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Objective:To observe the effects of transurethral split of the prostate (TUSP) on the urodynamics, the sexual function and the quality of life of benign prostatic hyperplasia.Methods:Eighty patients with benign prostatic hyperplasia admitted to the Deqing People′s Hospital of Zhejiang Province from January 2017 to June 2019 were enrolled into the research objects prospectively. According to the random digits table method, they were divided into group A and group B, with 40 cases in each group. The group A was treated with TUSP, while the group B was treated with bipolar transurethral plasma kinetic prostatectomy (TUPKP). The operation time, intraoperative blood loss, bladder irrigation time, urinary catheter indwelling time, hospitalization time of the two groups were compared and surgical effects were evaluated. The changes of hemoglobin (Hb), serum sodium (Na), post-void residual volume (PVR), maximum urinary flow rate (Q max), international prostate symptom score (IPSS) and international index of erectile function score (IIEF-5), the quality of life index (QOL) of 2 groups before and after the operation were measured. Surgical complications were recorded. Results:The operation time, bladder irrigation time, urinary catheter indwelling time and hospital stay in group A were all shorter than that in group B: (15.63 ± 4.17) min vs. (58.79 ± 10.45) min, (6.26 ± 1.17) h vs. (45.51 ± 10.03) h, (3.07 ± 0.68) d vs. (5.67 ± 1.51) d, (3.63 ± 0.43) d vs. (6.08 ± 1.72) d, (18.32 ± 2.79) ml vs. (65.26 ± 20.64) ml, and there were statistical differences ( P<0.05); there were no statistical difference between 2 groups in surgical curative effect grade and Na 1 d after operation ( P>0.05); 1 day after operation, Hb in group A was higher than that in group B: (115.63 ± 9.78) g/L vs. (109.65 ± 8.36) g/L, and there was statistical difference ( P<0.05); PVR, Q max, IPSS, IIEF-5 and QOL 3 and 6 months after surgery were improved in 2 groups ( P<0.05), but the difference between 2 groups was not statistically significant ( P>0.05); the total complication rate in group A was lower than that in group B: 10.00% (4/40) vs. 27.50% (11/40), and there was statistical difference ( P<0.05). Conclusions:TUSP and TUPKP are equally effective in the treatment of benign prostatic hyperplasia, both of which can improve the symptoms of prostatic hyperplasia, improve the quality of life and improve sexual function. But TUSP has less intraoperative bleeding, shorter operation time, faster postoperative recovery, fewer complications, and higher safety.
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Objective To investigate whether initial intervention based on WBC measured within 2 hours postoperatively can reverse the uroseptic shock induced by UUTEL.Methods From May,2015 to July 2015,24 female New Zealand rabbits,weighing 2.0-2.5 kg,born 2-3 months,used as uroseptic shock model.Their ureters were ligated and followed by injection of Escherichia coli solution into the renal pelvis.Then,those animals were randomly assigned into control group(the first group)and experimental groups (the second group,the third group).Each group had 8 rabbits initially.The first group did not receive sensitive antibiotic or fluid resuscitation.The second group received imipenem and cilastatin sodium 15mg/kg and normal saline 5 ml/kg 2 hours postoperatively.The third group received sensitive antibiotic and fluid resuscitation the same dosage as the second group 6 hours postoperatively.Mean arterial pressure(MAP) was recorded for 10 hours and survival rate of all groups for 72h postoperatively was recorded..The clinical data of 46 patients whose WBC count less than 2.85 × 109/L within two hours after UUTEL were analyzed retrospectively.These patients were divided into two groups based on the time of intervention.Group A including 19 patients received routine antibiotic,fluid therapy,low-dose corticosteroids when there was symptom of shock.Group B including 27 patients immediately received resuscitation bundle protocol when there was a drastic decrease in WBC.The incidence of septic shock,the rate of intubation,length of stay in ICU,length of stay in hospital postoperatively,hospitalization cost and survival rate of these two groups were compared.Results All 8 rabbits of the first group died within 72 h,postoperatively and the median time of survival was 11 h.None of the second group rabbits developed shock and all rabbits survived 72 h after operation.6/8 rabbits of the third group survived 72 h after operation.15 patients in Group A and 3 patients in Group B experienced acute uroseptic shock (P ＜ 0.05).11 patients in Group A and one patients in Group B underwent tracheal intubation (P ＜ 0.05).18 patients in Group A and 6 patients in Group B were transferred to ICU(P ＜ 0.05),and their length of stay in ICU was (10.8 ± 5.4) d and (7.5 ± 2.8) d,respectively(P ＞ 0.05).The length of stay in hospital and hospitalization cost of Group A and B were (19 ± 9.8)d vs.(7 ±4.7)d(P ＜0.05),(94 583 ±51 623) RMB vs.(35 389 ± 16 342) RMB respectively (P ＜ 0.05).One patient in Group A died due to acute uroseptic shock and none of Group B died.Conclusions Our animal model and clinical cohort study showed that initial intervention based on WBC mneasured within 2 hours postoperatively can reverse the uroseptic shock induced by UUTEL and improve the prognosis.
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Eosinophilic cystitis [EC] is a rare inflammatory disorder. We herein report a case of EC in an asthmatic female patient who had a recent exacerbation with none known allergen. She was administered montelukast sodium orally for four weeks and received complete remission. This medication was successfully discontinued after a three-month follow up period. This case report about successful treatment of an adult EC patient using montelukast sodium may provide a new option for EC patients with allergic history
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Objective To discuss the diagnosis and surgical management of multilocular cystic renal cell carcinoma (MCRCC) and to evaluate the gene function of the mutation of von Hippel-Lindau (VHL) gene in MCRCC. Methods Seventeen MCRCC cases (11 men and 6 women) out of 512 cases of renal cell carcinoma from 2000 to 2010 were retrospectively analyzed. The mean age of the 17 patients was 46 years (37-61 years). Ultrasonography and CT were available in all 17 cases, and 1 case was misdiagnosed as parapelvic renal cyst. The mutation of VHL gene was detected by PCR in the specimens of can-cerous tissue and adjacent normal tissue from 11 cases of MCRCC. Results Three of 17 cases underwent nephron sparing surgery, the others underwent radical nephrectomy. One case underwent unroofing of parapelvic renal cyst, but the rapid frozen pathology of the cyst wall showed renal cell carcinoma of clear type. As a result, radical nephrectomy was eventually performed. All 17 cases were confirmed as MCRCC by eva-luating pathological characteristics, such as the cyst wall lined by single or several layers of clear tumor cells and the nuclei which were small and anachromasis. Clinical stages of all cases were T1N0M0, in which there were 14 cases with pathological T1G1 and 3 cases with pathological T1G2. All patients underwent a follow-up of 9 to 36 months (mean, 12 months) without recurrence or metastasis. Mutation of VHL gene was detected in 7 of 11 cases (64%), but all adjacent normal tissues were negative. Conclusions As a rare subtype of renal cell carcinoma, MCRCC is difficult to diagnose. CT is an essential measure in diagnosis of MCRCC preoperatively. Because of the good prognosis of reported cases, nephron sparing surgery for the treatment of MCRCC is recommended. VHL gene mutations may play an important role in the carcinogenesis of MCRCC.
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Objective To review the diagnosis and treatment of extra-adrenal pheochromocytoma with a 34cases report. Methods Thirty-four cases of extra-adrenal pheochromocytoma were retrospectively analyzed. Hypertension was observed in 27 cases. Abdominal pain was seen in 10 patients and intermittent hematuria in 2 patients. Serum and urinary catecholamine and urinary VMA were measured in 34 cases. The level of serum or urinary catecholamine elevated in 20 cases and urine VMA elevated in 24 cases. Thirty-four cases had ultrasound examination,25 cases underwent CT scan and 6 cases underwent MER scan.Results Pheochromocytomas of 12 cases were located in the renal hilum, 2 in the lower pole of the left kidney, 1 in the posterior aspect of the inferior vena cava, 3 in the interaortocaval region, 2 in the anterior aspect of the abdominal aorta, 1 in the anterior of the right common iliac artery, 1 in the hilum of the liver, 1 in the posterior o{ the pancreas, 2 in the bladder wall, 1 in the posterior of the descending colon, and 8 cases of multifoci. Twenty-two cases of extraadrenal pheochromocytoma were benign and 12 cases were malignant. Thirty cases were followed up from 6 months to 13 years. Among 27 cases with hypertension, the blood pressure of 22 patients returned to normal and 5 cases were still hypertensive. Nine cases of malignant pheochromocytoma all had tumor recurrence or metastases at one year postoperatively. Six patients died during followed-up from 6 months to 3 years, including 3 cases died of cerebral hemorrhage and 3 cases of tumor metastases. Three cases got stable with 131Ⅰ-MIBG radiotheraphy.Conclusions The accurate detecting extra-adrenal pheochromocytoma is difficult. CT scan could be reliable in localizing the lesions. Surgical resection of the tumor could be the best therapy. Patients of malignant extra-adrenal pheochromocytoma may be treated with 131Ⅰ-MIBG after surgical therapy.
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Objective To evaluate the feasibility and clinical results of laparoseopic reoperation for patients with history of previous ipsilateral urology laparoscopic surgeries. Methods Thirteen patients that underwent second ipsilateral urology laparoscopic surgeries were retrospectively ana-lysed. The reasons for a second operation included nonfunctional kidney after pyeloplasty, ure-terolithotomy or pyelolithotomy in 4 cases, recurrence of urinary calculi in 3 cases, pelviureteric june-tional stenosis after pyeloplasty in 1 case, recurrence of renal cyst in 1 case, recurrence of adrenal tumor in 1 case, residual adrenal tumor in 1 case, progression of polycystic kidney in 1 case and renal carcinoma after laparoscopic surgery for renal cyst in 1 case. Transperitoneal laparoscopie surgeries were performed in all cases and the first trocar was placed with open incision to avoid puncture injury. The adhesion between intestines and retroperitoneal space was dissected to expose the operative field. The lateral peritoneum and perirenal fascia were sutured after surgery in all cases except nephrectomy cases. Results For the first operation, the mean operative time was 93 min, the mean estimated blood loss was 70 ml and the average postoperative hospital stay was 4.8 d. The second operations on the 13 cases were successfully performed with mean operative time of 97 rain, mean estimated blood loss of 62 ml and average postoperative hospital stay of 5.0 d which were not significantly different from the first operation parameters(P＞0.05). During the secondary operations, adhesions and abnor-mal anatomic structure observed increased the difficulty of surgery. All patients after secondary opera-tions were followed up for 2--24 months and no major complication was observed. Conclusion La-paroscopic reoperation on patients with history of ipsilateral urology laparoscopic surgery is feasible in skilled and experienced hands and in properly selected cases.
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<p><b>OBJECTIVE</b>To probe into and improve the diagnosis and treatment of tuberculosis (TB) in the male genital system.</p><p><b>METHODS</b>Fifteen patients with the male genital system TB established by microbiological and pathological examinations were retrospectively reviewed.</p><p><b>RESULTS</b>The male genital system TB was diagnosed by history, physical examination, semen analysis, TB culture and biopsy. Treatment consisted of antituberculous chemotherapy for all the patients before and/or after operation, including 5 cases of epididymectomy and 6 cases of orchi-epididymectomy.</p><p><b>CONCLUSION</b>The male genital system TB tends to be atypical and semen polymerase chain reaction of TB (TB-PCR) may provide a new specific means for diagnosis in case of clinical suspicion. Surgical approaches should be cautiously adopted, especially for young patients.</p>
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Adult , Aged , Humans , Male , Middle Aged , Antitubercular Agents , Therapeutic Uses , Polymerase Chain Reaction , Retrospective Studies , Tuberculosis, Male Genital , Diagnosis , TherapeuticsABSTRACT
<p><b>OBJECTIVE</b>To study the clinicopathologic features and treatment of Paget's disease of the scrotum.</p><p><b>METHODS</b>Fifteen cases of Paget's disease of the scrotum, pathologically diagnosed and successfully treated by surgery from 1987 to 2003, were studied retrospectively.</p><p><b>RESULTS</b>Typical pathological features were observed in all the patients. Thirteen cases were followed up for 0. 5 approximately 13 years, of whom 1 case relapsed within 3 years, 2 died of metastasis after 2 years, and 3 died of cardiovascular diseases, with no recurrence in the others.</p><p><b>CONCLUSION</b>Early biopsy and extensive excision of the scrotal lesion is the first choice of treatment for Paget's disease, with good operative effect and satisfactory prognosis. A 2nd operation could be considered for patients of local relapse.</p>
Subject(s)
Aged , Aged, 80 and over , Humans , Male , Middle Aged , Genital Neoplasms, Male , Pathology , General Surgery , Paget Disease, Extramammary , Pathology , General Surgery , Retrospective Studies , Scrotum , PathologyABSTRACT
Objective To evaluate the role of nephron sparing surgery in patients with renal cell carcinoma. Methods Retrospectively analyzed a total of 17 patients with renal cell carcinoma treated with nephron sparing surgery between September 1997 and September 2002.Among these patients,2 cases were bilateral asynchronous and multicentric tumor,15 cases were unifocal tumor.2 cases were in imperative indications,6 cases in relative indications,and 9 cases in elective indications.The tumor diameter ranged from 2 cm to 6 cm,all tumor were in T 1 (1997 TNM staging system).15 cases underwent tumor enucleation at 1 cm apart from surgical margin,1 case underwent upper polar nephrectomy,1 case underwent wedged resection.Selected 20 patients matched for age, tumor location and stage who underwent radical nephrectomy at same period for comparison with an average follow-up of 36.4 months. Results The patients were followed up for an average period of 35.2 months (range,3 to 63 months),no surgical complication or local recurrence has been observed,and its long-term cancer-free survival was comparable to that after radical nephrectomy. Conclusions Nephron sparing surgery is safe and effective for the treatment of renal cell carcinoma and indicated for patients with small,localized,often incidental tumors and a normal contra-lateral kidney.
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Objective To evaluate the biological behavior,clinical features,and diagnosis and treatment of inverted urothelial papilloma. Methods A total of 113 cases of urothelial inverted papilloma were included in this retrospective analysis.Of them 102 were male and 11 were female,with a mean age of 55 years.Among the 113 cases of urothelial inverted papilloma 108 had the papilloma at low urinary tract.Of these cases,88 were treated by TURBT,6 by TURBT and TURP,10 by partial cystectomy,4 by partial cystectomy and prostatectomy,1 by total cystectomy.Five cases who had the papilloma at upper urinary tract underwent nephroureterectomy. Results 86 cases were followed up 0.5 to 10 years.Intravesical recurrentce occurred in 5 cases.Of them 2 cases developed malignance and 1 case underwent total cystectomy. Conclusions Inverted urothelial papilloma is a benign tumor,which appears male predominant.Most of the lesions localize at the bladder.The diagnosis can be established mainly by cystoscopy.Most of the inverted urothelial papilloma can be cured by TURBT with a satisfactory prognosis.