Comparison of effects of transurethral enucleation of prostate and suprapubic prostatectomy in the treatment of massive prostatic hyperplasia / 中国基层医药

Objective@#To compare the clinical effects of transurethral prostatectomy(TUERP) and suprapubic prostatectomy(SP) in the treatment of massive prostatic hyperplasia.@*Methods@#The clinical data of 40 patients with benign prostatic hyperplasia(BPH) with a volume range of 80-150 mL from October 2015 to October 2017 in Shengjing Hospital of China Medical University were retrospectively analyzed.They were divided into two groups: TUERP group(20 cases) and SP group(20 cases). The length and distribution of large prostate were measured.The degree of hemoglobin decrease, bladder irrigation time, operation time, indwelling catheter time, maximum urine flow rate(Qmax), international prostate symptom score(IPSS), prostate specific antigen(PSA), residual urine volume(PVR) and the incidence of complications were compared between the two groups before and after operation.@*Results@#It was found that the length of the prostatic fossa was less than 5 cm in patients with large prostatic hyperplasia whose volume ranged from 80 to 150 mL.After operation, the degree of hemoglobin decrease, bladder irrigation time, indwelling catheter time and the incidence of complications in the TUERP group were (7.9±2.3)g/L, (42.5±3.6)h, (5.3±1.1)d, 15%(3/20), respectively, while in the SP group were (14.2±4.4)g/L, (62.6±6.0)h, (7.8±0.8)d and 50%(10/20), respectively, there were statistically significant differences between the two groups(t=-5.7, -12.8, -8.6, χ2=5.6, all P<0.05). There were no statistically significant differences in operation time, Qmax, IPSS, PSA and PVR between the two groups(all P>0.05).@*Conclusion@#After TUERP treatment of large prostate hyperplasia, the improvement of urination and the decrease of PSA is similar to SP, and the hemostasis effect is good, the complications are less and the recovery is faster.

Comparison of effects of transurethral enucleation of prostate and suprapubic prostatectomy in the treatment of massive prostatic hyperplasia / 中国基层医药

Objective To compare the clinical effects of transurethral prostatectomy (TUERP) and suprapubic prostatectomy(SP) in the treatment of massive prostatic hyperplasia.Methods The clinical data of 40 patients with benign prostatic hyperplasia ( BPH) with a volume range of 80 －150 mL from October 2015 to October 2017 in Shengjing Hospital of China Medical University were retrospectively analyzed .They were divided into two groups :TUERP group(20 cases) and SP group(20 cases).The length and distribution of large prostate were measured.The degree of hemoglobin decrease ,bladder irrigation time,operation time,indwelling catheter time ,maximum urine flow rate ( Qmax), international prostate symptom score ( IPSS), prostate specific antigen ( PSA), residual urine volume (PVR) and the incidence of complications were compared between the two groups before and after operation .Results It was found that the length of the prostatic fossa was less than 5 cm in patients with large prostatic hyperplasia whose volume ranged from 80 to 150 mL.After operation,the degree of hemoglobin decrease ,bladder irrigation time,indwelling catheter time and the incidence of complications in the TUERP group were (7.9 ±2.3)g／L,(42.5 ±3.6)h,(5.3 ± 1.1)d,15%(3／20),respectively,while in the SP group were (14.2 ±4.4)g／L,(62.6 ±6.0)h,(7.8 ±0.8)d and 50%(10／20),respectively,there were statistically significant differences between the two groups (t＝－5.7,－12.8,－8.6,χ2 ＝5.6,all P＜0.05).There were no statistically significant differences in operation time ,Qmax,IPSS,PSA and PVR between the two groups (all P＞0.05).Conclusion After TUERP treatment of large prostate hyperplasia , the improvement of urination and the decrease of PSA is similar to SP ,and the hemostasis effect is good ,the complica－tions are less and the recovery is faster.

Current progress of intravesical instillation therapy in interstitial cystitis/bladder pain syndrome / 国际外科学杂志

Interstitial cystitis/bladder pain syndrome is a chronic pain syndrome characterised by pain/ discomfort attributed to the bladder,with associated urgency and urinary frequency.Its etiology is unknown and the syndrome probably have different manifestations.There is no specific treatment and multi-treatment often been used to treat interstitial cystitis/bladder pain syndrone.Bladder instillation therapy is often used as an important treatment because the drug is concentrated in the bladder and keeps a higher concentration.But the drug selection and treatment regimen of bladder instillation are not uniform.A number of intravesical agents are reviewed in this paper along with the available evidence for their use.

The Early Histological Effects of Intravesical Instillation of Platelet-Rich Plasma in Cystitis Models / 대한배뇨장애요실금학회지

PURPOSE: To evaluate the early histological effects of the intravesical instillation of platelet-rich plasma (PRP) in rabbit models of interstitial and hemorrhagic cystitis. METHODS: Thirty-six rabbits were classified into 6 groups: saline (S), S+PRP, hydrochloric acid (HCl), HCl+PRP, cyclophosphamide (CyP), and CyP+PRP. At 48 hours after induction, PRP was prepared and intravesically administered to the S+PRP, HCl+PRP, and CyP+PRP groups. Bladder sections were stained with toluidine blue for mast cell counting and with hematoxylin and eosin for histopathology and mitotic index determination. The proliferation index was determined by proliferating cell nuclear antigen (PCNA) immunolabeling. The nonparametric Mann-Whitney U-test was used for statistical analysis. RESULTS: No abnormalities were observed in the S group, whereas increased interstitial edema and increased average mitotic and proliferation indices were observed in the S+PRP group (P=0.023, P=0.004, and P=0.009, respectively). Intense epithelial loss, hemorrhage, and leukocyte infiltration were detected in the HCl and HCl+PRP groups, whereas a significantly increased average mitotic index was observed in the HCl+PRP group (P=0.002). When compared with its CyP counterpart, a significant reduction in hemorrhage and an increase in leukocyte infiltration and mitotic index were observed in the CyP+PRP group (P=0.006, P=0.038, and P=0.002, respectively). In addition, PCNA staining revealed a significantly increased proliferation index in the HCl+PRP and CyP+PRP groups (P=0.032 and P=0.015, respectively). CONCLUSIONS: The intravesical instillation of PRP increased the mitotic index in the saline and cyclophosphamide groups while decreasing macroscopic bleeding.

Intravesical OnabotulinumtoxinA Injection for Overactive Orthotopic Ileal Neobladder: Feasibility and Efficacy / 대한배뇨장애요실금학회지

The efficacy of intravesical onabotulinumtoxinA (BTXA) in the treatment of overactive bladder (OAB) has been well documented. The use of BTXA injection in orthotopic neobladders is yet to be studied. We present 4 cases of patients injected with intravesical BTXA for overactive orthotopic ileal neobladder. We recorded patient demographics, presenting and follow-up symptoms, urodynamic profiles, and Patient Global Impression of Improvement (PGI-I) scores. The 4 patients reported varying degrees of subjective improvements in the symptoms, including urgency, urge incontinence, and pad usage. Mean follow-up duration was 8.3 months (range, 5-14 months). Average PGI-I score was 3 ("a little better") (range, 2-4). To our knowledge, the current study is the first case series examining BTXA injection for orthotopic neobladder overactivity. BTXA injection yielded varying degrees of objective and subjective improvements, without significant complications. Intravesical BTXA injection is feasible and may be considered as a potential treatment alternative for OAB in orthotopic neobladders, although further study is warranted.

Infected Aortic Aneurysm caused by Mycobacterium bovis after Intravesical Bacillus Calmette-Guerin Treatment for Bladder Cancer

A 70-year-old man presented with lower back pain and cyanotic changes in his left lower extremity. He was diagnosed with infected aortic aneurysm and infectious spondylitis. He had received intravesical Bacillus Calmette-Guerin (BCG) therapy up to 1 month before the onset of symptoms. The aneurysm was excised and an aorto-biiliac interposition graft was performed. Mycobacterium tuberculosis complex was cultured in the surgical specimens. Real-time polymerase chain reaction (PCR) targeting the senX3-regX3 region, and multiplex PCR using dual-priming oligonucleotide primers targeting the RD1 gene, revealed that the organism isolated was Mycobacterium bovis BCG. The patient took anti-tuberculosis medication for 1 year, and there was no evidence of recurrence at 18 months follow-up.

Intravesical Sodium Chondroitin Sulphate to Treat Overactive Bladder: Preliminary Result / 대한배뇨장애요실금학회지

PURPOSE: This study aimed to verify the efficacy and safety of intravesical treatment with sodium chondroitin sulfate (CS) in patients with overactive bladder (OAB) who are refractory to previous antimuscarinic treatment. METHODS: This study was performed between June 2012 and January 2015 and included 31 consecutive women (mean age, 42.10+/-7.34 years) with OAB who had been previously treated with two types of antimuscarinic drugs. The results of gynecologic and cystoscopic examinations were normal, and OAB comorbidity was absent. Treatment with intravesical instillations containing 40 mL CS (0.2%; 2 mg/mL) was administered for 6 weeks; after weekly treatments, monthly treatments were administered. The OAB-validated 8 (OAB-V8) symptom scores, nocturia, frequency, urgency, urge incontinence, and urinary volumes measured by uroflowmetry were evaluated for all the patients. The values obtained before the treatment were statistically compared with those obtained six months after the treatment. RESULTS: The duration of the symptoms was 18.36+/-6.19 months. A statistically significant improvement of the patients' conditions was observed in terms of the OAB-V8 symptom scores, nocturia, frequency, urgency, urge incontinence, and urinary volumes measured by uroflowmetry after the treatment. CONCLUSIONS: Despite the limitations of this study, the outcomes confirmed that CS therapy is safe and effective for the treatment of OAB.

Clinical analysis of the diagnosis and treatment of male interstitial cystitis: report of 18 cases / 中华泌尿外科杂志

ObjectiveTo investigate the diagnosis and the treatment of male interstitial cystitis (IC) to improve the efficiency.MethodsEighteen cases of IC male patients treated from Jan 2010 to Dec 2010 who suffered from suprapnbic pain urinary frequency and urgency were analyzed retrospectively.All these patients were misdiagnosed as category Ⅲ chronic prostatitis.According to the NIDDK diagnostic criteria of IC,Pelvic Pain and Urgency Frequency (PUF) scoring,potassium sensitivity test (PST),and cystoscopy under anaesthesia were used to establish the diagnosis of IC.24 h urinary diary,routine uronoscopy,prostate fluid routine and bacterial culture examination were taken before the treatment of hydrodistention and intravesical instillation of heparin.ResultsAfter the follow-up 12 to 25 months ( average,19 months),the symptoms improved distinctly.The PUF scoring was 19.2 ±4.1 before treatment and 13.6 ±2.4 after treatment respectively ( P ＜ 0.01 ).24 hours' frequency and amount of urination were (7.5 ± 4.3)times and (241.7 ±45.3) ml after treatment compared with (11.5 ±3.9) times and (159.5 ±30.8) ml before treatment ( P ＜ 0.01 ).ConclusionsThe male IC and chronic prostatitis share the same symptoms.They can be differentiated by the IC diagnosis.The treatment of hydrodistention alone with oral tolterodine tartrate sustained release tablets and intravesical instillation of heparin can evidently improve the symptoms of the male IC patients.

Granulomas do pênis: uma complicação rara da terapia intravesical com Bacilo Calmette-Guérin / Granulomas of the penis: a rare complication of intravesical therapy with Bacillus Calmette-Guerin

A imunoterapia com o Bacilo Calmette-Guérin é amplamente usada no tratamento e profilaxia da neoplasia urotelial superficial. As complicações associadas ao tratamento são comuns. Os autores relatam um caso de inflamação granulomatosa do pênis, associada à terapia intravesical com Bacilo Calmette-Guérin, com múltiplos nódulos eritematosos indolores localizados na glande. É também efetuada uma revisão da literatura. A balanopostite granulomatosa é uma complicação rara associada à imunoterapia com Bacilo Calmette-Guérin, com uma apresentação clinicamente heterogênea que pode dificultar o diagnóstico. O seu reconhecimento clínico é essencial para o início precoce de tuberculostáticos e interrupção de Bacilo Calmette-Guérin.

Immunotherapy with Bacillus Calmette-Guérin is widely used for treatment and prophylaxis of superficial urothelial cancer. Complications associated with Bacillus Calmette-Guérin treatment are common. The authors describe a case of granulomatous inflammation of the penis associated with intravesical Bacillus Calmette-Guérin therapy, presenting with multiple erythematous and painless nodules located on the glans. A review of the literature is also performed. Granulomatous balanoposthitis is a rare complication of Bacillus Calmette-Guérin immunotherapy, with heterogeneous clinical presentation, which can make the diagnosis difficult. Its clinical recognition is essential for early start of therapy with antitubercular agents and interruption of Bacillus Calmette-Guérin.

Influence of intravesical chemotherapy combined with hyperthmia on TNF 、IGF in carcinoma of bladder after TURBt / 中国基层医药

Objective To explore the influence of intravesical chemotherapy combined with hyperthmia on levels of insulin growth factor( IGF) and tumor necrosis factor( TNF) in bladder cancer after operation. Methods 64 cases of transitional cell carcinoma of bladder accepted TURBt were randomly divided into two groups: intravesical chemotherapy combined with hyperthmia group and intravesical chemotherapy group. Levels of ICF and TNF in two weeks before therapy 、two weeks after therapy, four weeks after therapy were tested. Results The IGF levels were (65.97±5.25)μg/L,(49.93±1.98)μg/L,(36.82±1.89)μg/L in intravesical chemotherapy combined with hyperthmia group and(61.87 ±5.41)μg/L, (57.86 ±2. 18) μg/L, (48. 68 ±2. 26) μg/L in intravesical chemotherapy group. The TNF levels were(2.32 ±0. 36)μg/L, (3. 84 ±0. 31) μg/L, (8. 79 ±0. 46)μg/L in intravesical chemotherapy combined with hyperthmia group and(2. 21 ±0. 19)μg/L,(2. 89 ±0.47) μg/L, (3. 87 ±0.61)μg/L in intravesical chemotherapy group. The influence of intravesical chemotherapy with hyperthmia on levels of IGF and TNF were significant than intravesical chemotherap, and the influence degree showed in time-dependent manner (all P ＜ 0. 05 ). Conclusion Intravesical chemotherapy combined with hyperthmia had curative effect in inhibiting the recurrence of tumor after operation.

A clinical analysis of 47 cases of female cystitis glandularis / 中国医师进修杂志

Objective To evaluate the procedure of diagnosis and treatment for cystitis glandularis in female. Methods Forty-seven patients were classified into 3 groups randomly after being operated by tuansurethral resection:15 cases without any other therapy(A group), 16 cases with bladder instillation of pirarubicin afterward (B group), 16 cases with bladder instillation of mitomycin afterward (C group). Symptomatic reliof and recurrence were investigated in 1-year follow-up visit. Results Forty-four cases had fulfilled the entire follow-up visit. The effective rates of the three groups were 38.5%,87.5% and 86.7% respectively (X2=13.80,P＜0.01 ), the recurrence rate was 30.8% ,0,13.3% respectively (X2=4.86,P＞0.05).Conclusions The clinical situation of cystitis glandularis has no specificity. Cystisis glandularis has diversification of the clinical symptoms, urodynamics. Transurethral resection with bladder instillation is more effective than transttrethral resection simply, the recurrence rate is lower.

A pharmacodynamic study of intervals of Mitomycin C treatment on human bladder cancer cell line in vitro / 肿瘤研究与临床

Objective To study the relationship between the intervals of Mitomycin C treatment and cytotoxicity, apoptosis and drug resistance for bladder cancer cells.Methods The bladder transitional cell cancer line BIU-87 was treated for two hours every time for five times with intervals of 24, 48, 72 and 96 hours respectively.Cytotoxicity was measured by MTT.p53,bcl-2,Bax and p170 expression were analyzed by Western blot.Results The IC_(50)(?g/ml)were 4.41,0.71,2.83,4.51and 6.16 with treatment intervals of 24, 48, 72 and 96 hours respectively, p53 and bcl-2 were significantly down-regulated and bcl-2/Bax was re- duced at 24 hour treatment interval but not changed at 48,72 and 96 hour intervals,p170 was not detected at 24 hour treatment interval but increasingly expressed at 48,72 and 96 hours intervals.Conclusion The in- terval of Mitomycin C treatment is closely related with cytotoxieity and apoptosis and drug resistance of blad- der cancer cells.The intervals of intravesical instillations may play an important role in the effect of chemotherapy.

Intravesical instillation of sodium hyaluronate for the treatment of refractory non-bacterial cystitis:a multicenter study / 中华泌尿外科杂志

Objective To evaluate the efficacy and safety of intravesical instillation of sodium hya- luronate in relieving the symptoms of refractory non-bacterial cystitis.Methods Totally,20 patients(1 man and 19 women;mean age,47 years;age range,22-68 years)with refractory non-bacterial cystitis were included.Their disease course ranged from 1 month to 30 years.Of them,16 patients had the disease for more than 1 year.Instillation of sodium hyaluronate(50 ml solution of 40 mg HA)was performed intravesically in them for a total of 12 weeks(once a week for the first 4 weeks and once every 4 weeks for the succeeding 8 weeks).Follow-up visit ended at 16 weeks,when the patients filled in the symptom assessment scores(VAS on pain,frequency and urgency)according to the subjective evaluation.Therapeutic results were classified as(1)total response:symptom disappearance or relief by at least 90% of the symptom scores;(2)partial response:symptom relief by 50%-89%;(3)mild response:symptom relief by 49% or less;(4)no re- sponse:no improvement in symptom scores.Results Nineteen patients completed the 16-week follow-up with only 1 withdrawing.The average general symptom score decreased from 22.32?5.53 to 9.47?5.88 (P＜0.001);frequency score from 8.21?1.75 to 3.89v2.31(P＜0.001);urgency score from 7.47?2.14 to 3.37?2.14(P＜0.001);pain score from 6.63?3.47 to 2.21?2.74(P＜0.001).After 16 weeks,overall positive response rate(total+partial response)was 53%(10/19).No serious adverse effect occurred except for urethral irritation(25%,5/20),worsening of distending pain of the bladder(5%,1/20) and vertigo(15%,3/20)caused by the procedure itself.Conclusions For patients suffering from refrac- tory non-bacterial cystitis,intravesical instillations of sodium hyaluronate can significantly relieve the symp- toms and is safe and of good patient compliance.

Intravesical instillation of mitoxantrone for the prevention of postoperative recurrence of bladder cancer / 中华泌尿外科杂志

Objective To evaluate intravesical instillation of mitoxantrone(MTZ) for the prevention of postoperative recurrence of bladder cancer. Methods Intravesical instillation of 12 mg MTZ dissolved in 50 ml normal saline and retained in bladder for 2 hours were given to bladder cancer patients postoperatively once a week for 8 weeks and subsequently once a month for 12 months.Kidney and liver function,blood counting,urinalysis and cystoscopy were taken periodically.The systemic and local reactions were recorded every time after the intravesical instillation. Results All of the 98 cases were followed up for 6 to 24 months with a mean of 13 months.The recurrence rate was 6.2%.There was no generalized side effect. Conclusions Intravesical instillation of MTZ was efficacious for the prevention of postoperative recurrence of superficial bladder cancer with safety and less side effect.So it can be widely used in such patients.

Apoptotic mechanisms of pirarubicin against bladder cancer and its clinical use for preventing postoperative tumor recurrence / 中华泌尿外科杂志

Objective To study the antitumor mechanisms of pirarubicin (THP) and its effect on preventing postoperative recurrence of superficial bladder cancer. Methods MTT assay, flow cytometry and transmission electron microscope were used to assess the effects of different concentration of THP on T24 cell line. THP 40 mg in 50 ml distil water was used intravesically in 60 patients with transitional cell carcinoma after TURBT to prevent tumor recurrence. Results T24 cells were suppressed significantly by THP in concentrations of 10 mg/L and 100 mg/L,the suppressive rates being 80% and 94% respectively. Apoptosis peak was evident before G1 phase. The characteristics of cell apoptosis, such as bubble formation in cytoplasm and condensed chromosome, were typically manifested. Cells became necrotic when the concentration of THP was 1 000 mg/L. One course of THP intravesical administration was completed in 58 cases. All patients were followed up for a mean of 18.8 months (range 6～24 months), and tumor recurred only in 5 cases (8.6%). Conclusions Suppression of tumor cell growth and inducing apoptosis, even necrosis, might be the main antitumor mechanisms of THP. Clinically, intravesical administration of THP after TURBT was effective and safe for preventing tumor recurrence.