ABSTRACT
Objective:To explore the safety and efficacy of radiofrequency in the treatment of overactive bladder(OAB).Methods:A prospective, multicenter, non-randomized controlled trial was conducted. Eligible patients were divided into test group and control group in Zhejiang Provincial People’Hospital, The First Affiliated Hospital of Wenzhou Medical University, and Sir Run Run Shaw Hospital affiliated to Zhejiang University School of Medicine from March 2019 to June 2020. Inclusion criteria: patients diagnosed with OAB, and bladder capacity>100ml. Exclusion criteria: pregnant and lactating women; patients with secondary OAB symptoms such as urinary tract obstruction; patients with uncontrolled urinary tract infection within 1 week; patients in stable stage by using other treatment methods; patients implanted with any nerve stimulator, cardiac pacemaker or implantable defibrillator; patients with malignant tumors, serious cardiovascular, cerebrovascular diseases, renal insufficiency or received BTX treatment in recent 12 months. The patients were allocated to test group and the control group in a ratio of 2∶1 according to the time sequence of the visit. The patients in the test group were treated with radiofrequency treatment. After entering the group, they were treated for 4 times at the 1st, 2nd, 7th and 8th week respectively. In the control group, the energy was turned off during the radiofrequency treatment. The patients were followed-up every week until the end of the 12th week. The treatment success rate [the average frequency of urination in 24 h was reduced more than 50% from the baseline or returned to the normal (≤8 times/day) or the average frequency of urgent urination in 24 h was reduced more than 50% from the baseline], the frequency of urination, urgent urination and nocturnal urination before and after treatment, the residual urine volume of the bladder, the quality of life (QOL) score and the occurrence of catheter related adverse events in two groups were compared.Results:114 patients were enrolled in the study, including 76 patients in the test group and 38 patients in the control group. There were no significant differences in the age [(44.2±12.8) vs. (41.7 ± 12.1) years old], male female ratio (13/63 vs. 4/34), average course of disease [2.0(1.2, 5.0) vs. 2.0 (1.0, 4.0) years], the frequency of urination[12.8 (10.6, 16.8) vs. 12.8 (10.3, 17.0) times], urgency urination [11.8(9.3, 15.8) vs. 11.8 (9.0, 17.0) times], nocturia [2.7 (1.3, 3.7) vs. 2.3(0.7, 3.3) times], residual urine volume of bladder [12.0 (3.0, 28.0) vs. 14.0 (3.7, 20.0) ml ] and the QOL score [5.0(4.0, 5.0) vs. 4.0(4.0, 5.0)]before the treatment between the two groups ( P>0.05). The treatment success rate in the test group was 76.3% (58/76), while 26.3% (10/38) in the control group, with a statistically significant difference ( P<0.01). There were significant differences between the test group and control group in the frequency of urination [9.7 (7.7, 12.0) vs. 12.9 (9.6, 15.7) times], urgent urination [7.3 (5.0, 10.0) vs. 11.7 (7.3, 15.3) times], nocturia [1.3 (0.7, 2.0) vs. 1.7 (1.0, 3.0) times] and the QOL score of the patients[3.0(1.0, 3.0) vs. 4.0(3.0, 4.5)]after the treatment(all P<0.05). The frequency of urination, urgency urination, nocturia, the residual urine volume and the QOL score in the test group were significantly improved ( P<0.05) after the treatment.The frequency of urination, nocturia, residual urine volume and the QOL score in the control group were improved ( P<0.05) after the treatment. 13 (11.4%) patients had catheter related adverse events. In the test group and the control group, there were 7 cases of macroscopic hemorrhage caused by the placement of instruments (5/76 vs. 2/38), 5 cases of acute urinary tract infection within 3 days (3/76 vs. 2/38), and 1 case of instrument breakage (catheter breakage) (0/76 vs. 1/38). There were no significant differences in the adverse events between the two groups ( P> 0.05). Conclusions:Radiofrequency treatment of OAB can effectively improve the symptoms of patients, improve the QOL of patients, and has low incidence of adverse events, with good efficacy and safety.
ABSTRACT
Objective:To study the feasibility, efficacy and safety of low-power greenlight laser vaporization and enucleation with end-fire fiber in the treatment of large-volume (>90 ml ) benign prostatic hyperplasia.Methods:A retrospective analysis of 138 patients with benign prostatic hyperplasia volume greater than 90ml at Zhejiang Provincial People's Hospital from January 2016 to July 2018. The average age of the patients was (73.5±7.3) years and the average prostate volume was (110.2±23.7) ml, the median maximum urine flow rate before surgery was 5.3 (1.0-10.0)ml/s, and the median residual urine before surgery was 78.5 (51.6-108.5) ml. All patients underwent transurethral enucleation with greenlight laser vaporization and enucleation. The intraoperative vaporization power was 80 W and the optical fiber was end-fire fiber, the hemostasis power was 20 W. The optical fiber was straight out of the greenlight laser fiber. The combination of green laser vaporization and blunt dissection of the lens sheath was used to find the capsule, and the " three-leaf method" was used to enucleate the two and middle lobes of the prostate along the capsule level. After the enucleation, the tissues were pushed into the bladder, and the tissue morcellation was used. The tissue was crushed and removed after enucleation. After operation, an F20 three-cavity catheter was placed, and the balloon was filled with 50 ml of water. After 24 hours, the bladder was given a normal saline irrigation, and the catheter was removed 48 hours after the operation. Statistical analysis of these patients' baseline characteristics, perioperative results and complications.Results:The operation of 138 cases was successfully completed. The time of vaporization and enucleation was (58.6±6.1) minutes, and the time of morcellation was (12.6±5.6) minutes. Intraoperative and postoperative hemoglobin loss was (6.2±1.5) g/L, and no transfusion was required. Postoperative pain score(NRS) of 89 cases was 0, and 49 cases was 1. 123 patients who were removed catheter after 48 hours could urinate well, and 15 patients need re-catheterization. The catheter was removed again 7 days after surgery, and all patients returned to normal urination. Two cases of transient urinary incontinence occurred after the operation, both of which were urgent urinary incontinence. Both patients improved after oral tolterodine treatment and there was no stress urinary incontinence. There were 5 cases of urethral stricture after operation, all of which occurred 3 months after operation. They were cured after urethral stricture dilation or bladder neck orifice resection. The median maximum urinary flow rate was 17.5 (14-22) ml/s and the residual urine was 6.2 (2.7-11.3) ml in 1 month after operation, which were significantly different from preoperative parameters ( P <0.05). The maximum urinary flow rate was 16.1 (13-20) ml/s at 3 months postoperatively and 17.3 (11-24) ml/s at 12 months postoperatively, and remained stable. Conclusions:Low-power greenlight laser vaporization and enucleation in treating large-volume>90 ml has the advantages of short operation time, less pain, less blood loss, and quick recovery after surgery. The incidence of urinary incontinence and postoperative cardiovascular accident is low.
ABSTRACT
Objective To cxplore the variation of the range of motion (ROM) of operative level after different heights of artificial cervical disc replacement,and to provide guidance for clinical work in selecting appropriate height of artificial cervical disc prosthesis.Methods The preoperative cervical anteroposterior and lateral Ⅹ-rays of 9 fresh male cadaveric cervical spine specimens were obtained to measure the intervertebral height of C5-6,and 3 screened specimens with the height of about 5 mm were included in the experiment.The experiment was designed to test self-control,and other four groups of cervical specimens including intact group,appropriate height (5 mm) of C5.6 artificial cervical disc replacement group,1mm increased (6 mm) group and 2 mm increased (7 mm) group were made biomechanical test sequentially.The specimens were fixed to the cervical three-dimensional movement machine,with a 75 N follower load and pure moments of 2 Nm for flexion/extension 、left/right bending and left/right axial rotation,to measure the ROM of operative level under the condition of changes in 0.2 Nm/s.Results There were no significant differences in the ROM of flexion/extension,lateral bending and axial rotation between 5 mm group and intact group;the ROM of flexion/extension、lateral bending and axial rotation in 6 mm group increased compared with 5 mm group,but the difference was not statistically significant;the ROM of flexion/extension in 7 mm group was significantly less than that of intact,5mm and 6 mm group (9.5°± 1.0° vs 12.5°±0.9°、11.3°±0.8°、11.6°±0.9°),but significantly greater in axial rotation than 6 mm group (10.4°±1.4°vs 8.6°±0.3°),and there was no significant difference in lateral bending compared with other 3 groups.Conclusion 2 adjacent heights of cervical disc prostheses are implantedsuitably when testing the mold of disc prosthesis,the choice of cervical disc prosthesis with 1 mm increased can improve the ROM of operative level to some extent;while the height with 2 mm increased can lead to the ROM of flexion/extension at the operative level reduced,but the ROM of rotation shows an increasing trend.