ABSTRACT
Objective:To explore the treatment experience of holmium laser enucleation of prostate (HoLEP) with preservation of longitudinal urethral mucosa at 12 o’clock for benign prostatic hyperplasia (BPH) with small-medium gland.Method:From October 2018 to April 2021, 256 patients diagnosed BPH with small-medium gland(prostate volume 30-60 ml)were retrospectively analyzed, including general information, way of operation, intraoperative parameters and follow-up data. From October 2018 to June 2020, 186 BPH patients underwent conventional HoLEP, which did not retain longitudinal urethral mucosa at 12 o’clock as a conventional operation group. From July 2020 to April 2021, 70 BPH patients underwent modified HoLEP, which retained longitudinal urethral mucosa at 12 o’clock as a modified operation group. There was no significant difference between the two groups( P>0.05) in term of the age[(70.5±4.4)years old vs.(68.5±3.2)years old], Q max[(7.5±2.8)ml/s vs.(7.5±2.1)ml/s], IPSS[(20.3±4.6)vs.(21.4±3.7)], QOL[(4.5±1.0)vs.(4.2±1.4)], postvoid residual volume[(126.9±29.36)ml vs.(132.2±32.3)ml], PSA[(1.5±1.3)ng/ml vs.(1.8±1.1)ng/ml] and prostate volume[(48.1±11.1)ml vs.(48.0±12.7)ml]. Both groups were treated with "trefoil" enucleation of prostate. The modified group was improved compared with the conventional group by retaining a 12 o’clock longitudinal urethra mucosa from the bladder neck to the apex of the prostate. The technical improvements were as follows: ①the left lobe of prostate was removed from at 5 o’clock at the verumontanum to 1 o’clock at the prostate apex along the gap between the hyperplasia gland and the surgical envelope; ②the right lobe was removed from 7 o’clock at the verumontanum to 11 o’clock at the apex; ③the urethra mucous membrane was cut vertically from 1 and 11 o’clock at the bladder neck to 1 and 11 o’clock at the apex respectively, and retaining the longitudinal mucous membrane between 11 and 1 o’clock (including 12 o’clock). Efficacy and postoperative complications of the two groups were compared. Results:The difference between the conventional group and the modified group in operation time[(36.5±10.4)min vs.(40.7±9.7)min], enucleated glandular weight[(35.5±12.2)g vs.(31.6±10.4)g], hemoglobin decline[(6.1±2.2)g/L vs.(5.6±2.5) g/L], postoperative hospitalization time [(1.2±0.2)d vs.(1.5±0.4)d]and catheter indwelling duration[(2.3±1.3)d vs.(2.0±1.0)d] were not statistically significant ( P>0.05). There were 252 patients for follow-up, including 183 cases in the conventional group and 69 cases in the modified group, and 4 cases were lost to follow-up. Mean time of follow-up was 8.4 months. In both groups, postoperative IPSS were 5.4±2.3 and 5.9±1.2 respectively, QOL1.5±0.3 and 2.0±1.0 respectively, Q max(24.3±9.2)ml/s and (22.5±11.3)ml/s respectively and postvoid residual volume (8.3±4.5)ml and (7.7±2.9)ml respectively, which were significantly different from that before the operation ( P<0.05). However, there was not significant difference between the two groups ( P>0.05). The postoperative immediate urinary continence rate of the conventional group and modified group were 85.2% (156/183), 98.6% (68/69), respectively, and two groups had statistical differences ( P<0.05). Incidence of postoperative bladder neck contraction were 4.4% (8/183) and 0 respectively in the conventional and modified group, whose difference was significant( P<0.05). Conclusions:HoLEP with preservation of longitudinal urethral mucosa at 12 o'clock is the same effective as conventional operation in the treatment of BPH with small-medium gland, likewise it could significantly improve immediate urinary continence rate and reduce the incidence of bladder neck contraction.
ABSTRACT
Objective To prepare human foreskin tissue acellular matrix graft(AMGs), and explore the toxicity of the extracts on rabbit urethral mucosal cells. Methods After preparing the decellularized matrix of human foreskin tissue, the characteristics of decellularized matrix were observed by Masson staining, and the pore size was observed by scanning electron microscope. Results Masson staining showed that the cells were removed, and the scaffold was composed of collagen. Scanning electron microscopy showed that the pore size of the scaffold was about 20-50 μm, which was uniformly distributed. The appropriate concentration of AMGs matrix extract had no obvious toxicity to urethral mucosal cells. Conclusion The acellular matrix of human foreskin tissue is an ideal AMGs scaffold material. The prepared AMGs material has low cytotoxicity and has practical value.
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Objective To compare the phenotypes and biological characteristics between the rabbit hair follicle stem cells and urethral mucosa stem cells, and to explore the feasibility of using hair follicle stem cells as seed cells for tissue engineering urethra. Methods Rabbit hair follicle stem cells and urethral mucosa stem cells were isolated and cultured in vitro, and the cells with diameter <10 μm and integrin-α6+ /CD71- were sorted using flow cytometry. The maximum amplification factor and clone forming ability of the two kinds of cells were calculated. The positive rates of K19, p63 and β1-integrin in the two kinds of cells were detected by flow cytometry. The enriched stem cells were implanted in the urethral stent to construct tissue engineering urethra. Histology and fluorescent staining were used to observe the tissue-engineered urethra. Results The maximum amplification multiples of rabbit hair follicle stem cells and urethral mucosa stem cells were (6. 1±0. 8)×104 and (7. 1±1. 1)×103, respectively; and the clone formation rates were (10. 1±1. 3)% and (4. 3±1. 1)%, respectively. The positive rates of K19, p63, and β1-integrin in hair follicle stem cells were (90. 53±6. 77) %, (93.31±5.57)%, and (91. 17±6.98)%, respectively; and those in urethral mucosa stem cells were (88. 50±4. 95)%, (91. 63±5. 86)%, and (93. 35±6. 28) %, respectively. Both hair follicle stem cells and urethral mucosa stem cells formed complex layer epithelioid structure on the stents, with positive staining for AE1/AE3. Conclusion Rabbit hair follicle stem cells and urethral mucosa stem cells can both serve as seed cells for constructing tissue engineering urethra. As for the availability of seed cells, hair follicle stem cells are more superior to the urethral mucosa stem cells.
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Objective To explore the clinical effects of low-frequency (50Hz) pulse electrotherapy (LFPE) in the treatment of prostatic pelvic floor muscular spasm syndrome (PPMS), and the influence of this procedure on the temperature of rabbit urethral mucosa. Methods (1) A series of 60 cases of PPMS had undergone LFPE; (2) Thirty-six rabbits were randomly divided into 6 groups: 3 experimental groups were treated for 15 min, 30min and 50 min, respectively, while the other 3 groups served as control groups. Results All cases had been followed for (1～16) months, with a mean of 6 months. Of the 60 cases, 12 were cured, 38 improved, and 10 failed,effective rate being 83.3%(50/60). In animal experiment, there were no significant differences between the experimental and control groups on temperatures of rabbit urethral local mucosa (t=1.3306, P=0.1049). Conclusions The study demonstrates that 50Hz pulse electrotherapy may be effectively applied to PPMS.