatment.All the patients were then scheduled for 12-core prostate biopsy.Results The mean tPSA value was (6.5 ± 1.2) and (5.1 ± 1.2) μg/L respectively before and after antibiotic treatment ( P ＜ 0.01 ).Ninety-one patients (91.0％) showed tPSA reduction after antibiotic therapy,of which 13 ( 14.3％ ) had prostate cancer on biopsy.In 17 cases (18.7％) post-treatment tPSA was less than 4 μg/L.Three of the 17 cases (17.6％)had prostate cancer on biopsy.In 6 of the 100 men post-treatment tPSA was between 4 and 10 μg/L and the fPSA/tPSA ratio was above 0.25.One of these cases had prostate cancer on biopsy.Seven cases had a ＞50％ reduction in PSA levels with no positive biopsy results.Although mean total PSA and PSAD decreased after treatment in both groups,the reductions within these parameters were not significantly different between patients with and without prostate cancer (P ＞ 0.05).Furthermore,no differences emerged in terms of the changes of other PSA derivations including fPSA and fPSA/tPSA ( P ＞ 0.05 ).ConclusionsThe PSA levels may change with long-term antibiotic treatment in patients with elevated PSA values.A decrease in PSA after antibiotic treatment does not rule out the presence of prostate cancer even if PSA decreases to a normal level.But a ＞ 50％ reduction in PSA levels may be associated with a decreasing risk of prostate cancer,which may allow a postponement of prostate biopsy in selected patients.
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Objective To evaluate the two-stage repair in hypospadias cripples.Methods 35 patients with hypospadias cripples underwent two-stage repair.At the first stage,a full-thickness graft of skin or buccal mucosa was used for urethral plate reconstruction after the release of chordee.The second stage was performed 6 months after completion of the first stage.Tubularization of the replaced urethral plate was the preferred technique.Results There was no urethra stricture or “preplaced urethral plate ” atrophy.Fistula developed in 2 of 35 cases.Conclusion The twostaged technique was a useful strategy to deal with the myriad abnormalities encountered in crippled hypospadias.This technique could not only create a neourethra successfully,but also give the penis a near-normal shape and appearance.
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Objective To evaluate the efficacy of the suprapubic arch sling(SPARC)in female stress urinary incontinence by video-urodynamic tests.Method From January 2007 to October 2008,video-urodynamic tests,the pad test and ICI-Q-SF had been performed in all patients who received the SPARC before operation and 3,6 months after operation.Results Thirty-two cases of an effective follow-up for 6 to 20 months,31 patients were satisfied with urinary control,1 patient had mild urinary incontinence.Urodynamics:3,6 months after operation the maximum bladder capacity(MCC),residual urine(RU),detrusor pressure at maximum flow rates(Pdet,Qmax)were no statistical differences compared with those before operation(P＞ 0.05),3 months after operation,abdominal leak point pressure(ALPP)difference was statistically significant compared with that before operation(P =0.000),6 months after operation,the maximum urinary flow rate(Qmax),ALPP differences were statistically significant compared with those before operation(P values were 0.003,0.000).Static urethral pressure profile parameters before operation and 3,6 months after operation,the maximum urethral closure pressure(MUCP)was(35.2 ± 20.4),(53.1 ±22.5),(62.3 ± 19.8)cm H2O(1 cm H20 =0.098 kPa),respectively,functional urethral length(FUL)was (3.5 ± 1.3),(3.9 ± 0.9),(4.2 ± 1.1)cm,respectively,6 months after operation,MUCP,FU L differences were statistically significant compared with before operation(P values were 0.000 and 0.002).Conclusion Urodynamic evaluation by image,SPARC is one of the effective methods to treat the female stress urinary incontinence,the image within 6 months of urodynamic evaluation prompt surgery can increase urethral pressure,strengthen the control of urinary function,while no significant effect on bladder function.
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Objective To summarize the success of congenital penile curvature. Methods 401 cases of con-genital penile curvature,whose average age is 2. 5 years ,ranging from 1 year to 26 years old. Of all cases ,383 patients who have both hypespadias and penile cun, ature, only 18 patients are congenital penile curvatures. 295 paitents are slight curvature,85 patients are moderate curvature and 21 patients are severe curvature. Curvature correction was per-formed on a case-by-case basis by solution fibric trabs of ventrial urethra and surrounding,skin de-gloving, ff necessa-ry,dorsal plication,and confirmed by Gittes test. Results . Curvature correction was possible by mobilization of ure-thra after penile degloviag,only a few need dorsal plieation. Followup for 6 months to 2 years,396 patients are success at once. The others after a second surgery had 100% success. Conclusions Solution fibrie trabs of ventrial urethra and surrounding, skin de-gloving, if necessary,dorsal plication ,is the first choice to repair of the congenital penile cur-vature and have good results.
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Objective To analyze videourodynamic characteristics of female bladder outlet obstruction (BOO). Methods Retrospective analysis of videourodynamic characteristics were performed in 42 women with BOO. On the basis of the videourodynamic findings, women with BOO were categorized into five groups: bladder neck obstruction, middle urethra (urethral sphincter) obstruction, distal urethra obstruction, external orifice of urethra obstruction, high-grade pelvic organ prolapse. Data of five groups were compared in Qmax, maximum cystometric capacity, Pdet at Qmax, residual urine, detrusor instability and hydronephrosis. Data of all patients were analyzed by SPSS13 statistical software, measurement data by t-test and enumeration data by x2-test. Results Five groups had not significant deviation in the maximum cystometric capacity. however patients with bladder neck obstruction had significant deviation with others in Pdet at Qmax (78. 0 ± 23. 6)cm H2O, residual urine (120. 6±115.2)ml, Qmax (7.0±2.3)ml/s (P<0.05). There was significant deviation between middle urethra (urethral sphincter) obstruction(76.9%)and others in detrusor instability(P<0. 05). In all patients with hydronephrosis, bladder neck obstruction(57. 1 %) had significant deviation with others (P<0. 05). Conclusions Videourodynamic tests could assess lower urinary tract function, and may guide clinic management. The bladder neck obstruction was most serious and harmful to upper urinary tract.
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Objective To determine whether an increased number of transrectal biopsy cores improves the accuracy of biopsy Gleason score. Methods This study reviewed a total of 86 patients who were diagnosed as prostate cancer by transrectal needle biopsy and subsequently underwent radical prostatectomy (RP) without neoadjuvant therapy.The rate of grading concordance between biopsy and RP specimens was analyzed by dividing these patients into 2 groups according to the biopsy cores:group A,46 patients who underwent transrectai biopsy sampling of 6 cores,and group B,40 patients who underwent biopsy sampling of 13 cores. Results The concordance between prostate biopsy and radical prostatectomy Gleason score was 65.0%and 34.8% for 13 core and 6 core biopsy,respectirely (P＜0.05).Furthermore,these findings tended to be more prominent as the biopsy Gleason score was lower.Multivariate analysis identified the number of biopsy cores and percent of positive biopsy cores as independent predictors of accurate Gleason grading regardless of other parameters examined in this study. Conclusion Extended needle biopsy may increases the accuracy of biopsy Gleason score for assessing final prostate cancer grade.
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Objective To evaluate the effectiveness of the treatment of slight and moderate benign prostatic hyperplasia(BPH)with large doses of cemilton by urodynamie test.Methods A systematic review of using large doses of cernihon only for 80 patients with BPH with 7 grade ＜ International Prostate Symptom Score(IPSS)≤20 grade.All cases with cemilton had been administered in a dosage of 750 mg,three times a day for one year.All were respectively given IPSS,postvoiding residual urine(PVR),maximum flow rate(Qmax)and pressure-flow(A-G)test in order to assess the effectiveness at pre-treatment and 3,6,12 months after treatment.Results All patients had followed up for(1.2±1.6)years,additionally 26 of those were removed and others had received complete follow-up.Before the treatment IPSS was(20.5±4.5)grade,PVR was(42.5±8.2)ml,Qmax was(10.2±2.3)ml/s,A-G was 56.5±12.8,PQmax was (54.8±13.7)mm Hg(1 mm Hg = 0.133 kPa),and 12 months later,IPSS was(11.0±3.3)grade,PVR was (15.9±7.4)ml,Qmax was(15.7±2.5)ml/s,A-G was 49.2±13.6,PQmax was(43.6±14.9)mm Hg.There were significantly difference between pre-treatment and post-treatment data of the urodynamics(P ＜ 0.05).Conclusions The effectiveness of the treatment of slight and moderate benign prostatic hyperplasia with large doses of cemihon are relatively satisfactory.Main post-treatment urodynamic parameters obviously improves than that of the pre-treatment.
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Objective To evaluate the effectiveness of the treatment of high risk benign prostatic hyperplasia (BPH) with transrectal high-intensity focused ultrasound (TR-HIFU) by urodynamic test. Methods One hundred and thirty patients with BPH, most of who suffering with diabetes mellitus,cardio-cerebrovascular disease, respiratory disease. All patients were given the operation with Sonablate-500 high-intensity focused ultrasound (HIFU). International prostate symptom score (IPSS), quality of life (QOL), maximum urinary flow rate (Qmax), post void residual urine volume (PVR), pressure-flow tests (A-G) were employed for the evaluation of curatives effect on preoperation, 30th and 90th day after the treatment. Results The duration of the TR-HIFU prostate ablation treatment was 15-85 rain. One hundred and seven patients after treatment were followed up for 3 months. Compared the effect before treatment with that after treatment, IPSS improved from (27.0 ±11.5) scores to (8.5±1.4) scores, Qmax increased from (5.7±2.3) ml/s to (14.1±4.2) ml/s, PVR decreased from (118.5±78.0) ml to (30.0±15.0) mI,A-G parameters reduced from 62.4±19.3 to 25.6±13.0 and urine volume (VV) increased from (85.8 + 42.0) ml to (194.0±52.0) ml. The parameters all altered obviously (P < 0.05). Conclusions TR-HIFU appears highly attractive as a new optional, safe and efficacious and minimally invasive treatment for the high risk BPH. Main post-operative urodynamie parameters are more obviously improved than those of the preoperation.
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Objective To investigate the use and effect of dorsal dartos flap wrapping technique in complicated hypospadias fistulas repairs. Methods In the experimental group, the closed fistulas were wrapped with transferred dorsal dartos flap in the 32 cases of complicated hypospadias fistulas from March 2004 to January 2008. In the control group, the routine fistulas repairs were preformed in the 50 cases of complicated hypospadias fistulas from January 1998 to February 2004 . Results All cases had been followed up for 3 - 12 months, there were no fistula in the experimental group. There were 6 fistulas in the control group. There was significant difference between two groups (P<0.05). Conclusions The use of the technique can prevent urethrocutaneous fistulas after complicated hypospadias fistulas repairs, the fistulas rate are reduced for all cases combined. The technique would be the optimal repair for complicated hypospa-dias fistulas.
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Objective To investigate the use and effect of subcutaneous flap and tunica vaginalis flap in hypospadias repair and hypospadias fistulas repair. Methods A total of 73 cases of hypospadias and hypospadias fistulas following surgery were included.The new urethras or closed fistulas were wrapped with various types of subcutaneous flaps or tunica vaginalis flaps.In the 45 cases of hypospadias,dorsal dartos flap technique was used in 27,tunica vaginalis flap technique in 3,and adjoining pedicle advance dartos flap technique in 15.In the 28 cases of urethral fistulas,dorsal dartos flap technique was used in 4,X-V skin flap technique in 14,and adjoining U-shaped subcutaneous flap technique in 10. Results All the cases were followed up for 3 to 36 months.Of the 45 cases of hupospadias, fistulas occurred in 3.Of the 28 cases of urethral fistulas, no fistulas occurred.The success rate of operation was 95.9%. Conclusions The use of these techniques can reduce the incidence rate of urethrocutaneous fistulas in hypospadias repair and hypospadias fistulas repair.Based on our experience these techniques are the optimal repair for classical patients with hypospadias and hypospadias fistulas.